Hunter et al. (Institute of Psychiatry, London) has developed a form of cognitive behavioural therapy (CBT) for the condition that treats it in a similar way to how anxiety disorders would be treated.
The therapy developed by Hunter and colleagues is centred upon five main interventions. These interventions are as follows:
- REDUCING AVOIDANCE
- CHALLENGING CATASTROPHIC ASSUMPTIONS
- REDUCING SELF-FOCUSED ATTENTION
- KEEPING A DAILY DIARY
- PSYCHOEDUCATION AND NORMALIZATION
Let’s briefly look at these in turn:
The individual is encouraged to gradually expose him/herself to thoughts, feelings and situations which would previously have caused high levels of anxiety and depersonalization but only those thoughts, feelings and situations the patient is able to tolerate without inducing undue anxiety. Using this technique (known as GRADED EXPOSURE), the potential for the thoughts, feelings and situations to which the patient is encouraged to expose him/herself starts off very low with challenges that are relatively easy to meet and, as the patient’s confidence increases, s/he is encouraged to expose him/herself to more and more difficult challenges. The patient only moves on to each more challenging task when s/he has successfully exposed him/herself to the previous (less challenging) task without becoming so anxious that s/he experiences depersonalization (a major symptom of dissociative disorder whereby the patient experiences his/her thoughts and feelings as unreal or belonging to another person).
CHALLENGING CATASTROPHIC ASSUMPTIONS:
Individuals affected by dissociative disorder tend to be highly prone grossly to overestimate the harm their condition will do them. For example, such catastrophizing may involve the patient believing that his/her condition will send him/her irrevocably and irreversibly insane or that there is no possibility whatsoever that s/he will recover from his/her condition. Such thinking errors increase fear and anxiety which, in turn, exacerbates the condition. In this way, a vicious cycle may develop in the absence of appropriate therapy. Therapeutic interventions include psychoeducation (see below) and helping the patient to learn to self-soothing techniques (e.g. self-hypnosis, mindfulness).
REDUCING SELF-FOCUSED ATTENTION:
Those who suffer from dissociative disorder are prone to fixate on the symptoms of their condition which, in turn, acts as a trigger to generate even more intense symptoms and, in this way, a vicious circle can develop. This cycle can be broken by teaching the patient grounding techniques which distract the brain from its previously obsessive focus on their symptoms.
KEEPING A DIARY:
Sufferers of dissociative order may wish to keep a diary of times in the day when their symptoms ease to remind themselves that these symptoms can fluctuate and are therefore not permanent and unchanging – just as symptoms can ease, so too, by applying therapeutic techniques, can they disappear altogether.
PSYCHOEDUCATION AND NORMALIZATION:
It is important that those with dissociative disorder understand the cause of their condition and that it is essentially a normal response to extreme stress that has arisen as a psychological defence to protect the sufferer from unbearable feelings relating to the experience of past trauma. Research suggests that the development of the condition is frequently linked to subtle forms of childhood emotional abuse and neglect. Once the patient understands their condition and that it is a normal and common way for the brain to attempt to protect itself, s/he is less likely to be so anxious about it and, instead of catastrophizing it (see above), instead simply observe his/her symptoms in a calm and accepting manner, leading to less anxiety and a virtuous cycle of increasingly diminishing symptoms.
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