A couple walks hand-in-hand through a garden while having a deep discussion.Paranoia is a belief or fear that something bad will happen or is happening. This belief often has no proof to support it and may persist despite contradicting evidence. Due to the isolating nature of paranoia, someone may go a long time before admitting their symptoms are an issue.

Someone who is ready to seek help for paranoia can benefit by contacting a mental health professional. During treatment, the person may use a combination of therapy, medication, and lifestyle changes. With patience and trust, an individual can reduce their paranoia symptoms. 

Therapy for Paranoia

The therapist’s first goal is often to establish trust with the individual challenged by paranoia. For therapy to be successful, the person must trust the therapist to provide help, not harm. Since defensiveness and suspicion are often part of paranoia, building trust will likely be be a gradual process.

In therapy, individuals typically work on building life skills, including:

  • Communication skills, to express fears in a more relatable manner.
  • Relaxation skills, to reduce the anxiety caused by paranoid thoughts.
  • Mindfulness skills, to identify and avoid triggers that may provoke paranoia.

Talking therapies are often used to treat paranoia. For example, a psychodynamic therapist can show the person how their unconscious emotions may be contributing to paranoia. In family systems therapy, a person may learn how their family of origin has influenced their current life. 

Cognitive behavioral therapy (CBT) is a particularly common treatment for paranoia. CBT explores how paranoid thoughts can affect one’s behavior. CBT allows both the therapist and person in therapy to examine the paranoid behaviors, rather than giving the therapist all the agency. 

Medication for Paranoia

Depending on the severity of an individual's paranoia, psychotropic medication may be prescribed along with therapy. Antipsychotics can make paranoid delusions feel less threatening or appear less often. However, they are typically reserved for diagnoses of paranoid schizophrenia or delusional disorder.

Since people with paranoia are often suspicious of others, they may not comply with a medication regimen. They may distrust their prescribing clinician or believe the medicine is poison. One study on paranoid schizophrenia found people were less likely to take their medicine if they had a negative view of medication in general. Compliance was also less likely if the person had difficulty recognizing their own symptoms.

Barriers to Treatment for Paranoia

A worried woman covers her mouth with a fist.Individuals with paranoia may be reluctant to seek treatment. Those with mild or moderate paranoia may realize their thoughts don’t have much basis in reality. Yet they may worry about stigma or feel their fears aren’t severe enough for therapy. 

People with more severe paranoia may not realize their symptoms are an issue. They may have trouble trusting a therapist enough to relay their thoughts and experiences. In some cases, an individual experiencing paranoia may believe the therapist is part of the threat.

Some individuals may be more willing to try therapy if accompanied by a loved one. Having knowledge about their diagnosis can also improve compliance. Although people with paranoia may be suspicious of their therapist at first, trust can build over time. As paranoia symptoms decrease, individuals will likely be more willing to participate in therapy. 

Self-Help for Paranoia

Individuals can work to address paranoia on their own by making certain lifestyle changes. Someone with paranoia may wish to:

  • Avoid recreational drugs and alcohol, as they can prompt paranoid thinking. 
  • Prioritize getting enough rest each night, since studies show insomnia can prompt paranoia. Good sleep hygiene can help individuals fall asleep more easily.
  • Make a habit of meditation and mindfulness. These practices can reduce any worry or stress contributing to paranoia. They can also help a person find a more balanced perspective on their situation.
  • Keep a diary to track the development of paranoia over time. A person may write down their worries, rate them, and identify triggers. They could also list evidence for or against the paranoia to determine whether it stems from rational or irrational thought.

People with more severe paranoia may struggle to enact these lifestyle changes. For example, someone who keeps a diary may become paranoid about others reading their notes. Individuals may wish to practice these coping strategies under the direction of a therapist to ensure they are being used effectively. 

It is important to note that lifestyle changes alone cannot cure paranoia. Only a mental health professional can treat paranoia symptoms.

Dealing with Paranoia in a Relationship

Conjugal paranoia typically leads an individual to experience feelings of extreme jealousy over perceived infidelity. The person typically has no basis for their suspicion. If they do have “evidence,” it will often be an innocuous event such as smiling at a stranger on the street. Sometimes the person has experienced infidelity with a prior partner and is projecting their insecurities onto a new relationship.

A jealous individual may stalk their partner or constantly accuse them of cheating. This behavior often puts significant strain on the relationship. In fact, it may drive away the very partner the individual was afraid of losing.

The accused partner may feel hurt that their lover won’t trust them. They may blame themselves for “provoking” the jealousy. However, no matter how much the accused partner denies the infidelity, they are unlikely to change the paranoid thoughts. Conjugal paranoia can persist even when all evidence points to innocence.

If your partner has conjugal paranoia, you can help your loved one by: 

  • Minimizing stress: Stress often makes paranoid thoughts worse. You can help your partner by making sure they have a balanced diet and are getting enough sleep.
  • Avoiding defensiveness: You may be angered by your lover’s false accusations, understandably so. While it can be difficult, try to remember that the paranoia stems from your loved one’s fear and insecurity. Being the target of paranoia does not mean you are a bad person.
  • Keeping the story simple: When explaining your side of the story, you likely want to stick to the basic facts. Too many details may overwhelm your loved one and feed into the belief that you are “hiding something.”
  • Getting a support network: Your partner may try to isolate you, believing that will reduce their paranoid thoughts. Yet all people need emotional support for their own well-being. Friends and family can offer you important stress relief. You can also find help by attending a support group with your partner.  
  • Encouraging your partner to go to treatment: A person with paranoia may be reluctant to go to therapy. You may wish to attend appointments with them to make sure they go. 

A person who has paranoia may find it difficult to maintain a healthy relationship while the condition goes untreated. They are not to blame for having a mental health condition. However, you are not responsible for their behavior either. If you ever feel threatened or abused, you can call 911 for immediate help. 

Case Example of Paranoia Treatment

  • Paranoia experienced with posttraumatic stress (PTSD) after tour overseas: After returning from a tour of duty in Afghanistan, Patrick feels isolated and begins to distrust those around him. He also experiences PTSD symptoms such as flashbacks, angry outbursts, and difficulty relaxing without alcohol. Patrick wants to tell friends and family about what he went through. However, he fears they will somehow use the information against him. Patrick eventually enters therapy and tells the therapist he believes those around him are discussing him constantly. He reports that his girlfriend and parents act uneasy around him, make strange phone calls, and hide messages and mail. It has become difficult to sleep, he says, because he worries people are scheming to lock him up. The therapist listens to Patrick's concerns and allows him to express his fear and frustration. The therapist then asks him several questions about his experience in Afghanistan. Patrick finds his anxiety easing over time as he becomes more comfortable talking to the therapist. After several sessions, the therapist brings up Patrick's suspicions. As Patrick has come to trust the therapist, he considers the therapist’s suggestion that he may be seeing a threat where there is none. He agrees to begin tracking instances that trigger his paranoid thinking. He practices relaxation techniques and becomes more aware that his suspicions are unlikely to have much basis in fact. He also grows more comfortable discussing his experiences with his family as he continues work with the therapist. After more sessions, Patrick reports his suspicious thinking has improved greatly. He is also drinking less and has fewer outbursts of anger.

If you or a loved one are seeking treatment for paranoia, you can find a therapist here.


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