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Stress and Psychosis

Nobody can say for certain what causes psychosis. We know that there are probably a number of different factors that interact with each other to make the onset of psychotic experiences more likely. This idea is described as the “Stress-Vulnerability” model.

This stress-vulnerability model suggests that every individual has a different vulnerability to developing psychosis. People are more or less vulnerable depending on the combination of biological, psychological and social factors that are present for them at any given time. Examples of these different factors are given below:-

Biological factors

  • an underlying genetic vulnerability 
  • an acquired brain injury or abnormality following an accident or illness

Psychological Factors

  • Having poor social skills and finding making relationships with people difficult
  • Lacking the resources to cope well with difficulties encountered
  • Not having a good support network around you
  • Finding it hard to talk about your feelings with others
  • Having a tendency to be critical of yourself and having low self esteem

Environmental Factors

  • Using drugs or alcohol
  • Being bullied at school
  • Having problems at work
  • Being in debt or having financial problems
  • A relationship breakdown
  • Experiencing major life events e.g. bereavement, moving house

This list is not exhaustive, but if there are a lot of these factors –or vulnerabilities – in a person’s life then they are at a higher risk of developing psychotic symptoms if exposed to further stress. If an individual’s vulnerability is high then only low levels of additional stress might be enough to cause symptoms. Whereas if a person’s vulnerability is low – they don’t experience many of the above - then they might be able to tolerate much higher amounts of stress and not develop psychosis.

Having many of these vulnerabilities does not mean you will definitely develop psychosis, it simply means you might be at greater risk and therefore more susceptible to the effects of additional stress.

By using a stress-vulnerability model to explain the onset and course of psychosis, we can see that any one of us might develop psychosis given the right, or perhaps more accurately the wrong set of circumstances. For example, if we have an underlying vulnerability, perhaps someone in the family already has psychosis AND we are exposed to high amounts of stress.

What is stress?

The word “stress” means different things to different people. Most of us get stressed from time to time: for example if we have to take an exam, make a speech, start a new job or move house. This is a part of life and we would expect the stress to disappear once we have tackled its cause. Our stress levels change from day to day and week to week. Sometime we cope better than others but generally, we know what to do to manage it. Stress can become a problem when it lasts for longer and is harder to manage. Some examples of different types of stress are shown below:-

  • Physical Stress -  Late nights, binge drinking, illicit drug use, lack of routine, poor diet
  • Environmental Stress– Poor housing, social isolation, unemployment, new environments to adjust to such as moving house or holidays
    • Emotional Stress - relationship problems, peer pressure, high expressed emotion within the family home, conflicting cultural values and beliefs, leaving home, marriage
    • Acute Life Events – Bereavement, physical illness, accidents, arrest / imprisonment, fights, pregnancy and childbirth, rape and assault
    • Chronic Stress – Accommodation problems, debts, prolonged use of drugs / alcohol, social anxiety

How do I know I’m stressed?

Being exposed to stressors like those above can affect how you feel, think and behave. Some examples of this are given below:-

Physiological responses

  • Churning stomach
  • Shortness of breath
  • Pounding heart
  • Tension in muscles
  • Headache
  • Sweating
  • Restlessness and inability to relax

 Psychological responses

  • Racing thoughts
  • Difficulty concentrating
  • Inability to make decisions
  • Anxiety
  • Irritability
  • Loss of self confidence
  • Not feeling good enough
  • Feeling overwhelmed

 Behavioural responses

  • Avoidance of people, places and activities
  • Slowing down
  • Crying
  • Increased use of alcohol or drugs
  • Forgetfulness
  • Changes in sleeping and eating patterns
  • Risk taking behaviours e.g. reckless driving

Everyone reacts differently to stress and some of the above symptoms will be more of a problem than others. It is important for all of us to learn to recognise the symptoms of stress and take steps to minimise them, however, this is especially important for those people who have an underlying vulnerability to psychosis.

How can I manage stress?

Leading a life totally free from stress is impossible. However, there are many things people can do to try to prevent stressful situations from developing and to reduce stress once it is present.

