Understanding and Managing Dissociation
John D. McKellar, PhD Bay Area Pain and Wellness Center Private Practice SF Bay Area
Definitions‌
A clinical or scholarly consensus on the definition of dissociation does not exist The role of dissociation as the most direct defense against overwhelming traumatic experience was first documented in the seminal work of Pierre Janet (1920s) Recent research on a dissociative subtype of PTSD, defined primarily by symptoms of derealization and depersonalization.
Depersonalization
An ‘out-of-body’ during which individuals often see themselves observing their own body from above has the capacity to create the perception that ‘this is not happening to me’ and is typically accompanied by a decrease of the emotional experience. The decrease in distress creates a powerful learning experience
Derealization States of derealization during which individuals experience that ‘things are not real; it is just a dream’ This create the perception that ‘this is not really happening to me’ and are often associated with the experience of decreased emotional intensity. The decrease in distress creates a powerful learning experience
Dissociative Identity Disorder
1. Disruption of identity characterized by two or more distinct personalities. This may be observed by other or reported by the patient 2. Involves periods of amnesia 3. The disturbance is not part of religious practice, cultural, or part of normal fantasy play for a chil
Initial Steps of Change
1. Determine what circumstances seem associated with periods of dissociation 2. Types of people, topics of discussion, emotions
Phase Oriented Treatment
Phase 1: Safety, stabilization, symptom reduction, skills building, and development of the treatment alliance.. Phase 2: Integration of traumatic memories. Phase 3: Personality (re) integration and (re) habilitation. The general idea is to create skills to enable management of traumatic memories/ emotions
Phase 1
1. Learning to identify and tolerate emotions, thoughts, sensations rather than avoid 2. This process is involves gradual learning and building of confidence 3. This is also where the need is for support of others
Phase 1 Techniques Grounding Technique (Safety) 1.
Techniques that aim to bring one directly into experience of the current moment
2.
Mental techniques- Use a phrase that brings you into the moment, read something word by word (aloud if helpful), run through categories such as types of dogs
3.
Physical techniques- focus on the contact of your feet with the ground, create a routine of stretching, carry an object (smooth rock) that you can
Phase 1 Techniques Mindfulness 1.
Learn non-judgment one small step at a time start with 2 minutes of meditation
2.
Practicing non-judgment can lead to changes in the wiring of you brain
3.
The more often you are able to spend time with your mind the more you learn that “thoughts are thoughts�
Treatment 1.
Moving forward after suffering significant trauma requires two essential components: commitment to change (tolerating discomfort) and skilled support
2.
Exposure to traumatic memories and requires working with a competent/caring professional
3.
Learning skills to manage emotions leads to lower need to manage emotions with dissociation
4.
Lower frequency of depersonalization and derealization leads to greater integration