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Treatments for Psychotic Symptoms

Psychosis includes a range of symptoms but typically involves one of these two major experiences:

Hallucinations are seeing, hearing or feeling things that aren’t there, such as the following:

  • Hearing voices (auditory hallucinations)

  • Strange sensations or unexplainable feelings

  • Seeing glimpses of objects or people that are not there or distortions

Delusions are strong beliefs that are not consistent with the person’s culture, are unlikely to be true and may seem irrational to others, such as the following:

  • Believing external forces are controlling thoughts, feelings and behaviors

  • Believing that trivial remarks, events or objects have personal meaning or significance

  • Thinking you have special powers, are on a special mission or even that you are God.

We are still learning about how and why psychosis develops, but several factors, including genetics, trauma, substance abuse, physical illness and injury, and mental illness can all contribute.

 

Treatment

The Lieber Clinic offers group-based treatments in which patients can learn skills to manage delusions and hallucinations, two common symptoms of psychosis. The objective of the treatment is to teach patients how to perform reality-testing, to decrease relative distress, and to reduce the degree to which psychotic thinking and phenomena interfere with everyday functioning. The two treatments currently being offered are CBT for psychosis and DBT for psychosis.


CBT for Psychosis
The therapeutic techniques used for patients with psychosis are based on the general principles of CBT. Links are established between thoughts, feelings, and actions in a collaborative and accepting atmosphere.  We currently offer an 8-10 session CBT-based group, as well as limited individual CBTp therapy. This treatment focuses on understanding and modifying the factors that lead to emotional distress and behavioral disturbance. The goals of the group are: Increased understanding of and insight into psychotic experiences improved coping with residual psychotic symptoms, reduction in distress associated with auditory hallucinations, reduction of degree of conviction and preoccupation with delusional beliefs, and maintenance of gains and prevention of relapse. Individual CBT for psychosis is also available.


DBT for Psychosis 
At the Lieber Clinic we have adapted Dialectical Behavioral Therapy, an evidence based treatment for overwhelming emotions and interpersonal effectiveness, for individuals who experience symptoms of psychosis.  In  DBT groups individuals learn to practice mindfulness meditation, distress tolerance  skills, emotion regulation skills and interpersonal effectiveness skills.  Because psychotic symptoms are usually associated with a great deal of anxiety we use DBT  strategies to manage those symptoms as well as to improve the ability to notice the onset of psychotic symptoms so that individuals can utilize supports and increase self-care skills as soon as possible.  Because cognitive deficits often accompany psychosis, this group thoroughly reviews each set of skills and reviews the practical applications of the skills with each patient.