A crisis-focused cognitive behavioural informed approach to formulating experiences of psychosis in acute mental health inpatient settings

Background: People experiencing psychosis in acute crisis should be offered cognitive behavioural therapy for psychosis (CBTp); however, there are few crisis-focused CBTp-informed models to underpin formulation development for people experiencing psychosis and receiving inpatient mental health care. Aims: This paper draws on existing CBTp and crisis theories to conceptualise a psychotic crisis from a cognitive behavioural perspective to inform the delivery of therapy in inpatient settings. Method: Previous literature is reviewed, critiqued, and synthesised. It draws upon relevant crisis and CBTp theories to outline how to best formulate a psychotic crisis. Discussion: Drawing on existing research and theory, this paper outlines how a psychotic crisis can develop and be maintained. It highlights the importance of the person’s context including the social, political, and cultural context, interpersonal context and trauma, and previous and current inpatient experience. It then outlines the key triggers, cognitive, behavioural, and emotional components of the crisis, and personal strenghts, values and resources. A crisis-focused CBTp-informed approach is outlined, which can be used to underpin formulation and brief therapy strategies for people experiencing a psychotic crisis. More research is required to explore the efficacy of such therapies.