Managing dissociation – an introduction

by Tom Cloyd, MS, MA – Counselor / Psychotherapist – Bellingham, Washington (360) 920-1226 – email: tc (AT) tomcloyd.com (please read about content licensing)

(PART I – THIRD DRAFT – needs references, etc. Also a caution about the appropriate use of this.)

This document, the longest of a set of three, takes up the concept of dissociation and gives it a context. It also explains how we may come to better manage a tendency to over-use dissociation in our lives. At the bottom of this document is a link to the next document in the series.

Dissociation in its natural setting

What exactly is dissociation? Put most simply, it is simply a separation process in the brain, in which we cease to have contact with and perception of something in the real world or in our mind. For example, if I look at a traffic light, I’m perceptually connected to it. When I look away I dissociate from it, and my perception ceases. Or I may avoid thinking about doing my income tax returns because they boring, and I can’t stand being bored.

We use the ability of our mind to dissociate from thing (and associate with others) for many reasons. Dissociation is not inherently good or bad. It all depends upon the situation.

Dissociation – the ability of our brain to shift focus – is an essential brain function. All normal human brains, and undoubtedly all higher-order animals brains as well, use dissociation as part of their normal functioning.

Since what we can pay attention to at any point in time is limited, we continually have to be able to turn away from some stimuli in order to be able to turn toward others. This “turning away” brain skills is simply a tool to be used in accomplishing the ongoing task of responding to internal needs and engaging with external resources which might meet those needs. It’s normally a good and essential brain activity.

Dissociation also helps us stay focused on something. We use it to ignore certain stimuli which enter our perceptual awareness, so that we can maintain focus on other stimuli. Some people are good at doing this, while others are poor. And…some do it excessively at times. In all cases, however, this is dissociation in its natural setting, since both functional and dysfunctional behavior are a part of the natural world.

Ability to dissociate varies from person to person, and this has implications

People are variable in all their qualities, including that of their ability to dissociate and to maintain attention. It is apparent that some people, from an early age, can use dissociation more easily than others.

Our brain uses the skills it has to adapt to threats

Brain are primarily internal regulation mechanisms. Their overall goal is to maintain the individual possessing the brain. Good brains respond adequately to threats (internal or external), and take good advantage of opportunity.

When an emotionally distressing stimulus arises in our perception – such as an awareness that we are more alone than we find comfortable, or that we are actively being threatened – our brains will seek to resolve the problem. We may use our body to run move quickly, or to curl into a ball, or…to shift our attention to other, less distressing matters. If any response we use is rewarding, as it will be if it reduces our distress, the likelihood that we’ll use that response again in a similar situation will typically increase. This is how we learn to adapt to challenges. We act, experience a desirable consequence, and remember what we did so we can do it again.

Since engaging dissociation can reduce our emotional distress, it can easily become one of our adaptive responses to such distress, especially in childhood, when our “adaptive toolkit” is most meager.

Adaptive responses we learn as children can be maladaptive as adults

That which was the best we could achieve as a child may well no longer be good enough for us as adults. This can especially be true with adaptations we learn to emotional distress.

A strong tendency to use dissociation to respond to emotional distress may certainly be the best we could put together as a child. As an adult, we have other, better options, whether we know it or not.

Responding to adult over-use of dissociation

A primary appropriate response is to reduce the causes of emotional distress by using psychotherapy to reduce or eliminate the stimuli in our memory which cause emotional distress and thus trigger us to dissociate. The methods for achieving this outcome are fairly well known, and they typically work well, tending to produce distinct improvements in overall function. They also do not take particularly long to achieve their results, in the great majority of cases.

Another excellent response, usually best used in conjunction with psychotherapy, and after it’s under way and achieving results, is to learn to manage our brain’s tendency to over-use dissociation to adapt to emotional distress. Responding this way is no different from other responses we routinely adopt to respond to vulnerabilities we may have, like a tendency to get cold easily, or to sweat excessively when nervous, or to overeat at parties. Once we know what the problem is, we can construct a way of managing it, so that it doesn’t take control of our lives at critical times.

