Frequently Asked Questions
What is a thought disorder?
The interplay between genetics (e.g. family history of mental illness) and environment (e.g. infections or drug use) leads some people to develop impaired brain function during late adolescence and adulthood. This can affect the brain circuits responsible for perception, emotional regulation, motivation, memory, attention, language, executive function (problem solving & planning), and social cognition. For simplicity, these deficits are often broken down into two categories: negative and positive symptoms. Positive symptoms are the abnormal thoughts, perceptions or behaviors, such as hallucinations or delusions (i.e. things that are there, but shouldn’t be.). Negative symptoms are things that should be but are absent, like motivation, hygiene, or looking forward to activities. Positive symptoms are what draws the most attention from society and are the most amenable to treatment with medications. Contrary to popular belief, merely improving or eliminating these positive symptoms alone only provides a modest benefit when it come to overall functioning and perceived quality of life. In contrast, improvement in negative symptoms is the best predictor of real recovery and satisfaction in life.
Is recovery possible?
Yes! Psychosis often comes in episodes of heightened symptoms that can last a few days to months. In between these episodes, symptoms can be very manageable. Those who begin treatment soon after the onset of symptoms are the most likely to achieve full recovery. Through a combination of effective treatment and illness self-management techniques, many go on to live the life they want!
Are there any early warning signs before a thought disorder emerges?
Early signs and symptoms are often subtle and every person’s experience will differ, though some people may notice gradual changes in their thoughts, behaviors, and feelings.
- A drop in grades, job performance, or other activities
- Trouble thinking clearly, feeling distracted, or difficulty concentrating
- Suspiciousness or uneasiness with others
- A decline in self-care or personal hygiene
- Withdrawing from family and friends and spending a lot more time alone than usual
- Stronger emotions (anxiety, sadness) than usual or having no feelings at all
While many of these symptoms may not represent early psychosis, it is important to reach out if you start to notice any of these changes in. a loved one. Responding to these symptoms early can make a BIG difference on future outcomes.
Does hearing voices mean I have schizophrenia?
The short answer is NO! [1] Hearing the voices of people not around you is far more common than you think. Voice hearing is frequent among writers, those with sleep disturbances, following the death of a loved one or after a traumatic experience, but it can also occur in the context of a thought disorder.
[1] David, T. and I. Leudar. (2001). Head to head: Is hearing voices a sign of mental illness? The Psychologist, 14, no. 5, 256-259.
What isn’t psychosis?
Psychosis is not being “crazy” or “psycho” or violent. Research has shown that people with psychosis are more likely to be the victims of violence than the perpetrators of violence. It also does not mean that you have multiple personalities. This myth comes from a misunderstanding of the word ‘schizophrenia’ which literally means ‘split mind’. Most importantly, it is not the result of any personal failure. Psychosis is not your fault or the fault of anyone else.
The early signs of a thought disorder seem like they could apply to almost any young person at some point. Can you be more specific?
The changes fall into three categories:
Social & Cognitive Performance
- Trouble reading or understanding complex sentences
- Trouble speaking or understanding others
- Becoming easily confused or lost
- Trouble in sports or other activities that used to be easy
- Attendance problems related to sleep or fearfulness
Emotion & Behavior
- Extreme fear for no apparent reason
- Uncharacteristic and bizarre actions or statements
- Impulsive and reckless behavior
- Extreme social withdrawal
- Decline in appearance and hygiene
- Dramatic changes in sleep or eating
Perception & Interpretation
- Fear that others are trying to hurt them
- Heightened sensitivity to sights, sounds, or touch
- Making statements like “my brain is playing tricks on me.”
- Reporting visual changes (i.e. colors are more intense, faces distorted, etc.)
- Feeling like someone else is putting thoughts into their brain or others are reading their thoughts
- Hearing voices or other sounds that others don’t hear
What is meant by Coordinated Specialty Care?
CSC not a specific program, but rather a general term used to describe a certain evidence-based type of wraparound first episode psychosis treatment that was developed as part of the NIMH funded RASIE research initiative. California OnTrack is largely based on NAVIGATE, one of the two CSC programs tested as part of project RAISE (Recovery After an Initial Schizophrenia Episode.)
CSC programs offer a menu of evidence-based services that support recovery, delivered by an integrated team within a shared decision-making framework. At its core, CSC is a collaborative, recovery-oriented approach involving clients, treatment team members, and when appropriate, relatives, as active participants. CSC emphasizes shared decision making as a means for addressing the unique needs, preferences, and recovery goals of individuals with FEP. Collaborative treatment planning in CSC is a respectful and effective means for establishing a positive therapeutic alliance and maintaining engagement with clients and their family members over time. [1].
