Evidence-Based Paranoia Treatments

In general, a person is experiencing paranoid thoughts when they become suspicious (without evidence) that other people are out to get them or cause them harm in some way. Paranoia can be associated with multiple mental health conditions, but up to 20% of the general population is thought to have paranoid thoughts on a regular basis. 

When a person experiences paranoia, experts recommend they seek treatment early. Researchers haven't identified one exact cause of short-term or ongoing paranoia. Instead, paranoia may have multiple causes, ranging from substance misuse to personality disorders. For this reason, there are multiple potential paranoia treatments. Some treatments may be more appropriate for some people than others, depending on a person’s underlying cause of paranoia. However, in many cases, a person may benefit most from trying multiple treatments for paranoia symptoms, often including therapy.

Talk therapy for paranoid thoughts

According to Mental Health America, paranoia is most often treated using a combination of cognitive behavioral therapy (CBT) and prescription medication. Other types of therapy have also been used to treat paranoia. Here's a brief overview of different therapy types that have been studied for paranoia:

• Cognitive behavioral therapy (CBT): When it comes to paranoia and delusions, research has found that CBT usually improves symptoms in about 60% of people, with 20% of them typically showing major improvement. CBT generally helps people become aware of their fears and other potential causes of suspicious thoughts. It can also teach individuals strategies for letting go of such thoughts. Experts normally recommend people with paranoid delusions engage in CBT for six months or more.
• Anxiety-based CBT: Anxiety-based CBT can be seen as a subset of cognitive behavioral therapy that specifically focuses on reducing anxiety and practicing relaxation techniques, like deep breathing. One case study found that 10 weeks of anxiety-based CBT usually led to fewer paranoid thoughts among participants compared to a control group. Authors of another study argued that treating worry may be the best way to reduce paranoia in the general population.
• Virtual reality CBT: In virtual reality CBT, a person usually undergoes both cognitive behavioral therapy and virtual reality sessions. Virtual reality sessions typically mimic situations that usually trigger paranoia within a person, giving them a safe opportunity to practice strategies geared toward reducing paranoia and distress.
• Evolutionary systems therapy (EST): Evolutionary systems therapy is a newer type of therapy that considers evolutionary tendencies that may contribute to a person's thoughts and behaviors. Like CBT, EST usually helps people gain awareness of why they think the way they do so that they can change unhelpful patterns. One study found that six of seven people with paranoid personality disorder no longer qualified for the diagnosis after 10 months of evolutionary systems therapy. 
• Cognitive analytic therapy (CAT): Cognitive analytic therapy is a short-term therapy that usually looks at a person's history and relationships to identify what has contributed to their current psychological challenges. A case study found that CAT successfully treated paranoia in a person with paranoid personality disorder (PPD), but additional research may be needed.
• Narrative therapy: Narrative therapy is primarily based on the idea that a person's thoughts and actions stem from their identity, which is the story or narrative they tell about themselves. One case study found that narrative therapy helped a woman who had paranoia related to schizophrenia. Narrative therapy may be particularly useful when a person's paranoia stems from a mental illness, and they have woven the negative stigma surrounding their diagnosis into their personal story in unhelpful ways.
• Metacognitive interpersonal therapy (MIT): MIT is a form of therapy that often uses tools like guided imagery, role-playing, mindfulness, bodywork, and rewriting scripts for various situations. A case study found that six months of metacognitive interpersonal therapy reduced symptoms in a man with paranoid personality disorder.
• Attribution therapy: Attribution therapy usually helps people identify how they observe the world and draw conclusions about it. A case study found that a person experiencing paranoid delusions about being persecuted experienced reduced symptoms after attribution therapy treatment, but updated research may be needed.
• Therapeutic aphorisms: Aphorisms can be described as short, memorable, and meaningful phrases that can be used to help people decide how to act in a challenging situation. Therapeutic aphorisms can be integrated into any style of therapy. One expert argues that therapeutic aphorisms work well for paranoia treatment. He outlines many examples, such as, "Every complaint hides a desire."

