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Delusional Disorder

Treatments

COMBINATION PSYCHOTHERAPY AND ANTIPSYCHOTIC MEDICATION

Treatment Summary: Delusional disorder is difficult to treat because of the client's suspicious and delusional beliefs. However, research indicates that psychotherapy in conjunction with antipsychotic medication is the most effective form of treatment. The treatment of psychotherapy is used to explore the possible biological problems and to decrease the delusional symptoms. Additionally, it helps the client to work toward reality. It is imperative during psychotherapy for the therapist to join with the client. The therapist should express empathy, support, and trust toward the client. Once a strong relationship has been established, the therapist can begin to focus on increasing the client's self-confidence, and slowly challenge the delusional thought process. This is done best through cognitive-behavioral therapy and other solution-oriented therapies. Research indicates that antipsychotic medications' effectiveness is marginal. About one-third of patients respond somewhat positively, one-third show little change, and one-third worsen or do not take the medication as prescribed. Nevertheless, through antipsychotic medications such as Haldol and Risperidone, the agitation that is often present with the disorder can be subsided. Additionally, the medications can block the inappropriate behaviors associated with the delusional type.

  • Reference: Psych Central. (1998-2006). Retrieved from http://psychcentral.com/disorders/sx11t.htm Encyclopedia of Mental Disorders. Delusional Disorder. (2007-2010). Retrieved from http://www.minddisorders.com/Br-Del/Delusional-disorder.html
  • Submitter: N/A

Cognitive Behavioral Therapy

Treatment Summary: Cognitive Behavioral Therapy is one of the research-proven methods for treating patients diagnosed with any of the subtypes of Delusional Disorder. The first step involves the therapist working to establish a strong therapeutic alliance with the patient. Because most patients who experience delusions have experienced the disbelief of medical providers and close friends and family, they are naturally suspicious of anyone who attempts to help them. They fear that they will once again not be believed. In the first stage of working with a patient diagnosed with Delusional Disorder then, it is advised to not try to challenge the reality of the delusion. Rather, therapists are encouraged to empathize with the patient in regards to the impact the symptoms have on their everyday life (Salvatore et al., 2012). This first stage of therapy can be extensive because the "paranoia" that accompanies not being believed about something that seems so real to the patient is pervasive and usually well-entrenched by the time they seek treatment. The next stage of therapy involves challenging the patient in regards to their belief in their delusion. Many patients who are diagnosed with Delusional Disorder report that the delusions manifest themselves during times of stress and anxiety and are accompanied by feelings of vulnerability. Therefore, the delusion, in some ways, acts as a defense against perceived threats from the outside (Salvatore et al., 2012). Encouraging patients to engage in metacognition exercises where they deconstruct situations to identify their emotions and thoughts that might be triggering the delusions is thought to help them learn to challenge their views and thinking, particularly in stressful situations (O'Connor et al., 2007). The last stage of therapy involves helping the patient learn how to test reality so that delusions can be avoided in future situations. If metacognition has improved, patients are able to identify the emotions and the thinking that leads them to the delusional thoughts and feelings and stop the delusion from occurring in the first place.

  • Reference: O'Connor, K., Stip, E., Pelissier, M., Aardema, F., Guay, S., Gaudette, G., Leblanc, V.(2007). Treating delusional disorder: A comparison of cognitive-behavioural therapy and attention placebo control. Canadian Journal of Psychiatry, (52)3, 182-190. http://publications.cpa-apc.org/media.php?mid=375 Salvatore, G., Russo, B., Russo, M., Popolo, R., & Dimaggio, G. (2012). Metacognition oriented therapy for psychosis: The case of a woman with delusional disorder and paranoid personality disorder. Journal of Psychotherapy Integration, (22)4, 314-329. doi: 10.1037/a0029577
  • Submitter: Jeanne Mallory

Worry Cognitive Behavioral Therapy (W-CBT)

Treatment Summary: Research indicates it is common for individuals diagnosed with delusional disorder to also have comorbid disorders such as anxiety. Grandiose and persecutory subtypes typically occur together in individuals who exhibit anxiety. Essentially, it's applying worry interventions with CBT. Worry interventions such as reviewing positive and negative beliefs about worrying, identifying triggers, learning relaxation techniques, and etc. to reduce worry and distress.

  • Reference: Foster, C., Startup, H., Potts, L., & Freeman, D. (2009). A randomized controlled trial of a worry intervention for individuals with persistent persecutory delusions. Journal of Behavior Therapy and Experimental Psychiatry, 41, 45 - 51. doi: 10.1016/j.jbtep.2009.091
  • Submitter: Lan Carter