The Mindfulness Response: Safety & Security for Psychosis and PTSD

Safety and Security for Psychosis and PTSD

            Participants told the group about feeling intense emotions and having problems staying present in their physical bodies.  The group discussed how they used grounding skills to feel present. Other participants talked about the five senses and grounding. Being present and grounded is necessary to feel calmer.

            I wasn’t in my body. I wasn’t connected to it.

            I was confused and my family told me that I couldn’t organize my thoughts.

            I got off my medications and walked downtown on a cold day only wearing my shorts.  I      don’t remember doing this.

            They told me that I got aggressive, but I can’t remember it.

            I was afraid of everybody. I couldn’t trust anyone.

            I was seeing things like I was in a movie, but I wasn’t, and I couldn’t stop it.

Warning Signs

            I dissociated and did things in my house that I don’t recall.

            I was having flashbacks and nightmares and couldn’t stop them.

            I felt unsafe because of the trauma memories returning, so I went to the hospital.

            Maslow’s Hierarchy of Needs addresses safety and security and having a safe place to live.  Homelessness is dangerous. It exposes the individual to prostitution, sex trafficking, drugs, unreliable acquaintances, disease, unsanitary conditions, and exposure to harsh weather.  Some individuals live from one friend’s house to another, and their lives quickly become uncertain. Having a safe place to live, with food and shelter is a priority. Children under 18 years who argue and fight with their parents or are victims of abuse are at risk of homelessness.  Having a supportive person to help is necessary to make it through this process.

            A supportive person is needed and can advocate for a variety of treatment options.  Sometimes legal systems are needed to establish guardianship, conservatorship, POA, Rep-payees, and legal holds to be admitted for inpatient mental health treatment or entry into outpatient treatment. To stabilize symptoms, a supportive person can help bridge the gap between the severe symptoms and treatment.  One person said, “My mom helps me do reality checks with me when I can’t figure out if people at work or the customers are mad at me.’

            Establishing care with a prescriber is the next step. A prescriber may be a nurse practitioner, a physician’s assistant, or a psychiatrist at a doctoral level. Medications are very helpful for managing severe symptoms.  A consultation with a psychiatrist is recommended.           

The group discussed how carrying a copy of all medications, and telling the provider about what is helping and what is not helping severe symptoms was part of staying well.  The list is part of maintaining open communication with your providers. Participants talked about taking medications daily for safety and security.  The group discussed instances when they believed they did not need their medications because their symptoms had decreased, and they were putting their safety at risk. 

            One participant told the group about a detox diet and that included going off all medications. The participant was excited about the new diet.  The group discussed how detox diets may be a fad. The participant admitted that they ended up being admitted to the hospital for treatment of psychosis. The group talked at length about how the body needs the medications to help maintain the inner balance and how it was similar to people who take extra iron pills when they are anemic or heart disease patients who must take their medications.

            Ensuring safety and security are the next steps in managing severe symptoms. The group discussed how the Primary Care Physician (PCP) helps monitor physical health and how they need regular physicals.  Participants talked about psychosis symptoms increasing when physical health deteriorated. Problems with sinus infections, virus infections, and respiratory infections can cause an increase in symptoms and cause a stable participant to become unstable.  One participant noticed after having a respiratory virus and feeling ill for over a week that the “voices got louder and were yelling at me.”

            The group discussed how physical illnesses, viruses, and infections can change symptoms quickly. Getting treatment at a medical clinic to treat viruses, flu, or other illnesses that get out of control can help manage psychosis symptoms.

            One participant told the group how they got sick with fever, chills, sore throat, upset stomach, everything, and was sick for days.  The voices got worse and worse, and hallucinations started. The participant talked openly about never wanting to commit suicide but saw a shadow of a person hanging in the closet. It got to be too much for me, and I told my psychiatrist and then went to inpatient mental health.

            A supportive person is needed and can advocate for a variety of treatment options.  Sometimes legal systems are needed to establish guardianship, conservatorship, POA, Rep-payees, and legal holds to be admitted for inpatient mental health treatment or entry into outpatient treatment. To stabilize symptoms, a supportive person can help bridge the gap between the severe symptoms and treatment. 

            One participant told the group how they later realized they were manic, had all this energy, walked for miles, got tired, and eventually stopped at a gas station, but didn’t know how to get home. The participant called a friend to come and get them and had to ask their location to give directions to their location. The participants did not realize that they had walked miles and miles from home.

            Another participant became argumentative, combative, and rebellious with family, insisted on going out socializing, and abused substances. Later, the participant called a supportive family to come and get them to go home.  When the family arrived, the participant had no shoes, was drunk and high, and didn’t know where the shoes were. The participant told the group that they did not recognize the symptoms of a manic episode at the time and later realized how unsafe it was.

            The group discussed how sometimes families are faced with difficult decisions on what to do, if a participant who needs treatment refuses, is combative, or resistant.  Participants talked about friends or family contacting the police, paramedics, or social workers to help them get treatment. Some participants talked about being arrested when manic and not recalling the psychosis or manic episode. They can transport the person in a locked vehicle to the hospital. 

            One participant recalled being concerned about an unsafe teen who had a suicide attempt and drove the teen to the hospital for treatment. On the way there, the teen tried to jump out of the car, while it was moving, because the voices told the teen to die and to jump.  The group discussed how it was risky to transport the teen and sometimes another person or the police would be needed to ensure a safe transport.

Symptom	Coping Strategies
Anxiety	-Talk with your support person about your feelings. -Use relaxation or mindfulness skills and deep breathing. -Use positive affirmations to challenge negative thoughts, such as “I can let go of fears.”
Depression	- Schedule your day; include chores and fun activities. - Get exercise - walk, run, bike, do Yoga, or Tai Chi. - Give yourself credit for small things on your list.
Sleep Difficulties	- Go to sleep at the same time each evening. - Listen to relaxing music or do mindfulness before bedtime. - Avoid arguments before bedtime.
Delusions	- Distract yourself from distress by reading or doing puzzles. - Do a reality check with your support person.
Hallucinations	- Use headphones to listen to music or a podcast. - Tell voices to “stop” or say to yourself, “I am safe.” - Ignore the voices. - Call your clinic to report on symptoms and leave a message.
Concentration Difficulties	- Minimize distractions. Focus on one thing at a time. - Write dates of events on a paper calendar. - Write down notes in a paper notebook. - Call your clinic about difficulties and report symptoms.

Coping Strategies