Medication

The medication a person might take for paranoia generally depends on their diagnosis. Sometimes, anti-anxiety medications are given for paranoia, but they may not help all people, depending on the underlying cause of paranoid symptoms. In addition, there is no official medication approved specifically for paranoid personality disorder. When paranoia is experienced as part of a psychotic disorder, like schizophrenia or delusional disorder, antipsychotics may be prescribed.

More research is needed on the best medications for paranoia. People seeing a doctor or psychiatrist for paranoia treatment may have to go through a process of trial and error as they try different medications and dosages until they find something that works for them. Never start, stop, or change the way you take medication without consulting your prescribing provider.

Lifestyle changes

A few different lifestyle modifications have been recommended as part of a paranoia treatment plan. Experts suggest that people with paranoia may be more open to trying lifestyle changes as part of a treatment plan since they are less stigmatizing and more common among the general public.

Improved sleep

Multiple experts recommend improving sleep as part of a paranoia treatment plan. One randomized controlled trial of 3,755 participants found that cognitive behavioral therapy for insomnia could not only improve sleep but could also reduce paranoia. 

Stress and sleep deprivation often co-occur and may impact one another, as well as paranoia. Improving insomnia and reducing stress at the same time may start an upward spiral that also reduces paranoia as all three types of symptoms may begin to decrease in severity.

Reduced stress

Stress can trigger paranoid thoughts among the general population, as well as more serious episodes of paranoid delusion among people with psychotic disorders. Reducing stress, as well as easing worries and anxieties, may reduce paranoia symptoms and improve mental health in general.

A systematic review of 19 studies found that treatments aimed at anxiety tend to help with paranoia as well. 

Similarly, the Substance Abuse and Mental Health Services Administration (SAMHSA) advises that stress management activities like meditation and tai chi may help people with schizophrenia reduce stress that would otherwise trigger symptoms, including paranoia. 

Improved nutrition

Nutrition may play a role in disorders that involve paranoia, like schizophrenia. In an overview of multiple studies, some experts propose that Mediterranean eating habits, Dietary Approaches to Stop Hypertension (DASH) eating habits, ketogenic eating habits, or gluten-free eating habits could potentially help with schizophrenia symptoms like paranoia. These types of eating habits may help by providing general health benefits, reversing inflammation, and resolving nutrient deficiencies. 

While studies suggest improving nutrition can benefit people with schizophrenia, more research is needed to know which type of eating habits is best or if one specific type of eating habits can help everyone with the disorder. Some experts suggest that personalized nutrition may be best for schizophrenia, as different people may be experiencing different underlying physiological problems and have different nutritional needs.

Personality disorder treatments

Because paranoia can be associated with some personality disorders, psychiatrists and therapists alike may choose to treat the disorders overall rather than the symptom of paranoia in particular. That said, personality disorders are often seen as difficult to treat because most people living with them do not believe they need treatment. Among people who receive treatment and stick with it for at least six months, approximately 10% may experience resolved personality disorder symptoms.

Personality disorder treatments may require further study, as treatment options are not well-defined. The most common treatments for personality disorders are usually a combination of medication and one-on-one talk therapy, with the particular medications and therapies dependent on the type of disorder a person has. At times, group therapy or support groups may also be tried as treatments, as may social skills training or other courses.

As far as personality disorders are concerned, paranoia most commonly occurs alongside two of them.

Paranoid personality disorder

In paranoid personality disorder (PPD), paranoia is usually the primary symptom and an essential trait in a person's personality. People with PPD are generally distrustful and suspicious of others, which can greatly impact their relationships and ability to function in the world. Some people with PPD may become physically aggressive or overly litigious, bringing unfounded lawsuits against others repeatedly.

Borderline personality disorder

People with borderline personality disorder (BPD) often fear abandonment to a degree that significantly impairs their self-worth and ability to maintain relationships. They may have dramatic mood swings, episodes of impulsivity, and paranoia during times of stress and relationship conflict. Their paranoia usually fades once the stress passes and relationship issues are resolved.

