Living with Psychosis

What is Psychosis?

“Psychosis is when people perceive or interpret events differently from other people. This could include experiencing hallucinations, delusions or flight of ideas”. (Mind)

This is a good working definition provided by the mental health charity Mind. Let’s explore it in a little more detail.

What are hallucinations?

Hallucinations are sensations that appear real to you, but are actually created by your mind. They can affect all of our five senses:

• Visual hallucinations – These involve seeing things that aren’t there. For example, you might see people or objects that no one else can see.

• Olfactory hallucinations – These relate to your sense of smell. You might smell a bad odour, which no one else perceives, or even a pleasant fragrance, like the smell of perfume.

• Gustatory hallucinations – These concern your sense of taste. Often people who have gustatory hallucinations experience strange or unpleasant tastes.

• Auditory hallucinations – These involve hearing things that no one else can. Often these are voices, but they can be any sort of sounds, such as music or the noise of road traffic.

• Tactile hallucinations – These relate to our sense of touch. For example, you may feel someone touching you when there is no one physically present.

What are flight of ideas?

Flight of ideas is when your thoughts race from idea to idea, making connections which are irrational and cannot be understood by others.

What causes Psychosis?

• Scientists often cannot explain why a person has a particular hallucination, delusion or irrational change of ideas. However, here are some ideas about things that may make psychosis more likely:

• Physical illness or injury – You may hallucinate if you have a head injury, a high fever, or lead or mercury poisoning. People with conditions such as Parkinson’s disease or Alzheimer’s disease may hallucinate or experience delusions.

• Drugs – Drugs such as cannabis and LSD can make you hallucinate. Some prescribed drugs can have a similar side effect, as can coming off psychiatric drugs.

• Lack of sleep – People who have a severe lack of sleep can hallucinate as a consequence.

• Hunger – As with sleep, if you aren’t eating enough, or if you are very hungry, you may hallucinate.

• Bereavement – You may perceive the presence of someone close to you who you have recently lost, when no one else can. And grieving can cause hallucinations.

• Abuse or trauma – If you have experienced abuse or a very traumatic event, you are more likely to experience psychosis.

• Spiritual experiences – Some people experience voices or visions as part of a spiritual experience. This may be a positive experience for you – it may make you feel special or help you make sense of your life. It could be a negative experience – for example, you may feel that you are possessed by an evil spirit.

• Family inheritance – You are more likely to experience psychosis if a blood relative has also experienced it.

Diagnoses

If you experience psychosis, you may be given one of these diagnoses:

• Severe depression

• Schizophrenia or schizophreniform disorder

• Bipolar disorder

• PTSD (Post Traumatic Stress Disorder)

• Post-partum psychosis

• Delusional or paranoid disorder

• Brief psychotic disorder (you may be given this diagnosis if you experience psychosis for less than a month and your doctor doesn’t think that another diagnosis describes your symptoms better)

Coping Exercises

You can find a variety of exercises that help you cope with psychosis, both in books and online. Here are a little selection of exercises that you can use throughout the day:

A thought is just a thought

Think of thoughts as guesses or just words, not facts. Thoughts can be noticed (catch it) and let pass without judgement. Images, such as thoughts coming and going like gentle waves on the ocean, can be helpful.

Awareness exercise for distressing thoughts or voices

Notice or “catch” thoughts, emotions, or bodily sensations. Now label the thought, emotion, or experience. For example, “I just had a sad thought”. “I just had an angry thought about the voices”. Just notice the thought or sensation and gently let it go. Notice that thoughts, experiences, or sensations don’t last – they come and go.

Belly breathing

“Belly” beathing – also known as diaphragmatic or “deep” breathing – is a helpful strategy you can use throughout the day. Take a deep belly breath. Inhale to the count of four, and then exhale for a longer time than your inhale – perhaps to the count of five. Pause after your exhale and then repeat. If this is stressful at first, focus on your slowed breathing, doing a longer exhale than your inhale. A calming image or word such as “peace” or “relax” can be helpful to use.

Coping affirmations

Think of healthy and helpful statements about yourself, your accomplishments, your strengths, and your qualities. Write the coping statements or affirmations on a coping card that you can look at whenever you want. (You can put the coping card in your wallet or purse or on a wall). Practice saying the affirmations. You can make it like a new habit over time. These statements can shift unhealthy or unhelpful beliefs.