Benefits which come from better managing our dissociation

It’s important to know why it might be work making the effort needed to change an automatic response to some stressor. This can help build our motivation, and this motivation is essential to success. So, here a few of the benefits we may anticipate will derive from our learning better to manage a tendency to dissociate more than we want to.

Increased alertness and sense of aliveness. Being in a dissociated state typically means that we become to some significant degree dull to and unaware of our surroundings. This may make us socially unresponsive or inappropriate. It may also make us feel sleepy or tired at inappropriate times. Blocking dissociation, or constructing a productive end to it, will simply produce a state of appropriate mental alertness. This usually will simply work better for us, regardless of our situation.

We will be able to learn better. Overuse of dissociation prevents new learning. Imagine how poorly we’d learn how to drive if every time we got in a car to learn, we had to stop the car and get out after a couple of minutes. Separating ourselves from learning environments (most of which are realistically in daily life, not a classroom!), is rarely helpful to our life-education. Ceasing to turn away from such environments surely will be.

Life will be more rewarding, satisfying, and comfortable or us. If you want to enjoy a movie, the best place to do it is in the theater, not across the street on the sidewalk! To smell the flowers, you have to be able to walk in the garden. Living well requires living in contact with the “stuff” of life, and inappropriate use of dissociation acts to prevent this. Stop doing this and you’ll very likely find you’re living a fundamentally better life.

We’ll probably seem, to ourselves and to others, more mature. Most people who dissociate too much do it either because of their genetics (some brains just do it more than others) or because of early childhood contact with emotionally distressing home environments which were chronic. Psychotherapy cannot help genetically-based dissociation (nor can anything else). Psychotherapy usually can help environmentally derived dissociation, although it may not be able to resolve the problem completely.

To continue to act as if we are living in the same environment as that in which we grew up is usually not the best we can do. Learning more adult responses increases our adaptive options considerably in most cases, allowing our responses to stress to become significantly more age-appropriate. Life becomes easier, and more rewarding. We feel more comfortable, more competent, more adult.

Who most benefits from learning dissociation management?

Since the capacity to dissociate appears to vary from person to person, and since there is reason to believe that those who dissociate most easily are most at risk for adverse response to extreme emotional distress (which well may result in psychological trauma), it is people who tend most easily to use dissociation who will benefit most from learning to better manage this response.

Even after psychotherapy has addressed all known and accessible causes of emotional distress, some people will still tend to over-use dissociation at times. Different people have different inherent strengths and vulnerabilities. To know that you have the vulnerability of tending to dissociate more than other people will give you the power to respond to this effectively, if you know how.

What’s natural to us may not be good for us

Just because we tend naturally to do something doesn’t mean it’s a good idea. We may well tend naturally to favor fatty foods, for example, and this makes sense if we live in an environment where periodic calorie insufficiency is a problem, as did most of our ancestors. In other contexts, this tendency is will only lead to a compromise of our health. We’ll have to learn to manage it. So it is with the tendency to dissociate excessively.

How to learn the new skill of dissociation management

The nature of our brains is to be efficient, and to make use of what it already has. This means that the brain is essentially conservative. It likes to make and keep habits. If we want to instill a new habit, we will be going against this nature to a degree. There are ways to do this which tend to work. One of the best is to present the brain with something which works better than an older way of responding to some challenge.

But how will the brain ever experience the improved way, if it only wants to use the old way? We have to intervene in its natural process and take it in a different direction, and this will usually take thoughtful, intentional effort.

