How paranoid fears keep themselves going
A warm, plain-language explainer on how worry, how you see yourself, poor sleep, feeling odd inside, quick conclusions and staying on guard can keep fears that others mean you harm going, and how they can ease. Based on Freeman et al. (2002) and Freeman (2016): a checklist of ways I keep safe and a reflection added.
Written by Tarun Vermani, Trainee Clinical Psychologist Updated
Assign and Download open signup, then return you to this worksheet. No card required. Resource access depends on your plan or trial. Already have an account? Sign in
Worksheet preview
How paranoid fears keep themselves going
PreviewLive preview: type in any field to try it. Nothing is saved here.
Feeling under threat
Every day, all of us have to decide whom to trust. That is hard, because we cannot see inside other people's heads. Most people have suspicious thoughts sometimes, such as wondering whether people are talking about them or whether someone means them harm. For some people these fears come often, feel very certain and are frightening. If that is you, you are not alone, and it is not a sign that you are weak or bad.
Some dangers are real. People do face harassment, bullying, discrimination, racism and abuse. If something like this is happening to you, your therapist will take it seriously and help you think about how to stay safe. This sheet is about something different: how fears can grow bigger than the danger in front of you, and how they can stay stuck even when nothing bad happens.
Reading this does not mean anyone has decided what is going on for you. Your therapist will work that out with you.
What can keep the fears going
Researchers have found several everyday things that can keep fears of other people going. Not all of them will fit you.
Worry: going over and over 'what if' thoughts brings frightening ideas to mind, keeps them there and makes them feel more likely.
How you see yourself: if you feel different from others, less than them or easy to hurt, often because of hard things that have happened, the world can seem more dangerous.
Feeling odd inside: being on edge, feeling unreal, or noticing that things look, sound or feel strange can make it seem as if something is wrong around you. A racing heart from anxiety can be mistaken for a sign of danger. Cannabis can make these odd feelings stronger.
Poor sleep: being short of sleep makes everyone more anxious and less able to think things through, and it can make odd experiences more likely.
Quick conclusions: when you feel under threat, the mind tends to jump to the first explanation and it can be hard to see any others. Your therapist can share a sheet on slowing down conclusions, which helps with this.
Ways of keeping safe: the things you do to protect yourself, which the next section looks at.
These parts feed each other. For example, worry keeps you awake, poor sleep makes you feel more on edge, and feeling on edge makes the worry stronger.
Why keeping safe can keep fear going
When you feel under threat, it makes sense to protect yourself. You might stay in, avoid people, keep watch or plan a way out. These things can bring some relief.
The trouble is what happens next. When nothing bad happens, it is natural to think, 'I was safe because I was careful'. So you never get the chance to find out that you might have been safe anyway. The fear stays, and staying in or keeping watch can also leave you lonely, tired and more on edge.
Tick any that you notice yourself doing. Please do not stop any of them on your own: that is something to plan with your therapist.
How the fears can ease
The fears can ease when the things that keep them going are worked on, one at a time, with your therapist. People often choose a few of these to start with:
Worrying less: learning to step back from 'what if' thoughts and to put worry in its place.
Sleeping better: getting a steadier sleep routine.
Feeling better about yourself: noticing your strengths and the good things about you, and treating yourself more kindly.
Making sense of odd feelings: understanding that feeling on edge or strange can come from anxiety, poor sleep or stress, and does not have to mean that someone is out to get you.
Thinking things through: slowing down and holding more than one explanation in mind.
Learning that you are safe now: once these feel more manageable, you and your therapist can plan small steps back into places and activities, dropping one safety behaviour at a time, to find out how safe things are today. The aim is not to argue about what happened in the past, but to build up a sense of feeling safe now. Your therapist can share a sheet on planning a safe test of a frightening belief.
Plan every step with your therapist, including which precautions to keep because they protect you from real danger. Do not confront, follow, record or investigate anyone, as that could put you or others at risk.
If you ever feel driven to get back at, confront or hurt someone you are afraid of, stop and contact your therapist or care team straight away, before you do anything.
This worksheet is for feelings you can manage. If you have urges to hurt yourself, or you feel unsafe, use your safety plan if you have one and tell your therapist. If you might act on the urges, call 999 or go to A&E. To talk to someone now, call Samaritans free on 116 123.
Over to you
Write a few lines to bring to your next session. It is fine if you are not sure yet.
Try it here. Nothing you type is saved. Sign up to assign it and let clients complete it on any device.
When to use ‘How paranoid fears keep themselves going’
‘How paranoid fears keep themselves going’ is a psychoeducation handout based on cognitive behavioural therapy (CBT), most often used in CBT for psychosis.
It is designed to be read within therapy rather than as a standalone self-help tool: a therapist introduces it and discusses it with the client. You can preview the full handout above, then assign it for clients to read between sessions on any device or download it as a print-ready PDF. Where a short reflection is included, it offers space to respond to the reading.
