Psychosis
Arbitrary Inference
Information handouts
Behavioral Experiment
Worksheets
Behavioral Experiment (Portrait Format)
Worksheets
Catastrophizing
Information handouts
Disqualifying Others
Information handouts
Everyday 'Unusual' Experiences
Information handouts
Hindsight Bias
Information handouts
Jumping To Conclusions
Information handouts
Therapy Blueprint (Universal)
Worksheets
Understanding Psychosis
Guides
Unhelpful Thinking Styles
Information handouts
What Is Compassion Focused Therapy (CFT)?
Information handouts
What Keeps Psychosis Going?
Information handouts
Window Of Tolerance
Information handouts
Assessment
Intervention
Treatment guidelines
- NICE guidelines for psychosis and schizophrenia (February 2014) download
- Understanding psychosis and schizophrenia – British Psychological Society, Division of Clinical Psychology download archived copy
Treatment manuals
- A manualised treatment protocol to guide delivery of evidence-based cognitive therapy for people with distressing psychosis | Morrison | 2017 download archived copy
- Cognitive Behaviour Therapy for Psychotic Symptoms: a treatment manual | Laura Smith, Paula Nathan, Uta Juniper, Patrick Kingsep, Louella Lim | 2003 download archived copy
- Social Anxiety in Schizophrenia: A Cognitive Behavioural Group Therapy Programme | Patrick Kingsep, Paula Nathan | download archived copy
- Social Skills Training for Severe Mental Disorders | Patrick Kingsep, Paual Nathan download archived copy
Information
- What is CBT for psychosis anyway? | Dr Lucy Maddox link
- Key features of cognitive therapy for psychosis | Dr Ron Unger download archived copy
Self-Help
- Self-help guide to talking with voices: ideas for people who hear voices and want to try engaging in dialogue with them (2nd edition) | Rufus May, Elisabeth Svanholmer | 2019 download archived copy
Information Handouts
- What is psychosis? download archived copy
- Causes of psychosis download archived copy
- Drugs and alcohol download archived copy
- Early intervention download archived copy
- Goal setting download archived copy
- Lifestyles download archived copy
- Medication download archived copy
- Persistent symptoms download archived copy
- Problem solving download archived copy
- Psychosocial treatments download archived copy
- Relapse prevention download archived copy
- Relapse prevention planning download archived copy
- Social support download archived copy
- Stress management 1 download archived copy
- Stress management 2 download archived copy
The PsychosisSucks website (sadly now defunct) had a number of free worksheets available for download in multiple languages. The archive.org page is still operational here:
- What is psychosis brochure archived copy
- Drugs and alcohol archived copy
- Early intervention archived copy
- Gaol setting archived copy archived copy
- Problem solving archived copy
- Relapse prevention planning archived copy
Understanding Voices (UV) is produced by Hearing the voice (Durham University) in collaboration with voice-hearers, their families, and other professionals.
- What is hearing voices? download archived copy
- A spectrum of experience download archived copy
- Why do people hear voices? download archived copy
- Coping with voices download archived copy
- Talking about voices: suggestions for voice-hearers download archived copy
- Talking about voices: suggestions for supporters download archived copy
- Talking therapies for voices download archived copy
Exercises
- Self-help guide to talking with voices: ideas for people who hear voices and want to try engaging in dialogue with them – 2nd version | Rufus May, Elisabeth Svanholmer | 2019 download archived copy
- Self-help guide to dialoguing with voices – 1st version | Rufus May, Elisabeth Svanholmer | 2017 download archived copy
Worksheets
- What is psychosis? download archived copy
- What causes psychosis? download archived copy
- Treatment for psychosis download archived copy
- Telling others download archived copy
- Stress management download archived copy
- Stigma download archived copy
- Social circles download archived copy
- Problem solving download archived copy
- Preventing relapse download archived copy
- Preventing weight gain download archived copy
- Phases of psychosis download archived copy
- Persistent symptoms download archived copy
- Persistent symptoms ratings download archived copy
- Moving forward download archived copy
- Goal setting download archived copy
- Enjoyable activities download archived copy
- Drugs and alcohol download archived copy
