Dissociation preventing any progress in therapy

[Deleted member 39476]

I entered into EMDR therapy about a year and a half ago after being tormented for a long time about lots of really innocuous things that bothered me an extreme amount. Got diagnosed with C-PTSD. When I tried EMDR at first either I could not feel anything, or I would feel way too much, become totally overwhelmed, and then not feel anything, so it basically could not accomplish anything. We decided that I was not ready for any processing because I was not stable enough so I have been trying to find stability for a long long time. Meditation does not work, I am way too disturbed to even begin to clear my head. I can't do yoga because I can't control my muscles in a panic attack. Grounding techniques not only don't work but actually have the opposite effect, because it takes me out of my dissociated state and throws me back into severe anxiety and pain. Drugs didn't help at all. It's getting to the point where I don't just get triggered often or have difficulty concentrating, but actually get triggered by the act of trying to concentrate itself, because internally there is so much conflict.

Has anyone been in a similar situation and had some success? I'm starting to lose faith in a lot of ways, my therapist is probably the best in my city, I am very confident his method is the best method for this kind of problem and strongly oppose CBT and similar top down strategies, I like and trust my therapist, I have felt what its like to be successful and its amazing, but its just so incredibly difficult dealing with dissociation of this degree, I feel like it will prevent me from ever getting better.

Thoughts?

 

[Paradox]

SAME. To literally all of that. Everything everywhere leads to a trigger once you start being mindful, so instead you have to always keep tense. Yes. I can't do yoga or a lot of things either because of that. No one gets this shit. Feel free to message me.

 

[EveHarrington]

Can you describe what you've tried in terms of skills? I'm just curious as, for example, "typical" meditation doesn't work for many, but there are many kinds of meditation and it may be a matter of trying variants to see what works for you.

 

[Justmehere]

Have you ever done mindfulness while being active? I can't do sitting still mindfulness activities. My symptoms just spike. But things like mindfully cooking or playing basketball totally work well for me. There's tons of options out there like this. My trauma therapist told me to avoid mediation or yoga early on in recovery because it typically leads to symptom spikes. Mindfulness can be about internal states, which is the case when being still or doing yoga, or it can be about noticing how does the basket ball feel in my hands, noticing how it sounds when I bounce it, etc. Really being here NOW with the ball. That's it.

It's important to understand that processing trauma doesn't mean someone has to be able to not dissociate. Same with other symptoms. Processing trauma doesn't mean someone has to be able to shut out panic symptoms. Just to be able to manage them when they happen. Dissociation isn't separate from processing the trauma. The dissociation, panic, etc, is all part of processing the trauma. Instead of trying to eliminate dissociation, try to focus on managing it, and you might have more success.

Dissociation can actually be worked with in EMDR a little like other body sensations are processed. When I did it, my therapist had me track the level of numbness and where I felt it and etc.

It was so strange and uncomfortable to be with any symptoms in that way, and I was so overwhelmed by it at first, we only worked on processing trauma for 1 minute per session at first. No joke. Then 2 minutes. Then 5 minutes. Now I can do it 90 minutes when needed, no problem.

EMDR is well known for being a challenge to use when someone has unmanaged dissociation in or outside of sessions. When a therapist is able to pace the work and direct it slowly enough, and work through the dissociation and the client is able to ride out and manage spikes in dissociation and other symptoms after sessions, then the chances of EMDR working are higher.

Another way to slow down the work: if diving into the trauma means your brain dissociates too much to proceed with the EMDR on the traumatic event itself, then either try doing it with something mundane and indirectly connected to the trauma. The way I did it for one traumatic event was to not actually do EMDR with the trauma at first, but do EMDR with what I was doing hours before the trauma happened. (Getting out of bed, making breakfast...) That actually stirred up enough symptoms but not too much to work with.

But you are right that one has to have a certain level of stability and ability to manage symptom spikes, before even trying to process trauma, especially with EMDR, more than most other trauma therapies. Even when trying to process a distant event for just one minute.

Have you considered low dose naltrexone for the dissociation? It's a good med that many docs don't know about that is the only med that directly treats dissociation. The only downside is other symptoms will often get worse if the low dose naltrexone works to reduce the dissociation.

Every time dissociation gets better via any form of management, other symptoms will kick in. They were the symptoms being numbed out. The more you can step into feeling those symptoms, even for 1 minute at a time, the less you will need to use dissociation to block them out.

Dissociation is a survival response. It's your brain trying numb out what feels like inescapable life and death trauma. You may need to find ways to really connect with the truth that the trauma is over now, you can escape threats now, etc. The more you can connect to safety in this moment now, the better you will be able to manage the dissociation.

And if none of this helps, please totally feel free to disregard. I hope you do find what does work for you! :)

 

[Muted]

I had that problem too. I'm not sure what techniques my t did, but they've helped a lot. I also quit my stressful job and that helped.

 

[JEKBreatheandBelieve]

Have you ever practiced grounding techniques at neutral times? This helped me. I practiced grounding when I didn't need it and found that it helped me more when I did need them. I use a lot of looking for colors or even saying the alphabet backwards. There are so many grounding techniques out there that you may just need to find the ones that work best for you. I was really resistant to them until I learned to practice them. I used to think nothing would ever work, but I realized I had to open myself up to doing even though I felt at times that it would make things worse, eventually they started to work.

