#psychoeducation

I'm not entirely sure if I've correctly interpreted your question, but I will do my best to answer it!

So, I did a little research, as I don't often have information on hand, and it seems to me that the line between psychosis and unusual perceptual experiences (UPEs) is a bit blurred? They are similar, but they are two dichotomous experiences, meaning you cannot experience both at the same time.

First, we have to define what psychosis and UPEs are. Psychosis is the experience of "hallucinations (perception of stimuli that do not exist) and/or delusions (beliefs maintained despite being contradicted by reality)"*. Perception is "the organisation, identification and interpretation of sensory stimuli to process the environment". This can "manifest as UPEs whereby individuals interpret stimuli incorrectly, thus resulting in distortions".**

More simply: UPEs are distortions in interpretations of stimuli, while psychosis is a state of detachment from reality. UPEs are also usually more transient - temporary - and don't as severely impact the person with them as psychosis, understood in the way that during UPEs, a person is able to maintain a sense of rationality and recognition that what they are experiencing may not be real, while those with psychosis may not be able to do so.

This post in the r/Schizotypial subreddit may also be helpful: Hallucinations vs Unusual Perceptual Experiences : r/Schizotypal

So, during psychosis, the one experiencing it is strongly of the belief that what they are experiencing is real, while the one experiencing UPEs is able to maintain a stable sense of reality and acknowledge that their experience(s) might not be real and instead a product of their brain incorrectly interpreting stimuli.

I hope that makes sense, but please feel free to ask more questions if you have any! Lastly, I will link to some websites that can (hopefully) expand on what psychosis symptoms and UPEs (referred to as anomalous experiences on Wikipedia) can look like.

Psychosis and Unusual Experiences Resources

Anomalous experiences

Schizotypal traits and anomalous perceptual experiences are associated with greater visual temporal acuity (PDF) <- I have yet to read this myself, but I skimmed it and it might be an interesting read!

The Healing Potential of Anomalous Perceptual Experiences by Dr. Andrew Powell (PDF) <- Again, I have not read this in full, but it includes "four clinical examples of anomalous perception" and contemplates what "reality" may mean. Please note that it contains mentions of death and SA in the clinical examples.

References/sources for the quotes and descriptions below the cut:

Because when we talked about diagnoses and stuff, she said, repeatedly, that it was overdiagnosed, and it was me pointing out that it might be overdiagnosed IN BOYS but it’s definitely underdiagnosed in girls and women that got her to correct what she was saying. Btw, the group consisted, if I remember correctly, of two men, one nb person, and about 8-9 women.

Then we came to collecting ideas about what can help dealing with ADHD. I read @thebibliosphere, so I had some ideas, but apparently removing the doors to your kitchen cabinets is “a bit extreme”. And the most important is “planning and organizing”. Now I’m not an expert, but I believe that if they were able to plan and organize, they wouldn’t have ADHD.

(I know, this is basically coming out of nowhere. I do humbly apologise 😂)

I am such a huge fan of the Inside-Out movies, and I was so excited to go and see the sequel in cinemas – and I have to say, it did not disappoint. The writers and the creators REALLY did their research, which showed up so clearly in so many exciting ways.

If you will indulge me, I would love a moment of your time to bring attention to each of the psychological and psychoeducational concepts alluded to, referred to, and discussed in Inside Out 2:

Emotional messages 

Something that the first film did perfectly, was introducing the idea that every emotion exists to communicate a message. Emotions are quite literally messages from the brain, giving us information about the environment and situations around us: 

The above are some of the more important emotions when it comes to survival, but I suspect that Ennui was added for comedy (they were a great addition, in fairness!), and Envy was added to remind the viewer of a key part of the teenage experience; the importance of fitting in, and belonging to a ‘tribe’. 

From an evolutionary perspective, it is extremely important for all humans to be part of a ‘tribe’. Banding together led to the best chances of survival; from protecting each other from predatory tigers (and other tribes), to sharing resources and food with each other. 

Therefore, we have developed emotions like Shame/Embarrassment and Envy to help motivate us to remain part of the tribe. At the core, all our brain wants is for us to survive.

Fear vs Anxiety 

When the second film was announced, along with the character Anxiety, I admit that I initially offered criticism of this, based on the fact that anxiety is very much a subset of fear.  

