A ‘delusion’ might sound like a belief that is obviously unreal. But if someone in your life is experiencing one, it will certainly feel real to them. In some cases, it might even seem plausible to you at first – especially when it draws on real experiences or common fears.

A delusion could look like:

• a friend or partner feeling convinced that they’ve been sabotaged by their co-workers, and hyperfocusing on past conversations and emails;
• a university student believing that social media posts and songs contain messages intended specifically for them, making it harder to focus on anything else; or
• a family member saying they have been chosen for a special mission – that they are the only person who can expose a vast network of corruption.

If you have a loved one who has a concerning belief and who you think might show signs of delusional thinking, it’s normal to feel frightened for them, overwhelmed and unsure how to respond. You might wonder whether it’s best to question the belief, to just ignore it or to encourage the person to get help. Many people find themselves caught between two fears: the fear of saying too much and making things worse, and the fear of saying too little and overlooking a serious problem.

This Guide is for people in your situation. As a clinical psychologist, I’ve spent much of my career working with people who are experiencing delusions and other symptoms of psychosis, as well as with the loved ones who support them. My approach is informed by a framework called cognitive behavioural therapy for psychosis (CBTp), which emphasises curiosity, collaboration and reducing distress. I’ll draw on these experiences throughout this Guide. After saying a bit more about what delusions are, I’ll describe how to consider whether someone in your life is truly experiencing one – and if so, what you can do to help.

What mental health experts mean by ‘delusions’

In everyday language, people use the word ‘delusion’ loosely, but clinically it refers to a belief that remains fixed despite clear evidence to the contrary, and one that is not widely shared within a person’s cultural or social context. What matters is not just the content of the belief, but how a person experiences it.

Often, it’s not one unusual statement that alerts loved ones, but the growing certainty a person feels and the increasing distress and disruption to daily life. I’ve seen versions of this pattern many times. For example, parents might initially hear their university-age child say that a group of students in the library seemed to be watching them, or that cars of the same make or colour kept appearing around campus. The comments may sound a little odd, but still plausible enough that the parents brush them off. Over time, the student may become increasingly certain that the other students, the cars and other seemingly unrelated events are all connected and are evidence that someone is monitoring them. The parents might eventually find out that the young person has lost weight and has been avoiding the dining hall and other places because they no longer feel safe there.

Some people have a single delusional belief, while others have several, often with related themes. They may occur on their own, or alongside other symptoms of psychosis – such as hearing or perceiving things that other people don’t, or disorganised speech or behaviour. Delusions can also coincide with mood disorders, substance use or periods of extreme stress or sleep disruption. (They are also seen in medical conditions such as dementia and Parkinson’s disease, and can appear at any stage of life, but this Guide focuses primarily on adults and adolescents who have delusions in the context of mental health conditions.) For loved ones, it is usually less important to determine the exact cause than to notice that something has changed and that it’s affecting the person’s wellbeing.

You do not need to diagnose someone, nor convince them that their belief is wrong, in order to help. In fact, approaching them with curiosity and compassion, and focusing on staying connected, can help preserve the trust between you and make it easier for them to accept support.

Look for the signs of a delusion

Not all unusual or strongly held beliefs are delusions. For example, anxiety can lead to intense thoughts like ‘Something bad is going to happen’ or ‘People are judging me,’ but these tend to shift over time and respond to reassurance. Similarly, people who have experienced actual harm or discrimination might understandably be vigilant in certain situations. And cultural, ideological or religious beliefs that seem unfamiliar to you would not be considered clinical delusions if they are widely held and meaningful within a person’s cultural group.

To understand whether a belief is a delusion rather than a more common or understandable way of thinking, clinicians look at three core features:

1. Conviction: how strongly the belief is held, and whether the person can consider other explanations.
2. Frequency and intensity: how often the belief comes up and how much it occupies the person’s attention.
3. Impact: how much the belief is affecting a person’s emotions, behaviour and day-to-day life.

