Understanding Dissociation as Disconnection From Present Reality

Summary

This article provides an in-depth examination of dissociative symptoms—disconnection from self, body, reality, or memory—as trauma responses. It explains the spectrum of dissociation from depersonalization to dissociative amnesia, the neurobiology behind these protective mechanisms, and why standard CBT often fails with dissociative clients. The article details essential adaptations including extensive grounding techniques, working within the window of tolerance, building present-moment awareness, and carefully titrated trauma processing. Case examples demonstrate practical application with clients experiencing chronic depersonalization, dissociative amnesia, and derealization.

At a Glance

• What Is Dissociation: A spectrum of experiences involving disconnection from present reality, one’s body, emotions, sense of self, or continuity of experience—developed as psychological escape from overwhelming trauma
• Types of Dissociation: Includes depersonalization (feeling disconnected from self), derealization (world feels unreal), dissociative amnesia (memory gaps), identity fragmentation, absorption states, and emotional numbing
• Trauma Origins: Develops most commonly from early or chronic trauma when physical escape was impossible; the mind learned to escape psychologically by “going away” mentally
• Why Standard CBT Fails: Traditional approaches assume the person is present and aware enough to engage with cognitive and behavioral techniques, which dissociation directly undermines
• Grounding as Foundation: Extensive teaching and practice of sensory, physical, cognitive, and mental grounding techniques to bring awareness back to present moment and exit dissociative states
• Window of Tolerance: Treatment focuses on recognizing arousal levels and developing skills to stay within the zone where processing is possible without triggering shutdown/dissociation
• Adapted Treatment Approach: Includes building awareness of dissociative states, pacing slowly enough to prevent overwhelm, titrated trauma processing with frequent breaks, and body-based interventions for reconnection
• Recovery Process: With specialized treatment that recognizes dissociation and provides appropriate tools, people can learn to reduce disconnection and reclaim presence in their lives

Dissociation is one of the most misunderstood and underrecognized trauma responses, yet it’s remarkably common among people who’ve experienced significant trauma, particularly chronic or early trauma. In its essence, dissociation is a disconnection—from present reality, from one’s body, from one’s emotions, from one’s sense of self, or from the continuity of one’s experience. It’s the mind’s way of creating distance from overwhelming or intolerable experiences, and while it serves crucial protective functions during trauma, it often persists long after the traumatic circumstances end, creating significant distress and functional impairment.

When most people hear “dissociation,” they might think of Dissociative Identity Disorder (formerly called Multiple Personality Disorder) with its dramatic presentation of distinct alternate identities. But dissociation exists on a spectrum, and severe disorders like DID represent only the extreme end. Most people with dissociative symptoms experience subtler forms—feeling disconnected from their body, as if they’re watching themselves from outside; experiencing the world as unreal, dreamlike, or behind glass; having gaps in memory for periods of time; feeling disconnected from their emotions, as if observing them rather than experiencing them; or losing time and discovering they’ve done things they don’t remember doing.

These experiences range from mild and brief to severe and chronic. Mild dissociation is actually universal—everyone has experienced moments of “highway hypnosis” where you arrive at your destination without remembering the drive, or absorption in a book or movie where you lose awareness of your surroundings. These are normal dissociative experiences that don’t cause problems. But trauma-related dissociation is different in degree, frequency, and impact. It occurs more intensely, more frequently, often at times when being present is important, and interferes significantly with functioning and quality of life.

Someone with trauma-related dissociation might find themselves “spacing out” during important conversations, unable to recall what was said. They might feel like they’re watching their life happen rather than living it, creating a sense of profound disconnection from their own experience. They might have hours or days they can’t account for, discovering evidence they were functional during that time—they went to work, had conversations, completed tasks—but have no memory of it. They might feel disconnected from their body to the extent that physical pain doesn’t register normally, or they injure themselves without noticing, or they feel like their body belongs to someone else.

The relationship between trauma and dissociation is well-established. Dissociation develops as an adaptive response to overwhelming trauma, particularly trauma that occurs early in development or that involves betrayal by caregivers. When a child experiences abuse, neglect, or other overwhelming experiences and cannot physically escape, the mind learns to escape psychologically by “going away” mentally—disconnecting from the experience, from the body that’s being hurt, from the emotions that are overwhelming, or from the self that’s being violated. This disconnection makes unbearable situations more bearable. It’s a survival mechanism that serves crucial protective functions.

The problem is that dissociation, once learned as a coping strategy, often continues to activate automatically even when the person is no longer in danger. The nervous system learned: “When things are overwhelming, disconnect.” This pattern persists, so the person might dissociate in response to stress, strong emotions, reminders of trauma, or sometimes seemingly without trigger at all. What was adaptive during trauma becomes problematic in post-trauma life because it prevents the person from being fully present for their life, relationships, work, and healing.

Standard Cognitive Behavioral Therapy, with its focus on thoughts, behaviors, and conscious processing, often struggles with dissociative symptoms because dissociation by its nature involves being disconnected from conscious awareness and from the ability to think clearly or implement behavioral strategies. When someone is dissociated, they can’t engage with cognitive restructuring—they’re not present enough to examine their thoughts. They can’t implement behavioral activation—they’re disconnected from motivation and from the present moment. Standard CBT techniques assume the person is present and aware enough to engage with them, which dissociation directly undermines.

