Cognitive Behavioral Therapy (CBT) for Schizophrenia (2023)

CBT is the leading psychotherapy treatment for schizophrenia. It may be particularly effective combined with antipsychotic medication and psychosocial support.

If you’ve been diagnosed with schizophrenia, you’re definitely not alone.

Schizophrenia is a serious mental illness that affects about 1% of the American population. That may sound like a small number until you realize it amounts to about 3.32 million people.

The condition usually begins during adolescence or early adulthood, and it affects your thinking processes. You may have auditory and visual hallucinations, meaning you hear and see things that others do not.

You may have episodes of psychosis, in which you experience a complete break with reality. You may experience and believe things that are not real, although they seem very real to you. These are called delusions. For example, you may begin to think people are controlling you or plotting against you.

You may also lose interest in people and activities that you used to enjoy. You may find it difficult to organize your thoughts and actions, and say or do things that others find disturbing. Additionally, you may find it difficult to express emotion or initiate and continue projects.

The good news is that schizophrenia is treatable. The most effective schizophrenia treatment combines medication, psychotherapy, and psychosocial support, according to the American Psychiatric Association. This type of combined treatment is sometimes called coordinated specialty care (CSC).

What is cognitive behavioral therapy?

(Video) CBT Treatment Goals for Schizophrenia

Cognitive behavioral therapy (CBT) is a type of talk therapy in which you work with a therapist to learn how to replace negative thoughts and behaviors with more accurate, functional ones. With the therapist’s help, you learn to:

  • check the credibility of your thoughts and perceptions
  • ignore or tolerate unreal voices you may hear
  • manage your response to other symptoms

CBT is not meant to be a cure for schizophrenia or lead to remission. There is no cure for this condition. Treatment is intended to reduce your symptoms and help you learn to manage them. In most cases, it’s not realistic to expect your symptoms to go away completely.

Medication is considered the primary treatment for schizophrenia. CBT is used to supplement medication, not replace it. CBT is usually a short-term course of therapy, taking from 6 to 9 months.

In the United States, CBT is recognized as the gold standard of psychotherapy for psychosis associated with schizophrenia. The American Psychiatric Association recommends that CBT be used for the treatment of psychosis in schizophrenia, combined with medication and psychosocial support.

Similarly, the English government recommends CBT be offered for all patients with schizophrenia or psychosis. Its direction appears in the National Institute for Clinical Excellence (NICE) guidelines.

Worldwide, however, the World Health Organization does not specifically include CBT in its recommendations for treatment of schizophrenia. It recommends a combination of medication and psychosocial support.

Research shows CBT to be especially helpful when medication does not significantly improve the symptoms of schizophrenia. About 30% of people diagnosed with schizophrenia don’t respond to medication.

(Video) Schizophrenia CBT

What does the research say?

Research indicates that CBT, in combination with medication, can help lessen psychotic symptoms in schizophrenia. Evidence points to CBT’s particular effectiveness in reducing auditory hallucinations, one of the most distressing symptoms for people with schizophrenia.

However, some researchers over the past decade point to biases and small sample sizes that flaw some research favoring CBT. One study reported only a small benefit from CBT by the end of a trial, which did not hold a follow-up. Another study goes so far as to question whether the benefit of CBT for schizophrenia had been “oversold.”

How is CBT used to treat schizophrenia?

CBT may help reduce hallucinations, delusions, and paranoia in people with schizophrenia. These are what doctors call the “positive” symptoms of schizophrenia. The therapy works by helping people identify their delusions, cope with them, and learn acceptable responses.

The National Alliance on Mental Illness points out that CBT helps people with schizophrenia by identifying what triggers their psychotic episodes and developing ways to lessen the number and severity of episodes.

CBT can also be useful for what are called the “negative” symptoms of schizophrenia, such as:

  • low self-esteem
  • flat expression
  • trouble organizing thoughts and actions
  • loss of interest in people and activities that used to interest you

What can you expect in CBT?

You will begin your CBT course by building trust in your therapist. This is an essential part of CBT because you will be working very closely on issues that may be troubling or even frightening to you. You will be learning a whole new way of looking at your life and finding new ways to act.

Next, you will collaborate with your therapist to develop a “problem list” of issues in your life that you want to work on. These may include schizophrenia symptoms like auditory hallucinations, as well as issues in your life like poor communication with your family or failing grades at school.

You and the therapist will work together to design goals that you want to achieve during therapy. These will be very specific, such as learning one new communication skill for talking with your family or raising one of your school grades from a failing grade to a C.

As your therapy continues, you will begin to learn new coping skills for dealing with your schizophrenia symptoms. You will often have homework in between your CBT sessions in which you practice your new skills in real-life situations. For example, you might try the new communication skill you learned in therapy at home with your family.

