How to Reduce Dissociation in PTSD

For anyone who experiences dissociation as part of the posttraumatic stress disorder (PTSD), (and this includes me during my PTSD years) you know how frustrating, embarrassing and uncontrollable it can be. Reducing dissociation in PTSD is something we all want.

I have a client who, as he puts it, "zones out" -- a lot. Literally, he'll be in a therapeutic setting with me or other practitioners and his mind just goes away. He falls into a blank stare and becomes unresponsive. Or, he'll be commuting to work on the train and disappear in his head only later to find he's been assaulted by some youths in the seats behind him. Or he'll be at work in a meeting on a bright and sunny afternoon and then find himself alone in the dark conference room in early evening.

Sometimes he can bring himself back from dissociating in a few moments, other times it takes hours. Sometimes the intervention of a cool washcloth placed on his forehead breaks the spell and other times he's left to sit out the dissociative experience for hours alone.

A Brief Portrait of Dissociation in PTSD

Your psyche is designed to protect you. During trauma and throughout the emotional upheaval that often comes afterward, your psyche may put in place actions designed to help you cope. Dissociation is one of the most common practices of your psyche's natural protection processes and can happen both during a traumatic event and also later as a frequent symptom of posttraumatic stress disorder.

Technically, dissociation covers a wide variety of experiences from mild detachment (perhaps you fall into a distracted reverie) to complete disconnection from all conscious physical and emotional experiences. It can be a coping or defense mechanism. In many cases it is your mind's response to feeling a sensation of threat or danger. This can be in response to:

• Emotions that come up
• The presence of others
• A situation that reminds you of some element of your trauma
• An event that threatens your sense of emotional, psychological or physical safety

How to Reduce Dissociation in PTSD

Decreasing dissociation often happens in direct correlation to increasing awareness. The more you can keep yourself grounded in the present -- and a sense of safety and self-efficacy -- the more you will be able to limit and then even eliminate your need to dissociate. Plus, the more you feel you can protect yourself (by building in tools, choices and actions that ensure your health and safety) the less your mind will feel the need to "go away" as one of my clients calls it.

According to Teresa Bennett Pasquale, Clinical Director of RecoIntensive (a trauma-conscious 6-week Intensive Outpatient Program),

The mind needs to be able to integrate the understanding that it is safe in the present moment without the fear experiences of the past overtaking or highjacking the brain-body-nervous system response and tricking the present-moment brain into believing there is danger.

This needs to happen at all levels of the brain--the prehistoric or "survival" brain level from which fear originates, the limbic or "feeling" brain level which absorbs that fear response and brings forth the sensory and emotional responses to danger or fear, and the prefrontal cortex or "thinking" brain level which rationalizes and can organize past from present and danger from safety.

Unfortunately dissociation as a response doesn't speak to the thinking brain before deciding to go offline so in order to get back to the rational part of the brain first the survival and the feeling brain have to be calmed down enough to integrate rational thought.

To help reduce and even eliminate dissociative tendencies Pasquale suggests,

To be able to soothe the survival brain's response when a person is triggered to dissociation involves finding ways to keep the mind in the present long enough to get to rational thought. Since the senses and somatic dimensions are the places where stress and the stress response is manifested we have to find a way to soothe the senses and the body long enough for a person to realize they are in the present moment of safety rather than a previous experience of danger [or trauma].

For these purposes I usually begin with breath. Learning to breathe slowly and calmly [first in periods of rest so that it can be intuitive in periods of distress] through practices like three part breath [from the yoga lineage] can help to reduce the tension in the body and stave off the survival breath patterns of holding their breath or hyperventilation. Also, the presence of a safe relational experience such as with animals [equine-facilitated psychotherapy and canine therapy are two options for this] help provide a grounding anchor in the present moment, the tactile experience of touch, and a safe base for clients to hold themselves intentionally in the present.

Additionally, psycho-education and normalizing dissociation for clients can be powerful. It is an often frightening and stigmatized experience; to be able to offer clients an understanding of their stress response system and why dissociation makes sense, when no other means of safety or support are available, goes a long way towards client's motivation for their healing and empowerment in being able to change this process in their mind, body, and spirit.

How I Reduced My Dissociation in PTSD

My own quest was long but finally I found that dissociation occurred less and less often when I engaged in alternative healing practices (e.g. emotional freedom technique, thought field therapy, tapas acupressure technique) that reduced the emotional charge of trauma topics and started giving me tools to emotionally self-regulate. Later, the dissociation completely stopped when my trauma recovery was completed.

We're all different, so what works to help reduce dissociation in one person may or may not help another. The key is to keep trying things until you find what works for you.

Connect with Michele on Google+, LinkedIn, Facebook, Twitter and her blog. Michele is the author of Your Life After Trauma: Powerful Practices to Reclaim Your Identity.