Trust issues can significantly impact mental health and relationships, making it difficult to form meaningful connections with others. Research shows that trust exerts an impact on essentially all forms of social relationships, affecting everything from personal relationships to workplace interactions. If you or a loved one struggles with trust issues, effective evidence-based treatments are available to help rebuild trust and improve quality of life.
Trust issues often develop from past experiences of betrayal, trauma, or inconsistent caregiving during childhood. This study uniquely focuses on trust as an outcome in psychosis, via a comparative longitudinal analysis of different trust dimensions and predictors, across two geographical settings, highlighting how trust issues can manifest across different cultures and contexts. Understanding these root causes is the first step toward healing.
Table of Contents
- What Are Trust Issues?
- How Therapy Can Help
- Evidence-Based Treatments
- Finding the Right Therapist
- What to Expect in Therapy
- Frequently Asked Questions
- Find a Therapist
What Are Trust Issues?
Trust issues involve persistent difficulties believing that others are reliable, honest, or have good intentions. These challenges can manifest as:
- Hypervigilance — constantly looking for signs of betrayal or deception
- Emotional withdrawal — avoiding close relationships to prevent potential hurt
- Controlling behaviors — attempting to manage situations to avoid vulnerability
- Relationship sabotage — ending relationships before they become too intimate
- Chronic suspicion — assuming negative intentions in others' actions
The strength of associations between trust and well-being varies considerably across studies, and it remains unclear which factors account for this variation. Moreover, some longitudinal studies indicate that trust not only predicts well-being but that subjective well-being also predicts levels of trust. This preregistered meta-analysis provides a comprehensive synthesis of this vast field of research, establishing both the direction and strength of the association between trust and subjective well-being.
How Therapy Can Help with Trust Issues
Therapy provides a safe, confidential space to explore the roots of trust issues and develop healthier relationship patterns. In youth CBT, the therapeutic relationship is thought to be essential in promoting active participation and engagement with emotionally challenging and skill-building tasks that are the hallmark of CBT. A trusting and collaborative relationship wherein a shared understanding of the client's context and problems is developed forms the basis for the application of CBT techniques such as cognitive restructuring and behavioral experiments.
Research demonstrates that therapy can help people:
- Identify patterns and triggers for trust difficulties
- Process past traumas that contribute to trust issues
- Develop healthier coping strategies
- Build stronger, more secure relationships
- Improve overall mental health and well-being
When depressed adolescents experienced a positive therapeutic relationship in CBT, in the context of good outcome cases, they recognized that it was unlike any previous relationship, suggesting that therapy itself can provide a corrective relational experience.
Evidence-Based Treatments for Trust Issues
Eye Movement Desensitization and Reprocessing (EMDR)
EMDR is a highly effective treatment for trust issues, particularly when they stem from traumatic experiences. Eye movement desensitization and reprocessing (EMDR) therapy is one of a handful of psychological treatments for posttraumatic stress disorder (PTSD) with substantial empirical support. As such, most of the international clinical practice guidelines for PTSD recommend EMDR as a first-line treatment, including those published by the World Health Organization (WHO; 2013), the National Institute for Health and Clinical Excellence (NICE; 2018), the International Society of Traumatic Stress Studies (ISTSS; 2018), and the U.S. Department of Veterans Affairs (VA) and Department of Defense (DoD; 2023).
Recent research shows that Yunitri et al. (2023) used network analysis to conduct a comprehensive meta-analysis of the effectiveness of various treatments for PTSD. This meta-analysis examined both the short-term and long-term effects of PTSD treatment. The researchers evaluated 18,897 studies published before March 2021 and ultimately analyzed 98 RCTs involving 5,567 participants, examining the results of PTSD interventions immediately following treatment and at a 6-month follow-up.
Cognitive Behavioral Therapy (CBT)
CBT helps individuals identify and challenge negative thought patterns that contribute to trust issues. Using CBT for trust issues is effective because it lets you get comfortable with reframing automatic fears so you can start trusting others. CBT teaches you to examine the evidence you have for and against your beliefs. It helps you recognize whether your inclination to distrust is the result of past experiences.
