The 4 Best Depersonalization Therapies! (I’m 100% Cured)

Hi, my name is Ben. I had depersonalization/derealization disorder for 5 months before I got out. Today I’m living a happy and normal life and strongly believe that therapy played a crucial role in speeding up my recovery. Let me share with you what I’ve learned about therapy and depersonalization.

Here are the 4 best depersonalization therapies backed by scientific research and or my own experience:

Psychodynamic therapy
Cognitive-behavioural therapy
Acceptance and commitment therapy
Integrative manual therapy

Are you interested in hearing about the most impactful questions I encountered during DDD therapy, and want to learn more about the Four (4) types of therapies that helped me or have been mentioned to have helped others with DDD in scientific publications, then keep on reading.

How did Therapy Effect my Depersonalization Derealization?

During my time with DDD, I was asked two essential questions that had a huge positive effect on me. These questions are typical cognitive-behavioural-therapy questions, but in my case, they were asked during integrative manual therapy (IMT) sessions, which was the therapy that helped me the most. Here are the two questions:

If you feel deep inside yourself and ask how long depersonalization will last, what would you say?
Describe the feelings you associate with depersonalization?

1. If you feel deep inside yourself and ask how long depersonalization will last what would you say?

While answering this question, I had the urge to scream out NEVER, due to the hopelessness and frustration that had built up in me, but the therapist encouraged me to listen to my inner self and try to feel how long I thought it would last. I took a deep breath and said 7 months. And I didn’t make this number up, it was something inside me that said this is how long it would take.

This question did two things: It gave me an end date, even though it was far into the future, it gave me hope, and not just some “fake hope” but sincere hope since I truly believed this number to be true coming from inside me. Second, my answer to this question was remarkably accurate, which retrospectively is quite amazing. Even though I already got out of DDD about two months later, it took another couple of months to adjust back to reality, thus my remaining recovery period took close to 7 months.

2. Describe the feelings you associate with depersonalization?

The day I was asked this question I came back into reality and out of DDD. I paused for a while after being asked which feelings I associated with derealization and then said shame. Shame for having a mental disorder. Ashamed of being classified as crazy in the eyes of “normal” people. After my answer, the therapist asked me to draw a mental picture of what this feeling looked like or whatever came to my mind. I described it to her. The picture included people in my life. Then she asked me to look at these people and tell them that I must keep on going down this path, and it’s OK to do so.

Now nothing happened immediately after this but about two hours later while walking home I had a feeling in my head, about half a finger length beneath my forehead (in the prefrontal cortex). I had this feeling four times before and it always was a feeling of breaking through to the other side, reaching through to reality, of getting rid of DDD, but it never got me all the way back to normality.

This time though it did!

It wasn’t the crazy relief you may think it was though, since I was still uncertain if it would last and I still felt very weird. Why did I still feel wired, well think about it this way, if you are in a completely dark room for a long period of time and then step out into the sun your eyes would be distressed at first and would need some time to adjust. With DDD it’s similar.

In addition to these two questions, psychodynamic- as well as IMT-therapist addressed my past and with it the death of my sister. Working through this topic had a great impact on my recovery as well.

The 4 Best Therapies For Depersonalization / Derealization Disorder

The 4 therapies I recommend for depersonalization are integrative manual therapy, psychodynamic therapy, cognitive-behavioural therapy, and acceptance and commitment therapy.

I’ve included acceptance and commitment therapy (ACT) for two reasons 1. So many people who have gotten out of DPDR, including myself, state that acceptance played a significant role in the healing process and 2. One of the best books I’ve read on DDD “Overcoming Depersonalization Disorder: A Mindfulness and Acceptance Guide to Conquering Feelings of Numbness and Unreality” by Fugen Neziroglu, PhD and Katharine Donnelly, MA, has amazing insights and tips concerning depersonalization and ACT. The following illustration gives you an overview of the types of therapy discussed in this article.

Psychotherapy approaches for depersonalization/derealization disorder

Before we dive into the different approaches of psychotherapy, let’s clarify what is psychotherapy actually?

“The treatment of the mental or emotional disorder and adjustment problems through the use of psychological techniques rather than through physical or biological means.”

The Gale Encyclopaedia of Psychology 2^nd edition

The following descriptions of the different psychotherapy approaches are designed so that you get an idea of which ones might help you. I will only describe the approaches that helped me during my DPDR battle or the ones I found being mentioned in publications in combination with DPDR.

