Treatment for Psychosis

Living with bipolar disorder through Cognitive Behavioral Therapy for psychosis

Mental illness can be a lifelong struggle, as you may know. I have struggled with bipolar disorder for about a decade, having been diagnosed in 2009 as a teenager. Thanks to good doctoring, therapy, perseverance and medication, I think I am entering a period of relative stability, once again. 

Before I get into my experience with CBTp (Cognitive Behavioral Therapy for psychosis) and how it has affected my day-to-day life, I want to provide some background about me. 

Since my initial episode I have had bouts of instability, for sure, but by and large things have been OK. By OK I mean that I graduated from college, worked for about two years and then went to graduate (law) school. Graduate school is where the problems started, again. 

Well, really, looking back I realize that things were deteriorating prior to that, while I was working, but graduate school is where it came to a head. 

Fortunately, I did not have a manic episode or require hospitalization, but my baseline psychotic symptoms, which are usually pretty mild, increased in intensity. My symptoms consisted of intrusive thoughts and hearing things in the wind. I was also somewhat sclerotic in my thinking and delusional — not a good combination for a law student who has to think and make arguments on the fly. Adding to the small parade of things that were going wrong, my school was in a different city than the one where my support network is. Going to school in a new city empty handed, so to speak, was a bad idea. A therapist I saw was supportive but not equipped to handle someone struggling with psychosis. 

The combination of a dip in my grades along with the persistent symptoms caused me to decide to transfer to a law school closer to home. The next semester was a little better, but still difficult. 

When I was back in Seattle I learned about CBTp and was fortunate enough to get into therapy. The treatment, which I will describe shortly, spurred my recovery and I credit it, along with a new medication regimen, to my current state. 

However, the treatment program did not resolve my doubts about a future life as a lawyer, so I decided to withdraw from law school, and am taking courses in preparation for an engineering program, something I am much more excited about. 

CBTp advanced my recovery in many ways. The therapy is a subset of regular CBT, which is a talk-based therapy that helps people cope and live with their symptoms, be it pain, anxiety, chronic illness or something else. CBTp differs in that it helps patients manage psychosis. 

It helped me develop insight into my condition and tools for dealing with symptoms that I previously did not have. Some of the techniques I learned in CBTp therapy may seem very basic to others, but they were not intuitive to me. And they are skills that have been fundamental to my recovery. 

The two main CBTp skills that I still consistently use are “identifying the thought” and “five steps of cognitive restructuring,” though most of the other skills are useful. Identifying the thought is when you have an unpleasant thought and you acknowledge the thought and then move on, when in the past I had avoided those thoughts.

The five steps of cognitive restructuring are: 1) identifying your unpleasant thought; 2) assessing whether it is plausible or not; 3) rating your thought on a scale of 0 to believable (100 percent); 4) making a new thought to explain the situation, emotion, judgement, etc; 5) writing out a new, more believable thought. For example, I was walking downtown and a woman scoffed when I passed her. My initial thought was, “She did not like my outfit or thought I was out-of-place.” 

After doing the five steps of cognitive restructuring, the new thought could be: “She was reading her phone and reacted to something on her phone, and not me.” This may seem like a pretty fundamental, ordinary skill, but it is a powerful tool for dealing with emotions like anxiety and worry.  

Those two skill sets have given me the confidence to address challenges — delusional thoughts, hearing voices — I face throughout the day, so that I can stay on task and not get absorbed by such distractions.

In addition to the box of mental tools that my CBTp doctor helped me develop, we kept track of my symptoms in a systematic way, which was also very helpful. Being able to look at where I was at the start of therapy versus months into the program offered insight about where I had room to grow and areas where I had made progress. 

However, therapy generally does not end in the doctor’s office. By this I mean that I put a lot of outside effort into trying to make CBTp work, by practicing the techniques I worked on in therapy and by reading some books my doctor recommended. She recommended two books, Distressing Voices and Paranoid and Suspicious Thoughts, which I studied and learned from in conjunction with the CBTp therapy. Learning through reading suits me, and it helped me further understand my condition and the therapy. I liked learning from the experiences of other patients, whose stories were included in the books. Those stories gave me exposure to how other people reacted to the therapy and why other people were in therapy. It sort of normalized my own experience. 

With my therapist I found that developing my own terms or ways of interpreting can be of benefit. For instance, I call some of my intrusive thoughts “dandelion thoughts.” They used to always grow back, but now that I have learned to acknowledge them instead of trying to stomp them out, they are less annoying. I also do yoga and work on breathing, a tenet of CBTp, that complements the therapy. 

As I hope this makes clear, CBTp has had a dramatic effect on my outlook with respect to psychotic symptoms. I wish I had been offered this therapy when I was first diagnosed or when I first started having symptoms. These are tools that I will use and call on for the rest of my life.

The writer of this viewpoint is anonymous out of concerns over stigma from identification.