I love this excerpt: “There is a lot of evidence to suggest that being able and willing to tolerate anxiety, as opposed to eliminating anxiety, actually results in more durable and long-term recovery. In other words, it is your inability to tolerate your unwanted intrusive thoughts that keeps them going. That inability keeps your brain using the old, fear-provoking pathways and prevents new ones from being created”.

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.

Just noticed something that helped me today. I was having the realization a lot of my issues stem from me not taking responsibility for my own life, and also not recognizing my own self-limiting beliefs (SLBs) and automatic negative thoughts (ANTs.) In doing this, I learned that the only way forward is confronting my deepest darkest fears head on and associated irrational/self limiting beliefs- and that for years and years, I have simply retreated and run away. One of my deepest darkest fears (one of my obsessions) is rooted in the understandable fear of the worst of humanity, and the 'what if' I was that (like many of us.) I actually can have compassion for myself because it is perfectly okay to be scared of the worst of people, and if something like that is perpetuated throughout pop culture-media- it would make sense to have associated thoughts about it. The fear is that I am a serial killer or have motives of one. And the OCD has caused me to constantly question my motives and actions to no end (how OCD latches on- makes you look for evidence where there is none.) For the longest time, I have been convinced I am one, and need to hide myself from the world, avoid people more than just because of social anxiety, what my main anxiety was back then. I look for signs everywhere- and the OCD latches on to any perceived (not real) evidence that I am one, that people think I am one. When I decided to confront this fear rather than run away like I have for years, it made me realize it is just a fear- it has nothing to do about who I am as a person, despite how strong the OCD tries to convince you otherwise. It is so sad how strong OCD can be, to make so many of us good intending people be convinced that they are something horrible. Anyway, I hope this can help people realize the best way forward is to confront it head on. It's akin to shining a light on the monster and seeing it for what it is - a goofy thing with fake prosthetics for a movie that isn't a monster after all- a sheep in wolfs clothing. It's just you have been running from it so long, your imagination has gotten so detailed about how horrible it is, hearing its fake growls, instead of turning around and blasting it with a spotlight. This is I guess what ERP is about. For me, one of the struggles with ERP and a specific exposure is that the OCD will jump to a different obsession , which then tells me ERP is a waste because Im not confronting the 'most recent' fear. This is faulty thinking though- because the solution is to confront the fear, not the specific thought. By doing that, you learn to not run away and do all the compulsions in your mind. Tl;dr- long winded post about me realizing how I have actually been avoiding the solutions (ERP) and making up reasons to not confront my fears this whole time. I have been running instead of shining a light on the sheep in wolfs clothing.

This one's a "what if" exposure; a way to trace the anxiety spiral and sit with the discomfort it brings, instead of trying to avoid or fix it. Here’s how it works: Start with your anxious thought: 1. “What if A happens?” Then go deeper: “Okay… if A happens, then what?” → “Then B.” 2. And again: “What if B happens?” → “Then C.” 3. Keep going (following the fear, not avoiding it) until you land on the core fear, the real root of the anxiety. It’s usually something sticky, existential, or deeply uncomfortable. 4. Once you’ve found it, stop. Now sit with it (the feeling). Notice how it shows up in your body. Where is the tension? The tightness? The urge to escape, fix, or seek reassurance? And just let it be there. Without trying to solve it. Just you, your body, and the fear; without resistance. This isn’t about fixing the fear. It’s about making room for it. It’s about learning that you can feel the fear and not let it control you.