But Anxiety perfectly explained that Fear appears based on the things that can be seen, whereas Anxiety is the fear of things that can’t be seen. 

Anxiety was very convincing in her justification that she “plans for the future”, convincing both the characters and the audience that she really did know better for Riley, when actually, we have to remind ourselves that while our brains can be good at coming up with potential scenarios to prepare for, our thoughts are not facts.  

Let me say that again: thoughts are not facts. 

This was brilliant to see on screen, because anxiety can almost make us feel like we are predicting the future, when in fact, our brains may be ‘catastrophising’. Inside Out did a great job of showing us catastrophising in action, when it showed Anxiety putting a lot of mind-workers to the task of thinking up dozens of worst case scenarios. She justified it by saying that she wanted Riley to be ‘prepared’ and ‘happy’, but Joy herself knew that it was harmful because it stopped Riley from getting any sleep!  

Window of Tolerance 

This is concept is very widely used in Emotional Literacy 101, so I won’t give a full explanation of this, because it can get long and confusing, but you can watch a brilliant video explanation here.

In short, the “Window of Tolerance” is a psychoeducation term to describe the internal ‘window’ in which we can tolerate uncomfortable emotions and sensations. This window is sometimes also known as the ‘Green zone’, where we can think rationally, react calmly, and make decisions. (Note: It does not necessarily mean that being in the Green Zone makes us happy or calm, just that we can tolerate our more unpleasant emotions.) 

If a situation is too uncomfortable or distressing, this can take us outside of our Window of Tolerance, and we will automatically either be in ‘Fight or Flight’ (what psychologists would call the ‘Red Zone’) or ‘Freeze’ mode (otherwise known as ‘Blue Zone’). 

When the builders moved into Riley’s mind and updated the console, this very much narrowed Riley’s Window of Tolerance, which meant that it was harder for her to tolerate her emotions: A button pressed by Anger turned into instant rage. Sadness accidentally activated a state of despair. And Disgust turned into actual loathing.  

Although not explicitly named in the film, I loved the allusion to the Window of Tolerance, illustrating just how uncomfortable emotions can become when we reach puberty, and highlighting that every teenager is learning to adjust their Window of Tolerance.  

Helpful vs Unhelpful emotions 

This was such a small mention in the film, but I loved it anyway. Joy tried to reassure the basic emotions about Anxiety’s presence by saying “I know sometimes they can feel unhelpful...”, before noting that she managed to improve her understanding of Sadness.  

When giving psychoeducation about emotion management, we always try to move away from viewing emotions as positive/negative, and more towards helpful/unhelpful, because the truth is that emotions can be more or less helpful depending on the situation and what the message of the emotion is telling us.  

Imagine we are in a dark forest at night – this is when fear would be really helpful! By keeping us alert and on our toes, we can be better prepared for any potential danger. The same can be said for waiting for an interview – a little dose of anxiety can actually help us perform better in stressful situations (look up the Yerkes-Dodson curve).  

An emotion stops being helpful when it starts to cause harm to us, or when it doesn’t match the situation that we are in. For example, going food shopping in the supermarket, when we are suddenly struck with overwhelming anxiety, that stops us from being able to get food. In this situation, it is wholly unhelpful, because it stops us from functioning in a normal way.  

In Inside Out 2, Anxiety became an unhelpful emotion, because she stopped Riley from sleeping, from enjoying her favourite hobby, and created a panic attack.

Beliefs 

This concept is popularly used in Cognitive Behavioural Therapy: Whether they are aware of it or not, everybody has subjective beliefs about themselves, the world, and other people around them, and these beliefs would have been entirely formed by experience and development. 

For example, a child who grows up in an environment that is healthy and safe, with parents who are loving and nurturing, will have formed generally positive beliefs about themselves, others, and the world around them: 

I am good. I am strong. I am worthy. I am loveable. 

Others are good natured. Others can help me. Others are trustworthy. 

The world is a good and fair place.  

These form part of our core beliefs. 

In contrast, when a child grows up in an unstable environment, doesn't often get their needs met, and their parents are inconsistent and unreliable, their core belief system will adapt to integrate these beliefs into their understanding of the world. This is also the case for children who grow up in abusive environments, whose parents may even be overtly harmful or destructive, and this will creative adaptive beliefs: 

I am bad. I am weak. I am unworthy. I am unlovable. 

Others can’t be trusted or relied on. Others can hurt me.  

