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CBT for Derealization: Understanding Causes, Symptoms, and Treatment

a person struggling with depersonalization and derealization needing cbt therapy
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Have you ever planned to meet a friend at a restaurant after work, but somehow, you ended up at home instead? It’s like you were on “autopilot,” not paying attention, and just followed your usual route home without realizing it.

This can happen when you’re feeling “dissociated,” which means you were mentally disconnected from the present moment. During this experience, you might have also felt a bit “out of it” or like things weren’t quite real.

What is Derealization?

Derealization may seem like a term out of a sci-fi novel, but it’s something we’ve all experienced at some point. It’s normal to have these moments occasionally, but if they happen frequently and intensely, with prolonged feelings of disconnection, it might be a sign to pay closer attention and consider seeking support or help.

Derealization is a mental health symptom affecting many of us right now. Imagine feeling disconnected from the world, as if everything around you is a dream or a movie. Feeling as though you are on autopilot and every day is groundhog day. That’s what it feels like to struggle with derealization.

This blog post will explore derealization, what the experience is like, its connection to dissociative disorders, common triggers, and how to identify its symptoms. We’ll also discuss the process of diagnosis, treatment options, and coping strategies for those experiencing this perplexing phenomenon.

Exploring Derealization: Definition and Connection to Dissociative Disorders

A person looking confused and overwhelmed, representing the feeling of derealizationDerealization is a unique mental state where you feel detached from reality. It’s a symptom of dissociative disorder, often linked to trauma or stress. Dissociative disorders encompass various mental health conditions that involve disruptions in:

  • Memory
  • Identity
  • Emotion
  • Perception
  • Behavior

Examples of dissociative disorders, a category of psychiatric disorders, include dissociative identity disorder (formerly known as multiple personality disorder).

To better understand derealization, let’s delve into its definition, its relationship with other dissociative disorders, and how it differs from depersonalization.

Defining Derealization

Derealization creates a sense of disconnection from your environment, where people and things around you feel unreal. This form of dissociation can be triggered by chronic stress, trauma, intense anxiety, psychosis, or a mental health disorder such as dissociative identity disorder.

Symptoms can include distorted perceptions of time, distance, size, and shape of objects, as well as surroundings that seem blurry, colorless, two-dimensional, or even cartoonish.

These experiences are distinct from those of dissociative amnesia, which involves memory loss for personal information.

In moments of derealization, you may feel:

  • Brain fog
  • blurriness
  • feeling of vertigo
  • Warped perception of time
  • Numbness/apathy
  • Anhedonia
  • Sounds and colors are distorted

This experience can last days, weeks, or months. You may feel as if you’re going crazy or can’t distinguish reality. You may feel a lack of motivation, pleasure, loss of interest in activities that used to bring you joy, and a sense of emptiness and meaninglessness.

Relationship with Dissociative Disorders

Derealization, a symptom of dissociative disorders, shares similarities with other mental health conditions that involve disruptions in mental functioning. There’s a strong connection between early traumatic events and dissociative disorders, including derealization.

Therefore, it’s crucial to recognize and address the factors contributing to derealization in order to provide appropriate support and treatment for those affected.

Derealization vs. Depersonalization

Depersonalization and derealization are both types of dissociative symptoms, but they have distinct characteristics.

Depersonalization is a feeling of being detached or disconnected from oneself, as if observing one’s actions, feelings, thoughts, or self from an outside perspective. It’s like a feeling of being an outside observer of your own life.

Derealization, on the other hand, is a sense of unreality or detachment from the world around you. People experiencing derealization may feel like their surroundings are dreamlike or foggy, or that people and objects appear unreal or distorted.

Derealization involves feelings of detachment from one’s surroundings, while depersonalization focuses on detachment from oneself. Both can be triggered by traumatic events, long-term stress, and other mental health issues, leading individuals to feel disconnected from reality.

Common Triggers and Causes of Derealization

A person looking stressed and overwhelmed, representing the triggers and causes of derealization

Triggers for derealization include traumatic events, chronic stress, and co-occurring mental health disorders. Understanding these factors can help identify potential sources of derealization and provide targeted support for those affected.

Let’s examine each of these triggers and causes in more detail.

Traumatic Events

Traumatic events, such as narcissistic abuse, gaslighting, DARVO, or emotional manipulation can result in experiencing derealization. Any threat to one’s life or loved one’s such an accidents, can have a profound impact on an individual’s mental health, leading to conditions like derealization and post traumatic stress disorder.

When faced with a traumatic or stressful event like childhood trauma, the mind may respond by dissociating from the experience, resulting in feelings of disconnection and altered perception, which can contribute to traumatic stress. Recognizing the role of trauma in derealization is essential for providing effective support and treatment.

