Psychiatry

Psychiatry is a specialized field of medicine dealing with the diagnosis, prevention, and treatment of mental health illnesses. What makes this discipline unique is its position at the intersection of natural and social sciences. It combines knowledge from fields such as biochemistry, physiology, and genetics with insights from psychology, sociology, and philosophy. This interdisciplinary approach is important because physical and mental illnesses often overlap and influence each other. Therefore, psychiatry combines psychological and biological methods in both clinical practice and research.

Difference between psychiatry and psychology

Many people think psychiatry is about treating mental illnesses with medication, while psychotherapy uses “gentler” methods like talk therapy. But the line between the two is not so clear, as psychiatry also includes the use of psychotherapeutic techniques.

The main difference lies in the professionals themselves: psychiatrists are always medical doctors, meaning they have completed medical school. In Germany, after finishing medical school, aspiring psychiatrists must undergo an additional five years of training that includes clinical psychiatry, psychotherapy, and one year of inpatient neurology.

Because of their medical training, psychiatrists can investigate potential factors linked to psychological symptoms. As doctors, they can also prescribe medications for mental health conditions, known as psychotropic drugs. Psychiatrists can treat patients with medication, psychotherapy, or a combination of both.

Psychiatric treatment methods

The psychiatric treatment methods expanded in the past 3 decades to the point of independent subdisciplines:

Psychotherapy

involves treating mental illnesses using psychological methods. While it is a subset of psychiatric therapy, it is also integral to psychosomatically oriented medicine. Psychotherapy is based on diverse methods, described in detail in another chapter, with key foundations in depth psychology and learning/behavioral psychology.

Psychopharmacological therapy (pharmacopsychiatry)

involves using medications to treat mental illnesses. This approach now constitutes the largest part of somatic treatments in psychiatry.

Sociotherapy (Social Psychiatry)

focuses on the psychosocial, especially interpersonal, aspects of mental illness that are important for understanding its origins and, more importantly, for treatment and rehabilitation.

Key areas of psychiatry

The areas of psychiatry reflect their therapeutic implementation and consist of:

Psychopathology

The psychopathology studies abnormal behaviors and their influence on the affected individuals. It explores how these pathological symptoms relate to one another, describing and categorising them. Additionally, psychopathology is examining the underlying connections within mental disorders (interpretive psychopathology) and their links to interpersonal processes (dynamic or progressive psychopathology).

Biological-Psychiatric Research

employs methods such as neuroanatomy and neuropathology, neurophysiology and psychophysiology, pharmacology, genetics, and others. Chronobiology examines the timing and rhythmic patterns of mental illnesses. Psychophysiology explores the relationship between physiological and psychological or psychopathological processes. This involves studying brain activities (e.g., EEG and neuroimaging methods like CT and MRI scans) and peripheral nervous system’s activities (e.g., autonomic functions like heart rate, blood pressure, skin conductivity, and temperature).

Psychology

relates to the scientific studies of normal and pathological mental processes and their practical applications. For medical professionals, areas like developmental psychology, personality theory, and psychological diagnostics are particularly relevant. Psychology interlinked with psychiatry includes the following sub-diciplines:

Medical psychology

Topics combining psychology and psychiatry are grouped under medical psychology, which includes subjects like psychosocial development, studies on mental health illnesses, and doctor-patient relationships.

Clinical psychology

is a branch of applied psychology and doesn’t refer to clinical settings or treatment in the traditional medical sense. Instead, it focuses on personality diagnostics (e.g., testing methods) and psychological insights to interactions across various life areas, such as counseling (e.g., education, career, family, or addiction counseling). The line between psychological counseling and psychotherapy is not always clearly defined.

Neuropsychology

investigates the connections between brain structure and function on the one hand and mental (including psychopathological) processes on the other, particularly in individuals with brain injuries. Of great practical significance is psychopharmacology, which studies the influence of medications on mental processes. This field is divided into neuropsychopharmacology, which includes animal experiments and biochemical research, and clinical psychopharmacology, which primarily focuses on therapeutic applications.

Psychiatric Medication: Psychopharmaka

Medications, known as psychopharmaka, play a vital role in treating mental illnesses. These substances influence certain metabolic processes in the brain, suppressing the symptoms of mental health disorders. Experts call these psychoactive or psychotropic effects.

Psychopharmaka are among the most commonly prescribed drugs, used not only by psychiatrists but also by doctors from various specialties. They are essential for treating mental disorders like schizophrenia, bipolar disorder (manic-depressive illness), or severe depression. They also play a crucial role in managing strong anxiety and obsessive-compulsive disorders. These medications often make treating such illnesses possible by creating a foundation for psychotherapy and additional treatments, like sociotherapy. Modern psychopharmaka often enable outpatient care, helping patients reintegrate into society and work more quickly.

Like all medications, psychopharmaka might have side effects and interactions with other drugs, highlighting the importance of their careful use under strict medical supervision. For each patient, the personal benefits must be weighed against potential side effects. A trusting doctor-patient relationship remains the foundation for effective treatment.

