Seeking medical treatment for paranoia is crucial when delusions and paranoid thoughts cause distress and affects one’s ability to function in daily life. Paranoia treatment can help you overcome the symptoms and improve your overall mental health.
Importance Of Paranoia Treatment
Treatment for paranoia and delusions 1 Freeman, D., & Garety, P. (2014). Advances in understanding and treating persecutory delusions: a review. Social psychiatry and psychiatric epidemiology, 49(8), 1179–1189. https://doi.org/10.1007/s00127-014-0928-7 depend on various factors such as underlying causes, severity of symptoms and willingness of the sufferer to seek treatment. As the thought disorder makes it difficult for the sufferer to trust others, it may be challenging for them to realize that they are suffering from a mental health condition. Moreover, as it often leads to social withdrawal and isolation, it can also be difficult for them to seek help from others for a long time.
This is why it is crucial for family and friends to encourage them to seek medical attention and help them trust the treatment process. It is also important that the patient trusts their doctor or mental health professional to ensure compliance to the treatment plan. The doctor needs to help the patient gain trust and build a positive relationship with them for cooperation and better recovery. With trust, patience and willingness, an individual can relieve the symptoms and develop a more healthier mindset.
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How Paranoia Treatment Can Help?
Depending on the intensity of the symptoms and the person, a mental health professional like a psychiatrist or a psychologist, may recommend psychotherapy, medication or a combination of both for effective paranoia treatment. Therapy helps patients to develop certain skills to cope with their distorted thought patterns and enhance interpersonal communication and socialization. Research 2 Ritzler BA. Paranoia–prognosis and treatment: a review. Schizophr Bull. 1981;7(4):710-28. doi: 10.1093/schbul/7.4.710. PMID: 7034193. shows that therapy techniques, such as milieu therapy, cognitive therapy and group therapy, tend to generate favorable outcomes in patients in reducing delusional behavior.
Medications are also an important aspect of paranoia treatment as it helps patients to become more grounded in reality. Medications, such as anti-anxiety drugs, can help to reduce feelings of anxiety and fear, while atypical antipsychotic medications can help to reduce symptoms. Once the sufferer is stabilized, their doctor may recommend a modified treatment plan, which may involve digital innovations 3 Garety, P. A., Ward, T., & Rus-Calafell, M. (2020). Beyond belief—New approaches to the treatment of paranoia. A Clinical Introduction to Psychosis, 591-613. https://doi.org/10.1016/b978-0-12-815012-2.00025-0 in paranoia treatment, like mobile apps, virtual reality, SlowMo 4 Garety, P. A., Ward, T., Freeman, D., Fowler, D., Emsley, R., Dunn, G., Kuipers, E., Bebbington, P., Waller, H., Greenwood, K., Rus-Calafell, M., McGourty, A., & Hardy, A. (2017). SlowMo, a digital therapy targeting reasoning in paranoia, versus treatment as usual in the treatment of people who fear harm from others: study protocol for a randomised controlled trial. Trials, 18(1), 510. https://doi.org/10.1186/s13063-017-2242-7 and other new blended treatment options for effective recovery.
If paranoid thoughts and delusions are caused by substance abuse, then treatment may focus on the process of detoxification and prevention of further use of recreational drugs and alcohol. Studies 5 Munro A, Mok H. An overview of treatment in paranoia/delusional disorder. Can J Psychiatry. 1995 Dec;40(10):616-22. doi: 10.1177/070674379504001008. PMID: 8681259. have found that when treated effectively using both therapy and medications such as the antipsychotic drug Pimozide, paranoia tends to have a “reasonably good prognosis.” However, further research may be required.
Strategies For Paranoia Treatment
Here are some of the treatment options available for someone with paranoid thoughts:
1. Psychotherapy
Therapy is usually the most effective treatment for paranoia. Psychotherapy can enable patients to identify their symptoms and help with:
- Boosting their self-esteem and sense of self
- Accepting their own vulnerabilities
- Gaining trust on loved ones and others
- Identifying and expressing their emotions in a healthy way
- Enhancing their communication and social skills
- Learning coping skills
- Gaining relaxation and mindfulness skills
This can significantly help in reducing anxiety and avoiding triggers that provoke suspicious thoughts. Mind Help explains that “therapy can enable the patient to overcome their symptoms and enhance their ability to function in everyday life. However, it can be challenging for the therapist to get the patient to talk freely and openly. Hence, progress for paranoia treatment is usually extremely slow.”
