Hello Xantin:
How an individual chooses to deal with persecutory delusions might depend on which model they subscribe to. If, for example, you subscribe to the idea that your experiences are a direct result of neurological faults or imbalances you might feel the most appropriate response is medication. Within this model, whatever thoughts or experiences you have might be considered as nonsensical. You might be advised to ignore them or push them away until the medication can "take affect".

If you subscribe to the idea that your experiences have a psychological basis, you might feel the most appropriate response is a form of talk therapy. Within that kind of model, persecutory delusions might be related to your state of ego stability. If the ego is unstable, this will produce anxiety and fear which you may then try to explain by looking for a cause in the external world, i.e., I don't feel safe in my own home/body -- the government is watching me wherever I go. Persecutory delusions might also indicate concerns about your relationships with others, i.e., Why is my brother looking at me that way -- does he think I'm different now?

Recently I spent some time with an individual who was in a state of active psychosis. One of their concerns at that time was that the house was on fire. When they expressed those concerns we accepted that they felt real and valid to them. We'd encourage them to walk around the house and use their senses -- smelling the air to see if they could detect the scent of burning materials or touching the walls to see if they could feel heat. We also sat down with them and drew up a plan for how we would respond if the house really was on fire, how we'd get out and keep ourselves safe. They found this to be reassuring.

In addition, we also talked with them about inner psychological states and how people may revert to symbolic/metaphoric expressions when in a crisis state. We pointed out that a house is a symbolic expression of the self and also shared that this experience they were having was one that other people had experienced. During this time, that individual became quite drawn to a picture of a phoenix rising out of the flames and would frequently return to the image to study it.

This process was repeated numerous times over the course of several days as other themes arose. The goal was both to acknowledge their fear and anxieties as being very real to them and respond to that while also inviting them to consider other perspectives that might apply. At no time did we suggest they were delusional, rather, we accepted that they were "living" in a different state of consciousness than we were and part of their conflict and confusion was a result of trying to make sense between these two states.

Because that individual's previous experience with neuroleptics was extremely detrimental (neuroleptic malignant syndrome) no anti-psychotic medications were used although they did continue to take an anti-depressant medication they had been on. The crisis state has since resolved itself. They are continuing to use a psychological model to make sense of and understand their experience.