Reality checking techniques

Experiencing psychosis can be frightening and disorienting, both for the person going through it and for those supporting them. Psychosis can involve hallucinations (seeing, hearing, or sensing things that aren’t there), delusions (strong beliefs that don’t match reality), or a general sense of confusion about what’s real. Experiencing psychosis doesn’t reflect who you are as a person.

If you are experiencing psychosis, there are a few things you can do in the moment to help reduce distress and regain a sense of stability. One commonly used in-the-moment technique is called reality checking. It can work well alongside other strategies, like distraction or grounding. For example, checking the time can double as both a reality check and a grounding activity.

What is reality checking?

Reality checking is the process of gently testing what you’re experiencing against what you know is true. It won’t make symptoms disappear, but it can help create a small amount of distance between you and what you’re experiencing and reduce feelings of fear and confusion in the moment.

Reality checking works best when it’s done gently and without judgement. The goal is to create a small reference point that you can hold on to as true; it’s not to argue with yourself or dismiss what you’re experiencing.

6 Ways to reality check

Question and challenge your worries

Some questions you could ask yourself are:

• • What would I say to someone who came to me with a similar worry?
  • Have I talked to other people about my worries and suspicious thoughts?
  • Are my worries based on events that could be viewed in different ways?
  • Are my worries based on my feelings rather than evidence?
  • Is there any evidence against my beliefs?

Gently test your worries

If a worry is causing you to avoid certain places, people, or situations, you can gradually test it in a safe and manageable way, once you’ve thought it through using the questions above.

Start small and build up the testing as you become more comfortable. For example, if you’re worried about leaving your home, you could begin by stepping outside for a few minutes, then gradually increase the distance or time away from your home.

Only test worries in ways that keep you physically safe and don’t put you in danger or intense distress. If a worry involves feeling unsafe around someone, it’s better to talk it through with a trusted person or professional than to test it directly. Keep a note of what you expected to happen and what actually happened, to help you reflect on whether your fears were supported by what happened in reality

Keep a diary

It can help to keep a diary of your thoughts and how you’re feeling.

You could record:

• What your worries are
• When you have them
• How you feel about them
• How often you think about them

You could do this in a notebook or use an app on your phone. It might help to give a thought a number from 1 to 10 to show how strongly you believe it and how distressing you find it.

This may help you to:

• Identify what might be triggering these thoughts and when you’re most likely to experience them
• Recognise worries when they happen so that it can become easier to  question and challenge them
• Think about what has helped in the past

Contact someone you trust

Reality checking techniques can be hard to follow, use and believe when you’re experiencing psychosis. Sometimes reaching out to someone you trust can help. This might be a family member, friend, a medical professional like your GP, or a helpline. Speaking to or spending time with someone you trust can be calming, even without talking about what’s happening.

When speaking to someone:

• You can ask them whether something is happening. Hearing a calm and honest answer from someone you trust can be reassuring
• Let them know beforehand what support is helpful, such as sitting with you, distracting you, or helping you reality check your thoughts
• Keep a short list of trusted people and their contact details somewhere easy to find, so you can access support without having to search for it during a difficult episode

Check the time or date

Look at a clock, your phone, or a calendar to help anchor you in the present moment.

Recall a fact you’re certain of

This might be your address, your age, the day of the week, or something stable that doesn’t change no matter what else is happening. Reality checking is meant to help manage distress in the moment, but it does not replace professional support.

Reach out for help if:

• Distress is getting worse rather than easing, even after reality checking
• You feel unsafe, or unable to keep yourself safe
• This is a new experience, or symptoms are escalating quickly
• You have thoughts of harming yourself or someone else

Supporting someone experiencing psychosis

If someone you know is reality checking, you can help by:

• Answering honestly and calmly. If someone asks you whether or not something is happening, a calm and concise answer is often more reassuring than a long explanation.
• Never mock or dismiss the worry. Even if a worry or belief seems untrue, it is important to remember that it feels real to the person experiencing it. Feeling dismissed can make things harder.
• Let them lead. The person may want you to sit quietly, distract them, reality check with them, or help them talk through a worry. It is important to ask them what they feel would help rather than assuming.
• Knowing when to seek help. If you’re worried about their safety or the situation is escalating, contact their GP, a helpline, or emergency services.

Feeling overwhelmed and want to talk to someone?

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