Chronic Stress

Chronic stress, or prolonged mental and emotional distress, can also contribute to the development of derealization symptoms. Over time, chronic stress can lead to an increase in stress hormones like cortisol, causing changes in the brain that result in derealization symptoms.

When we experience chronic stress, our nervous system can become overwhelmed, leading to various responses, including derealization and dorsal vagal shut down. Derealization is a defense mechanism, connected to fight-or-flight, where we may feel disconnected from reality or like we’re in a fog. When external stressors are beyond our maximum capacity, we shut down and go into freeze mode, leaving us feeling emotionally and mentally immobilized.

For example, during an extremely stressful situation like a high-pressure job or constant family conflict, our nervous system may become overloaded, and we might find ourselves feeling distant or disconnected from our surroundings. These responses are our body’s way of coping with the overwhelming stress, but if they persist chronically, they can significantly impact our daily functioning and develop into a disorder.

Co-Occurring Mental Health Disorders

Derealization may co-occur with other mental health disorders, such as anxiety, complex PTSD, or depression. The presence of multiple mental health conditions can exacerbate the symptoms of derealization, making it even more crucial to identify and address these co-occurring disorders in order to provide comprehensive support for those affected.

Treatment for derealization may include cognitive-behavioral therapy, medication, and lifestyle changes.

Identifying Symptoms of Derealization

A person looking confused and detached, representing the symptoms of derealization

Identifying the symptoms of derealization is an important step in understanding and managing this condition. Common symptoms include:

  • Feelings of disconnection
  • Emotional numbness
  • Altered perceptions
  • Dorsal vagal shutdown

Let’s take a closer look at each of these symptoms:

Feelings of Disconnection

Derealization can cause a sense of disconnection from one’s surroundings and experiences, making it difficult to engage with the world and maintain relationships. This sense of disconnection can have serious consequences, such as:

  • Depression
  • Anxiety
  • Sleep disturbances
  • High blood pressure
  • Isolation
  • Lack of motivation

Emotional Numbness

Emotional numbness is a common experience of derealization, making it difficult for you to connect with your emotions and with others. You may tune out what others are saying and find it difficult to engage in regular social interactions. This lack of emotional connection can impair your ability to enjoy experiences, bond with others, and cope with stress.

Altered Perceptions

Altered perceptions, such as feeling as if the world is unreal, are common in derealization. These distorted perceptions can lead to:

  • confusion
  • irritability
  • difficulty concentrating
  • hallucinations
  • Loneliness
  • Paranoia
  • Lack of purpose and motivation

Dorsal Vagal Shutdown

Dorsal vagal shutdown, also known as the “freeze” response, is a physiological and psychological reaction that occurs in response to extreme stress or trauma. It is a defensive mechanism triggered by the dorsal vagus nerve, a branch of the vagus nerve responsible for regulating the body’s parasympathetic nervous system.

When confronted with a traumatic event or threatening situation perceived as overwhelming or inescapable, the dorsal vagal nerve inhibits the body’s fight-or-flight response, leading to a state of immobility and shutdown.

This response is believed to have evolved as a survival strategy, allowing organisms to conserve energy and avoid further harm when escape or confrontation is not viable. Dorsal vagal shutdown is a crucial aspect of the broader concept of the polyvagal theory, proposed by Dr. Stephen Porges, which explains the different adaptive strategies the autonomic nervous system employs in various stress or social situations.

Dorsal vagal shutdown is a physiological response to stress that can contribute to derealization symptoms. Triggered by danger signals, this protective response can result in:

  • Feelings of sadness
  • Fatigue
  • Hopelessness
  • Shame
  • No motivation or ability to take action
  • Feeling numb and detached
  • Sense of unreality

Diagnosing Derealization: The Process and Criteria

In order to properly address derealization, it is important to accurately diagnose the condition. The process of diagnosing derealization involves:

  1. Taking a thorough medical history
  2. Conducting a physical examination
  3. Meeting the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM).

Let’s explore the steps involved in diagnosing derealization.

Medical History and Physical Examination

A comprehensive medical history and physical examination are necessary to diagnose derealization. These steps help rule out other potential causes of derealization, such as seizures, dementia, and drug abuse, before diagnosing a depersonalization-derealization disorder.

DSM Criteria

The Diagnostic and Statistical Manual of Mental Disorders (DSM) provides specific criteria for diagnosing depersonalization disorder as part of depersonalization/derealization disorder. These criteria include persistent or recurrent experiences of depersonalization, derealization, or both.

You don’t have to meet the full criteria for depersonalization disorder or dissociative identity disorder in order to still struggle with the experience of depersonalization. Depersonalization is a common experience that people can have, unrelated to a diagnosis, and may occur as a response to chronic trauma or grief.

The American Psychiatric Association provides guidelines for mental health professionals to accurately diagnose derealization and develop appropriate treatment plans that are based on evidence based practices that are scientifically proven to reduce symptoms of dissociative disorders.