Psychopharmaka are generally categorized into seven groups:

• Antidepressants
• Mood Stabilizers (Prophylactic treatments)
• Antipsychotics (Neuroleptics)
• Anxiolytics / Hypnotics
• Antidementia drugs
• Psychostimulants
• Other Psychopharmaka

Psychiatric treatment

Psychiatric disorders are at the forefront in terms of growth rates for outpatient, daycare, and inpatient treatment cases, as well as for days of inability to work and causes of illness-related early retirement. The state-of-the-art psychiatric therapy follows the holistic treatment approach, which integrates medical, psychological, and social support measures. Psychiatric care involves general practitioners, specialists in psychiatry, and psychologists.

Therapy options

Medication is typically just one part of a comprehensive treatment plan. Therapy options for mental disorders or illnesses are extremely diverse, with medication and psychotherapy forming the two main pillars of treatment. The focus on either component depends on the type and severity of the illness.

There are many disorder-specific therapeutic approaches proven effective in treating certain conditions.

Psychoeducation

Another important therapeutic element in both medication and psychotherapy is psychoeducation, which has become established in recent years. It involves targeted education and information about the disorder or illness.

Complementary therapies

Additionally, there are many complementary therapeutic methods, such as sociotherapy, relaxation techniques, and occupational therapy. The combination of therapy elements depends on various factors, such as the type and severity of the illness or disorder, its associated impairments, the patient’s personal preferences, and the skills they need to manage the condition. Which therapies and supportive methods are suitable in individual cases can be decided together with a psychiatrist or psychotherapist.

Founding difficuties

A particular challenge in psychiatric care in Dubai is the funding. Most insurance plans do not cover psychiatric or psychological treatment, creating a significant barrier for patients. Most insurance plans do not cover psychiatric or psychological treatment, creating a significant barrier for patients.

Out-patient psychiatric treatment

Mental illnesses arise from a combination of factors, such as personal history, personality, life experiences, current or past stressors, conflicts, social and financial problems, physical illnesses, and more. During outpatient treatment, patients can identify the connections between these influences and their current situation. This helps them take steps toward personal growth, which they can implement in their lives with the help of a therapist.

Outpatient treatment (from home) is often preferred by most people dealing with depression. In many cases, effective recovery is possible outside a hospital, thanks to the wide range of available resources: care from a doctor or psychologist, medication, self-help groups, and therapeutic techniques like relaxation or mindfulness exercises.

If symptoms of a mental illness start to affect the patient’s daily life (work, family, social interactions, education), a consultation with a specialist is recommended. Outpatient treatment can be applied if patient’s can maintain a daily routine and have a supportive social environment.

Appointments are typically scheduled weekly, biweekly, or three times a week, with frequency reduced as stability improves. The duration of outpatient treatment varies but often spans several months.

Outpatient treatment is the preferred option for most types of mental illnesses. Alternatives like inpatient treatment are only considered if the severity of the illness prevents patients from staying in their usual environment and routine.

Therapy methods used in out-patient treatment

A wide variety of psychotherapeutic methods can be applied depending on your condition. All therapies are based on personal, confidential conversations where you and your therapist define problems, set treatment goals, and choose an appropriate method.

Outpatient psychiatric treatment may also include social work or nursing support, as well as non-verbal therapy methods like body therapy, art therapy, or occupational therapy. Medication may also be part of outpatient care.

Goals of outpatient treatment

Outpatient treatment aims to achieve various objectives, such as:

• Receiving a diagnosis
• Reducing psychological distress
• Clarifying problems
• Changing thought patterns, emotions, and behaviors
• Setting realistic treatment goals
• Optimizing medication if necessary
• Understanding the illness (psychoeducation)
• Improving symptom management
• Increasing self-efficacy
• Enhancing social integration
• Potentially reintegrating into work

By tailoring treatment to your needs, outpatient care offers a structured and effective way to improve mental health and overall well-being.

In-patient (hospital) psychiatric treatment

An inpatient psychiatric stay allows you to leave your usual environment behind and focus fully on yourself and your recovery. It can be a solution when depression cannot be overcome outside a clinical setting or has reached a severe stage.

However, there are specific situations where inpatient treatment is necessary or even indispensable:

1. High Risk of Suicide

This is the most common reason for hospitalization.
The risk of someone acting on suicidal thoughts must be carefully assessed during the first contact with a medical professional. In uncertain cases, family members or friends can contact the treating doctor or emergency services.

This risk may be high at the start of treatment but can also arise during treatment. In such cases, it’s important to try to persuade the person to voluntarily agree to inpatient care. In rare situations, involuntary admission under legal provisions may be unavoidable.

2. Severe Symptoms and Distress

During a depressive episode, some people experience particularly intense symptoms such as:

• Extreme anxiety
• Persistent and overwhelming feelings of guilt
• Severe concentration difficulties

These symptoms may cause significant distress and make it hard for the person to function properly. If the person lives alone or lacks adequate support, inpatient treatment may be indicated. In many cases, simply being removed from their usual environment can bring therapeutic relief.

3. Insufficient Outpatient Care

While outpatient care offers a wide range of treatments, a hospital stay provides the opportunity to engage in these therapies (talk therapy, nonverbal therapy, individual or group therapy) more intensively.

Additionally, a multidisciplinary team of specialists can offer a more comprehensive and holistic view of the patient’s situation. Many patients also benefit from interacting with others in similar circumstances, allowing them to share experiences and feelings.