Following are the best types of psychotherapy for depersonalization (in my opinion):

Psychodynamic therapy (focuses on unconscious behaviours, and the past)
Cognitive-behavioural therapy (focuses on the here and now)
Acceptance therapy (focus on learning how to continue living a life of meaning and purpose)

Effect of Psychodynamic therapy on Depersonalization

Several people have emailed me stating they don’t know why they have DDD. If you are one of these people, psychodynamic therapy may be your solution, since it is designed to uncover past events or relationships that are unconsciously causing you distress.

What is psychodynamic therapy? Psychodynamic therapy uses a method called psychoanalysis. Hereby the therapist uses a set of questions with the objective of helping you examine your relationships, deep feelings and past events, which may reveal unconscious motivations and behaviours. Some of these motivations and behaviours could be a defence mechanism, unconsciously designed to decrease or avoid fear and anxiety. In the short term this will always lead to relief, but in the long term you will never be 100% free of anxiety and thus potentially of DDD because you don’t address the underlying problems. These defence mechanisms can be; denial, isolation, projection, repression, suppression, reaction formation, displacement, fixation, regression, introjection, identification, sublimation, rationalization, compensation, and humour.

How can psychodynamic therapy help with depersonalization? Psychodynamic therapy helps gain insights into unknown parts of one’s self. By doing so unconscious harmful motivations and behaviours can be explored and transformed with the goal of achieving symptom remission.

In the publication “The Efficacy of Psychodynamic Psychotherapy“ Dr. Joanathan Shelder outlines the processes and techniques that are characteristic for psychodynamic therapy as follows:

Focus on the expression of emotion and affect
Focus on avoidance attempts of unpleasant thoughts and feelings
Identification of patterns and recurring themes
Past experiences are discussed (developmental focus)
Exploration and discussion of interpersonal relations
Exploration of the therapy relationship
Exploration of desires, fears, daydreams, dreams and fantasies

When I was six years old my sister died, leaving a huge void inside of me. One example of how therapist helped me work through this, is by asking me to remember the six-year-old me, then to talk to the younger me, and to tell him that what happened is not his fault.

Children often blame themselves for the things happening around them. Why is mom so upset? Why is dad so mad? It must be my fault.

Growing older we forget these things happened or lock them away intentionally. Consciously these traumata don’t seem to be an issue anymore, but unconsciously they can be stressing your mental health immensely.

Effect of Cognitive therapy on Depersonalization

As mentioned earlier, during my DDD, I was asked two questions by the therapist that helped me enormously with my recovery. Both questions were characteristic for cognitive therapy, which is why I find this type of therapy so interesting for DDD. Also, cognitive therapy or cognitive-behaviour therapy (CBT) is mentioned in a vast amount of research about depersonalization. Thus, I strongly believe it to have a huge potential for DDD.

What is Cognitive-Behavioural Therapy? The core difference between psychodynamic therapy and CBT is that CBT doesn’t focus on uncovering unconscious motivations or behaviours, but rather views the problems as learned behaviours, which can be adjusted. CBT focuses mainly on the present and how to change things in the ‘here and now’.

How can Cognitive-Behavioural Therapy help with depersonalization? Anthony S. David published a great book on DDD (Overcoming depersonalization and feelings of unreality: a self-help guide) in which he describes the main steps of CBT as follows:

Identify your main problems and understand how they’re influencing your life (Obviously it’s depersonalization, but you will work together with the therapist to find possible causes. For example, anxiety, fear or shame)
Identify what you are doing or maybe not doing that causes these problems to stick around. These causes could be of the following nature:
- Cognitive: unhelpful thinking patterns, beliefs, meanings, attention, images and memory
- Emotional: negative emotional states or your moods
- Behavioural: unhelpful behaviours like avoiding situations or taking drugs
- Physical: body related feeling such as tiredness or pain, or concentrating on visual disturbances
- Environmental: relationships, work, everyday situations, home
Define changes that will eliminate these causes
Pursue these changes using techniques learned during therapy

To give you a better understanding of how CBT works I want to give you an example using the “five System model”, which was developed by Dr. Greenberger and Dr. Padesky, two experts in the field of CBT. The “five System model” displays the interconnections between cognition, emotion, behaviour, physiology and environment as seen below:

Let’s use this model to examine a normal day with DDD, during which you are feeling anxious, shameful and hopeless. These feelings could trigger thoughts such as “my life is over”, which in return enhances these feelings. Also, your behaviour will be affected. Most likely you will want to stay at home and say ‘fuck you’ to social activities. I mean what’s the point, right? You feel miserable so why go out? At least this was my attitude in the beginning. All these negative feeling and overthinking can cause your body to react, your heart rate to increase and possibly welcome a panic attack.

