Close this search box.

Understanding Anxiety and Derealization

cbt therapy in san francisco can help with anxiety and derealization
Table of Contents

In the field of mental health, it’s common to see anxiety and derealization closely linked. These two conditions frequently coexist, impacting individuals’ psychological well-being. These conditions can deeply affect an individual’s perception of reality, making the world seem distant or unreal. In this journey, we delve into the enigma of these intertwined phenomena, exploring their interconnections, manifestations, and potential coping strategies related to anxiety and derealization.

Exploring the Link Between Anxiety Disorders and Derealization

Anxiety and derealization

Derealization, where the world appears unreal or dream-like, is a frequent symptom of anxiety disorders. This unsettling sensation often emerges during periods of intense anxiety, a phenomenon frequently associated with psychiatric disorders. Anxiety, particularly panic attacks, can alter and intensify derealization symptoms, especially in individuals with specific conditions such as vestibular disorders.

Evaluating anxiety levels can clarify their contribution to derealization symptoms. Various tools such as the one-minute instant results Anxiety Test, Anxiety Disorder Test, or Hyperstimulation Test can be utilized for this purpose. A higher rating on these tests indicates a higher likelihood of anxiety contributing to symptoms of derealization.

The Anxiety-Derealization Connection

Perception alterations and a sense of detachment from reality, culminating in derealization, can result from severe anxiety disrupting normal brain functioning. Anxiety can lead to the onset of derealization symptoms by generating a sense of distorted reality. This symptom is often associated with intense anxiety, although it can also be attributed to other factors including:

  • trauma
  • substance abuse
  • depression
  • dementia
  • schizophrenia

These factors can cause various psychological symptoms.

Research has shown a significant, positive correlation between anxiety and symptoms of derealization and depersonalization, which are common in dissociative disorders. This connection underscores the deep intertwining of anxiety and derealization, highlighting the need for comprehensive understanding and management strategies.

How Derealization Manifests in Anxiety

Derealization manifests as feelings of detachment and a perception of the outside world as unreal. Individuals with anxiety who experience derealization often report feeling detached from their surroundings and their own emotions, perceiving the world as distorted, especially during periods of extreme stress.

In anxiety disorders, derealization frequently presents as one of the anxiety symptoms, associated with severe stress or trauma. It entails a sensation of detachment from one’s environment and thoughts. The key feature is a profound feeling of disconnection and lack of control amid psychological distress. This experience can be quite unsettling, as it occurs alongside other anxiety symptoms.

The Nervous System

Nervous system and anxiety

Our nervous system, which manages anxiety and derealization, plays a critical role in our own body. It regulates all bodily functions and activities, enabling us to react to stimuli, maintain equilibrium, and perform various other essential tasks. Its critical role during stress involves triggering specific responses to effectively manage the situation, which can be particularly important for individuals with depersonalization disorder.

In response to anxiety and stress, like during a panic attack, the sympathetic nervous system becomes activated, triggering the ‘fight or flight’ response. This results in:

  • The release of stress hormones
  • An increase in heart rate
  • An increase in blood pressure
  • An increase in respiration

These physiological changes ready the body for dealing with or evading stressors.

Fight, Flight, or Freeze

To prepare for action, the body automatically reacts to perceived threats with physiological changes induced by the fight, flight, or freeze response. When this response is triggered, the body undergoes changes such as:

  • Rapid heart rate
  • Reduced perception of pain
  • Rapid breathing
  • Flushed skin
  • Tense muscles

In individuals with anxiety disorders, this fight, flight, or freeze response manifests as an intensified or prolonged activation of the body’s stress response system. It leads to heightened sensations of fear, panic, and a strong inclination to evade or avoid the perceived threat. A freeze response may also occur, rendering individuals immobilized or unable to take action.

Dorsal Vagal Shutdown

In response to severe stress, the body may undergo what’s known as a dorsal vagal shutdown. This is a physiological response in which the dorsal branch of the vagus nerve causes the body to freeze or become immobilized, a reaction commonly observed in anxiety and derealization situations.

The dorsal vagal shutdown can contribute to derealization symptoms by inducing:

  • a sense of disconnection from reality or other people
  • low energy or fatigue
  • slow heart rate or breathing
  • a feeling of numbness or dissociation

This shutdown may lead individuals to experience a sense of detachment and a lack of presence in the present moment.

The Phenomenon of Depersonalization in the Context of Anxiety

Depersonalization and anxiety

Depersonalization, closely linked to anxiety and derealization, is another prevalent phenomenon. It’s characterized by the sensation of being detached from one’s body and feeling a lack of control over one’s actions. This feeling of detachment can cause physical sensations like numbness or tingling.

Various factors contribute to depersonalization symptoms in individuals with anxiety, including:

  • Stress
  • Trauma
  • Severe mental illness
  • Drug use

The enduring and recurring episodes of depersonalization or derealization can lead to challenges, causing distressing episodes that disrupt various aspects of the individual’s life, including work, school, and other significant areas.

