Understanding Psychosis

Experiencing psychosis for the first time can be both terrifying and disorienting, as it may feel as though reality is slipping away, leaving one uncertain of what is real. Psychosis is a mental health condition characterized by difficulties in distinguishing between reality and imagination, often resulting in hallucinations, delusions, and disorganized thinking. The encouraging news is that psychosis is treatable, and there is hope. Through interventions such as Cognitive Behavioral Therapy (CBT) and medication, many individuals can recover and lead fulfilling lives. This overview only scratches the surface—there are numerous ways to understand and effectively manage psychosis.

What is Psychosis?

Psychosis is not a disease in itself; rather, it is a symptom that can manifest as part of various mental health conditions, including schizophrenia, bipolar disorder, and severe depression. It typically first presents in late adolescence or early adulthood, though it can occur at any age.

When an individual is experiencing psychosis, they may experience a variety of symptoms, including:

Hallucinations: Perceiving things that are not actually present. Hallucinations can affect any of the senses:

• Auditory hallucinations: Hearing voices or sounds that others cannot hear. This is the most common type of hallucination.

• Visual hallucinations: Seeing things that are not there, such as people, objects, or patterns.

• Tactile hallucinations: Feeling physical sensations, such as bugs crawling on the skin, that have no external cause.

• Olfactory hallucinations: Smelling odors that have no source.

• Gustatory hallucinations: Tasting things that are not present, often unpleasant or metallic tastes.

  
  

Delusions: Strong beliefs that are not based in reality. Common types of delusions include:

• Grandiose delusions: Believing one has exceptional abilities, wealth, fame, or power.

• Persecutory delusions: Believing that others are out to harm or conspire against them.

• Paranoid delusions: Feeling an intense and irrational suspicion or mistrust of others.

• Delusions of reference: Believing that random events or unrelated occurrences have a personal significance.

  
  

Disorganized Thinking: This may manifest as difficulty organizing thoughts, making communication or following conversations challenging. The person’s speech may become tangential or incoherent.

In addition to these positive symptoms (hallucinations and delusions), there are also negative symptoms of psychosis, which reflect a reduction or loss of normal function, including:

• Blunted affect: A lack of emotional expression, where the individual’s face appears flat or unresponsive.

• Avolition: A lack of motivation to start or complete tasks, even simple daily activities.

• Anhedonia: Inability to experience pleasure from activities that were once enjoyable.

• Social withdrawal: Isolating oneself from social interactions and relationships.

These negative signs can be just as debilitating as the more obvious symptoms of hallucinations and delusions, contributing to the overall impact of psychosis on the individual’s life.

Understanding the variety of symptoms associated with psychosis is crucial for recognizing the condition and seeking appropriate treatment.

For the person experiencing these symptoms, they feel very real and can be profoundly distressing. However, understanding what is occurring is the first step toward seeking help.

The Importance of Medical and Psychiatric Attention

One of the most important things to understand about psychosis is that it often requires prompt medical and psychiatric treatment. Antipsychotic medications are usually prescribed to help reduce or eliminate symptoms. These medications work by balancing the chemicals in the brain that affect how we think and perceive the world.

Early intervention is critical. The sooner someone experiencing psychosis receives medical attention, the better their chances of recovery. Delaying treatment can lead to more severe symptoms and a longer recovery time. Seeking help as soon as possible not only improves the outcome but also helps prevent further complications.

A Background on Cognitive Behavioral Therapy (CBT)

Cognitive Behavioral Therapy, or CBT, is one of the most effective forms of therapy for managing psychosis. It’s a practical, hands-on approach that helps people understand how their thoughts, feelings, and behaviors are connected.

CBT was developed in the 1960s by Aaron Beck, a psychiatrist who noticed that his patients often had patterns of negative thinking that contributed to their mental health problems. He believed that by helping people change these thinking patterns, they could also change how they feel and behave.

For someone experiencing psychosis, CBT can be particularly helpful. It doesn’t dismiss their experiences but instead works with them to understand and challenge the delusions and hallucinations they might be having. Over time, CBT can help people develop healthier thinking patterns, reduce distress, and improve their quality of life.

Practical Exercises for Managing Psychosis

Here are a few CBT-based exercises that anyone can try, whether they’re dealing with psychosis themselves or supporting someone who is:

Reality Checking

o   What it is: This exercise helps you question whether a delusion or hallucination is real.

o   How to do it: When you have a thought that feels real but might not be, ask yourself:

• What evidence do I have that this is true?