The world is unjust and unfair, and isn’t a safe place. 

(Image is from Beck's Cognitive Triad)

Joy took Sadness and the viewers on a journey to the Core Belief system, and even showed a few examples of Riley’s positive self-concept (“I am a good person”).  

However, when Anxiety flooded the Core Belief system with hand-picked memories from Riley’s more anxious moments, Riley’s core belief system adapted, and created a new core belief: “I’m not good enough.”  

In Riley’s case, she does have strong attachments with her parents, and with her friends, but in that time frame where her strong attachment to her friends was threatened, even Riley was susceptible to developing negative self-beliefs.  

I personally loved this touch, because it really just goes to show how complex and multi-faceted human beings are. There are no people who are just ‘positive’ or just ‘negative’, but instead we all have a mix of core beliefs working together to create our sense of self.  

Attachment 

I touched on this briefly when talking about Core Beliefs, but attachment theory is an important framework to understand child development and human interpersonal relationships. Overall it’s a huge topic and I won’t go into too much detail on it (you can read more here), but in both Inside Out films, it is very clear that Riley has a strong and secure attachment to her parents - as evidenced by her resilient and positive self-concept.

I enjoyed that even though Riley demonstrates a secure attachment style (you can read about the different styles here), she is still susceptible to negative core beliefs: this is reflective of how humans are, that nobody is perfect, no parenting style is immune to outside influence, and it is still possible to carry both positive and negative self-concepts no matter what style of attachment we may have. 

However, I will emphasise that secure attachment by itself is also a protective factor for developing a healthy self-concept.

Psychology jokes 

Just for fun, because I like it and/or they made me laugh:

Emotional baggage: Anxiety arrived to headquarters carrying mountains of suitcases.

Bottling up emotions: When Anxiety literally puts Joy, Anger, Sadness, Disgust and Fear into a bottle to repress them. 

Brain Storm: self-explanatory, and oh so fun.

Sar-chasm: self-explanatory, and comedic genius. 

Overall I really enjoyed both the Inside Out films, but Inside Out 2 is a masterpiece of bringing psychological concepts to the everyday audience. It’s so clear how much love and work they put into the film. It made me cry -  and to me, that’s equivalent to a 10/10 rating.

Welcome to part one of my series, Flavours of Autism, and my big, feisty feelings around the gatekeeping of autism diagnoses.

Depending on where you live, you’re forced to pay an inordinate sum for a private assessment, wait years for a publicly funded one, or worse, both. Some adults, like me, get lucky and skip the line due to a preexisting relationship with a qualified diagnostician. Unlike most kids, some get lucky and skip the line because their school already has one.

But what breaks my heart entirely is when autistic folks arrive for their assessment and fail to receive diagnoses due to a lack of knowledge and language to describe their lived experience. Not to mention that many symptoms of autism can interfere with the assessment process — and don’t get me started on how gender influences the likelihood of receiving a diagnosis and accurate assessment.

In my most professional, clinical opinion, I consider the process an absolutely abysmal bunch of rotten bananas — and sadly, my hands are mostly tied as a Registered Clinical Counsellor in BC, Canada. RCCs cannot diagnose, but we can provide specialized therapy and recognize, refer, and support clients throughout their journey. Not-so-recently, I realized this isn’t enough to bridge the gap, but through the wise words of the millennial icon, Junie B. Jones, I can assure you “that didn’t even faze me.”

I remain unphased because it is within my scope to disseminate and share what I know and continue to learn. I hope anyone encountering my content can use it to support themselves or others in preparing for their autism assessment. It’s overflowing with all the psychobabble and clinical jargon that might stand between them and an accurate assessment. Education is power, baby.

My words, this article, and the Flavours of Autism series are not a substitute for professional mental health advice or support, such as connecting directly with a psychotherapist or psychiatrist. Moreover, while it’s important to honour and explore your lived experience, reading and resonating with this article does not diagnose you or anyone else with autism, nor mean you or anyone else is autistic.

1. Monotropism

Monotropism refers to an intense focus on one interest or task at a time. Autistic individuals with monotropism may find it difficult to switch their attention between tasks. This deep, single-minded concentration can lead to exceptional expertise in their area of interest. However, it can also cause challenges when adapting to new activities or demands. Understanding monotropism can help create supportive environments that honour their focus while gently encouraging flexibility.

