Kimberley's Story: A Psychologist's Perspective
*Trigger Warning: contains references to drug usage, psychological distress and physical health concerns.
When I was 18 years old, I tried cannabis with my then partner. Moments later, I experienced intense panic and a sense of unreality that left me terrified and literally shaking for hours. This state unfortunately persisted for months. Over this time, everything felt distant, like I was in another dimension, or weird dream. Time also seemed to have altered and it felt like I had opened a door that could never close; that my life would never be the same again. One researcher has likened it to finding a crack in the glass that you had been looking through all your life, and now discovering a shocking realisation – that you were separated from the world by this window the whole time.
After several months of unbearable suffering, my boss told me off for looking so anxious all the time, despite the fact that I was trying to “act normal.” I later came to learn that the contrast between acting normal and feeling unreal can actually intensify the feelings of detachment and unreality.
My experience eventually led me to study Psychology, and ten years later, I went to university and became a Clinical Psychologist…although the symptoms continued to wax and wane in the background.
I tried to make sense of this disorder by learning about a Cognitive Behavioural Model for Depersonalisation by Hunter et al (2003). She proposed that people prone to depersonalisation/derealisation process anxiety differently. For people like us, when anxiety reaches a certain threshold, the brain overcompensates by ‘shutting down’ the symptoms a bit too much. This can result in an unpleasant ‘unreal’ state.
People may interpret this state as an impending madness or brain damage (I certainly thought both of these things). In turn, thinking you are going mad or losing control increases fear/anxiety, which makes your brain try to shut down the anxiety, which just keeps the symptoms going.
For myself, the symptoms initially lasted for about 6 months with not one second of let up. Ten years later, I find they now come and go. But if I “listen in” to them, they always find me!
Over time, and with my training, I have learnt strategies that help my DPDR (and things that make it worse).
Things that might help reduce DPDR
Shifting attention away from symptoms and towards tasks. I found the more I “listened in” to the symptoms, the more they were present. I learnt an acronym by a Psychiatrist, Dr Claire Weeks, that got me through the early days, called AFRT. This stands for ACCEPT, RELAX, FLOAT THROUGH, LET TIME PASS.
I used ARFT all day, every day, in the beginning. When I felt the weird sensations I would completely relax my body (to the best of my ability) and accept the feelings (not fight them). I still hated the experience, but ‘acceptance’ took away the secondary stress that I was feeling. I likened the skill to using a Chinese Finger Trap. With these traps, the more you struggle to get free of the trap the more it tightens around your finger. But if you relax, your finger, it can easily slide out of the trap.
In the beginning, I would apply ARFT, by ‘accepting’ the strangeness, ‘relaxing’ to the best of my ability, ‘floating through’ (not fighting) the time it took for the fear to lessen, and ‘letting time pass.’ I used this framework as the mornings turned into afternoons, and the afternoons turned into evenings and then into night, only to repeat the process the next morning. I used ARFT to simply get through time, and eventually the terrifying weirdness lost some of its grip on me.
Distraction. Intense focus away from thoughts is helpful. As soon as you notice yourself becoming distant/unreal, count from 100 backwards in 2’s, name animals from A-Z, or any intense distraction you can think of when things get to crisis level.
Grounding. There is a hypothesis that DPDR symptoms occur more often in people with poor proprioceptive awareness (our awareness of where we are located in space). Things like a weighted blanket, lying in bed with a heavy pillow over your feet, wearing a tight beanie, holding or squeezing toys, stones, or just making tight fists can all help increase proprioceptive awareness.
Challenging catastrophic thoughts about going mad or crazy. You are not going crazy!
Some medications can work for some people. In emergency states, benzodiazepines can help shut the symptoms down. This would need to be under supervision from your GP. Some people get relief with antidepressants, which can at least can treat other emerging conditions (depression).
Talking to a therapist. Some techniques such as working with internal parts of self/ EMDR, and learning strategies all show promise.
Things that might make DPDR worse
Coffee or Energy Drinks. Caffeine may be ok in small doses, but caffeine can trigger anxiety, and possibly worsen DPDR symptoms.
Artificial lights, or white energy saving lights, which can add to a sense of unreality.
New places, in which normal feelings of unfamiliarity can mistakenly be attributed to increasing DPDR symptoms.
Hangovers
Lack of sleep, which mimics DPDR feelings.
Avoidance. Having little to do and too much self-focused attention can exacerbate things.
Busy places such as malls, airports, supermarkets, etc. However, if you can, it’s important to keep going to these places, as avoidance of these places makes them seem more frightening and can lead to an increasingly restricted life.
Increasing ‘symptom monitoring’ can lead to an increase in symptoms.
Finally though – I have found that DPDR sufferers are some of the kindest, most beautiful people I have ever met. I wish you well and walk alongside you on this extraordinary path my friend.
Kimberley Sutherland
Registered Clinical Psychologist
New Zealand