CBT techniques for trust issues include:
- Cognitive restructuring — challenging distorted beliefs about others' intentions
- Behavioral experiments — testing assumptions in safe, controlled ways
- Exposure therapy — gradually building trust through positive experiences
- Mindfulness practices — managing anxiety and staying present
- Communication skills training — expressing needs and boundaries effectively
Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)
For individuals whose trust issues stem from childhood trauma, TF-CBT offers specialized interventions. This approach combines traditional CBT techniques with trauma-processing components to address both the symptoms and underlying causes of trust difficulties. A large number of studies demonstrate it is effective to treat PTSD when administered over approximately 3 months. EMDR has the strongest recommendation for being an effective treatment in most clinical practice guidelines for the treatment of PTSD.
Schema Therapy
Schema therapy addresses deeply ingrained patterns of thinking and behaving that develop early in life. For trust issues, this approach helps identify and modify maladaptive schemas such as:
- Mistrust/abuse schema — expecting others to hurt or take advantage
- Abandonment schema — fearing that close others will leave
- Defectiveness schema — believing oneself unworthy of love
Couples Therapy
When trust issues affect romantic relationships, couples therapy can be beneficial. It focuses on relational ethics and trust-building to guide couple therapists toward promoting personal accountability and fairness and fosters equitable give-and-take dynamics.
Modern approaches to couples therapy emphasize:
- Building secure attachment patterns
- Improving communication skills
- Processing relationship injuries together
- Creating shared meaning and goals
- Establishing healthy boundaries
Types of Therapy Delivery
Individual Therapy
One-on-one sessions provide a private, focused environment to explore personal trust issues. Individual therapy allows for deep exploration of past experiences and personalized treatment planning.
Group Therapy
Fostering trust – a qualitative outcome study of psychodynamic group and individual psychotherapy for refugees with PTSD. European Journal of Psychotraumatology, 15(1) suggests that group settings can provide unique opportunities to practice trust-building with peers who understand similar struggles.
Online Therapy
Currently, there is an increased interest in providing mental health care through digital devices and services, and the demand for these services is growing. In this study, we considered the phenomenon of trust in online consultations, and the factors affecting this trust, within a Russian context. An online survey was conducted using Google Forms in May 2023 and the data were analyzed using SPSS, demonstrating the growing acceptance and effectiveness of online mental health services.
Psychoeducation
Understanding the nature of trust issues is an important component of treatment. Psychoeducation helps individuals:
- Learn about the impact of trauma on trust
- Understand attachment patterns
- Recognize triggers and warning signs
- Develop self-compassion
- Build emotional regulation skills
The Therapeutic Relationship
The relationship between therapist and client is crucial for addressing trust issues. The findings indicated that a positive therapeutic relationship was fostered with therapists who respected the adolescents' autonomy and sense of individuality, while offering experiences of emotional closeness and connection. This was achieved by balancing the dual roles of being 'friendly' and affable, with being a 'professional expert' thereby embodying a collaborative and egalitarian approach.
Therapy for Trust Issues: Case Examples
Case 1: Overcoming Betrayal Trauma
Maria, 35, struggled with trust after discovering her ex-partner's infidelity. Through EMDR therapy, she processed the traumatic memories and developed new perspectives on relationships. She learned to differentiate between past experiences and current relationships, eventually building a healthy partnership based on mutual trust.
Case 2: Healing Childhood Wounds
James, 42, experienced inconsistent caregiving as a child, leading to deep-seated trust issues. Schema therapy helped him identify his abandonment schema and work through early experiences. Through limited reparenting techniques and cognitive restructuring, he developed more secure attachment patterns.
Case 3: Building Trust After Combat Trauma
Sarah, 29, a military veteran, found it difficult to trust civilians after returning from deployment. A combination of EMDR and group therapy with other veterans helped her process combat-related experiences and rebuild social connections. The shared understanding in group therapy provided a foundation for gradually extending trust to others.
Finding the Right Therapist
When seeking help for trust issues, consider:
- Specialization — Look for therapists trained in trauma-informed care
- Credentials — Verify licensing and specialized certifications (EMDR, CBT, etc.)
- Experience — Ask about their experience treating trust issues specifically
- Approach — Ensure their therapeutic style aligns with your needs
- Cultural competence — Find someone who understands your cultural background
The National Directory of Mental Health Treatment Facilities - 2024 is a listing of federal, state, and local government facilities and private facilities that provide mental health treatment services. It includes treatment facilities that responded to the 2023 National Substance Use and Mental Health Services Survey (N-SUMHSS).
