People can be on the best psychotropic medication targeting a mental health disorder and still experience disruptive and paralysing symptoms. These breakthrough symptoms can be voices, delusions, paranoia, anxiety, or perhaps even depressive features that go unchallenged and uncontrolled by medication. Breakthrough symptoms can be very disturbing and demoralising, due to the chronic, sporadic, and their seemingly unpredictable nature.
This type of symptom activation can be triggered by something external. This phenomenon typically occurs when a mental health condition goes untreated for a long time. Whether a person ‘falls out of treatment’ or loses connection to their provider, deems themselves cured, and goes without mental health medication and/or psychotherapy, these are symptoms which take us by complete and total surprise.
In some cases, the person is already symptomatic, and due to being exposed to an extremely traumatic experience, an existing mental health condition becomes exacerbated and symptoms intensify. In other cases, a person can be simply adjusting to new circumstances (such as work, living space or interpersonal conflict) and their existing condition devolves into a more serious mental health diagnosis.
When breakthrough symptoms manifest in our lives, it can be a devastating blow to morale and our hope of recovery. Imagine doing everything at your disposal to heal and you simply continue to experience intrusive and paralysing symptoms. As a therapist, these are the toughest features of a mental health disorder to predict or plan for with our patients. Since these symptoms can be so unpredictable, early identification can be difficult and troublesome for the most seasoned therapist.
Because of this, patients often lose faith in their therapist and treatment team. This is because it can seem to some people experiencing breakthrough symptoms as though their therapist was unable to prepare them adequately for these disturbing and jarring experiences.
To avoid losing patients to disillusionment, which can, in turn, result in their further instability and reactivation of symptoms, it is important to explain to patients in advance, all of the troublesome and problematic possibilities they may experience during their recovery. With this said, patients need to know that, at any time during the lifespan of their mental health diagnosis, they may re-experience severe and possibly upsetting symptoms similar to earlier on in their condition when symptoms were more intense, frequent, and difficult to manage without intensive support and medication.
Psychoeducation will go a long way in helping clients feel less blindsided by their symptoms and at the mercy of their unpredictable nature, which can make it seem like there has been no progress since the onset of their mental health condition. Even more critical, therapists treating breakthrough symptoms can help their patients by proactively establishing an ongoing dialogue around practising coping skills, which target and offset the wake and disruption of new unknown thoughts, feelings, and behaviours.
Breakthrough symptoms can start as early as immediately following discharge from the hospital, from the first onset of a new condition, or anywhere in between, months and years down the line. This is why I teach my patients radical acceptance. Simply stated, when it doesn’t seem like a person’s breakthrough symptoms will go unabated, and ultimately improve over time – the importance of teaching people to deal with what is and what will always be, becomes so important and vital to patients keeping their condition in a healthy perspective.
Patients are more likely to get through the darkest hours of their healing unscathed with psychoeducation and a radical acceptance of their condition. Here are a few other approaches to managing breakthrough symptoms:
- Trigger identification – knowing your potential reactivity to new events, response to unforeseen difficult circumstances, or stimuli
- Reducing the likelihood of being thrown into a jarring unknown – this is when these or any symptoms can be the most paralysing
- Learning to make periodic and strategic course corrections in life when you feel like to are walking down the wrong mental or emotional path
- Staying positive is critical to approaching breakthrough symptoms. There’s no doubt, having the right attitude and creating the right space to reduce their overall impact will, in turn, reduce the harm in your life. Negativity and a poor outlook on your general mental status will only magnify the ripple effect of breakthrough symptoms wreaking havoc in your life.
- Most importantly, approach the treatment of these symptoms like any others. There are no ‘super’ symptoms among mental health disorders like there are superbugs associated with colds and flu. Treat these symptoms like any other acute or chronic problem and adjust the treatment fit if you do not experience relief. Research suggests that breakthrough symptoms are just as treatable as those knocked out and eliminated by medication and psychotherapy.
These symptoms will not persist forever. Over time, the frequency and intensity of breakthrough symptoms should be less chronic and severe as you begin to manage your recovery and experience healing from its trauma. Remembering to be even more vigilant in staying focused in your recovery, given the vulnerable aspects of your symptoms, will go a lot further than fearing their chronicity and ongoing future occurrences. Some of us are a little more susceptible to setbacks when dealing with breakthrough symptoms. These setbacks can be waiting just around the corner, so don’t tempt fate, and continue walking the path of healing and recovery at all times.
Max E. Guttman, LCSW is a psychotherapist and owner of Recovery Now, a mental health private practice in New York City.