What Is Psychosis?
Signs and Symptoms of Psychosis
Four main symptoms are associated with a psychotic episode:
Hallucinations are defined as a sensory perception in the absence of a corresponding external or somatic stimulus. Hallucinations may occur with or without insight into their hallucinatory nature, but the absence of insight defines it as a psychotic symptom. Auditory hallucinations involving hearing voices conversing with one another or offering a running commentary are common experiences in psychosis.Delusions are fixed false beliefs. They are based on false inferences about external reality and are maintained firmly despite incontrovertible evidence to the contrary. Delusions experienced by people with psychosis might include:
persecutory delusions—beliefs that one is being harmed, or that harm is impending;
grandiose delusions—an unshakable conviction that one possesses special powers, talents, knowledge, or abilities;
religious delusions—any delusions with a religious context.
Psychological Models and Theory of Psychosis
In Garety, Kuipers, Fowler, Freeman, and Bebbington’s (2001)
cognitive model of positive symptoms of psychosis,biopsychosocial vulnerabilities and triggers combine to produce anomalous experiences (e.g., hearing a voice, a sense of being watched or followed). In psychosis these experiences are appraised as being external, resulting in positive symptoms of delusions and hallucinations. The appraisals an individual makes are influenced by prior beliefs and experiences and cognitive biases. The implications of the model are that changes in appraisals can be a powerful way of reducing distress in psychosis.Similarly, Morrison’s cognitive approach to understanding hallucinations and delusions (2001) argues that it is the misinterpretation of intrusive cognitive experiences that gives rise to distress and disability in psychosis. Morrison proposes that such misinterpretations are more likely to occur in individuals who have experienced traumatic events, and that if an intrusion has been misinterpreted once it is more likely to be misinterpreted if it occurs again. Morrison also proposes that counterproductive attempts to control unwanted experiences are also involved in the maintenance of psychosis.
Evidence-Based Psychological Approaches for Working with Psychosis
Cognitive Behavioral Therapy for Psychosis (CBTp)
CBTp was originally developed as an individual treatment to reduce the distress associated with the symptoms of psychosis and to improve functioning. It has since been adapted as a group treatment. Brabban, Byrne, Longden, and Morrison (2016) propose that key elements of CBTp are:
the collaborative development of a shared formulation to make sense of the origin and maintenance of psychotic symptoms and experiences;
normalization of psychotic experiences to decrease the stigma that is associated with psychosis;
acceptance of psychotic symptoms rather than attempting to alter their occurrence.
Individualized Resiliency Training (IRT)
IRT is an individual therapy designed for individuals experiencing a recent onset of psychosis (Penn et al, 2014). It draws upon a CBT background and consists of 14 modules covering topics including: education about psychosis; processing the psychotic episode; relapse prevention planning; developing resiliency; managing distress; coping with symptoms; improving social functioning; and addressing substance abuse.
References
Brabban, A., Byrne, R., Longden, E., & Morrison, A. P. (2017). The importance of human relationships, ethics and recovery-orientated values in the delivery of CBT for people with psychosis. Psychosis, 9(2), 157–166.
Garety, P. A., Kuipers, E., Fowler, D., Freeman, D., & Bebbington, P. E. (2001). A cognitive model of the positive symptoms of psychosis. Psychological Medicine, 31(2), 189–195.
Morrison, A. P. (2001). The interpretation of intrusions in psychosis: an integrative cognitive approach to hallucinations and delusions. Behaviouraland Cognitive Psychotherapy, 29(3), 257–276.
Penn, D. L., Meyer, P. S., & Gottlieb, J. D., with Cather, C., Gingerich, S., Mueser, K. T., & Saade, S. (2014). Individual Resiliency Training (IRT). Bethesda, MD: National Institute of Mental Health. Retrieved from: https://www.nasmhpd.org/sites/default/files/IRT%20Complete%20Manual.pdf
