Managing Delusions

Learn about delusions and how to help your loved one manage their delusions.

Understanding and managing delusions

Delusions are a very common symptom of schizophrenia. They include illogical ideas, bizarre fantasies, and false beliefs not based in reality. Even though delusions are not real, they feel real to the person experiencing them. The steps below can help you support someone experiencing delusions.

managing symptoms
bcss british columbia schizophrenia society person working with delusions

    • Do not reason, argue, or challenge the delusion. Attempting to disprove the delusion is not helpful and will create mistrust.
    • Assure the person that they are safe and no harm will come.
    • Always use openness and honesty.
    • Encourage the person to verbalize feelings of anxiety, fear, and insecurity – offer concern and protection to prevent injury to themselves or others.
    • Convey acceptance of the need for the false belief.
    • Focus on building a trusting relationship with the person rather than the need to control their symptoms – remain calm.

    • Empathize with the person and try to understand the purpose behind the delusion.
    • Paraphrase what the person is saying or trying to say to clarify any confusion about the delusion they are describing.
    • Without agreeing or arguing, question the logic or reasoning behind the delusion. For example: “If the CIA is harassing you, who is the contact person?”
    • Do not confirm or feed into the delusion by asking questions about it when the person is not in psychosis. For example, NEVER ask, “How’s the CIA today?” when the person is well.
    • Identify the central topic.
    • Identify the main feeling or tone of the delusion.

    • Assess if and how the delusions are interfering with a person’s life. For example, can they no longer function or participate in regular everyday life?
    • Assess if the delusion is affecting a person’s relationship with others.
    • Determine if the person has taken action based on their delusion.

    • Keep a log documenting the intensity, frequency, and duration of a person’s delusion.
    • Determine if their delusions occur at a specific time of day or are related to certain activities or actions. Understanding if there is a pattern can help you look for ways to avoid situations that may trigger paranoia or delusions.
    • Some delusions are fleeting and brief, while others are more long-lasting and endure long periods.

    • Does the person always greet you with the delusion? If so, quietly listen and then give directions for the task at hand.
    • If the individual cannot stop talking about the delusion, ask them gently if they recall what you were doing and that it’s time to resume that activity.
    • If the person is very intent on telling you their delusion, quietly listen until there is no need to discuss it further.
    • Remember that it is helpful to reassure the person during the delusion that they, as a person, are okay.

Communicating with someone who has delusions

Try to offer empathy and focus on the emotions that the person is experiencing. Arguing facts and details may cause the person to shut down and feel you are judging them. By offering support without judgment and without confirming or denying the delusion, the person may feel consoled and trust that you care for them. Here are some things to remember as you speak to the person.

These strategies are from Tamara Hill’s article on PsychCentral, an independent mental health website with information and content created and overseen by mental health professionals.

  1. 1

    Pay attention to the emotions of the person.

  2. 2

    Discuss the way you see the delusion.

  3. 3

    Express that you are concerned about the person.

  4. 4

    Offer to pursue therapy together but be strategic.

  5. 5

    Ask the person why they believe as they do and be open-minded.

  6. 6

    Avoid getting frustrated and expressing that to the person.

  7. 7

    Learn about cognitive distortions or thinking errors.

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