Gradually, you will be able to change your response to your symptoms. By the conclusion of therapy, you will have a number of tools available to respond differently to your symptoms. For example, you may learn that you hear voices most when you are stressed or tired. Knowing this, you could make an effort to practice calming meditation and get sufficient sleep to reduce the episodes.

(Video) Psychological Treatments for Schizophrenia [AQA ALevel Psychology]

CBT doesn’t help everyone with schizophrenia. Part of the reason for this is that expectations may be set too high. You may want your symptoms to go away altogether. But the goal of CBT is to develop tools to deal with your symptoms, not to eliminate symptoms altogether.

If CBT does not seem to be helping you, the first step is to check with your treatment team to ensure your medication is appropriate and working as it should. CBT is most effective for schizophrenia when combined with an appropriate medication regimen.

If CBT isn’t working, you may try:

  • a new course of CBT
  • a new therapist
  • a different type of therapy

Some alternative therapies are very much like CBT, while others are very different. Your treatment team will be able to point you toward therapies that may work for you.

Some alternative therapies for schizophrenia treatment recommended by healthcare professionals and public service groups include:

  • dialectical behavior therapy (DBT)
  • acceptance and commitment therapy (ACT)
  • cognitive enhancement therapy (CET)

Further treatment options include psychosocial treatment or assertive community therapy. These are programs that focus on helping you live independently and become active within a community. They involve assistance in a wide range of personal issues including:

  • financial management
  • employment
  • education
  • home structure
  • co-occurring medical conditions
  • social skills
  • family education and involvement
  • alcohol and other substance use
  • child custodianship
  • domestic violence

Also, some researchers report success with holistic treatment of schizophrenia. These complementary and alternative health approaches can be part of a comprehensive treatment plan, according to the National Alliance on Mental Illness (NAMI).

(Video) Cognitive Behavioral Therapy | Schizophrenia

You may want to discuss with your doctor whether you could benefit from complementary treatment options, such as:

  • yoga therapy
  • nutritional and diet guidance
  • exercise and movement training
  • meditation and relaxation practice
  • acupuncture and acupressure

Schizophrenia is a serious mental illness that usually begins in early adulthood and can cause lifelong disability if left untreated. The good news is that it is treatable with a combination of medication, psychotherapy, and psychosocial support. With treatment, you can expect to live a long and satisfying life.

Medication is the primary treatment for schizophrenia, often supplemented with psychotherapy and psychosocial support. The most common psychotherapy prescribed is cognitive behavioral therapy. In CBT, you collaborate with a therapist to define goals in your life and learn new ways of thinking and acting to achieve them.

CBT doesn’t work for everyone with schizophrenia. Alternatives involve a change in your medication, a new therapist or a different therapy, and a variety of holistic treatment approaches and psychosocial support programs.

To find a CBT therapy provider, your best option is to check with a trusted healthcare professional for a recommendation. To look for available practitioners in your area, you can go to the Academy of Cognitive and Behavioral Therapies website where you can search for one of their certified therapists by zip code.

To learn about schizophrenia treatment options and available resources, consider visiting the Schizophrenia & Psychosis Action Alliance website. If you’d like to learn about early identification of mental illness, along with options for care, services, and support on the way to recovery, the Mental Health America website offers valuable resources.


How many CBT sessions are needed for schizophrenia? ›

The duration of therapy varies according to the individual's need, generally between 12 and 20 sessions, but often with an option of ongoing booster sessions. CBT for psychosis usually proceeds through the following phases.

What is the success rate of CBT in schizophrenia? ›

Seven (41%) of the 17 patients receiving CBT had an improvement of more than 50% in the PANSS total score compared with three (18%) of 17 receiving treatment as usual. Meanwhile, rates of serious adverse events were similar between the groups, with two in the CBT group and six among those receiving standard treatment.

Does CBT work for schizophrenia? ›

Cognitive behavioral therapy can also help people with schizophrenia to develop better social and problem-solving skills, reduce the severity of symptoms, and lower the risk of relapse, a period of time when schizophrenia symptoms return.

Which CBT technique is used for schizophrenia? ›

Specific CBT approaches used in treating schizophrenia include cognitive restructuring, behavioral experiments / reality testing, self-monitoring and coping skills training.

How many CBT sessions will I need? ›

If CBT is recommended, you'll usually have a session with a therapist once a week or once every 2 weeks. The course of treatment usually lasts for between 5 and 20 sessions, with each session lasting 30 to 60 minutes.

How long does it take to see results from CBT? ›

How long does CBT take to treat moderate anxiety? 6 or 12 to 24 sessions of CBT therapy may be enough to successfully treat a presentation of moderate anxiety. Some people may need a bit longer, for instance where symptoms have been contained in the background for some years prior to treatment.

