I honestly don't know when I'm being paranoid, but I know when I'm anxious and when I feel bad. IMO it doesn't matter what is real, it matters how you deal with it. Only when I'm calm do I fully realize how bizarre my thoughts were so I focus on staying calm. always stay calm.

I do things like wayfarer, I try to bring myself outside of myself by grounding. I also do meditation like that and try to bring it to another level of calm by relaxing my mind as much as I can. I consciously let go of all my thoughts and do breathing exercises.
Lately I've noticed that meditation sounds help SO MUCH. I mean, I'm not even paranoid when I have it playing so I'm keeping it play all day. I feel so calm and relaxed. Even if a paranoid thought filters through I can so much easily let it go and I feel no distress.
I actually have an app on my phone for it and it's called Lightning Bug, it's for android if you are interested. It's awesome.