Psychosis is a mental health problem that causes people to perceive or interpret things differently from those around them. This might involve hallucinations or delusions.
The two main symptoms of psychosis are:
– where a person hears, sees and, in some cases, feels, smells or tastes things that aren't there; a common hallucination is hearing voices
delusions – where a person believes things that, when examined rationally, are obviously untrue – for example, thinking your next door neighbour is planning to kill you
The combination of hallucinations and delusional thinking can often severely disrupt perception, thinking, emotion and behaviour.
Experiencing the symptoms of psychosis is often referred to as having a psychotic episode.
What causes psychosis?
Psychosis isn't a condition in itself – it's triggered by other conditions.
It's sometimes possible to identify the cause of psychosis as a specific mental health condition, such as:
schizophrenia – a condition that causes a range of psychological symptoms, including hallucinations and delusions
bipolar disorder – a mental health condition that affects mood; a person with bipolar disorder can have episodes of depression (lows) and mania (highs)
severe depression – some people with depression also have symptoms of psychosis when they're very depressed
Psychosis can also be triggered by traumatic experiences, stress or physical conditions, such as Parkinson's disease, a brain tumour, or as a result of drug misuse or alcohol misuse.
How often a psychotic episode occurs and how long it lasts can depend on the underlying cause.
For example, schizophrenia can be long-term, but most people can make a good recovery, and about a quarter only have a single psychotic episode. Episodes related to bipolar disorder usually resolve, but may reoccur.
You should see your GP immediately if you're experiencing psychotic episodes. It's important that psychosis is treated as soon as possible, because early treatment usually has better long-term outcomes.
Your GP will look at your symptoms and rule out short-term causes, such as drug misuse. They may ask you some questions to help determine what's causing your psychosis. For example, they may ask you:
whether you're taking any medication
whether you've been taking illegal substances
how your mood has been – for example, whether you've been depressed
how you've been functioning day-to-day – for example, whether you're still working
whether you have a family history of mental health conditions – such as schizophrenia
about your hallucinations – such as whether you've heard voices
about your delusions – such as whether you feel people are controlling you
whether you have any other symptoms
Your GP should refer you to a mental health specialist for further assessment and treatment.
Treatment for psychosis involves using a combination of:
antipsychotic medication – which can help relieve the symptoms of psychosis
psychological therapies – the one-to-one talking therapy cognitive behavioural therapy (CBT) has proved successful in helping people with schizophrenia and, in appropriate cases,family therapy has been shown to reduce the need for hospital treatment in people with psychosis
social support – support with social needs, such as education, employment or accommodation
Most people with psychosis who get better with medication need to continue taking it for at least a year. Some people need to take medication long term to prevent symptoms reoccurring.
If a person's psychotic episodes are severe, they may need to be admitted to a psychiatric hospital.
Getting help for others
People with psychosis often have a lack of insight. They're unaware that they're thinking and acting strangely.
Due to their lack of insight, it's often down to the friends, relatives or carers of a person affected by psychosis to seek help for them.
If you're concerned about someone you know and think they may have psychosis, you could contact their social worker or community mental health nurse if they've previously been diagnosed with a mental health condition.
If you think the person’s symptoms are placing them at possible risk of harm you can:
take them to the nearest accident and emergency (A&E)department, if they agree
call their GP or local out-of-hours GP
call 999 and ask for an ambulance
People with a history of psychosis are much more likely to have drug and/or alcohol misuse problems.
This may be because such substances can provide short-term symptom relief, although they usually make symptoms worse in the long term.
People with psychosis also have a higher than average risk of suicide. It's estimated that 1 in 5 people with psychosis will attempt to commit suicide at some point in their life, and 1 in 25 people with psychosis will kill themselves.
Side effects can also occur if taking antipsychotics on a long-term basis. Weight gain is a common side effect. In rare cases, a person with psychosis may also develop type 2 diabetes.
Symptoms of psychosis
Someone who develops psychosis will have their own unique set of symptoms and experiences, according to their particular circumstances.
However, four main symptoms are associated with a psychotic episode. They are:
confused and disturbed thoughts
lack of insight and self-awareness
These are outlined in more detail below.
