In this article, we will talk about one of the most common symptoms of complex post-traumatic stress disorder – dissociation. We will explore different methods and tools that help us to reconnect with our body in the long term. Since one of those tools is therapy, we will also talk about the limits of talk therapy, and address how working with our body directly can teach us new and healthier responses when we are overwhelmed.
Definition and Explanation of Dissociation
For every trauma survivor, dissociation looks differently and has varying levels of intensity. Some of us might only experience dissociation in difficult moments or as part of a flashback, while others can live in a state of persistent dissociation.
There are different definitions of dissociation. When we look at what they all have in common, we can say that dissociation is a form of the fight, flight, or freeze response. Dissociation can happen when we experience a threatening situation which we cannot escape from, and also cannot resolve or change. As an adaptive response, a form of detachment from that experienced reality takes place. That detachment can be from our surroundings, from our emotions or our body, and, in severe cases, reveal in a complete shut down; a freeze.
In the article, The association between peritraumatic dissociation and PTSD symptoms: the mediating role of negative beliefs about the self, Thompson-Hollands points out the relation between peritraumatic dissociation and the symptoms of post-traumatic stress disorder:
“Peritraumatic dissociation, a term used to describe a complex array of reactions to trauma, including depersonalization, derealization, and emotional numbness, has been associated with posttraumatic stress disorder (PTSD) symptoms across a number of studies.”
In other words, dissociation is a form of coping with intensely overwhelming, overpowering, or traumatic experiences. Since the perception of such an experience is individual – depending on our individual coping disposition and skill, the state of our nervous system, and our personal history of trauma – anything can cause that response in an individual.
Dissociation is a completely normal response to traumatic events and was needed at that point in time. There is nothing wrong with you if you responded or still respond in that way. We are just talking about it to learn to manage our responses in a way that supports our healing.
In general, a mild form of dissociation can be healthy and helpful to tolerate stress for a limited amount of time. Dissociation becomes a problem when it gets out of our conscious control and starts limiting our life. Not everyone diagnosed with complex post-traumatic stress disorder experiences dissociation, but for those who do, it can show itself in the following ways:
Symptoms of Dissociation
- Lack of memory (for some people, this can be a very long timespan or even most of their childhood years)
- A general feeling of disconnection
- Not knowing how you feel and struggling to engage with emotions
- Not feeling your body or only noticing strong stimuli like pain and stress
- Speaking about emotions in a monotone voice and having difficulty making eye contact
- Depression, anxiety, or both
- Being overwhelmed by emotional or physical intimacy
- Experiences of fragmented reality
- A general feeling of disorientation or difficulty orienting within surroundings
- Trouble getting “out of your head”
As mentioned above, dissociation becomes a problem when we cannot use it deliberately and in our favor. Instead, our organism reacts with it in a situation where we want to or need to stay connected. For example, we could get overwhelmed by intimacy in a relationship. When that is the case, our coping mechanism becomes a mechanism of self-sabotage.
How Dissociation inhibits Healing
Dissociation is the opposite of association or connection. Since most processes in our brain are associative, recurrent states of dissociation interfere with our ability to process information in a healthy way.
Connection, intimacy, emotional integration – these are all only possible in an associative state.
As important and necessary as cognitive elaboration and integration of the traumatic memory is, healing of complex trauma can ultimately only be achieved by creating and therefore experiencing a different reality. Creating a new pattern requires us to be present. Experiencing is also only possible in an associative state. If we dissociate in a moment where we had a chance to experience connection, intimacy, or safety because we were overwhelmed, that reinforces negative patterns and thoughts.
At the same time, it is so difficult to stay connected in these important moments, because we struggle with emotional regulation.
This is why dissociation might intensify posttraumatic symptoms and inhibit the recovery process. It repeats past experiences and feelings by disabling the connection to the emotions of the present moment.
Emotional Regulation, Homeostasis, and Healing
Healing is a long-term process of repetitive adaptation to new stimuli that overwhelm us, by exposing ourselves to a level that we can handle without dissociating, while our ability to regulate our emotions improves. If we let it overwhelm us too much, the cycle described above occurs. Dissociation and confused emotional regulation bring our body out of homeostasis.
Peter Levine, who is a somatic trauma therapist, describes it as follows:
“The failure to restore homeostasis is at the basis for the maladaptive and debilitating symptoms of trauma.”
Homeostasis is the state in which our organism functions optimally and has access to its own internal healing and recovering abilities. For people with complex post-traumatic stress disorder, that mainly refers to a balanced state of their nervous system.
As a person who struggled with severe and long term dissociation myself, I find this a challenging and painful reality. It is not our fault that our organism trained itself to be in a state like that, but we have to deal with the consequences. Simultaneously, only we have the power to change that. For me, it sometimes is frustrating to face that reality, because it feels unfair. On the other hand, there is something empowering behind that responsibility; we can change it. We are not dependent on the choices of other people in the same way anymore, but on our own. We can make a promise to ourselves: go through the uncomfortable process of change and reconnect with our organism.
Recovering from complex trauma and from post-traumatic stress disorder takes time because those responses need to be managed in a sustainable way; a way that lets our organism restore homeostasis. And that takes a lot of practice in emotional regulation, which includes preventing and managing dissociation.
Potential Limitations of Talk Therapy and the Body Oriented Approach
Bessel van der Kolk and Peter Levine, both trauma therapists, agree that the processing and reintegration of traumatic memories and emotions are crucial to healing. It is important to feel those emotions that do not want to be felt, to reframe the experience and integrate them.
