Living Well With Psychosis: Is It Possible?

For ages, psychosis was seen as a sort of "kiss of death" diagnosis.

Living well with a serious mental health condition was seen as staying out of the hospital and on medication. Yet 'treatment compliance' alone is rarely a life goal.

Pioneers like Patricia Deegan spoke openly against this mentality. A psychologist who herself had journeyed through psychosis, she argued that people can live good lives with mental health conditions and that recovery is possible.

Along with Deegan, numerous individuals stood up to ignite hope through advocacy, peer support, and sharing stories of hope, while also supporting interventions to improve the lives of those affected.

Recovery-Oriented Cognitive Therapy

Today, many practitioners have embraced the concept that a person can live a good life after the diagnosis of a mental health condition involving psychosis. ISPS-US, an organization that brings people from all around to discuss psychological and social approaches to psychosis, is one such group. Each year, at their annual conference, clinicians and individuals with lived experience join together to discuss psychological and social interventions for psychosis.

This is where I met Aaron Brinen.

Brinen is one of a team of psychologists who co-created 'recovery-oriented cognitive therapy.' Recovery-oriented cognitive therapy (CT-R) blends the message of recovery—that it is possible to have a good life with mental health conditions—with specific principles of cognitive behavioral therapy to help individuals get back on track with their life goals.

The therapy has shown success in improving hope and encouraging steps toward recovery in people with mental health conditions when compared to treatment as usual (Arya et al, 2024). It has been integrated in all levels of mental health treatment, from state hospital settings to specialized programming for young adults walking through a first episode of psychosis. Researchers have begun to apply the principles of CT-R beyond the mental health system to individuals recovering from other conditions, such as cardiovascular disease, and have found improvements in quality of life and life expectancy (Naghavi et al., 2024).

Living Well With Psychosis

I eagerly read Brinen's recent book, Living Well With Psychosis: Practical Strategies for Improving Your Daily Life. In it, he tackles a range of topics related to coping with psychosis and creating the life you want through a mix of applicable skills and reflective worksheets.

Written in a friendly voice, the book offers partnership with the reader in clarifying their aspirations and the steps that can be taken toward them. He references evidence-based practices, like activity scheduling. He also dives deep into some of the core aspects of life, like friendship and love.

In an encouraging tone, he writes, "Beyond the survival benefits of connection, friends and lovers provide joy and enrichment. They color in and highlight the stories of our lives." After this declaration, an exploration of real-life worries and strategies is engaged.

All this is done from a perspective of CT-R.

Not Fragile

In addition to the practical pieces, I appreciated how Brinen tackled such a wide variety of topics in a way that assumes strength rather than fragility, including trauma.

Historically, clinicians have been hesitant to approach trauma in people living with psychosis due to fear that they would not be able to process it. Yet, PTSD in people who have experienced psychosis is common, with one study reporting 38% of surveyed participants with a psychotic disorder having PTSD and an additional 37% showing subthreshold symptoms (Martin et al., 2023). And recent evidence has shown that when applied effectively, people with both psychosis and PTSD can benefit greatly from trauma therapy (Hardy et al., 2024).

The book approaches PTSD and the value of PTSD treatment in a straightforward manner. Brinen writes, "Thoughts are like boomerangs, not sticks. The harder you throw them out of your mind, the faster they come back. When you were in class giggling, and the harder you pushed out the thought of that Far Side cartoon with a polar bear, the faster it came in and the more you giggled. PTSD is the same, but instead of the funny cartoon making you giggle, the memory terrifies you. You become hypervigilant for the memory entering your mind and for triggers for the memory. Thinking about trying not to think of the memory can trigger the memory. You may work harder to avoid the memory and the reminders of the memory, which brings back the memory more."

This may be one of the best descriptions of PTSD I have read.

Closing

I found Living Well With Psychosis to be a beautiful guide on a difficult topic. Compared to depression or anxiety, few resources exist that are written directly for individuals who have psychosis. It is refreshing to see more come available as well as to watch how current treatment strategies are acknowledging the persons experiencing psychosis as fellow humans. I enjoyed the worksheets as I considered my current life, contemplating some of my own aspirations. As well, I plan to share this resource with those I work with.