Common Treatment Approaches For Psychosis

Psychosis is considered to be a mental health symptom rather than its own, standalone diagnosis. It can affect a person's sense of connection to reality as well as certain cognitive and interpersonal abilities. A person might have a single psychotic episode in their lifetime, or they could have a condition that will put them at risk for recurring episodes if proper treatment is not received; it depends on the cause. In either case, seeking professional treatment for psychosis warning signs or symptoms is typically paramount for the individual’s safety, well-being, and mental health. Read on for a brief overview of what psychosis is along with the three key treatment approaches for addressing it.

What is psychosis?

The symptom of psychosis is often associated with mental health disorders such as schizophrenia, schizoaffective disorder, and even major depressive disorder, bipolar disorder, and postpartum disorder in some cases. Some medical conditions—such as dementia, HIV/AIDS, lupus, and Huntington’s disease—may also cause psychosis. Or, it can be a result of an intense life stressor or trauma like the sudden loss of a loved one, or a side effect of certain prescription medications or substance use. Certain individuals may be at higher risk of experiencing psychosis because of factors like brain chemistry and structure, genetics, and a history of trauma.

The SAMHSA National Helpline for support with substance misuse is available 24/7 and can be reached by calling (800) 662-4357.

Psychosis is associated with three main symptoms:

• Hallucinations, or sensory perceptions that aren’t caused by tangible stimuli, such as hearing sounds or feeling sensations that others can’t and that aren’t linked to identifiable physical causes
• Delusions, or belief systems that are disconnected from the experience of reality, such as believing that one has a superpower or that strangers are conspiring against them
• Disorganized or disturbed thinking, such as thoughts that jump around without any clear connection to each other, which can result in confused speech and social dysfunction

A person can experience psychosis for a brief period of time, as with postpartum psychosis, or it can have the potential to recur as part of a lifelong condition, as with schizophrenia.

The stress-vulnerability model and psychosis

The stress-vulnerability model is often employed by mental health professionals when developing treatment plans for individuals with certain mental health disorders, including those that can cause psychotic symptoms. This model posits that three main factors contribute to the development of any serious mental illness. These factors are: 

1. Biological vulnerability
2. Stress
3. Protective factors

Biological vulnerability refers to the belief supported by many researchers and psychologists that some people may be born with certain biological risk factors—such as differences in brain chemistry—for developing a certain condition. The fact that many mental illnesses have been shown to have a genetic component supports this belief. While biological vulnerabilities don't mean a person will definitely develop a particular mental illness or another condition, they appear to increase the chances. 

This brings us to the second factor: stress. According to the model, someone who already has a biological vulnerability to a certain mental illness may be even more likely to develop symptoms when exposed to certain life stressors such as trauma or a lack of productive, purposeful work of any kind. That said, the third component of the model—protective factors—has the potential to counterbalance the first two or at least decrease their effects in some cases. Examples of protective factors that could decrease an at-risk person’s chances of developing a certain mental illness and/or a certain symptom include social support, coping skills, and medication.

The stress-vulnerability model can help explain the reasoning behind different methods of treating psychosis, including why employing only one form of treatment is typically not effective on its own, and why early intervention is usually key in relapse prevention. 

Common options for treating psychosis

Treatment for virtually any mental illness is typically most effective when it’s highly individualized to a given person’s circumstances. That’s just one reason why you should seek the support of a licensed mental health care professional if you’re experiencing symptoms of any mental health condition, because what works for one person may not be right for another. That said, the three options below are commonly recommended—typically in combination with each other as well as with healthy lifestyle habits and regular check-ins with a psychiatrist, doctor, therapist, and/or other members of one’s care team.

Antipsychotic medication

Antipsychotic medications are pharmacological interventions that can help reduce certain symptoms of psychosis. Again, medication isn’t right for every person in every scenario, so it’s important to consult with your doctor or psychiatrist before starting, stopping, or changing any medication. That said, antipsychotics are a very common element of treatment for psychosis—particularly for those who have an illness that’s associated with the potential for recurring psychotic symptoms.

The aim of most antipsychotic medications is to help resolve hallucinations and delusions in particular. That’s why medication is often a cornerstone of psychosis treatment, because it can be difficult to address other symptoms in a meaningful way if these two still exist. Note, however, that research suggests that medication is often more effective when combined with other treatment methods such as cognitive behavioral therapy and family intervention, as described below. 

Cognitive behavioral therapy

Cognitive behavioral therapy (CBT) focuses on developing an awareness of one’s thoughts and how they impact feelings and behaviors. While cognitive behavioral therapy is unlikely to reduce psychosis symptoms unless it is also used in conjunction with antipsychotic medication, it can help address some of the problematic thought patterns commonly associated with psychosis. These patterns could be influenced by low self-esteem, stress related to social interactions, and depression and anxiety resulting from the kinds of adverse situations that many people with psychosis may experience, including isolation, hostility, and the side effects of antipsychotic medication. 

The goal of using CBT in psychosis treatment is generally to help the client develop a healthier view of their condition—one in which psychosis is viewed as a singular aspect of their life and not a defining characteristic. Achieving such a viewpoint could be considered a protective factor in the stress-vulnerability model referenced above. Additionally, cognitive behavioral therapy can result in a higher likelihood of beneficial behaviors, such as medication adherence and developing meaningful relationships, both of which may help prevent future psychotic episodes. 

Family intervention

Family intervention, like cognitive behavioral therapy, is also based in part on the stress-vulnerability model of treating psychosis. In this context, “family members” are generally considered to include people with a significant emotional connection to the individual, such as partners, parents, siblings, and/or close friends. The overall goal of family intervention is to improve the family atmosphere, which can significantly reduce the probability of the client experiencing another psychotic episode. Family therapy in this context can include:

• Providing general information about psychosis and specific information about an individual’s particular disorder to them and their family members (also known as psychoeducation)
• Identifying concerns related to the individual’s experience of psychosis and agreeing on solutions to these concerns with the family unit as a whole
• Improving communication skills within the family
• Helping family members and the individual to identify, set, and hold boundaries

In addition to focusing on improved outcomes for the individual, family intervention may also help reduce the stress that may be experienced by other members. 

Finding support for mental health symptoms like psychosis

If you or a loved one is experiencing symptoms of psychosis, seeking professional attention in person immediately is recommended in order to minimize any harm and/or distress caused. For those who have a long-term mental illness that can result in psychosis symptoms, such as schizophrenia, it’s common to assemble a care team to help you manage your illness over time. This may consist of a doctor, a psychiatrist, and a therapist, for example. 

If you’re interested in pursuing cognitive behavioral therapy as part of your treatment plan for psychosis or related symptoms, you can generally choose between in-person and online care. Again, therapy—particularly online interventions—is not considered to be a replacement for emergency care or the in-person support of a psychiatrist. However, online CBT can be a convenient and powerful tool for many people in the longer-term management of their illness. With an online therapy platform like BetterHelp, you can get matched with a licensed therapist with whom you can meet via phone, video call, and/or in-app messaging from the comfort of home. Research suggests that online therapy can be as effective as in-person sessions in treating a variety of symptoms, so it may be worth exploring for those who feel more comfortable with this format.