Hallucinations are where a person perceives something that doesn't exist in reality. They can occur in all five of the senses:
sight – someone with psychosis may see colours and shapes, or people or animals that aren't there
sounds – someone with psychosis may hear voices that are angry, unpleasant or sarcastic
touch – a common psychotic hallucination is that you are being touched when there is no-one there
smell – usually a strange or unpleasant odour
taste – some people with psychosis have complained of having a constant unpleasant taste in their mouth
A delusion is where a person has an unshakeable belief in something implausible, bizarre or obviously untrue.
Paranoid delusion and delusions of grandeur are two examples of psychotic delusions.
A person with psychosis will often believe that an individual or organisation is making plans to hurt or kill them. This can lead to unusual behaviour.
For example, a person with psychosis may refuse to be in the same room as a mobile phone because they believe they are mind-control devices.
Someone with psychosis may also have delusions of grandeur. This is where they believe they have some imaginary power or authority.
For example, they may think that they're the president of a country or that they have the power to bring people back from the dead.
Confused and disturbed thoughts
People with psychosis often have disturbed, confused and disrupted patterns of thought.
Signs of this include:
rapid and constant speech
random speech – for example, they may switch from one topic to another mid-sentence
a sudden loss in their train of thought, resulting in an abrupt pause in conversation or activity
Lack of insight
People who have psychotic episodes are often totally unaware their behaviour is in any way strange, or that their delusions or hallucinations are not real.
They may recognise delusional or bizarre behaviour in others, but lack the self-awareness to recognise it in themselves.
For example, a person with psychosis being treated in a psychiatric ward may complain that their fellow patients are mentally unwell, while they're perfectly normal.
Postnatal psychosis, also called puerperal psychosis, is a severe form of postnatal depression (a type of depression some women experience after having a baby).
It's estimated that postnatal psychosis affects around 1 in every 1,000 women who give birth. It most commonly occurs during the first few weeks after having a baby.
Postnatal psychosis is more likely to affect women who already have a mental health condition, such as bipolar disorder or schizophrenia.
As well as the symptoms of psychosis (see above), symptoms of postnatal psychosis can also include:
a high mood (mania) – for example, talking and thinking too much or too quickly
a low mood – for example, depression, lack of energy, loss of appetite and trouble sleeping
Postnatal psychosis is regarded as a medical emergency. Contact your GP immediately if you think that someone you know may have developed postnatal psychosis. If this isn't possible.
If you think there's a danger of imminent harm, call 999 and ask for an ambulance.
Causes of psychosis
The causes of psychosis have three main classifications.
They are psychosis caused by:
psychological (mental) conditions
general medical conditions
substances, such as alcohol or drugs
The three classifications are described in more detail below.
The following conditions have been known to trigger psychotic episodes in some people:
schizophrenia – a chronic (long-term) mental health condition that causes hallucinations and delusions
bipolar disorder – a condition that affects a person's moods, which can swing from one extreme to another (highs and lows)
severe stress or anxiety
severe depression – feelings of persistent sadness that last for more than six weeks, including postnatal depression, which some women experience after having a baby
lack of sleep
The underlying psychological cause will often influence the type of psychotic episode someone experiences.
For example, a person with bipolar disorder is more likely to havedelusions of grandeur, whereas someone with depression or schizophrenia is more likely to develop paranoid delusions.
General medical conditions
The following medical conditions have been known to trigger psychotic episodes in some people:
HIV and AIDS – a virus that attacks the immune system (the body’s natural defence against illness and infection)
malaria – a tropical disease spread by infected mosquitoes
syphilis – a bacterial infection that's usually passed on through sexual contact
Alzheimer's disease – the most common form of dementia that causes a decline of mental abilities, such as memory and reasoning
Parkinson's disease – a long-term condition that affects the way the brain coordinates body movements, including walking, talking and writing
hypoglycaemia – an abnormally low level of sugar (glucose) in the blood
lupus – a condition where the immune system attacks healthy tissue
Lyme disease – a bacterial infection that's spread to humans by infected ticks
multiple sclerosis – a condition that affects the nerves in the brain and spinal cord, causing problems with muscle movement, balance and vision
brain tumour – a growth of cells in the brain that multiply in an abnormal and uncontrollable way
Alcohol misuse and drug misuse can trigger a psychotic episode.
A person can also experience a psychotic episode if they suddenly stop drinking alcohol or taking drugs after using them for a long time. This is known as withdrawal.
It's also possible to experience psychosis after drinking large amounts of alcohol or if you're high on drugs.
