**3. Conclusion**

(black or white), arbitrary inference (jumping to conclusions), and selective abstraction (only focusing a little part of the overall picture) are some of the most observed thinking errors in psychosis. With the help of cognitive model, patient can understand that how he interprets the situations can affect how he feels and how he reacts that way. He also comprehends the relation between his irrational thinking and his symptomatology. Then, the patient and the therapist can collaboratively work on changing the interpretations of the problem and explor-

There is also a link between early psycho-social stressors, dysfunctional assumptions underlying core maladaptive schemas, and the psychotic symptoms. Fowler and colleagues [1] summarized the main schematic themes for psychosis, and they categorized five schemas including *the belief that the self is extremely vulnerable to harm*—for example, "I am unsafe," *the belief that one is highly vulnerable to losing self-control*—for example, "I am dangerous to others," *the belief that the self is doomed to social isolation* "I am totally alone in the world," *the belief in inner defectiveness*—for example, "I am damaged/deficient," *the belief in strict standards*—for example, "I must perform the optimum standard in all areas at all times (schema compensation). Other core maladaptive schemas such as "I am different," "I am special," and "I am abandoned" are also effective in the development and the maintenance of the

It is known that individuals with psychosis have smaller social networks and less satisfying relationships [66]. Social support is accepted as an important factor in every stage: in the

Outcomes of the studies which examined the relation of positive social support/lack of social

One of these studies in which the quantity and quality of social relationships in young adults at ultra-high-risk for psychosis were evaluated, fewer close friends, less diverse social networks, less perceived social support, poorer relationship quality with family and friends, and more loneliness were determined, and these features have been found to be related to low functioning, and also a high symptom severity [66]. Correlatively, Schuldberg and colleagues have found that high-risk individuals reported receiving significantly less positive social support from both friends and family [67]. The relationship between psychosis proneness and negative social support (e.g., hostility and criticism from others) has not been examined yet [68].

In a study that aimed to understand the gender differences between childhood physical and sexual abuse, social support and psychosis, it was suggested that especially for women with a child maltreatment history, powerful social network systems and perceptions of social support were found as important factors for resilience and against developing psychosis [69].

A study that examined the role of social support in delays between the onset of psychotic illness and initiation of an adequate treatment found that good social support was associated

ing more rational perceptions and more adaptive alternative responses [65].

psychotic symptoms, especially of the delusions [65].

32 Psychosis - Biopsychosocial and Relational Perspectives

*2.3.3. The role of social support for challenging psychosis*

development, maintenance, and recovery of psychosis.

*2.3.3.1. The role of social support in the development of psychosis*

support and psychosis indicated many important results.

with a significant increase in this duration [70].

The aim of this chapter was to understand the continuum between the normality and psychosis, to review the coping-related explanations and coping strategies for psychosis. It is important to understand patients' own coping mechanisms, as well as their relatives' coping strategies because of the relation between psychotic symptoms, "expressed emotion," and "social support." Studies show that most of these coping strategies used are maladaptive, thus it is important to educate patients about cognitive model and adaptive-coping strategies via cognitive-behavioral therapy.

It is remarkable that almost all cognitive explanations have a similarity with vulnerabilitystress model, and they resemble each other except a few differences. The author tries to summarize all these explanations herein subsequently and show in a schematic assumption named as "a Coping Related Model for Psychosis" in **Figure 1**.

When a person with cognitive and physical vulnerability is exposed to stressful life events (e.g., low social support, environmental difficulties, or psychological traumas) which surpass his vulnerability limit, he may experience an anomalous experience. For example, he can hear a whisper

or is supposed to see someone. If the person attributes this experience to an external source and interprets it such as "a talk of a Devil" instead of explaining it with an internal cause like "I must be tired," the anxiety level may increase. Because of the cognitive and emotional changes, the psychotic symptoms can occur. Once it develops, the maladaptive thinking patterns including attention to the perceived threat, dysfunctional schemas, cognitive errors, and selective attribution, or maladaptive behaviors like safety behaviors, or avoidance increase the risk of maintaining the psychotic symptoms. The individual's acceptance of the patient role, his compliance to the medical and psychological treatment, being educated about using adaptive-coping behaviors, or changing misinterpretations may help to enhance his vulnerability limit and ability to cope with stress, consequently to increase the possibility of recovery. Social support is also an important factor to decrease the potential risk of psychosis and to cope with the illness. On the contrary, a high level of expressed emotion is accepted to negatively affect the prognosis and may contribute to develop relapses. Therefore, integrating family members to cognitive-behavioral therapy program is very important in reducing expressed emotion and improving interpersonal environment.

From Vulnerability to Resilience: A Coping Related Approach to Psychosis

http://dx.doi.org/10.5772/intechopen.78385

35

**Conflict of interest**

**Author details**

Oya Mortan Sevi

**References**

10.5080/u14975

S0033291710001005

The author confirms that there is no conflict of interest.

Address all correspondence to: oyamortan@gmail.com

Practice. Chichester: Wiley; 1995. 192 p

Department of Psychology, Bahcesehir University, Istanbul, Turkey

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[3] Binbay T, Mısır E, Onrat Özsoydan E, Artuk M, Fidan S, Karakiraz A, Önder E, Öztürk A, Sayin MB, Ulaş H, Akdede B, Alptekin K. Psychotic experiences in the adaptation process to a new social environment. Turkish Journal of Psychiatry. 2017;**28**(1):1-10. DOI:

[4] Kelleher I, Cannon M. Psychotic-like experiences in the general population: Characterizing a high-risk group for psychosis. Psychological Medicine. 2011;**41**:1-6. DOI: 10.1017/

Psychiatric Epidemiology. 2009;**44**:905-910. DOI: 10.1007/s00127-009-0012-x

**Figure 1.** A coping-related model for psychosis.

or is supposed to see someone. If the person attributes this experience to an external source and interprets it such as "a talk of a Devil" instead of explaining it with an internal cause like "I must be tired," the anxiety level may increase. Because of the cognitive and emotional changes, the psychotic symptoms can occur. Once it develops, the maladaptive thinking patterns including attention to the perceived threat, dysfunctional schemas, cognitive errors, and selective attribution, or maladaptive behaviors like safety behaviors, or avoidance increase the risk of maintaining the psychotic symptoms. The individual's acceptance of the patient role, his compliance to the medical and psychological treatment, being educated about using adaptive-coping behaviors, or changing misinterpretations may help to enhance his vulnerability limit and ability to cope with stress, consequently to increase the possibility of recovery. Social support is also an important factor to decrease the potential risk of psychosis and to cope with the illness. On the contrary, a high level of expressed emotion is accepted to negatively affect the prognosis and may contribute to develop relapses. Therefore, integrating family members to cognitive-behavioral therapy program is very important in reducing expressed emotion and improving interpersonal environment.
