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CBT for Depersonalization & Derealization

By Debra Kissen

Depersonalization & Derealization sensations can be extremely uncomfortable and anxiety provoking.  The good news is that they can be effectively treated with CBT for Panic Disorder. By applying the principles of cognitive therapy, behavioral therapy, interoceptive exposure and mindfulness you will teach your brain to get unstuck from “feeling unreal” and teach it to return to the present moment and disengage from compulsions such as:

  • Trying to figure out deep, philosophical questions
  • Engaging in checking compulsions to determine if you are in fact real
  • Obtaining reassurance from others that “you are ok”
  • Researching/googling to figure out what is wrong with you
CBT for Depersonalization & Derealization

Sample Exercise

The brain is always scanning for danger. Sometimes it misfires and determines one is in danger when one is actually safe and sound. A panic attack is simply a false alarm going off in your brain.

For you to know:

Have you ever accidentally set off the smoke detector? Perhaps you were making yourself a meal when all of a sudden a ton of smoke arose from the frying pan, setting off the smoke alarm. Similarly, a panic attack is a false alarm going off in your brain.

For you to do:

Let’s play a game of Danger Versus False Alarm. For the situations listed below, specify whether they represent an appropriate time to experience the panic response or a false alarm.

  • You are driving on the highway and notice a spacey feeling in your head.
  • A lion lunges for your face.
  • You are at a party with friends and begin to feel weird and out of it.
  • You are about to step on a rattlesnake.
  • You think about how weird it is to be alive.

The next time you begin to panic because you feel depersonalization or derealization sensations, play a game of Where Is the Danger? Do a quick true danger assessment:

  1. Are there any angry bears approaching?
  2. Do I see any armed gunmen?
  3. Is there a volcano erupting before my eyes?
  4. Is the ground shaking due to an earthquake?
  5. Is hail coming down from the sky (or locusts or angry wasps or other dangerous objects?)
  6. Add your own true danger assessment question.

If the answer to any of these questions is yes, immediately stop reading this information and instead attend to the emergency at hand. If the answer to these questions is no, then remind yourself that panic over feeling uncomfortable sensations is a false alarm going off in your brain and you are actually safe and sound.

Next, respectfully inform your brain that until you observe any of the previously listed dangers, you are going to mindfully return back to the current moment and in the process teach it that it is (and you are) actually safe.

For the next week, for all panicky depersonalization or derealization moments, jot down your initial anxiety level. Next, play a quick game of Where Is the Danger? and look around the room for any imminent threats. Finally, jot down your anxiety level after playing Where Is the Danger?

More to do:

Create a coping card to remind yourself that a panic attack is simply a false alarm going off in the brain. Be as creative as possible. Try drawing a picture that represents this concept. Where can you keep this coping card to keep this concept handy and accessible when you need it most?

Dr. Debra Kissen is CEO of Light On Anxiety CBT Treatment Center. Dr. Kissen specializes in Cognitive Behavioral Therapy (CBT)...

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