Expanding Your Potential: Integrating Cognitive Behavioral Therapy in Schizophrenia Treatment

For many years, medication was regarded as the frontline and often sole therapy in schizophrenia treatment. However, experts now believe that medication alone cannot be used to adequately address all of the symptoms of the illness. Over the past decade, there has been increasing evidence that integrating Cognitive Behavioral Therapy (CBT) in treatment plans can address both acute and residual symptoms to improve outcomes and enhance the lives of people with schizophrenia. Recently, researchers at the Perelman School of Medicine at the University of Pennsylvania found that adding CBT to standard treatment can increase functioning for even those who are hit hardest by the illness, and works to “improve quality of life, reduce symptoms, and promote recovery.”

Cognitive Behavioral Therapy in Practice

So what is CBT? Brendan Pease of the Harvard Science Review writes:

CBT differs from traditional psychotherapy in that it focuses on behavioral and cognitive processes that negatively affect the patient’s life. It is also goal-oriented, requiring the therapist and the patient to work together toward the ultimate goal of changing harmful thought processes that the patient experiences.

The flexible and versatile nature of CBT allows therapists to tailor treatment to the needs of each client, focusing on each person’s unique symptoms while drawing on their interests and strengths to engage in a natural healing process. Therapists use techniques such as role-play, journaling, validity testing, and guided discovery to help you examine and remove emotional and behavioral barriers to healing. By adding CBT to your treatment plan, you can not only increase adherence to psychotropic treatment, but you can go beyond medication to create lasting emotional and behavioral changes that augment your self-awareness, independence, confidence, and overall quality of life.

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Enhancing Tolerability of Medication

Cognitive Behavioral Therapy can also help you manage the side effects of medication to increase tolerability and encourage adherence. Atypical antipsychotics such as Seroquel and Zyprexa are particularly notorious for causing weight gain and sedative effects, often leading to emotional distress, limiting function, impairing self-image, and causing some people to discontinue medication. By giving you behavioral management tools, CBT can help you engage in positive behaviors like exercise, healthy sleep patterns, and good eating habits to increase energy and minimize weight gain, optimizing your chances of staying on track with medication.

Filling In The Gaps

Even when you find a medication that works well for you, many people with schizophrenia continue to have relapses and residual symptoms—particularly negative symptoms, like lack of motivation, inability to experience pleasure, and emotional numbness. CBT techniques can be employed to help you stay active and increase motivation while exploring distorted and automatic thoughts, and help you break through emotional and cognitive obstacles. This is particularly important to enhancing your ability to cope if you develop tolerance to your medication and you experience decreased therapeutic benefit over time.

Reality Testing

A major part of CBT for many people with schizophrenia includes targeting delusional symptoms through reality testing, or an evaluation of the validity of beliefs. For example, you may be asked to explore the basis for your beliefs and find evidence that what you believe is true. You may also engage in behavioral experiments to test your beliefs. For example:

If a patient believes his or her neighbor is communicating threats by sneezing, the patient may set up an experiment in which he or she watches a television program to evaluate other theories that could explain the neighbor’s sneezing—such as sickness or allergies.

Behavioral experiments give you ways of exploring the reality of your thoughts through simple observation and logic. By learning how to confirm or dispel your beliefs, you can increase your sense of control and self-reliance while actively challenging delusional or paranoid thoughts.


One of the hardest things many people with schizophrenia face is the feeling that they are crazy. While some mental health disorders have enjoyed increased public awareness and destigmatization campaigns, schizophrenia remains a highly stigmatized illness, and that stigma can become internalized by those who suffer from it, leading to emotional distress, shame, anxiety, and isolation. Therapists using CBT often employ a technique called normalization to help you reframe schizophrenic symptoms like delusions and hallucinations as existing on a continuum of normal human experiences. Knowing that what you are experiencing is normal and understandable can help you feel less frightened, and reduce catastrophic thinking while enhancing your self-esteem and confidence.

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Challenging Negative Core Beliefs

CBT can also help you overcome the negative beliefs you may have about yourself based on your experiences with your illness. Many people with schizophrenia have suffered major roadblocks as the result of their symptoms, including the inability to hold down a job or complete educational pursuits, the fracturing of relationships with loved ones, and difficulties with forming and maintaining new relationships. As a result, you may have developed beliefs about yourself grounded in a sense of hopelessness, self-blame, and anxiety about the future. Researchers at the Boonshoft School of Medicine at Wright State University note:

These multiple experiences of failure and loss, not surprisingly, can cement negative core beliefs, an obvious target for CBT. The same techniques that one would use to combat these core beliefs and the automatic thoughts that arise from them in depression can be used to help the person with schizophrenia.

Through CBT, you can begin to counteract these beliefs by remembering successes, forming realistic and achievable goals, and improving your sense of hope, possibility, and self-assurance. Meanwhile, you can learn concrete skills to enhance your social and occupational functioning such as forming reality-based understandings of social encounters, learning how to manage conflict, and developing increased emotional regulation.

Cognitive Behavioral Therapy at Bridges

The clinicians at Bridges to Recovery integrate CBT in schizophrenia treatment to optimize healing. Through intensive individual psychotherapy as well as group therapies designed around CBT principles, you gain invaluable insight and concrete skills to help you improve emotional and behavioral functioning and restore stability. The warm, relaxing environment afforded by our beautiful residential facilities gives you the time, space, and serenity to engage in dedicated CBT practices with the support of compassionate staff and peers. Because schizophrenia is a chronic condition, CBT is not a cure, but it can greatly enhance your quality of life and give you the concrete skills to maintain progress long after you return home.

Bridges to Recovery offers innovative, comprehensive treatment for people living with schizophrenia as well as co-occurring mental health disorders. Contact us for more information about how we can help you or your loved one.