The Mindfulness Response: Understanding Psychosis and What Reality Is

Blog 3  March 13, 2024

The Mindfulness Response: Understanding Psychosis and What Reality Is

            The Mindfulness Response is the ability to disengage from distress experienced in daily life. This can come in the form of environmental stressors or our own physical and mental health symptoms. Maintaining calm is the key. This ability to remain calm and not get into a panic takes regular practice over months. Noticing what causes distress helps decrease anxiety.

In outpatient mental health, people are referred for treatment of mood disorders or depression, anxiety, or bipolar disorder. Some are referred for trauma, and psychosis and others have physical health problems on top of all the rest. The work was done in a group therapy setting.

One participant talked about being anxious in a group setting and was reassured that anxiety is common among those who are new to the group. They wanted to feel as if they belonged to a group, just as others belonged to a family, workplace environment, or a volunteer job. Everyone wants to have friends. Everyone wants to be loved and they discussed how they felt comfortable being in the group therapy.

There is trouble when a person has anxiety, panic attacks, depression, or trauma. There is more trouble when they explain that they have a physical health disease and symptoms of psychosis. Fortunately, outpatient programs have nurses and occupational therapists along with psychotherapists to help address symptoms. It takes courage to participate in group therapy and many people reported feeling anxious when they started the program.

            Their reality isn’t questioned. At the time that anyone experiences the symptoms, they are real for that person. It would be the same for a person with a heart condition who is out of breath and can’t walk up the stairs. Their reality is different from others who don’t have a physical health condition. With help from professionals, and community workers, people can put their lives back together.

            To put people at ease, self-compassion concepts are discussed openly along with the cognitive behavior therapy base. Self-compassion includes mindfulness, self-kindness, and common humanity. Being patient with yourself, not criticizing yourself, calling yourself names, not using put-downs, not swearing at yourself, and being non-judgmental are keys to self-kindness. The group discussed how they try to practice this on themselves and then apply it to others. Being patient with another person who bothers you is a true test of managing distress.

The connections between anxiety, depression levels, negative thoughts, strong feelings, actions, psychosis, and PTSD symptoms are difficult to identify, but with discussion in the group, people began to see their habits. Helping them understand this connection enabled participants to address past regrets or grudges, which is vital to managing symptoms. 

One person told the group about being in the hospital, getting treatment, and experiencing hallucinations. They were afraid that others would harm them and heard voices criticizing and insulting. It was a very confusing time and scary for the person. Some group members validated the fear level and said that they had experienced extremely high levels of fear in the past and needed help and were glad that the person received it.  

The group discussed different levels of fear and anxiety. There is calm, and then anxiety, and then higher levels of anxiety might be social anxiety where a person feels fear at a social event.  More intense than that is hyper-vigilance that comes from trauma, where combat veterans or victims of crimes are constantly checking over their shoulders to be sure that there isn’t something dangerous near them. Higher than that is paranoia. With paranoia, one person told the others that “the fear is now! It’s here!”  It is the core of fear.

            Psychosis involves all of the senses. Sensations, images from visual hallucinations, flashbacks, or nightmares of trauma-related all matter. Hearing that other people also have had experiences similar to what was discussed is a relief.  “Yes, I had that too, and I had to get help by taking this medication and going to therapy.” A big weight drops off their shoulders as they listen to others talk about similar symptoms and experiences. Severe symptoms require more help from a team of providers.

Group therapy participants often talked about the voices and other sounds that they heard. One person talked about a comforting voice that was helpful and friendly. Another talked about never being lonely because the voice was helpful and caring. Bigger problems arise when people talk about voices criticizing or insulting them or sounding like demons or aliens.  This is frightful for people.  

One participant was hesitant to discuss olfactory sensations (odors, smells, or aromas) unless someone else did first and was surprised that it came up in the discussion. Participants talked about unusual smells of smoke, or blood, or death when there should be no such smell.

 Unusual smells can be associated with physical health issues or medication side effects. Sometimes people can’t smell anything because of congestion from allergies. During the pandemic, COVID-19 took some people’s sense of smell away temporarily or permanently.

Group therapy participants discussed tastes in their mouths that should not exist or the tactile hallucinations of something crawling on their skin. These sensations need to be explored further to understand if physical health, medication side effects, or physical disease symptoms are causing the unusual sensation.

Occupational therapy explains the five senses and finding comforting tastes or touch to calm oneself. In the occupational therapy clinic, there was a discussion about anxiety and panic attacks and how the body feels when a panic attack occurs. This discussion started at the head with headaches, and jaw, shoulder, and neck aches produced by anxiety. Loss of focus or feeling afraid, blurry vision, ringing in your ears, dry mouth, can’t swallow, or can’t catch your breath are anxiety and panic attack symptoms.