4. Other Reasons for Inpatient Treatment

Other situations where hospitalization might be necessary include:

• Adjusting or changing medications due to side effects or inadequate response
• Managing patients with complex physical symptoms requiring closer monitoring

Inpatient care can offer unique therapeutic benefits, helping patients receive the support and treatment they need in a safe and structured environment.

Psychotherapy in psychiatric treatment

Psychotherapy, alongside medication (pharmacotherapy), plays a crucial role in treating mental and psychosomatic illnesses. Below is an overview of the most important psychotherapy methods. Cognitive behavioral therapy, with its techniques tailored for various disorders, is undoubtedly one of the most significant approaches today.

Additionally, psychodynamic therapy and person-centered therapy remain relevant in practice. Interpersonal therapy is also an important method for treating depressive disorders.

Behavioral Therapy

Behavioral therapy is effective for many conflicts, mental illnesses, and disorders. It is one of the most widely used and scientifically studied psychotherapy methods today. Based on modern learning theory, it assumes that all behaviors can be learned, maintained, and unlearned. “Behavior” refers not only to observable actions and physical reactions but also to internal feelings, thoughts, motives, and evaluations.

Modern behavioral therapy places emphasis on “cognitions,” meaning thought patterns and mental evaluations, leading to its current name: Cognitive Behavioral Therapy (CBT). Mental disorders are seen as maladaptive behaviors learned in response to external and internal stimuli. The goal is to relearn healthier behaviors or acquire skills that were previously not learned. Patients are encouraged to develop active, positive behavioral patterns.

Behavioral therapy is problem-focused. At the start, the therapist works with the patient to analyze the core issue and understand the underlying behavioral patterns. This includes identifying conditions that trigger or sustain certain reactions. Therapy goals are then clearly defined, treatment principles explained, and a detailed therapy plan established.

A key feature of behavioral therapy is the active involvement of patients, including tasks or “homework” between sessions. The main focus is to empower patients with self-help tools, helping them better manage daily challenges after gaining insight into the causes and development of their problems. Once therapy goals are achieved, treatment typically ends.

Behavioral therapy is used for various disorders, including anxiety disorders, depression, psychosis (e.g., schizophrenia), eating disorders (e.g., anorexia), addictions (e.g., alcohol dependency), obsessive-compulsive disorders, sexual dysfunctions, psychosomatic disorders, and different childhood and adolescent disorders.

Techniques of Cognitive Behavioral Therapy

In recent years, various psychotherapeutic methods based on behavioral therapy have been developed to address the wide range of mental disorders and symptoms, along with their individual manifestations. Depending on the nature of the problem, these techniques can be applied individually or in combination. Behavioral therapy serves as a foundational model that can be adapted to specific patient issues using a modular, multimodal treatment approach.

Cognitive techniques, or “working on thought patterns,” have gained significant importance. They help patients realize they can control their problems. Cognitive therapy is based on the idea that conditions like depression, anxiety, and obsessive-compulsive disorders are linked to negative, irrational, and distorted thinking patterns. Patients often generalize, focus narrowly on specific themes, or think in black-and-white terms. Therapy teaches them to observe themselves, identify problems, recognize personal blocks, develop and test alternatives, and ultimately reassess their thinking and behavior patterns—such as distancing themselves, reinterpreting situations positively, or viewing problems as challenges.

Exposure techniques

aim to reduce anxiety by confronting patients with fear-inducing thoughts or situations they tend to avoid. These techniques are particularly used for anxiety disorders, post-traumatic stress disorders, eating disorders, and obsessive-compulsive disorders. Examples include systematic desensitization and flooding.

Systematic desensitization

is based on the idea that fear and relaxation cannot coexist. Patients confront their fears gradually, starting with the least fear-inducing element and progressing to the most, while practicing relaxation techniques like progressive muscle relaxation. Initially, scenarios are imagined, and then they are experienced in reality. This method is mainly used for specific phobias, such as test anxiety, and aims for fear-free experiences from the start.

Flooding

exposes patients immediately to their most fear-inducing stimuli and encourages them to endure the situation until their fear subsides. This helps patients learn that anticipated negative outcomes do not occur and that they can influence their fear and the situation.

Behavioral therapy often uses positive reinforcement to encourage desired behaviors. The idea is that positive consequences increase the likelihood of repeated desired behaviors. Reinforcers can be social (e.g., praise or attention) or material (e.g., tokens). Patients participate in deciding what motivates them. Conversely, negative consequences like punishment reduce unwanted behaviors, according to operant conditioning principles.

Model learning

allows patients to observe and imitate complex behaviors demonstrated by role models. For instance, a therapist might show a patient with obsessive-compulsive disorder how to wash hands or check locked doors in a “normal” manner, enabling the patient to adopt these behaviors.

Developing skills in underdeveloped personal areas complements other treatment methods. Role-playing exercises help patients practice specific behaviors to better handle challenging situations. For instance, a patient with social phobia might engage in social skills training to assert themselves, express their needs, and build confidence. Problem-solving and communication training are also vital components in many cases.

Dialectical Behavioral Therapy (DBT)

Dialectical Behavioral Therapy (DBT) is a specialized form of cognitive behavioral therapy designed primarily to treat the complex symptoms of borderline personality disorder. DBT focuses on emotional regulation issues, viewing borderline symptoms, such as self-harm, as attempts by individuals to reduce intense emotional distress.