When you are concerned about a belief that someone has, it’s natural to focus on whether the belief is true. But a more helpful approach is to consider these key features. To start, you might ask yourself: What has changed, and how is this affecting them?

You might begin to notice patterns such as:

• growing certainty or difficulty considering other explanations;
• the belief coming up more often or taking up more mental space;
• increased fear, anxiety or urgency;
• changes in behaviour, such as avoiding certain situations, withdrawing socially or heightened alertness to possible threats; or
• a negative impact on school, work or relationships.

Consider a relatively common scenario: someone becomes very interested in an online conspiracy theory. They bring it up from time to time and seem to believe parts of it strongly, but they also recognise that others see it differently and they acknowledge that it is a controversial interpretation. The belief is shared by a broader online community, does not dominate their attention and is not significantly affecting their daily life. The belief may seem unusual or concerning to you, but those features would make it less suggestive of a delusion.

In contrast, consider someone who becomes convinced that posts on social media or comments made on television are sending messages specifically to them. At first, they mention it occasionally, but over time, they become increasingly certain that the messages are intentional and meant to warn them. They spend hours looking for connections, have difficulty considering that the posts or broadcasts may be unrelated to them, and begin missing school or work because they feel the need to keep monitoring the messages. Here, the strong conviction, increasing preoccupation, and disruption to daily life would be indicative of a possible delusion and potentially a need for professional help.

It is also important to look at the broader picture. A concerning belief or potential delusion may occur alongside other experiences, such as:

• hearing or perceiving things that others do not;
• unusually elevated or irritable mood;
• disorganised speech or behaviour;
• changes in thinking or memory;
• severe sleep disruption;
• high levels of stress; or
• substance use.

These signs can provide important context and strengthen the case for seeking direct guidance from a clinical professional. At the same time, none of these features allows you to diagnose someone yourself. The goal is not to decide with certainty that a person is having a delusion, but to recognise when a pattern is concerning enough to warrant a closer look or professional support.

Prioritise your connection

If someone is showing signs of delusional thinking, it is very difficult to make progress starting from a place of conflict. Good communication strategies work best when the relationship feels safe.

In practice, this means staying connected in ways that are not centred on the belief. Spending time together, continuing shared routines or talking about everyday things can help maintain a sense of normality and trust. In many ways, the relationship itself can be a foundation for change. If someone feels judged or corrected, they are more likely to become guarded. By contrast, if they feel understood and respected, they are more likely to stay engaged, reflect on their experience and accept support. The way you show up in everyday interactions could matter as much as what you say about the belief itself.

Staying connected can be challenging if you become part of the delusional belief yourself: for example, if the person is convinced that you cannot be trusted, that you are working against them, or even that you aren’t who you say you are. In these situations, if the person can tolerate your presence, try to preserve the relationship through ordinary activities or neutral topics. But if being around you seems to increase their fear, mistrust or agitation, it may be necessary to step back and ask another trusted person in their support network to take a more active role for a time. If you ever feel unsafe, prioritise your safety and get support (see the later step Reach Out for Professional Guidance).

One of the most important principles when talking with someone about a concerning belief is to approach them with curiosity and compassion rather than confront them. Although it is very understandable to want to challenge the belief directly – especially when it’s causing distress – in most cases, a direct challenge does not help. Because the belief feels real to the person, it can lead to defensiveness, pulling away or increased distress.

Express your curiosity

Curiosity communicates that you are trying to understand the person’s experience rather than judge or correct it. You could use open-ended questions such as:

• ‘Can you tell me more about what’s been happening?’
• ‘When did you first notice this?’
• ‘What has that been like for you?’

