The World Health Organization estimates that schizophrenia affects around 24 million people, or roughly 1 in 300 individuals worldwide. This severe mental illness not only disrupts the lives of those affected but also carries significant social and economic burdens. Even more concerning, individuals with schizophrenia have an average life expectancy 15-20 years shorter than the general population, primarily due to higher rates of physical health conditions, lifestyle factors, and the challenges of accessing consistent, effective care.

Like many mental health conditions, psychotic disorders such as schizophrenia are often accompanied by significant stigma. Fueled by widespread misconceptions and harmful stereotypes, this stigma perpetuates false beliefs such as, all individuals with schizophrenia are violent or pose a danger to society.

As a result, people with schizophrenia are sometimes unfairly isolated, marginalized, or treated with fear and mistrust. These negative attitudes not only worsen the challenges that individuals with schizophrenia face but also contribute to social exclusion. With this ostracism making it more difficult for them to seek help, maintain relationships, and lead fulfilling lives.  

Both the limitations and lack of efficacy of current treatments are key factors contributing to the lower quality of life for schizophrenic individuals. Antipsychotic medications are typically the primary, and often only, treatment available for schizophrenia, and they can be effective in managing positive symptoms like hallucinations and delusions. However, these medications do little to address persistent negative symptoms like blunted emotional expression and social withdrawal, or cognitive deficits like impaired memory, attention and executive functioning. Additionally, the current antipsychotics are often accompanied by a range of troublesome side effects, adding another layer of complexity to treatment and further diminishing the quality of life for many patients.  

We spoke with Joshua Kantrowitz, an associate professor of Clinical Psychiatry at Columbia University Irving Medical Center and director of the Columbia Schizophrenia Research Center. He shares that “Regulatory-approved pharmacological treatments are mostly effective for positive symptoms and full or partial treatment resistance is common, particularly for negative symptoms and cognitive impairment associated with schizophrenia.” 

He continues that because schizophrenia is a complex condition with many different causes, not everyone with schizophrenia has the same symptoms or underlying issues, which makes it harder to treat effectively. Most approved treatments for schizophrenia work in the same way: blocking a specific brain receptor called dopamine type 2 receptor. However, this single approach doesn’t work for everyone, and that’s part of the reason why treatment responses are sometimes incomplete or not as effective for all patients.

What steps can be taken to address these challenges and improve the treatment of resistant symptoms?

A 2024 study conducted by researchers at Utah State Hospital suggests that one key solution to addressing these issues is group therapy intervention. Research has shown that group therapy can be particularly effective, often outperforming individual therapy in certain areas. Additionally, it is a cost-effective option, allowing one clinician to treat multiple patients in a shorter amount of time. Recent estimates indicate that increasing the use of group therapy by just 10% nationwide could expand treatment access for over 3.5 million people while saving more than $5.6 billion.

The American Psychiatric Association practice guidelines emphasize that comprehensive care is the most effective approach to treating schizophrenia. This approach includes psychotropic medications, individual therapy, family therapy, occupational therapy, and recreational therapy. Incorporating evidence-based psychosocial treatments, such as group therapy, can enhance the quality of care and more effectively address the negative symptoms and cognitive deficits of schizophrenia.

The study highlights the importance of social skills  training, as poor social competence is a key characteristic of the disorder and often disrupts interpersonal relationships and community integration. Social skills training typically includes five components: explanation, demonstration/modelling, role-play, positive/corrective feedback, and homework. The group format enhances the effectiveness of this intervention by allowing participants to model skills, support one another, practice together, solve problems collectively, and offer encouragement. This approach has been shown to significantly improve behavioural measures of social skills, self-assertiveness, and even hospital discharge rates.

Cognitive remediation therapy (CRT) is another key component of group therapy for schizophrenia, as the disorder consistently impacts areas such as attention, working memory, verbal learning/memory, and executive functions. Cognitive dysfunction can vary from moderate to severe and significantly contributes to functional impairments in social skills, vocational capacity, and independent living. CRT is a behavioural treatment approach aimed at improving cognitive abilities in these critical areas, thereby improving daily functioning and overall quality of life.

Mental health care should emphasize the importance of providing individuals with schizophrenia the tools to enhance their quality of life and reintegrate into society. Kantrowitz concludes that with a focus on comprehensive care, incorporating evidence-based interventions like group therapy for social skills training and CRT, can help individuals manage negative symptoms and cognitive deficits. This holistic approach not only improves their mental health but also empowers them to make meaningful contributions to their communities. 

There is an increasing call for greater focus on outpatient group treatments for people with schizophrenia, in addition to inpatient care. More research is needed to assess the effectiveness of these treatments. By offering and evaluating outpatient group therapy, we can better support individuals in sustaining recovery, ensuring they continue to thrive after inpatient care, and lead fulfilling lives.

 -Shontae Cameron, Contributing Writer

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