The therapy aims to identify the crises that lead to these unsuccessful coping attempts. Previously uncontrolled processes are made predictable for both the patient and therapist. Patients are taught and practice effective coping strategies to manage their often overwhelming emotional states.

DBT also addresses negative self-perception and interpersonal behavior patterns in borderline patients. Depending on the patient’s history and issues, trauma therapy techniques may also be incorporated.

Research has shown DBT to be highly effective in treating borderline personality disorder.

Cognitive Behavioral Analysis System of Psychotherapy (CBASP)

The Cognitive Behavioral Analysis System of Psychotherapy (CBASP) is the only psychotherapy method specifically developed for treating chronic depression. This approach combines interpersonal, cognitive, behavioral, and psychodynamic strategies. It is based on the understanding that chronically depressed patients often become unresponsive to feedback and consequences from their environment due to a disconnect in their perception.

The techniques used in CBASP focus primarily on social and interpersonal learning. Patients are encouraged to distinguish between familiar dysfunctional relationship patterns and the behaviors of the therapist or others, helping them change negative interaction patterns. To achieve this, an explicit transference hypothesis is developed. Unlike traditional psychodynamic therapy, this approach openly discusses potential “confusions” early in therapy, guiding patients to consciously differentiate the therapist from influential figures in their past.

Building specific behavioral skills is another key component of CBASP.

Studies have shown CBASP to be as effective as medication. The combination of CBASP with pharmacotherapy proved to be the most successful.

Psychoeducation in psychiatric treatment

Psychoeducation is the effort to translate complex medical and scientific facts into a form that patients and their families can easily understand. It aims to help them grasp key information about the illness and necessary treatment measures. Understanding one’s own illness is the foundation for managing it responsibly and successfully overcoming it.

The term “education” comes from the Latin word educare, meaning to “lead out” of ignorance and inexperience. Psychoeducation, therefore, refers to therapeutic guidance that helps patients and their families gain knowledge and a clearer understanding of the illness, necessary treatments, and potential self-help strategies.

The term “psychoeducation” was introduced into psychiatry in the 1980s, adopted from English to facilitate international scientific exchange. In practice, psychoeducational groups are often labeled differently, such as info groups, psychosis groups, or family groups.

Individual or Group Sessions

Psychoeducation can take different forms. The most common is one-on-one sessions where the therapist explains the background of the illness and treatment measures in a clear and relatable way to the patient or their family members.

Group sessions, however, can be especially helpful. In these settings, multiple patients learn about their specific illness together and share their experiences. Hearing others’ perspectives and positive experiences with therapy and self-help strategies provides valuable support during recovery and in preparing for potential future crises.

Family members also benefit greatly from attending psychoeducational groups and sharing experiences with others in similar situations.

Forms of Psychoeducation

The following overview outlines the main forms of psychoeducation used today (according to Pitschel-Walz et al.).

Participants

• One-on-one sessions with patients or family members
• Sessions with individual families
• Sessions with multiple families (approximately 3-6 patients and their families)
• Groups for family members only (around 8-15 participants)
• Groups for patients only (around 6-12 participants)
• Parallel sessions for patients and family members (bifocal approach)

Duration

• Single session (individual or group)
• Short-term psychoeducation (about 2 to 8 sessions)
• Long-term psychoeducation (more than 8 sessions, lasting 3 months to 2 years)

In German-speaking regions, several psychoeducation programs are now available for schizophrenia-related psychoses. These programs share many similarities but differ in participant groups, duration, and focus areas.

Benefits of Psychoeducation

For Patients

For patients newly diagnosed with the illness, it often brings significant uncertainty and overwhelm. As laypersons, they usually have little knowledge about the condition and may struggle to even comprehend that such an illness exists.

Psychoeducational groups help patients become familiar with the current understanding of their illness and provide therapeutic support to better process the challenging facts about their condition.

Fortunately, there are now several highly effective medical, psychotherapeutic, and psychosocial treatments available, offering genuine hope. However, these measures can only be effective if patients are aware of them and willing to engage with them. In psychoeducational groups, different treatment methods are discussed, including their advantages, disadvantages, success rates, and potential concerns. This gives patients a solid foundation to actively participate in decisions about their treatment.

A key benefit for many patients is overcoming the fear and stigma associated with terms like “schizophrenic psychosis.” This leads to reduced anxiety, uncertainty, and exaggerated fears.

As patients gain knowledge and feel more informed about their condition, they develop greater confidence and self-assurance. This often fosters renewed hope, which can unlock unexpected strengths. Overall, psychoeducational groups help patients rebuild trust in their abilities, regain control of their lives, achieve greater independence in daily life, and find satisfaction in their journey.

Being well-informed and becoming experts in their illness improves their chances of a positive outcome, such as fewer relapses and reduced hospital stays.

Additionally, in direct exchanges, professionals also gain valuable practical insights from patients, benefiting future patient care.

For Family Members

Most mental illnesses are not solely a “private matter” for patients. Close family members are often significantly affected as well.

However, not all symptoms are easy for family members to understand. There is often confusion and frustration among them. Psychoeducational groups are essential for helping families correctly interpret symptoms, develop empathy, and understand the burdens their loved ones face.