 

[Suzetig]

EMDR isn't always for everyone, no one therapy is and while there are therapies with more evidence base than others for PTSD, treatment is always going to be a mixed bag, trial and error thing.

Your T may not recommend CBT because they are t trained in it but skills based therapies e.g. CBT and DBT are incredibly useful in complex PTSD. Traditional talking therapy also has its place in complex PTSD, EMDR is part of a tool kit, it's not the whole toolkit.

What has changed for you since seeing this therapist, if nothing has changed for the better after 18 months, you need a new therapist.

 

[Deleted member 39476]

Have you ever done mindfulness while being active? I can't do sitting still mindfulness activities....

Sadly I've tried basically all of these things. I try being mindful all the time by doing things like playing basketball, and what I find is that it isn't just meditating that causes me to disconnect, its literally mindfulness itself that does it. So when I try to just feel the basketball in my hands, feel my presence, I get a massive spike and completely lose it, often to the point of falling over because I totally leave my body. Almost every single session for the last year we've tried things like focusing on bodily sensations, but found that was way too much and not manageable. Tried things like focusing on very specific things, like the feeling in my shoulders, but still the feelings are not even close to manageable due to the severe level of anxiety.

We also tried methods of very short term grounding to see if I could manage it for maybe 30 seconds at a time, and found that I could not manage it at all, and as soon as I used any sort of grounding strategy, I started feeling like I was being ripped out of a dream and shoved into a nightmare, so it was really bad. Right now the strategy we are trying is to imagine some sort of electrical circuit that would allow me to turn down the strength of the emotions so I can only experience a little bit of them at a time, but no matter what I always get the full brunt of the pain and disconnect. Even doing basic things like deep breathing techniques aren't possible for me under this amount of stress. It's really really hard to live like this, it never goes away, even when I'm sleeping the stress and fear is exactly the same, I get the same themed nightmare every single night.

 

[shimmerz]

It's getting to the point where I don't just get triggered often or have difficulty concentrating, but actually get triggered by the act of trying to concentrate itself, because internally there is so much conflict.

Yes. I call it fear of the fright. I used to trigger over everything. It was unbearable.

As my body started to release some of the pent up trauma (shaking, shivering, buckling), I started to be able to tolerate more external stimuli. It's a bitch of a situation. Don't give up though. With the good T that you have, you will get there.

 

[EveHarrington]

No drugs have worked?

What have you tried so far?

 

[Deleted member 39476]

Your T may not recommend CBT because they are t trained in it but skills based therapies e.g. CBT and DBT are incredibly useful in complex PTSD. Traditional talking therapy also has its place in complex PTSD, EMDR is part of a tool kit, it's not the whole toolkit.

The thing is we generally don't do any EMDR, we tried it a few times to see what would happen, and then realized I wasn't stable enough so we have been trying numerous other strategies since. My Therapist would be fully willing to do CBT if I wanted to, I personally disagree with that kind of thing on a fundamental level, I don't believe you can solve anything from the top-down, not to mention the fact that I don't even have the executive control to do extremely basic life tasks, never mind attempting to control these things consciously.

No drugs have worked?

What have you tried so far?

Zoloft, Paxil, Prozac. The only thing that would work is the hard stuff and that's a bad idea for me.

 

[Suzetig]

How is your day to day functioning? I ask because if you're so dysregulated you can't do basic life tasks, once a week therapy isn't going to be enough. While I accept your belief that you can't resolve things from the "top down", learning to control our thoughts and having strategies for consciously dealing with our feelings can create enough distress tolerance to do the deeper work that's needed.

I'd also say if you can't tolerate bodily feelings in therapy, stop doing body work for a while and just talk. It may be that reconnecting with your body will be further along the journey for you - just talking and being able to tolerate being in relationship with someone without checking out will make the world of difference for you.

When you say you've tried things, what do you mean? E.g. With basketball is that something you thought might help so you tried it, something your T suggested, a planned mindfulness programme and how long did you try for. Think about that for each thing you've tried. Grounding techniques do work BUT you need to practice a lot, at times when you're not triggered so that you know what grounded feels like and can automatically switch into the grounding activity and different things will work for different people. Same with breathing exercises, they work because they trigger a physical response in the body but you really need to practice and keep practicing.

Basically recovery is hard, uncomfortable work - you need to really give a variety of things a good, consistent try. So in the early days for me I had a journal with 5 different things I needed to do every single morning, at lunchtime and before bed, as well as every single time I felt X. Yes, lots of effort and it felt like it wasn't making a difference at all until one day I realised I hadn't been dissociated that week, or I'd not fallen into a really negative thought pattern in the way I usually would.

You can't be mindful every second of every day so pick a time or activity to do mindfully and do it every single time. For me it's the shower. Do breathing exercises as part of your morning and evening routine. Journal or read at some point in every day, use scent or sound or taste every day to get your system used to whatever you do and reach for it faithfully when you're feeling activated in some way. If you literally don't have enough control to build this kind of activity into your day consistently over a period of months, you need more support than weekly therapy can offer.