Treatment Options for Derealization

A person talking to a therapist, representing the treatment options for derealization

Once the derealization is diagnosed, the focus shifts to finding effective treatment options. CBT, somatic psychology, polyvagal exercises, and medication management are common treatment options for treating symptoms related to dissociative disorders and trauma. These treatments address the underlying stressors causing the symptoms, helping you reconnect with yourself and break free from feelings of detachment.

Let’s examine these treatment options in more detail:

Cognitive-Behavioral Therapy

Cognitive-behavioral therapy (CBT) is a form of psychotherapy that focuses on identifying and modifying negative thought patterns and behaviors. CBT can help individuals with depersonalization understand and manage their symptoms by addressing the underlying causes, such as trauma or stress.

Cognitive Behavioral Therapy (CBT) offers effective techniques for treating depersonalization or dissociation, especially when linked to severe trauma or PTSD symptoms. Through CBT, individuals can identify confusion and work towards understanding the impact of traumatic experiences on their relationships.

Therapists may use tools like the Dissociative Experiences Scale to gauge the extent of detachment and address problems functioning. By targeting the roots of trauma and incorporating environmental factors, CBT helps clients regain a sense of reality and alleviate symptoms associated with depersonalization stemming from severe trauma.

Medication Management

In some cases, medications like antidepressants or anti-anxiety medications may be used to treat co-occurring mental health disorders that contribute to dissociative symptoms. Medication management involves monitoring the use of prescribed medications to ensure they are taken correctly and provide the desired results.

Coping Strategies for Depersonalization

A person doing breathing exercises, representing the coping strategies and self-care tips for derealization

If you’re experiencing depersonalization, you may benefit from learning coping strategies for getting grounded, present, and reconnecting with yourself and others.

These include mindfulness and self-compassion techniques, emotion regulation skills, somatic experiencing, stress management, emotion exposure, and polyvagal exercises.

Cognitive Behavioral Therapy (CBT) offers specific techniques proven to be effective in treating derealization and depersonalization. Emotion exposure supports you in confronting and processing distressing emotions related to trauma, facilitating emotional regulation and reducing dissociative experiences.

Somatic experiencing helps you reconnect with bodily sensations, helping you ground in the present moment and address feelings of detachment.

Mindfulness practices, including the “5 senses” exercise, encourage you to engage fully with your surroundings, developing a sense of reality and presence.

Additionally, practicing self-compassion helps you develop a kind and gentle attitude with yourself, reducing self-criticism and enhancing overall well-being.

Let’s explore these helpful strategies to better manage depersonalization:

Mindfulness and Self-Compassion

Using mindfulness and compassion-based approaches can be highly effective in treating dissociative symptoms. Mindfulness practices encourage individuals to develop present awareness, helping them anchor themselves to the reality of their surroundings and bodily sensations.

This can be particularly beneficial for those experiencing dissociation, as it fosters a greater connection with internal experiences in the body and reduces feelings of detachment. This compassionate attitude towards oneself can help soothe the distress associated with dissociation and create a safe space for exploring and processing underlying emotions and trauma.

Grounding Techniques

Grounding techniques can help individuals with depersonalization disorder reconnect with their surroundings and reality. Examples of grounding techniques include:

  • Taking slow breaths and counting
  • Listening to the sounds around you
  • Feeling the ground with your bare feet
  • Wrapping yourself in a blanket and noticing how it feels

Emotion Exposure and Somatic Experiencing

person healing dissociation with emotion exposure and cbtEmotion exposure involves gradually confronting distressing emotions related to past traumas, such as childhood abuse or life-threatening danger, in a safe and supportive environment.

For instance, a person with depersonalization disorder stemming from childhood abuse may work with their therapist to process and express the fear, anger, or sadness tied to those experiences. This process allows individuals to gain a deeper understanding of their emotions and their impact on their current dissociative symptoms, ultimately leading to a reduction in depersonalization episodes and identity confusion.

Somatic experiencing focuses on bodily sensations and helps individuals release stored tension resulting from unprocessed trauma in one’s life. For example, a person who experienced dissociative fugue due to life-threatening danger may engage in somatic experiencing to address the physical manifestations of fear or anxiety still held within their body.

Through guided exercises and heightened body awareness, they can gradually release the stored tension and restore a sense of safety and embodiment. This process enables clients to experience a more profound reconnection with their bodies and a greater sense of groundedness in their life, reducing the frequency and intensity of dissociative episodes.

Stress Management

Managing stress through relaxation techniques and self-care can help reduce dissociation symptoms. Some practices that can contribute to improved well-being and reduced stress levels include:

  • Deep breathing
  • Yoga
  • Meditation
  • Getting enough sleep
  • Eating right
  • Exercising

Polyvagal Theory

Polyvagal Theory sheds light on the autonomic nervous system’s role in regulating responses to stress and social interactions. Understanding that dissociation and detachment are adaptive responses to overwhelming experiences, allows therapists to tailor interventions to address the root causes of these issues.