Drugs known to trigger psychotic episodes include:
methamphetamine (crystal meth)
mephedrone (MCAT or miaow)
psilocybins (magic mushrooms)
In rare situations, psychosis can also occur as a side effect of some types of medication, or as a result of an overdose of that medication.
For example, levodopa, a medication that's used to treat Parkinson's disease, can sometimes cause psychotic episodes. However, any medicine that acts on the brain can cause psychosis with an overdose.
Never stop taking a prescribed medication unless advised to do so by your GP or another qualified healthcare professional responsible for your care.
See your GP if you're experiencing psychotic side effects due to taking a medication.
There's been a great deal of research into how psychosis affects the brain and how changes in the brain can trigger symptoms of psychosis.
Research has revealed that during a psychotic episode several physical and biological changes occur in the brain.
The results of magnetic resonance imaging (MRI) scans have shown that some people with a history of psychosis have less grey matter (the part of the brain responsible for processing thoughts) than most other people. However, it’s not yet fully understood why this is.
Researchers also believe that dopamine plays an important role in psychosis.
Dopamine is a neurotransmitter – one of many chemicals the brain uses to transmit information from one brain cell to another. Dopamine is associated with how we feel something is significant, important or interesting.
It's thought that in people with psychosis, levels of dopamine in the brain become too high. The excess dopamine interrupts specific pathways in the brain that are responsible for some of its most important functions, such as:
Disruption to these important brain functions may explain the symptoms of psychosis.
Evidence for the role of dopamine in psychosis comes from several sources, including brain scans, and the fact that medications known to reduce the effects of dopamine in the brain also reduce symptoms of psychosis.
However, illegal drugs known to increase levels of dopamine in the brain – such as cannabis, cocaine and amphetamines – can trigger psychosis.
You should visit your GP if you're experiencing psychotic episodes.
It's important to speak to your GP as soon as possible, because early treatment of psychosis usually has better long-term outcomes.
There's no test to positively diagnose psychosis. However, your GP will look at your symptoms and rule out short-term causes, such as drug misuse.
Your GP may ask questions to determine the cause of your psychosis. For example, they may ask you:
whether you're taking any medication
whether you've been taking illegal substances
how your moods have been – for example, whether you've been depressed
how you've been functioning day-to-day – for example, whether you're still working
whether you have a family history of mental health conditions, such as schizophrenia
about the details of your hallucinations, such as whether you've heard voices
about the details of your delusions, such as whether you feel people are controlling you
about any other symptoms you have
The evidence supporting the early treatment of psychosis means you're likely to be referred to a specialist urgently. This will either be during or after your first episode of psychosis.
Who you're referred to will depend on the services available in your area. You may be referred to:
a community mental health team – a team of different mental health professionals who provide support to people with complex mental health conditions
a crisis resolution team – a team of different mental health professionals who treat people currently experiencing a psychotic episode, who would otherwise require hospitalisation
an early intervention team – a team of mental health professionals who work with people who have experienced their first episode of psychosis
These teams are likely to include some or all of the following healthcare professionals:
a psychologist – a healthcare professional who specialises in the assessment and treatment of mental health conditions
a psychiatrist – a qualified medical doctor who has received further training in treating mental health conditions
a community mental health nurse – a nurse with specialist training in mental health conditions
Your psychiatrist will carry out a full assessment to help identify and diagnose any underlying mental health condition that could be causing your symptoms. This will help when planning your treatment for psychosis.
The lack of insight associated with psychosis means that people experiencing psychosis aren’t always able to recognise their strange behaviour.
They may be reluctant to visit their GP if they believe there's nothing wrong with them, and you may need to get help for them.
Someone who has had psychotic episodes in the past may have been assigned a mental health worker (someone who works in social services), so try to contact them to express your concerns.
Someone who is having a psychotic episode for the first time may need a friend, relative or someone else close to them to persuade them to visit their GP.
If they're having a psychotic episode that's rapidly getting worse, you should contact their crisis team or – if not available – the duty psychiatrist at their nearest accident and emergency (A&E) department.
If a person who is having a psychotic episode refuses to seek help, and is believed to present a risk to themselves or others, their nearest relative can request that a psychological assessment is carried out. Your local mental health trust can advise you about this.
If someone has very severe psychosis, they can be compulsorily detained at hospital for assessment and treatment under the Mental Health Act (1983) (external link).
