Behavioral therapy heavily relies on analyzing behavior to find out how to improve it. I often get asked if I can provide a worksheet for a behavior analysis for dissociation and the answer is No.
Dissociation is not behavior.
It is an involuntary stress response.
Involuntary means that it is not conscious, by our free will, intentional or on purpose.
Dissociation happens when the body experiences a situation as dangerous and inescapable.
Our brain doesn’t ask our prefrontal cortex, the place where we could be conscious and weigh our options, for an evaluation or permission, it stays on the instinctual level of the reptilian brain.
If you treat dissociation like voluntary behavior, you will fail and your interventions will be pointless. Nobody would consider diarrhia from stress to be behavior. Then why do it with dissociation?
That said, it still makes sense to analyze the situations where we dissociate. We just can’t focus on ‘problem behavior’ when we do it. So I will call this a situation analysis. Then we could ask ourselves:
Where and when did I dissociate? Who was present? What was the location/environment like? What happened there? Is it possible that the dissociation was healthy in this situation?
What was the trigger? Was it on the outside (person, item, …) or on the inside (flashback, inner voices, overwhelming emotions, body sensation, …)
Is there any way I could have prepared for this situation? Was it necessary/unpreventable/unexpected or could I have avoided it? What could have increased my sense of safety?
What would it have needed in that situation for dissociation to be unnecessary? (support person, flashback-stop, time to withdraw and regulate, exercises, items, …)
What kind of skills could I have used? (dissociation-stop, orientation&grounding, discrimination, reality check,…)
What prevented me from using skills or exercises? Do I even know any? Do I have access to them? Do I know them well enough to use them when stressed?
How can I prepare myself for these kinds of situations in the future? Which skills do I want to learn or practice?
What is one exercise or skill I could try out right now to calm myself?
There is no reason to feel guilty or ashamed about dissociating. When it happens, we obviously didn’t have enough capacity to deal with the situation differently. And sometimes it is simply impossible to stop dissociation, no matter how much we know, because it happens too fast. Our eyes see a trigger and the brain shuts down before the awareness of the scene even entered our conscious mind. It is important not to beat ourselves up over this.
If you are dealing with actual problem behavior in DID, you can find a systemic behavior analysis here.
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