For example, if someone says they believe they are being watched, you might ask them to tell you what their experience has been like. They might say that they feel they can never relax, or that several events now seem connected. You could then ask how they have been making sense of the experience. They might respond: ‘I think someone is tracking me. I keep seeing the same kinds of cars, and people seem to show up wherever I go.’ Rather than immediately challenging that interpretation, you could stay curious, asking what feels most convincing, or most stressful, about the experience. You can also check in to make sure you are correctly understanding what they mean: ‘Am I getting that right?’ And, if not, then: ‘Thank you for clarifying. I want to understand what you’re going through.’ This kind of back-and-forth can help you understand how the person is interpreting what is happening, how strongly they hold the belief and how much distress or disruption it is causing.

It is common to feel hesitant about asking these kinds of questions. In practice, though, respectful curiosity often helps the person feel less alone. Focusing on these questions can also help you avoid defaulting to rapid-fire interrogation (‘Are you sure? What proof do you have?’), which can feel like a challenge rather than an attempt to help.

Validate their emotions

Even with the best intentions, most people feel a strong pull to correct or reassure someone who’s describing a delusion. This is sometimes called the ‘righting reflex’. You might feel compelled to say things like ‘That’s not happening’ or ‘You’re overthinking this.’ These responses might come from a place of care, but they are likely to backfire. If you’re feeling this way, it can help to notice that urge without acting on it right away. You might remind yourself that you do not have to settle the question of what is true at that moment. If the person feels frightened, confused, defensive or overwhelmed, the more useful first step is usually to try to understand what they are experiencing and respond to that.

Validation involves showing someone that you understand what they are saying and take their experience seriously, even if you do not agree with the belief itself. For example, instead of saying ‘That’s not happening,’ you might say: ‘That sounds really frightening. I can see why you’d feel on edge.’ You might also reflect other emotions they’re feeling, such as frustration, confusion or feeling overwhelmed or unsafe. A helpful way to think about this is that, while the belief may not be accurate, the emotion is always real. Acknowledging the emotional experience helps the person feel seen and understood. Sometimes it can help to gently connect how the other person is feeling to what they are experiencing in their day-to-day life: ‘It sounds like you’ve been really on edge, and that’s why it’s been hard to go out or be around people.’

There are ways to disclose that you don’t agree with the person’s belief or interpretation of a situation while still being supportive. For example, you might say: ‘I’m not interpreting the situation the same way, but I can see how real and upsetting this feels to you.’ This allows you to be supportive without colluding with the belief or setting aside your own perspective.

When someone feels understood, they are often less defensive and more able to stay in the conversation. This creates the conditions for trust, problem-solving and greater flexibility. It makes it easier to help them consider other ways of seeing their experience (without feeling confronted) and accept support when needed. We’ll turn to these things next.

Gently explore alternatives to their belief

As your conversations continue, one goal is to support greater flexibility over time. By flexibility, I mean helping the person become less certain that there is only one possible explanation for what they are experiencing, and more able to consider other possibilities. Typically, when flexibility increases, the beliefs also become less preoccupying and disruptive for the person who holds them.

When the person feels heard and the conversation is calm, you may be able to explore other possibilities. It can help to first ask permission: ‘Would it be OK if we thought through a few possibilities together?’

You might then ask:

• ‘What do you think is the most likely explanation?’
• ‘Have there been times when it felt less certain?’
• ‘Have you considered any other possible explanations?’ (You could ask about the possibility that seemingly related events are a coincidence, for example.)

For example, if someone says: ‘I know those people were talking about me,’ you might ask: ‘What makes that feel like the most likely explanation?’ After listening (and reflecting and validating how they feel), you could follow with: ‘Is there any other way you could imagine that situation?’ They might say: ‘Maybe they were talking about something else, but I still think it was probably me.’ That may seem like a small change, but being able to hold even one alternative alongside the original belief can be meaningful.

Your aim is not to replace the belief with a new explanation or convince them they are wrong. Rather, it is to help create a little more room for uncertainty and reflection. A change in how someone relates to a belief often happens gradually. Rather than trying to resolve everything at once, it can help to think in terms of ‘planting seeds’ over time. A foundation of curiosity and validation usually needs to come first: the person is more likely to consider other possibilities when they feel heard, respected and less defensive. Moments of gentle reflection can build on that foundation and create space to begin to question the belief or consider alternatives.