However, when CBT is adapted to specifically address dissociative symptoms—when it incorporates grounding as a primary intervention, when it helps people recognize when they’re dissociating rather than assuming they’re always present, when it includes techniques for staying within the window of tolerance, when it proceeds slowly enough to prevent triggering more dissociation, and when it integrates understanding of trauma and the nervous system—it can be remarkably effective in helping people reduce dissociation and reclaim presence in their lives.

For people with dissociative symptoms reading this, you may recognize experiences of feeling disconnected, “spacey,” or like you’re in a fog; watching yourself from outside your body; having memory gaps you can’t explain; feeling like the world is unreal; or struggling to stay present even when you want to. Understanding that dissociation is a trauma response—an adaptation that protected you when you needed protection but that now interferes with living fully—offers a framework for making sense of confusing experiences. More importantly, understanding that you can learn to reduce dissociation and increase presence offers hope.

For therapists, recognizing dissociative symptoms in clients and understanding how to work with them is crucial for effective trauma treatment. These symptoms are often missed or misdiagnosed because they’re subtle or because clients don’t recognize them as dissociation and describe them in ways that sound like anxiety, depression, or attention problems. Learning to identify dissociation and adapt your approach accordingly prevents treatment impasses and provides more effective care.

The Spectrum of Dissociative Experiences

Dissociation isn’t a single phenomenon but rather a spectrum of experiences involving disconnection from different aspects of consciousness, memory, identity, or perception.

Depersonalization: Disconnection From Self

Depersonalization involves feeling disconnected from oneself, one’s body, or one’s mental processes. People experiencing depersonalization describe feeling like they’re observing themselves from outside their body, watching themselves as if they’re a character in a movie rather than the person living the experience. They might feel disconnected from their emotions—able to observe that they’re sad or angry but not actually feeling the emotions. They might feel disconnected from their body—as if their body doesn’t belong to them, as if they’re a consciousness inhabiting a body rather than being the body, or as if their body is mechanical and they’re controlling it from a distance.

Someone with depersonalization might say: “I feel like I’m watching my life happen rather than living it,” “I can see that I’m crying, but I don’t feel sad,” “My body feels like it belongs to someone else,” “I feel like a robot just going through the motions,” or “It’s like I’m behind glass, separate from everything.” This disconnection from self creates profound alienation and distress, even though the person is often functioning outwardly.

Depersonalization can be brief—lasting minutes during stress—or chronic, where the person lives in a persistent state of disconnection from themselves. Chronic depersonalization creates exhaustion from the constant effort of functioning while feeling disconnected, confusion about identity when self-experience is disrupted, and difficulty with relationships when emotional connection is impaired.

Derealization: Disconnection From External Reality

Derealization involves feeling that the external world is unreal, dreamlike, distant, or distorted. The environment might seem foggy, flat, colorless, or like a movie set rather than real. Familiar places might suddenly seem strange or unfamiliar. People, objects, or surroundings might seem artificial or lacking in substance. The person knows intellectually that reality is real but can’t shake the feeling that something is fundamentally wrong with their perception of it.

Someone with derealization might describe: “The world looks flat, like a photograph rather than three-dimensional,” “Everything feels dreamlike, like I’m going to wake up,” “Familiar places suddenly feel completely foreign,” “People look robotic or fake,” “There’s a film or fog between me and the world,” or “Everything is distant and muted.” This creates disorientation and anxiety because the person’s perception doesn’t match their knowledge of reality.

Derealization, like depersonalization, can be brief or chronic. When chronic, it creates constant sense of strangeness and unreality that’s exhausting and disturbing. People with chronic derealization often fear they’re “going crazy” because they know their perception is off but can’t correct it through reasoning.

Dissociative Amnesia: Memory Gaps

Dissociative amnesia involves inability to recall important personal information, usually of a traumatic or stressful nature, that’s too extensive to be explained by normal forgetting. This might manifest as complete inability to remember periods of one’s past—childhood, traumatic events, or significant periods of one’s life. Or it might be more circumscribed—unable to remember specific traumatic events while other memories remain intact.

Some people experience ongoing dissociative amnesia where they regularly “lose time”—having gaps in memory for recent events. They might discover evidence they were active and functional during periods they can’t remember—they apparently went to work, had conversations, completed tasks, drove places—but have no memory of it. This is different from being distracted and not encoding memories; it’s being functional but completely dissociated such that no conscious memory is formed.

People with dissociative amnesia might say: “I have almost no memories of my childhood,” “I know something happened based on evidence, but I can’t remember it,” “People tell me about conversations we had that I have no memory of,” “I lost several hours today—I was apparently functional but don’t remember any of it,” or “My memory has huge gaps I can’t explain.”

This amnesia creates profound disturbance because memory is central to identity and continuity of experience. Not remembering one’s past or one’s recent activities creates fragmentation and confusion about who one is.

Identity Confusion and Fragmentation

Some trauma survivors experience confusion about identity or sense of having different parts or aspects of themselves that feel distinct. This exists on a spectrum. At the milder end, someone might feel like they have different “modes”—a work self that’s competent and professional, a home self that’s vulnerable, a social self that’s outgoing—and these selves might feel somewhat separate or inconsistent. At the more severe end, these parts might be more distinct, with separate memories, characteristics, or ways of perceiving the world.

