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Understanding Mental Health in Families

How To Respond To Someone Who Is Living In A Different Reality: Delusions, Hallucinations, and Paranoia

March 10th, 2025

When this happens, you can implement several strategies to help prevent the issue from escalating.

Communicating with a family member who is living in a different reality can be very challenging. This may come in the form of delusions, hallucinations, paranoia, or because they have adopted the language and misinformation of a larger group or cult.

How to respond to someone living in a different reality

When this happens, you can implement several strategies to help prevent the issue from escalating. As always, it’s also important to prioritize your own physical and emotional safety during these interactions.

  • Don't dispute, don’t reinforce. Validate the fear while calmly explaining that you see things differently. Recognise that their ideas and fears are real to them, but you disagree with them. For example, say, "I do not believe ______, but I can see that you are upset about it."
  • Listen to their statements without judgment. Do not act shocked or appalled by what they say, and do not laugh or mock them.
  • Validate and redirect. “I understand that you’re scared. Why don’t we get some water?”
  • Acknowledge their distress or fear. "I can see you are very upset.”
  • Try to be positive and comforting rather than negative and emotional. But don’t promise that everything is ok or will be ok.
  • Avoid annoyance or criticism. Just be respectful, even when it doesn’t make sense to you.
  • Evaluate risk. If you think the person is suicidal or there is a threat to someone else, call 911 or take the person to a hospital. You can also contact their therapist or medical team.
  • If the person is hearing voices, do not ask them to force the voices to stop.
  • Take breaks and listen to their availability. If you need a break, try to find help and get some space. Discussing these topics and watching someone you love in distress can be extremely taxing. It’s also important to recognize when they do not want to discuss this further. Trying to push them to continue speaking can increase agitation if they’re not ready.

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