Beyond Psychopharmacology: Emerging Psychosocial Interventions for Core Symptoms of Schizophrenia

Psychiatrists who work with patients with severe mental illness often are more focused on diagnosis, medical management, and psychopharmacology than on psychosocial treatments. Furthermore, many psychosocial interventions that show great promise may not be available locally, making it harder for psychiatrists to recognize emerging trends. Finally, there has not been an update in the American Psychiatric Association's Practice Guideline for the Treatment of Schizophrenia for many years, and the most recent Patient Outcomes Research Team (PORT) review of evidence-based psychosocial treatments for schizophrenia was published eight years ago. This article reviews a selection of psychosocial interventions that have shown success in treating some of the more vexing and persistent core schizophrenia symptoms that often continue despite optimal pharmacologic treatment; formerly these had been considered too risky or out of reach for psychosocial intervention. The interventions reviewed include cognitive-behavioral therapy for psychosis (CBTp), which aims to reduce distress and disability from psychotic symptoms; CBT and other behavioral interventions focused for comorbid posttraumatic stress syndrome; cognitive training (remediation) interventions that use computerized training programs to reduce the severity and consequence of cognitive impairment associated with schizophrenia; clubhouse and peer support models that address the social alienation and social defeat endemic to persons with severe mental illness; and supported employment interventions that are effective in helping patients get back to work in a competitive job environment. The interventions are reviewed with the needs of the prescribing mental health clinician in mind. Each intervention's strengths and weaknesses are described, as well as their role in recovery-oriented treatment services.