- Checklist for good sleep download archived copy
Presentations
- Assessment in early psychosis | Sean Halpin
downloadarchived copy - CBT for psychosis in practice | David Kingdon
downloadarchived copy - The Garety et al model of CBT for psychosis | Dr Anna Rowe download archived copy
Video
- Compassion for voices: a tale of courage and hope | Charlie Heriot-Maitland, Kate Anderson youtube
- CBTp – Assessment of voice hearing and developing a maintenance formulation | Psychosis Research Unit youtube
- CBTp – Assessment of thought broadcast and developing a maintenance formulation | Psychosis Research Unit youtube
- CBTp – Advantages and disadvantages of paranoia | Psychosis Research Unit youtube
- CBTp – Identifying goals using a Q sort task | Psychosis Research Unit youtube
- CBTp – Normalising voices | Psychosis Research Unit youtube
- CBTp – Maintenance formulation of threatening voices | Psychosis Research Unit youtube
- CBTp – Setting up a behavioral experiment | Psychosis Research Unit youtube
- CBTp – In-session behavioral experiment | Psychosis Research Unit youtube
- CBTp – Planning a survey (appearance) | Psychosis Research Unit youtube
- CBTp – Reviewing a survey for appearance | Psychosis Research Unit youtube
- CBTp – Reducing social isolation | Psychosis Research Unit youtube
- CBTp – Discussing sleep hygiene | Psychosis Research Unit youtube
- CBTp – Utilising attentional strategies | Psychosis Research Unit youtube
- CBTp – Survey planning: intrusive thoughts | Psychosis Research Unit youtube
- CBTp – Reviewing a survey for intrusive thoughts | Psychosis Research Unit youtube
- CBTp – Using evidential analysis with voice hearing | Psychosis Research Unit youtube
- CBTp – Exploring alternative explanations of voices | Psychosis Research Unit youtube
- CBTp – Using worry postponement in response to voices | Psychosis Research Unit youtube
- CBTp – Formulation of voice hearing and persecutory beliefs | Psychosis Research Unit youtube
- CBTp – Developing a longitudinal formulation and planning a thought broadcast survey | Psychosis Research Unit youtube
- CBTp – Designing a behavioral experiment for thought broadcast | Psychosis Research Unit youtube
- CBTp – Schema change (using positive data logs) | Psychosis Research Unit youtube
- CBTp – Imagery modification | Psychosis Research Unit youtube
- CBTp – Developing a longitudinal formulation | Psychosis Research Unit youtube
- CBTp – Relapse prevention | Psychosis Research Unit youtube
- Engaging with Voices | #1 Introducing ourselves, the videos, and our values youtube
- Engaging with Voices | #2 Things to consider when you want to engage with voices youtube
- Engaging with Voices | #3 Thinking about how to change the power balance youtube
- Engaging with Voices | #4 Thinking about the function a voice might have youtube
- Engaging with Voices | #5 How to work with non-verbal voices or voices that may not want to engage youtube
- Engaging with Voices | #6 Mapping out voices in space youtube
- Engaging with Voices | #7 Mapping out voices on paper youtube
- Engaging with Voices | #8 Nurturing a compassionate self and encountering a voice youtube
- Engaging with Voices | #9 Thinking about whether to talk directly or indirectly with a voice youtube
- Engaging with Voices | #10 Talking to a voice from compassionate self youtube
- Engaging with Voices | #11 Reflective practice with voices youtube
- Engaging with Voices | #12 Talking to a voice that sounds like an abusive person from the past youtube
- Engaging with Voices | #13 Writing with voices youtube
- Engaging with Voices | #14 Talking with a voice can help understand its intentions youtube
- Engaging with Voices | #15 Using the body youtube
Recommended Reading
- Morrison, A. P. (2000). The interpretation of intrusions in psychosis: an integrative cognitive approach to hallucinations and delusions. Behavioural and Cognitive Psychotherapy, 29, 257-276 download
- Morrison, A. P., & Barratt, S. (2009). What are the components of CBT for psychosis? A Delphi study. Schizophrenia Bulletin, 36(1), 136-142. download archived copy
- Morrison, A. P. (2017). A manualised treatment protocol to guide delivery of evidence-based cognitive therapy for people with distressing psychosis: learning from clinical trials. Psychosis, 9(3), 271-281. download archived copy
What Is Psychosis?
Signs and Symptoms of Psychosis
Four main symptoms are associated with a psychotic episode:
- hallucinations
- delusions
- confused and disturbed thoughts
- lack of insight and self-awareness
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