This fragmentation develops when trauma is so overwhelming that the developing mind doesn’t integrate into a cohesive sense of self. Instead, experiences, emotions, and memories that can’t be integrated remain separate. The person might have a part that holds trauma memories and emotions while another part goes about daily life unaware. They might have a part that’s capable and adult while another part feels young and vulnerable. These parts might have some awareness of each other or might be relatively separate.

People experiencing identity fragmentation might say: “I don’t know who I am—it changes depending on circumstances,” “I have parts of me that feel like different people,” “Sometimes I act in ways that don’t feel like ‘me,'” or “I feel like there are separate versions of me that don’t communicate.” This creates significant distress and confusion about identity.

It’s important to distinguish between the normal multiplicity of self—we all have different aspects and can behave differently in different contexts—and pathological dissociation of identity where the fragmentation is extreme, distressing, and interferes with functioning. The distinction is one of degree and impact.

Absorption and Reduced Awareness

Some dissociation manifests as excessive absorption where the person becomes so focused on internal experience that they lose awareness of external reality. This might look like “spacing out,” staring into space while unaware of surroundings, becoming absorbed in daydreams to the exclusion of present reality, or being so focused internally that external events don’t register.

This type of dissociation creates functional impairment when it happens frequently or at inappropriate times. The person might miss important information in conversations, not notice hazards in the environment, lose track of time regularly, or have difficulty maintaining attention on tasks because they’re frequently pulled into dissociative states.

People might describe: “I frequently ‘zone out’ and miss what’s happening around me,” “Time passes without me noticing—hours can go by,” “People have to repeat things multiple times to get through to me,” “I’m often ‘in my own world,'” or “I have trouble staying present in conversations.”

This is different from attention problems like ADHD, though they can coexist. Dissociative absorption is often triggered by stress, emotions, or trauma reminders and has the quality of disconnection or escape, whereas ADHD inattention is more about difficulty regulating attention consistently.

Emotional Numbing and Anesthesia

Dissociation can manifest as disconnection from emotions—numbness where the person can’t access feelings or experiences them in muted, distant ways. This emotional numbing is distinct from depression, though they can coexist. The person might observe that situations should evoke emotion—they know losing a job is sad, conflict with a partner is distressing, good news is exciting—but they don’t feel the emotions. They watch themselves go through experiences that should be emotionally significant while feeling nothing or feeling emotions in intellectual but not visceral ways.

This emotional dissociation might extend to physical sensations as well—reduced ability to feel pain, temperature, hunger, fatigue, or other body signals. This creates danger because the person might injure themselves without noticing, might push past physical limits without realizing they’re exhausted or in pain, or might neglect basic needs because body signals don’t register.

People might say: “I feel numb all the time,” “I know I should feel something, but I just don’t,” “It’s like my emotions are behind a wall I can’t get through,” “I don’t feel physical pain like I should,” or “I observe my life from a distance without feeling it.”

Why Dissociation Develops: The Neurobiology and Function

Understanding why and how dissociation develops helps explain why it persists and how to address it effectively.

Dissociation as Survival Strategy

At its core, dissociation is an adaptive survival strategy. When faced with overwhelming, inescapable threat—particularly for children who cannot physically escape abuse or neglect—the mind employs psychological escape. If the body can’t leave the dangerous situation, consciousness can leave by disconnecting from the experience, from the body, from the emotions, or from the self that’s being harmed.

This disconnection makes unbearable situations more bearable. A child being abused might dissociate—mentally “going away,” feeling like it’s happening to someone else, disconnecting from the body being hurt—which reduces the psychological impact of trauma in the moment. The same mechanism allows people to survive severe or prolonged trauma like captivity, torture, or chronic abuse. Dissociation is what makes it possible to endure the unendurable.

From an evolutionary perspective, when fight or flight aren’t possible, mammals have a third defense: freeze and dissociate. This reduces suffering in the moment and may increase survival odds by making the person appear dead or unresponsive, potentially reducing aggressor violence. For humans with complex consciousness, this basic freeze response can extend into sophisticated mental dissociation.

The adaptation is brilliant in the short term. The problem is that once the nervous system learns dissociation as a strategy for dealing with overwhelm, it continues using that strategy even when the overwhelming circumstances end. The pattern becomes automatic: “Overwhelm = dissociate.” This happens outside conscious control, so the person might suddenly dissociate in response to stress, emotions, trauma reminders, or sometimes without identifiable trigger.

Developmental Trauma and Structural Dissociation

Dissociation develops most profoundly when trauma occurs during early developmental periods when the sense of self is still forming. If trauma is severe and chronic during these critical periods, the personality structure itself may develop in fragmented ways rather than integrating into a cohesive whole.

Researchers describe this as structural dissociation, where the personality doesn’t develop as an integrated system but rather as separate subsystems or parts that handle different aspects of life. There might be parts that hold trauma memories and emotions, parts that function in daily life, parts that handle threat, parts that seek attachment, and so on. These parts may have different levels of awareness of each other and different capacities.

This fragmentation makes sense developmentally. When experiences are so overwhelming that they can’t be integrated into coherent narrative or sense of self, they remain separate. The child’s mind essentially says: “This experience is too much to integrate. It will stay over here, separate, while I go about life over here.” This allows the child to continue functioning and attaching to caregivers (even abusive ones, on whom survival depends) while containing the trauma separately.