Symptoms of Depersonalization Related to Anxiety

Depersonalization is a common anxiety symptom and is the experience of feeling disconnected from oneself and one’s body. Typical symptoms of depersonalization associated with anxiety include:

  • Experiencing a sense of detachment from reality
  • Feeling as if in a dream-like state
  • Having an out-of-body sensation
  • Feeling emotionally disconnected from people and surroundings
  • Feeling as if not part of reality

Depersonalization in individuals with an anxiety disorder can present as:

  • Emotional disconnection from loved ones
  • Feeling mentally detached or foggy
  • Perceiving their environment as distorted or unreal
  • Disconnect from their own thoughts, emotions, and physical sensations

Identifying the Triggers: What Causes Derealization and Anxiety?

Identifying derealization and anxiety triggers is a vital step towards managing these conditions. The triggers encompass a wide range of factors, including:

  • High levels of stress
  • Fear
  • Severe trauma or abuse during childhood or adulthood
  • Witnessing domestic violence
  • Psychological triggers such as severe emotional stress, trauma, and abuse

These triggers play a significant role in the development of derealization and anxiety.

Severe mental illnesses, including conditions like:

  • depression
  • anxiety
  • severe trauma
  • abuse or prolonged emotional distress

These conditions are recognized by the American Psychiatric Association as serious mental health issues that require proper care and treatment.

can disrupt the perception of reality and contribute to feelings of detachment and anxiety. Understanding these triggers is a crucial step in managing and dealing with derealization and anxiety.

Environmental and Psychological Triggers

The onset of derealization and anxiety can be significantly impacted by both environmental and psychological factors. Some prevalent environmental factors include:

  • High levels of stress
  • Severe anxiety
  • Lack of sleep
  • Environments that overstimulate
  • Acute stress or trauma
  • The use of certain illicit drugs

Psychological triggers such as:

  • high levels of stress and fear
  • childhood trauma
  • physical and emotional abuse
  • domestic violence
  • accidents
  • prolonged periods of stress and anxiety
  • significant life changes such as moving to a new city or country

can all lead to derealization and anxiety. Trauma can disrupt an individual’s sense of reality and cause feelings of detachment from oneself and the environment.

The Role of Severe Mental Illness

The onset of derealization and anxiety often has significant roots in severe mental illnesses. Conditions like:

  • depression
  • anxiety
  • severe trauma
  • abuse

can disrupt the perception of reality and contribute to feelings of detachment and anxiety.

Both depression and schizophrenia have direct ties to derealization. Severe anxiety and depression can trigger episodes of derealization, and individuals experiencing depression may interpret their surroundings as unreal, leading to distressing symptoms of anxiety and depression. Individuals with schizophrenia and bipolar disorder may also exhibit depersonalization and derealization symptoms.

Navigating Through the Fog: Coping with Derealization and Anxiety

Coping with derealization and anxiety

A combination of grounding techniques and deep breathing exercises often aids in managing derealization and anxiety. These methods can help individuals navigate the fog of these conditions, promoting a sense of stability and connection to reality. Grounding techniques are significant for individuals with derealization and anxiety as they assist in redirecting focus from anxious thoughts and feelings to physical sensations and experiences, thereby anchoring individuals in the present moment.

Deep breathing exercises that can promote relaxation, reduce anxiety, and alleviate symptoms of derealization include:

  • Lengthening your exhale
  • Abdominal breathing
  • Diaphragmatic breathing
  • Box breathing

Progressive muscle relaxation also plays a crucial role in managing derealization and anxiety by alleviating tension and stress in the body.

Grounding Techniques to Anchor Reality

To address derealization and anxiety, grounding techniques serve as crucial coping strategies. They help individuals effectively handle their symptoms and establish a connection with reality. Techniques include:

  • Practicing breathing techniques
  • Stretching
  • Exercise
  • Focusing on your senses
  • Holding objects
  • Asking yourself questions
  • Repeating positive statements
  • Grounding your feet in natural surfaces like grass or dirt

Grounding techniques play a crucial role in managing symptoms of derealization by redirecting attention towards the present moment, thereby helping to reduce feelings of detachment and the sense of unreality that often accompany derealization. They aid in reestablishing a connection with reality by directing their focus to the present moment and their surroundings.

Deep Breathing Exercises to Calm the Nervous System

To calm the nervous system and mitigate the likelihood of experiencing a dream-like state like derealization, deep breathing exercises play an integral role. Recommended exercises for anxiety and derealization include:

  • Lengthening the exhale
  • Practicing belly breathing or diaphragmatic breathing
  • Using alternate nostril breathing
  • The 4-7-8 breathing technique

Deep breathing has the physiological effect of increasing the activity of the vagus nerve, which signals the body to relax and activates the relaxation response. Additionally, it reduces emotional responses in the amygdala, promoting calmness and a decrease in anxiety levels.