This kind of exploration will be more useful in some situations than others. If someone is very distressed, highly certain of the belief or amid an acute episode of psychosis, they may have much more difficulty considering alternatives. In those moments, it is usually more helpful to stay calm, maintain connection through validation and help them access professional support rather than to keep pressing for a different interpretation.

Encourage support-seeking

If your concerns continue, it can help to raise the idea of seeking professional support, such as a therapist, primary care doctor or psychiatrist. Rather than focusing directly on the belief, connect the idea of seeking help to goals that you and the person both agree on, such as feeling less stressed, sleeping better, staying connected to others or getting back on track with school or work.

You might say, for example: ‘It seems like this experience has been really exhausting’ or ‘I can see how much this has been getting in the way of things you care about.’ From there, you can gently suggest support: ‘I wonder if talking with someone could help with some of that.’ Framing support in this way can feel more collaborative because it starts with the person’s own concerns and goals rather than asking them to agree that their belief is a symptom or accept a particular diagnosis.

If your loved one becomes upset or feels that you are dismissing their experience, it can help to step back from the suggestion of getting help and return first to validation. You might say: ‘I can see that this feels very stressful for you, and I don’t want you to feel like I’m dismissing what you’re going through.’ Once the person feels heard, you can leave the door open for a future conversation by adding something like: ‘If you ever want help figuring out how to make this feel less overwhelming, I’m here.’ When the person is not ready, you may need to return to the conversation at a later point.

Reach out for professional guidance

If you are worried about someone, you do not have to wait for the person to agree to seek help before reaching out for guidance yourself. You can contact a general practitioner or another primary care provider, a mental health professional, a specialised early-psychosis programme or a crisis service to describe what you are noticing and ask about next steps.

It can also be helpful to reach out to a professional for guidance about what you are noticing even when signs of possible delusional thinking are still relatively subtle. This might include various signs already discussed in this Guide, such as a loved one’s increasing distress or fear, withdrawal from others or beliefs seeming to interfere with daily life. Reaching out early can help clarify what is happening and provide support before the concerns escalate. (See the Links & Books section at the end of the Guide for examples of support-seeking resources.)

More urgent support may be needed if you notice a rapid decline in the person’s functioning, an inability to meet their basic needs, or extreme fear or agitation, or if you have concerns about safety. A local mobile crisis service may be able to provide timely assessment and support. If there is an immediate, life-threatening emergency, such as imminent harm to the person or someone else, contact local emergency services. Staying calm, giving the person space and speaking clearly can help reduce escalation while crisis support is being arranged.

In any of these situations, remember that you do not need to be certain about what is happening to take your concerns seriously or to reach out for guidance.

What recovery can look like

For someone who has experienced delusional thinking, recovery does not always mean that the delusion completely disappears. More often, the person becomes less preoccupied with the belief, feels less distress, experiences more flexibility and starts to function better in day-to-day life.

With support – which frequently includes therapy and medication – many people experience a meaningful improvement over time. For example, the student who felt certain that social media messages were directed at them might still occasionally have that thought, but it might feel less convincing and come up less often. They may be able to use social media again without becoming preoccupied and stay engaged in classes. Similarly, someone who felt they were being monitored may continue to have moments of doubt about whether that has happened – but they might stop avoiding places and no longer feel on edge the way they did before. The belief may still be there, but it no longer drives their behaviour or dominates their daily life.

Sometimes a delusional belief becomes less intense as stress decreases, sleep improves or the circumstances around it change. But when a belief is persistent, highly distressing or part of a mental health condition such as schizophrenia, another psychotic disorder or a mood disorder with psychotic features, professional treatment is often important. Some people with these conditions need support for a shorter period, while the majority benefit from ongoing care.

Families and loved ones are not expected to act as therapists or replace professional care. Rather, the tools in this Guide are meant to aid and empower you in how you communicate and stay connected, alongside appropriate professional support.

