Pathways to psychological treatments for psychosis

The distressing symptoms of psychosis, delusions, and hallucinations used to be thought of as unsuitable for psychological therapies. Recent research on the continuities between normal experiences and those found in psychosis has led to the development of a wider range of psychological therapies, adapted from approaches for anxiety and depression, to the more complex presentations found in psychosis. These can include overlaps with anxiety disorders, depression, obsessive–compulsive disorders, trauma, and personality disorders. Many people also have co-morbid substance misuse. In addition, there are issues relating to stigma, social exclusion, and barriers to recovery. Thinking about these overlaps has led to more creative therapeutic approaches with a developing evidence base. Of these, family interventions for psychosis and cognitive behavioural therapy for psychosis have some evidence for efficacy, and are recommended by National Institute for Health and Clinical Excellence guidelines for schizophrenia in combination with antipsychotic medication (being updated in 2008–2009). Problems remain regarding improving effectiveness, implementation, and increasing access across the National Health Service to psychological therapies for those with these more severe conditions.