Psychosis and Psychology

What role do psychological approaches play in psychosis?

Psychotic disorders have conventionally been considered within a bio-medical framework which perceives symptoms to be caused by a chemical imbalance in the brain that requires correction with medication. While anti-psychotic medication has been the mainstay of treatment for psychosis, most for whom it is prescribed find it difficult to tolerate and the majority will discontinue medication or take it erratically. Furthermore, there are many who experience only a marginal improvement with medication and continue to struggle with ongoing symptoms that can cause significant distress. The high risk of early mortality for those with psychotic disorders is also associated with the increase in weight gain caused by antipsychotic medication. While medication may still be a necessary component of treatment, there is a need for interventions that can assist in symptom management without such significant health risks and impact on quality of life.

Emerging research has also shown that psychotic symptoms exist on a continuum in the general population. For some these experiences may be mild and transitory causing little concern, and for others they may be more intense and severe. Furthermore, it has been found that psychotic symptoms are associated with suffering and times of acute emotional distress. Many people who may be experiencing other mental health problems such as anxiety and depression may also experience psychotic symptoms. These are examples of psychotic symptoms that may be experienced by people who are struggling with broader mental health difficulties who would not meet the clinical criteria for a diagnosis of a psychotic disorder. Consequently, most psychologists are likely to encounter clients with psychotic symptoms in their general practice.

There are a range of psychological interventions that have been developed for treatment of psychosis such as Cognitive Behaviour Therapy for Psychosis, Compassion Focussed Therapy for Psychosis, Acceptance and Commitment Therapy for Psychosis, Cognitive Behaviour Relating Therapy for Psychosis, Open Dialogue and psychodynamic approaches. It is also important for psychologists to have a general understanding of how psychotic experiences may arise and how to work effectively with those who are struggling with them. Psychological interventions play an important role in helping the person to understand and manage ongoing symptoms and to provide a space to reflect on their experience and make sense of it.