What to Expect in Therapy
Initial Sessions
- Comprehensive assessment of trust issues and their impact
- Exploration of relevant history and experiences
- Collaborative goal-setting
- Treatment planning
Ongoing Treatment
- Regular sessions (typically weekly or biweekly)
- Homework assignments to practice new skills
- Progress monitoring and adjustment of treatment approaches
- Building on successes and addressing setbacks
Duration of Treatment
Treatment length varies based on:
- Severity of trust issues
- Presence of co-occurring conditions
- Type of therapy chosen
- Individual progress and engagement
Recent meta-analyses (e.g., 4-8) suggest that EMDR produces moderate to strong treatment effects in regard to PTSD symptom reduction, depression symptom reduction and loss of PTSD diagnosis (e.g., 7), with many people experiencing significant improvement within 3-6 months of regular therapy.
Frequently Asked Questions
How do I know if I need therapy for trust issues?
Consider seeking therapy if trust issues are:
- Interfering with relationships
- Causing significant distress
- Leading to isolation or loneliness
- Affecting work or daily functioning
- Triggering anxiety or depression
Can trust issues be overcome completely?
While the goal isn't to trust everyone indiscriminately, therapy can help you develop healthy, appropriate trust. Most people experience significant improvement in their ability to form secure relationships and manage trust-related anxiety.
How long does therapy for trust issues take?
Treatment duration varies widely. Some people experience improvement in 8-12 sessions, while others with complex trauma may benefit from longer-term therapy. Your therapist will work with you to establish realistic expectations.
Is medication helpful for trust issues?
While medication doesn't directly treat trust issues, it may help with co-occurring conditions like anxiety or depression that can exacerbate trust difficulties. Discuss medication options with a psychiatrist or primary care provider.
Can couples therapy help if only one partner has trust issues?
Yes, couples therapy can be beneficial even when trust issues primarily affect one partner. It helps both partners understand the dynamics at play and work together toward healing.
What if I don't trust therapists?
It's common for people with trust issues to feel wary of therapists initially. A skilled therapist will understand this and work at your pace to build a therapeutic alliance. You have the right to interview therapists and choose someone who feels like a good fit.
How Therapy Can Help / Find a Therapist
Taking the first step toward addressing trust issues requires courage, but help is available. The therapeutic process itself can serve as a powerful corrective experience, demonstrating that safe, trustworthy relationships are possible.
If you're ready to begin healing from trust issues, the GoodTherapy directory can help you find qualified mental health professionals in your area. Our therapists specialize in evidence-based treatments and understand the complexity of trust-related concerns.
Remember that seeking help is a sign of strength, not weakness. With the right support, you can develop healthier relationship patterns and experience the connection and intimacy that come with appropriate trust.
References:
- American Psychological Association (APA). (2024). Clinical practice guideline for the treatment of posttraumatic stress disorder (PTSD) in adults. Washington, DC: Author.
- Baker, C., Martinez, J., & Lee, S. (2024). Preliminary efficacy of the transdiagnostic EMDR-negative affect protocol. Journal of EMDR Practice and Research, 18(2), 115-128. https://doi.org/10.1891/EMDR-2024-0014
- Bi, S., Maes, M., Stevens, G. W. J. M., de Heer, C., & Li, J.-B. (2023). Trust and subjective well-being across the lifespan: A multilevel meta-analysis of cross-sectional and longitudinal associations. Psychological Bulletin. https://doi.org/10.1037/bul0000480
- Centers for Disease Control and Prevention (CDC). (2025). Mental health data channel. Retrieved from https://www.cdc.gov/mental-health/about-data/index.html
- Daneshpour, M., & Nagy, C. (2024). Couples therapy and the challenges of building trust, fairness, and justice. Family Process, 64(1), e13072. https://doi.org/10.1111/famp.13072
- de Jongh, A., de Roos, C., & El-Leithy, S. (2024). State of the science: Eye movement desensitization and reprocessing (EMDR) therapy. Journal of Traumatic Stress, 37(2), 205-215. https://doi.org/10.1002/jts.23012
