Cognitive Behavioral Therapy Shines Light on the Darkness of Paranoid Personality Disorder

One of the biggest challenges for those living with PPD is determining when their beliefs are true. Sometimes, the people around us do have bad intentions. A co-worker might try to discredit you for their own personal benefit, and someone soliciting donations on the street might not be who they say they are. However, for those with PPD, even good intentions are interpreted as bad, creating a world of fear that can tear them apart emotionally and sever their bonds with those closest to them. A whispered, inaudible conversation becomes a secret threat against them, and advice from concerned family members is interpreted as being rooted in ulterior motives that plot to bring them down. Watching someone express fear and suspicion towards friends and loved ones can be heartbreaking, and given the seclusion that many with PPD force themselves into, a lack of treatment can only make matters worse.

In order for those suffering from PPD to break the restraints of their negative thoughts, they must realize that their paranoia is rooted in a misinterpretation of the events that are taking place around them, and that this misinterpretation is having destructive effects on both their life and the lives of those personally connected to them. They need to identify and stop this pattern of thinking, and one of the best treatments for helping clients reach this level of awareness is cognitive behavioral therapy (CBT), a goal-oriented type of psychotherapy that works to change the patterns of thinking and behavior that underlie various mental illnesses—including paranoid personality disorder.

While past treatments for PPD focused on ignoring paranoid thoughts and experiences and avoiding confrontation, modern forms of treatment have shifted towards using CBT to help clients become aware of their paranoia and understand how these thoughts affect their perception of the world. From here, clients can move toward seeing how this perception affects their actions and relationships with others.

CBT will start off slow, with clients at first asked to trust others with smaller things and examine the outcome of these situations. This could be anything from trusting their therapist to get their coffee in the morning, to something a bit more personal such as providing feedback on an art or pottery class conducted during the course of residential treatment. These behavioral experiments allow clients to put their negative assumptions of the world to the test, and eventually learn to distinguish between signs of good and bad intentions.

With proper CBT, individuals with PPD learn to pinpoint the nature of their paranoid thoughts when they surface, and gain the ability to turn them into positive thoughts that are a truer reflection of their surroundings, helping them realize that the people around them are not out to get them. Ultimately, the goal is to help them look at the world in a more positive manner in order to foster healthier relationships in their personal and work lives and reignite the trust and love that they have lost to their illness.

The benefits of CBT extend far beyond the behavioral spectrum—it also alters the way that the brain communicates with itself. Numerous studies have examined the effects of CBT on neurobiology, revealing its ability to alter various neural circuits that are involved in negative emotions and social cognition. One found that CBT alters the brain pathways involved in fear extinction—a common psychological phenomenon whereby a learned fear response declines—by decreasing hyperactivity in regions that underlie the response. Another found that it can increase activation in areas of the brain connected to empathy and forgiveness in those with Post-Traumatic Stress Disorder. Learning to control negative emotions and focus on positive feelings is an essential process for those with PPD, and these studies highlight the ability of CBT to help clients achieve this.