Can Conspiracy Theory Beliefs Be Treated?

“Each one of us here today will at one time in our lives look upon a loved one who is in need and ask the same question: We are willing to help, Lord, but what, if anything, is needed? For it is true we can seldom help those closest to us. Either we don't know what part of ourselves to give or, more often than not, the part we have to give is not wanted. And so it is those we live with and should know who elude us.” —A River Runs Through It

Conspiracy theory beliefs haven’t been a topic traditionally addressed in psychotherapy, but that may be changing. This past month, a series of articles have appeared in the mainstream press detailing peoples’ struggles with psychological distress related to conspiracy theory beliefs and how they’ve been working with psychotherapists to find relief.

For example, a Cosmopolitan article shared accounts of several women who were getting help in therapy to climb out—and stay out—of the QAnon rabbit hole.¹ One therapist featured in the article, who focuses on helping people pull back from conspiracy theory beliefs, described her practice as going “from steady to busy to overbooked” since 2020. In Mashable, Rebecca Ruiz likewise described conspiracy theory beliefs becoming a “recurring theme” in psychotherapy during the pandemic and called them a “public health problem” and a “mental health crisis.”² And as a Slate article made clear, this is by no means a uniquely American issue—efforts have been ongoing in places like Germany to “bring conspiracy theorists back from the brink.”³ Together, these anecdotal accounts suggest that people are increasingly looking to mental health professionals for help extricating themselves from the tangled web of conspiracy theory belief.

In Part 1 of this two-part series on Conspiracy Theories in Clinical Practice, I made the point that conspiracy theory beliefs are fundamentally distinct from delusions and do not, by themselves, constitute evidence of mental illness. Instead, the phrase "not mentally ill, but not mentally healthy" provides a better account of many conspiracy theory believers. In other words, conspiracy theory beliefs don’t arise because believers are “crazy,” but they can in some cases become so consuming that they can be “crazy making,” resulting in psychological distress including symptoms of anxiety and depression with believers pulling farther and farther away from their jobs, recreational activities, and relationships. When that happens, family members and other loved ones are likely to beg conspiracy theory believers to seek help and occasionally they do so on their own.

Once in therapy, success in working with conspiracy theory beliefs will likely depend on the strength of a patient’s conviction. I find it helpful to characterize believers according to five stages of ideological conviction⁴:

• Non-believers
• Fence-sitters
• True believers
• Activists
• Apostates

“Apostates” who have already renounced their conspiracy theory beliefs and “fence-sitters” who have not yet fully embraced them are the “low hanging fruit” of psychotherapy. Most of the anecdotes of conspiracy theory believers in treatment in the mainstream press that I cited earlier involve “apostates” who have “seen the light,” managed to climb out of the conspiracy theory rabbit hole, and have sought help regaining their lives above ground and reconnecting with relationships back in the real world. In much the same way, “fence sitters” who come to therapy—or for that matter to their physician, pastor, friend, or loved one—are often there “looking for answers” and wanting to talk things through. For “fence-sitters” and “apostates,” a variety of psychotherapeutic modalities including supportive therapy, psychodynamic therapy, motivational interviewing, acceptance and commitment therapy, and cognitive behavioral therapy (CBT) can be helpful depending on the individual situation. But whatever the treatment modality, addressing mistrust and misinformation through a trusting and reparative therapeutic alliance will likely be the key to success.

As always, psychotherapy offers the most benefit to those who are looking for help and open to change. The real challenge and unmet need of conspiracy theory belief can be illustrated by the old joke that asks, “How many psychologists does it take to change a lightbulb?” Answer: “Just one, but the lightbulb has to really want to change.”

Like people with clinical delusions, “true believers” whose identities have become intertwined with their beliefs aren’t likely to come into psychotherapy saying, “Please help me, I’m a conspiracy theory believer!” Although friends and family often ask me what they can do to pull their loved ones out of the conspiracy theory rabbit hole, true believers aren’t usually looking for help so much as they’re looking for a chance to defend their beliefs. Since conspiracy theory beliefs are rooted in mistrust and misinformation, believers often come armed with “evidence” in the form of misinformation and quickly dismiss counter-evidence as “fake news” from mistrusted informational sources. That inability to agree about what counts as “evidence” can make challenging beliefs—as a therapist might in CBT—a real challenge. Even worse, “activists” who have decided to take action to defend those beliefs—and their very identities—often feel threatened and can even resort to violence when their beliefs are confronted. Reaching "true believers" and "activists" can be guided by an extensive literature on the "deradicalization" of so-called "extremists." Whether in therapy or not, challenging the conspiracy theory beliefs of "true believers" and "activists" is unlikely to be successful without first establishing trust through non-confrontational listening. Next, replacing psychological needs with health alternatives and interacting with apostates are important components to facilitate "disengagement" from radical groups.⁵

But for any of that to happen, we have to get patients “on the couch.” That's the hard part. It's said that "you can lead a horse to water, but can’t make him drink," but in my experience, the opposite is true. With conspiracy theory believers, it’s often those who need the most help who prove the most elusive.

To read Part 1 of this two-part series on Conspiracy Theories in Clinical Practice:

• Conspiracy Theories Aren't Delusions