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What Treatment Is There For Dissociation?

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oasis2003

MyPTSD Pro
Hi
One of my main problems at the moment is dissociation. I am supposed to be noticing my emotions which are extremely uncomfortable, after being totally numb. As soon as they get overwhelming I just totally dissociate. First derealisation, then depersonalisation then I cannot feel anything or think any thing. I loose a great deal of time. Any suggestions any one? How do you stop this as I figure it is my defence mechanism that I have used since forever. Is there any treatment that works?
 
I am currently dealing with the same issue. I'm curious to see what others say. I try grounding techniques but I tend to get too panicked to do them. I usually just totally freak out and someone has to calm me down :(
 
Check out mindfulness and grounding techniques online. There are a number of sites that offer free advice about how to ground out of a dissociated state online. It's a way to cope with and reduce the symptom of dissociation. With practice, it can be quite effective. It is really helpful for when it comes time to process the trauma.

It will be important to practice grounding and mindfulness skills at times you don't feel like you need to do them. It will make it easier to do it when you do need them, and they will be more effective because your body and brain will be able to remember and access being in a present and grounded state easier.

It will also be important to remember that feeling grounded may feel like crap. The more healthy coping skills you have, the easier it will be to come out of dissociation.

To resolve the underlying cause of dissociation, I have found somatic experiencing, trauma focused CBT, internal family systems (I'm don't have DID but this still really helped), ego state theory work, exposure therapy, trigger planning (not complete trigger avoidance but learning to identify and manage triggers), work around naming emotions and learning to be with them, grief work, and lots of work on mindfulness.

Most trauma therapies can be used to help dissociation. It may take a little time and tail and error to find what works best for you.

Emdr is one trauma therapy that is helpful for some, but has a well deserved reputation for being more challenging and potentially backfiring for others. I found it to make dissociation a lot worse and difficult to manage.

One thing to remember is what you already recognize - dissociation is a defense mechaism. It's what your brain is doing to keep pain away. The more you can increase safety to feel the pain, and tolerate it, the less dissociation you will experience. Things may get worse for a time, and that's ok. It won't mean you are actually getting worse, but that you are coming up out of the fog and integrating in the pain of the trauma. It is hard for awhile, but it gets better. So much better.

Finding a good therapist and support system to help walk alongside you through it will likely really help - and you are taking a good step already by recognizing and naming the problem, and exploring options to work on it.
 
@MrsBeasley86 yes I also keep trying to use grounding techniques sometimes they work fine and other times they have no effect.
Thanks @Justmehere I will be looking online for grounding and coming out of dissociation. I do mindfulness but tend to stop if I am calm but will also practice to make a grounded state easier between mind and body. I have also tried emdr 2 times, it helped a little but like you it wasnt suitable yes I think I dissociated even more. I think I am at feeling like crap stage when grounding so dissociation seems better I know that I have to face all the fears but it really hard at the mo. So thanks for the great advice I will keep working on it all and hopefully it will be a bit easier. When some emotions have come bursting through it is very scary I don't think I realised how numb I really have been.
 
So sorry you are having to deal with this. I think I understand a little of what you are going through. I also lose time. I am doing it more, and more often nowadays. I have seen a few therapists. Okay more than a few therapists about this. I have had no luck with mindfulness, and grounding techniques. I have tried so many different ones. My current therapist has more experience with DID and other Dissociative disorders. She believes a part of me still doesn't feel safe, and still feels the need to dissociate. It may seem worse now because I am in active therapy and may be triggered more often. I was told over time it should lessen as I learn to trust the process, and my therapist. It makes me feel so crazy, but she keeps reminding me that what happened to me was crazy. I'm not crazy.
 
I stopped dissociating a couple of months or so ago....just seemed to happen completely out of the blue without any warning, so it was quite a shock.

I'm not really sure exactly how it stopped...!

Grounding techniques were useful. I found a couple of things worked particularly effectively, so I used those a lot - spraying/sniffing perfume, putting on hand cream and washing my hands in cold water. So smell and touch seemed to be the senses that responded best to stimulation to get me present. Might be worth experimenting because you probably have a preferred sense as well, which will work better for you than others.

Also agree that it helps to really force mindfulness where you can - and there will be plenty of times you won't want to! But dissociation can so easily sneak up on you and if you don't catch it and act early, that could be a massive chunk of time lost! So I used to regularly check in with myself. Which sometimes meant setting an alarm to go off every hour - or even half hour - during the day to just check I was here and that I could feel my feet etc. If I then realised that I felt spacey, I'd spray perfume, go and wash my hands, get up and stamp my feet, play a favourite song loudly etc. And I used to set a timer for half an hour when I had a bath as I often used to 'go' in the bath too - used to suddenly realise two hours had passed and I was sitting in cold water!

