Definition: Disruption in cognitive operations and activities.

Copyright © 2008 by F.A. Davis Company

Possible Etiologies ("related to")

[Inability to trust]
[Panic level of anxiety]
[Repressed fears]
[Stress sufficiently severe to threaten an already weak ego]
[Possible hereditary factor]

Defining Characteristics ("evidenced by")

[Delusional thinking (false ideas)]
[Inability to concentrate]
[Altered attention span].distractibility
Inaccurate interpretation of the environment
[Impaired ability to make decisions, problem-solve, reason, abstract or conceptualize, calculate]
[Inappropriate social behavior (reflecting inaccurate thinking)]
Inappropriate non-reality-based thinking


Short-Term Goal

By the end of 2 weeks, client will recognize and verbalize that false ideas occur at times of increased anxiety.

Long-Term Goal

Depending on chronicity of disease process, choose the most realistic long-term goal for the client:
  1. By time of discharge from treatment, client will experience (verbalize evidence of) no delusional thoughts.
  2. By time of discharge from treatment, client will be able to differentiate between delusional thinking and reality.

Interventions with Selected Rationales

  1. Convey your acceptance of client's need for the false belief, while letting him or her know that you do not share the belief. It is important to communicate to the client that you do not accept the delusion as reality.
  2. Do not argue or deny the belief. Use reasonable doubt as a therapeutic technique: "I find that hard to believe." Arguing with the client or denying the belief serves no useful purpose, because delusional ideas are not eliminated by this approach, and the development of a trusting relationship may be impeded.
  3. Help client try to connect the false beliefs to times of increased anxiety. Discuss techniques that could be used to control anxiety (e.g., deep breathing exercises, other relaxation exercises, thought stopping techniques). If the client can learn to interrupt escalating anxiety, delusional thinking may be prevented.
  4. Reinforce and focus on reality. Discourage long ruminations about the irrational thinking. Talk about real events and real people. Discussions that focus on the false ideas are purposeless and useless, and may even aggravate the psychosis.
  5. Assist and support client in his or her attempt to verbalize feelings of anxiety, fear, or insecurity. Verbalization of feelings in a nonthreatening environment may help client come to terms with longunresolved issues.

Outcome Criteria

  1. Verbalizations reflect thinking processes oriented in reality.
  2. Client is able to maintain activities of daily living (ADLs) to his or her maximal ability.
  3. Client is able to refrain from responding to delusional thoughts, should they occur.