Why delusions feel so real

Every person’s brain relies on mental shortcuts to make sense of the world quickly. This helps us interpret situations and respond efficiently, but it can also lead to common thinking patterns such as jumping to conclusions, black-and-white thinking, and catastrophising. Most of the time, these patterns are flexible and can be reconsidered. Under certain conditions, however – including stress, sleep disruption or mental health conditions such as psychosis – these thinking patterns can become more intense.

When someone is vulnerable to or experiencing psychosis, for example, certain ways of thinking often become more pronounced. A person might draw strong conclusions from limited information, begin to see personal meaning in neutral events or focus on information that supports a belief while overlooking other possible explanations. These patterns can reinforce one another over time and contribute to the development of delusional beliefs.

From this perspective, delusions can be understood as the brain’s attempt to make sense of experiences that feel confusing, intense or overwhelming. The delusional belief that results feels like a clear and convincing conclusion based on what the person is noticing and interpreting, even if it does not match how others see the situation.

A common and related part of delusional thinking is a limited ability to recognise that a belief may be inaccurate or part of a mental health condition. This is often referred to as reduced insight. Importantly, this is not the person simply being stubborn or in denial. It reflects a change in how the brain processes and makes sense of experiences. From their perspective, their interpretation feels accurate and logical. They may genuinely feel that nothing is wrong with their belief, or that others are misunderstanding what is happening.

This helps explain why correction or reassurance often does not work. When someone is convinced of their experience, being told they are wrong can feel dismissive or confusing, and it might even lead them to become more certain in their belief. Reduced insight can also affect how someone thinks about getting help. If the experience feels real and accurate, seeking professional help may not make sense to them, at least not at first.

For families and loved ones, understanding this can help to reduce frustration and blame, and encourage a more compassionate, effective approach. With support and treatment, insight often improves, and someone may become better able to reflect on their experiences and consider alternatives to their belief.

If you’re looking for help

In the United States, the Substance Abuse and Mental Health Services Administration (SAMHSA) offers a national directory to help find treatment, including early psychosis programmes and specialist care.

In the United Kingdom, the National Health Service (NHS) website provides information on psychosis, including guidance on accessing treatment.

In Australia, Medicare Mental Health is a government-supported service that helps people find mental health support, including early psychosis services.

If you want to learn more about delusions or psychosis

The book Back to Life, Back to Normality, Volume 2 (2018), edited by Douglas Turkington and Helen Spencer, is an accessible, practical guide for families that explains psychosis through a CBT-informed lens. It includes real-life experiences alongside concrete strategies for supporting a loved one’s recovery.

I helped create a series of videos for families through the STEP Learning Collaborative, part of the Specialized Treatment Early in Psychosis programme. They offer practical, relationship-focused guidance, including communication strategies and role-play demonstrations of how to support individuals experiencing delusions and other symptoms of psychosis.

Voices of Lived Experience, another video series from the STEP Learning Collaborative, features first-person accounts from individuals who’ve experienced psychosis and their caregivers. They describe what these experiences feel like and what support was helpful.

On the National Alliance on Mental Illness (NAMI) website, you can find family-friendly resources, education programmes and support groups for those supporting a loved one who’s experiencing psychosis or other mental health concerns.

The LEAP approach is a practical communication framework based on listening, empathising, agreeing and partnering, designed for supporting someone who may not recognise they need help. To find out more, check out the TEDx talk ‘I’m Not Sick, I Don’t Need Help!’ (2017), given by the clinical psychologist Xavier Amador, and the LEAP Institute website.

Psychosis REACH (Recovery by Enabling Adult Carers at Home) is a form of evidence-based training for families that teaches CBT-informed communication and support strategies. You can learn more on the REACH website or by reading the Psyche Guide informed by this approach: ‘How to Support a Loved One Through Psychosis’ (2022) by Akansha Vaswani-Bye.