I think a key thing was - I also had to put myself into a potentially very triggering situation/environment earlier this year and that was a really big deal for me. My therapist and I worked on it together for weeks in the run up and we did a lot to help me prepare. Most of that preparation work was focused on my boundaries - it was important that I felt safe, felt in control and that I stayed present. At the time, I thought my therapist was being a bit OTT! In reality though, I did manage to have the most positive experience I think I could have had and I didn't dissociate during the situation. So, I think the fact that I felt prepared and the fact that I had plans that put other strong boundaries in place and the fact that I made a huge effort to be mindful and stay present meant that my default boundary setting (dissociation) didn't kick in. My therapist kept saying afterwards how much I'd achieved and, again, I thought she was being OTT. But now I can see that it did pretty much coincide with dissociation disappearing for good, so I guess she was on to something! So I think maybe something in my psyche thought that I didn't need it anymore because I had other things to use.

It's a tough one and it is hard work. And, to be honest, it's still a tough one. Having dissociation disappear so suddenly is pretty uncomfortable as dissociation obviously protects us and keeps us from feeling things. Suddenly feeling things and not having dissociation swoop in to 'save me' is very, very hard. Also, my boundaries have become an even bigger issue than they've ever been....I think this is probably another layer of defence which has ramped up in the absence of dissociation. And I'm finding the boundary stuff a real struggle at the moment. It's causing a lot of anxiety...but my head doesn't check out at that point anymore so I just have to sit and feel all the anxiety. Ugh!

So...keep the faith...dissociation absolutely can be beaten. I couldn't have done it without my therapist and also without putting in a lot of hard work myself. And I'm certain that the prep we did before the triggering situation was really key to something in my brain realising that perhaps I didn't need it anymore. But also be prepared that, if it does go, that's just a whole other stage of stuff to work on. Because then you can't completely shut down from the uncomfortable feelings in the same way. And you may well find - as I have - that you have a few layers of other defence mechanisms underneath the dissociation...so that's more work to chip away at each of them until they dissolve too!

Sorry - this is such a long post! It's a very fresh thing for me at the moment so is very much on my mind. It does seem to be a long, long road. I'm sure it will be worth it in the end. It has to be, right?! ;-)
 
The body-focused therapy has been helpful for me (primarily Somatic Experiencing). The idea is also to not push myself to feel everything, but work on the more balanced regulation through only feeling a bit of what I can tolerate and then moving away safely, ideally while staying present in my environment. Also, if I am dissociative, it's been helpful to have the body focus for noticing what helps me either feel more safe or able to move back out of where I'm stuck. Sound helps me in many ways. Also, if I can cry in therapy, I snap out of being frozen zombie, but sometimes I can't cry. It's like my body has to relearn how to do this. But when I'm really stuck sensory things, like looking around, touching, smelling some nice oils, music, etc. help me slowly transition back.

Basically, I don't mess with too many hard feelings on my own (wait for therapy), but the somatic approach has probably been better for me in that it helps me find and utilize these tools that help me more on my own. So while I often avoid or distract myself from hard feelings, I don't feel like I'm so numbed out anymore, but have a little bit more range of feeling...and a little bit more difficult feelings that I can tolerate and get through on my own too. Sort of a slow process, but also feels more like real and lasting change is happening this way because I'm re-regulating and accessing new tools within myself.
 
I take a medication specifically to combat dissociation. It is Naltrexone (50 mg) and it has truly been a godsend. It is almost virtually impossible to dissociate on it due to the receptors it targets in the brain. I had severe issues with dissociation and derealization my entire life that are gone now thanks to this miracle drug.
 
@Casper1018 how do you cope with all the emotions etc if you do not dissociate. This is what is worrying me I see derealisation and depersonalisation as a massive defence mechanism. if it didn't happen to me then I really think I would not be able to cope or manage with anything I have had this all my life. Even though I do not like it and everything has been un real all week what would it be like otherwise ? Does this drug partly sedate you to deal with overwhelming issues? or how does it work.
@Chava I too find it difficult to cry in therapy or out. I feel sadness in my throat chest and stomach, I am working on staying with this sadness and not struggle to stop it them hopefully it will shift. This is very difficult for me and I am struggling all the time at the moment. It seems a very slow process to de numb yourself and relearn or even learn for the first time how to feel emotions. It has a lot to do with mirror neurones and developmental trauma so I have been told .@Barefoot I am sure I have further defence mechanisms underneath the dissociation it is like peeling onion skins from one another. Well done if you have worked through the dissociation. I am slowly feeling things and dipping my toe into feeling emotions but it is really hard at the moment and I am struggling big time with anxiety and derealisation nearly all the time at the moment. :hug: and :):) to you.
 
I am going to discuss changing my medication to more anxiety regulating ones rather than sertraline 100 mg. I will ask about this Naltrexone as well do you take any other meds anyone ?
 
a very slow process to de numb yourself and relearn or even learn for the first time how to feel emotions. It has a lot to do with mirror neurones and developmental trauma so I have been told

This makes sense to me. Also, so does slow (also glad my therapist validates slow and manageable). Trying to push into feelings just tips right back into dissociation or derealization or overwhelm of the self-injury sort. I'm glad you are working slowly with it, so it is manageable and sustainable towards true change
 
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