When family members properly understand and accept the illness and are well-informed about key treatment measures, they can positively influence the course of the illness.

This does not mean they should excessively interfere with or take over the treatment. Instead, their improved understanding and steadfast support can provide much-needed stability and encouragement to the patient.

By understanding the illness and the sensitivities of their loved ones, family members can also contribute to a less stressful home environment. These factors promote recovery and support long-term healing.

Advantages of Psychoeducation

It is well established that psychoeducation significantly increases knowledge about the illness and its treatment, while also improving collaboration with therapists (known as compliance). This leads to better treatment outcomes.

Numerous international studies have shown that psychoeducation reduces the rate of hospital readmissions for patients and their families compared to those without such education. For example, in the Munich PIP Study (Psychosis Information Project), only about half as many patients (21% instead of 38%) required readmission in the first year after discharge if they and their families participated in psychoeducational groups.

There is also evidence of the long-term benefits of psychoeducation. Patients in the Munich PIP Study who, along with their families, attended psychoeducational groups continued to see advantages even seven years later. They were significantly less likely to require psychiatric hospitalizations, and patients without psychoeducation spent, on average, three times as many days in psychiatric hospitals as those who had received psychoeducation.

Additionally, communication skills, including the ability to interact with others and handle conflict or crisis situations, improve significantly. This helps prevent stress early, which lowers the relapse rate. Moreover, family satisfaction with the home environment increases, improving the overall quality of life for the entire family.

Understanding Through Psychoeducation

In addition to sharing experiences in psychoeducational groups and realizing they are not alone in facing such challenges, many patients and family members focus on this question: How can we reconcile “chemistry and the soul” without seeing them as opposites?

In these groups, participants explore how every perception, feeling, and thought has a biochemical counterpart in the brain, and what changes occur in brain metabolism during a psychotic episode. By gradually building biological-medical knowledge while incorporating psychological insights, psychoeducation bridges the gap between everyday understanding and advanced scientific knowledge.

When it becomes clear that chemistry and the soul are not opposites but two complementary sides of the same coin, the question of choosing between medication or psychotherapy often disappears. It becomes evident that medication and psychotherapy complement each other and achieve progress only when combined.

Psychoeducational groups serve as a fundamental part of psychotherapeutic treatment. Providing patients with stable and reliable knowledge is a crucial milestone in building self-confidence and self-competence—the ability to take charge of one’s life.

The Role of Psychoeducation

Psychoeducation is an integral part of treating mental illnesses, aiming to improve understanding of the illness. Only those who understand what is happening can overcome their fears and actively contribute to managing their condition. In this sense, psychoeducation is a foundational form of self-help.

It is essential for patients to apply their knowledge about their illness and treatment options, making full use of modern psychiatry, particularly its two main pillars: medication and psychotherapy. Doing so significantly helps prevent relapses.

A comparison with diabetes may clarify this. Although physical and mental illnesses differ greatly, there are some parallels.

A person with diabetes needs two things to live a “normal” life: First, they must learn about their condition, understand why their blood sugar fluctuates, and what it means for their health. They must also learn how to live healthily, plan meals, organize their day, and adjust their lifestyle accordingly. Second, they need modern medication that meets the latest standards. Advances in medicine now allow blood sugar levels to be regulated to near-normal levels, including through innovative drug delivery methods.

Effective knowledge about the illness, acceptance of the condition, and use of modern treatments—including medications—enable many people with diabetes to lead largely “normal” lives.

Sociotherapy in Psychiatry

Sociotherapy provides practical guidance for severely mentally ill individuals to independently access prescribed medical, social, and therapeutic services within community-based psychiatric care. It addresses specific challenges faced by this patient group, such as difficulties with social interaction, loss of social connections, reduced ability to manage daily life independently, and limitations in employment capabilities.

The aim of sociotherapy is to activate the patient’s healthy resources and encourage self-help, enabling them to become as independent from external assistance as possible in a short time. Sociotherapeutic care is not a standalone psychotherapeutic concept but serves as a bridge or referral system in outpatient care, guiding patients to appropriate services.

The goal of sociotherapy is to facilitate the transition from medical treatment to social reintegration. It helps ensure optimal outpatient care by connecting patients to suitable treatment options. Additionally, it aims to enable patients to live outside psychiatric facilities, thereby avoiding or shortening hospital stays.

Applications of Sociotherapy

Sociotherapy is a patient-centered support approach tailored to individual needs. It is used for patients with psychoses or psychosis-like conditions, such as bipolar disorder. Sociotherapy is indicated in cases where:

• Social interaction difficulties exist,
• The patient can no longer maintain social relationships,
• Daily life is unmanageable, and the patient, for example, cannot maintain regular employment,
• There are issues with motivation, stamina, or resilience,
• Planning and decision-making abilities are impaired,
• The sense of reality is diminished,
• Cognitive (thinking-related) abilities are disrupted,
• Communication is severely limited, and
• A lack of insight into the illness leads to unwillingness to participate in other therapeutic measures (e.g., occupational therapy).

In practice, sociotherapy is primarily prescribed for patients with severe, chronic illness trajectories and those who have required multiple hospitalizations.

