A Closer Look

How to Prevent Students From Experiencing Psychosis

Did you know that it is rather common to have strange or extraordinary experiences? Many people experience these events, and they are usually harmless and are quickly forgotten. However, sometimes these experiences can be distressing and interfere with activities. Below are some examples of unusual or extraordinary experiences that students might mention or appear to be experiencing:

Alienating experiences

  • The surroundings seem strange, new, and not familiar
  • Time seems to pass quicker, and then slower
  • You lose contact with yourself, and it seems as though you are not in everyday reality

Experiences of being influenced

  • Feelings and thoughts do not seem to be under the control of your own will
  • Experiences that remind you of and evoke thoughts about telepathy
  • Thoughts about messages that are meant specifically for you, sent by others sometimes via the radio or television or any other medium

Experiences of threat

  • The frightening assumption that people are conspiring against you
  • The experience that others are ‘out to get you’

Sensory perceptions that only you have

  • The experience of sounds, whispering, a voice in or outside your head, or hearing your own thoughts spoken out loud
  • Strange visual perceptions and visions
  • Unusual bodily perceptions without a clear external cause

Confusion and difficulty concentrating

  • Difficulty with regulating one’s thoughts and choosing the right words; other people saying they cannot understand you properly

Changed experiences in contact with other people

  • Experiencing little pleasure from the company of others
  • Nervousness in the proximity of others
  • People saying that they think you do not express your feelings enough
  • People saying that you act strangely or that you have strange habits
  • Everyday problems and stressors become heavier to bear
  • Problems in the interactions with people at work or school

What Does It Mean to Be at Clinical High Risk for Psychosis?

Researchers and clinicians working with early psychosis in the 1990s discovered a concept referred to as the duration of untreated psychosis (DUP), and that the longer the DUP the poorer the outcome for the person. They also discovered a critical window of 5 years from onset of symptoms within which to intervene. This highlights the critical need for early intervention services.

Clinicians providing these services noticed that there was a subset of patients with attenuated symptoms that didn’t meet criteria for psychotic disorder. This is what came to be known as clinical high risk for psychosis (CHRP), at risk mental state (ARMS), or ultra high risk (UHR)—all synonyms.

Essentially, CHRP encompasses one of the following categories:

  • intermittent psychotic symptoms—symptoms present for less than a week and remit spontaneously for each episode
  • attenuated (subclinical) psychotic symptoms—either subthreshold intensity or subthreshold frequency
  • trait plus state risk factors—diminished functioning (social withdrawal) and having a first degree relative with psychosis

All of the unusual/extraordinary experiences listed at the top of this blog are examples of things that come into this CHRP category.

These are all perfectly normal experiences, and we now have data from six randomized controlled trials in Europe that suggest if we screen young people for CHRP and treat those who are at risk with a specific cognitive–behavioral therapy protocol, we can prevent them from developing full blown psychosis by a magnitude of 45–55%. However, the opposite can also happen if people catastrophize or shame the person who has these experiences, or alternatively if they are left untreated and catastrophize themselves.

So Where Do School Psychologists Come in?

If you notice that a student mentions or appears to be experiencing any of the things listed above, you have a very powerful role! If you follow the steps below you can get them to the right treatment and really improve their trajectory.

  • Go through the screening questionnaire Prodromal Questionnaire – Brief Version (PQ-B)
    • If the person endorses 3–5 items they are CHRP
  • Normalize
    • “You know, I have had some of these experiences from time to time [give examples].”
    • “A lot of people have similar experiences from time to time.”
  • Empathize
    • “It makes perfect sense that you would be anxious about these experiences as they are new for you and you have a lot going on right now.”
  • Refer
    • “I know a great team who specialize in supporting young people with these experiences. They have a lot of experience with such things and can answer all your questions.”
    • Visit http://www.easacommunity.org/national-directory.php and ask for the clinical high risk team

In short, unusual experiences do not have to be life changing for young people and students if detected early and treated with the right evidence-based therapy. School psychologists are perfectly positioned to be the key clinicians who can affect this change. 


About the Author

Dr. Sally E. Riggs, DClinPsy, ACT
Dr. Riggs is a licensed psychologist and expert in Cognitive Behavioral Therapy for psychosis with 18 years of experience working in this field in both London, UK and the US. She earned her Doctorate in clinical psychology at Royal Holloway, University of London, UK in 2005, during which time she was trained in CBTp. She completed her Postdoctoral Research Fellowship at the Aaron T. Beck Psychopathology Research Unit, University of Pennsylvania, working on a pilot study for CBT for negative symptoms, and pioneering training in CBTp in community mental health agencies. She moved to NYC in 2011 and has been working in public and private healthcare settings, practicing and teaching and training mental health professionals in CBTp since this time. She has been an invited member of the Annual International CBT for Psychosis Research Meeting since 2009, and is a Founding Member and current President of the North American CBT for psychosis Network. She founded NYC CBTp in 2016 the first ever private practice group dedicated to providing evidence based cognitive behavioral therapy for people with psychosis.