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Guest Blogger - Reality Testing (90Health)

The following blog article was written by Scott Bernard... Thank you, Scott for sharing the information. This type of support will undoubtedly help countless individuals.

As individuals with schizophrenia can relate, different people can express very different transitions between psychosis and their baseline state. Some individuals experience the transition as an on-off switch. Initially they may have near perfect insight into the cause of their hallucinations, and the flawed logic behind their delusional thoughts. Then suddenly, they may lose nearly all insight into their condition, and whole wholeheartedly believing in their delusional thoughts, or having trouble differentiating their hallucinations from reality.

Then there is another group of individuals who possess a level of insight which tends to fluctuate up or down more gradually. Rather than going from a complete understanding of the cause of symptoms, to a complete lack of insight into the driver of their symptoms, this group of individuals may instead experience varying degrees of difficulty differentiating between real and illusion, or logical and delusional. In this group of individuals, a practice called reality testing has proven to be a valuable tool in increasing insight, reducing distress, and even reducing the progression of delusional thinking. 

In psychiatry, there is a concept called “The Anomalous Experience Hypothesis.” This hypothesis posits that delusional thoughts are often the product of a search for meaning in bizarre sensory experiences which take the form of hallucinations. 

Other research suggests that hallucinatory experiences can easily become integrated into a delusional belief framework. For example, individuals who hear distant voices murmuring may develop secondary beliefs that people are trying to break into their home or spy on them from outside.

This is where reality testing can be very helpful. Most individuals with schizophrenia or psychosis have had the experience, especially in the early days of their illness, where they have asked a friend or family member if they are hallucinating. This is the most common form of reality testing used today. Unfortunately, many individuals don’t have optimal familial support, and don’t have a trusted person to help them reality test.  Further, many individuals don’t enjoy asking friends or family if they may be hallucinating out of fear of stigma, being hospitalized, or forced into higher levels of treatment. Finally, when symptoms worsen, often our paranoia can make us skeptical of others feedback on the presence of a hallucination. 

Many people have experienced the feeling of being 95% sure about the reality of a hallucination. But that 5 to 10% of uncertainty can make a big difference overtime. Think about when you’re out with friends at a get together, or at work with colleagues, and you start having auditory or visual hallucinations. This small level of uncertainty in the presence of hallucinations can significantly raise stress levels and distract you from engaging with friends or colleagues.  

This is where mobile technology has become increasingly useful over the past decade. Individuals have started to find that when looking through their phone camera, or when listening to an audio recording of their environment, their hallucination often no longer appears. Bizarre, right?! Today, there are thousands of reports on the popular reddit group “r/schizophrenia” touting the effectiveness of utilizing a mobile phone to reality test. What many individuals enjoy about this form of reality testing is the lack of reliance on external feedback from family or friends. This enables reality testing at any time of day, without stigma or fear of increased treatment.

Today, new companies have emerged that utilize object and sound detection technology to help provide individuals who struggle with identifying hallucinations, a more definitive determination on the presence or absence of a sound or object. One example is the 90Health mobile app, which gives individuals a determination in seconds on whether the system recognizes an object or sound. The app can identify sounds ranging from voices to doorbells, and objects from faces to animals. Further, the system allows individuals to watch a playback video or audio recording to decide for themselves whether they may be hallucinating. 

The promise of new technology for improving reality testing is immense. If individuals can properly identify hallucinations more rapidly as unreal, then they can limit building these hallucinations into their delusional belief systems, potentially reducing long term worsening of delusional thoughts. 

About the Author 

Scott Bernard is a psychosis researcher with the Powers Lab at Yale Medical School, and founder of 90Health. For more information on 90Health’s mobile reality testing app visit: 90Health.com/schizophrenia-app

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