Coping with visual hallucinations worksheet
Reality testing gives clients with psychosis a structured way to examine their thoughts and beliefs, and a reality testing psychosis worksheet walks them through the process step by step.
This article provides an overview of psychosis and reality testing questions for psychosis to suggest to clients.
Download our free reality testing techniques for psychosis handout and save it to your electronic health record (EHR) to use in your practice.
What is psychosis?
Psychosis is a term used to describe symptoms, such as hallucinations, affecting an individual’s perception of reality. Several mental health disorders can involve psychosis, including schizophrenia spectrum disorders, bipolar disorder, and severe depression. Psychosis can occur as a result of substance use and medical conditions, like a brain injury or dementia. Our guide to the ICD-10 code for psychosis can help you find the right diagnostic code.
Symptoms of psychosis include:
Delusions: Fixed false beliefs, such as thinking that someone is out to hurt them. They may also think they are receiving messages through the television, radio, or other devices.
Hallucinations: Seeing or hearing things that are not real. A person may think these voices are telling them to do something, or the voice may be critical of them.
Disorganized thinking or speech: A person may show tangential thoughts, incoherent speech, and difficulty telling reality from fantasy.
Changes to behavior and functioning: A person may show social withdrawal, difficulty communicating with others, lack of self-care, disrupted sleep, trouble concentrating, and poor performance at school or work.
Psychosis can be distressing. According to the National Institute of Mental Health (NIMH), people with psychotic symptoms are more likely to harm themselves than someone else, and recovery is possible with early diagnosis and appropriate treatment.
Treatment options for psychosis include:
Medication: Medical providers may prescribe antipsychotic medication, and sometimes mood stabilizers or antidepressants.
Psychotherapy, like cognitive-behavioral therapy (CBT) for psychosis, has shown efficacy for delusions and hallucinations when added to standard care, according to University of Oxford clinical psychologist Daniel Freeman.
Other supportive measures include coordinated specialty care, involving family members in treatment and recovery, psychoeducation, social support, case management, and employment and education support services.
Reality testing questions for psychosis
The reality testing psychosis worksheet covers two ways to approach reality testing for psychosis: behavioral experiments and self-led reality testing.
Behavioral experiments
This involves creating an experiment to test the validity of a belief:
Before the experiment: Help the client consider the thought they’re testing, what information is needed, how they’ll capture it, and how they’ll measure the data.
After the experiment: Help the client evaluate how the results of the experiment weighed against the original thought, how that outcome influences the validity of the original thoughts, and, based on the results, create a more balanced and helpful way of looking at the situation.
Self-led reality testing
Clients doing their own reality testing can use the three Cs approach:
Catch it:
What was the automatic thought?
What were you noticing about your thoughts?
Is this thought helpful to achieve my goals?
Check it:
How did the thought make you feel?
What did it make you do?
What is the evidence for and against the thought?
Have I been wrong about a thought like this in the past?
How would you advise a friend with a similar thought or situation?
Is this a distorted thought (cognitive distortion) like black and white thinking or jumping to conclusions?
Change it:
What is another way of looking at this situation?
What are some alternative explanations?
How can I reframe this thought to help me reach my goals?
How to use the reality testing psychosis worksheet
You can download and use the reality testing psychosis worksheet in several ways:
Use the worksheet to provide psychoeducation about psychosis and how to check the accuracy of thoughts and delusions.
Give the client a copy to take home.
Ask the client to reflect on the worksheet and complete the reality testing questions for psychosis between sessions and report their findings at their next therapy appointment.
Use the reality testing questions for psychosis in group therapy sessions to encourage clients to share with other participants what helps them during psychosis.
Combine this worksheet with other cognitive-behavioral therapy worksheets into a CBT for psychosis worksheet PDF.
Pair the worksheet with a CBT thought record or cognitive restructuring worksheet to help clients practice reframing their thoughts between sessions.
Share the worksheet with coworkers or leave copies in your office.
Use this worksheet to provide training to interns or supervisees on CBT for psychosis.
Complete the worksheet together with the client during sessions when possible, and adapt terms like psychosis and delusions to the client’s level of insight.
Sources
Freeman, D. (2013). Cognitive-behavioral therapy for psychotic disorders. Psychiatric Times.
Landa, Y. (2017). Cognitive behavioral therapy for psychosis (CBTp): An introductory manual for clinicians. VA VISN 2 Mental Illness Research, Education, and Clinical Center (MIRECC).
National Institute of Mental Health. (2023). Understanding Psychosis.
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