• If the patient meets the criteria for sociotherapy, the treating neurologist or psychiatrist (sometimes following a referral from a general practitioner) informs the patient about its purpose and benefits. The doctor, alongside an experienced sociotherapist (social worker, social pedagogue, or a nurse with psychiatric training), then has a detailed discussion with the patient, explaining the goals and structure of sociotherapy.
• Following close collaboration between the psychiatrist and sociotherapist, an individualized sociotherapeutic care plan is developed. This plan is agreed upon and signed by all parties (patient, psychiatrist, and sociotherapist) and includes all goals and steps of the therapy.
• Finally, the sociotherapy plan involves documenting and coordinating the prescribed services to guide the patient toward suitable therapeutic resources.

Medical treatment, medication, and (socio)therapeutic support are tightly integrated. Throughout the process, the sociotherapist and treating physician maintain constant, active communication. The type and duration of sociotherapy depend on the illness and its severity.

Content and Modules of Sociotherapy

The foundation of sociotherapy is a dialogue about the patient’s illness, current social situation, problems, and fears. A key component is educating the patient about their condition. This includes helping them recognize signs of the illness, particularly early symptoms of recurring psychotic episodes, and manage their effects (psychoeducation).

The main contents and modules of a sociotherapeutic care plan, tailored to the patient’s situation and condition, include:

1. Counseling in Conflict and Crisis Situations

The focus is on restoring a sense of reality. Patients are guided to recognize their resources and limitations, rather than blaming an “unreasonable environment” for their issues. Sociotherapists help correct maladaptive behaviors.

2. Strengthening Self-Reliance

In acute cases, sociotherapists arrange for nursing services or outpatient psychiatric care (APP) to support self-care. This includes guidance on daily hygiene, proper medication management, and identifying self-harm risks. Support is provided within the patient’s living environment.

3. Motivating the Use of Medical Care

Sociotherapists emphasize the importance of consistent treatment, encouraging patients to take medications and attend regular medical appointments. By providing thorough information, patients gain trust in prescribed measures, increasing therapy compliance (acceptance).

4. Collaboration with Social Service Providers

Sociotherapists work with social service agencies (e.g., employment offices, pension authorities, welfare agencies, health departments) to assess and coordinate the patient’s entitlements as part of a “care management” approach.

5. Assistance with Housing and Employment

Sociotherapists provide guidance on housing solutions, such as “supported independent living,” where patients live alone but receive help with basic social functions, like daily structure, independence, and practical life skills.

They also work with the patient to plan steps for gradually resuming work, collaborating with specialized integration services. If this is not feasible, options like sheltered workshops for mentally disabled individuals are considered. The goal is to promote social integration and reintegration into work in familiar environments.

6. Coordinating Occupational Therapy

Occupational therapy is a key element in sociotherapy. Through individual or group activities, such as crafts, games, and creative projects, patients can maintain or regain daily living skills. This therapy enhances self-confidence, motivation, and initiative.

7. Promoting Social Connections

Sociotherapists provide resources for fostering social interactions, including contacts to local social-psychiatric centers (SPZ), support groups, and leisure groups, depending on community psychiatric offerings.

8. Encouraging Recreational Activities

For patients with social or functional impairments, sociotherapists introduce them to recreational opportunities (e.g., sports, cultural events). Rehabilitation sports, in particular, offer physical and emotional balance.

9. Informing Families About Support for Caregivers

Sociotherapists involve families in therapy by connecting them with regional support groups for families of mentally ill individuals. Family-focused interventions provide information about the patient’s illness and offer guidance for managing conflicts and challenges. This support not only alleviates family burdens but also aims to reduce relapse rates and foster a better understanding of the illness.

Relaxation techniques in psychiatry

Relaxation techniques are an integral part of treating mental health disorders and other conditions like headaches. They are also effective for reducing stress and play an important role in preventive healthcare.

Widely recognized methods include progressive muscle relaxation (PMR) by Jacobson, autogenic training, biofeedback, and modern hypnosis. Additionally, various forms of meditation and imaginative techniques (based on visualization) have relaxing effects. Many of these methods originate outside Western cultures, such as yoga or Zen practices.

Relaxation Technique: Progressive Muscle Relaxation

Progressive muscle relaxation is not only the easiest to learn but also the most thoroughly researched method, making it generally preferable to other techniques. However, other methods may also be beneficial for individuals.

American physiologist Edmund Jacobson (1885–1976) developed progressive muscle relaxation, discovering in 1929 that muscle tension increases with feelings of restlessness or excitement. Conversely, anxiety can be reduced by decreasing muscle tension. While the original method required over 50 sessions to master, simplified versions are now available and can be learned in just a few hours.

The Principle of Progressive Muscle Relaxation

A muscle group can be effectively relaxed by first intentionally tensing it. Progressive muscle relaxation leverages this effect: as relaxation moves from one muscle group to another, it triggers further relaxation throughout the body. This process can lower blood pressure, slow heart rate and digestion, and promote calmer breathing.

Relaxation Technique: Autogenic Training

Autogenic training is another widely practiced relaxation method in Germany, though it is less well-researched compared to progressive muscle relaxation (PMR). It is also harder to learn, making it less universally recommended.

