Should you challenge someone's delusions?

From the Guidelines

Generally, it's not advisable to directly challenge someone's delusions. Instead, focus on building trust, expressing empathy, and gently redirecting the conversation while acknowledging the person's feelings without validating false beliefs. When interacting with someone experiencing delusions, maintain a calm demeanor, use simple language, and avoid arguing or trying to convince them their beliefs are false, as this often increases distress and can damage your relationship with them. If the person is in treatment, follow the guidance of their mental health provider, who might recommend specific approaches tailored to their condition. For someone experiencing delusions, professional help from a psychiatrist is essential, as treatment typically involves antipsychotic medications such as risperidone, olanzapine, or aripiprazole, combined with therapy. Challenging delusions directly is counterproductive because these fixed false beliefs are symptoms of underlying conditions like schizophrenia, bipolar disorder, or severe depression, and the person genuinely believes them to be true despite evidence to the contrary. In emergency situations where the person might harm themselves or others based on their delusions, contact emergency services immediately.

Some key points to consider when interacting with someone experiencing delusions include:

• Building trust and expressing empathy
• Gently redirecting the conversation without validating false beliefs
• Maintaining a calm demeanor and using simple language
• Avoiding arguments or attempts to convince them their beliefs are false
• Following the guidance of their mental health provider
• Seeking professional help from a psychiatrist for treatment, which may include antipsychotic medications and therapy.

According to recent studies, such as 1, delirium is a common accompanying symptom for other presentations, and its diagnosis is extremely important as mortality in patients may be twice as high if the diagnosis of delirium is missed. Additionally, studies like 1 suggest that antipsychotic agents should be discontinued immediately following the resolution of the patient’s distressful symptoms.

In terms of treatment, antipsychotic medications such as risperidone, olanzapine, or aripiprazole are commonly used to manage delusions, as mentioned in studies like 1. It's also important to note that non-pharmacological interventions, such as reorientation, cognitive stimulation, and sleep hygiene, should be maximized before pharmacologic interventions are used, as suggested by studies like 1.

Overall, when interacting with someone experiencing delusions, it's essential to prioritize their safety and well-being, while also providing emotional support and guidance. By following the guidance of their mental health provider and seeking professional help when needed, individuals can receive the treatment and support they need to manage their delusions and improve their overall quality of life.

From the Research

Challenging Delusions

• Challenging someone's delusions can be a complex issue, and research suggests that it should be approached with caution 2.
• Studies have shown that people with delusions may become violent when their beliefs are challenged, especially if the challenge is vigorous and not done in a safe and clinical environment 2.
• However, cognitive-behavioral therapy (CBT) has been used to modify psychotic symptoms, including delusions, and has been shown to be effective in reducing violence in people with psychosis 2.

Alternative Explanations

• Research has also shown that people with delusions often do not consider alternative explanations for their experiences, and that having doubt in a delusion without an alternative explanation can be associated with lower self-esteem 3.
• Clinicians may need to develop plausible and compelling alternative accounts of experience in interventions, rather than merely challenging patients' delusional beliefs 3.

Understanding Delusions

• Delusions can be understood as complex phenomena that emerge from a dynamic interplay between interdependent subpersonal, personal, interpersonal, and sociocultural processes 4.
• The Emergence Model of Delusion proposes that delusions are strongly individualized and inherently complex phenomena that require an integrative approach to research and clinical care 4.
• Effective clinical care for individuals with psychosis may need to adapt to match more closely the subjective experience and meaning of delusions as they are lived through 4.

Belief Flexibility

• Research has also shown that people with delusions may have less belief flexibility and more extreme responding than non-clinical controls, and that belief flexibility may be related to less delusional conviction 5.
• Cognitive-behavioral therapy may usefully focus on generally thinking style as a preparation for working more directly with delusional beliefs 5.

Clinical-Phenomenological Perspective

• A clinical-phenomenological perspective on delusions emphasizes the importance of considering the experiential dimension of delusion, and how specific alterations to self-consciousness and reality experience underlie delusions 6.
• This approach may offer new ways to advance current research and clinical practice, and highlights the need for a more nuanced understanding of delusions beyond the traditional conception of false beliefs 6.