Mental Health Week Event -- Arranged by Lanark County Community Education Committee
Caregiver CBT for Psychosis
We had 22 people attend the event on Wednesday May 4th at Lanark Community Programs in Carleton Place. There was an even split of caregivers and clinicians and other professionals. Dr. Nicola Wright and Tyrone Gamble joined us to share their expertise and experiences with CBT (Cognitive Behaviour Therapy) in Psychosis with the service providers and caregivers in Lanark County.
Below is a summary from the notes gathered from the presentation.
CBT is an important part of recovery. Medication only therapy can often treat the "positive" (added in) symptoms, i.e. hallucinations, paranoia and delusions, however it does not deal with the underlying causes which can be a combination of issues including psychological trauma.
Changing the words we use can have a positive impact on someone suffering with psychosis. When we ask about distressing thoughts or experiences, people are more likely to share their experiences because the language expresses compassion and a non-judgemental attitude. If we ask about or say someone is having delusions, the language implies that their reality is the wrong one and that it is not real. This leads to a person shutting down and being less likely to be willing to engage with you.
Giving a name to an emotion that someone is experiencing helps to calm the body, which in turn calms the emotion rather than escalate it. I.E.) "Wow, you seem to be really afraid."
All people can experience a paranoid thought. If we fuel the thought, the natural feedback loop that occurs is a stress response, which in turn, causes more paranoid thoughts, which creates more stress. Some people worry they are sick because of a distressing thought or hearing a voice. Repetitively checking to see if the thought is still there makes it more likely to get worse. --> BUT trying to suppress the voice or thought can also make it worse.
Some people will have thoughts about being vigilant about getting caught while doing illegal drugs. That leads to always feeling vigilant when doing drugs. This can easily lead to paranoia around "the cops" as a result of selectively attending to certain beliefs.
Refugees commonly experience fear of harm--fear of government. Because they spend a lot of time attending and focusing on these thoughts, they can become hyper vigilant about safety, even after the need for these thoughts has past.
Humans have a negativity bias. Saying "Tell me something you feel good about over the week" helps to plant the focus on the positive and breaks the habit of negativity bias. If the person is attending a group or meeting regularly, they will begin to pay attention to the positive things to share at that group/meeting.
CBT helps move toward living a life out of your gifts and strengths rather than out of deficiencies. When a person is suffering from schizophrenia/psychosis the world shrinks to living the illness.
Nicola's 3 C's
Catch it
Check it
Change it
Looking at distressing thoughts or behaviours.
First--Catch it--Notice that you are having the thought or doing a behaviour. I.E. end up in the bathroom without purpose to be there.
Second--Check it--Check out why we have the thought or why we are doing a behaviour.
Third--Change it--If it's a thought, help move through the thought to consciously thinking about other thoughts, or moving to a different behaviour.
Tyrone expressed that he has stumbled on the last C. He experienced trouble moving directly to the Change. He has added a 4th C
Tyrone's 4 C's
Catch it
Check it
**Cope with it**
Then Change it
Tyrone shared that sometimes before moving to the change, he had to sit with the thought/behaviour for a while before he was able to push through that place.
CAREGIVERS need to use "I" statements in order to express what they see, in a non-judgemental way. "I notice this......., have you noticed that?" Focus on "We" instead of "You" I.E. We all can have distressing thoughts. Sharing your experience of what you notice can help the person living the experience to start to "catch it".
We need to recognize that Recovery does not necessarily mean a return to pre-illness state and functioning. Some people have referred to a psychotic episode as having a brain attack and there needs to be time and compassion to move toward recovery. It helps to be curious, but in a way that is caring. Ask how they cope with all the thoughts/voices. What works best for them.
A very important job of the caregiver is to hold onto the hope and see the beauty of the person until they can regain their own hope and recognize their value.
The Road to Recovery is a Road of Rediscovery.
It is important know a variety of things that helps to keep a person well. If a person counts on only one thing (a medication) and it stops being effective, then a person will be significantly worse off than if they have a toolbox of wellness tools.
If someone is unable to make sense of what they are going through, they will have a much harder time. Going through WRAP (Wellness Recovery Action Plan) program and other tools will help a person to recognize, name and understand what they are going through.
Anyone interested in becoming a member of our Community Education Committee and helping to plan next year's event is encouraged to contact me at mentalhealthfamilies@gmail.com
Caregivers at the event expressed frustration accessing help from the mental health systems and frustration with waitlists. Tyrone encouraged people to access services and groups at the PSO (Psychiatric Survivors of Ottawa) which was created because of the lack of services offered by the medical system.
http://www.pso-ottawa.ca
For more information see resources listed on
www.treatingpsychosis.com
