Early intervention in psychosis

Getting help straight away will give you a higher chance of getting better. Several ‘interventions’, or forms of treatment and support, have shown considerable benefit if provided early enough.

The support offered by the team may include:

• Help with improving ways to cope with worries and stress
• Support with learning ways to manage distressing symptoms
• Assistance with recognising symptoms early
• Support and advice for family members and carers 
• Discussion and negotiation around the need for medication
• Support with accessing education, training, or returning to a working environment
• Support with social activity
• Housing and benefit advice and assistance.

These are some of the ways the team may support you to keep well.

Psychosis is a condition that can affect any one of us. Currently about two or three people in every hundred experience this condition. Stress plays a major part in triggering symptoms of psychosis. Adolescence and early adult life is a particularly difficult period for all of us and if we are vulnerable to psychosis, symptoms can be triggered during this phase.

Symptoms of psychosis can include:

• Muddled thinking
• Feeling suspicious of others
• Hearing, feeling or seeing things that others cannot
• Feeling isolated and unhappy
• Feeling especially overactive
• Racing thoughts

These and other symptoms can be experienced, and they have to occur for a specific length of time to indicate psychosis.

A meeting will be arranged at a place and time convenient to you. At the first meeting, we aim to get a clear understanding of what difficulties you are experiencing and what you feel would help you most.

If the service is right for you, a specific worker will be allocated to support you. They will begin to work with you on deciding which areas of your life they would like support with. A person can have the support of the team for up to three years.

The team will work with you in a way that makes the best use of all resources and services available in the community.

View the psychosis page on the NHS website or download our DEIPS leaflet.

The charity Rethink also produces a useful early intervention in psychosis factsheet.

Our Early Intervention Service is made up of two teams:

Derby City and South Derbyshire Early Intervention Service

St Andrews House, 201 London Road, Derby, DE1 2TZ 

Telephone: 0300 123 3239

North Derbyshire Early Intervention Service

Bayheath House, Rose Hill West, Chesterfield S40 1JF 

Telephone: 0300 123 4451

Both teams operate from 9am - 5pm, Monday to Friday.

If you require any resources in different languages, have a visual or hearing impairment or any other requirement to enable to you access information, please let the team know and they will be happy to help.

What are psychological therapies?

Psychological therapies, sometimes called talking therapies, are treatments that involve talking to a trained professional about your experiences and feelings, and how these affect your life. Therapy can help you to make sense of things, help you to cope, and help you to make changes in your life, if you want to. 

What can therapy help with?

Therapy can help with:

• worrying or confusing experiences
• difficult feelings, such as sadness, anger or feeling numb
• low self-esteem
• relationship problems
• difficult or traumatic life experiences
• specific mental health problems (1 in 4 of us will experience a mental health problem of some kind each year)

What does therapy involve?

As there are many different ways to understand experiences and people, there are different types of psychological therapy. However, they all involve meeting with a therapist or psychologist on a regular basis. The number of meetings will depend on your needs. Therapy often involves talking about your experiences, thoughts, feelings and actions. By talking and thinking with a therapist or psychologist, different ideas can be considered. This can help you to make sense of things and work out what might help.

Could therapy help me?

Psychological therapies have been shown to be helpful for some people, some of the time.

The NHS recommends cognitive behavioural therapy (CBTp) for people who have experiences such as hearing voices or believing things that others find strange (mental health services sometimes refer to these experiences as ‘psychosis’). If you are distressed by such experiences, CBTp can help you to reduce your distress and work towards goals that are important to you. CBTp encourages you to consider different ways of understanding what’s happening. This is because changing how you think about your experiences can change how you feel and what you are able to do. For CBTp, it is important that you carry out tasks in between meetings.

Other psychological therapies are available if you prefer a different therapy or have different needs. These may be helpful if you prefer a less structured therapy, have other concerns, or have long-standing difficulties. Some therapies can help you to understand yourself better by exploring your past experiences and relationships. Other therapies can help you to resolve complicated thoughts and feelings or find ways to live with them. Elements of different therapies, including CBTp, can also be combined to suit your individual needs.

If you are unsure about psychological therapy, you can try it, to see whether you find it helpful. Therapy isn’t a quick fix, so it might take some time to decide whether it’s helpful or not. It isn’t helpful for all people, all of the time, which is why a variety of treatments are offered by Early Intervention.

How to contact us

If you would like to find out more about psychological therapy, we would be happy to speak with you. Appointments can be in person, online or via telephone. It may also be possible to speak with one of our peer support workers about their experience of therapy. If you would like to access therapy, please either let your care coordinator know or call us on the numbers overleaf.

You can contact our team/service in any of the following ways:

North Derbyshire Early Interventions

• Bayheath House, Rose Hill West, Chesterfield, Derbyshire, S40 1JF
• 0300 123 4451

South and City Early Interventions

• St Andrew’s House, 201 London Road, Derby, DE1 2TZ
• 0300 123 3239

Frequently Asked Questions

This information aims to provide you with some basic information about CBT(p) and the therapy sessions themselves. The term ‘therapy’ covers a lot of different approaches, but in this information, we will just focus on CBTp. If you have any further questions about CBTp after reading all this information, or about therapy in general, please do not hesitate to raise this with your Care Co-Ordinator or therapist.