Autogenic training was developed in 1932 by the German physician Johannes H. Schultz (1884–1970), who had extensive experience with hypnosis and understood the power of suggestion. Schultz aimed to create a method of self-induced relaxation through mental influence.

Principle of Autogenic Training

Autogenic training is a form of self-hypnosis designed to shift physical and autonomic functions (such as blood circulation, heart rate, and breathing) into a state of rest. Unlike PMR, where relaxation is achieved indirectly through voluntary muscle tension, autogenic training uses focused mental concentration to induce calm directly.

Practicing Autogenic Training

Exercises are performed in specific postures, such as the “coachman’s posture” while sitting or lying down. Guided by phrases like “I am completely calm” or “My left arm is very warm,” thoughts and visualizations are directed to specific sensations. By repeating these phrases multiple times—ideally after some practice under guidance—a state of relaxation eventually occurs automatically.

Basic Exercises (First Phase: Lower Level)

This phase focuses on influencing physical processes. Key exercises include:

• Heaviness Exercise: Starting with one body part, the sensation of heaviness is practiced, eventually extending to the whole body for general relaxation. Example phrase: “My right arm is very heavy.”
• Warmth Exercise: The sensation of warmth begins with one body part and spreads throughout the body, promoting vasodilation and calming effects. Example phrase: “My right arm is very warm.”
• Heart Exercise: Concentrating on the heartbeat helps calm it. Example phrase: “My heart beats calmly and regularly.”
• Breathing Exercise: This stabilizes breathing frequency. Example phrase: “My breathing is calm.”
• Solar Plexus Exercise: Focuses on relaxing and harmonizing the digestive organs. Example phrase: “My solar plexus feels radiantly warm.”
• Head Exercise: Visualization creates a sensation of a cool, clear head. Example phrase: “My forehead is pleasantly cool.”

Advanced Exercises (Second Phase: Upper Level)

This phase involves a waking-dream technique, where imagined images are brought into awareness and reflected upon. This technique promotes deeper self-awareness and, under a psychotherapist’s guidance, can aid in conflict resolution and identifying new solutions.

Application of Autogenic Training

Autogenic training is used for many psychological and psychosomatic disorders. The method aims to promote calmness, relaxation, and improved concentration. It enhances stress tolerance and is effective for managing chronic pain. However, it should be used cautiously in cases of excessive physiological dysregulation (e.g., heart palpitations, fainting spells). Imaginative techniques associated with autogenic training are unsuitable for patients with psychoses.

Relaxation Technique: Biofeedback

Similar to autogenic training, biofeedback involves learning to consciously influence involuntary bodily functions. This is achieved by using electronic devices to make these functions perceptible. For example, muscle activity can be measured with surface electrodes, amplified, and converted into visible or audible signals. This feedback allows individuals to understand their muscle tension and consciously adjust it through focused thought.

The method is most commonly used to measure skin resistance for reducing muscle tension and to control breathing for relaxation. Using technological tools, biofeedback can also enhance blood flow, regulate heart rate, or influence the activity of the cerebral cortex.

Relaxation Technique: Modern Hypnosis

Hypnosis is one of the oldest methods incorporated into psychotherapy. It was practiced as a technique of suggestion in ancient Egypt, demonstrating an early understanding of influencing a person’s thoughts, emotions, will, and actions. Modern hypnosis is a short-term therapy that works quickly and effectively to achieve targeted results.

Principle of Modern Hypnosis

Hypnosis induces a state of altered consciousness (trance) in patients, while autonomic body functions (e.g., breathing) shift toward relaxation. This state of focused awareness allows the therapist to make targeted suggestions based on the patient’s illness or symptoms. Despite feelings of heaviness and drowsiness, hypnosis is not a sleep-like state, as confirmed by electroencephalogram (EEG) readings.

Conducting Modern Hypnosis

As with any therapy, hypnosis should be preceded by a thorough physical and psychological examination. An initial informative conversation is crucial for building trust between the therapist and the patient.

There are several techniques for inducing a trance state:

• One approach involves soothing verbal suggestions delivered in a monotone voice to convey calmness, warmth, and increasing drowsiness.
• Another common technique is the fixation method, where the patient focuses intently on a small nearby object, gradually tiring their eyes and leading to a trance state.

The therapist’s repetitive voice and monotonous, vivid imagery narrow the patient’s awareness, relax their muscles, and cause blood vessels to dilate.

At the end of a hypnosis session, the trance state is reversed to prevent any unwanted aftereffects, such as lingering drowsiness.

Applications of Modern Hypnosis

Hypnosis can be helpful for certain psychological and physical conditions or for addressing specific symptoms such as headaches, anxiety, or trembling. It is often used in pain management and for preparing patients for surgery. Additionally, hypnosis can sometimes uncover unconscious memories. However, it is not recommended for patients with psychoses.

Performing Progressive Muscle Relaxation

The exercises are performed either lying down or in a comfortable chair. One muscle group at a time is worked on by tensing it, holding the tension briefly, and then releasing it—starting with the right hand, moving through the arms, face, neck, back, abdomen, and finally the legs and feet. Throughout, attention is focused on the sensations associated with muscle activity during both tension and relaxation.

During training, participants learn to distinguish between normal and excessive tension, developing a conscious awareness of their body. In advanced stages, similar to autogenic training, participants focus on the sensations of “letting go” to enable relaxation in daily life situations.

