Schizophrenia is a very disabling psychiatric illness affecting about 2 to 3 million Americans. Contrary to popular perception, it has nothing to do with a “split personality.” Schizophrenia is a chronic brain disorder involving “positive” and “negative” symptoms. Positive symptoms include hallucinations (hearing voices or seeing visions that aren’t real), delusions (fixed false beliefs), and disorganized thinking or speech. People suffering from active positive symptoms often respond to those symptoms in ways that are obvious to others around them (e.g., agitation, disorganization). Negative symptoms include marked decreases in a person’s social interactions, communication, and motivation, and are associated with cognitive dysfunction, including how a person organizes and retrieves information. Positive symptoms may fluctuate over time; negative symptoms tend to be more chronic and pervasive. Positive symptoms may improve, sometimes dramatically, when a person is treated with antipsychotic medications. Negative symptoms often do not respond to these medications.

These positive and negative symptoms make it difficult for a person with schizophrenia to establish and maintain relationships, work productively, and interact socially. Cost factors can be a barrier in obtaining treatment, and the disordered thinking that is part of this illness may make it difficult for a person to understand that their thinking is abnormal and to follow treatment recommendations. Sometimes, people with schizophrenia abuse street drugs. When substance dependence develops in a person with schizophrenia, effective treatment is even more difficult.





Importantly, the need for this type of cognitive restructuring is not unique to schizophrenia; it cuts across psychiatric disorders and may contribute to the effectiveness of CBT in depression, anxiety disorders, and personality disorders, among others. In our view, CBT may alter defects in information processing that are common to a range of psychiatric disorders. There are many types of psychotherapies, but only a few, such as CBT, are supported by evidence from carefully performed research showing that the treatment works better than the important, but non-specific, effects of talking with and listening to a caring therapist.


An advantage of evidenced-based psychotherapies like CBT is that they can be performed by trained individuals who are not physicians. Care of people with severe psychiatric illnesses benefits from teams of mental health professionals that include psychiatrists, psychologists, social workers, and therapists. Such team approaches allow effective treatments to reach more patients in a fiscally responsible manner. We strongly encourage team approaches and believe it is critical for therapists to use the most up-to-date evidenced-based psychotherapies.


Demystifying Psychiatry

A resource for patients and families
Charles F. Zorumski, MD


Most Recent Posts from Demystifying Psychiatry

The Immune System and Psychiatry

The influence of immune system function on the brain.

One Step Closer to a Rapidly Acting Antidepressant?

A rapidly acting antidepressant that is a step beyond ketamine.

A Possible New Class of Antidepressants

Neuroscientific advances are leading to new treatments for depression.