Psychotic disorder treatments

As with personality disorders, a mental health professional may decide to treat a psychotic disorder more holistically instead of focusing on paranoia in particular. Two psychotic disorders are commonly associated with paranoia: schizophrenia and delusional disorder.

Schizophrenia

Schizophrenia is one of a spectrum of disorders with psychotic symptoms. Psychotic symptoms typically involve a disconnect from reality, whether through delusions, which are persistently held untrue beliefs, or hallucinations, which are sensory experiences that occur without external stimuli.

The most common delusions in schizophrenia are usually paranoid in nature. People with schizophrenia who experience paranoia tend to be more likely to have trouble fitting in socially than people with schizophrenia who don't experience paranoia. They may also be more hostile and more likely to interpret people's neutral facial expressions as angry or untrustworthy.

Delusional disorder

Delusional disorder typically differs from schizophrenia in that a person's delusional thoughts aren't overtly bizarre or entirely disconnected from reality. For example, while a person with schizophrenia and paranoia may believe aliens, a celebrity, or the U.S. federal government are plotting their demise, people with delusional disorder tend to experience paranoia related to actual people and situations in their lives.

In delusional disorder, a person may persistently believe something that is potentially plausible but ultimately untrue for over a month. For example, they may become convinced their spouse is cheating on them, that they have developed a serious illness, that someone with whom they're in a platonic relationship is actually falling in love with them, or that someone or many people are conspiring against them, harassing them, or trying to bring about their downfall in some way.

People with delusional disorder who experience paranoia are usually referred to as having the "persecutory type" of the disorder. Delusional disorder tends to be much rarer than other mental illnesses associated with paranoia, although of those who live with it, the persecutory type is typically the most common type.

Substance use treatments

A wide variety of substances, such as alcohol, cannabis, stimulants, and hallucinogens, can trigger or exacerbate paranoia. If a person is experiencing paranoia due to a substance use disorder, treating the substance use disorder is normally a top priority, as treating the paranoia symptom itself likely wouldn't be successful if substances were still being used. 

Substance use treatments may include one-on-one therapy, inpatient care, and medications. Some people with substance use disorder also benefit from group therapy, support groups, and 12-step programs.

Treatments for paranoia-related illnesses

At times, a person may experience paranoia due to an underlying physical illness. For example, Alzheimer's disease, epilepsy, brain tumors, and traumatic brain injuries can trigger or worsen paranoia in some people. In these cases, treating the underlying illness usually takes priority over treating paranoia symptoms directly, although some practitioners may recommend both types of treatment at once.

Does it seem like others are out to get you?

Work through paranoia in online therapy

When to seek mental health help

If you are struggling with paranoia, whether as part of a mental illness or on its own, you may find talking with a mental health professional helpful. Remote therapy may be an appealing option since you can attend sessions from the safety and comfort of your home or any preferred location with an internet connection. BetterHelp is a remote therapy platform that can connect you with a suitable therapist.

Researchers haven't widely studied therapy treatments for paranoia. However, paranoia can be a type of delusion, and delusions have been more widely studied. One study found that cognitive behavioral therapy (CBT) significantly helps about 20% of people with delusions and reduces symptoms in another 40%. 

Cognitive behavioral therapy may be especially helpful for people who are distressed by their paranoia symptoms, and it may reduce the chance of symptom relapses. Research suggests that online CBT tends to be just as effective as in-person CBT, so online treatment may be effective in addressing paranoia. However, individuals who are experiencing acute psychosis may need to seek in-person care.

Takeaway

Paranoia can be present in certain mental health conditions and up to 20% of the general public. Paranoid thoughts usually involve believing or suspecting that others are out to get you or planning to do you harm. Having paranoid thoughts and feelings can lead to distress and limit a person's life as they distance themselves from others or experience interpersonal conflicts. There are a variety of treatment options for paranoia. Talk therapy and prescription medication are generally those most supported by research, although improving sleep, nutrition, and stress levels can also be helpful. If you’re living with paranoia, consider reaching out to a therapist in your local area or online.