Depersonalization: Clinical Features and Treatment Approaches

DEPERSONALIZATION: CLINICAL FEATURES AND TREATMENT APPROACHES Fugen Neziroglu, Ph.D. & Katharine Donnelly, M.A. Bio-Behavioral Institute Great Neck, NY 11021

What is Depersonalization? ,[object Object],[object Object],[object Object],[object Object],[object Object]

Depersonalization Disorder (DPD) ,[object Object],[object Object],[object Object],[object Object],[object Object]

Coining the DPD ,[object Object]

Two types of DPD ,[object Object],[object Object]

Main Feelings of DPD ,[object Object],[object Object],[object Object]

Depersonalization vs. Derealization ,[object Object],[object Object],[object Object]

Derealization as Part of DPD ,[object Object],[object Object],[object Object],[object Object],[object Object]

What does DPD feel like? ,[object Object],[object Object],[object Object],[object Object]

Symptoms of DPD ,[object Object],[object Object],[object Object],[object Object],[object Object]

Symptoms of DPD ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Symptoms of DPD ,[object Object],[object Object]

Symptoms of DPD ,[object Object],[object Object],[object Object],[object Object]

Symptoms of DPD ,[object Object],[object Object],[object Object]

Behaviors, Feelings, and Thoughts Associated with DPD ,[object Object],[object Object],[object Object],[object Object],[object Object]

Sensory Changes ,[object Object],[object Object],[object Object]

Perceptual Changes ,[object Object],[object Object],[object Object]

Mood Changes ,[object Object],[object Object],[object Object],[object Object]

Changes in the Way One Thinks ,[object Object],[object Object],[object Object],[object Object]

Behavioral Changes ,[object Object],[object Object],[object Object]

Triggers of DPD ,[object Object],[object Object],[object Object],[object Object],[object Object]

Impact of Depersonalization ,[object Object],[object Object],[object Object],[object Object],[object Object]

DPD, as it relates to Anxiety ,[object Object],[object Object],[object Object],[object Object]

The Development of DPD ,[object Object]

Trauma ,[object Object],[object Object]

Trauma ,[object Object],[object Object],[object Object]

Cultural Factors ,[object Object],[object Object],[object Object],[object Object]

Substance Abuse ,[object Object],[object Object],[object Object],[object Object]

Neurobiology ,[object Object],[object Object],[object Object]

Pharmacological Options ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Cognitive Behavior Therapy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Acceptance and Commitment Therapy (ACT; Hayes, Strosahl & Wilson, 2003) ,[object Object],[object Object],[object Object],[object Object]

The Town Crier and Law Enforcement “ Numbness! Numbness! What does this mean?! … What are we going to do about this?! Find a way to Fix it!” “ Okay! I’m trying. I’m doing everything that I know how to do!”

The Town Crier and Law Enforcement “ Numbness! Numbness!....... Hey!.... What do we do?!” ::poke:: “ WAKE UP!” “ ZZZZZZZZZZZ” Ironic Processing (Wegner, 1992) tells us that unpleasant feelings become so relevant because you need to be alerted to them in order to get rid of them. When this system is unsuccessful or off guard…. This system continues to acknowledge discomfort, relentlessly

Is Depersonalization in Part a Failure to Stay Present? Both DP and lacking present moment awareness involve some kind of distance from the emotions that underlie emotional issues. Depersonalization Lack of Present Moment Awareness Description of the Experience ,[object Object],[object Object],-Your thoughts, the stories that you tell yourself, and basically everything that is going on “upstairs” is more relevant or more “real” than what happens external to the content of thoughts. -Unpleasant emotional experiences are either suppressed or turned into problem-solving exercises. Problem solving exercises result in rumination or emotional/thought suppression. Sometimes a solution to the problem results, but with regard to emotional problems over the average day, this is the exception rather than the rule.

Depersonalization and Lack of Mindfulness (Cont.) ,[object Object],[object Object],[object Object]

Depersonalization & Mindfulness (cont.) ,[object Object],[object Object]

Depersonalization & Mindfulness (cont.) ,[object Object],[object Object],[object Object]

Narrow Behavioral Repertoire : A person with DPD may restrict what they are willing to experience in order to avoid intense feelings Experiential Avoidance : Individuals with DPD may avoid unpleasant thoughts/feelings/ sensations, in order to avoid feelings of DP. Dominance of Verbal Realities: An individual with DPD may become preoccupied by imagined scenarios of the future, and attention to the present moment is lost. Self-as-Content: Unpleasant thoughts and feelings may feel so inextricably linked to a DPD sufferer’s sense of who she is. Cognitive Fusion: Negative thinking about discomfort is a feature of chronic DPD; when you are fused with these thoughts, you believe that they reflect objective reality. Psychological Inflexibility Lacking Clarity of Values: This refers to lacking an awareness of what is truly important to you.

ACT Case Conceptualization for DP ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Committed Action : Acting according to what is meaningful in your life, despite any discomfort that might accompany these actions. Acceptance/ Willingness : Allowing DP and other unpleasant feelings to be there without trying to force them away or change them. Present Moment Awareness : Observing what is happening right now, rather than attending to thoughts unrelated to what is directly in front of you Transcendent Sense of Self : “the self” is constantly changing and is not defined by any one trait, feeling, role, or thought pattern, including DP Cognitive Defusion: Viewing thoughts and feelings as what they are (mere mental events), not what they appear to be (reflections of reality). Psychological Flexibility Clarity of Values : Having a strong sense of what is important and meaningful to you in life

ACT Treatment Suggestions ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Case of “Michelle” ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Case of “Michelle” cont. ,[object Object],[object Object],[object Object],[object Object],[object Object]

Case of “Michelle” cont. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Case of “Michelle” cont. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Depersonalization: Clinical Features and Treatment Approaches

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Depersonalization: Clinical Features and Treatment Approaches