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Staying Present: Incorporating Mindfulness into Therapy for Dissociation

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Abstract

Dissociation involves retreating from the experience of the present moment through various processes, while mindfulness cultivates the ability to stay in the present moment. We argue that mindfulness is thus uniquely well suited for treatment of dissociation. This paper delineates the theoretical relationship between mindfulness and dissociation, discussing how incorporating mindfulness into psychotherapy can improve outcomes for dissociative clients. Mindfulness can provide clients with specific techniques for enhancing prediction of and control over dissociation through building awareness of dissociative processes and offering a tool for staying in the present moment. Mindfulness reduces reliance on avoidance, which in turn diminishes the need for dissociation. In addition, taking the position of the observer, which is a key feature of mindfulness, is itself a capability associated with dissociation. We discuss the application of mindfulness to three types of dissociative processes: detachment (e.g., depersonalization, derealization), absorption (e.g., daydreaming, “blanking out”), and compartmentalization (e.g., amnesia, conversion symptoms). Three mechanisms underlying the effectiveness of integrating mindfulness into treatment of dissociation are proposed: (1) the techniques of mindfulness (e.g., observing, staying present), (2) the metacognitions of mindfulness (e.g., acceptance, nonjudgment), and (3) the emergent processes of mindfulness (e.g., reperceiving, dialectical thinking). Challenges to implementation of mindfulness with dissociative clients are also explored. Information and recommendations are provided to guide applications to intervention.

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References

  • Allen, J. G., Console, D. A., & Lewis, L. (1999). Dissociative detachment & memory impairment: reversible amnesia or encoding failure? Comprehensive Psychiatry, 40, 160–171.

    Article  PubMed  Google Scholar 

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, fifth edition. Arlington, VA: Author.

  • Arch, J. J., & Craske, M. G. (2006). Mechanisms of mindfulness: emotion regulation following a focused breathing induction. Behaviour Research and Therapy, 44(12), 1849–1858.

    Article  PubMed  Google Scholar 

  • Bach, P., & Hayes, S. C. (2002). The use of acceptance and commitment therapy to prevent the rehospitalization of psychotic patients: a randomized controlled trial. Journal of Consulting and Clinical Psychology, 70, 1129–1139.

    Article  PubMed  Google Scholar 

  • Baer, R. A., Smith, G. T., & Allen, K. B. (2004). Assessment of mindfulness by self-report: the Kentucky Inventory of Mindfulness Skills. Assessment, 11, 191–206.

    Article  PubMed  Google Scholar 

  • Baer, R. A., Smith, G. T., Hopkins, J., Krietemeyer, J., & Toney, L. (2006). Using self-report assessment methods to explore facets of mindfulness. Assessment, 13, 27–45.

    Article  PubMed  Google Scholar 

  • Baslet, G., & Hill, J. (2011). Case report: brief mindfulness-based psychotherapeutic intervention during inpatient hospitalization in a patient with conversion and dissociation. Clinical Case Studies, 10(2), 95–109.

    Article  Google Scholar 

  • Bishop, S. R., Lau, M., Shapiro, S., Carlson, L., Anderson, N. D., Carmody, J., et al. (2004). Mindfulness: a proposed operational definition. Clinical Psychology: Science & Practice, 11, 230–241.

    Google Scholar 

  • Block-Lerner, J., Adair, C., Plumb, J. C., Rhatigan, D. L., & Orsillo, S. M. (2007). The case for mindfulness-based approaches in the cultivation of empathy: does nonjudgemental, present-moment awareness increase capacity for perspective-taking and empathetic concern? Journal of Marital and Family Therapy, 33, 505–516.

    Article  Google Scholar 

  • Boon, S., Steele, K., & van der Hart, O. (2011). Coping with trauma-related dissociation: skills training for patients and therapists. New York: Norton.

    Google Scholar 

  • Braude, S. F. (2009). The conceptual unity of dissociation: a philosophical argument. In P. F. Dell & J. A. O’Neil (Eds.), Dissociation and the dissociative disorders: DSM-V and beyond (pp. 27–36). New York: Routledge.

    Google Scholar 

  • Brown, K. W., & Ryan, R. M. (2003). The benefits of being present: mindfulness and its role in psychological well-being. Journal of Personality and Social Psychology, 84(4), 822–848.

    Article  PubMed  Google Scholar 

  • Brown, K. W., Ryan, R. M., & Creswell, J. D. (2007). Mindfulness: theoretical foundations and evidence for its salutary effects. Psychological Inquiry, 18(4), 211–237.