Applications of Progressive Muscle Relaxation

This method is used as a supportive treatment for many psychological and physical disorders. It is often included in systematic desensitization, where a patient gradually confronts fear-inducing objects or situations while using relaxation techniques.

Progressive muscle relaxation promotes calmness and serenity, helps manage certain types of sleep disorders, and generally improves stress tolerance. It is especially suitable for patients who are nervous or internally restless.

When addressing sleep disorders, it is important to first master the technique before using it in challenging situations. This means the individual should have prior experience successfully achieving a relaxed state during high tension. Only then does it become effective for managing insomnia caused by restlessness or nervousness (though not all sleep disorders involve these factors).

Additionally, progressive muscle relaxation is effective for chronic pain, with proven benefits for chronic tension headaches.

Because it is the easiest relaxation technique to learn, it is also helpful for hyperactive or restless children. However, it is not recommended for individuals with acute psychosis, muscle disorders, or muscle cramps.

Relaxation Technique: Biofeedback

Similar to autogenic training, biofeedback (English: biological feedback) helps you learn to consciously influence involuntary bodily functions. This is achieved by using electronic devices to make these functions visible. For instance, muscle activity can be measured with surface electrodes, amplified, and translated into visual or auditory signals. Presented this way, individuals can perceive their muscle tension and use mental focus to adjust it in the desired direction.

The method is most commonly used to measure skin resistance to reduce muscle tension and to control breathing for relaxation. With the help of these devices, blood circulation can be improved, heart rate increased, or even the activity of the cerebral cortex influenced.

Occupational Therapy in Psychiatric Treatment

Occupational therapy supports and guides individuals of all ages who are limited in their ability to function or are at risk of such limitations. The goal is to help them engage in meaningful activities related to self-care, productivity, and leisure within their personal environment.

Occupational therapy is offered in various settings:

• Inpatient: Within psychiatric and psychotherapeutic clinics.
• Partial Inpatient: In day clinics.
• Outpatient: In private practices or social psychiatric outpatient services.

Treatment can take the form of individual therapy, small group sessions, or larger group therapy, depending on the patient’s needs.

Questions and Answers About Psychoeducation

What happens in psychoeducational groups?

The focus is on open discussions and sharing experiences between participants and the group leader. This foundation is used to present key scientific insights in an understandable way, providing patients and their families with a clear overview of the illness and necessary treatments.

Alongside the information provided, emotional relief plays a significant role. This involves addressing and processing the emotional impact and distress caused by the illness.

Structured information helps participants organize their personal experiences into a coherent framework. The sessions build on participants’ prior knowledge, offer additional insights, and provide guidance and support for any doubts or questions.

Patients are encouraged to engage in the recommended treatments, adopt health-promoting behaviors, and develop confidence and calmness in managing their condition. The primary focus of the sessions is often on psychoeducation for treating schizophrenia.

Who benefits from psychoeducation?

Psychoeducation is designed for patients and their families. It can be applied to virtually all mental illnesses and many psychologically challenging physical conditions (e.g., diabetes, tinnitus, eczema, asthma, cancer, AIDS, heart disease). However, not all conditions have fully developed therapeutic concepts yet.

The most experience and scientific evidence for effectiveness in psychiatry come from psychoeducational groups for schizophrenia and schizoaffective disorders. Psychoeducation is especially important for schizophrenia, given the lack of societal understanding, its reputation as a mysterious illness, and the stigma faced by patients and their families.

Psychoeducational groups have also become increasingly common for depression, with promising concepts emerging for bipolar disorder, obsessive-compulsive disorder, anxiety disorders, addictions, eating disorders, personality disorders, and dementia (mainly for family members).

Who should not join psychoeducational groups?

There are few significant reasons to avoid psychoeducational groups. However, patients with acute schizophrenia experiencing severe thinking, concentration, or attention problems may find it overwhelming to process too much information at the onset of their illness. Participation is not recommended in such cases.

Severe anxiety, especially fear of groups, can initially be a barrier. However, with skilled group leaders and strategies to address these fears, group participation can help overcome them.

Patients experiencing extreme agitation or mania should wait until they are calmer and can concentrate for at least 30 minutes before joining these groups.

Why are psychoeducational groups valuable for family members?

Over half of patients return to live with their families after being discharged from the hospital. To better understand the initial challenges, fears, and low mood of their loved ones, family members need a thorough understanding of the illness and its treatment.

Family members must also distinguish between symptoms of the illness and side effects of medication, such as low energy levels. Without this knowledge, families may misinterpret withdrawal or isolation as laziness instead of illness-related overwhelm.

Families without access to such information risk being overly critical, hostile, or excessively worried. Conversely, research shows that well-informed and guided families can play a crucial supportive role at home, significantly reducing the relapse risk for various mental illnesses.

Not involving families in psychoeducational groups would be a missed opportunity to prepare them for their role as “co-therapists.” Patients often benefit greatly from their family’s participation in these groups.

For families, the shared experience and mutual support in psychoeducational groups can be immensely relieving. Realizing that other families also struggle with similar challenges can be freeing and inspiring. Learning from others’ experiences can help families discover new ways to cope with the illness.