Stress Vulnerability Model
There are multiple causative factors in the development of psychosis but most research suggests that theStress-Vulnerability model of psychosis is the most dominant.
This model suggests that a vulnerability to psychosis is acquired through a genetic predisposition or as a result of an environmental insult to the brain (e.g. head injury). This vulnerability, however, is not considered to be sufficient to manifest the disorder and must be ‘triggered’ by environmental processes. The environmental component can be biological (i.e. an infection, or even drugs and alcohol) or psychological (stressful living situation, school exams, travel etc.).
- vulnerability to psychosis is acquired through a genetic predisposition, or as a result of an environmental insult to the brain.
- to manifest, the disorder must be ‘triggered’ by environmental processes
- the amount of environmental stress needed to ‘trigger’ psychosis likely differs from person to person, as does the amount of vulnerability that at risk people have for psychosis.
The ‘stress’ component of the model may take many forms, including:
- Traumatic life events.
- Use of drugs and alcohol.
- Stressful living conditions (e.g., low socioeconomic status; high levels of family conflict).
DECREASED STRESS TOLERANCE
There is also some agreement that people with psychosis handle stress poorly. It seems that they have a low tolerance for stress – things that would have not been stressful for someone who does not have psychosis can prove too much for those who do have it. There is also a lower tolerance of intense emotions from others, e.g. anger, criticism, conflict or extremes in positive concern or over involvement. Clearly this makes knowing how far to push or encourage someone to do something a difficult decision. On the one hand too much pushing may lead to problems and even relapse, whereas no encouragement to do things may see someone sink into apathy and withdrawal.
Certain factors can also reduce the risk that an at-risk person will develop psychosis:
- Use of appropriate prescription medication.
- Use of stress management techniques.
- Reliable support systems (e.g., family, a hospital day program).
THINGS FAMILY OR FRIENDS CAN DO:
Learn to recognize what signs indicate a person needs time out:
Decrease stimulation and decrease stress.
Psychosis is a stress sensitive illness with a diminished tolerance of stress including lower tolerance for interpersonal relationships and stress common to family and friendship.
- Allow the person to close the door of their room.
- Although the person may not be able to have a conversation; they can socialize by playing board games, cards, TV, movies, crafts, gardening.
- Be reassuring – It’s Ok if you get nervous, just sit with me for a while
- Provide a structured and predictable environment.
The recovering patient will have problems with sensory overload. In order to reduce stress plan activities for each day and keep big events to a minimum. Keep routines simple and allow the ill person time alone each day.
- Let them know in advance if company is coming.
- Encourage participation in family activity, but accept refusals.
- Give choices – maybe quiet outing like a walk in the park rather than shopping in the mall.
Caregivers should agree on a plan of action and follow it. If you are predictable in the way you handle recurring concerns, you will help to reduce confusion and stress for the ill person.
Maintain peace and calm at home.
You will want to keep voices down and speak at a slower pace. Shorter sentences will also help to reduce stress. Avoid arguing about delusions (false beliefs).
Together learn how to cope with stress.
Anticipate ups and downs and prepare accordingly. A person with psychosis needs to learn how to cope with stress in a socially acceptable manner. Your positive role modeling will be most helpful.
- Help your relative plan strategies for dealing with stress at events e.g. go to the washroom, outside for air, come late, leave early
RESPONSES TO STRESS / HOW YOU KNOW YOU’RE STRESSED:
Physiological: How the Body Responds
- Rapid pulse
- Increased perspiration
- Pounding heart
- Tightened stomach
- Tensing of muscles in arms and legs
- Shortness of breath
- Gritting of teeth
- Clenching of jaw
- Inability to sit still
Psychosocial: How the Mind Responds
- Racing thoughts
- Inability to concentrate
- Difficulty making simple decisions
- Loss of self-confidence
- Irritability or frequent anger
- Insatiable cravings
- Worry or anxiety
- Irrational fear or outright panic
Behavioral: What You Do
- Increased use of medication
- Nervous tics or mannerisms
- Accident proneness
- Hair pulling, nail biting, foot tapping
- Increased or decreased eating
- Increased or decreased sleeping
- Increased use of alcohol or drugs
- Reckless driving
- Inappropriate aggressiveness
Vancouver/Richmond Early Psychosis Intervention Program
207-2250 Commercial Drive
Vancouver, BC, V5N 5P9