Now I’m sure, if you have DDD you can relate to what I’m talking about. The important message I want to get across in this example is that you won’t get out of DDD living with these thought patterns and behaviours. Your body and mind never relax, your anxiety levels will stay high, your DDD will keep on thinking it has to protect you from the world around you until you decrease your negative feelings. The cognitive-behaviour therapist will help you understand the cognitive, emotional, physical and behavioural connections that arise in a variety of everyday life situations so that you notice when your thoughts are getting out of hand and are creating negative feelings, or when your behaviours are holding you back from leading a meaningful life.

Yes, this is so hard to do, I know, and the worst part is you must keep on trying for months. Months in which nothing seems to be changing. But you will get out, just because you feel numb and can’t feel anything doesn’t mean you can’t live a meaningful life! Keep living a meaningful life and before you know it, a year went past, and suddenly you notice you don’t have DDD anymore.

For more information on CBT and DDD, you can have a look at the amazing work of Dr. Daphne Simeon “Feeling unreal: Depersonalization Disorder and the Loss of Self”.

Effect of Acceptance and Commitment Therapy on Depersonalization

As mentioned above, loads of DDD recoveries, including myself, state the importance of acceptance during their path back to reality. I will explain the basics of acceptance and commitment therapy (ACT) using the book ”Overcoming Depersonalization Disorder: A Mindfulness and Acceptance Guide to Conquering Feelings of Numbness and Unreality” written by Dr. Fugen Neziroglu as my main source of information.

What is Acceptance and Commitment Therapy? ACT is a form of psychotherapy that originates from cognitive-behavioural therapy (CBT) and traditional behavioural therapy (psychologytoday.com/us/therapy-types/). ACT follows the belief that people tend to live unhappy lives because they let their negative emotions rule their behaviour, ‘I don’t feel like it, so I won’t do it’. ACT addresses exactly these feelings and teaches the patient how to keep on going with their lives using ACT principles. The core difference between ACT and CBT is that ACT focuses on accepting negative thoughts and emotions and CBT aims to change the patient’s thought patterns and thus their emotions.

This is so critical, since your body and mind need so much time to recover, and you need to live a 100% physically and mentally healthy life to get better. Staying alone at home, locked in a room, with nothing to do but research your condition will cause your physical and mental health to deteriorate even further, pushing your DDD recovery further and further into the future.

How can Acceptance and Commitment Therapy help with depersonalization? Having gone through DDD I know how important acceptance is. Nevertheless, I also know how unhelpful this sounds to someone with DDD. Therefore, I want to ask you to let me give you some examples from Dr. Fugen Neziroglu’s book “Overcoming Depersonalization Disorder” in which she described how ACT can help you live with DDD. Yes, I know you don’t want to live with DDD, but this is the path you should try going because DDD generally doesn’t vanish quickly. The following dysfunctionalities could be part of the reasons that your DDD is not vanishing. ACT helps you recognise and work through the following six dysfunctional processes:

Cognitive fusion
Differentiating between who “you” are and who you believe you are
Worry and rumination
Experiential avoidance
Not having a clear set of self-defined values
Narrow behavioural repertoire

Cognitive fusion: Our mind wants us to believe everything it presents us. This is an immensely important mechanism considering it warns us of dangerous situations. It would be quite insufficient to start questioning its authority of assessing life-threatening situations, during a life-threating-situation, as I’m sure you would agree. This relationship of blindly trusting our minds is cognitive fusion. However, this can turn into a trap when your mind evaluates emotional problems. In ACT you will learn how not to give in to the belief that everything your mind is communicating is set in stone.

Having DDD your mind will constantly set off alarm bells, telling you something is terribly wrong, you will believe it because of cognitive fusion. You will start searching for the danger. What is happening? You must be dead sick, have a tumour or something worse. What can it be? Your mind will drive you insane with worry. But the reality is you don’t have anything life-threatening. You don’t have to ruminate. In contrast, you should try to calm your mind down, not worry and keep on going with your life.

You are still you, and not your beliefs about you: ‘You’ are still ‘you’. Don’t define yourself according to your feelings: “I am anxious”, thoughts: “I am depressed”, labels: “I am unreal”, evaluations “I am not socially compatible”. These sentiments have one commonality, they all include “I am”. Thus, how easy is it to believe that those sentiments are who you are, right? But they change so fast how can they be you? Aren’t you something more constant, more stable, beneath all this fluctuating cognitive activity?

