**1. Introduction**

In the beginning, the common idea was that the psychosis is completely different from the other disorders. But this idea has only increased the stigmatization and labeling. As a result, severe mental illnesses like psychosis and schizophrenia were categorized as "disorders which are untreatable with psychological methods." Today, models suggesting the existence of a continuity between normal beliefs, anomalous experiences, and psychotic symptoms are accepted [1]. It is well known that healthy people may also experience mild psychotic symptoms like delusions of being watched or talked about, or auditory and visual hallucinations as a result of stress, drugs, trauma, and sleep deprivation [2, 3]. These kinds of thoughts and perceptions are called as psychotic-like experiences, to the extent that they do not necessitate

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

getting any support or treatment [3–5]. In community, every one person of four reports at least one psychotic-like experience [3]. The rate of psychotic experiences that cause seeking treatment ranges from 3 to 8% [2, 3, 6].

similarities between the normal, anomalous, and the psychotic experiences. With the aim of evaluating the psychotic symptoms in a continuum, we separately look through these

From Vulnerability to Resilience: A Coping Related Approach to Psychosis

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

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Vulnerability-stress model integrates the overall explanations—biological, psychological, and social factors—to explain the structure of psychosis [1, 9–14]. The vulnerability to severe illnesses can arise due to genetic predisposition, birth trauma, brain injury, viruses, and early childhood traumas like physical and interpersonal deprivations [1]. It can be said that a person who has been influenced by one or more of these factors is more vulnerable to develop a

But vulnerability only defines the possibility of developing a psychiatric illness while facing stress. We all have different psychological structure and social environment, and accordingly, the stress level that we each can endure is different. Some of us have significant heritability for the psychotic disorders and the others have not [15]. For instance, the family history of psychosis can indicate the high vulnerability. The more vulnerable person is, the less stress is required for the occurrence of psychosis. According to Zubin and Spring's concept of vulnerability-stress diathesis, so long as the stress stays below the threshold of vulnerability, the individual can cope with events, but whether the stress surpasses the limit, he/she can

The use of cognitive-behavioral theory (CBT) for psychosis is originated from Beck's theory of emotional disorders [15, 17]. Nearly 60 years ago, Beck has started to investigate the delusional system of a paranoid patient who believed that he was being watched by the members of a military unit who were working on behalf of the FBI. At the end of a 30-session treatment process, the patient recognized that his delusions were related to his own beliefs (e.g., "I am responsible of my daddy's unfavorable behaviors" and "I'm supposed to be punished due to my weaknesses") and impressed guilty in a schematic level [14, 17]. Thus, cognitive therapy

Then, this success was supported by another case study [17]. Hole et al. [20] defined four dimensions for measuring delusions as a result of their hour-long interviews with delusional inpatients: *conviction, accommodation* (the degree to which a delusion could be modified by external events), *pervasiveness* (the percentage of the day spent ruminating about delusions), and *encapsulation* (the extent to which a decrease in pervasiveness could occur without any decrease of conviction). They decided that delusions may function as the other beliefs and may differ from them only quantitatively regarding how they can be influenced by external

In his subsequent studies, Beck stated that the psychotic patients (particularly paranoids) concentrate especially on monitoring external—including social—sources on the purpose of

was first shown as helpful for the treatment of psychotic patients [17–19].

explanations.

*2.1.1. Vulnerability-stress model of psychosis*

develop a psychotic episode [16].

*2.1.2. Beck's theory for delusions*

events [16, 20].

mental illness than the others who do not have such a past.

The persons who are confronted with anomalous experiences and do not need to seek help are the ones who generally do not overevaluate these kinds of experiences. On the other hand, the persons who develop psychosis in the end are more anxious about and more preoccupied with their beliefs and experiences. The person searches for a meaning of this anomalous experiences and the coping process with severe anxiety lead delusions and voices [7, 8]. In addition, maladaptive-coping strategies such as avoidance or safety behaviors play a particularly important role in the maintenance of the psychotic symptoms.

In this chapter, we initially review the vulnerability-stress models and the other cognitivebehavioral explanations to psychosis. These explanations will be stated as "coping-related explanations" in the text, because they often emphasize the coping process with the anomalous experience or the interactions between internal (e.g., deprivation in self-monitoring process) and external (e.g., environment, trauma) factors. With the help of these explanations, we try to understand the development of psychotic symptoms as a continuity of normality. Then, we handle the role of maladaptive-coping strategies in the maintenance of psychotic experiences. Patients' relatives' coping strategies will also be taken into consideration due to their role in the maintenance of psychosis. We finally address the importance of developing and enhancing adaptive-coping strategies and changing irrational thinking for challenging psychosis. We also emphasize the role of social support in every stage of psychosis.