Mental Health Act (1983)
The Mental Health Act (1983) is the main piece of legislation that covers the assessment, treatment and rights of people with a mental health condition.
Under the Act, a person can only be compulsorily admitted to hospital or other mental health facility (sectioned) if they:
have a mental disorder of a nature or degree that makes admission to hospital appropriate
should be detained in the interests of their own safety, for the protection of others, or both
Two doctors need to agree on the above assessment. Depending on the nature of the mental health disorder and the individual’s circumstances, the length of time a person can be sectioned is:
Before these time periods have elapsed, an assessment will be carried out to determine whether it's safe for the person to be discharged, or whether further treatment is required.
If you're held under the Mental Health Act (1983), you can be treated against your will because it's felt can’t make an informed decision about your treatment. However, certain treatments, such as brain surgery, can't be carried out unless you consent to treatment.
Any person compulsorily detained has the right to appeal against the decision to a Mental Health Review Tribunal (MHRT). A MHRT is an independent body that decides whether a patient should be discharged from hospital.
Having psychosis could affect your ability to drive.
It's your legal obligation to tell the Driver and Vehicle Licensing Agency (DVLA) about any medical condition that could affect your driving ability.
The GOV.UK website provides details about telling the DVLA about a medical condition.
Treatment for psychosis involves a combination of antipsychotic medicines, psychological therapies and social support.
Your care team
Your treatment is likely to be coordinated by a team of mental health professionals working together. If this is your first psychotic episode, you may be referred to an early intervention team.
Early intervention teams
An early intervention team is a team of healthcare professionals set up specifically to work with people who have experienced their first episode of psychosis.
Some early intervention teams only focus on a certain age range, such as people who are 14-35 years old. Depending on your care needs, early intervention teams aim to provide:
a full assessment of your symptoms
prescriptions for medications
social, occupational and educational interventions
Treatment for psychosis will vary, depending on the underlying cause. You'll receive specific treatment if you've been diagnosed with an underlying mental health condition as well.
For example, treatment for bipolar disorder uses a variety of medications, which could include antipsychotics to treat symptoms of mania, lithium and anticonvulsants to help stabilise mood, as well as psychological therapy, such as cognitive behavioural therapy (CBT).
Treatement for schizophrenia usually involves a combination of antipsychotic medication and social support. CBT or another type ofpsychotherapy called family therapy are also often used.
Psychosis related to drug or alcohol intoxication or withdrawal may only require a short course of antipsychotics or tranquilisers (which have a calming effect). Referral to an addiction counsellor may then be recommended.
Antipsychotic medicines, also known as neuroleptics, are usually recommended as the first treatment for psychosis. They work by blocking the effect of dopamine (a chemical that transmits messages in the brain). However, they're not suitable or effective for everyone, as side effects can affect people differently.
In particular, antipsychotics will be monitored closely in people who also have epilepsy (a condition that causes seizures or fits) andcardiovascular disease (conditions that affect the heart, blood vessels or circulation, such as heart disease).
Antipsychotics can usually reduce feelings of anxiety or aggression within a few hours of use, but they may take several days or weeks to reduce other psychotic symptoms, such as hallucinations or delusional thoughts.
Antipsychotics can be taken orally (by mouth) or given as an injection. There are several "slow-release" antipsychotics, where you only need one injection every two to six weeks.
Depending on the underlying cause of your psychosis, you may only need to take antipsychotics until your psychosis subsides. However, if you have a condition such as schizophrenia or bipolar disorder, you may need to take antipsychotics on a long-term basis to prevent further episodes of psychosis.
Antipsychotics can have side effects, although not everyone will experience them, and their severity will differ from person to person.
Side effects can include:
drowsiness (which may affect your driving ability)
shaking and trembling
muscle twitches and spasms (where your muscles shorten tightly and painfully)
loss of libido (sex drive)
See the patient information leaflet that comes with your medicine for a full list of possible side effects.
In addition, long-term use of antipsychotics can lead to complications such as weight gain and diabetes.
Tell your GP if you have side effects that are becoming particularly troublesome. There may be an alternative antipsychotic medicine you can take.
Never stop taking medication prescribed for you unless advised to do so by a qualified healthcare professional responsible for your care.
Suddenly stopping prescription medication could trigger a relapse (a return of your symptoms). When it's time for you to stop taking your medication, it will be done gradually and under close observation.
