Stress and Schizophrenia: What’s the Connection?

Schizophrenia likely develops from a combination of factors, including genetics, brain development, and environmental influences. Stress may contribute to the onset or worsening of psychosis in people with schizophrenia, but this risk factor may depend on the type of stressor and how you respond to it.

Keep reading to learn about the relationship between stress and schizophrenia, how stress affects treatment, and ways to manage it. Caregivers will also learn how they can help.

How Are Stress and Schizophrenia Connected?

Researchers are still exploring how schizophrenia may affect the body’s response to stress. They’re also studying how different types of stressors, including environmental and social factors, may affect the risk and symptoms of psychosis, which involves some loss of contact with reality.

Stress Response

One study found differences in how people with schizophrenia respond to stress. When people without schizophrenia feel stressed, their bodies release chemicals including dopamine and cortisol. The findings suggest that this stress response may work differently in people with schizophrenia.

More research is needed to understand these differences and which coping strategies are most helpful.

Studies also suggest that stressful life events may worsen schizophrenia symptoms. Ongoing stress has also been linked to a higher risk of relapse.

Type of Stress

Some types of stress may have a stronger link to psychosis than others. Studies have linked several social and psychological stress factors with a higher risk of psychosis:

• Psychosocial stress — Traumatic or stressful life events, such as emotional or physical mistreatment during childhood
• Interpersonal sensitivity — Strong concerns about social situations, other people’s opinions, or feeling rejected or left out
• Social withdrawal — Social isolation and loneliness due to fear of rejection, embarrassment, or feeling disconnected from others

These factors don’t account for all forms of stress. Other environmental factors have also been linked to a higher risk of schizophrenia, possibly by affecting brain development or interacting with genetic risk. These factors may include:

• Early life factors — A mother’s stress or certain infections during pregnancy, older parental age, and complications during pregnancy or birth
• Childhood and later life factors — Childhood adversity, head injuries, and substance use

Schizophrenia itself can also bring stress and anxiety, including worries about symptoms returning. Anxiety is common among people with schizophrenia, and worsening anxiety may sometimes be an early sign that psychosis is getting worse.

Some MySchizophreniaTeam members have described feeling worried and unsure where to turn. “I was diagnosed a year ago, and I feel lost, overwhelmed, scared, and not sure what to think,” said one member.

How Does Stress Affect Schizophrenia Treatment?

Stress can affect how people with schizophrenia manage their condition or recover from psychosis. It’s important to tell your caregiver and healthcare team about major life events so they can provide the support you need to help manage stress and reduce the risk of symptoms getting worse.

For example, someone who withdraws from friends, family, and medical support may not be aware of new or worsening symptoms. Social withdrawal can be an early sign of worsening mental health and may make it harder to notice changes or seek help. Delays in treatment can make recovery more challenging.

Researchers have suggested that having less social and sensory stimulation may contribute to symptoms such as seeing or hearing things that aren’t there. However, more research is needed to understand this possible connection.

Stress can also make it harder to follow your medication schedule. Traumatic or stressful life events may disrupt your usual routine, making it easier to miss a dose.

Below are a few stress-management strategies to consider. If you’re not sure where to start, talk with your care team about strategies that may be appropriate for you.

Caregivers can also ask healthcare providers for resources and advice on how to best support their loved one during emotionally challenging times.

Lean on Community

Staying connected with your community can help you cope with stress and support your mental health. Even during high-stress situations, having reliable social support may help reduce the risk of relapse.

For some people, this may mean reaching out to parents, siblings, and close friends. For others, it may look like:

• Joining a support group
• Participating in a local running or reading group
• Going to regular study groups at school
• Taking classes to learn a new skill
• Finding opportunities to interact with colleagues at work
• Volunteering at a local animal shelter or food pantry

Caregivers can help by offering to spend time together or providing space to talk. They can also offer to go on community outings or provide transportation if their loved one would find that helpful.

Try Mental Reframing

Positive coping can include finding helpful ways to think about and respond to difficult situations. Optimism, humor, and openness to new experiences have been linked to lower levels of distress in people who experience psychosis.

Caregivers can help by listening to and acknowledging stressful feelings rather than dismissing them. When appropriate, they can help their loved one consider different ways to view or respond to a difficult situation. This approach may help a person move toward problem-solving rather than self-blame or withdrawal.

Engage in Cognitive Behavioral Therapy for Psychosis

Cognitive behavioral therapy for psychosis (CBTp) is a type of talk therapy that can help people manage psychosis and the distress associated with it. CBTp can address experiences such as hallucinations, delusions, and paranoia. In group settings, people may be able to practice social skills and connect with others.

This type of therapy can also help people learn to manage emotions and cope with difficult experiences. Techniques may include:

• Using relaxation techniques for the body and mind
• Examining thoughts and experiences more closely
• Finding ways to make thoughts less distressing
• Building confidence in new social skills

Family caregivers can explore cognitive-behavioral family interventions for psychosis with their loved one. This type of therapy can involve family members in problem-solving stressful situations, improving communication and understanding, and finding ways to reduce stress together.

Build a Healthy Routine

Engaging in hobbies and self-care can help you build a healthy routine that supports your mental health. When stressful situations arise, you’ll be better equipped to handle them.

Your routine can be based on what works for you and what you can realistically maintain. Below are a few ideas to get started:

• Get regular physical activity, such as taking walks or attending a yoga class.
• Aim for a nutritious diet that includes a variety of whole foods and limits sugary or processed products.
• Keep a regular sleep schedule by going to bed and getting up around the same time each day.
• Consider limiting social media if certain online content increases your stress or makes symptoms harder to manage.

Some MySchizophreniaTeam members have found routines that work for them. For example, one member said they worked up to three-mile morning walks after years of feeling “out of touch” with their body: “Half of that walk is spent getting centered and planning out my day at a casual stroll, and the other half is spent challenging myself. I’ll start jogging soon, but these small, attainable goals help me build the habit.”

Join the Conversation

On MySchizophreniaTeam, people share their experiences with schizophrenia, get advice, and find support from others who understand.

If stress affects your schizophrenia symptoms, how do you manage it? Let others know in the comments below.