Here’s what a lot of experience has taught us is the best way to do this:

1. Identify and validate a new way of responding, and describe it well. You will do much better if you have a clear target behavior to aim at.
2. Study, understand, and slowly work through the new way. Practice it slowly, and as perfectly as possible, in an environment that is as non-threatening as possible. Mistake-free practice is the goal, in the beginning, not speed. This is critical.
3. Repeat this practice, ideally more than once daily, for a number of days. Always aim for perfect execution, else you’ll be learning mistakes. It is very much true that a slow beginning, well done, is the fastest way.
4. Be patient, and simply allow the brain to notice and absorb the new way. There’s no rush, no reason to be anxious. It is the practice itself which gets the job done.
5. Once you are executing the new habit perfectly and reliably, slowly bring it into the real context where it will be needed. Slowly increase the challenge you will have to deal with, which is both the anxiety associated with the real context AND your tendency to use the OLD way of responding. Continue to work at perfect execution. THIS is where your brain learns that it really does have a new way of responding. Should you start to make mistakes, simply reduce the stress you’re experiencing for a practice sessions.
6. Keep the faith: remember that this is the way highly skilled people, such as accomplished gymnasts, golfers, professional musicians, etc., learn new things. If it works for them it will work for you.
7. Continue practicing, in a real context, until you are satisfied with your results.

Note that until you start getting BETTER results in a a real context, you will be pushing (exerting effort) to achieve leaning. But, when faced with these better results, your brain will start pulling you into the new response. It will become desirable. You’ll like it, and want to do it. You’ll then own it. Mission accomplished.

There is a hidden benefit from accomplishing this type of learning. You’re not just learning a new, and vital skill. You’re also, because of your increased awareness of what you’re doing, learning how your brain really works. You can take this awareness of HOW to learn to many other situations.

The next step

Now that you have basic understanding of what you’re going to do, it’s time to start. We’ll begin simply, as all change processes should, and build on what we’re learning as we go along.

The next step is to become more aware of ourselves, in the midst of our lives. I take this up in the brief document Managing dissociation – becoming more aware, the next document in this series.

PART TWO – Managing dissociation – becoming more aware

((ROUGH FIRST DRAFT – I’ll likely move this along to a more polished version Saturday, 11/1, in the evening.)

(This document presumes that one has read its antecedent: Managing dissociation – an introduction)

The critical first step: stopping

All interventions begin with awareness of some current situation or state. We do have to start somewhere, after all. In a real world intervention, there’s only ONE starting point: right now.

So, all we’re going to do in this “becoming more aware” process is stop our forward flight through time and catch up with our current state of mind, and most particularly with our degree of dissociation. Since dissociation can often be triggered by something we’re feeling, we’ll also try to get a sense of that as well.

The goal: automatic noticing of our state of mind

Once our mind learns to make a useful distinction, it will often tend to do it spontaneously, but first we must learn the distinction. The desired outcome, nevertheless, is make the distinction spontaneously. It can often take surprisingly little time to accomplish this.

Preparation

We are going to momentarily stop our activity and simply assess our degree of dissociation. It will be adequate for our purposes for us to simply do this subjectively. We can make good use of simple measurement device: a subdivided line – which functions very much like a measuring stick or ruler.

0——-1——-2——-3——-4——-5——-6——-7——-8——-9——-10

One can draw something like roughly on a sheet of paper, if desired. It’ll work just fine.

We’ll use this measuring to produce an answer to this question:

DISSOCIATION QUESTION – At this time, how dissociated or “spacey” you you feel?

With this measuring device we will specify that “0” equals “not at all” and “10” equals “completely”. In reality, most people’s normal state of mind will fall somewhere between these two extremes.

Training

First two days

Probably the best way to start is to allocate two days for initial training. Set a timer, if desired, so that approximately every hour or so, for approximately four hours or more, you stop whatever you’re doing and ask yourself the “dissociation question” given above.

Obtain your answer to the question by moving a pen or pencil tip alone the line from 0 to 10, until you find the spot one the scale that FEELS about right. You’ll find that there IS such a spot, but you won’t find it by thinking. You can only find it by feeling for it. It’s a very simple process, and quite easy once you try it a few times.