Here are some psychotherapy options usually recommended for the treatment of paranoid thoughts:
A. Talking therapy
Talking therapy can be beneficial for milder symptoms. A form of counseling, it can help the patient to gain valuable insight about their condition, understand their experiences, cope with paranoid symptoms, gain a more realistic view of the world and develop coping strategies.
B. Cognitive behavioral therapy (CBT)
CBT 6 Garety P. A. (2003). The future of psychological therapies for psychosis. World psychiatry : official journal of the World Psychiatric Association (WPA), 2(3), 147–152 . is one of the most common paranoia treatment options as it enables the therapist to understand how paranoid thinking patterns and attitudes tend to affect the patient’s thoughts, emotions, feelings and behavior. Moreover, in this form of psychotherapy, both the patient and therapist have the ability to analyze the disorder and this can make the patient feel more comfortable with the treatment process.
Cognitive behavioral therapy is helpful in reducing stress, anxiety and worry which can add to the feelings of paranoia. According to research 7 Freeman, D., Dunn, G., Startup, H., Pugh, K., Cordwell, J., Mander, H., Černis, E., Wingham, G., Shirvell, K., & Kingdon, D. (2015). Effects of cognitive behaviour therapy for worry on persecutory delusions in patients with psychosis (WIT): a parallel, single-blind, randomised controlled trial with a mediation analysis. The lancet. Psychiatry, 2(4), 305–313. https://doi.org/10.1016/S2215-0366(15)00039-5 , paranoia is often caused by worry and CBT targeted on worry can help in significantly reducing long-standing delusions. CBT can also be beneficial when such thoughts and feelings are induced by medications or substances or experienced due to underlying mental health problems.
Studies indicate that paranoia may be caused by worry and worry intervention techniques, like CBT, “might be a beneficial addition to the standard treatment,” of persecutory delusions in patients with psychosis. One 2018 study 8 Health Quality Ontario (2018). Cognitive Behavioural Therapy for Psychosis: A Health Technology Assessment. Ontario health technology assessment series, 18(5), 1–141. states “People affected by schizophrenia reported that CBT for psychosis was valuable in conjunction with antipsychotic medication.” Another study found that CBT is also a cost-effective treatment option for paranoia and psychosis.
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C. Art therapy
Arts and creative activities can often be utilized in a therapeutic environment to help people cope with stress, anxiety, worry and depression. One 2019 study 9 Abbing, A., Baars, E. W., de Sonneville, L., Ponstein, A. S., & Swaab, H. (2019). The Effectiveness of Art Therapy for Anxiety in Adult Women: A Randomized Controlled Trial. Frontiers in psychology, 10, 1203. https://doi.org/10.3389/fpsyg.2019.01203 explains that art therapy “is effective in reducing anxiety symptoms, improving quality of life and aspects of emotion regulation.”
Using art-based therapies can enable the sufferer to understand their emotion and express themselves in a positive manner through their art. This form of psychotherapy can be especially useful if the patient is struggling with communicating their experiences. “Although effective in patient care, the practice of art therapy is extremely underutilized,” found a scientific analysis 10 Bitonte, R. A., & De Santo, M. (2014). Art Therapy: An Underutilized, yet Effective Tool. Mental illness, 6(1), 5354. https://doi.org/10.4081/mi.2014.5354 .
D. Milieu therapy
Milieu therapy 11 Van Putten, T. (1973). Milieu therapy: Contraindications? Archives of General Psychiatry, 29(5), 640. https://doi.org/10.1001/archpsyc.1973.04200050053009 is a type of psychotherapy which utilizes therapeutic communities to help the recovery process in paranoia treatment. It provides a safe space for the patients to develop positive coping mechanisms while cultivating a sense of community, thus reducing feelings of isolation which is common in paranoid people. It helps in creating a therapeutic environment to help the sufferer build adaptive coping skills, relationship skills and socialization skills. In this therapy, the sufferer participates in a group involving 30 patients for around 9 to 18 months. During this period, the patients take responsibility for each other and their own selves. Senior patients encourage others by exhibiting appropriate behavior and intervene when others violate rules of the group.