The Window of Tolerance

The window of tolerance, a concept developed by Dr. Dan Siegel, helps explain when and why dissociation occurs. The window of tolerance is the zone of arousal where a person can process emotions and experiences effectively—not too activated, not too shut down. Within this window, the person can think clearly, regulate emotions, and respond to situations adaptively.

When arousal exceeds the window—when emotions or experiences are too intense—the person moves into hyperarousal (too activated: anxious, panicked, overwhelmed, fight-or-flight activated) or hypoarousal (too shut down: numb, disconnected, frozen, dissociated). Dissociation is movement into hypoarousal—the nervous system shuts down and disconnects to prevent further overwhelm.

For people with trauma histories, the window of tolerance is often narrow. Experiences that others might find manageable push them out of their window into either hyperarousal or hypoarousal. Additionally, trauma survivors often oscillate between the two—becoming hyperaroused and overwhelmed, then flipping into dissociative hypoarousal as their system tries to escape the overwhelm.

Understanding this helps explain dissociation: it’s what happens when the person’s nervous system is pushed beyond its capacity to remain present and processes by shutting down and disconnecting. It’s not chosen consciously; it’s an automatic protective response.

Dissociation as Avoidance

From a behavioral perspective, dissociation functions as experiential avoidance. It’s a way of not being fully present for experiences that feel threatening, overwhelming, or intolerable. This might include avoiding trauma memories, painful emotions, difficult conversations, confrontation with reality, or even positive experiences that trigger vulnerability.

Like any avoidance, dissociation is negatively reinforced—it temporarily reduces distress, which increases the likelihood of dissociating again in similar situations. The person doesn’t consciously choose this, but the pattern strengthens: “When I feel [trigger], I dissociate, and then I don’t feel it anymore.” This reinforcement maintains the dissociative pattern even though it creates long-term problems.

The challenge therapeutically is that unlike behavioral avoidance where someone consciously decides not to do something, dissociation is mostly involuntary. The person doesn’t decide “I’ll dissociate now”—it happens automatically. This means interventions must work at a more fundamental level of awareness and nervous system regulation rather than just addressing conscious avoidance.

Why Standard CBT Often Falls Short

Traditional Cognitive Behavioral Therapy approaches often struggle with dissociative symptoms for several reasons.

Dissociation Prevents Engagement With CBT Techniques

Standard CBT assumes the person is present, aware, and able to engage consciously with therapeutic techniques. When someone is dissociated, these assumptions don’t hold. They can’t examine their thoughts because they’re disconnected from their thinking. They can’t identify emotions because they’re disconnected from feeling. They can’t implement behavioral strategies because they’re not present enough to recognize when to use them or to execute them effectively.

A therapist might teach cognitive restructuring, and the person might understand it intellectually while present in session. But when dissociation occurs outside session—when they most need the tools—they can’t access them. The dissociation itself prevents the kind of conscious, deliberate processing that CBT techniques require.

Similarly, exposure therapy commonly used in trauma treatment assumes the person can stay present with distressing material long enough for habituation to occur. But trauma survivors who dissociate often can’t stay present—as distress increases, they dissociate automatically, disconnecting from the exposure. This prevents processing because the person isn’t actually experiencing the distress they need to process; they’ve escaped into dissociation.

Standard Approaches May Increase Dissociation

Ironically, some standard CBT and trauma treatment approaches can increase dissociation in susceptible individuals. Trauma-focused exposure therapy that pushes someone to confront traumatic material before they have adequate skills to stay present often triggers overwhelming dissociation as the nervous system attempts to escape the overwhelm.

Similarly, emotion-focused interventions that ask someone to deeply feel and express emotions might trigger dissociation in someone whose coping strategy has been disconnecting from feelings. Pushing too quickly into emotional territory exceeds the person’s window of tolerance, triggering the protective dissociative response.

This creates a paradox: the treatments that should help process trauma instead trigger more dissociation, preventing processing and potentially reinforcing the dissociative pattern. The person needs to approach trauma and emotions, but approaching must be done carefully enough not to exceed their window of tolerance and trigger more disconnection.

Lack of Focus on Present-Moment Awareness

Standard CBT focuses on thoughts, behaviors, and their interactions but doesn’t typically emphasize present-moment awareness and embodiment. For people who dissociate, learning to stay present and grounded in the moment is foundational—without that capacity, other interventions can’t be implemented effectively.

Grounding and presence aren’t typically central to traditional CBT protocols. They might be mentioned briefly, but treatment focuses primarily on cognitive and behavioral change rather than on building capacity to remain present. For dissociative clients, this is backwards—presence must be established before cognitive and behavioral work can proceed effectively.

Dissociation May Go Unrecognized

Perhaps most problematically, dissociative symptoms often go unrecognized by therapists not trained to identify them. The person might appear to be listening and engaged while actually being significantly dissociated. They might nod, make appropriate responses, and seem present when they’re actually disconnected and won’t remember the session content later.

Therapists might interpret dissociation as resistance, poor engagement, or lack of motivation rather than recognizing it as an automatic trauma response. They might think the person isn’t doing homework when actually the person dissociated and couldn’t access what was discussed in session. This misunderstanding creates frustration for both therapist and client and prevents effective treatment.

