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What Keeps Psychosis Going?

The "What Keeps It Going?" series is a set of one-page diagrams explaining how common mental health conditions are maintained. Friendly and concise, they provide an easy way for clients to understand at a glance why their disorders persist, and how they might be interrupted. What Keeps Psychosis Going? is designed to help clients with psychosis understand more about their condition.

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A PDF of the resource, theoretical background, suggested therapist questions and prompts.

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Languages this resource is available in

  • Arabic
  • English (GB)
  • English (US)
  • Italian
  • Polish
  • Spanish (International)

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Introduction & Theoretical Background

It is surprisingly common to see or hear things that other people don’t, or to hold beliefs that other people might find unusual. If you keep hearing voices or seeing things that aren’t there (in a way which causes you distress, and prevents you from living your life as you want), you may be experiencing psychosis. Psychosis can cause a wide spectrum of experiences which include:

  • Hearing voices or sounds that no-one else can hear.
  • Seeing, feeling, smelling or tasting things that others can’t.
  • Holding unusual beliefs that others around you do not share.
  • Struggling to think or concentrate. (You may come across as muddled to others.)
  • Acting strangely or unpredictably. (Your behavior may seem unusual to others.)
  • Struggling to do daily activities such as working, studying, or caring for yourself.
  • Feeling disconnected. (You may not feel emotions as strongly as you used to.)

Research studies have shown that Cognitive Behavioral Therapy (CBT) is a helpful psychological therapy for psychosis. CBT therapists work a bit like firefighters: while the fire is burning they’re not so interested in what caused it, but are more focused on what is keeping it going, and what they can do to put it out. This is because if they can work out what keeps a problem going, they can treat the problem by ‘removing the fuel’ and interrupting this maintaining cycle.

In 2001, clinical psychologist Anthony Morrison published a model of psychosis which describes some of the ‘parts’ that keep psychosis going. The What Keeps Psychosis Going? information handout describes some of the key factors which act to maintain psychosis. It illustrates them in a vicious flower format in which each ‘petal’ represents a separate maintenance cycle. Helping clients to understand more about these processes is an essential part of cognitive therapy for psychosis. Therapists can use this handout as a focus for discussion, or as a template from which to formulate an idiosyncratic model of a client’s experiences.

Therapist Guidance

One interesting way of thinking about psychosis is to look at why, for some people, it does not get better by itself. This handout shows some of the most common reasons why some people keep experiencing symptoms of psychosis. I wonder if we could look at it together and think about whether it describes some of what is happening for you?

References And Further Reading

  • 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. 
  • 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. 
  • 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.
  • National Collaborating Centre for Mental Health (2014). Psychosis and schizophrenia in adults: treatment and management.