The conversation moved to the chest and lower body by describing numbing and tingling sensations, hot and cold flashes, breaking out in a sweat, nausea, dizziness, fainting, and chest aches where people think they are having a heart attack. Participants talked about “butterflies in my stomach, or my stomach is tied up in knots.” Others noticed they had frequent urination, upset stomachs, diarrhea, or vomited.  Restlessness, jittery legs, and feet, and “ not being able to sit still,”  were observed.  Aches and pains could move down to the legs, knees, feet, and outer extremities.  The group practiced progressive muscle relaxation as a way to teach the brain to respond calmly to distressing symptoms and events.

Another participant expressed that the room seemed to be moving and the walls were wobbling.  Discussions with the staff nurse went into detail about medication side effects that can cause unusual bodily sensations. Physical sensations can be produced by side effects from medications or physical health issues such as chronic pain.  Sleep and wake hallucinations are associated with falling asleep or waking up from sleep. The brain is coming out of REM sleep and hypnogogic or hypnopompic hallucinations can be experienced.

            Sometimes more than one sense overlaps with another. This is where discussions about proprioception, (where my body is in space) vestibular (balance), and interoception (how I feel inside my body, like hunger) entered the picture. The participants discussed how they didn’t feel connected to their bodies. One participant explained that it was like observing oneself, or not feeling like I am myself.  The group discussed the origins of the sensation and asked if it was from trauma. The group discussed trauma responses that can cause dissociation, where a person feels they are observing themselves, or depersonalization. The group also discussed derealization, where the person doesn’t feel that the environment around them is real.   

Another participant said that it was difficult to know where I began and where I ended.  A discussion about personal boundaries and what was a physical boundary helped clarify if it was a physical reaction. Staying in the present moment, practicing deep breathing techniques, grounding skills, and mindfulness helped lower anxiety and depression symptoms and it helped participants feel grounded in their body. Asking them to talk with their psychiatrist about this symptom was encouraged.

The Mindfulness Response: Identifying Trauma from Psychosis

            Many participants talked openly about trauma that arose from psychosis symptoms. Some of them discussed being in the hospital and recalling that their mind was doing one thing and their body doing another. They talked openly about how they became more aware of their paranoia level but previously believed the delusional thoughts were real. There were stories from participants who did not recall anything about a psychotic episode or how their family and friends brought them to the hospital emergency department.

            Participants came into the hospital knowing that their symptoms were becoming uncontrollable and that they needed help. Many skills and a great deal of inner knowledge are needed to recognize when medications aren’t working well, and how outside stressors impact mental health symptoms. Psychosis symptoms become unmanageable when participants experience life stressors, such as grief and loss, changes in physical health conditions, or medications not working well.  

During the Pandemic: Environmental Stress

            During the pandemic all hospital-based group therapy sessions moved to safer online group meetings; the risk of infection made it too dangerous. This was a welcome change for some who enjoyed online group therapy. Some lived in rural communities, hours away from the hospital, and were grateful for online services.

            For others who didn’t have access to computers, or couldn’t afford the equipment, or internet, it became problematic, some rural and urban areas had no connection, and they had to seek assistance from family or the county. Setting up a computer and connecting to an online appointment requires knowledge that not everyone has. Many people required assistance.

Obstacles arose when participants reported receiving messages or hearing voices coming from electronic devices and this psychosis symptom interfered with concentration. The group helped each other problem-solve, and gain the patience needed to work with the symptoms and some days they signed off early because of the intrusive symptoms.

The skills taught online had the same CBT base with self-compassion concepts added to the process.  The regular practice of mindfulness continued. The Mindfulness Response helped the group gain insight and control over distressing reactions generated from symptoms. 

For some participants, being online was just too much. They were uncomfortable with electronics and the conversation, and it caused increased anxiety and confusion. This anxiety increased their psychosis symptoms, and they couldn’t focus on therapy or education. They were encouraged to find clinics that offered in-person services, which increased over time.

Some participants talked about their fears that the virus was in the environment and how it increased their paranoia and delusional thoughts. The group often discussed how the virus took over and that they were afraid to leave their homes. Self-compassion was added to the conversation to remind people that there were vaccines and medications to help people who got COVID-19 and that things were changing slowly. The group practiced mindfulness and staying in the present moment. They focused on what things they could control, and what were safe ways they could go out in the community. They discussed and practiced observing their fears and doubts and acknowledging the thoughts and feelings that came with them. They practiced relaxation and talked about grounding skills to stay in the present.

Grounding Skill: Noticing Shapes and Colors in the Room

Practicing grounding skills builds concentration and focus and keeps you in the present moment. It reduces anxiety and distress by paying attention to a specific task.  When done in group therapy, participants took turns observing their environment and reporting their findings to the larger group.

The group named all the square, triangular, round, oblong, and other shapes in their environment. They told others what they noticed and the colors of them. They examined the ceiling, the walls, the floor, the furniture, decorations, and personal items that they had.

Notice your environment. What in your environment is square? Round? Triangular? Oblong? Other? __________________________________________________________________________________________________________________________

What colors do you see? Name the colors on the floor, walls, ceiling, on objects.

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