    Article  Google Scholar 

  • Chambers, R., Gullone, E., & Allen, N. B. (2009). Mindful emotion regulation: an integrative review. Clinical Psychology Review, 29, 560–572.

    Article  PubMed  Google Scholar 

  • Chiesa, A., & Serretti, A. (2011a). Mindfulness based cognitive therapy for psychiatric disorders: a systematic review and metaanalysis. Psychiatry Research, 187, 441–453.

    Article  PubMed  Google Scholar 

  • Chiesa, A., & Serretti, A. (2011b). Mindfulness-based interventions for chronic pain: a systematic review of the evidence. Journal of Alternative and Complementary Medicine, 17, 83–93.

    Article  Google Scholar 

  • Cloitre, M., Courtois, C. A., Charuvastra, A., Carapezza, R., Stolbach, B. C., & Green, B. L. (2011). Treatment of complex PTSD: results of the ISTSS expert clinician survey on best practices. Journal of Traumatic Stress, 24, 615–627.

    Article  PubMed  Google Scholar 

  • Coffey, K. A., Hartman, M., & Fredrickson, B. L. (2010). Deconstructing mindfulness and constructing mental health: understanding mindfulness and its mechanisms of action. Mindfulness, 1(4), 235–253.

    Article  Google Scholar 

  • Corrigan, F. M. (2002). Mindfulness, dissociation, EMDR and the anterior cingulate cortex: a hypothesis. Contemporary Hypnosis, 19, 8–17.

    Article  Google Scholar 

  • Dell, P. F. (2009). Understanding dissociation. In P. F. Dell & J. A. O’Neil (Eds.), Dissociation and the dissociative disorders: DSM-V and beyond (pp. 709–825). New York: Routledge.

    Google Scholar 

  • Epstein, M. (1998). Going to pieces without falling apart. New York: Broadway Books.

    Google Scholar 

  • Farb, N. A., Anderson, A. K., Mayberg, H., Bean, J., McKeon, D., & Segal, Z. V. (2010). Minding one’s emotions: mindfulness training alters the neural expression of sadness. Emotion, 10(1), 25.

    Article  PubMed  Google Scholar 

  • Foa, E. B., & Meadows, E. A. (1998). Psychosocial treatments for posttraumatic stress disorder. In R. Yehuda (Ed.), Psychological trauma (pp. 179–204). Washington: American Psychiatric Press.

    Google Scholar 

  • Follette, V. M., & Vijay, A. (2009). Mindfulness for trauma and posttraumatic stress disorder. In F. Didonna (Ed.), Clinical handbook of mindfulness (pp. 299–317). New York: Springer.

    Chapter  Google Scholar 

  • Follette, V., Palm, K. M., & Pearson, A. N. (2006). Mindfulness and trauma: implications for treatment. Journal of Rational-Emotive & Cognitive-Behavior Therapy, 24, 45–61.

    Article  Google Scholar 

  • Fosha, D. (2000). The transforming power of affect: a model for accelerated change. New York: Basic Books.

    Google Scholar 

  • Germer, C. K. (2009). The mindful path to self-compassion. New York: Guilford.

    Google Scholar 

  • Gold, S. N., & Seibel, S. L. (2009). Treating dissociation: a contextual approach. In P. F. Dell & J. A. O’Neil (Eds.), Dissociation and the dissociative disorders: DSM-V and beyond (pp. 625–636). New York: Routledge.

    Google Scholar 

  • Greenberg, L. S. (2002). Emotion-focused therapy: coaching clients to work through their feelings. Washington, DC: APA.

    Book  Google Scholar 

  • Hanh, T. N. (1976). The miracle of mindfulness: a manual of meditation. Boston: Beacon.

    Google Scholar 

  • Hayes, A. M., & Feldman, G. (2004). Clarifying the construct of mindfulness in the context of emotion regulation and the process of change in therapy. Clinical Psychology: Science and Practice, 11(3), 255–262.

    Google Scholar 

  • Hayes, S. C., Wilson, K. G., Gifford, E. V., Follette, V. M., & Strosahl, K. (1996). Experiential avoidance and behavioral disorders: a functional dimensional approach to diagnosis and treatment. Journal of Consulting and Clinical Psychology, 64(6), 1152.

    Article  PubMed  Google Scholar 

  • Hayes, S. C., Strosahl, K., & Wilson, K. G. (1999). Acceptance and commitment therapy: an experiential approach to behavior change. New York: Guilford.

    Google Scholar 

  • Herman, J. L. (1992). Trauma and recovery. New York: Basic Books.