Psychological treatment can help reduce the intensity and anxiety caused by psychosis. Some possible psychological treatments are discussed below.
Cognitive behavioural therapy
Cognitive behavioural therapy (CBT) for psychosis is based on an understanding of how people make sense of their experiences and why some people become distressed by them.
The aim of CBT is to identify unhelpful thinking patterns and emotions that may be causing your unwanted feelings and behaviours. It's then possible to learn to replace this thinking with more realistic and balanced thoughts.
A CBT therapist may encourage you to consider different ways of understanding what's happening to you. The aim is to help you achieve goals that are meaningful and important to you, such as reducing your distress, returning to work or university, or regaining a sense of control.
Family therapy is known to be an effective form of treatment for people with psychosis.
Family therapy is a way of helping both you and your family to cope with your condition. After having an episode of psychosis, you may rely on your family members for care and support. While most family members are happy to help, the stress of caring for somebody can place a strain on any family.
Family therapy involves a series of informal meetings that take place over a period of six months. Meetings may include:
discussing your condition and how it might progress, plus the available treatments
exploring ways of supporting someone with psychosis
deciding how to solve practical problems caused by psychosis, such as planning how to manage future psychotic episodes
If you're experiencing episodes of psychosis, you may benefit from being around other people who've had similar experiences.
For example, the mental health charity Mind has over 150 local Mind networks, which may be able to put you in touch with a support group in your area, as well as providing a range of other useful services.
Mental Health Act (1983)
If you're experiencing a particularly severe psychotic episode, and it's thought that you present a significant danger to yourself or others, you can be compulsory detained at a hospital or a psychiatric clinic under the Mental Health Act (1983) (external link).
If you're detained under the Act, every effort will be made to obtain your consent to treatment. However, treatment can be carried out without your consent if it's felt you don't have the mental capacity to understand the issues surrounding treatment.
An independent panel will regularly review your case and progress. Once they feel you're no longer a danger to yourself and others, you'll be able to leave the hospital or clinic. However, your care team may recommend that you remain in the hospital or clinic on a voluntary basis.
Violence and aggression
Acts of violence and aggression are fairly uncommon in people with psychosis. They're more likely to be victims of violence than perpetrators. However, there may be times when your behaviour places yourself or others at risk of harm.
Mental health staff have been specially trained to deal with aggressive behaviour.
If you fail to respond to requests to calm down, it may be necessary to hold you down without hurting you. This is known as a physical intervention. You may then be moved to a secluded room to calm down.
In some cases, you may need to be given medication that will quickly make you very relaxed. This is known as rapid tranquillisation.
You'll be asked to take the medication voluntarily, but if you refuse, you can be treated against your consent. This may involve giving you an injection of a tranquiliser.
It's important to stress that these methods are only used in extreme circumstances, and they're not routinely used to treat psychosis.
If you're at risk of having psychotic episodes in the future, and there are certain treatments you don't want to have, it's possible to pre-arrange a legally binding advance decision (previously known as an advance directive).
An advanced decision is a written statement about what you'd like health professionals and your family or friends to do if you experience another psychotic episode. You may also want to include the contact details of your care team.
To create an advance decision, you need to make your wishes clear in writing and ask a witness to sign it. You should include specific details about any treatments you don't want and specific circumstances in which they may apply.
However, it's important to remember that the advance decision can be overruled if a person is subsequently detained under the Mental Health Act.
Although your doctors will try to take your wishes into account when deciding on treatment, they may decide it's in your best interests not to follow the advance decision.
Complications of psychosis
Someone experiencing a psychotic episode may self-harm. Suicidal thoughts and an increased risk of suicide are also common.
Self-harming behaviour is a relatively common complication in people with psychosis. A study found that 1 in 10 people with psychosis also had a history of self-harm.
The risk of self-harm is thought to be highest in people who are experiencing their first episode of psychosis who aren't receiving treatment.
See your GP if you're self-harming. You can also call the Samaritanson 08457 90 90 90 for support. The mental health charity Mind also has some useful information and advice.
If you think a friend or relative is self-harming, look out for signs of unexplained cuts, bruises or cigarette burns, usually on the wrists, arms, thighs and chest. People who self-harm may keep themselves covered up at all times, even in hot weather.
A person who's self-harming may feel deep shame and guilt, or they may feel confused and worried by their own behaviour. It’s important to approach them with care and understanding.