Write down the time of day and the number you produce with this process. You may put down numbers like 5, 3.4, 7.6, and so on. The scale is divided, you’ll note into segments that are 20% of the distance between the main points on the scale, but don’t worry about being too exact. An approximation will work just fine.

Then ask yourself: Am I feeling any noticeable degree of any of these feelings:

• fear – terror
• anger – rage
• distress – anguish (what we feel when we lose something)
• shame – humiliation
• disgust

An alternative way of doing this is to do the stopping-and-noticing process every hour for 6-8 hours, and only write down the number and feelings every other time.

Concluding days

It is recommended that for at least two more days you continue this process, but to do it at less frequent intervals – say every two hours. This will be easier, and less intrusive, but will still keep asking your brain to stop and notice. If it hasn’t already happened, it well may be during this time that you start noticing yourself spontaneously stopping and noting your state of mind, without any prompting by an alarm or other device.

It is also at this time, at some point (your choice), that you can begin phasing in the Structured Response Protocol (SRO) to which there is a link at the bottom of the page.

Assessment of outcome

This step is virtually effortless, and all but unstructured. Just do this: in the days following the “concluding days” segment of the structured training, just notice to see if you are spontaneously checking your degree of dissociativeness – you don’t need to take a measurement. The question simple is: Are you pausing at times to notice. When you’re more dissociated than you wish to be, do you respond with the SRP?

If not, redo the training, but in an abbreviated version. By then, things should be working more or less to your satisfaction. You may need, at times, in the future, to refresh yourself with an even more abbreviated “refresher training” cycle. To have to do this would be in no way unusual, and should not cause you any concern at all. But…different people’s brains may be expected to respond in different ways, so you’ll simply need to see how your responds, and go forward form there.

Next step: Managing dissociation – a structured response protocol

PART THREE – Managing dissociation – a structured response protocol

(ROUGH FIRST DRAFT. I expect to have this document also fully developed into second draft status by the evening of 2008.11.1.)

There are three key steps to this response protocol. It is critical that they be done in this order:

Organic problem rule-outs

Many mental health problem symptoms can be triggered by basic organic problems. There are five we should check for, in this order – their approximate likelihood of being present:

1. Blood sugar problems: for most people, the issue is low blood sugar, due to having gone too long without eating. Diabetics can also have high blood sugar problems.
2. Sleep deficit issues: sleep-deprivation fatigue is a real problem for many people.
3. Illness – ongoing or impending: physical sickness can induce or trigger (not the same thing) distinct changes in our state of mind.
4. Drug side effects: Easy to forget, the wide range of known drug side effects are impressive, and some of them are mental. This problem can arise with a drug you’ve been successfully taking for a long time, and without any change in dosage, if some key aspect of your metabolism changes.
5. Brain injury: Other than in the case of a stroke which has gone undetected (and this is very possible with small, undramatic strokes), most people with brain injury know they have it. Drug or alcohol induced brain injury, however, can be present without having been identified by anyone, so this possibility must be considered as well. The effects may not show up for years.

If any of the organic problem are found, or suspected, it is difficult to see past them to clearly identify a psychological problem. In addition, in many people, a physically caused problem in mood or perception can trigger an addition problem of purely psychological origin. The only way to reduce this problem to manageable simplicity is to address the physical (organic) problem first, and to reduce it as much as possible.

Any part of an organic problem which cannot be fully resolved must simply be managed like any other mental or physical vulnerability.

Induce strong engagement

If your dissociation has not progressed too far, you can often simply induce a state increased brain alertness and awareness, which will stop the problem.

Support and resolve the dissociation

As a last, and very good response (because it usually works quite well), adopt the attitude that your brain actually knows what it’s doing. Actively support its desire for a break. When you do this correctly, you will get that rest, and recover quickly. You will achieve a new and satisfying level of engagement and mental alertness.

(Obviously need finishing.)