Recognition

  • Learn to recognise what situations you find stressful and more importantly understand why you feel stressed.
  • Once you understand why the situation is difficult then you can take steps to manage it. Perhaps you fear being judged negatively in certain situations or are concerned that you will not know the answers to questions you might be asked. Preparing or rehearsing in advance what you might say and do could be helpful

 Challenge unhelpful thoughts

  • Recognise what unhelpful thoughts you might experience, e.g.; “I can’t do this” or “Everyone is better than me” and try to challenge them. Look for evidence to refute your thoughts and try to generate alternative ways of thinking about the problem, e.g. “I find this hard but I am not the only one”.
  • Learn to predict what thoughts you might experience in stressful situations and prepare in advance how to challenge them
  • Reward yourself each time you successfully challenge your thoughts

Relaxation

Find an activity that helps you to relax and try to do it frequently – Don’t wait until you are stressed to do this. Staying relaxed is a great proactive way to stop stress building up

  • Take part in sporting activities
  • Walking
  • Yoga
  • Tai chi
  • Meditation
  • Massage
  • Reading

 Nutrition

 Try to eat a balanced diet

  • Decrease the amounts of caffeine, sugar and alcohol consumed

 Support Network

  • Try to find someone who you trust to talk with about how you feel
  • Try not to bottle your feelings up
  • You don’t have to cope on your own

 Exercise

  • “Exercise helps mental health”
  • A survey by the charity “MIND” found that 83% of people with mental health problems looked to exercise to help lift their mood or to reduce stress.
  • 58% of people did not know that GP’s can sometimes prescribe exercise sessions and activities.
  • The biggest barriers that prevented people from taking part in physical exercise were motivational problems, the cost of sport and lack of confidence.
  • 6 out of 10 people said that physical exercise helped to improve their motivation, 50& said it boosted their self-esteem and 24% said it improved their social skills.

Sleep

Below are some essentials of good sleep habits.

Many of these points will seem like common sense. But it is surprising how many of these important points are ignored by many of us.

Your Personal Habits

Fix a bedtime and an awakening time. Do not be one of those people who allows bedtime and awakening time to drift. The body "gets used" to falling asleep at a certain time, but only if this is relatively fixed. Even if you are retired or not working, this is an essential component of good sleeping habits.

Avoid napping during the day. If you nap throughout the day, it is very likely that you will not be able to sleep at night. The late afternoon for most people is a "sleepy time." Many people will take a nap at that time. This is generally not a bad thing to do, provided you limit the nap to 30–45 minutes and can sleep well at night.

Avoid alcohol 4-6 hours before bedtime. Many people believe that alcohol helps them sleep. While alcohol has an immediate sleep-inducing effect, a few hours later as the alcohol levels in your blood start to fall, there is a stimulant or wake-up effect.

Avoid caffeine 4-6 hours before bedtime. This includes caffeinated beverages such as coffee, tea and many sodas, as well as chocolate, so be careful.

Avoid heavy, spicy, or sugary foods 4-6 hours before bedtime. These can affect your ability to stay asleep.

Exercise regularly, but not right before bed. Regular exercise, particularly in the afternoon, can help deepen sleep. Strenuous exercise within the 2 hours before bedtime, however, can decrease your ability to fall asleep.

Your Sleeping Environment

Use comfortable bedding. Uncomfortable bedding can prevent good sleep. Evaluate whether or not this is a source of your problem, and make appropriate changes.

Find a comfortable temperature setting for sleeping and keep the room well ventilated. If your bedroom is too cold or too hot, it can keep you awake. A cool (not cold) bedroom is often the most conducive to sleep.

Block out all distracting noise, and eliminate as much light as possible.

Reserve the bed for sleep. Don’t use the bed as an office, workroom or recreation room. Let your body "know" that the bed is associated with sleeping.

Getting Ready For Bed

Try a light snack before bed. Warm milk and foods high in the amino acid tryptophan, such as bananas, may help you to sleep.

Practice relaxation techniques before bed. Relaxation techniques such as yoga, deep breathing and others may help relieve anxiety and reduce muscle tension.

Don’t take your worries to bed. Leave your worries about job, school, daily life, etc., behind when you go to bed. Some people find it useful to assign a "worry period" during the evening or late afternoon to deal with these issues.

Establish a pre-sleep ritual. Pre-sleep rituals, such as a warm bath or a few minutes of reading, can help you sleep.

Get into your favourite sleeping position. If you don’t fall asleep within 15–30 minutes, get up, go into another room, and read until sleepy.

Getting Up in the Middle of the Night

Most people wake up one or two times a night for various reasons. If you find that you get up in the middle of night and cannot get back to sleep within 15–20 minutes, then do not remain in the bed "trying hard" to sleep. Get out of bed. Leave the bedroom. Read, have a light snack, do some quiet activity, or take a bath. You will generally find that you can get back to sleep 20 minutes or so later. Do not perform challenging or engaging activity such as office work, housework, etc. Do not watch television.

Television

Many people fall asleep with the television on in their room. Watching television before bedtime is often a bad idea. Television is a very engaging medium that tends to keep people up. We generally recommend that the television not be in the bedroom. Some people find that the radio helps them go to sleep. Since radio is a less engaging medium than TV, this is probably a good idea.


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