They may not want to discuss their self-harming behaviour with you, but you could suggest that they speak to their GP or a counsellor on a support helpline.
People with psychosis also have an increased risk of suicide.
It's estimated that 1 in 5 people with psychosis will attempt suicide at some point in their life, and 1 in 25 people with psychosis will kill themselves.
If you're feeling suicidal you can:
call the Samaritans support service on 08457 90 90 90
go to your nearest accident and emergency (A&E) department and tell the staff how you're feeling
speak to a friend, family member or someone you trust
make an urgent appointment to see your GP, psychiatrist or care team
If you're worried that someone you know may be considering suicide, recommend that they contact one or more of the organisations above and encourage them, in a non-judgemental way, to talk about how they're feeling.
If the person has previously been diagnosed with a mental health condition, such as depression, you can speak to a member of their care team for help and advice.
Using antipsychotics on a medium- to long-term basis can cause a number of complications. Some of the more common complications are discussed below.
Weight gain is a complication of many commonly used antipsychotics.
There are two main reasons why weight gain is thought to occur. Antipsychotics can:
lead to an increase in appetite
make you less active
You'll probably be advised to take more exercise to help burn off the excess fat.
Metabolic syndrome is a term describing a number of related conditions linked with weight gain, such as:
high blood sugar (hyperglycaemia)
hig h cholesterol
high blood pressure (hypertension)
These health conditions can also increase your risk of developing type 2 diabetes, heart disease and, most seriously, heart attack or stroke.
Due to the risk of metabolic syndrome, you'll usually need to have regular blood tests and blood pressure tests while taking antipsychotics.
If your test results show you have an increased risk of developing a condition such as heart disease, a number of preventative treatments, such as statins, are available to help lower cholesterol levels.
Tardive dyskinesia (TD)
Tardive dyskinesia (TD) is another common complication of long-term antipsychotic use.
TD is a movement disorder where a person experiences involuntary movements, such as twitching, tics, grimaces, tremors and spasms.
It usually starts in the face and mouth before spreading to the rest of the body.
Mind estimates that one in five people who've been taking an antipsychotic for four years or more will develop TD.
In some cases, stopping taking an antipsychotic will provide relief from TD symptoms, but in other cases it makes the TD symptoms worse.
However, stopping medication isn't always safe and has to be balanced against the risk of having a relapse.
In some cases, TD can be a permanent condition.
There are also a number of treatments that can sometimes improve the symptoms of TD, including:
clonazepam – a medication that's used to treat epilepsy (a condition that affects the brain and causes seizures or fits)
vitamin E supplements – check with the doctor in charge of your care before taking vitamin supplements because they're not safe or suitable for everyone
It's not always possible to prevent psychosis.
For example, schizophrenia is caused by a combination of biological, psychological and environmental factors you may not be able to avoid.
However, psychosis caused by taking illegal drugs can be prevented.
Research has shown that regular cannabis users are 40% more likely to develop a psychotic illness, such as schizophrenia, than people who don't use the drug.
Cannabis is known to increase levels of dopamine (a chemical that helps transmit messages) in your brain. Therefore, long-term cannabis use may cause permanent changes in your brain's chemistry that could lead to psychosis.
People who regularly use "skunk" (the herbal type of cannabis specifically grown for its increased strength) are thought to be most at risk.
You should also avoid using other recreational drugs, such as cocaine and ecstasy, because they also increase your risk of developing psychosis.
Stress and depression
Experiencing prolonged bouts of stress can sometimes trigger an episode of depression. Both stress and depression are major risk factors for psychosis.
The advice below may help reduce your stress levels, preventing depression and subsequent psychotic episodes:
Use a problem-solving approach to deal with stress and worries.
Try to identify negative thoughts and change them to positive ones.
Assess your symptoms regularly and speak to your GP or counsellor if problems arise.
Take regular exercise. Exercise triggers the release of a mood-boosting brain chemical called serotonin.
Learn how to relax using relaxation exercises and tapes.
Activities such as yoga and meditation can reduce stress levels. Having a massage can also help relieve tension and anxiety.
Join a self-help group to discuss your feelings and concerns. This can help you feel less isolated.
Avoid smoking, taking illegal drugs and drinking alcohol. These substances may make you feel better in the short term, but they'll usually make you feel worse in the long term.