    Google Scholar 

  • Holmes, E. A., Brown, R. J., Mansell, W., Fearon, R. P., Hunter, E., Frasquilho, F., et al. (2005). Are there two qualitatively distinct forms of dissociation? A review and some clinical implications. Clinical Psychology Review, 25, 1–23.

    Article  PubMed  Google Scholar 

  • International Society for the Study of Trauma and Dissociation (ISSTD). (2011). Guidelines for treating dissociative identity disorder in adults (3rd rev.). Journal of Trauma & Dissociation, 12, 115–187.

    Article  Google Scholar 

  • Kabat-Zinn, J. (1990). Full catastrophe living: using the wisdom of your body and mind to face stress, pain, and illness. New York: Dell.

    Google Scholar 

  • Keng, S. L., Smoski, M. J., & Robins, C. J. (2011). Effects of mindfulness on psychological health: a review of empirical studies. Clinical Psychology Review, 31, 1041–1056.

    Article  PubMed Central  PubMed  Google Scholar 

  • Kennerley, H. (1996). Cognitive therapy of dissociative symptoms associated with trauma. British Journal of Clinical Psychology, 35, 325–340.

    Article  PubMed  Google Scholar 

  • Kluft, R. P. (1999). An overview of the psychotherapy of dissociative identity disorder. American Journal of Psychotherapy, 53, 289–319.

    PubMed  Google Scholar 

  • Koons, C. R., Robins, C. J., Tweed, J. L., Lynch, T. R., Gonzalez, A. M., Morse, J. Q., et al. (2001). Efficacy of dialectical behavior therapy in women veterans with borderline personality disorder. Behavior Therapy, 32, 371–390.

    Article  Google Scholar 

  • Kumar, S. M. (2002). An introduction to Buddhism for the cognitive-behavioral therapist. Cognitive and Behavioral Practice, 9, 40–43.

    Article  Google Scholar 

  • Langmuir, J. I., Kirsh, S. G., & Classen, C. C. (2012). A pilot study of body-oriented group psychotherapy: adapting sensorimotor psychotherapy for the group treatment of trauma. Psychological Trauma: Theory Research Practice and Policy, 4, 214–220.

    Article  Google Scholar 

  • Lee, M. Y., Zaharlick, A., & Akers, D. (2009). Meditation and treatment of female trauma survivors. In M. Y. Lee, S. M. Ng, P. P. Y. Leung, & C. L. W. Chan (Eds.), Integrative body-mind-spirit social work: an empirically based approach to assessment and treatment (pp. 275–289). New York: Oxford University Press.

    Google Scholar 

  • Linehan, M. M. (1993a). Cognitive-behavioral treatment of borderline personality disorder. New York: Guilford.

    Google Scholar 

  • Linehan, M. M. (1993b). Skills training manual for treating borderline personality disorder. New York: Guilford.

    Google Scholar 

  • Loizzo, J. (2009). Optimizing learning and quality of life throughout the lifespan: a global framework for research and application. Annals of the New York Academy of Sciences, 1172, 186–198.

    Article  PubMed  Google Scholar 

  • Mennin, D. S. (2006). Emotion regulation therapy: an integrative approach to treatment-resistant anxiety disorders. Journal of Contemporary Psychotherapy, 36(2), 95–105.

    Article  Google Scholar 

  • Michal, M., Beutel, M. E., Jordan, J., Zimmerman, M., Wolters, S., & Heidenreich, T. (2007). Depersonalization, mindfulness, and childhood trauma. Journal of Nervous and Mental Disease, 195, 693–696.

    Article  PubMed  Google Scholar 

  • Najavits, L. M. (2002). Seeking Safety: a treatment manual for PTSD and substance abuse. New York: Guilford.

    Google Scholar 

  • Neziroglu, F., & Donnelly, K. (2013). Dissociation from an acceptance-oriented standpoint. In F. Kennedy, H. Kennerley, & D. Pearson (Eds.), Cognitive behavioural approaches to the understanding and treatment of dissociation (pp. 236–250). New York: Routledge.

    Google Scholar 

  • Putnam, F. W. (1989). Diagnosis and treatment of multiple personality disorder. New York: Guilford.

    Google Scholar 

  • Rizvi, S. L., Steffel, L. M., & Carson-Wong, A. (2013). An overview of dialectical behavior therapy for professional psychologists. Professional Psychology: Research and Practice, 44(2), 73.

    Article  Google Scholar 

  • Robins, C. J. (2002). Zen principles and mindfulness practice in dialectical behavior therapy. Cognitive and Behavioral Practice, 9, 50–57.

