1010-Practical Tools to Support Those with Psychosis _ Counselor Training

Counselor Toolbox Podcast with DocSnipes

1. Introduction

2. Understanding Psychotic Symptoms

• Symptoms Defined: Psychotic symptoms include hallucinations, delusions, disorganized behavior, and speech.
• Associated Disorders:

3. Causes of Psychotic Symptoms

• Breakthrough Symptoms: These can occur even in individuals who are generally functional.
• Causes:
• Unmedicated State: By choice or due to forgetfulness.
• Medication Non-compliance: Due to side effects or difficulty maintaining a regimen.
• Stress: A major trigger for acute episodes.
• Medication Imbalances: Can be caused by dehydration, heat, dietary changes, weight fluctuations, and drug interactions (e.g., antibiotics, caffeine, nicotine).
• Other Factors: Conditions like hypoglycemia, severe sleep deprivation, and chronic stress can exacerbate symptoms.

4. Strategies for Support

• Medication Management: Ensuring compliance and adjusting for lifestyle changes.
• Stress Reduction:
• Identify stressors (physical, cognitive, emotional) and work to mitigate them.
• Develop emergency plans to address prodromal symptoms (early signs of relapse).
• Cognitive Behavioral Therapy (CBT) for Psychosis:
• Typically more effective during remission than in acute episodes.
• Focuses on reducing symptoms, distress, and interference with quality of life.
• Techniques include relaxation training, graded exposure, scaffolding, and activity scheduling.
• Environmental Modifications: Adjusting surroundings to minimize stressors and support daily functioning.

5. Recognizing and Managing Prodromal Symptoms

• Prodromal Symptoms:
• Chronic anxiety, mood swings, sleep disturbances, memory problems, social withdrawal, decline in hygiene, and inability to perform daily tasks.
• Early Intervention: Recognizing these signs allows for early intervention to prevent full-blown episodes.

6. Addressing Hallucinations and Delusions

• Safety and Reality Testing:
• Initially, join the individual in their reality to establish safety.
• Avoid arguing or reasoning with delusional beliefs during acute episodes.
• Use CBT techniques to challenge and reframe delusions during remission.
• Behavioral Strategies: Encourage comparison of their behavior to others, use of distraction techniques, and reinforcing positive behaviors.

7. Enhancing Functionality

• Daily Living Support: Use lists, schedules, and guides to help individuals manage daily tasks.
• Token Economies: Reward systems to encourage participation in therapeutic activities.
• Environmental Prompts: Reminders and tools to support memory and task completion.

8. Cognitive and Executive Functioning

• Support Strategies:
• Break tasks into smaller components (chunking).
• Minimize distractions and create structured environments.
• Roleplay problem-solving scenarios.
• Use alarms and reminders for medication and daily tasks.
• Cognitive Behavioral Therapy (CBT): Applied during remission or prodromal phases to manage residual symptoms and improve quality of life.

9. Final Considerations

• Relapse Prevention:
• Continuous monitoring of stress levels and medication effectiveness.
• Developing a strong support system and improving stress management skills.
• Therapeutic Engagement: Ensuring clients feel safe and validated in discussing their symptoms.

10. Conclusion

• Further Resources: Dr. Snipes mentions an upcoming on-demand class for more in-depth learning about CBT for psychosis.

Chapters:

00:00:00 - Supporting Functional Individuals with Psychotic Symptoms

00:06:51 - Factors Affecting Psychosis Management

00:13:38 - Managing Prodromal Symptoms and Breakthrough Episodes

00:20:25 - Understanding and Supporting Disorganized Behavior

00:27:09 - Token Economy and Motivational Enhancement

00:34:00 - Scaffolding for Learning and Cognitive Impairment

00:40:43 - Managing Hallucinations and Delusions

00:47:14 - Understanding the Pre-Delusional Beliefs

00:54:14 - Addressing Hallucinations and Delusions

01:00:58 - Understanding Cognitive Behavioral Therapy for Psychosis

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