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Online Therapy for Paranoia

Phi Atratus
  • Jan 18, 2022
  • 5 min read
man experiencing paranoia

Paranoia is a state of mind where you think, feel, and believe you’re being threatened in some way, such as the impression that people are conspiring against you or that you are being watched. Such beliefs are irrational, delusional, and persistent, don't require evidence, and are often unfounded but feel real just the same. 

Though we all suspect others may have bad intentions towards us from time to time, paranoia exaggerates these thoughts in a way that makes fear and stress part of our daily life. 10–15% of the population experiences such thoughts regularly. This makes life difficult and is why therapy is needed.

If you suspect that you or someone you know may have paranoia, equipping yourself with all there is to know about it is the next step. Let’s discuss the symptoms, causes, and courses of treatment for paranoia. 

What Are the Symptoms of Paranoia?

Delusional and intense suspicion or mistrust of others, one that leads to feelings of fear, stress, or anger, is one of the more common paranoia symptoms. Others include:

  • Hypervigilance 
  • Defensiveness
  • Being concerned with hidden motives
  • Fear of being taken advantage of or deceived
  • Difficulty relaxing
  • Feeling misunderstood by others
  • Feeling victimized

What Causes Paranoia?

It is not exactly known what causes paranoia, but several factors related are known to potentially lead to it.

Childhood trauma

Experiencing trauma during childhood can leave a mark on our developing brain and negatively affect how we interact with the world around us. In particular, repressed feelings of lack of safety or trust can cause paranoia as we grow up, as we learn to see the world as unsafe and the people around us as untrustworthy. 


Research shows that people who experience stress from their environment also have more symptoms of paranoia. Exactly how stress leads to paranoia is not clear, but what’s clear is that the connection is definitely there. 


Similarly, people with insomnia also experience higher levels of paranoia. Further research is needed to understand how insomnia is related to paranoia, but the stress that follows prolonged lack of sleep may be an important factor. 

Other mental disorders

Paranoia may be indicative of other mental disorders causing it, such as paranoid personality disorder (PPD) or schizophrenia. In the case of PPD, therapy can often help, but in the case of schizophrenia, psychiatric help and medications are needed.

Genetic reasons

Evidence suggests that paranoia may be hereditary, and therefore can occur regardless of life events or circumstances, but as part of the brain’s biology. Whether or not this means it can or cannot be cured is unclear, but treatment via therapy or medications is always possible.

What Is Online Therapy for Paranoia Like? 

As mistrust is one of the key symptoms of paranoia, therapy for paranoia, be it online therapy or in-person, must establish trust between the therapist and client. Trust allows the client to feel like therapy is a safe space to open up about their thoughts, feelings, and beliefs. Without this trust, the therapy is unlikely to be effective. 

One of the most common therapeutic approaches for paranoia treatment is cognitive behavioral therapy (CBT), a type of psychotherapy that aims to change maladaptive patterns of thought and behavior into adaptive ones. In the case of paranoia, this means changing delusional and irrational thoughts and behaviors into ones that are more grounded in reality.

CBT is a gradual, evidence-based process. It starts by helping you become more aware of how paranoid thoughts affect how you see the world and later how this altered perception affects the actions you take and how your relationships develop, among other aspects of life.

Cognitive behavioral therapy for paranoia often involves behavioral experiments. For example, the therapist may ask you to try and trust them in a low-stakes situation, such as trusting that they will begin each session by complimenting them or treating them to a tasty snack.

Later on, these types of experiments can move outside the sessions, such as trusting your barista to use non-dairy milk and watching as they do so when making your coffee. The stakes can then begin to gradually escalate.

These behavioral experiments essentially gather data that suggests other people can indeed be trustworthy. With the help of your therapist, you learn to question the validity of the negative assumptions you may have about other people and the world around you.

Being able to question your own paranoid thoughts helps identify when they come up and helps transform them into positive thoughts and assumptions that better reflect your reality. When you realize people aren’t trying to get you, you can begin cultivating healthy relationships.

The effectiveness of cognitive behavioral therapy as a form of treatment for paranoia is proven by research. What you may not know is that CBT also works just as well with online therapy. For someone with paranoia to whom forming trust is extra difficult, online therapy for paranoia may provide an easier start.

CBT doesn’t use different techniques depending on whether or not you and your therapist are sitting in the same room together. A video session with a good therapist experienced working with CBT for paranoia is just as good as in-person. But with online therapy, you don’t have to get to their office. To some, this alleviates a lot of the stress that comes with paranoia.

Many online counseling platforms also let you text with your therapist throughout the week and between sessions. This can make quite the difference for those who feel a more frequent need for support.

With lower prices, improved accessibility, and equal effectiveness, online therapy for paranoia is a great alternative to in-person therapy and one you should definitely consider.

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Self-Help Treatment for Paranoia

While self-help options are always good to have, keep in mind that they are not a viable replacement for therapy, as they do not engage with the source of your paranoia, only with its symptoms. 

Reality testing

Reality testing is a technique in which you question your own thoughts and ask someone close to you if the thought makes sense. For example, if you find yourself thinking the person next to you on the bus is secretly spying on you, contacting a family member and asking them if the thought makes sense gives you input about the validity of your paranoid thoughts. Reality testing is a skill that needs to be developed and can be further practiced as part of therapy. 

Avoiding alcohol and drugs

Drugs and alcohol don’t exactly go hand-in-hand with paranoia and can often trigger it and make it worse. If your mind struggles with irrational thoughts, substances can only compound this problem. 

Maintaining a healthy sleep schedule

As previously mentioned, insomnia can lead to symptoms of paranoia. One way to tackle this problem is to do what you can to maintain a healthy sleep schedule. This means going to sleep and waking up at regular hours, avoiding your phone and other devices before going to sleep, and making sure you are going to sleep in a well-darkened room. 


Meditating is associated with maintaining slower brain waves, which help you relax. You don’t need to be religious or even spiritual to meditate. You can try guided meditations available online or focus on your breathing as you inhale and exhale. Meditation alone will not make your paranoid thoughts go away, but it will help you respond to them more calmly.


Paranoia is not something that will go away on its own. If you or someone you know is struggling with it, professional help is always available. The effectiveness of therapy is well-established, and online therapy is just as effective too.

Many of the therapists at DoMental are experienced working with paranoia and are ready to give you a helping hand, no matter where you live. If you are willing to give trusting them a shot, you won’t be disappointed.

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