"Quick comment": Using mindfulness if you experience psychotic episodes
Updated: Nov 23
I was asked to offer a short comment for a self help book called "The Beginner's Guide to Sanity" As it covered some useful tips, I thought I would reprint my contribution here.
In essence, mindfulness is the ability to live in the present, to actively choose our behaviours with awareness of how they may impact on others; and to be aware of what our body is telling us – and to use that knowledge. Simple deep breathing, stretching with awareness of how our body is feeling and meditation provide a good start as a form of mindful practice – and this is what most people commonly recognise as “mindfulness”. I suggest in my book “The Leader’s Guide to Mindfulness”, that while these are indeed methods of practice, any technique which enhances our ability in the areas of awareness of the self, the other, active behaviour and to embrace the present moment can help us be more mindful.
What mindfulness offers – as well as feelings of relaxation – is the ability to take control of your behavioural and emotional state.
However, for those suffering with psychotic episodes, conventional meditation may not be helpful. The silence and the length of some meditative sessions can be disconcerting and potentially trigger overwhelming attention to unwanted thoughts or voices. Research is currently looking at how to make meditation accessible for those with psychotic symptoms, but it’s practical applications may be more successful as a means of immediate help.
The following suggestions are developed from the use of mindfulness within DBT (Dialectic Behaviour Therapy) approach to Borderline Personality Disorder – a disorder with symptoms which cross from neurosis to psychosis:
Be aware of – and list for others – your Self-Care options
· Do you have a small group of people you can call on for support?
· Do you have a specific method of managing a psychotic experience?
By making what or who you need explicit, it is easier for others to administer immediate and effective support.
In the same way as someone with allergies may wear a bracelet denoting this, a “care plan”/”Crisis pack” (DBT terminology), or Wellness Plan is an excellent way to ensure you get what you need when you need it. Never be ashamed to ask for help - especially when you are explaining how best you can be helped. Remember you are taking a very empowering step.
Recognise your supportive relationships
· Do you nurture relationships with people who make you feel good about yourself?
· Are you able to set appropriate boundaries?
Having the “right” people around us is a huge source of support. A toxic environment where criticism or judgment is at the fore is not a healthy place to heal. Research shows that there is a greater chance of relapse when a schizophrenic patient returns to a “highly emotionally expressive” (Butzlaff& Hooley, 1998 amongst others). Further, we often “reflect back” our surroundings, so make sure that they are positive.
- Do a “friend cull” (or at least a “mute”) of any account you are following social media that does not make you feel positive.
- Practice phrases to keep those who are not conducive to your wellbeing at bay eg: “I am unable to see you today, I’ll check in with you when I’m ready.”
- Recognise that sometimes your symptoms may make you respond in a way that upsets or even antagonises others – try to educate them on your condition.
The following tips will help you remain in control where you can:
1. Try and keep a diary of what is happening so that you can look at your account and compare it with what you may be told later by those around you
2. Try and see people who are not part of the direct situation - and try to have the confidence to ask someone you trust (or a helpline such as MIND) "This happened...is this right?"
3. Find a therapist who understands your condition and who is able to help build your empowerment rather than a focus on taking responsibility for your actions or differences in your thought process – a diagnosis of psychosis is NOT YOUR FAULT and effective help starts first with validation. It is very easy for professionals to approach treatment through challenging the psychotic thinking patterns eg the therapist working with you and your condition – but this can create a sense of conflict with the client. If the therapist starts from a point of validation and then seeks to look at how or why you think as you do, then you and the therapist can work together to battle the disorder.
 Butzlaff RL, Hooley JM (June 1998) "Expressed emotion and psychiatric relapse: a meta-analysis". Arch. Gen. Psychiatry. 55 (6): 547–52
Dr Audrey Tang is a chartered psychologist and author. Listen to her podcast Retrain Your Brain here; and catch her practical masterclasses Psych Back to Basics on DisruptiveTV & Energy Top Up for resilience For quick tips and tools: click for SKILL PILL and Q&A videos and here for Media appearances. Twitter/IG @draudreyt