'You've got your own demons that you've got to fight every day': A qualitative exploration of how people respond to the experience of psychosis.

Abstract

Cognitive models of psychosis implicate how people respond to their distressing experiences in the maintenance of such experiences. Safety-seeking behaviours, which are employed in response to a catastrophic misinterpretation of threat, are viewed as unhelpful maintenance factors. However, the concept of safety seeking was developed in relation to anxiety disorders, and there may be additional complexities that apply in relation to the experience of psychosis. The ways in which people respond to their distressing experiences of psychosis are complex, multifaceted, and changeable, and qualitative research is needed to further the understanding of this process. A qualitative study was conducted using grounded theory methodology. In-depth interviews were conducted with fifteen participants who had experience of psychosis. A core category of fighting a daily battle to maintain functioning was identified. Related to this, three main themes also emerged. These were the perceived importance of responses, appraisal of threat, and perceived ability to control experiences. These categories are interrelated in that an increase in one is likely to result in increases in the others. Although these results provide partial support for the traditional view of safety-seeking behaviours, they also demonstrate further complexities in the way that distressing psychotic experiences are responded to. This has implications for cognitive behavioural therapy where emphasis is often placed on dropping safety-seeking behaviours. The traditional emphasis in cognitive behavioural therapy on dropping safety-seeking behaviours may not always be appropriate. This approach could have an impact on engagement in therapy and have the effect of reducing the client's feelings of choice and control. A detailed assessment of strategies used historically and how these may have been helpful previously, for example, suspiciousness, and withdrawal as a survival strategy should be conducted. The therapist should support the client to evaluate the importance of their responses alongside the accuracy of both threat appraisals and perceptions of ability to control experiences.