Psychosis
Mary Congrove, Licensed Independent Social Worker (LISW)
1 Early Onset Psychosis: What It Is and How Psychotherapy Can Help
By: Mary Congrove, Licensed Independent Social Worker (LISW)
Experiencing or witnessing psychosis for the first time? Learn the signs, causes, and how early intervention therapy can make a lasting difference in recovery.
Understanding First Episode or Early Psychosis
A first episode of psychosis can be frightening and confusing for the person experiencing it and for their loved ones. It often happens in late adolescence or early adulthood and marks the first time someone loses touch with reality, experiencing hallucinations, delusions, or disorganized thinking.
But here’s the most important thing to know:
Psychosis is treatable, especially when caught early.
Therapy and early intervention services can significantly improve outcomes and reduce long-term mental health impacts.
What Is Psychosis?
Psychosis is a symptom and not a diagnosis. It refers to a break from reality and is often associated with conditions like:
Schizophrenia
Schizoaffective disorder
Bipolar disorder
Severe depression
Trauma or substance use
During psychosis, a person may:
Hear, see, or feel things others do not (hallucinations)
Hold strong false beliefs that don’t match reality (delusions)
Struggle with disorganized thoughts, speech, or behavior
Withdraw from others or stop functioning in daily life
Show rapid mood changes, paranoia, or confusion
Early Warning Signs to Look Out For
Before a full psychotic episode, people often go through a prodromal phase which is a period of subtle changes. These might include:
Social withdrawal
Trouble concentrating
Decline in school or work performance
Unusual thoughts or suspiciousness
Increased sensitivity to sounds or sights
Mood changes or anxiety
Sleep disturbances
Catching and responding to these early signs can prevent further decline. These symptoms have been known to start as early as 15.
What Causes Psychosis?
Psychosis can be triggered by a variety of factors, including:
Genetic vulnerability (family history of psychosis)
High stress or trauma
Sleep deprivation
Substance use (especially cannabis, LSD, or stimulants)
Brain chemistry changes during adolescence or young adulthood
Medical conditions, like epilepsy or autoimmune disorders
Psychosis is nobody’s fault. It's a mental health condition, not a moral failing or character flaw.
How Therapy Helps During the Onset of Psychosis
Early treatment is critical. Research shows that people who receive help quickly after their first episode have better recovery rates, fewer hospitalizations, and a greater chance of returning to work or school.
Therapy at REAL for Psychosis may include:
Cognitive Behavioral Therapy for Psychosis (CBTp): Helps challenge delusional beliefs and reduce distress.
Family therapy and psychoeducation: Supports loved ones and teaches communication strategies.
Skills training: For social interaction, self-care, and stress management.
Relapse prevention: Identifying early warning signs and creating a safety plan.
I have supported many individuals and families going through psychosis and one of the most difficult parts is the stigma that is created around these diagnoses. Psychosis does not look like what is often portrayed in the media. It is a spectrum of symptoms and rarely do two people come in with symptoms that look exactly the same. REAL Therapists help reduce fear, rebuild trust in reality, and guide individuals toward stability.The earlier we intervene, the more we can preserve relationships, goals, and long-term well-being.
2 Help! Does My Teen Have Psychosis?
Early Warning Signs, What to Do, and How Therapy Can Help
Worried your teen may be showing signs of psychosis? Learn the early symptoms, what causes psychosis in teens, and how therapy can help your family find answers and support.
When Something Feels Off
As a parent, you know your child better than anyone. So when your teen starts acting in ways that feel confusing, distant, or alarming, it’s natural to worry.
If you're searching for answers to behaviors that seem strange, paranoid, or disconnected from reality, you may be wondering:
"Does my teen have psychosis?"
While that question can feel terrifying, early intervention can make a powerful difference. Understanding the signs and knowing what to do next is the first step toward getting your teen the help they need.
What Is Psychosis in Teens?
Psychosis is a serious mental health symptom that causes a person to lose touch with reality. It often first appears in late adolescence or early adulthood. This is generally between the ages of 15 and 35. That’s why it’s important for parents to recognize potential red flags early on.
Psychosis can involve:
Hallucinations (hearing, seeing, or sensing things that aren’t there)
Delusions (firm beliefs that aren't based in reality)
Disorganized thinking or speech
Extreme paranoia or suspiciousness
Sudden drop in school performance or social withdrawal
Early Warning Signs of Psychosis in Teens
Before a full episode of psychosis occurs, many teens go through a “prodromal phase”—a period where subtle symptoms begin to show. These may include:
Withdrawing from family and friends
Unusual or obsessive thoughts
Difficulty concentrating or focusing
Speaking in a way that’s hard to follow
Loss of motivation or personal hygiene
Strong emotional swings or flat, unemotional behavior
Believing others are watching or plotting against them
Important: These symptoms don’t automatically mean your teen has psychosis. They can also be caused by anxiety, depression, trauma, or even substance use.Seeing these signs means that it’s time to seek some REAL support.
What Causes Psychosis in Teens?
Psychosis doesn’t have one single cause. It’s often the result of a combination of factors:
Genetics: Family history of psychotic disorders
Brain chemistry: Imbalances in dopamine or other neurotransmitters
Trauma or high stress: Especially early-life trauma or ongoing anxiety
Substance use: Cannabis, LSD, or hallucinogens can trigger psychosis
Medical issues: Rarely, physical illnesses or infections can contribute
How Therapy Helps Teens with Psychosis
The earlier psychosis is identified and treated, the better the outcome. Early intervention therapy can:
Reduce the severity and duration of symptoms
Lower the risk of future episodes
Help your teen stay in school, work, and social life
Provide education and support for the whole family
Build coping tools and improve emotional regulation
Evidence-based therapies such as Cognitive Behavioral Therapy for Psychosis (CBTp), family-focused therapy, and psychoeducation have all been proven to help.
Your teen doesn't need to face this alone—and neither do you.
What You Can Do as a Parent
Trust your instincts. If something feels wrong, it’s worth getting checked out.
Stay calm and supportive. Approach your teen with compassion, not fear.
Keep notes of behavior changes. This will help during evaluations.
Seek professional assessment. A licensed therapist or psychiatrist can determine what’s going on.
Get support for yourself. This is a heavy burden—therapy can help you, too.
Worried Your Teen May Be Experiencing Psychosis? We Can Help.
At REAL, we specialize in early intervention for teens and families navigating the uncertainty of psychosis and other complex mental health concerns.
You don’t have to have all the answers. You just have to take the first step.