I remember lying in bed, depressed, thinking about the old me. It was so hard to get up and go outside. The new depersonalized me, had no quality of life I believed. I still got up, I did go outside, I kept on going because this state these thoughts and labels weren’t me. I did not let these states of mind decide what I did with my life. My mood did not dictate my life. It is so important to know you are still there, your quality of life is still there, don’t give up.

Rumination and worry: You have depersonalization, nothing is “seriously” wrong with you. You can keep on living your life. Acceptance is key. STOP worrying and ruminating about your depersonalization. This topic is so clear to everyone with DDD I know I don’t have to go into detail.

Experiential avoidance: Experiential avoidance is when you avoid doing something because you fear it will bring you discomfort. Avoiding speaking in front of a crowd is the classic example.

Depersonalization often leads to a life full of experiential avoidance and could thus be a source of its perpetuation. One could even say depersonalization itself is a form of experiential avoidance, which was triggered in response to extreme feelings and thus avoiding them and feeling numb instead. In ACT a range of techniques will be taught, which focus on improving your willingness to work through unpleasant situations. In consequence, you will be equipped with tools to battle depersonalization caused experiential avoidance.

I felt completely numb during my time with DDD and often contemplated the worth of my life. Was it worth it to do anything? Was it worth it to face my discomfort, be social and meet people? Looking back and having some perspective, I can say, yes, absolutely! During this time, I had one of the most meaningful relationships in my life. And I’d like to emphasize the word meaningful. Even though I felt numb inside, and while having sex I felt so little emotions do to my depersonalization, this relationship still had immense meaning for me.

In retrospect, this is fascinating to me, because the numbness almost made me blind to the value of living a meaningful life.

DDD cannot take away your freedom of living a meaningful life unless you let it.

Not having a clear set of self-defined values: What do values have to do with your DDD recovery? From my own experience, I know how easy it is to think that your life has lost meaning. Values are pillars during these dark times, guiding and encouraging you to live your life. They give you meaning, pull you through, make you get up and socialize, go running, go to work even though your DDD is telling you to give up. If you have values you do these things because they are who you are, beneath this dreadful state of depersonalisation. In ACT your therapist will talk about things that are important to you, about things you value and how they give your life meaning and will guide you through your DDD.

One huge benefit I got out of my DDD, was that it sparked my interest in personal development, which included defining my own values such as; health, courage, love, growth, sustainability and contribution.

Narrow behavioural repertoire: Having a narrow behavioural repertoire means not executing on the things that are important to you. In other words, not letting your values guide you. With DDD every action you take has some discomfort to it, and thus it seems desirable to avoid action. In ACT the therapist will have you define your values, pursue behaviours inline with these, and do so with acceptance and willingness towards arising feelings of discomfort. This will strengthen the desperately needed stamina for your DDD recovery.

Effect of Integrative Manual Therapy on Depersonalization

I’m an engineer, I love logic, facts and things I understand. In consequence integrative manual therapy (IMT) isn’t my favourite topic to explain, since it’s ‘energy-work’ and has an esoteric feel to it. But I do trust my experiences, and through my parents, I’ve had contact with alternative medicine and bodywork all my life. And I can say, as a fact, some people can feel into your body and resolve your problems with merely a touch of their hands. Let me give you an example: More than once have I been e.g. in an IMT treatment and not said where I was having pain and the therapist went right to the body part that was bothering me and said something like “I feel an inflammation in your knee” and I was left thinking to myself “how the hell did they know/feel this? Nevertheless, be aware, as in every profession there are good and bad therapists. Don’t blindly trust the first one you encounter.

What Is Integrative Manual Therapy? IMT follows the belief that the body can heal itself but does not always know when or where to start on its own. The treatment compromises a special set of approaches, techniques, and methodologies designed to treat dysfunction, pain, disease and disability. The integrative manual therapy association describes IMT as a health care process, which observes and treats the body at the cellular level.

How can Integrative Manual Therapy help with depersonalization? IMT therapist use their hands to treat the patient. They place their hands on the patient’s body, in consequence creating a mechano-energetic-interface which will encourage the healing process. One could say IMT functions as a trigger that activates the healing process. The approach taken is integrative and encompasses several systems of the body. Depending on the root cause of the patient problems the treatment will focus on physiological, anatomical, psychological and nutritional approaches. With respect do DDD, IMT can help the body to detox and or resolve psychological discomforts that may be causing DDD.

My advice to you, if you believe your DPDR has a psychological cause

Find a therapist that meets your needs. In case you still are uncertain which therapy is suitable for you, I recommend checking out this article I wrote on how to find a therapist for depersonalization. In this article, in addition to a brief description of the different therapy methods, I describe how to self-analysis your DDD so that you can choose the most suitable therapist for you.