How it works
Most people work through it in around 9 minutes. It moves through five short sections to read:
- Feeling under threat: Every day, all of us have to decide whom to trust. That is hard, because we cannot see inside other people's heads. Most people have…
- What can keep the fears going: Researchers have found several everyday things that can keep fears of other people going. Not all of them will fit you. Worry: going over…
- Why keeping safe can keep fear going: When you feel under threat, it makes sense to protect yourself. You might stay in, avoid people, keep watch or plan a way out. These things…
- How the fears can ease: The fears can ease when the things that keep them going are worked on, one at a time, with your therapist. People often choose a few of…
- Over to you: Write a few lines to bring to your next session. It is fine if you are not sure yet.
The handout can be read on a phone, tablet or computer, or downloaded as a print-ready PDF. If it includes a reflection, answers entered on the Formulate platform are saved automatically and shared back with the therapist for review before the next session.
The CBT approach behind it
‘How paranoid fears keep themselves going’ introduces a CBT approach that involves mapping how the parts of a problem connect and keep it going (formulation). The aim is not positive thinking but a clearer, shared understanding of what keeps a difficulty going and practical, testable ways to change it.
Because it is a CBT tool it stays focused on the here-and-now links between thoughts, feelings, the body and behaviour, and it works best as one part of a wider course of therapy rather than as advice or a diagnosis.
Evidence & sources
This handout is grounded in established cognitive behavioural therapy theory and practice. Key sources include:
- Freeman, D., Garety, P.A., Kuipers, E., Fowler, D., & Bebbington, P.E. (2002). A cognitive model of persecutory delusions. British Journal of Clinical Psychology, 41(4), 331-347. doi:10.1348/014466502760387461
- Freeman, D. (2016). Persecutory delusions: A cognitive perspective on understanding and treatment. The Lancet Psychiatry, 3(7), 685-692. doi:10.1016/S2215-0366(16)00066-3
- Freeman, D., Emsley, R., Diamond, R., Collett, N., Bold, E., Chadwick, E., Isham, L., Bird, J.C., Edwards, D., Kingdon, D., Fitzpatrick, R., Kabir, T., & Waite, F. (2021). Comparison of a theoretically driven cognitive therapy (the Feeling Safe Programme) with befriending for the treatment of persistent persecutory delusions: A parallel, single-blind, randomised controlled trial. The Lancet Psychiatry, 8(8), 696-707. doi:10.1016/S2215-0366(21)00158-9
- National Institute for Health and Care Excellence (2014). Psychosis and schizophrenia in adults: prevention and management (CG178). NICE.
For use alongside professional support
Formulate provides educational CBT resources for use with a qualified therapist. They are not a substitute for professional assessment, diagnosis, or crisis care.
If you need urgent help now:
- Emergency services: 999 — if you or someone else is in immediate danger
- NHS 111 (NHS 24 in Scotland): 111 — choose the mental health option for urgent help, in England, Scotland and Wales (in Wales, press 2)
- Lifeline: 0808 808 8000 — for urgent help in Northern Ireland, free, day or night
- Samaritans: 116 123 — free, day or night, 365 days a year
- Shout: 85258 — text SHOUT, free, day or night
- SANEline: 0300 304 7000 — 4pm–10pm, every day
More Psychosis (CBTp) worksheets
View all Psychosis (CBTp) worksheets →Psychosis (CBTp)
CBTp formulation (Morrison's cognitive model)
Map how an unusual experience, what you take it to mean, how you feel and how you cope keep each other going, using Morrison's cognitive model of psychosis.
Psychosis (CBTp)
Voice power differential worksheet
Look at your beliefs about how powerful a voice is, how much it knows and how much you must obey it, and test whether they hold up. Based on Chadwick (2006): ratings of the voice's power, knowledge and control, with evidence, a rating of your own power and a re-rating added.
Psychosis (CBTp)
Normalising unusual experiences
Look at an unusual experience alongside what is known about how common such experiences are and what can bring them on. Rate how unusual it feels, what you fear it means, and your distress, before and after. Based on Morrison (2001): normalising, with ratings added.
Psychosis (CBTp)
Coping strategy enhancement record
Look at how you already cope with distressing experiences, rate how well each strategy helps, and try new ones with your therapist. Based on Tarrier et al. (1993): naming the experience and building on existing coping, with distress ratings before and after added.
Psychosis (CBTp)
Understanding psychosis
A warm, non-stigmatising explainer on what psychosis means: unusual experiences that are more common than people think, why they happen, and how people recover and live well. Based on Zubin and Spring (1977) and Kingdon and Turkington (1994): adds a checklist of experiences and a reflection prompt.
Psychosis (CBTp)
Noticing the context and meaning of voices
Notice the setting, meaning and effects of one voice-hearing experience with your therapist.
Want to assign this to a client?
Create a free therapist account to use the homework and library download tools. Clients can complete assigned homework online or use a blank PDF. See how the homework workflow works.
No card required. The Free plan includes 10 worksheet uses a month. Check plan access and limits.