• Could there be another explanation?

• What would I say to a friend who had this thought?

o   Why it helps: This technique encourages you to think critically about your experiences and can help you separate reality from the delusion.

Grounding Techniques

o   What it is: Grounding exercises help you stay connected to the present moment when you’re experiencing hallucinations.

o   How to do it: Focus on your senses. For example, look around and name five things you can see, four things you can touch, three things you can hear, two things you can smell, and one thing you can taste.

o   Why it helps: This exercise shifts your attention away from the hallucination and brings you back to the real world.

Journaling Your Thoughts

o   What it is: Writing down your thoughts can help you track and analyze them over time.

o   How to do it: Whenever you experience a delusion or hallucination, write it down. Note what was happening before, during, and after the experience. Later, review these notes to see if any patterns emerge.

o   Why it helps: Journaling helps you become more aware of your thoughts and can be a valuable tool for discussing your experiences with a therapist or doctor.

Mindfulness Meditation

o   What it is: Mindfulness involves paying attention to the present moment without judgment.

o   How to do it: Sit quietly and focus on your breathing. If a hallucination occurs, acknowledge it without engaging with it. Instead, gently bring your focus back to your breath.

o   Why it helps: Mindfulness can reduce the emotional impact of hallucinations and help you stay calm during an episode.

Understanding That Psychosis Can Be Part of a Larger Condition

It’s important to know that psychosis doesn’t exist in a vacuum. It’s often part of a larger mental health condition, like schizophrenia or bipolar disorder. But this doesn’t mean it’s hopeless. In fact, understanding the broader context of psychosis can help you or your loved one get the right diagnosis and treatment.

With proper care—medication, therapy, and support from loved ones—many people with psychosis can recover and lead fulfilling lives. The journey might be challenging, but it’s important to hold onto hope.

Mental Health Conditions Most Commonly Associated with Psychosis

Schizophrenia: This chronic and severe mental health disorder often includes psychosis as a core feature. Schizophrenia is typically marked by episodes of psychosis, delusions, hallucinations, disorganized thinking, and impaired functioning.

NOTE: A key phase to understand is the prodromal phase of schizophrenia, which precedes the full onset of psychosis. During the prodromal phase, subtle changes in mood, thinking, and behavior may emerge. People may begin withdrawing socially, experiencing unusual thoughts, or struggling with concentration, but full-blown psychosis has not yet occurred. Identifying the prodromal phase early can help in seeking treatment before the psychotic episode develops, leading to better long-term outcomes.

Bipolar Disorder: Psychosis can occur during extreme mood episodes in bipolar disorder, typically during manic or depressive phases. In manic psychosis, a person may experience grandiose delusions or hallucinations, while depressive psychosis may involve feelings of paranoia or worthlessness accompanied by hallucinations.

Major Depressive Disorder with Psychotic Features: Severe depression can sometimes lead to psychosis, especially when the individual experiences delusions or hallucinations related to their feelings of worthlessness or guilt. This is often referred to as "psychotic depression."

Substance-Induced Psychosis: The use of drugs like amphetamines, hallucinogens, or alcohol can trigger psychosis. Withdrawal from certain substances can also lead to hallucinations and delusions.

Medical Conditions: Psychosis can sometimes result from underlying medical issues, such as brain injuries, neurological disorders, or infections like encephalitis. It's important to rule out medical causes when evaluating psychotic symptoms.

By understanding that psychosis can be part of these broader conditions, it becomes easier to navigate the treatment options and long-term management. Early intervention, especially in the prodromal phase of schizophrenia, can play a key role in improving outcomes and reducing the severity of future episodes.

There is Hope

If you or someone you care about is experiencing psychosis, remember that help is available, and recovery is possible. It’s okay to reach out for support, whether from a doctor, therapist, or loved one. The road to recovery often involves a combination of medication and therapy, and while it might take time, many people do find relief from their symptoms.

Psychosis is a serious condition, but it doesn’t have to define your life. With the right treatment and support, you can manage your symptoms and move forward. There is always hope, and you don’t have to go through this alone.

     Eugene Roginsky, a licensed psychotherapist with over 28 years of experience, serves clients in Lake County, Illinois. As the founder of Bridge2Horizon Psychotherapy and Counseling Services, he works with individuals facing a wide range of mental health conditions. In addition to his clinical practice, Eugene is a speaker and clinical educator, sharing his expertise through lectures and workshops. Learn more at www.Bridge2Horizon.com.