Understanding Psychosis

It is surprisingly common to see or hear things that other people don’t, or to hold beliefs that other people might find unusual. Up to 1 in 10 people say that they have heard voices, or seen things that aren’t there at least once in their lifetime (McGrath et al, 2015; Bevan et al, 2011). If you keep having experiences like this in a way which causes you distress, and prevents you from living your life as you want, you may be experiencing psychosis.

The Understanding Psychosis guide is designed to help clients experiencing symptoms of psychosis understand more about the condition. As well as a clear description of symptoms and treatments, the guide explores key maintenance factors for psychosis including:

• Interpreting triggers in unusual and threatening ways.
• Your past, your beliefs, and assumptions.
• Using strategies to try to control your thoughts.
• Safety behaviors and avoidance.

• Scaffold knowledge. The guides are perfect during early stages of therapy to help your clients understand how their symptoms fit together and make sense.
• Reassure and encourage optimism. Many clients find it hugely reassuring to know there is a name for what they are experiencing, and that there are evidence-based psychological models and treatments specifically designed to help.
• De-mystify the therapy process. To increase your client’s knowledge of the therapy process and the ingredients that it is likely to involve. If you can help your clients to understand why an intervention is important (think exposure!) it can help encourage them to engage.
• Signposting. If you’re just seeing a client briefly for assessment, or you have a curious client who wants to know more, these resources can be a helpful part of guiding them to the right service.
• Waiting time not wasted time. When you’ve assessed someone but their treatment can’t begin right away, psychoeducation can help them learn about how therapy can help while they’re waiting.

• Case examples to help your clients relate to the condition, and to normalize their experiences.
• Jargon-free descriptions of symptoms, and descriptions of how they might affect your thoughts, feelings, and actions.
• A symptom questionnaire for screening assessment.
• An accessible cognitive-behavioral account of what keeps the problem going, or what stops it from getting better.
• A description of evidence-based treatments for that condition, including an overview of the ‘ingredients’ of a good cognitive behavioral approach.

• McGrath, J. J., Saha, S., Al-Hamzawi, A., Alonso, J., Bromet, E. J., Bruffaerts, R., ... & Kessler, R. C. (2015). Psychotic experiences in the general population: a cross-national analysis based on 31 261 respondents from 18 countries. JAMA psychiatry, 72(7), 697-705. 
• Beavan, V., Read, J., & Cartwright, C. (2011). The prevalence of voice-hearers in the general population: a literature review. Journal of Mental Health, 20(3), 281-292. 
• National Collaborating Centre for Mental Health (2014). Psychosis and schizophrenia in adults: treatment and management.
• “Seeing, hearing or sensing someone who has died” (nd.). Cruse Bereavement Care. https://www.cruse.org.uk/get-help/about-grief/seeing-hearing-or-sensing-someone-who-has-died
• British Psychological Society. Division of Clinical Psychology. (2017). Understanding psychosis and schizophrenia. British Psychological Society.
• Pitt, L., Kilbride, M., Nothard, S., Welford, M., & Morrison, A. P. (2007). Researching recovery from psychosis: a user-led project. Psychiatric Bulletin, 31(2), 55-60. 
• Varese, F., Smeets, F., Drukker, M., Lieverse, R., Lataster, T., Viechtbauer, W., ... & Bentall, R. P. (2012). Childhood adversities increase the risk of psychosis: a meta-analysis of patient-control, prospective-and cross-sectional cohort studies. Schizophrenia bulletin, 38(4), 661-671.. 
• Myin-Germeys, I., Krabbendam, L., Delespaul, P. A. E. G., & Van Os, J. (2003). Do life events have their effect on psychosis by influencing the emotional reactivity to daily life stress? Psychological Medicine, 33(2), 327-333.
• Di Forti, M., Quattrone, D., Freeman, T. P., Tripoli, G., Gayer-Anderson, C., Quigley, H., ... & van der Ven, E. (2019). The contribution of cannabis use to variation in the incidence of psychotic disorder across Europe (EU-GEI): a multicentre case-control study. The Lancet Psychiatry, 6(5), 427-436. 
• Fett, A. K. J., Lemmers-Jansen, I. L., & Krabbendam, L. (2019). Psychosis and urbanicity: a review of the recent literature from epidemiology to neurourbanism. Current opinion in psychiatry, 32(3), 232. 
• Morrison, A. P. (2001). The interpretation of intrusions in psychosis: an integrative cognitive approach to hallucinations and delusions. Behavioural and Cognitive Psychotherapy, 29(3), 257-276.
• 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.