Therapeutical Approaches to Psychosis

Therapeutical Approaches to Psychosis

Command hallucinations are commonplace in psychosis. Psychosis is usually defined not as a disorder per se, but as a symptom of a particular mental illness. For example, bipolar disorder, psychotic depression, schizophrenia and schizoaffective disorder all usually include psychotic features. Also, hallucinations represent perception in the absence of real sensory stimuli. Further, commonly referred to as “hearing voices”, command hallucinations, commonplace in many mental disorders, cause great anxiety and even distress to patients suffering from psychotic episodes.

Furthermore, Cognitive Behavioural Therapy(CBT) may help alleviate some of these command hallucinations (e.g. when the voices are telling the person to do something, often times in a dangerous manner, which may endanger the person or others, in which case the legal measures permit an involuntary psychiatric hospital stay). An alternative therapy, which may be used in conjunction with CBT is Acceptance and Commitment Therapy (ACT). ACT has a different approach to hearing voices, stating that it is better to accept one’s symptoms, and in a way simply almost ignore them, focusing instead on one’s personal values and on how one must direct one’s own life.

Turning the page on psychosis requires pharmacotherapy, among other things. Image: Megan Jorgensen (Elena).

A particular treatment of command hallucinations is named TORCH (Treatment of Resistant Command Hallucinations), an alternative treatment is called Befriending. Psychotic episodes, including command hallucinations have been documented as very detrimental to the person suffering from the psychotic episode. For example, research data shows that command hallucinations and other psychotic disturbances may result in very destructive behaviours. For example, a person suffering from psychosis may act illogically and irrationally, throwing out all their personal belongings without thinking about subsequent financial need. Likewise, they may fight with all their friends, eventually becoming friendless since their hallucinations and delusions lead them to believe that friends are somehow at fault and maybe even trying to harm them.

Moreover, the situation is made worse when close ones try to make the person with psychosis consult a doctor, since the hallucinations and delusions seem real to the person suffering from psychosis, he or she may get angry at those trying to make them get help, instead thinking that they are lying or simply refusing to understand them. Delusions, unlike hallucinations, refer to fixed false beliefs held despite all evidence to the contrary. In conclusion, it is imperative for a person suffering from psychosis to get professional, psychiatric help because they often live in a sort of nightmare and because the condition may bring about drastic consequences if left untreated.

Hallucinations are experiences that seem very real but are not. Illustration: © Megan Jorgensen.