[1] Heinssen, R., Goldstein, A. B., & Azrin, S. T. (2014). Evidence- based treatments for first episode psychosis: Components of coordinated care. Recovery after an initial schizophrenia episode. Bethesda, MD: National Institute of Mental Health. Retrieved from: http://www.nimh.nih.gov/health/topics/ schizophrenia/raise/nimh-white-paper-csc-for-fep_147096.pdf
Can I continue seeing my own psychiatrist while in the OnTrack program?
YES, in fact, we encourage it. Within the shared decision-making models employed at California OnTrack, and all CSC programs, you choose. We can work collaboratively with your existing doctor as consulting experts. Even clients who wish to continue seeing their existing doctor will have an initial evaluation by our psychiatrist upon entering the program and will be offered monthly follow-up appointments. Naturally, if you do not have a good existing relationship with a psychiatrist, we will help you find someone you can continue with after completing the program.
Does OnTrack treat drug abuse?
Drugs like cannabis can trigger a new thought disorder or worsen an existing one. Staying abstinent from these triggering drugs is an absolutely essential part of the recovery process. We offer our clients the tools to avoid using drugs that can cause relapse, but we require that clients are already committed to sobriety prior to entering our program. In other words, if you arrive clean, we can help you stay that way. However, if you need detox or other treatment for active substance abuse, we are happy to provide you with referrals to appropriate programs
What are the expectations for group participation?
Program and group ground rules include, but are not limited to:
Arrive on time – The program day starts promptly. Each group starts promptly on the hour. It is important to be on time so as not to disrupt the experience of other participants.
Respect – In order for the group to be a safe place to explore ourselves and our relationships, it is important to have an environment of mutual support and respect. In order to achieve this, consider the following elements that foster respect:
Active listening – This means paying attention to what is being said, demonstrating good eye contact, and showing that you are attending to what is being said.
Participate – It is important to participate and contribute to the group to the best of your ability. You can decline to talk, but we encourage you to participate even when you do not want to—this is practicing the opposite action skill and is one way people get better.
Offering feedback – If you choose to offer feedback to another group member, please consider asking for their permission. Try not to offer unsolicited advice.
Body language – Hold yourself with a posture that shows you are present, open, and willing to participate.
Outside appointments – Please schedule personal appointments outside of treatment hours. If you will be arriving late or will be absent from any scheduled treatment day, please call your assigned primary clinician or leave a message at the main line (415) 476-7400 as soon as possible. Given the nature of the program, a welfare check may be initiated for no-call/no-shows of PHP participants.
No verbal or physical threats/violence – This is grounds for immediate dismissal from the program.
No acts of theft – This is grounds for immediate dismissal from the program. Please note that this is an open building and we cannot be responsible for lost or stolen goods. Please keep your personal belongings with you.
No drugs or alcohol – We encourage you to abstain from all drugs and alcohol and while you are in the program. This will help ensure your assessment, treatment, and long-term planning is based on the clearest view of yourself and your situation.
Cell phones – All cell phones must be turned off while in groups. Groups should be as free of distractions as possible. Please DO NOT take pictures of the treatment area or other participants in the program (see confidentiality/privacy below).
Confidentiality – Maintaining the confidentiality and privacy of other participants is a crucial part of creating a safe therapeutic environment. There are many ways we do this:
Group confidentiality – Anything said between two or more group members at any time is part of the group process and is confidential. What is said in the group stays in the group—meaning, at no time, should you disclose group member names or personal/identifying information outside of treatment areas.
Pictures/social media – Please DO NOT take, share, or post pictures of the treatment area or pictures of other participants on social media.
No romantic or financial involvements – We encourage you to get to know your peers, as the feedback and support from other participants can be an important part of your treatment. At the same time, romantic and/or financial relationships within a group therapy process tend to interfere with treatment. When these relationships develop during treatment, the strong emotions that naturally develop cannot be adequately dealt with in the groups, and the safety of the groups is diminished for all the participants.
No fragrances – Be aware that there are people who are sensitive to fragrances. Persons attending groups are requested to refrain from using perfume or cologne for the comfort of other participants. The group rooms are closed environments and strong smells are not easily dissipated.
No eating in groups – Please do not bring food into groups or eat during sessions as this can be disruptive to others in the room. Beverages are okay to have in sessions. If you need to eat urgently, please be mindful to do this during planned breaks—between sessions, at lunch, or excuse yourself from the room for a short break as needed.
Medications – Please do not take prescribed or over-the-counter medications while in group sessions, as this can be unintentionally distressing to other group members. If you need to take a medication during the course of the treatment day, please be mindful to do this during planned breaks—between sessions, at lunch, or excuse yourself from the room to take your medication as needed.