Other physiological treatments

We’ve been studying some new treatment approaches in the Depersonalisation Disorder clinic at the Maudsley Hospital, one of which is biofeedback. This is based on the fact that people can learn to control certain bodily functions – such as pulse rate, blood pressure and reactions to emotions – if these measures are fed back to the person, and changes are displayed, in an easily accessible way. For example, if someone can actually hear their heartbeat, they may find that something they do (it doesn’t matter what) makes it go up or down. The body then learns what it is that makes a difference, especially if this is rewarded in some way, through a kind of unconscious learning.

Biofeedback training has proved to be valuable in the treatment of a range of clinical conditions such as hypertension (high blood pressure), migraine headache, and even epilepsy. We described in Part 1 (see page 25) how our research has shown that DPAFU is characterized by reduced body arousal (arousal is the body gearing itself up for action) and reactions to emotions. We have started to investigate whether increasing body arousal may help relieve some of the symptoms of DPAFU. The person sits in front of a computer screen while electrodes from the skin of their hand convey to the computer skin conductance (arousal) levels. The person can then increase conductance levels and this is displayed in the form of a computer game. The sessions take between 20–40 minutes and have to be repeated several times to make a difference. Preliminary results suggest that it may be an effective treatment – at least in the short term. Clinical trials are currently underway.

Appendix I

The Cambridge Depersonalization Scale cambridge depersonalization scale (State Version)

The wording of the scale has been amended slightly from the original to improve clarity

NAME:____________________  AGE:________

(please circle as required)   SEX: male / female

SCHOOLING: primary / secondary / higher (e.g. university) (please circle as required)

PLEASE READ INSTRUCTIONS CAREFULLY:

This questionnaire describes strange and ‘funny’ feelings that people may have in their daily life. Please read carefully each of the following descriptions. If you feel you are having right now any of the following experiences, please let us know how bad it is at the moment by making a mark on the line.

Example:

(I’m not having it at all)    (It’s as bad as it can get)

1   I’m feeling strange, as if I were not real or as if I were cut off from the world. Please mark the line to show the present intensity of this experience.

2   Things around me are now looking ‘flat’ or ‘lifeless’, as if I were looking at a picture. Please mark the line to show the present intensity of this experience.

3   I am feeling as if parts of my body don’t belong to me. Please mark the line to show the present intensity of this experience.

4   I’m now having the feeling of being a ‘detached observer’ of myself.

5   My body is feeling very light now, as if I were floating on air.

6   I am not feeling any emotions at all.

7   If I read this sentence aloud, my voice sounds remote and unreal.

8   I am having a feeling of complete emptiness in my head so that I am not having any thoughts at all.

9   I’m having the feeling that my hands or my feet have become larger or smaller.

10   My surroundings are feeling detached or unreal, as if there was a veil or a fog between me and the outside world.

11   It seems now as if things that I have recently done took place a long time ago. For example anything which I have done this morning feels as if it were done weeks ago.

12   If I now try to remember important events in my life (e.g. graduation, wedding etc.), I feel so detached from the memories that it seems as if I had not been involved in them.

13   I don’t seem to be feeling any affection towards my family and close friends.

14   Objects around me are looking smaller or further away.

15   I cannot feel properly the pencil that I have in my hand, as if it were not me who were holding it.

16   If I now try to imagine the face of a relative or friend whom I frequently see (but who is not with me at present), I do not seem able to picture it in my mind.

17   If I pinch myself in my arm now, I feel so detached from the pain that it feels as if it were ‘somebody else’s pain.’

18   I am now having the feeling of being outside my body.

19   I am feeling as if I were not in charge of my movements, so that I feel ‘automatic’ and mechanical, as if I were a ‘robot’.

20   I am feeling so detached from my thoughts that they seem to have a ‘life’ of their own.

21   I feel like touching myself to make sure that I have a body or a real existence.

22   I am still having the same strange feeling as when I started to answer this questionnaire.