Is CBT better than medication for schizophrenia? ›

Combining CBT with antipsychotic drugs is known to help people with schizophrenia, and the National Institute for Health and Care Excellence has recommended that all patients with schizophrenia should be offered CBT and not just drug therapy.

Can CBT treat schizophrenia without medication? ›

Together they work to establish the triggers and how the patient can avoid those triggers. Treating schizophrenia without medication using Individual Psychotherapy has a great outcomes. Cognitive Behavioral Therapy (CBT) Can Do Wonders!

What is the most effective therapy for schizophrenia? ›

“The best treatments for schizophrenia are cognitive behavior therapy (CBT), psychotherapy, family therapy, psychosocial therapy, and group counseling.”

Can psychosis be cured by CBT? ›

Compared with any control, CBT for psychosis significantly improved overall psychotic symptoms, positive symptoms, auditory hallucinations, delusions, and negative symptoms.

How effective is CBT for hallucinations? ›

The CBT treatment program was conducted for 9-10 sessions twice/wk. The results showed a significant reduction (P < 0.005) in the severity and frequency of hallucinations, delusions, negative symptoms, distress and anxiety after group-based CBT.

What are 3 treatments for schizophrenia? ›

These may include:
  • Individual therapy. Psychotherapy may help to normalize thought patterns. ...
  • Social skills training. This focuses on improving communication and social interactions and improving the ability to participate in daily activities.
  • Family therapy. ...
  • Vocational rehabilitation and supported employment.
7 Jan 2020

How do I know if my CBT is working? ›

If CBT is working for you, you should notice explicit behavioral changes (i.e., the ability to approach situations that you feared or to function better when depressed). With your therapist, take time to reflect on your treatment goals and discuss the progress being made.

Can you practice CBT by yourself? ›

By making your problems more manageable, CBT can help you change your negative thought patterns and improve the way you feel. CBT can help you get to a point where you can achieve this on your own and tackle problems without the help of a therapist.

Can I practice CBT on my own? ›

If you've wanted to try CBT for anxiety or depression but aren't able to see a CBT therapist, you may not need to. Many studies have found that self-directed CBT can be very effective.

What are the disadvantages of CBT? ›

Some of the disadvantages of CBT to consider include: you need to commit yourself to the process to get the most from it – a therapist can help and advise you, but they need your cooperation. attending regular CBT sessions and carrying out any extra work between sessions can take up a lot of your time.

How many weeks should CBT last? ›

A highly effective psychotherapy called cognitive behavioral therapy (CBT) focuses on how our thoughts, beliefs, and attitudes can affect our feelings and behavior. Traditional CBT treatment usually requires weekly 30- to 60-minute sessions over 12 to 20 weeks.

How do I get the most out of cognitive behavioral therapy? ›

5 ways to make the most of your CBT therapy sessions
  1. Get yourself a therapy notebook. ...
  2. Learn to journal. ...
  3. Be clear about your goals. ...
  4. Be honest. ...
  5. Do your homework.
12 Jun 2018

Can schizophrenics get better without medication? ›

Although currently there is no cure for schizophrenia, you can treat and manage it with medication, self-help strategies, and supportive therapies.

Can therapy alone help schizophrenia? ›

Many types of psychotherapy can reduce your symptoms, help with day-to-day activities, and improve your quality of life. Types of psychotherapy used for schizophrenia include the following: Cognitive behavioral therapy (CBT) helps you build coping methods for symptoms that medication doesn't resolve.

Is CBT effective without medication? ›

For anxiety disorders, cognitive-behavioral therapy, antidepressant medications and anti-anxiety medications have all been shown to be helpful. Research generally shows that psychotherapy is more effective than medications, and that adding medications does not significantly improve outcomes from psychotherapy alone.

What therapy is not effective for schizophrenia? ›

Summary: New research concludes that cognitive behavioral therapy is of no value in schizophrenia and has limited effect on depression.

What is the best chance for recovery from schizophrenia? ›

Schizophrenia Recovery

Ten years after diagnosis: 50% of people with schizophrenia recover or improve to the point they can work and live on their own. 25% are better but need help from a strong support network to get by. 15% are not better.

What disorders does CBT not work for? ›

In a landmark 2009 review published in the journal Psychological Medicine, the study authors concluded that CBT is of no value in treating schizophrenia and has limited effect on depression. The authors also concluded that CBT is ineffective in preventing relapses in bipolar disorder.

Can you recover fully from psychosis? ›

Psychosis can be treated, and many people make a good recovery. Research suggests that the earlier intervention can occur, the better the treatment outcome. Therefore, it is important to get help as early as possible.