Coping cards

Use coping cards (index cards or business size cards) to record your affirmations, things learned. For example, “I don’t need to pay attention to my voices”. “I can get on with my day and my goals”. “Gently turn down the volume”. “Think of the voices as background noise”. Coaching statements may also be helpful: “You can get through this”, “This will pass”.

Grounding exercises

1. Notice yourself in this moment. For example, notice the feel of your bottom and back against the chair. Notice the feel of your feet firmly placed on the ground. Notice your hands and arms on the armrest of your chair or feel your arms and hands against your legs. Gently place your hand on your chest over your heart area.

2. You may also use stones or other objects to ground you in the present moment. Notice the stones with as many senses as possible.

3. You may also choose to use food items or those with a pleasant odour to engage your senses.

Leaves on a stream

Imagine placing thoughts (or voices) on leaves that are gently flowing down a stream and floating out of sight. Other images such as clouds in the sky or a train going by can also let you distance yourself from thoughts or voices.

Progressive muscle relaxation

Tighten and release muscle groups in your body. Start with your feet, then calves, thighs, bottom, stomach, chest, arms, hands, neck, and face. Tensing and relaxing muscles helps you let go of the tension you carry in your body

Thoughts are not facts

This exercise can be done to highlight that thoughts are not facts and to gain distance and perspective around thoughts. Say out loud, “My chair will break in ten seconds”, and then notice what happens. Consider what this exercise tells you about your thoughts and how you relate to, or think about, your thoughts. Another thought to check out is “I cannot touch the chair/table/wall”. Say the thought out loud as you put your palm flat on the chair/table/wall. Repeat these thoughts as you touch the chair, table, or wall.

Try and keep an open mind, give the coping exercises above a try. Some will probably work better for you than others, it just depends on the individual. Experts say that when practicing coping exercises, it sometimes takes you a while to feel the benefits fully. So I would urge you not to give in and persevere with any coping exercise you think may be helpful.

Keeping a Voice Diary

Auditory hallucinations are among the most common type of hallucination. And keeping a voice diary can be helpful.

This involves six easy steps (detailed below) for every episode/occurrence.

By learning more about your voices, you can empower yourself and spend more of your time and energy working towards your goals.

Try to see what you can learn about your voices. Do you notice any patterns? When do you tend to hear your voices? What do your voices tend to say? You can use this same model for other types of hallucination too.

1. Situation/Event/Activity – First, try writing down the situation or event that was happening when you heard the voice.

2. Voice – Try to write down what the voice said.

3. Rate distress of voice (0-100) – How distressing was it on a scale of 0 to 100?

4. Emotion (s) – What emotions did you feel when you heard the voices? For example, fear, anger, sadness, shame, or happiness.

5. Coping strategies – List the coping strategies you used.

6. Outcome distress rate (0-100) – Rate your distress after you used your coping strategies.

Following this plan should help you focus on your recovery.

Triggers and Early Warning Signs

Even if we do all we can to stay well, we can have stresses or setbacks sometimes.

Triggers can be things like an illness, a change at work, an anniversary, and so on, which cause us to relapse. Know your triggers and have solutions to them, should they arise.

In addition to triggers, there can be early warning signs – signals that we may be starting to become unwell. Here are some common early warning signs:

• Poor sleep

• Poor eating habits

• Withdrawing from others

• Feeling more anxious

• Feeling more fearful

• Feeling more down

• Thinking and feeling like you can’t cope

• Feeling helpless

• Feeling hopeless

• Reduced concentration

• Less interest in activities

• Increased irritability

• Experiences like being more sensitive or suspicious in social situations; hearing voices or more distressing voices; experiencing changes in thinking and changes in what you notice, such as what you see, hear, feel, smell, or taste

With early warning signs, it’s important:

1. To know that setbacks may happen

2. To notice your early warning signs

3. To have a plan to deal with those early warning signs (in particular, the coping exercises that work for you)

The journey of life naturally involves some bumps along the way, but if you have tools to cope with the bumps you shall have a better quality of life and future.

Finally, think of ways you can treat and reward yourself for all of your efforts at staying well and working towards your goals. Remember, it can be hard to do self-care on a regular basis – be kind and compassionate to yourself and celebrate your efforts!