Additionally, clients often don’t recognize or report dissociative symptoms because they’ve lived with them so long they seem normal, they’re embarrassed by symptoms that feel “crazy,” they dissociate their dissociation—they disconnect from awareness of disconnecting, or they lack language to describe experiences that are confusing and hard to articulate.

Pacing Is Often Too Fast

Standard CBT protocols often move quickly—assessment, psychoeducation, skills training, and intervention within a few sessions. This pace overwhelms people who dissociate. They need more time to build safety, learn to recognize dissociation, develop grounding skills, and expand their window of tolerance before approaching trauma content or making significant changes.

Rushing the process pushes them out of their window of tolerance repeatedly, triggering more dissociation and preventing the integration that healing requires. Treatment must proceed at a pace that keeps the person within their window, which often means much slower than standard protocols allow.

Adapted CBT for Dissociative Symptoms

Effective treatment requires specific adaptations and additional techniques that address dissociation directly.

Psychoeducation About Dissociation

The first intervention is education about what dissociation is, how it develops, why it persists, and how it can be recognized. Many people have experienced dissociation for years without understanding what it was or knowing it had a name. This psychoeducation provides enormous relief—the person isn’t “going crazy”; they’re experiencing a known trauma response.

Education covers: dissociation as protective response to overwhelming experiences, how it works neurobiologically (window of tolerance, freeze response), different types of dissociative experiences, why it continues even after trauma has ended, and that dissociation is treatable—people can learn to reduce it and increase presence.

The therapist normalizes dissociation: “Your brain learned to disconnect when things were overwhelming. That protected you when you needed protection. It makes complete sense that your brain still uses this strategy. We’re going to help you recognize when it happens and give you tools to stay more present.”

This reframe—from “something’s wrong with me” to “my brain is using an adaptive strategy”—reduces shame and creates foundation for change. The person can observe and work with dissociation rather than being frightened by or ashamed of it.

Building Awareness and Recognition

Many people dissociate without recognizing it’s happening. They just experience confusion, time loss, or disconnection without identifying it as dissociation. Building awareness is crucial.

The therapist helps identify the person’s specific dissociative experiences: “What does it feel like when you dissociate? Do you feel foggy? Disconnected from your body? Like you’re watching from outside? Like the world is unreal? Do you lose time? Forget conversations?” Together, they create personalized descriptions of the person’s dissociative states.

They identify early warning signs—subtle signals that dissociation is beginning before it becomes severe. This might include slight fogginess, vision tunneling, sounds becoming distant, feeling of floating or heaviness, slight numbness, or difficulty following conversations. Catching dissociation early makes it easier to intervene.

The person practices noticing: “Throughout the day, check in. Am I present right now? Do I feel connected to my body? Can I see my surroundings clearly? Am I feeling emotions? Or am I dissociated?” This builds meta-awareness—awareness of one’s state of consciousness.

Journaling supports this. The person tracks: “When did I dissociate today? What was happening before it started? How long did it last? What helped me come out of it?” Patterns emerge: dissociation happens during stress, after phone calls with family, when emotions get intense, or in specific situations. This pattern recognition helps anticipate and prevent dissociation.

Grounding Techniques as Primary Intervention

Grounding is the cornerstone intervention for dissociation. Grounding techniques bring the person back to present moment awareness, reconnect them with their body and surroundings, and help them exit dissociative states. Unlike standard CBT where grounding might be mentioned briefly, in dissociation-adapted CBT, grounding is taught extensively, practiced regularly, and used as the primary tool for managing symptoms.

Sensory grounding: Engaging the five senses to anchor in present reality. The 5-4-3-2-1 technique: name 5 things you can see, 4 things you can touch, 3 things you can hear, 2 things you can smell, and 1 thing you can taste. This forces attention outward to current sensory reality, disrupting dissociation.

Other sensory techniques: holding ice cubes (strong sensation), smelling strong scents (peppermint, coffee, citrus), eating something with strong flavor (sour candy, mint), listening to music at specific volumes, or looking at colors and describing them in detail.

Physical grounding: Reconnecting with the body. Feel your feet on the floor—press them down, notice the weight and pressure. Touch objects around you and describe their texture, temperature, weight. Stretch or move deliberately, noticing sensations. Place your hand on your chest and feel it rise and fall with breath. These physical actions bring awareness back to the body.

Cognitive/verbal grounding: Using words and thoughts to orient to present. Say out loud: “My name is [name]. Today is [date]. I am [age] years old. I am in [location]. I am safe right now.” This establishes temporal and spatial context. Or describe your surroundings in detail out loud: “I’m sitting in a blue chair. There’s a window to my left. I can see trees outside. The walls are white.” Verbal description engages the thinking brain and orients to current reality.

Mental grounding: Simple mental tasks that engage conscious awareness. Count backwards from 100 by 7s, name states and capitals, recall facts (names of planets, presidents, etc.), or describe a familiar routine in detail. These tasks require enough focus to disrupt dissociation without being overwhelming.

The person practices these techniques regularly—both when dissociated and when present—so they become automatic and accessible. They identify which techniques work best for them and keep a “grounding toolkit” readily available.

