Overcoming depersonalization and feelings of unreality a self-help guide using Cognitive Behavioral Techniques

DAWN BAKER, ELAINE HUNTER, EMMA LAWRENCE and ANTHONY DAVID

 

 

 

Constable & Robinson Ltd

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London WC1B 4HP

www.constablerobinson.com

First published in the UK by Robinson, an imprint of Constable & Robinson Ltd 2007

This edition published in 2010

Copyright © Dawn Baker, Elaine Hunter, Emma Lawrence, Anthony David, Nick Medford and Mauricio Sierra 2007, 2010

The right of Dawn Baker, Elaine Hunter, Emma Lawrence, Anthony David, Nick Medford and Mauricio Sierra to be identified as the authors of this work has been asserted by them in accordance with the Copyright, Designs and Patents Act, 1988.

The information on antidepressants in Appendix 2 © 2007 Royal College of Psychiatrists

‘The Cambridge Depersonalization Scale: a new instrument for the measurement of depersonalization’, by M. Sierra-Siegert and G. E. Berrios in Psychiatry Research, 93 (2), pp. 153–64. Reproduced in Appendix 1 © Elsevier, 6 March 2000.

All rights reserved. This book is sold subject to the condition that it shall not, by way of trade or otherwise, be lent, re-sold, hired out or otherwise circulated in any form of binding or cover other than that in which it is published and without a similar condition including this condition being imposed on the subsequent purchaser.

A copy of the British Library Cataloguing in Publication Data is available from the British Library.

Important Note

This book is not intended as a substitute for medical advice or treatment. Any person with a condition requiring medical attention should consult a qualified medical practitioner or suitable therapist.

Isbn 978-1-84529-554-7 eIsbn 978-1-47210-574-5

Typeset by TW Typesetting, Plymouth, Devon Printed and bound in the EU

1 3 5 7 9 10 8 6 4 2

Table of contents

Acknowledgments

Preface

Introduction: Why a cognitive behavioral approach?

PART ONE:   Understanding DPAFU

1   What is DPAFU?

2   DPAFU case studies

3   A brief history of DPAFU

4   What causes DPAFU?

PART TWO:   Overcoming DPAFU

5   The cognitive behavioral therapy approach: CBT for DPAFU

6   Dealing with the core problem

7   Other useful techniques

8   How to deal with problems related to DPAFU

9   Other types of treatment

Appendix I: The Cambridge Depersonalization Scale

Appendix II: What are antidepressants?

Appendix III: Blank worksheets

Glossary

Further information

Index

Acknowledgments

The Depersonalisation Research Unit at the Institute of Psychiatry and Maudsley Hospital, London, opened in 1998 and was the first unit in the UK to specialize in depersonalization and feelings of unreality (DPAFU). The Unit was in part set up by a grant from the Pilkington family charities, to whom we are hugely indebted. The Pilkington family have shown enduring faith in our work and have continued to challenge us to improve our understanding of the condition and, hopefully, help to overcome it. The launch of the Unit was marked by an article in The Times by Dr Thomas Stuttaford (12 March 1998), which prompted a flood of enquiries from people seeking more information and help. The Unit was initially co-directed by psychiatrist Mary Phillips, whose work on emotion and the brain helped increase our appreciation of DPAFU and what might cause it. Many other individuals have contributed to the clinic over the years as psychologists and psychiatrists including Carl Senior PhD, Poppy Schoenberg, Dr Michele Lambert, Dr Maxine Patel and numerous visitors from abroad. In addition, work in the US by Dr Daphne Simeon’s group has added to our knowledge about this condition and has therefore been drawn on throughout the book. The research undertaken in our Unit has also been supported by various additional funding agencies such as the Medical Research Council and Wellcome Trust. Most importantly, however, we would like to thank the people who experience DPAFU and who have agreed to take part in the numerous research studies our Unit has conducted. The Unit continues today as part of a national service within the South London and Maudsley National Health Service Foundation Trust. Referrals must come through a general practitioner or psychiatrist.