Vagus nerve exercises, such as deep breathing, singing, and gentle neck stretches, can activate the parasympathetic nervous system, promoting a sense of safety and connection. By incorporating these techniques into therapy, individuals can learn to self-regulate their physiological responses, fostering a greater sense of presence and grounding in their lives, and facilitating healing from dissociative experiences by promoting emotional integration.

Seeking Support

Seeking support from friends, family, or licensed psychologists can be beneficial for those who feel detached. Talking to others about their experiences, joining support groups, or engaging in therapy can help you feel less isolated and more understood.

Also, finding ways to express yourself, such as writing, drawing, or engaging in creative activities, can also provide a helpful outlet for managing dissociative experiences.


In this blog post, we delve into the complexities of derealization and its ties to dissociative disorders, examining the triggers, symptoms, and various treatment approaches. It’s crucial to understand these disorders for effective healing and overcoming the impacts of past traumas.

If you’re experiencing symptoms like feeling detached from your body or having dissociative episodes, often linked to traumatic experiences, addressing unresolved traumatic memories can be beneficial. At The Bay Area CBT Center, home to some of the top-notch therapists in the Bay Area, we’re here to provide the specialized support you need. We offer a range of services, including couples therapy led by skilled marriage therapists in San Francisco.

Our center is equipped to provide CBT group therapy, workshops, and retreats, focused on trauma. We also offer online CE training for clinicians seeking to deepen their understanding in these areas. Whether you prefer in-person or online therapy in San Francisco, our Bay Area therapists, proficient in talk therapy, somatic interventions, and CBT, are ready to assist you.

These comprehensive services are designed to help both individuals and couples work through the challenges of derealization, depersonalization, and other trauma-related issues, guiding you on a path towards healing and improved relationship dynamics.

Frequently Asked Questions

Evidence-based therapy involves interventions that are scientifically proven to be effective for particular issues. In this approach, a strong partnership based on trust and collaboration is formed between you and your therapist. Within this supportive and unbiased environment, you can freely express yourself without fear of judgment. Over a series of sessions, you and your therapist will work together to address obstacles and set goals aimed at personal growth and fulfillment. This method ensures that the techniques and strategies used are not only supportive but also empirically validated to help you achieve your therapeutic goals.

The Bay Area CBT Center provides therapy services for everyone, from children to adults, and welcomes individuals, couples, and groups. We help with various concerns like anxiety, depression, trauma, relationship issues, and behavior challenges. We value diversity and cultural differences, offering personalized and culturally sensitive care to each client.

Studies show that the bond between you and your therapist, known as the therapeutic alliance, is a key factor in treatment success. This alliance is characterized by the strength of your relationship and how well you both agree on treatment goals. Research indicates that individuals with a solid therapeutic alliance experience better treatment outcomes including greater productivity at work, more satisfying relationships, improved stress management, and decreased engagement in risky behaviors.

You can expect a 15-30 minute phone call with our care coordinator, who is extensively trained in ensuring the perfect match for you. During this conversation, our matching expert will collaborate with you to understand your therapy needs, preferences, and scheduling availability. This discussion builds upon the information you provided during sign-up and offers an opportunity for you to address any personal questions or concerns you may have about therapy or our services at The Bay Area CBT Center. Following your conversation, we’ll pair you with the therapist who best aligns with your needs, goals, and preferences.

At your matching appointment, we will match you with a therapist specifically chosen for you and schedule your first session. Depending on your availability, you can expect to meet your therapist anywhere from one day to a week after this appointment.

Our approach to therapy includes a flexible hybrid model, blending both online and face-to-face sessions. This option is perfect for clients situated close to our clinics in the Bay Area who prefer the flexibility of choosing between virtual consultations or meeting their therapist in person. Our aim with hybrid care is to ensure every client is matched with the ideal therapist and therapy environment, be it from the convenience of your own home or in one of our clinics.

At the Bay Area CBT Center, we accept PPO insurance plans that allow you to use out-of-network providers. This means if your insurance plan is a PPO and it includes mental health benefits, you could get back some or all of the money you pay for our services, depending on what your insurance company allows. When you see one of our therapists, they’ll give you a superbill. You can send this superbill to your insurance company to ask for reimbursement. If you’re not sure if your insurance covers services from providers not in their network, it’s a good idea to give them a call and check.

You may be eligible to have 60-80% of your costs covered by out-of-network benefits.

Also, if you have an FSA (Flexible Spending Account), you can usually use it to pay for individual counseling sessions. It’s wise to double-check with your FSA provider or talk to your accountant to make sure that counseling sessions are considered an allowed expense.

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