Does CBT work for schizoaffective disorder? ›

With conditions like schizoaffective disorder that have symptoms of psychosis, additional cognitive therapy is added to basic CBT (CBTp). CBTp helps people develop coping strategies for persistent symptoms that do not respond to medicine.

What drug improves cognitive symptoms of schizophrenia? ›

Some studies have reported selective cognitive improvement in patients with schizophrenia following galantamine treatment. Newer antipsychotics, including paliperidone, lurasidone, aripiprazole, ziprasidone, and BL-1020, have also been reported to exert cognitive benefits in patients with schizophrenia.

What kind of therapy is best for psychosis? ›

Cognitive behavior therapy (CBT).

A therapist will show them ways to deal with voices and hallucinations. With a combination of CBT sessions and medication, they can eventually tell what triggers their psychotic episodes (times when hallucinations or delusions flare up) and how to reduce or stop them.

How do you challenge delusions with schizophrenia? ›


However, research indicates that psychotherapy in conjunction with antipsychotic medication is the most effective form of treatment. The treatment of psychotherapy is used to explore the possible biological problems and to decrease the delusional symptoms.

What can worsen schizophrenia? ›

Some people may be prone to schizophrenia, and a stressful or emotional life event might trigger a psychotic episode.
The main psychological triggers of schizophrenia are stressful life events, such as:
  • bereavement.
  • losing your job or home.
  • divorce.
  • the end of a relationship.
  • physical, sexual or emotional abuse.

What should schizophrenics avoid? ›

Help Them Avoid Alcohol and Illicit Drugs

When people with schizophrenia experience symptoms, such as hearing voices, some may seek relief by using alcohol and drugs, which work quickly to help them feel different.

How often do schizophrenics go to therapy? ›

A course of ECT therapy usually involves 2-3 treatments per week for several weeks.

What is the duration of treatment for schizophrenia? ›

You may only need antipsychotics until your acute schizophrenic episode has passed. However, most people take medication for 1 or 2 years after their first psychotic episode to prevent further acute schizophrenic episodes occurring, and for longer if the illness is recurrent.

How many sessions is cognitive processing therapy? ›

CPT usually takes 12 weekly sessions, so treatment lasts about 3 months. Sessions are 60 to 90 minutes each. You may start to feel better after a few sessions.

What is the most successful treatment for schizophrenia? ›

Antipsychotic medications are the most effective treatment for schizophrenia. Medications such as Risperdal and Zyprexa have been shown to reduce both the positive and negative symptoms of schizophrenia by up to 40%.

What calms a schizophrenic? ›

Connecting face-to-face with others is the most effective way to calm your nervous system and relieve stress. Since stress can trigger psychosis and make the symptoms of schizophrenia worse, keeping it under control is extremely important.

What is the most effective therapy for schizophrenic disorders? ›

The most common types of therapy for schizophrenia include: Cognitive behavior therapy (CBT). This treatment helps you change how you think and react to things. It also teaches you to deal with negative feelings by thinking about them in a different way so you feel good instead.

Can you ever fully recover from schizophrenia? ›

Most people with schizophrenia make a recovery, although many will experience the occasional return of symptoms (relapses). Support and treatment can help you to manage your condition and the impact it has on your life.

Can schizophrenia be treated fully? ›

Schizophrenia requires lifelong treatment, even when symptoms have subsided. Treatment with medications and psychosocial therapy can help manage the condition. In some cases, hospitalization may be needed. A psychiatrist experienced in treating schizophrenia usually guides treatment.

Is 3 therapy sessions enough? ›

Therapy has been found to be most productive when incorporated into a client's lifestyle for approximately 12-16 sessions, most typically delivered in once weekly sessions for 45 minutes each. For most folks that turns out to be about 3-4 months of once weekly sessions.

Why are therapy sessions usually only 45 or 50 minutes? ›

It's mostly for logistical reasons. People tend to schedule appointments on the hour. And, most therapists provide 50 minute sessions so that they can take a 10-minute break between sessions to use the bathroom, grab something to drink and review notes before the next session.

Is CBT a time-limited therapy? ›

CBT is a structured and time-limited treatment. For non-comorbid anxiety or depression, a course of CBT typically lasts 5–20 sessions.


1. What is Cognitive Behavioral Therapy?
(Psych Hub)
2. How Does Cognitive Behavioral Therapy Work?
(Psych Hub)
3. Schizophrenia: Lesson 10 - Psychological Therapies - CBT
4. Cognitive Restructuring in Schizophrenia
(Beck Institute for Cognitive Behavior Therapy)
5. The Use of CBT in the Treatment of Schizophrenia
(Beck Institute for Cognitive Behavior Therapy)
6. Online CBT for Schizophrenia: Jennifer Gottlieb and Brian Chiko
(One Mind)
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