Therapy will not cure or treat the underlying cause of the delusions or
hallucinations (most commonly voices), but can help you deal with the distress
associated with them.
This self help guide
assumes that you are already receiving treatment from an appropriate mental
health professional or doctor. If you are experiencing symptoms such as
hearing voices or others are concerned about your responses to what might be
normal events as a result of your fixed, false and unreasonable beliefs, then
you should seek the help initially of your GP who will refer you to a
psychiatrist for appropriate treatment.
In this context,
"paranoia" is the false and fixed belief that others are persecuting you or
trying to harm or kill you, rather than an anxiety about others thinking
critically of you, for example at a social gathering.
As explained on
this page, CBT looks at the links between our thoughts,
our feelings and our behaviours. Our feelings result from the way we
interpret and try to make sense of our world, which is often a result of our
culture, education and our experiences. In psychosis, this process
doesn't work quite the way it normally does, and we can experience sensations
that other people don't (hallucinations) and have fixed, false beliefs
(delusions) about what are otherwise seemingly
normal events, causing much distress. These voices or delusions can often
be related to our past.
We often use the
acronym "ABC" to look at this process.
Activating Event (or voice)
Belief about the event (or voice)
Consequence - feelings and behaviours
For instance, a
paranoid delusion - the distressing meaning we give to a situation - might be:
My cousin is
trying to kill me!
This came about in
the following way:
It wasn't the event
itself which causes the distress, but the belief or meaning we give the event,
the way we make sense of it. Just as in CBT for
depression and anxiety, we can
challenge and learn to think
differently about our thoughts.
In the case of distressing
voices, then it's the belief we have about, or meaning we give the voices, that
causes the distress. This might include how much we believe that the voice
speaker is able to control us, how powerful it is, how harmful they might be,
who it is, how many of them there are, and what we believe about what the voice
Example of Distressing Voice
resulting in self-harm:
If the voice hearer was able to
challenge or think differently about the voice, or about the belief they have or
meaning they give the voice, then they are less likely to feel distressed, and
therefore much less likely to self-harm.
The first step is to start to
become aware and notice what's happening at those times - just as in CBT for
depression and anxiety,
we can start to notice our thoughts, emotions, physical sensations and
behaviours using the 5 Aspects or the ABC Worksheets below. Initially it
helps to write these down after the event, when the distressed has mostly
passed. Later, as you get more used to it, you will start to notice these
internal experiences at the time that they happen.
Example 5 Aspects formulation of
It helps to get someone on side,
who can help you with this - perhaps a therapist, but also a close family member
Notice when the voices are worse
- louder, more frequent, when you think
you're less able to cope and feel more distressed by them.
Notice the situations in which
you feel paranoid, or are more likely to feel distressed. Where, when, who
with, what is it about those times?
Early Warning Signs
form PDF to help you
identify when you're becoming more vulnerable or unwell
Doing things differently
If distressed by voices:
Can you do anything differently
at those times when you're likely to feel more distressed by voices?
For instance: Focus your
attention on something other than the voices (see
mindfulness page) - listen attentively to music (use headphones?), engage in
an absorbing activity, be with others rather than alone, mindful breathing,
focus on the environment around you, talk to someone,
Talk into a mobile phone if you
need to talk back to voices
Teach the voice to tone down, or
visualise an internal volume control (turn the dial down a little at a time)
Give the voices a job to do
elsewhere for a few minutes or hours
Pause, take a breath, don't react automatically
- Ask yourself:
What am I reacting to?
fact or opinion?
it real" test: 1. Is it possible? 2. Check the evidence
(e.g. check reaction of others, ask someone etc)
Is it a voice or other
What meaning am I
giving this experience or thought?
What goes through my
mind when the voice says that?
What do I believe about
Am I agreeing with the
Does that thought or
belief fit with my own inner beliefs and morals?
How am I making sense
What is it that I think
is going to happen here?
What's the worst (and
best) that could happen? What's most likely to happen?
Am I getting things out
How important is this
really? How important will it
be in 6 months time?
Am I overestimating the
Am I underestimating my
ability to cope?
How much control does
this voice or belief have over me?
Am I mind-reading what
others might be thinking?
Am I believing I can
predict the future?
Is there another way of
looking at this?
What advice would I
give someone else in this situation?
Am I putting more
pressure on myself?
Just because I
bad, doesn't mean things really
Use Wise Mind
What do I want or need
from this person or situation? What do they want or need from me? Is
there a compromise?
What would be the
consequences of responding the way I usually do?
How would that help?
Is there another way of
dealing with this? What would be the most helpful and effective action to
take? (for me, for the situation, for the other person)
Self Help - this page as PDF
Further Information &
Overcoming Paranoid & Suspicious Thoughts
Overcoming Distressing Voices
Schizophrenia for Dummies
Living with Schizophrenia
Coping with Schizophrenia: a guide for Patients, Families & Caregivers