It is considered to be helpful 12 Ciompi, L., & Hoffmann, H. (2004). Soteria Berne: an innovative milieu therapeutic approach to acute schizophrenia based on the concept of affect-logic. World psychiatry : official journal of the World Psychiatric Association (WPA), 3(3), 140–146. in treating various behavioral problems, personality disorders and thought disorders like paranoia. “Milieu therapy has long existed as an effective treatment modality for the mentally ill. It has also been a significant aspect of psychiatric-mental health nursing practice for several decades,” states a 1992 study 13 Tuck I, Keels MC. Milieu therapy: a review of development of this concept and its implications for psychiatric nursing. Issues Ment Health Nurs. 1992 Jan-Mar;13(1):51-8. doi: 10.3109/01612849209006885. PMID: 1737703. .
E. Psychodynamic psychotherapy
Psychodynamic 14 Hingley SM. Psychodynamic perspectives on psychosis and psychotherapy. II: Practice. Br J Med Psychol. 1997 Dec;70 ( Pt 4):313-24. doi: 10.1111/j.2044-8341.1997.tb01909.x. PMID: 9429752. psychotherapy is also often utilized for paranoia treatment. A therapist may use a psychodynamic approach to help the sufferer realize how their subconscious thoughts and emotions can influence their paranoid thoughts and delusions. Based on the principles of psychoanalysis, this therapy primarily focuses on the unconscious content of the patient’s psyche for relieving mental distress.
It is a deeper form of talk therapy that relies more on the patient’s external environment. It also relies on the interpersonal relationship between the sufferer and their therapist. Psychodynamic therapists focus on past issues to resolve present conflicts as they believe unconscious problems are based in our past experiences. By identifying our past issues, we can develop the right coping strategies and reduce psychological and emotional stress through self-examination and self-reflection.
F. Other therapies
Apart from these, there are other types of psychotherapies that may be recommended for people with paranoia or mental conditions that involve paranoid symptoms, such as:
- Family therapy or group therapy
- Supportive psychotherapy
- Cognitive enhancement therapy
- Vocational training therapy
- Counseling
- Peer support group
These types of therapy can help a paranoid person live independently, enhance their communication skills, boost emotional regulation and experience overall well-being. Loved ones and caregivers can provide better care by learning about the thought disorder and associated mental health conditions. Moreover, they should also encourage the patient to seek professional help and follow the treatment plan.
2. Medications
Depending on the severity of the symptoms, a psychologist or a psychiatrist may prescribe psychotropic medication in addition to therapy for paranoia treatment. Medicines are usually targeted at associated mental illnesses rather than directly at paranoid thoughts itself. Doctors may prescribe anti-anxiety medication, atypical antipsychotic medications and antidepressants to relieve certain symptoms.
Antipsychotics can be highly helpful in reducing paranoid delusions and making them appear less threatening or be frequent. Antipsychotics can also help in reducing delusions, hallucinations and disturbing thoughts. According to a 2013 study 15 Birkeland SF. Psychopharmacological treatment and course in paranoid personality disorder: a case series. Int Clin Psychopharmacol. 2013 Sep;28(5):283-5. doi: 10.1097/YIC.0b013e328363f676. PMID: 23820335. , antipsychotics tend to be effective and safe for paranoia treatment in the short term.
Studies 16 Targum S. D. (2001). Treating Psychotic Symptoms in Elderly Patients. Primary care companion to the Journal of clinical psychiatry, 3(4), 156–163. https://doi.org/10.4088/pcc.v03n0402 reveal that Risperidone is also “effective in reducing aggressive behavior as well as paranoia and delusions in elderly psychotic patients.” However, it may take time for medications to take effect and to understand the combination of medication necessary for each individual. Research 17 Hany M, Rehman B, Azhar Y, et al. Schizophrenia. [Updated 2020 Dec 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539864/ indicates that about 30% of patients tend to respond negatively to antipsychotic drugs and for around 7% of people, medications tend to be ineffective.