Staying Within the Window of Tolerance

Treatment emphasizes helping the person recognize their window of tolerance and develop skills for staying within it or returning when they exit it. This prevents dissociation by keeping arousal at manageable levels.

The person learns to recognize: when they’re within their window (able to think clearly, feel emotions without being overwhelmed, stay present), when they’re in hyperarousal (anxious, panicked, activated, can’t calm down), and when they’re in hypoarousal/dissociation (numb, disconnected, foggy, shut down).

They develop skills for each: if moving into hyperarousal, use calming techniques (deep breathing, progressive muscle relaxation, self-soothing). If moving into hypoarousal/dissociation, use activating techniques (physical movement, sensory stimulation, engagement with environment). The goal is bringing arousal back into the window before full dissociation or panic occurs.

Therapy itself is conducted to keep the person within their window. The therapist watches for signs of dissociation or overwhelm and adjusts pacing immediately. If the person starts looking glazed or disconnected, the therapist pauses: “I notice you might be dissociating. Let’s ground for a moment. Can you look around the room and tell me what you see?” This prevents therapy itself from triggering more dissociation.

Titrated Trauma Processing

When trauma processing is appropriate and the person has adequate skills, it must be carefully titrated—approached in small doses with frequent breaks and grounding. This prevents overwhelming the person and triggering dissociation.

Techniques like the “pendulation” approach: briefly touch on traumatic material (30 seconds to 2 minutes), then deliberately shift attention to something positive, neutral, or calming (2-3 minutes), then return briefly to trauma material, alternating back and forth. This prevents sustained overwhelm that triggers dissociation while still allowing processing.

Or “containment” visualization: the person imagines a safe container where traumatic material can be temporarily stored. They can open the container briefly to work with material, then close it securely when done, preventing leakage and overwhelm outside of therapy sessions.

The therapist constantly monitors: “Are you still present? Can you feel your feet on the floor? Are you in your window?” If the person dissociates, trauma processing stops immediately and grounding begins. The session only continues with trauma content when the person is fully present again. This prevents the pattern of approaching trauma → dissociating → not processing → remaining stuck.

Developing a Relationship With Dissociation

Rather than viewing dissociation as an enemy to be eliminated, treatment helps the person develop a different relationship with it. Dissociation was protective and still is trying to protect. Understanding this reduces the struggle against dissociation that often makes it worse.

The therapist might guide: “When you notice you’re starting to dissociate, can you thank that part of you for trying to protect you? Can you tell it: ‘I appreciate you trying to keep me safe. Right now I’m actually safe and I need to be present. I’ve got this.'” This internal communication acknowledges the protective function while asserting adult agency.

This approach, borrowed from parts work or Internal Family Systems, recognizes that dissociation isn’t just a symptom but a part of the survival system that’s trying to help. When treated with respect rather than rejection, it often becomes more willing to relax and allow presence.

Somatic and Body-Based Interventions

Because dissociation fundamentally involves disconnection from the body, interventions that reconnect with bodily experience are crucial. This includes developing interoceptive awareness—noticing internal body sensations like heartbeat, breath, muscle tension, temperature, or digestive sensations without judgment. For people who dissociate, this internal awareness has often been shut down, and rebuilding it helps maintain presence.

Gentle movement practices like trauma-informed yoga, tai chi, qigong, or simple stretching help reconnect with the body. The person practices moving slowly and deliberately while noticing sensations. This is different from exercise for fitness—it’s about developing body awareness and learning the body is safe to inhabit.

Progressive muscle relaxation adapted for dissociation: tense and release muscle groups while really noticing the difference between tension and relaxation. This builds awareness of body states and provides a tool for regulating arousal.

Some people benefit from working with somatic therapists (Somatic Experiencing, Sensorimotor Psychotherapy) alongside CBT. These modalities explicitly work with how trauma is held in the body and nervous system, complementing CBT’s cognitive and behavioral focus.

Building Capacity for Presence

Treatment includes explicit practice of being present—staying conscious and aware in the current moment. This might seem basic, but for people who’ve spent years dissociating, presence is a skill that must be consciously developed.

Mindfulness practice adapted for dissociation: brief periods (starting with 1-2 minutes, gradually increasing) of deliberately paying attention to present moment with curiosity rather than judgment. Notice breath, body sensations, sounds, or a single object. When the mind wanders or dissociation begins, gently bring attention back.

For dissociative people, standard long mindfulness meditation can trigger more dissociation—sitting still with eyes closed can facilitate disconnecting. Adaptations include: keeping eyes open, shorter practices, anchoring in external objects rather than internal awareness, and combining with gentle movement.

Presence practice in daily activities: choose one routine activity daily—showering, eating, walking—and practice being fully present for it. Notice every sensation, smell, sight, sound. When noticing dissociation beginning, use grounding to return to presence. This builds capacity to stay present through ordinary activities before approaching more challenging situations.

Addressing Trauma Without Overwhelming

Eventually, addressing underlying trauma that created dissociation becomes important. But this must be approached in ways that don’t trigger overwhelming dissociation that prevents processing.

Rather than extensive exposure to traumatic memories, treatment might use cognitive approaches to work with meanings and beliefs that developed from trauma. Schema work—identifying beliefs like “I’m not safe,” “I can’t trust anyone,” or “I’m helpless”—and examining these beliefs, understanding their origin, and testing them in current reality.

