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

All resources

See popular resources

Recent releases

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

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 ~~download~~ archived copy
CBT for psychosis in practice | David Kingdon ~~download~~ archived 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

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