We also have some very personal acknowledgments we wish to make:

Dawn

For my children, Jodie, Leah, Alex, Isabelle and Hannah, and my god son Charlie. Not least Tony.

Elaine

To Prakash Bijwe for his love and wisdom.

Emma

To the three Ss, Julie, Caroline and all those who have supported me along the way.

Preface

This book has been produced by the Depersonalisation Research Unit at the Institute of Psychiatry and Maudsley Hospital, London. The Unit conducts various research projects as well as providing a clinical service to people who suffer with depersonalization/derealization disorder and feelings of unreality (DPAFU).

The book will help you to understand and manage your DPAFU using highly effective Cognitive Behavioral Therapy (CBT) strategies. Numerous research studies have shown that CBT works extremely well with a variety of different types of people and problems. In some people with DPAFU these strategies may help the problems all but disappear. With others the severity of the problems may reduce to the extent that the person can get on with their life again. In other cases the frequency of the DPAFU may lessen. You are likely to feel more in control of your problems and better able to cope. There may be a range of benefits derived from the techniques we suggest here. We can’t promise this book will provide you with a complete cure since there may be factors beyond the scope of this book that need to be addressed, but you will learn strategies that are likely to have a positive impact on helping you feel better.

Using principles derived from CBT does not mean that the physical and biochemical aspects of DPAFU are not important – because they almost certainly are. In fact we believe that it is these very aspects that make depersonalization different from anxiety and depression. We will discuss these physical and biochemical aspects, along with medical (i.e. drug) and other treatments for depersonalization disorder. And though we believe the strategies we outline are likely to be of real benefit, this book isn’t intended to be a replacement for treatment or therapy. If you feel you need to talk to a professional about your problems, then your GP may be able to help. If he or she can’t help, a referral to a psychologist or psychiatrist may be appropriate.

The CBT approach helps people to look at the connections between how they think, how they feel and how they behave. The theory suggests that if the ideas, beliefs and values you hold are unrealistic or have become distorted, then ‘negative’ thinking patterns are likely to occur. Negative thinking patterns can lead to negative feelings such as loss of confidence, feeling low and anxiety. When you feel low or anxious you often change your behavior. For instance, you may feel less like socializing, and so you go out less. If you go out less you may end up feeling lonely, which in turn leads to a lower mood. This can develop into a downward spiral that feels as if it is difficult to break on your own. This cycle will then lead to a continuation of the original problem. Only once the problem has been identified, and you are able to see why it is continuing, can you then think about how you would like things to be different. The changes you want to make can become your goals and you can become more focused in achieving these goals. This self-help guide will help you through that process.

The key ideas from CBT are:

 

•   It is not what happens but how you interpret the experience that matters.

•   How you think, or your beliefs about a situation or experience, will influence how you feel and behave.

•   How you behave affects what you think and how you feel.

•   Our thoughts, feelings, emotions and behaviors are all connected and each influences the other.

The key components of CBT treatment are:

 

•   To identify and define your core problem(s) and how they influence your everyday life.

•   Once a problem is defined, you need to identify the things that you do (or don’t do) that lead to the problem continuing. These could include:

   Unhelpful behaviors – for example, taking drugs or avoiding particular situations.

   Negative thinking patterns – such as only focusing on the worst scenario.

   Negative emotional states – like hopelessness or numbness.

   Focusing on physical sensations – such as visual disturbances.

•   You need to set out clear and specific changes that you would like to make. These then become the goals to work towards during CBT.

•   The idea is then to actively work on achieving these goals using the variety of techniques set out in this book.

•   Throughout this process you will be encouraged to evaluate your progress. This will involve recognizing what is working well and not so well. You can then draw up new goals to help you use what you’ve learned and apply this knowledge to other situations

•   In essence, you will become your own therapist.