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Evaluating Outcomes: 5 Signs Cognitive Therapy is Working for Someone with Schizophrenia or Other Mental Illness


When someone has a serious mental health disorder such as schizophrenia we always seem to know when things aren’t going well. It can be much harder to tell when things are going right. This final installment in our series on cognitive therapy looks at the results of treatment and how to know whether it is working.

Key Concepts from Part 1 in this series:
Cognitive therapy is a time-limited, results-oriented approach that is most effective when there’s a specific problem or goal to work on.
Cognitive Remediation (CR) uses individualized drills and group bridging sessions to improve functioning in targeted areas of cognition such as attention, memory, and problem-solving.
Cognitive Behavior Therapy (CBT) is a form of psychotherapy that helps people understand how their thoughts influence their feelings and behavior.

Fortunately, cognitive therapies like CR and CBT are time-limited and results-oriented. Evaluating their success is more straight-forward than it is for many other forms of mental health treatment and support.

How to Tell Cognitive Therapy is Working for You (or a Loved One)

1. You have learned new skills – A skill is observable, specific, and enduring. It is an ability that combines knowledge and behavior to do the things that make a difference in your life. Having a more positive attitude is not a skill. Using a Thought Record in CBT to evaluate and respond to automatic negative thoughts is.

2. You are making progress towards your long-term goals – Cognitive therapy for people with serious mental illness is most effective when it is linked to long-term goals for recovery such as finishing college or living independently. You can measure short-term progress by breaking these big recovery goals into smaller steps. Strengthening attention and working memory in CR can lead to improved prospects for success in college.

3. You can measure the results – It is the therapist’s responsibility to provide you a way to measure your progress. The computer-based drills of the Neuropsychological Educational Approach to Cognitive Remediation (NEAR) allow you to monitor weekly progress on those exercises. CR providers should also offer comprehensive testing that measures overall improvement in your thinking skills over the course of the entire program. In CBT, your therapist should help you set specific goals and a time frame for achieving them. Many CBT therapists assign homework at the end of sessions. Focusing on specific assignments, tasks, and exercises makes it easier for your therapist and you to measure the results.

4. Other people notice you are getting better – Cognitive therapy focuses on helping people achieve specific real-world goals. Once that happens people around you will start to notice and those who are closest to you will no doubt want to share their excitement at seeing the changes you have made.

5. You look forward to the next session with enthusiasm – Cognitive therapy is not about hashing over old problems and feelings from the past. It’s about learning new skills and moving forward in your life. Chances are that if that’s happening in sessions you will feel good about them and want to return. This is the most important indicator of success: your own feeling that you are getting better.

Two questions to ask a provider when you aren’t sure a treatment is working:

I’m not feeling it yet. How long before I start to see results? A skilled provider will give you an idea of the length of treatment at the start. If you’re still not feeling the benefits within the agreed upon time frame, by all means tell your therapist. Keep in mind that some problems and diagnoses will take longer to treat than others. Some phobias and problems with anxiety can be treated in as few as 12 sessions. A typical course of CR is 3-6 months, and CBT for psychosis may take a year or longer to take effect.

Do I need another form of treatment in addition to or instead of cognitive therapy? Cognitive therapy works best in combination with other evidence-based practices such as treatment with medication or supported employment (see Part 3). A person who experiences active psychosis may not be able to benefit from cognitive therapy. No mental health treatment works for all people all the time. If you feel you’ve given cognitive therapy enough time and it still isn’t working, ask your therapist about other options or contact our Resource Specialist for help finding other mental providers in your community.

Be sure to catch up on Part 1Part 2, and Part 3 in this series.

If you think you or someone you know might benefit from cognitive therapy, it is important to seek help from a qualified mental health professional. Our Resource Specialist can help you find expert mental health resources to recover in your community. Contact us now for more information on this free service to our users.

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Jay Boll, Editor in Chief www.rtor.org

2 thoughts on “Evaluating Outcomes: 5 Signs Cognitive Therapy is Working for Someone with Schizophrenia or Other Mental Illness

  1. Eddie Roy Davis says:

    I am starting my 501C3 non profit in Atlanta Ga and just reading some of your information seems to be a perfect fit for what we will be doing g here. I hope I can get feed back from you.


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