The Benefit of Counseling as Treatment for Psychosis

There exists a great deal of evidence now, documenting the significant prevalence of psychotic disorders as well as mental health problems in the Australian community. In the study done by the "National Survey of Mental Health and Wellbeing" it has been reported that 4 to 7 people out of 1000 of the Australian adult population suffers from a psychotic disorder. Based on this statistics, it can be concluded that there is a significant number of people who are struggling with the severely debilitating symptoms and experiences associated with psychosis. The estimated number is over 100,000 Australian adults.  

Defining The Illness and Determining The Cause

Psychosis is a medical term used to describe mental health problems that impact a person’s thought process and cause inability to distinguish reality from imagination. For people suffering from psychosis, perception and interpretation of events has a tendency to be different to that of others around them.

It is usually defined as a set of symptoms, so psychosis is never given as a standalone diagnosis. There are two main mental diseases that are considered to be responsible for a number of psychological symptoms - Schizophrenia and Bipolar disorder. Both are long-term conditions that can be subdued using the right set of treatments. Other occurrences of psychosis include drug-induced psychosis, puerperal psychosis, personality disorders like BDP and many other causes including genetics, physical injury, severe lack of sleep, food deprivation and trauma.

Psychosis is not a diagnosable disorder in itself; it is actually triggered by other conditions and can usually be identified by two distinct symptoms - hallucinations and delusions.

Hallucinations are a visual, verbal or physical illusion that a person sees, hears or feels and mistakes for reality. The cause for hallucinations apart from mental illness can be misuse of substances such as illegal drugs. Psychosis can also often stimulate tastes, smells and sensations that aren’t really occurring.

Delusions are defined as false personal beliefs that are not subject to reason or contradictory evidence, while at the same time they can not be explained by a person's usual cultural and religious concepts. They are usually manifested as false beliefs of persecution or grandeur demonstrated by patient suffering from psychosis.

In addition to hallucinations and delusions, psychotic episodes can also include confusion of thought and lack of insight.

Treatment Options and Support

In recent years, there has been a shift in direction when it comes to treatment of psychosis. For many years it has been believed that antipsychotic drugs were enough when it comes to initial psychosis treatment. Although they do treat the symptoms, they have no effect on the underlying psychotic illnesses. That is why there is a need to implement counselling and cognitive behaviour therapy along with other non-chemical methods.

Most people that opt for medication need to stay on the regimen for at least a year, and continue the treatment if the symptoms recur. This can have some harmful consequences due to adverse effects of the medication. This is why The World Health Organization (WHO) has set evidence-based recommendations for antipsychotic medications used in psychotic disorder treatment.

Counseling and CBT  

In order to understand how Counseling and CBT help with the elimination of the cause of psychosis, it is important to understand the difference between the two approaches.

While counseling has shown great results with psychosis that has been brought on by a single traumatic event or change in patient's life, the cognitive behavioral therapy has had more effect in treatment of acute states, and behavioral changes.

Counseling as an approach is theory based, it draws from a number of theoretical approaches including those that are cognitive, affective, behavioral, and systemic. It is shaped in accordance to the patient's needs. For patients suffering from psychosis, counselling helps in determining the cause and in exploring the ways of resolving the core issues. It is especially important to implement this type of treatment immediately after  the first psychotic attack in order to help the patient deal with the fear and the life adjustment that need to be made in order to combat the illness causing the psychosis.

When using CBT to deal with psychosis, there are several basic techniques used by a number of leaders in the field of CBT.  Tarrier and Haddock note the recognition of coping strategies as a buffer against psychotic decompensation and the positive influence of  CBT on these coping strategies already being employed by people dealing with psychosis. They describe the following characteristics of coping training:

  1. Emphasis on the normal and general process of dealing with adversity (psychosis is an example of adversity)
  2. Use of overlearning, simulation, and role playing
  3. Addition of coping strategies together to progress toward in-vivo implementation
  4. Provision of a new response set to ongoing problems
  5. Coping skills that often begin with external verbalization, which then diminishes as the procedure becomes internalized
  6. Behavioral coping skills that are learned through graded practice or rehearsal.

Specific cognitive and behavioral techniques advocated by Tarrier and Haddock are attention switching, attention narrowing, increased activity levels, social engagement and disengagement, modification of self-statements, and internal dialogue.

Conclusions

From the first episode of psychosis, the patient needs to be actively involved in the recovery process. The support of the family and the environment is crucial for dealing with the causes of psychosis as well as the effects.

A combination of several approaches has so far given  the best results when it comes to helping patients suffering from psychosis. The medications help relieve the symptoms of psychosis and they have a crucial role in prevention of further episodes of illness.

The role of therapy comes in play after the medications. Both counseling and CBT have the goal of finding the cause of the psychotic episodes and the best way for eliminating it. Counseling has proven to be beneficial for patients that have suffered some kind of severe trauma, abuse or loss and have experienced psychotic episodes as a result of that. Helping these types of patients deal with the reasons of their psychosis and at the same time providing the support needed for overcoming their issues, can result in complete prevention of any further episodes.

The CBT on the other hand has had more effect with treating psychosis that resulted from more chronic psychological illnesses, like Schizophrenia and Bipolar disorder.

References

https://www.ccpa-accp.ca/wp-content/uploads/2015/05/NOE.What-is-Counselling-A-Search-for-a-Definition.pdf

http://www.camh.ca/en/hospital/health_information/a_z_mental_health_and_addiction_information/psychosis/first_episode_psychosis_information_guide/Pages/fep_treatment.aspx

http://www.counselling-directory.org.uk/psychosis.html

http://www.psychiatrictimes.com/special-reports/cognitive-behavioral-therapy-psychotic-disorders

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2811142/

http://ps.psychiatryonline.org/doi/full/10.1176/appi.ps.52.4.469

http://www.cci.health.wa.gov.au/docs/Psychosis%20Manual.pdf

http://www.ncbi.nlm.nih.gov/pubmed/16513854/