We recommend reading Overcoming Paranoid and Suspicious Thoughts. This provides extensive information to help people understand exaggerated or unrealistic suspiciousness. Further, six practical steps are provided to help people cope with such fears.
However, people sometimes want to consider other sources of help – perhaps seeing a therapist or trying medication. Or sometimes people simply want to find out a bit more about the issues.
So how do we know when it’s right to ask for professional help? There’s no cut and dried answer to this one, but basically it boils down to:
- how much distress the thoughts are causing
- how much disruption the thoughts are causing on work, relationships, activities, or quality of life
If the thoughts are making a person feel very anxious or down, or if they’re stopping a person from functioning as they’d like to, then thinking about seeking professional help may be a good idea. This is definitely the case if the person is feeling very depressed or even suicidal.
If you do decide to seek professional help, it’s crucial that you find the right person. If you think your GP doesn’t understand paranoid thoughts and their treatment, ask to be referred to a specialist. It’s relatively easy to get knowledgeable advice on medication, but harder to find someone with specialist psychological knowledge.
Cognitive Behaviour Therapy
There are lots of types of psychological therapy (also called “psychotherapy” or “talking therapy”). But the therapy that has been proved to be highly effective in dealing with suspicious thoughts is Cognitive Behaviour Therapy (or CBT for short).
CBT is a collaborative therapy. The therapist and client will work together to:
- agree the goals of the therapy
- identify the causes of distress
- decide on strategies for reducing that distress.
A client can expect the therapist to share their knowledge with you, and to regularly monitor progress, but it’s definitely not a case of the therapist simply telling the client what the problem is and what should be done about it.
How many sessions of CBT does a person need? Well, that’s something that needs to be discussed with the therapist but most people have around 10 to 20 weekly sessions.
CBT is mainly provided by clinical psychologists, though more and more psychiatrists, counselling psychologists, counsellors, and nurses are becoming trained in this approach.
Clinical psychologists have studied psychology at university and then completed a three-year postgraduate degree. Most also have a doctoral degree in clinical psychology (meaning that they use the word “Doctor” before their name). Clinical psychologists apply psychological theories and research to problems and don’t prescribe medication.
Psychiatrists have trained as medical doctors and then gone on to specialise in the care of people with mental health problems. Their first line of treatment is usually medication, but some psychiatrists are also trained in psychological therapies such as CBT.
Defining the term counsellor is trickier. It’s a title used by people with widely differing types and amounts of training. Chartered counselling psychologists, for example, have studied for several years, obtained a doctoral degree, and are often very similar to clinical psychologists. Some counsellors have extensive training but not in CBT. Others have only attended short courses. When you’re looking for a counsellor, check that they’ve been properly trained, that they’re a specialist in CBT, and that they belong to an appropriate professional body. A number of organisations keep registers of CBT therapists (for example, the British Association for Behavioural and Cognitive Psychotherapies), and you can find details of these in the list of useful links.
If you want to explore the options for getting CBT, it’s usually best to talk first to your family doctor (called a GP or General Practitioner in the UK). Your doctor has a good general knowledge of common illnesses and will be able to advise you on access to local resources and refer to a therapist if appropriate. It’s important to be referred to a therapist who has been properly trained in the use of CBT: ask your doctor if you’re not sure.
In the UK most CBT therapists work in the National Health. Alternatively you may want to consider a private therapist. Sometimes private therapy can be arranged by your GP. If not, you may need to find a therapist on your own. As ever, make sure your therapist is properly qualified! (Again, see the list of useful links for help with this.)
The PICuP Clinic
The PICuP Clinic is a specialist psychological therapies service providing CBT for paranoia and other distressing unusual experiences, such as hearing voices. It is headed by international clinical and academic experts, and shows excellent outcomes in terms of reduction in distressing symptoms and increase in quality of life. 91% of people who have had CBT with PICuP report that they are satisfied with the therapy they received.
PICuP takes referrals from GPs and community mental health teams throughout London and the South East.
PICuP Clinic, PO79
Clinical Treatment Centre
London SE5 8AZ
Tel: 0203 228 3524
Fax: 0203 228 5278
Web site: www.national.slam.nhs.uk/services/adult-services/picup/
* This is subject to the referring team/GP having a “contract” with the clinic, and referrals may need to go through a funding panel for approval.
Medication is often prescribed for people who are suffering with severe paranoid thoughts and many find it helps.
Remember that psychologists and counsellors can’t prescribe medication; only GPs and psychiatrists can do so. As part of the consultation, they’ll want to investigate possible physical causes of the suspicious thoughts. For example, they may take a blood sample so they can check for infection and see how the liver, kidneys, and thyroid gland are functioning.
Two major categories of medication are given to combat paranoid thoughts:
Each of these two categories includes lots of different individual drugs. Finding out about these drugs can be a confusing business because they all have at least two names! Each drug has an official medical name (its generic name) and the trade name given by the company that makes it. For example, the drug fluoxetine is widely known by the trade name Prozac. We use the generic names here.
Everyone responds differently to particular drugs so it may take time to find the right medication and the right dose. Each drug also has its own set of potential side-effects and risks. Your doctor will discuss how a person is getting on with the medication they’ve prescribed and they may alter the dose or even the drug until the one that’s most effective is found. Make sure the doctor explains:
- how much of the medication to take and how often
- the potential side-effects
- how a person would go about stopping the medication, if that’s what eventually decided (for example, it’s often best to gradually reduce the amount you take rather than immediately stopping altogether)
As we’ve mentioned, anti-psychotics are one of the two major types of drug prescribed for suspicious thoughts. Anti-psychotics are mainly prescribed for people with mental health problems such as schizophrenia or psychosis, but in smaller doses they’re sometimes used to treat anxiety and agitation.
Anti-psychotics take a few days or weeks to act. If one doesn’t work, doctors often try one of the others. There are lots of nti-psychotic medications now. The older ones include chlorpromazine, haloperidol, and trifluoperazine. Among the newer ones, often called ‘atypical anti-psychotics’, are risperidone, amisulpride, olanzapine, and clozapine. If the doctor suggests an anti-psychotic, it’s likely to be a low dose of an atypical.
The downside of anti-psychotics is the unpleasant and occasionally severe side-effects they can produce, including drowsiness, weight gain, reduced sexual desire, and diabetes.
The doctor may feel that suspicious thoughts will reduce if the person’s mood is better. In this case, they’ll probably prescribe an anti-depressant. There are various types of anti-depressants, but chances are a person would be given one of the newer SSRIs (or `selective serotonin reuptake inhibitors’).
Commonly used SSRIs are fluoxetine, paroxetine, citalopram, and sertraline. As with anti-psychotics, it may be a while before the SSRI starts working. However the side-effects (for example, stomach upset, agitation, rashes, reduced sexual desire) are usually less common and less severe than those caused by anti-psychotics.
The other commonly prescribed type of anti-depressants is the tricyclics – examples include amitryptyline, imipramine, and clomipramine. SSRIs are thought to have fewer side-effects than the tricyclic medications.
The web site www.mentalhealthcare.org.uk provides useful information about medication.