Sometimes the distress associated with psychosis can be less about hallucinations or delusions and more about loneliness, fear and loss of self. At the risk of sounding overly optimistic - something us care professionals are famous for - I'd like to share five steps that can help you help your loved one overcome fear and isolation.
1. Maintain trust and involvement
It can be easy to wonder if your ongoing support and empathy is making a difference. Yet while it can go unnoticed, trust is the foundation for helping your loved one.
Being involved in their treatment is also important. While family members are increasingly included in treatments such as family therapy and open dialogue – evidence suggests this helps prevent relapse – it doesn't need to be a formal intervention for you to play a role. Talk to your loved one about their treatment and help them explore answers to their day-to-day challenges. If they agree, you can maintain communication with their treating team or attend appointments.
Being trusted and involved also means you can encourage your loved one to do other things to stay well. For example, maintaining a healthy lifestyle and making use of non-clinical services such as support groups and peer mentor programs.
2. Challenge beliefs
Cognitive behavioural therapy (CBT) is widely used in treating depression and anxiety, but did you know that it’s also effective in treating psychosis? CBT works by exploring the beliefs which underpin our reactions to events. You don't need to be a psychologist to put some of this into practice.
In the case of an auditory hallucination, the event might be a voice that tells your loved one they are worthless or can't do anything right. Their reaction might be to lose confidence and become withdrawn and isolated. But in between the voice and the reaction is a belief. In this case, a belief that the voice is right. Our aim is to challenge that belief and over time, to change it. While it may not make the voice go away, it can change the way your loved one responds and help restore their confidence and sociability.
3. Normalise psychosis
Like many beliefs and experiences, symptoms of psychosis can be viewed in the context of everyday events. Have you ever heard someone laughing and for a brief second suspected they were laughing at you? At the extreme end of the spectrum this can become a paranoid delusion. As this article explains, not everyone who hears voices is experiencing psychosis. Recognising that symptoms of psychosis can be part of every day experience can help your loved one to feel less alone in their experience. Perhaps you have an event of your own that you can share.
4. Identify triggers and early warning signs
It helps knowing when the symptoms of psychosis are approaching, so you’re ready to challenge them. Common triggers include stress, lack of sleep and drug and alcohol use. Others are less obvious, such as places, people or situations.
Talk to your loved one about their triggers and identify the best way to manage them. It could be avoiding them altogether or finding a way to make them less threatening.
Early warning signs are also important. Knowing what the warning signs are means your loved one can access additional support before reaching crisis point.
5. Develop a relapse plan
Often when everything is going well the last thing we want to talk about is what to do if things take a turn. Encourage your loved one to consider their preferred action plan if symptoms escalate. Templates like this one by a American organisation are available online.
There are a number of therapeutic and medicinal approaches used to manage symptoms of psychosis, and these steps are just an insight into the many options available. Living with psychosis can be a life long challenge and everyone is different in the techniques and supports they find helpful. If you’d like to find out more about available services or to discuss your own situation, contact the SANE Help Centre on 1800 18 7263.