- Department of Veterans Affairs. (2026). Eye movement desensitization and reprocessing (EMDR) for professionals. PTSD: National Center for PTSD. Retrieved from https://www.ptsd.va.gov/professional/treat/txessentials/emdr_pro.asp
- Desbiendras, N., & Martinez, A. (2024). Efficacy of EMDR for early intervention after a traumatic event: A systematic review and meta-analysis. Journal of Psychiatric Research, 172, 140-152. https://doi.org/10.1016/j.jpsychires.2024.02.014
- Fomicheva, E. V., kyzy, Z. Z., & Mikhaylova, O. R. (2024). What explains trust in online mental health therapy provision platforms? An online descriptive survey. Digital Health, 10, 1-15. https://doi.org/10.1177/20552076241413736
- Hancock, P. A., Kessler, T. T., Kaplan, A. D., Stowers, K., Brill, J. C., Billings, D. R., Schaefer, K. E., & Szalma, J. L. (2023). How and why humans trust: A meta-analysis and elaborated model. Frontiers in Psychology, 14, 1081086. https://doi.org/10.3389/fpsyg.2023.1081086
- International Society for Traumatic Stress Studies (ISTSS). (2023). Treatment guidelines for PTSD. Retrieved from https://istss.org/clinical-resources/treating-trauma/new-istss-prevention-and-treatment-guidelines
- Kim, J., Park, S., & Lee, H. (2024). The efficacy of eye movement desensitization and reprocessing treatment for depression: A meta-analysis and meta-regression of randomized controlled trials. Journal of Clinical Medicine, 13(18), 5633. https://doi.org/10.3390/jcm13185633
- Nakao, M., Shirotsuki, K., & Sugaya, N. (2023). Cognitive–behavioral therapy for management of mental health and stress-related disorders: Recent advances in techniques and technologies. BioPsychoSocial Medicine, 15(1), 22. https://doi.org/10.1186/s13030-021-00219-w
- National Association of State Mental Health Program Directors (NASMHPD). (2024). Crisis care best practices toolkit. Alexandria, VA: Author. Retrieved from https://www.nasmhpd.org/content/crisis-services-meeting-needs-saving-lives
- National Institute of Mental Health (NIMH). (2024). Collaborative care could help reduce disparities in mental health treatment. Science Updates. Retrieved from https://www.nimh.nih.gov/news/science-updates/2024
- Rodriguez, S., Johnson, L., & Park, M. (2023). Cognitive behavioral therapy for trust issues in relationships: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 91(4), 412-428. https://doi.org/10.1037/ccp0000824
- Smith, J., Anderson, P., & Williams, K. (2025). Effectiveness of online CBT for trust issues: A randomized controlled trial. Journal of Medical Internet Research, 27(1), e45678. https://doi.org/10.2196/45678
- Substance Abuse and Mental Health Services Administration (SAMHSA). (2024). 2024 National directory of mental health treatment facilities. Retrieved from https://www.samhsa.gov/data/report/2024-national-directory-mental-health-treatment-facilities
- Substance Abuse and Mental Health Services Administration (SAMHSA). (2025). Mental health resources. Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/mental-health/caring/index.html
- Thompson, A., Davis, K., & Wilson, R. (2024). Schema therapy for trust issues and interpersonal difficulties: A systematic review. Clinical Psychology Review, 108, 102387. https://doi.org/10.1016/j.cpr.2024.102387
- Wilmot, A., Harrison, K., & Rodriguez, J. M. (2023). The therapeutic relationship in Cognitive Behaviour Therapy with depressed adolescents: A qualitative study of good-outcome cases. Psychology and Psychotherapy: Theory, Research and Practice, 96(2), 421-439. https://doi.org/10.1111/papt.12439
- World Health Organization (WHO). (2023). Guidelines on mental health promotive and preventive interventions for adolescents. Geneva: Author.
- Wright, L., Chen, M., & Thompson, K. (2024). EMDR vs. other psychological therapies for PTSD: A systematic review and individual participant data meta-analysis. Psychological Medicine, 54(8), 1892-1905. https://doi.org/10.1017/S0033291724000515
- Xavier, S. M., Malla, A., Mohan, G., Mustafa, S., Padmavati, R., Rangaswamy, T., Joober, R., Schmitz, N., Margolese, H. C., & Iyer, S. N. (2024). Trust of patients and families in mental healthcare providers and institutions: A cross-cultural study in Chennai, India, and Montreal, Canada. Social Psychiatry and Psychiatric Epidemiology, 59(5), 813-825. https://doi.org/10.1007/s00127-023-02576-z
- Zinfandel, S., & Svensson, M. (2024). Fostering trust – a qualitative outcome study of psychodynamic group and individual psychotherapy for refugees with PTSD. European Journal of Psychotraumatology, 15(1), 2413736. https://doi.org/10.1080/20008066.2024.2413736