    Article  Google Scholar 

  • Roemer, L., & Orsillo, S. M. (2009). Mindfulness- and acceptance-based behavioral therapies in practice. New York: Guilford.

    Google Scholar 

  • Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2002). Mindfulness-based cognitive therapy for depression: a new approach to preventing relapse. New York: Guilford.

    Google Scholar 

  • Shapiro, S. L., Carlson, L. E., Astin, J. A., & Freedman, B. (2006). Mechanisms of mindfulness. Journal of Clinical Psychology, 62, 373–386.

    Article  PubMed  Google Scholar 

  • Simeon, D. (2009). Depersonalization disorder. In P. F. Dell & J. A. O’Neil (Eds.), Dissociation and the dissociative disorders: DSM-V and beyond (pp. 435–444). New York: Routledge.

    Google Scholar 

  • Steele, K., Dorahy, M., van der Hart, O., & Nijenhuis, E. R. S. (2009). Dissociation versus alterations in consciousness: related but different concepts. In P. F. Dell & J. A. O’Neil (Eds.), Dissociation and the dissociative disorders: DSM-V and beyond (pp. 155–169). New York: Routledge.

    Google Scholar 

  • Steinberg, M. (1995). Handbook for the assessment of dissociation: a clinical guide. Washington, DC: American Psychological Association.

    Google Scholar 

  • Wachs, K., & Cordova, J. V. (2007). Mindful relating: exploring mindfulness and emotion repertoires in intimate relationships. Journal of Marital and Family Therapy, 33, 464–481.

    Article  PubMed  Google Scholar 

  • Wagner, A. W., & Linehan, M. M. (1998). Dissociative behavior. In V. M. Follette, J. I. Ruzek, & F. R. Abueg (Eds.), Cognitive-behavioral therapies for trauma (pp. 191–225). New York: Guilford.

    Google Scholar 

  • Wagner, A. W., Rizvi, S. L., & Harned, M. S. (2007). Applications of dialectical behavior therapy to the treatment of complex trauma-related problems: when one case formulation does not fit all. Journal of Traumatic Stress, 20(4), 391–400.

    Article  PubMed  Google Scholar 

  • Walach, H., Buchheld, N., Buttenmüller, V., Kleinknecht, N., & Schmidt, S. (2006). Measuring mindfulness in insight meditation and meditation-based psychotherapy: the development of the Freiburg Mindfulness Inventory (FMI). Personality and Individual Differences, 40, 1543–1555.

    Article  Google Scholar 

  • Waller, N., Putnam, F. W., & Carlson, E. B. (1996). Types of dissociation and dissociative types: a taxometric analysis of dissociative experiences. Psychological Methods, 1, 300–321.

    Article  Google Scholar 

  • Walser, R. D., & Westrup, D. (2007). Acceptance and commitment therapy for the treatment of post-traumatic stress disorder and trauma-related problems: a practitioner’s guide to using mindfulness and acceptance strategies. Oakland: New Harbinger.

    Google Scholar 

  • Williams, J. M. G. (2010). Mindfulness and psychological process. Emotion, 10, 1–7.

    Article  PubMed  Google Scholar 

  • Zylowska, L., Ackerman, D. L., Yang, M. H., Futrell, J. L., Horton, N. I., Hale, S., et al. (2008). Mindfulness meditation training in adults and adolescents with ADHD: a feasibility study. Journal of Attention Disorders, 11, 737–746.

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors wish to express our appreciation to “Madison,” the client who inspired this work; her excitement and enthusiasm over mindfulness fed our curiosity to gain a deeper understanding of the relationship between mindfulness and dissociation. We would also like to thank Frank Putnam for his consultation regarding that case; his input was invaluable in discussing the case assessment, treatment plan, and the model that was used. The authors also appreciate the insightful recommendations made by M. Zachary Rosenthal, Clive Robins, Lisa Smith Kilpela, and Andréa Hobkirk. We appreciate the helpful suggestions made by the editor and reviewers.

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Authors and Affiliations

  1. Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Box 3026, Durham, NC, 27710, USA

    Noga Zerubavel

  2. Department of Psychology, Miami University, Oxford, OH, 45056, USA

    Noga Zerubavel & Terri L. Messman-Moore

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  1. Noga Zerubavel
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  2. Terri L. Messman-Moore
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Correspondence to Noga Zerubavel.

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Zerubavel, N., Messman-Moore, T.L. Staying Present: Incorporating Mindfulness into Therapy for Dissociation. Mindfulness 6, 303–314 (2015). https://doi.org/10.1007/s12671-013-0261-3

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