Talk therapy can be a powerful tool to help manage psychosis and schizophrenia. While psychiatry and medication are often the focus for schizophrenia treatment, combining both with therapy may offer insights and coping strategies that can further enhance your well-being. Lesley McCuaig explores how talk therapy helped her with auditory hallucinations.

When we think about treating schizophrenia, talk therapy isn't usually the first option that comes to mind. We tend to focus on medication and psychiatry, which are important, of course. However, we often overlook the benefits of talk therapy for those living with the condition.

I could be a bit biased. As a registered counseling therapist candidate, I'm actually waiting to train in cognitive behavioral therapy for psychosis (CBTp). It would be a natural fit for me to work with people who have serious mental illnesses like schizophrenia.

But I also should note that I'm writing this article from a personal perspective as someone with schizophrenia, not from my professional perspective as a therapist.

Personally, therapy has been a great help with some of schizophrenia's negative effects, such as auditory hallucinations (hearing a voice or voices).

In fact, I see talk therapy as the sole reason why I didn't have anosognosia when my schizophrenia symptoms started. Anosognosia isn't simply denying that there's a problem with your mental or physical health. It's a neurological condition often linked to mental illnesses, strokes, or dementia. People with anosognosia believe that they are completely healthy, even when there's clear evidence that this isn't true.

I can struggle with insight into my illness when the auditory hallucinations are strong, but I've never experienced anosognosia. Talk therapy helps with my clarity and understanding, which helps me in a different way from my other treatments.

Changing perspective on your illness with talk therapy

In my experience, finding a therapist who understands psychosis and works with people who hear voices can be a difficult task.

But don't let this discourage you.

I've found that combining talk therapy with my prescribed medication has helped reduce my symptoms more than the medication alone.

There are a range of therapies used when helping someone with auditory hallucinations. Here are a few examples:

Cognitive behavioral therapy for psychosis (CBTp)

CBTp aims to reduce distress during psychosis symptoms rather than removing symptoms altogether. CBTp doesn't try to convince someone that their experiences aren't "real." Instead, it focuses on how a person reacts to hallucinations and aims to change the way they think about these symptoms. This can help reduce their anxiety and stress when they experience hallucinations again.

Acceptance and commitment therapy for psychosis (ACTp)

Like CBTp, ACTp doesn't focus on reducing psychotic symptoms. Instead, ACTp aims to improve coping skills and reduce the distress related to those symptoms. A key difference between ACTp and CBTp is that ACTp focuses on accepting your experiences. In contrast, CBTp tries to change the thoughts and behaviors that cause distress.

Hallucination-focused integrative treatment (HIT)

Hallucination-focused Integrative Treatment (HIT) is specifically for managing auditory verbal hallucinations (hearing voices). Using many CBT techniques, HIT also focuses on family involvement, crisis intervention, coping skills, and medication.

Using therapy to find psychosis triggers and coping strategies

A counselor can help you identify triggers, such as situations, thoughts, memories, emotions, or substances that cause auditory hallucinations.

By looking at how loud, frequent, and intense the voice is, the counselor can help you understand it better. Together, you can create coping strategies. These strategies may include:

• Listening to audiobooks, podcasts, or music
• Mindfulness and connecting with nature
• Using grounding techniques that engage your five senses. These can help you manage the constant sounds from the hallucinations

How talk therapy may help with psychosis trauma and disconnect

Auditory hallucinations can be a traumatizing experience - especially the first time. Talking to a trained therapist about how the experience affected you can be helpful, as well as, or instead of, talking to family and friends.

While they may be empathetic, it can be hard for friends and family to understand the illness and its complexities. This is especially true if they haven't experienced it themselves. Having a neutral third party who can listen, empathize, and offer strategies for coping can prove invaluable.

I know that anosognosia may prevent someone from seeking therapy. However, therapy can be beneficial even if a person does not fully understand their illness yet. CBTp can be an effective long-term treatment that helps people better understand their condition.

The takeaway

I've gained many benefits from talk therapy for psychosis and schizophrenia, including:

• A better sense of self and purpose
• Learning better ways to manage stress
• Recognition of distorted thinking
• Increased self-acceptance and self-esteem
• Improvements in my interpersonal skills

But the most important benefit is having someone to talk to about my experience of hearing voices. It's been hard to find a neutral person who won't judge, will empathize, and can help me move forward from what can be a traumatic experience. But it’s been so worth the wait.

The information presented is solely for educational purposes, not as specific advice for the evaluation, management, or treatment of any condition.

The individual(s) who have written and created the content in and whose images appear in this article have been paid by Teva Pharmaceuticals for their contributions. This content represents the opinions of the contributor and does not necessarily reflect those of Teva Pharmaceuticals. Similarly, Teva Pharmaceuticals does not review, control, influence or endorse any content related to the contributor's websites or social media networks. This content is intended for informational and educational purposes and should not be considered medical advice or recommendations. Consult a qualified medical professional for diagnosis and before beginning or changing any treatment regimen.

NPS-ALL-NP-01467 FEBRUARY 2025