Understanding Psychosis
A warm, non-stigmatising explainer on what psychosis means: unusual experiences that are more common than people think, why they happen, and how people recover and live well.
Written by Tarun Vermani, Trainee Clinical Psychologist Last reviewed
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Understanding Psychosis
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What psychosis means
Psychosis is a word for a group of experiences. It can mean hearing or sensing things that other people do not, such as voices or sounds. It can mean holding beliefs that others find hard to share or understand. Or it can mean your thoughts feeling jumbled, racing, or hard to follow. These experiences can be frightening or confusing, but they are understandable, and they are not a sign that someone is dangerous or beyond help. They are something a person goes through, not the whole of who they are.
These experiences are more common than people think
It can feel very isolating to have these experiences, as though no one else could possibly understand. But unusual experiences are far more common than most people realise. Many people in the general population hear voices, sense a presence, or hold unusual beliefs at some point, especially during times of stress, grief, sleep loss, or after trauma. Rather than there being a sharp line between people who have these experiences and people who do not, it is more like a continuum that we all sit somewhere along. You are not alone in this, and you are not on the wrong side of some line.
Common experiences
People go through different things, and there is no right or wrong here. Tick any of these that feel familiar to you. It is completely okay if only some apply, or if yours are not quite on the list.
Why they happen
There is no single cause, but one helpful way to understand it is the idea of stress and sensitivity working together. Each of us is born with, and shaped into, a certain level of sensitivity to stress. When enough stress builds up, through life events, sleep loss, trauma, or other pressures, it can tip someone into having unusual experiences. In part, these experiences can be the mind's attempt to make sense of things that feel confusing or frightening. Understanding it this way can take away some of the fear and self-blame: this is something that has happened to you, not a flaw in who you are.
What helps
There are good reasons to feel hopeful. Talking therapies for psychosis, such as CBT for psychosis, can help you make sense of your experiences and feel more in control of them. Support from a mental health team can make a real difference, and for some people medication is a helpful part of the picture too. Looking after the basics also matters: reducing stress where you can, and protecting your sleep, can both help a great deal. Many people who have these experiences go on to recover and to live full, meaningful lives.
A note on getting support
If you are going through any of this, please do not carry it alone. Speaking to your GP or a mental health team is a good and brave first step, and they can talk through the options with you. If at any point you feel unsafe, or that you might act to harm yourself or someone else, please reach out straight away. In an emergency call 999. You can call Samaritans free on 116 123 at any time, day or night, or text SHOUT to 85258. Reaching out is a sign of strength, and support is there for you.
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When to use ‘Understanding Psychosis’
‘Understanding Psychosis’ is an interactive cognitive behavioural therapy (CBT) worksheet, most often used in CBT for psychosis.
It is designed to be used within therapy rather than as a standalone self-help tool: a therapist introduces it, works through it collaboratively, and helps make sense of what it surfaces. You can preview the full worksheet above, then assign it digitally for clients to complete between sessions on any device — or download it as a print-ready PDF.
How it works
Most people work through it in around 9 minutes. It moves through six short steps:
- What psychosis means — Psychosis is a word for a group of experiences. It can mean hearing or sensing things that other people do not, such as voices or sounds.…
- These experiences are more common than people think — It can feel very isolating to have these experiences, as though no one else could possibly understand. But unusual experiences are far more…
- Common experiences — People go through different things, and there is no right or wrong here. Tick any of these that feel familiar to you. It is completely okay…
- Why they happen — There is no single cause, but one helpful way to understand it is the idea of stress and sensitivity working together. Each of us is born…
- What helps — There are good reasons to feel hopeful. Talking therapies for psychosis, such as CBT for psychosis, can help you make sense of your…
- A note on getting support — If you are going through any of this, please do not carry it alone. Speaking to your GP or a mental health team is a good and brave first…
Completed on the Formulate platform, your client's answers are saved automatically and shared straight back to you, so you can review them before the next session rather than waiting for a paper copy to come back.
The CBT approach behind it
In common with other CBT methods, ‘Understanding Psychosis’ works by noticing the links between situations, thoughts, feelings, physical sensations and behaviour — and finding practical ways to change unhelpful patterns. The aim is not positive thinking but a clearer, shared understanding of what keeps a difficulty going — and practical, testable ways to change it.
Because it is a CBT tool it stays focused on the here-and-now links between thoughts, feelings, the body and behaviour, and it works best as one part of a wider course of therapy rather than as advice or a diagnosis.
Evidence & sources
This worksheet is grounded in established cognitive behavioural therapy theory and practice. Key sources include:
- Zubin, J. & Spring, B. (1977). Vulnerability: A new view of schizophrenia. Journal of Abnormal Psychology, 86(2), 103-126.
- Kingdon, D.G. & Turkington, D. (1994). Cognitive-Behavioral Therapy of Schizophrenia. New York: Guilford Press.
For use alongside professional support
Formulate provides educational CBT resources for use with a qualified therapist. They are not a substitute for professional assessment, diagnosis, or crisis care.
If you need urgent help now:
- Emergency services: 999 — if you or someone else is in immediate danger
- Samaritans: 116 123 — free, day or night, 365 days a year
- SANEline: 0800 689 5555 — 4:30pm–10:30pm, every day
More Psychosis (CBTp) worksheets
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A maintenance-focused formulation for psychosis — mapping triggers, experiences, appraisals, emotions, and coping responses.
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Examine beliefs about the power of voices — challenging omniscience, omnipotence, and the need to comply.
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Normalising Unusual Experiences
Explore how common unusual experiences are in the general population — and how context, stress, and sleep deprivation can produce them in anyone.
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Coping Strategy Enhancement Record
Systematically evaluate and build on existing coping strategies for managing distressing psychotic experiences.
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