Techniques for Managing Dissociation
Sensory grounding techniques are the most effective interventions for managing dissociation, helping individuals stay present in the moment and prevent further dissociation. 1
Understanding Dissociation
Dissociation is characterized by temporary episodes of impaired awareness that can range from mild detachment to more severe disconnection from one's surroundings. It's commonly seen in Functional Neurological Disorder (FND) and other trauma-related conditions, and represents a lack of normal integration of thoughts, feelings, and experiences into consciousness and memory.
Effective Techniques for Managing Dissociation
1. Sensory Grounding Techniques
These techniques help keep individuals present in the moment and focus attention to prevent dissociation:
- Visual grounding: Noticing specific details in the environment (colors, textures, shapes)
- Cognitive distractions: Engaging in word games, counting backwards, or solving simple puzzles
- Tactile grounding: Using sensory-based distractors such as:
- Flicking a rubber band on the wrist
- Holding and feeling textured objects
- Using hot/cold sensations (holding ice, feeling warm objects)
2. Breathing and Body Awareness Techniques
- Controlled breathing: Teaching breathing techniques that promote calm and present-moment awareness
- Progressive muscle relaxation: Systematically tensing and releasing muscle groups
- Body scanning: Directing attention to different parts of the body sequentially
3. Creating Safety Plans
Having a predetermined plan for managing dissociative episodes is crucial:
- Ask the person how they wish to be supported during a dissociative episode 1
- Help the person to a safe space where they are unlikely to injure themselves
- Avoid constant reassurance and physical contact or restraint
- Communicate calmly, as people can sometimes hear and understand during dissociative states even if unable to respond
Implementation Considerations
For Healthcare Providers
- Assessment: Identify triggers and warning signs of imminent dissociative episodes
- Education: Explain the physiological process of dissociation, particularly for those who may not recognize anxiety (described as "panic without panic" or "alexithymia") 1
- Practice: Teach techniques during calm states before they're needed during acute episodes
For Individuals Experiencing Dissociation
- Practice grounding techniques regularly, not just during episodes
- Identify personal triggers and early warning signs
- Develop personalized safety plans with healthcare providers
Special Considerations
For Dissociative Seizures
When working with individuals experiencing dissociative (non-epileptic) seizures:
- Advise others to behave as they would if someone is having a panic attack 1
- Avoid physical restraint which may worsen the episode
- Create a calm, safe environment
For Anxiety-Related Dissociation
Since anxiety commonly co-occurs with dissociation:
- Incorporate anxiety management strategies including cardiovascular exercise
- Use thought reframing techniques
- Practice mindfulness and present-moment awareness 1
Effectiveness of Interventions
The most recent evidence suggests that sensory grounding techniques are particularly effective for preventing and managing dissociation. These techniques help interrupt the dissociative process by anchoring attention to present sensory experiences rather than allowing disconnection from reality 1.
When properly implemented, these techniques can help reduce the frequency, duration, and severity of dissociative episodes, ultimately improving quality of life and functional outcomes for affected individuals.