To achieve the best results in managing anxiety and derealization symptoms, deep breathing exercises can be practiced daily for up to 20 minutes.

Treatment Options for Anxiety and Derealization

Treatment options for anxiety and derealization

Seeking professional help becomes crucial when symptoms of derealization and anxiety become overwhelming. Various treatment options are available, including psychotherapy and medication. In treating anxiety and derealization, psychotherapy, particularly cognitive behavioral therapy (CBT), plays a crucial role. It focuses on addressing the underlying causes, teaching coping skills, and promoting groundedness to help patients effectively manage their symptoms.

For panic disorder, which is commonly associated with anxiety and derealization, medications also present a viable treatment option. They can be utilized independently or in combination with psychotherapy. A qualified mental health professional, such as a therapist or psychiatrist, can provide assistance with panic disorder and derealization, offering essential treatments like psychotherapy and medications tailored to an individual’s specific requirements.

The Role of Psychotherapy

In managing anxiety and derealization, psychotherapy, particularly cognitive behavioral therapy (CBT), can be effective. It aids individuals understanding and managing symptoms by addressing root causes and offering coping strategies.

Scientific evidence validates the efficacy of psychotherapy, particularly CBT, in addressing anxiety and derealization. Studies have demonstrated that CBT can effectively lessen symptom severity and enhance the overall well-being of individuals with depersonalization-derealization disorder. Additionally, somatic psychotherapy and hypnosis-based treatment have displayed potential in addressing these conditions.

Medication and Other Therapeutic Interventions

In managing anxiety and derealization, medication plays a key role. Typical medications prescribed for anxiety disorders include:

  • Selective serotonin reuptake inhibitors (SSRIs) such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac)
  • Antidepressants like duloxetine (Cymbalta), venlafaxine (Effexor), sertraline (Zoloft)
  • Benzodiazepines including alprazolam (Xanax) and diazepam (Valium)

For managing symptoms of derealization, frequently prescribed medications include:

  • SSRIs
  • Anti-anxiety medications
  • Mood-stabilizing medications
  • Antipsychotic medications

Some of these medications, such as SSRIs and anti-anxiety medications, are also used in the treatment of anxiety disorders.

Understanding Diagnostic Criteria: DSM-5 and Depersonalization-Derealization Disorder

For diagnosing mental health conditions, including depersonalization-derealization disorder, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) provides a comprehensive set of criteria. It serves as a crucial reference tool for the diagnosis of mental disorders.

The DSM-5 criteria for depersonalization-derealization disorder include:

  • Persistent or recurrent experiences of depersonalization, derealization, or both
  • The severity of the disorder is determined by the persistence or recurrence of these experiences
  • Diagnosis is typically made when these experiences result in substantial distress or impairment in daily activities.


Understanding the complex relationship between anxiety and derealization is crucial, as they intertwine to affect one’s perception of reality. Coping strategies like grounding techniques and deep breathing can provide relief, yet it’s essential to seek professional help when necessary. A combination of self-help methods and professional guidance can empower individuals to navigate through these challenges. By comprehending these conditions and their triggers, and applying effective coping strategies, individuals can move towards a clearer, healthier state of mental well-being.

We specialize in addressing the intricate link between anxiety and derealization as part of our comprehensive San Francisco therapy services. Our therapists in San Francisco are experienced in providing effective anxiety treatment, focusing on helping individuals understand and manage the symptoms of both anxiety and derealization.

In addition to traditional in-person therapy, we also offer virtual therapy in California, making our services accessible to a wider audience. Our approach combines cognitive, somatic, and behavioral strategies to provide a holistic treatment plan tailored to each individual’s needs.

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.

You May Also Like


Services we Offer

Helping You Align Mind, Body, and Actions.

cbt therapists cbt therapy SF bay area california

Service 2

Individual Therapy

cbt online therapy and online counseling in SF bay area california

Service 2

Online Therapy

couple doing couples therapy and couples counseling in sf bay area california

Service 2

Couples Therapy

people doing CBT group therapy and workshops in san francisco california

Service 2

Groups & Workshops

coworkers doing CBT executive coaching in SF bay area california

Service 2

Executive Coaching

a man getting treatment with a counselor in san francisco ca

Service 2

Conditions We Treat

Check Out Our Books

Acceptance and Commitment Therapy in the Bay Area. You could say we wrote the books on it.

Our Groups & Workshops

Check Out Our CBT Quizzes

cbt therapy treatment services therapy

Procrastination Quiz

grief and loss

Relationship Schemas Quiz

Self-Compassion Quiz

workplace schemas questionnaire

Workplace Schemas Quiz

relationship satisfaction

Relationship Satisfaction Quiz

person struggling with a trauma bond

Complex Trauma Quiz