Summary

This chapter summarized the central themes of acceptance and commitment therapy (ACT), with an emphasis on managing depersonalization. We discussed the importance of doing what works as opposed to doing what feels right. We suggested accepting your discomfort while staying engaged in life, as an alternative to waiting for depersonalization to go away. We summarized the six functional processes of ACT:

Cognitive defusion was introduced as a strategy for approaching unpleasant thoughts that targets the influence we allow our thoughts and feelings to have over our behaviors.

The observer self represents the aspect of you that has observed every thought, feeling, role, interest, and phase of physical development you have undergone. Tapping into your observer self helps you maintain focus on the transience of your emotional experiences and the ebb and flow of life in general.

Mindfulness refers to being immediately aware of what you are experiencing. This is an important skill that’s difficult for people with depersonalization to foster due to the perceptual disturbance that’s common. Mindfulness strategies will be explored in greater detail in chapter 7.

Willingness and acceptance is the opposite of avoidance. Being willing to endure and accept emotional pain is necessary to pursue anything of value in life.

Clarifying your values allows you to base your life choices on more than what “feels right.” Values are less susceptible to change than are emotions or thoughts. They represent important areas of your life that can serve as your direction for the life choices you make.

Committed action refers to pursuing behaviors that are in line with your values, with a spirit of acceptance and of willingness to experience the discomfort that may arise in the process.

Acceptance of discomfort leads seamlessly into a discussion of behavioral strategies for combating depersonalization, because behavioral approaches are most effective when you completely throw yourself into the activity with an attitude of willingness (for example, not avoiding your emotions while you participate in exposure exercises).

7

Using Dialectical Behavior Therapy Strategies

In this chapter, we’ll discuss another acceptance-oriented approach, called dialectical behavior therapy (DBT) (Linehan 1993b). DBT was originally developed for people with borderline personality disorder (BPD), a disorder characterized by extreme emotional volatility, recklessness or impulsivity, and relationship problems. Many people with BPD say they experience episodes of depersonalization, which isn’t surprising, given that extreme emotional discomfort can bring on depersonalization. Likewise, as discussed in chapters 1 and 2, chronic depersonalization itself is extremely uncomfortable, which may lead to emotional volatility and emotion-driven decision making, two tendencies DBT specifically targets.

DBT focuses on behaving deliberately, tolerating distress, and acting with mindful awareness of what you are experiencing and what’s best for you. Many of the techniques included in DBT are useful for treating DPD, including mindfulness and distress-tolerance techniques. This chapter will briefly explore the basic concepts of DBT as they relate to DPD, and we’ve included a few DBT exercises to help manage the discomfort of DPD. However, because an in-depth understanding of DBT concepts and strategies is beyond the scope of this book, if you are interested in further study, refer to The Dialectical Behavior Therapy Skills Workbook: Practical DBT Exercises for Learning Mindfulness, Interpersonal Effectiveness, Emotion Regulation, and Distress Tolerance, by Matthew McKay, Jeffrey C. Wood, and Jeffrey Brantley (New Harbinger, 2007).

We know DBT works for people with BPD, who, like those with DPD, express feelings of numbness, unreality, and inability to connect to others. Because feelings of unreality and numbness are the central experiences of DPD, you, too, can benefit from learning to regulate your emotions and tolerate your distress.