The key is to do that in a safe and productive way that does not cause retraumatization or dissociation. We will explore some safe ways to do that later.
Talk therapy is a great tool for many of us and as much as it can help with various steps in the process of reframing and reintegrating our memories, it has a risk to cause dissociation or retraumatization when we have not learned how to stay connected while regulating those emotions.
Talking about a traumatic event or the emotions associated with it can be so overwhelming that we can only do that while switching to a dissociated state, which then inhibits integration. Alternatively, we can become so overwhelmed that everything just bursts out and we may emotionally re-experience that trauma. For those of us who struggle with that, a body-oriented form of therapy can be a helpful tool. Body oriented means that the focus is on creating a state of connection to the older parts of our brain through the body and then working from there, instead of being more frontal lobe oriented. Such a method is designed to, and could, prevent dissociation.
If this is something you struggle with, here are a few body-oriented methods to manage dissociation.
Preventing and Managing Dissociation
Taking some time each day to breathe deeply into your belly teaches the organism to restore homeostasis and therefore balances the nervous system. You can put a hand on your chest and the other hand on your belly. Now focus on deep belly breathing instead of breathing into the chest.
Meditating regularly changes your relationship with your thoughts. You can sit with them, let them be, feel yourself and focus on your breathing. Meditating a few minutes daily helps in being aware and connected to the present. It also shuts down the negative voices in the head over time because when you start feeling that you are not your thoughts, those negative voices lose their power.
Practicing being fully connected to the present moment. You can do that in many ways– In a conversation with a friend, spending time with family or children and really focusing on the present moment, being in nature, meditation; what comes to your mind? The key is not being on ‘autopilot’ but as engaged as you can. A few examples to connect with the present moment: Take a walk in the park, take a shower and feel the warm or cold water, focus on your surroundings and feel/hear/smell five things
- Moving your body consciously
We experience life and every emotion through our body. We feel with our body. Moving while consciously tuning into our body and focusing on how that movement feels rebuilds the relationship with the body. You can take some time each morning and practice getting into your body. Do you feel differently during the day?
- Actively asking yourself how you feel
We can practice being in touch with our feelings and awareness by slowing down a few times each day and ask ourselves how we feel. You can set an alarm or a reminder on your phone to do that. If you find out that you are not feeling well, keep in mind that it is ok. Do not judge yourself for not feeling well or for feeling disconnected. Noticing how you feel is an important step in healing. It takes time. It is okay to take little steps and to take a step back when needed.
- Yoga and Martial Arts
Yoga and Martial Arts are both ways to engage in physical activity that requires us to be very aware of how we feel. Both bring up emotions, help with emotional regulation and integration and also involve our mind. Yoga helps with reconnecting body and mind. Martial Arts helps with widening one’s window of tolerance and creating new and positive scenarios, as well as building up self-esteem and self-confidence.
- Dancing, singing, and music
Creative activities that involve movement help us getting into an associative state. It is simply easier to train ourselves to get and stay in associative states with joyful activities. The more often we are in an associative state, the easier it gets to stay connected.
- Being in nature
Nature has a very positive effect on our well being. Being in nature makes us feel present, more connected and more grounded. Also walking barefoot on grass is especially grounding.
- Consciously focusing and experiencing your senses and sensations
Similarly to asking yourself how you feel; consciously focusing on our senses and sensations connects us to our internal experience and to our immediate surroundings. Sometimes emotions or thoughts can be a part of our old patterns. When we consciously connect to our present sensations and our surroundings we might process that experience differently and have a better orientation. It helps in creating new experiences. It is okay to not feel a rapid improvement.
Give yourself time and trust the process. It will come.
My current journaling routine is that I take some time every morning and write down what I am grateful for. Then I check in with my inner child and ask it how I can be there for it today. I end my routine by checking in with my future self – what can I do today to become my future self? Every part of this routine is about today with the goal to fully ground myself with intention and awareness in the present moment to start my day centered and connected.
- Experiencing Joy
Joy is the experience of flow. When we feel joy, we are in a highly connected state. Trauma survivors might have difficulties to be joyful even years later. But being joyful can be relearned. Think about all the memories of joy you had in your life and try to connect with that feeling. Maybe write them down. Consciously do something that you associate with that state every day.
In the past, I struggled a lot with dissociation while being in talk therapy and a more body-oriented approach was a significant step in my healing process. I am still practicing grounding and connecting to my organism every day because it brings more happiness into my life.
Reconnecting to yourself and others can be scary and uncomfortable in the beginning but it so important for our healing. I encourage and invite you to try it out.
- Van der Kolk, B. A. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. New York: Viking
- Levine, P. A. (2005). Healing trauma: a pioneering program for restoring the wisdom of your body. Boulder, CO: Sounds True.
- Levine, P. A. (1997). Waking the Tiger: Healing trauma: the innate capacity to transform overwhelming experiences. Berkeley, Calif: North Atlantic Books.
- Thompson-Hollands J, Jun JJ, Sloan DM. (2017). The association between peritraumatic dissociation and PTSD symptoms: the mediating role of negative beliefs about the self. J Trauma Stress
- Brandon, A. (2018). Teaching Trauma-Sensitive Yoga: A Practical Guide. Berkeley, North Atlantic Books.