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The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) defines dissociation as “a disruption and/ or discontinuity in the normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control and behavior.” The symptoms of dissociation are divided into the following five clusters:

  1. Depersonalization: feeling detached from one’s thoughts, feelings, and body
  2. Derealization: feeling disconnected from one’s environment
  3. Dissociative amnesia: experiencing retrospective memory gaps (e.g., unable to remember important information about one’s life, history, and/ or identity)
  4. Identity confusion: feeling unsure of one’s sense of self or place in the world
  5. Identity alteration: the sense of being markedly different from another part of oneself

It is important to bear in mind that there are different types and varying degrees of dissociation. Severe dissociative symptoms may be indicative of a dissociative disorder that requires professional treatment. Every individual is unique and will respond distinctly to the array of therapeutic modalities available when it comes to treating dissociation. There are, however, certain treatment options that are recognized as more effective than others when treating dissociative disorders, including dialectical behavior therapy.

Dialectical Behavior Therapy

Dialectical behavior therapy (DBT) is an evidence-based psychotherapy that emphasizes the psychosocial aspects of treatment. It is founded on the principals of cognitive behavioral therapy (CBT) and blends Eastern mindfulness techniques (e.g., awareness, mindfulness, and attentiveness to current situations and emotional experiences) to encourage acceptance and change. Psychologist Marsha M. Linehan developed DBT in the late 1980s as a means to more effectively treat chronically suicidal individuals diagnosed with borderline personality disorder (BPD). Currently, DBT remains the gold-standard form of treatment for individuals with BPD and has also proven to be a successful treatment method for individuals experiencing other mental health illnesses such as eating disorders, post-traumatic stress disorder, generalized anxiety disorder, dissociative disorders, depression, substance use disorder, etc. 

Dialectical behavior therapy is comprised of three different therapy settings, including weekly individual psychotherapy sessions, weekly group DBT skills therapy sessions, and as-needed phone coaching to provide additional support between weekly individual and group sessions. The DBT group skills sessions focus on the following four skill modules, provided by Behavioral Tech:

  1. Core Mindfulness: the practice of remaining fully present in the moment at any given time.
  2. Distress Tolerance: learning to tolerate pain in challenging situations.
  3. Interpersonal Effectiveness: increasing one’s self-awareness and authentically advocating for one’s own wants and needs in a relationship in a way that is both self-respecting and non-damaging.
  4. Emotion Regulation: decreasing emotional impulsivity, learning to manage and shift intense, problematic emotions.

By nature, there are integral aspects of the DBT process, specifically in the distress tolerance module, that directly help individuals learn to manage dissociation symptoms (e.g., the TIPP skill, self-soothing skills, the ACCEPTS skill, etc.). Distress tolerance skills help individuals cope with feelings that do not have an immediately known resolution. They are short-term coping strategies that can help an individual manage emotional pain and avoid triggering dissociative symptoms. 

Disclaimer: 

The information above is provided for the use of informational purposes only. The above content is not to be substituted for professional advice, diagnosis, or treatment, as in no way is it intended as an attempt to practice medicine, give specific medical advice, including, without limitation, advice concerning the topic of mental health. As such, please do not use any material provided above to disregard professional advice or delay seeking treatment.