1. A cognitive science based understanding of spirituality offering a less stigmatizing clinical approach to psychosis. Isabel Clarke Consultant Clinical Psychologist Southern Health NHS Foundation Trust.

2. Two Ways of Knowing Subjective, knowing by experience –Relationship –Emotion –Beauty –Spirituality – everything really important! Objective, knowing about –Science –Precision –Assumption that it is the only ‘true’ knowledge Where the two ways of knowing become distinct, we get a different quality of experience

3. The levels of processing problem Being human is difficult because our brains have 2 main circuits – they work together most of the time, but not always. There is one direct, sensory driven type of processing and a more elaborate and conceptual one. The same distinction can be found in the memory. Direct processing is emotional and characterised by high arousal. The other one filters our view to make it more manageable The direct processing system is the default system – the one that dominates if the other gets disconnected – in which case we lose that filter – and land up ACROSS THE THRESHOLD –THE TRANSLIMINAL

5. Getting a scientific grip on the transliminal The transliminal can be experienced like another reality, another world – this comes from the split in us! Interacting Cognitive Subsystems provides a way of making sense of this split. (Teasdale & Barnard 1993). –An information processing model of cognition –Developed through extensive research into memory and limitations on processing. –A way into understanding the “Head/Heart split in people.

6. Body State subsystem Auditory ss. Visual ss. Interacting Cognitive Subsystems. Implicational subsystem Implicational Memory Propositional subsystem Propositional Memory Verbal ss.

7. Linehan’s STATES OF MIND (from Dialectical Behaviour Therapy) – Maps onto Interacting Cognitive Subsystems REASONABLE MIND ( Propositional subsystem) EMOTION MIND ( Implicational subsystem) IN THE PRESENT IN CONTROL WISE MIND WISE MIND

8. Important Features of this model Our subjective experience is the result of two overall meaning making systems interacting – neither is in control. Each has a different character, corresponding to “head” and “heart”. The IMPLICATIONAL Subsystem manages emotion – and therefore relationship. The verbal, logical, PROPOSITIONAL ss. gives us our sense of individual self.

9. Two Ways of Knowing Good everyday functioning = good communication between implicational/relational and propositional At high and at low arousal, the implicational ss becomes dominant This gives us a different quality of experience – one that can be either valued and sought after, or shunned and feared

10. The Everyday The Transliminal Ordinary Clear limits Access to full memory and learning Precise meanings available Separation between people Clear sense of self Emotions moderated and grounded A logic of ‘Either/Or Numinous Unbounded Access to propositional knowledge/memory is patchy Suffused with meaning or meaningless Self: lost in the whole or supremely important Emotions: swing between extremes or absent A logic of ‘Both/And’

11. A Challenging Model of the mind The human being is a balancing as the two organising systems pass control back and forth: there is no boss. The mind is simultaneously individual, and reaches beyond the individual, when the implicational ss. is dominant. This balancing act between logic and emotion gives us human fallibility The self sufficient, atomistic, mind is an illusion In our implicational/relational mode we are a part of the whole.

12. Web of Relationships Self as experienced in relationship with primary caregiver Sense of value comes from rel. with the spiritual primary care-giver In Rel. with wider group etc. In Rel. with earth: non humans etc.

13. Unpacking the Web We learn about ourselves from the way the important people around us treat us from babyhood on. The function of emotions is the organisation of relationship: relationship with others, but also our relationship with ourselves. Emotions communicate directly between people, bypassing the verbal-logical (they are catching).

14. Looking Beyond the Individual – to understand Spirituality We are defined by relationships that go beyond our current human bonds These include relationship with our ancestors and those who will come after us Moving out to relationship with our group, nation, other peoples, humanity Our relationship with the non human creatures is deep and significant for us

15. Taking Experience Seriously in Psychosis Acknowledging that psychosis feels different Normalising the difference in quality of experience as well as the continuity Positive side as well as vulnerability Helping people to manage the threshold – mindfulness is key Sensitivity and openness to anomalous experience – continuum with normality: Gordon Claridge’s Schizotypy research. Understanding the role of emotion – where expression of emotion is not straightforward.

16. Evidence for a new normalisation Schizotypy – a dimension of experience: Gordon Claridge. Mike Jackson’s research on the overlap between psychotic and spiritual experience. Emmanuelle Peter’s research on New Religious Movements. Caroline Brett’s research: having a context for anomalous experiences makes the difference between whether they become diagnosable mental health difficulties and whether the anomalies/symptoms are short lived or persist. (New chapters by Brett and Jackson in Psychosis and Spirituality: consolidating the new paradigm – along with new qualitative research) Wider sources of evidence – e.g.Cross cultural perspectives; anthropology. Richard Warner: Recovery from Schizophrenia.

17. Part of a 3 rd Wave, Holistic Revolution in Psychosis Recognising the role of arousal (Hemsley, Morrison) Importance of emotion (Gumley & Schwannauer: Chadwick) Attachment and interpersonal issues (“) Mindfulness - Chadwick Self acceptance and compassion (“ + Gilbert):Self esteem, (Harder). Recognition of the role of Loss and Trauma The Recovery Approach. All these lead to a blurring of diagnosis

18. The What is Real and What is Not Programme First : Form an Alliance. Validate their reality – shared and unshared reality Away from illness language – diagnosis Normalising openness to unshared reality – idea of the schizotypy spectrum Advantages and disadvantages of openness to unshared reality – positive role models Idea of the line/ the threshold. Importance of being able to manage the line Motivational aspect – pros and cons. Coping skills to manage the line Arousal management – up and down Grounding in the present Wise mind and mindfulness Focusing/mindfulness v. distraction

19. Session 2. The role of Arousal shaded area = anomalous experience/symptoms are more accessible. Level of Arousal Ordinary, alert, concentrated, state of arousal. Low arousal: hypnagogic; attention drifting etc. High Arousal - stress

21. Making sense of the experience Discussion: Why do people click into/get lost in unshared reality/the transliminal? Different meanings for the experience Meaning for the individual Place in their life – what was happening in their life when it all started? Address and validate the emotion – that is reliable. 'Problem Solving' idea – Mike Jackson’s research. Touching on the transformative potential of the transliminal.

22. Evaluation project 31 participants in 14 groups over a 6 month period. Before and after measures and satisfaction questionnaire. Mental Health Confidence Scale – increase in confidence, significant for coping Significant Increase in idiographic goal attainment CORE – not sig. but trend in right direction.

23. Comments Q3: Has it made you think differently about anything? If so, please tell us about this. ‘I feel clearer about what’s real and what’s not, what to share and what is personal’ ‘Yes without a doubt. I feel better about myself’ ‘That I can take control of myself’ Q4: Please tell us what, if anything, has changed in the way you think about your mental health issues since attending the group. ‘Yes, I am thinking of more positive things about my life’ ‘I have now realised that I in-fact do have a problem’ In answer to questions about coping strategies, participants identified mindfulness and breathing as the most helpful

24. Contact details, References and Web addresses Isabel.Clarke@southernhealth.nhs.uk AMH Woodhaven, Calmore, Totton SO40 2TA. Clarke, I. (Ed.) (2010) Psychosis and Spirituality: consolidating the new paradigm. Chichester: Wiley Clarke, I. ( 2008) Madness, Mystery and the Survival of God. Winchester:'O'Books. Clarke, I. & Wilson, H.Eds. (2008) Cognitive Behaviour Therapy for Acute Inpatient Mental Health Units; working with clients, staff and the milieu. London: Routledge. www.SpiritualCrisisNetwork.org.uk www.isabelclarke.org