If the patient does not respond to the antipsychotics, then the doctor may prescribe different medicines or suggest different dosage. The antipsychotic medicine Pimozide 18 Sultana A, McMonagle T. Pimozide for schizophrenia or related psychoses. Cochrane Database Syst Rev. 2000;(3):CD001949. doi: 10.1002/14651858.CD001949. Update in: Cochrane Database Syst Rev. 2007;(3):CD001949. PMID: 10908518. has also been found to successfully treat querulous-litigious delusional disorder when prescribed in low doses, found a study 19 Ungvari GS, Hollokoi RI. Successful treatment of litigious paranoia with pimozide. Can J Psychiatry. 1993 Feb;38(1):4-8. doi: 10.1177/070674379303800103. PMID: 8448720. . However, another 1998 study 20 Silva H, Jerez S, Ramirez A, Renteria P, Aravena N, Salazar D, Labarca R. Effects of pimozide on the psychopathology of delusional disorder. Prog Neuropsychopharmacol Biol Psychiatry. 1998 Feb;22(2):331-40. doi: 10.1016/s0278-5846(98)00008-6. PMID: 9608605. found that “the therapeutic role of pimozide in the treatment of delusional disorder,” or paranoia is limited.
Antipsychotic drugs or anti-anxiety medications can not only help to ease paranoia symptoms, it can also help to improve psychological well-being. However, paranoid individuals may refuse to accept any type of medications as they have a false belief that it may harm or kill them. People with paranoia may not be able to fully trust their doctor regarding the medication regimen. The patient may think that the medication is taken to make them feel worse or may be fatal for them. Hence, they may be reluctant to take the medicines making the treatment process more difficult.
When paranoia is caused by substance or drug abuse, then therapy can be helpful unless the effects of substance use wears off. Once the patient has been ‘detoxed’, the doctor may encourage the patient to take part in a drug treatment program as a part of their paranoia treatment plan.
3. Virtual reality
Virtual reality is also an effective paranoia treatment option which is commonly available. Paranoid thoughts can also be treated through virtual reality (VR 21 Kim, S., & Kim, E. (2020). The Use of Virtual Reality in Psychiatry: A Review. Soa–ch’ongsonyon chongsin uihak = Journal of child & adolescent psychiatry, 31(1), 26–32. https://doi.org/10.5765/jkacap.190037 ) technology and therapy. Paranoid individuals tend to avoid situations, environments and people that may appear threatening or may trigger anxiety. Experts believe that virtual reality can be combined with CBT to enable patients to practise being in environments that make them feel scared and face their fears in a safe and protected way. A research paper 22 Pot-Kolder, R. M., Geraets, C. N., Veling, W., Van Beilen, M., Staring, A. B., Gijsman, H. J., Delespaul, P. A., & Van der Gaag, M. (2018). Virtual-reality-based cognitive behavioural therapy versus waiting list control for paranoid ideation and social avoidance in patients with psychotic disorders: A single-blind randomised controlled trial. The Lancet Psychiatry, 5(3), 217-226. https://doi.org/10.1016/s2215-0366(18)30053-1 published in The Lancet Psychiatry reveals that “the addition of VR-CBT to standard treatment can reduce paranoid ideation and momentary anxiety in patients with a psychotic disorder.”
Virtual Reality environments and therapy can enable people affected with a psychosis, resulting in excessive suspicion, to overcome their anxiety and paranoia. VR therapy can enable patients to experience anxiety and do things they are afraid of while being aware that they are completely safe. According to the University Medical Center Groningen, Netherlands, “VR enables people with paranoia and anxiety problems to practise situations that are possibly too frightening in real life.”
4. Hospitalization
In severe cases, a doctor may recommend hospitalization or rehabilitation until the paranoia and associated conditions stabilize. When therapy and medications do not prove effective in paranoia treatment, then a doctor may recommend hospitalization if the symptoms fail to improve over time. Moreover, if the patient is prone to causing harm to others or themselves or is having suicidal thoughts, then hospitalization may become mandatory until their paranoia is stabilized and underlying conditions are treated.
Paranoia Treatment Can Be Effective
Outlook for individuals suffering from paranoia and seeking treatment for the same is mostly positive. Although therapy and medication can be effective, the recovery process can be slow. Moreover, it is crucial that the patient trusts their doctor and follows the treatment plan properly. However, their paranoid thoughts can often make them distrustful of others which can make compliance of treatment an issue and adversely affect recovery.
According to a 2017 study 23 Krzystanek, M., Krysta, K., & Skałacka, K. (2017). Treatment Compliance in the Long-Term Paranoid Schizophrenia Telemedicine Study. Journal of technology in behavioral science, 2(2), 84–87. https://doi.org/10.1007/s41347-017-0016-4 , treatment compliance in the long-term for patients with paranoid schizophrenia was found to be low at around only 46% and it failed to improve over the study period. This is why family members and friends must encourage the patient to seek treatment, trust their doctor and follow the treatment plan for effective recovery.