What is CBT/CBTp?

Cognitive Behavioural Therapy (CBT) works with the relationship between thoughts (cognitions), behaviours, feelings, and bodily responses. It helps us manage psychological problems - including stress, anxiety, depression, and psychosis - by adjusting the way we think and behave. It helps us identify unhelpful thinking styles and behaviour patterns and allows the person receiving therapy to learn skills and strategies they can use long after therapy has finished. 

CBTp is CBT for psychosis. In essence, it uses the same approaches and techniques as standard CBT but tends to focus more on unusual ideas and difficult experiences- such as voices or distressing beliefs, though it is not limited to this. These experiences can sometimes be very distressing and impact on a person’s life significantly. CBTp aims to reduce this distress and support the person to increase their quality of life. You can still really benefit from CBTp, even if you don’t believe you have experienced psychosis. Agreeing to CBTp does not necessarily mean you agree that you experience psychosis. 

What will we talk about? Will I have to discuss things I don’t want to talk about?

In the first few sessions, we can decide what you would like to focus on. 

You might hear voices or have distressing beliefs that others don’t share, but it doesn’t mean you have to talk about them. Some people find their voices or beliefs comforting at times. You might find it more helpful to work on anxiety perhaps, or sleep. 

In therapy, it can be really useful to explore difficult experiences, even if they are uncomfortable to talk or think about. You will be supported throughout this process, in a skilled and sensitive way. However, you will not be pressured to talk about anything you do not want to.

Will it be difficult? 

Therapy is not a quick fix; it can feel difficult at times because it involves confronting your emotions and anxieties - and so you may experience initial periods where you feel more anxious, emotionally uncomfortable, or physically drained. 

Other difficulties can include problems with concentrating or feeling motivated, especially if you are feeling depressed. 

We will work with you to develop skills to help cope with this and we will work at a pace that is right for you to help your life feel more manageable. 

What can I expect in my sessions?

We work together to complete a full assessment of your difficulties and establish a joint understanding of how they developed and are maintained. We then create a plan for therapy which allows a clear focus of the issues you wish to work on. From there, goals for treatment can be set. We deliver evidence-based interventions that are targeted towards your specific problems and work together on developing more helpful approaches. We set an agenda each week to ensure therapy remains focused on your goals. As with learning anything new, practice is important so tasks between sessions will be set - often referred to as ‘between session plans’ - to help you get the most out of the therapy.

How long are the sessions and where do we have them?

Sessions normally last around 50-60 minutes. They are usually held weekly and can be by video call, by telephone, or in-person at home or at a healthcare setting. The number of sessions you will have will be discussed between you and the therapist but initially you may agree to do a small number first and then review how the therapy is going. 

What if the therapist thinks badly of me depending on what I share?

Therapy is a safe space where you can open up about your true thoughts and feelings without fear of judgement. Your therapist will not judge you for what you think, feel or do. 

What about confidentiality?

We have a strict confidentiality policy, meaning your information will be kept confidential and only shared with the professionals involved in your care. However, in some rare circumstances, we may have to break confidentially – for instance, if you were in danger of harming yourself or others, or if you told us something that puts someone else at risk. 
We will always try to discuss this with you and be as transparent as possible. This policy is the same standard that your Care Co-ordinator works to also. Please ask more about this if you are worried.

Can I change my mind/stop therapy?

Yes - this is always your choice, and you can decide to stop therapy whenever you wish. You are not obliged to stay in therapy just because you have started, though it is always helpful to talk through any worries you might have with your Care Co-ordinator or therapist- we may be able to help or work through it. 

How long does therapy last for?

Therapy normally lasts between 15-30 sessions, though this very much depends on the content of therapy, the therapeutic relationship and the goals set. Usually this equates to 6-12 months of therapy as a very rough guide. We will agree an end date, and the learning will be consolidated into a Staying Well Plan you can use long after therapy comes to an end.

How can I get the most out of therapy?

• It is important that you try to prioritise therapy and ensure arrangements are made for childcare, transport, etc as far as you are able. We know this isn’t always possible and occasional cancellations are fine. 
• CBT is quite a commitment and works best when it is weekly or fortnightly. 
• It is a partnership between you and the therapist: the therapist is not there to ‘fix’ or ‘teach’ to you, but to work with you to improve your situation. 
• CBT requires you to practise techniques and work on things in between sessions such as reading, keeping diaries, completing agreed activities, etc. This gives you a much better chance of feeling better and staying well in the future. 
• CBT might not ‘cure’ your problems or make an unpleasant situation go away, but it could give you the skills to cope with your situation in a healthy way and to feel better about yourself and your life. 
• Most importantly - we are here to help! We want to work with you to help reduce any distress, improve your quality of life, and achieve your goals. Therapy can be a hard but ultimately very helpful and worthwhile experience for many people. 

We look forward to working with you!

Chris, a client who has used the psychological therapies service.

"I found completing my therapy with the EIPS [Early Intervention in Psychosis Service] to be an amazing experience, not only in terms of overcoming psychosis but also becoming more myself”