DPDR

i came out of it now i’m back in , what helps?

Hi! I've been on my OCD healing journey for about half a year and I have seen a lot of success. I'm reaching out for advice, I am very willing to do exposures because I know the more I do them, the more I get better, but I struggle with the response prevention part. I don't know how to control my brain when it comes to facing the fears especially since most of my compulsions are mental. I can tell myself the typical things "I am okay with the uncertainty of this happening", etc. but its like my brain doesn't believe them. I've been stuck in this disconnect for a while and would love advice you have heard from a therapist or learned that has really help you.

I recently posted about my experience with Existential OCD (https://app.treatmyocd.com/community/posts/2184668), and one of the most common questions I got was how to deal with DPDR (depersonalization and derealization), as it often goes hand-in-hand with existential obsessions. I wanted to create this post to summarize my thoughts and understanding of DPDR, so I have something to point people towards. For context, I'm not a trained mental health professional, doctor, or neuroscientist. I'm just someone who has been through the gambit with OCD, and has learned about the mind through conversations with several therapists, reading books, and watching videos. I also regularly consult with a few Buddhist teachers, and have been practicing meditation for several years. Please keep all of this in mind, and take everything I say with a grain of salt. First, some quick terminology: Depersonalization = a feeling of "detachment" from your own body, almost as if you're living life as an autonomous robot. Derealization = a feeling of "detachment" from the outside world, where people, places, and things feel distant or alien. They often go hand-in-hand, and mainly differ in terms of what feels "unreal" (yourself, or the outside world). It's easy to see how this can coincide with obsessive existential thoughts. After all, when things feel unreal, how can you help but think about the big questions of existence? So these feelings often make those with OCD extremely uncomfortable, and the desire to make it "go away" inevitably arises. But, just like with anxiety, most attempts to "get rid" of it generally make it worse. Even grounding exercises can become problematic if the goal of those exercises is to get rid of DPDR, just like any other compulsion. That's why my first piece of advice is always to acknowledge and accept the feeling. One way to get comfortable accepting any feeling is to understand where it comes from. As of today, the exact neurobiological workings of DPDR aren't fully understood, but one thing seems to be pretty clear: DPDR is the result of the brain momentarily shifting gears to protect itself from overwhelm. It's something that happens when you are stressed, and/or burnt out. It's the brain protecting itself from overstimulation, similar to a circuit breaker closing down parts of an electrical circuit to prevent overloading. It's important not to take this information as reassurance against the existential intrusive thoughts that arise during DPDR, rather simply as an explanation as to what is happening in the present moment. I'm a big proponent of using "maybe, maybe not" responses to intrusive thoughts. So in the case of DPDR, you may considering responding to the existential thoughts with: "Maybe that's true, maybe it isn't. Right now, this brain is overwhelmed, and it is protecting itself." (Side note: the use of "this brain" instead of "my brain" is a habit I've picked up from Buddhist philosophy. It's a way of practicing non-attachment to the self. If that doesn't work for you then feel free to phrase it in whatever way makes sense. I also recognize the beautiful irony of bringing up non-attachment in a post about DPDR 😂) Basically, you want to acknowledge the existential thoughts, acknowledge the feeling of DPDR, acknowledge that the DPDR is coming from a place of stress, and then refocus your attention to the present moment. The key is to not refocus your attention in hopes to GET RID of the thoughts or feelings, but to do it DESPITE those things. You need to teach yourself first-hand that none of those things are dangerous, and that you can continue to live life while scary thoughts exist in the mind, and while you feel uncomfortable things. The more you try to push the DPDR away, or logically dig yourself out of a hole, the more stressed you will become. And since DPDR is a stress response, this will only cause it to stick around longer. It's the same ironic cycle that fuels the intrusive thought / compulsion loop. Sometimes it can last for a few minutes, a few hours, days, weeks, or even months. While DPDR disorder exists, in many cases (especially with OCD), DPDR tends to persist because of our resistance to it. If you find that it just won't go away, try not to get discouraged. Instead, look for the resistance, and consider how you may be able to open up to the experience in a lighter way. If you find yourself resisting, gently remind yourself: "I don’t need to figure this out right now. I can let the brain do its thing and focus on living life." It can also help to recontextualize the DPDR. I like to think of it like a warm blanket or sweater, or the brain taking a nap. You wouldn't want to wake someone up from a nap, would you? Let 'em rest! I hope there is something helpful here for those struggling with this issue. Trust me, I've been there.