2. Echolalia

Echolalia involves the repetition of words or phrases spoken by others. This can be immediate, where the repetition happens right after hearing the words, or delayed, occurring hours or even days later. Echolalia is often a way for autistic individuals to process language, learn speech patterns, or communicate their needs. Recognizing echolalia as a meaningful communication attempt rather than mere imitation is important.

3. Idiosyncratic Phrases

Autistic individuals might use unique or unconventional phrases that hold personal meaning. These idiosyncratic phrases can confuse others but are significant to the individual. They may stem from specific interests, favourite media, or personal experiences. Understanding these phrases requires patience and a willingness to learn their context and significance.

4. Issues with Interoception

Interoception is the ability to sense internal bodily states like hunger, thirst, or temperature. Autistic individuals might struggle with interoception, making it hard to recognize and respond to their bodily needs. Interception issues can also lead to increased sensitivity to bodily states. This can lead to challenges in maintaining regular eating, drinking, and temperature regulation. Awareness and support in recognizing these internal cues are crucial for well-being.

5. Issues with the Vestibular System

The vestibular system, responsible for balance and spatial orientation, can be problematic for some autistic individuals. Difficulties with the vestibular system may result in coordination, balance, and movement challenges. This can affect daily activities like walking, running, or participating in sports. Occupational therapy and other supportive measures can help improve vestibular function and coordination.

6. Motor Tics

Motor tics are involuntary, repetitive movements such as blinking, twitching, or jerking. These tics can vary in intensity and frequency, sometimes becoming more noticeable during periods of stress or excitement. While motor tics are generally harmless, they can be distracting or socially stigmatizing. Understanding and accommodating these tics can help create a supportive environment.

7. Vocal Tics

Like motor tics, vocal tics involve involuntary sounds or noises like grunting, coughing, or throat clearing. These tics can be frequent and disruptive, affecting communication and social interactions. Recognizing vocal tics as involuntary behaviours and providing supportive responses can help reduce the individual’s anxiety and stress.

8. Repetitive Motor Movements

Repetitive motor movements, often called “stimming,” include hand-flapping, rocking, or spinning. These self-stimulatory behaviours are used to self-soothe, manage sensory input, or express excitement. While stimming is a natural and important behaviour for many autistic individuals, it might need to be managed in certain settings to ensure safety and social comfort.

9. Masking

Masking involves suppressing or hiding autistic traits to fit in socially. This can be exhausting and lead to significant stress or burnout over time. Masking often requires constant monitoring of one’s behaviour to meet social expectations, which can be mentally draining. Recognizing and validating the effort behind masking can lead to better support and understanding.

10. Camouflaging

11. Sensory Sensitivities

Sensory sensitivities refer to over- or under-reactivity to sensory input such as lights, sounds, textures, or smells. Autistic individuals may experience sensory overload or actively seek certain sensory experiences to regulate their sensory input. Understanding these sensitivities and creating accommodating environments can significantly improve comfort and functionality.

12. Executive Function Challenges

Executive function challenges include difficulties with planning, organizing, and completing tasks. These challenges can impact daily activities, academic performance, and time management. Supportive strategies, such as breaking tasks into smaller steps and using visual schedules, can help improve executive function skills.

13. Social Communication Differences

Social communication differences involve challenges with understanding and using verbal and nonverbal communication. This may include difficulties with eye contact, interpreting body language, or understanding social cues. Providing clear, direct communication and allowing extra time for processing can enhance social interactions.

14. Issues with Emotional Regulation

Emotional regulation refers to the ability to manage and respond to emotions appropriately. Autistic individuals might experience intense emotional reactions and find it hard to calm down. Developing coping strategies and providing a supportive environment can aid in better emotional regulation.

15. Aphantasia

Aphantasia is the inability to visualize images in the mind. People with aphantasia do not create mental pictures and may rely on other senses to process information. This condition can affect memory and imagination but also encourages unique ways of thinking and problem-solving.

16. Hyperlexia

Hyperlexia is characterized by advanced reading ability at a young age, often coupled with difficulties understanding spoken language. Autistic individuals with hyperlexia might have a strong interest in letters and numbers. Recognizing and supporting this unique learning style can help harness their reading skills effectively.

17. Alexithymia

Alexithymia involves difficulty in identifying and describing one’s own emotions. This can lead to challenges in emotional expression and understanding others’ emotions. Providing tools and strategies for emotional awareness and expression can improve communication and emotional health.

