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Psychosis

Psychosis is a set of symptoms that includes hallucinations and delusions. Hallucinations are sensations that are not real, such as seeing or hearing things that aren’t there. The experience of hearing voices is one common type of hallucination, but hallucinations can be experienced in any of our senses (sight, sound, smell, touch, or taste). Delusions are strong beliefs that are not true. Common delusions include the belief that you are being followed or watched, or the belief that you have extraordinary abilities. Although traditional approaches to psychosis have been biomedical there is increasing recognition of the utility of psychological approaches. Psychological approaches to psychosis might attempt to gain an understanding of: how predisposing factors may have led to the onset of symptoms; how symptoms are understood; and how psychotic experiences are perpetuated. Read more
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Problem

Therapy tool

Language

Behavioral Experiment

Behavioral experiments are planned experiential activities to test the validity of a belief. They are one of the most powerful techniques available to ... https://www.psychologytools.com/resource/behavioral-experiment/

Worksheet

Behavioral Experiment (Portrait Format)

Behavioral experiments allow individuals to test the validity of their beliefs and assumptions. They are a core experiential technique for therapeutic ... https://www.psychologytools.com/resource/behavioral-experiment-portrait-format/

Worksheet

CBT Thought Record

The CBT Thought Record is an essential tool in cognitive behavioral therapy. Thought challenging records help people to evaluate their negative automa ... https://www.psychologytools.com/resource/cbt-thought-record/

Worksheet

Motivational Systems (Emotional Regulation Systems)

At the heart of Compassion Focused Therapy (CFT) is an evolutionary model of human motivational systems. Developed by Paul Gilbert it is a helpful len ... https://www.psychologytools.com/resource/motivational-systems-emotional-regulation-systems/

Information Handout

Therapy Blueprint

Since the publication of this version of the therapy blueprint we have also developed a more sophisticated version: Therapy Blueprint (Universal) A th ... https://www.psychologytools.com/resource/therapy-blueprint/

Exercise

Unhelpful Thinking Styles

Human thinking is subject to a number of characteristic biases. Cognitive restructuring is the process of helping individuals to overcome their biases ... https://www.psychologytools.com/resource/unhelpful-thinking-styles/

Information Handout

What Is Compassion Focused Therapy (CFT)?

Compassion focused therapy (CFT) was developed to work with issues of shame and self-criticism. The CFT model complements and expands the traditional ... https://www.psychologytools.com/resource/what-is-compassion-focused-therapy-cft/

Information Handout

Assessment

  • Beliefs About Voices Questionnaire – Revised (BAVQ-R) (Chadwick et al, 2000)  download  download

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

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:

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

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 Bulletin36(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. Psychosis9(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