Feeling on edge while walking down an empty street at night; thinking you are being gossiped about at work; feeling like you need to be on guard around certain people… Worrying that others are intending to do us harm is a surprisingly common experience.

Acting on these concerns can be helpful – checking things out with people, taking time to build trust in a new friend. Unfortunately there are times when being caught up with suspicions creates problems – making unfounded accusations, cutting off friends and family, even feeling afraid to leave the house or to trust anyone.

We are living in an age of increasing paranoia. We are regularly encouraged by society to be fearful and suspicious: exposed to daily news reports of violent crime and corruption, governments warning us to be vigilant of terrorism, the surveillance of our emails and internet use by corporations and intelligence agencies.

Surveys suggest that up to a third of the population are regularly troubled with suspicious thoughts. And yet it is not something that is easy to talk about. People can be afraid of being seen as “paranoid” if they express these concerns. The stigma attached to “being paranoid” may increase isolation and worry: the very things that can strengthen the impact of these experiences. It can be quite a brave step to seek help.

Acceptance and Commitment Therapy provides several ways to help clients struggling with suspicious thoughts. This is because ACT works to undermine the processes that amplify the power of thoughts, and encourages connection with meaning and purpose, which may transcend moments of fear and suspicion.

Here are four ways that the ACT therapist can help:

Improving Sleep – our ability to flexibly respond to our fears and suspicions is limited when we have poor sleep. Periods of insomnia appear to increase the frequency of suspicious thinking and unusual experiences. One of the most effective things the ACT therapist can do is to help the client increase the quality of their sleep. This could be through education and sleep hygiene, or a focused ACT intervention, if sleep problems are long-standing or the focus of over-control and worry.

Noticing Worry and Rumination Traps – like many other experiences, a suspicion is made larger by worry and rumination. A concern about whether a friend is undermining you can become much more upsetting and compelling by spending a lot of time going over past events or thinking over all the ways they could hurt you. Practicing present moment awareness and gently noticing the urges to worry and ruminate may allow for suspicions to be experiences, rather than threats that must be acted on. Exploring the workability of responses to suspicions can help the client to find ways to act that are guided by values rather than fear. This may even include skilful ways to respond when they are being undermined!

Activating rather than Avoiding –  suspicious thoughts can invite a variety of unhelpful ways of avoiding the situations and people that trigger them. This can strengthen their impact and maintain their sense of accuracy (i.e., by limiting contact with moments of  discovering when they are inaccurate). Suspicion can also intensified by depression: being fused with thoughts about deserving punishment or being powerless, negative thoughts about people and the world, and patterns of inactivity. The ACT therapist can encourage an activation approach, fostering choice in response to triggers that invite avoidance. Along with the client being in greater contact with rewarding moments, suspicions can be undermined as both guides to action (considering workability) and useful reflections of “reality” (through noticing occasions when they are disconfirmed).

Connecting rather than Isolating – Isolation can lead people to have unusual ideas and experiences. Having no-one around to check these ideas with can make them more compelling, especially if they relate to important concerns, such as being accepted by others or work performance. People who struggle with suspicions can be socially isolated, increasing the chance of unusual ideas and limited chances of checking them out. The ACT therapeutic relationship can be a powerful context: where it is safe to discuss unusual ideas and experiences with an accepting person, and to have modelled a defused and pragmatic way of responding to these. This may also help with developing more flexible perspective-taking (e.g., imagining another person’s point of view; access to more than one perspective on a situation; cultivating greater self-acceptance and compassion). Through values work, previously-avoided directions of connecting with others may also be encouraged, reducing isolation and fostering social supports.

Helping clients who struggle with suspicious thoughts can be challenging. There can be moments when the client treats the therapist with suspicion, with motives questioned, or sessions finished early due to client worries. Flexible persistence may be required: from experience, ACT creates a space where people can discover that even the most worrying thoughts about others can be responded to in a way that broadens their lives, rather than limits them.

Author’s note:  My opinion about how ACT may help with suspicious thinking and paranoia has been influenced by the ground-breaking research done by Prof Daniel Freeman and colleagues.