18. Dyspraxia

Dyspraxia, also known as Developmental Coordination Disorder (DCD), affects motor skill development. This can lead to clumsiness and difficulties with tasks requiring coordination. Occupational therapy and targeted exercises can help improve motor skills and daily functioning.

19. Hyperfocus

Hyperfocus is the intense concentration on a task or interest to the exclusion of everything else. While this can be highly productive, it may cause neglect of other responsibilities. Balancing hyperfocus with scheduled breaks and reminders can enhance productivity and overall well-being.

20. Synesthesia

21. Issues with Proprioception

Proprioception refers to the sense of body position and movement. Issues with proprioception often arise as an increased or decreased sensitivity in specific situations. These challenges typically affect coordination and spatial awareness. Exercises and physical therapies that enhance proprioceptive feedback can improve movement and balance.

22. Auditory Processing Disorder (APD)

Auditory Processing Disorder (APD) involves difficulty processing and interpreting auditory information. Individuals with APD may struggle to distinguish similar sounds or understand spoken language in noisy environments. Supportive strategies include using visual aids and ensuring a quiet learning environment.

23. Tactile Defensiveness

Tactile defensiveness is a strong negative reaction to touch or certain textures. This can lead to discomfort with certain fabrics, foods, or physical contact. Gradual exposure and sensory integration therapies can help reduce tactile defensiveness and improve comfort.

24. Selective Mutism

Selective mutism is the inability to speak in certain social situations despite being able to speak in others. Often linked to anxiety, it can be seen in social or unfamiliar settings. Creating a supportive and low-pressure environment can encourage communication.

25. Rigid Thinking

Rigid thinking involves difficulty in adapting to changes or seeing different perspectives. Autistic individuals may prefer routines and struggle with unexpected events or new ideas. Encouraging flexibility and gradual exposure to change can help ease rigid thinking patterns.

26. Sleep Difficulties and Disorders

Sleep disorders include difficulty falling, staying, or maintaining a regular sleep schedule. Common in autistic individuals, these disorders can impact daily functioning. Establishing a consistent bedtime routine and creating a calming sleep environment can improve sleep quality.

27. Anxiety Issues and Disorders

Anxiety disorders involve high levels of anxiety that can interfere with daily life. This may include social anxiety, generalized anxiety, or specific phobias. Counselling, coaching, psychotherapy, and other anxiety management strategies can provide relief and improve quality of life.

28. Depression

Depression involves persistent feelings of sadness, hopelessness, or loss of interest. It can affect mood, energy levels, and overall well-being. Seeking professional help and building a supportive network are crucial steps in managing depression.

29. Avoidant/Restrictive Food Intake Disorder (ARFID)

ARFID involves extreme avoidance of certain foods, leading to nutritional deficiencies and weight issues. It is not driven by body image concerns but by sensory sensitivities, which are common in autism spectrum disorder (ASD). Autistic individuals may avoid foods based on texture, colour, or smell. Understanding ARFID involves recognizing these sensory challenges. Supportive strategies include working with dietitians or therapists to expand food choices and address anxieties. Providing a supportive environment can help improve nutrition and reduce food-related stress.

30. Twice-Exceptional (2e)

Here’s hoping this was helpful and that you’re satiated for now. Learning more about autism, the autistic experience, its nuances, and controversies is a labyrinth. However, I’ll always argue that it’s a worthwhile journey. Plus, aren’t we autistic folk notoriously partial to puzzles and deep dives?

Imposter Syndrome can take over our lives and make us see ourselves like a completely different person.

Bipolar I disorder applies to people who have experienced an episode of mania. A majority of people with this diagnosis (though not all) experience an episode of depression at some point as well. Bipolar I is estimated to affect about 0.6 to 1 percent of people during their lifetime.

Bipolar II disorder includes people who have experienced an episode of hypomania as well as an episode of depression. Bipolar II affects about 0.4 to 1 percent of the population.

Cyclothymic disorder is a less severe form of bipolar disorder. It involves frequent fluctuations between manic and depressive symptoms, but they are more sustained and less severe than a manic, hypomanic or depressive episode. Although the symptoms are less intense, the chronic nature of the disorder takes its toll. This disorder is believed to affect up to 2.5 percent of people.