Narrative work where the person gradually develops coherent narrative of their experiences, filling in gaps and creating continuity, but always at a pace that doesn’t exceed their window of tolerance. The goal is integration—helping separate, fragmented experiences become part of a cohesive life story.

For some people with severe dissociation, trauma processing may not be appropriate in standard CBT framework. They may need longer-term, specialized trauma treatment that explicitly works with dissociation and structural fragmentation. Knowing when to refer to specialists in dissociative disorders is important.

Enhancing Daily Functioning

Practical strategies help manage dissociation in daily life. Creating routines and structure provides external scaffolding when internal sense of continuity is disrupted. Using external memory aids—calendars, notes, reminders—compensates for dissociative amnesia. Letting trusted others know about dissociative symptoms so they can help recognize and respond to dissociation.

Safety planning is crucial for people who dissociate because disconnection creates vulnerability. If the person dissociates while driving, they need alternative transportation plans. If they lose time, they need systems to track where they are and what they’re doing. If they disconnect from pain, they need to check for injuries regularly.

Case Examples: Working with Dissociation in CBT

Seeing how adapted approaches work with specific individuals illustrates principles in practice.

Mia: Depersonalization and Chronic Disconnection

Mia, thirty-two, sought therapy for what she described as feeling “not real.” She’d felt disconnected from herself, her body, and her emotions for as long as she could remember. She watched her life happen from a distance, felt like she was performing rather than genuinely experiencing, and struggled to connect with others because she couldn’t really feel emotions. She functioned well outwardly—she had a job, relationships, responsibilities—but internally felt empty and disconnected.

Assessment revealed severe childhood neglect. Mia’s parents were physically present but emotionally absent, providing no attunement or emotional responsiveness. From early childhood, Mia learned to disconnect from her emotions and needs because no one responded to them. The dissociation that began as disconnection from unmet needs became a chronic state of depersonalization.

Standard CBT had been tried previously without success. Mia could intellectually understand concepts but couldn’t connect with them emotionally. She’d try behavioral activation but felt disconnected from any enjoyment or meaning in activities. The cognitive and behavioral work didn’t address her fundamental problem: she wasn’t present to engage with any intervention.

Treatment was reframed around dissociation. The therapist explained: “You’re experiencing chronic depersonalization—feeling disconnected from yourself and your experience. This developed as protection when you were a child whose emotional life was ignored. Your brain learned: ‘My feelings don’t matter and no one responds to them, so I’ll disconnect from them.’ That was adaptive then. Now it’s creating suffering.”

This explanation gave Mia a framework. She wasn’t “broken” or “empty”—she had a dissociative adaptation that made sense given her history. Understanding this reduced her shame and hopelessness.

Learning to recognize her dissociation was first. Mia had lived dissociated so long that it felt normal. She had to learn the difference between present versus depersonalized. The therapist guided: “When you’re present, you feel emotions in your body. You feel connected to what you’re doing. When you’re depersonalized, there’s a sense of distance, disconnection, watching yourself. Can you notice which you’re experiencing right now?”

Initially Mia couldn’t distinguish. The work involved the therapist pointing out signs: “I notice when you talked about that difficult event, your affect flattened and you seemed to disconnect. That might be depersonalization happening. Did you notice a shift?” With practice, Mia began recognizing the shift into depersonalization.

Grounding techniques became central. Mia learned sensory grounding—holding ice, smelling peppermint oil, touching textured objects. Physical grounding—pressing feet into floor, stretching deliberately. Verbal grounding—describing her surroundings out loud. She practiced these techniques multiple times daily, whether dissociated or not, until they became automatic.

Body awareness work was crucial. Mia had disconnected from her body so thoroughly she barely felt physical sensations. The therapist guided gentle body scans: “Can you feel your right foot? Your left hand? Your breath?” Initially Mia felt almost nothing. Over weeks of practice, sensations slowly returned. She began noticing: “My shoulders are tense.” “My stomach hurts.” “I’m cold.” These seemed basic but were profound—she was reconnecting with her body.

Emotional reconnection happened gradually. The therapist would ask: “What emotion might be present? Even if you can’t feel it fully, can you think about what emotion would make sense right now?” Mia would intellectually identify: “Probably sadness.” Then: “Can you notice if there’s any sensation in your body that might be sadness? Even a tiny bit?” With practice, Mia began detecting faint emotional sensations she’d been disconnected from.

Behavioral activation was reframed. Rather than “do activities for enjoyment,” the goal became “practice being present during activities and notice any glimmers of feeling.” Mia would walk in nature and practice staying present—noticing sights, sounds, body sensations—without expecting to enjoy it. Occasionally, small moments of actual feeling broke through: “I felt a second of peace looking at the water.” These moments were encouraged and built upon.

Trauma processing addressed the childhood neglect that created dissociation. Mia grieved for the child whose emotional life was ignored, the years of disconnection from herself, and the genuine connection she’d never learned to have. This grief itself was challenging—Mia had to stay present with painful emotions rather than automatically disconnecting. The therapist carefully supported: “I know this is painful and your automatic response is to disconnect. Can you stay with me here, feeling just a little bit of this sadness?”

Over many months, Mia’s chronic depersonalization decreased. She still dissociated sometimes, especially under stress, but she could recognize it and ground back to presence. She began experiencing emotions more fully—not just intellectually knowing she should feel something but actually feeling. She described “coming back to life” after decades of watching from a distance. She still had to consciously practice presence, but it became more natural over time.

Nathan: Dissociative Amnesia and Lost Time

Nathan, twenty-seven, came to therapy because his partner insisted something was wrong. Nathan would “lose time”—have gaps in memory where he’d apparently been functional but couldn’t remember anything. His partner would reference conversations they’d had that Nathan had no memory of. Nathan would find evidence he’d done things—emails he’d sent, places he’d apparently driven to—without any recollection. He was frightened he had a neurological problem or was “losing his mind.”

Medical workup was negative. Assessment revealed severe childhood trauma—Nathan’s father was explosively violent and unpredictable. Nathan learned to dissociate during abuse, mentally “going away” to escape. This dissociation became automatic and continued into adulthood. When stressed or triggered, Nathan would dissociate so completely that he’d function on autopilot without forming conscious memories.

The therapist explained: “You’re not losing your mind. You’re experiencing dissociative amnesia—your brain disconnects so completely under stress that memories aren’t formed consciously. This is your brain’s old strategy for dealing with overwhelming situations. It protected you from your father’s violence, and it’s still activating when you’re stressed.”

This explanation provided enormous relief. Nathan wasn’t developing dementia or psychosis—he had a trauma response with a name and treatment. Understanding this reduced his terror and created foundation for work.

Identifying triggers for time loss became crucial. Nathan tracked when amnesia occurred. Patterns emerged: after phone calls with his father, during conflict with his partner, when work stress was high, or when facing situations requiring confrontation. These situations triggered the dissociative response learned in childhood.

Learning to recognize dissociation beginning—before it became severe enough to cause amnesia—was essential. Nathan’s early warning signs included: feeling foggy, vision tunneling, sounds becoming distant, sensation of floating, and difficulty tracking conversations. When he noticed these signs, he could intervene with grounding before dissociation progressed to amnesia.

Grounding techniques were practiced extensively. Nathan needed techniques strong enough to cut through significant dissociation. He used ice water on his face (triggers dive reflex, brings sharp awareness), intense physical exercise (jumping jacks, running in place), and loud music. These strong sensory experiences pulled him back from dissociation.

He also used cognitive grounding especially adapted for preventing amnesia. When noticing dissociation beginning, he would say out loud: “I’m Nathan. Today is [date]. I’m in [location]. I’m safe right now. I don’t need to disconnect.” This verbal orientation helped maintain conscious awareness and prevented complete dissociative amnesia.

Nathan’s partner was educated about dissociation and given strategies to help. If she noticed Nathan dissociating—his eyes glazing, responses becoming automatic, him seeming “not there”—she would gently ground him: “Nathan, can you look at me? Can you tell me what you see in this room? Can you feel your feet on the floor?” This external support helped Nathan exit dissociation before amnesia occurred.

Window of tolerance work was central. Nathan’s window was extremely narrow—moderate stress would push him out of it into dissociation. Treatment focused on expanding his window through developing emotional regulation skills, practicing staying present with gradually increasing distress, and building confidence that he could tolerate stress without dissociating.

Processing childhood trauma happened carefully. Nathan had extensive traumatic memories that he’d dissociated during. The therapist would work with memories very briefly—2-3 minutes—then ground completely, then return. This titrated approach allowed processing without triggering the complete dissociation that had prevented processing in the past.

Over time, Nathan’s dissociative amnesia decreased significantly. He still dissociated sometimes, but he could recognize it early and ground himself, preventing the complete time loss that had been so frightening. When he did lose time, it was briefer and he could work with his partner to reconstruct what happened. His fear that something was fundamentally wrong with him decreased as he understood and managed his dissociative symptoms.

Sophia: Derealization and Feeling in a Dream

Sophia, thirty-nine, sought therapy for persistent feeling that the world was “unreal, like a dream I can’t wake from.” People, places, and objects seemed flat, fake, or distant. She knew intellectually that reality was real but couldn’t shake the pervasive sense that something was fundamentally wrong with her perception. This derealization had been constant for two years following a traumatic car accident and was causing severe anxiety and depression.

Assessment revealed the car accident had triggered chronic derealization. The derealization itself was traumatizing—the constant sense of unreality was terrifying and isolating. Sophia feared she was psychotic or had brain damage. Previous treatment hadn’t addressed the derealization specifically, focusing instead on anxiety and depression, which hadn’t resolved because the core symptom—derealization—remained untreated.

The therapist provided psychoeducation: “You’re experiencing derealization—a dissociative symptom where the external world feels unreal. This developed after your accident as your brain’s way of creating distance from trauma. Your brain is still in protection mode, keeping you disconnected from full experience because full experience felt dangerous after the accident. You’re not psychotic and you don’t have brain damage—you have a treatable dissociative symptom.”

This explanation was profound relief. Sophia had been terrified by her symptoms, which had made the derealization worse. Understanding it as dissociation—something known, trauma-related, and treatable—reduced her terror significantly.

Learning to recognize derealization as a symptom rather than as accurate perception was crucial. When the world felt unreal, Sophia would think: “Reality is actually wrong somehow.” The reframe was: “My perception is being affected by dissociation. Reality is real; my brain is creating distance from it.” This simple reframe created critical space—she wasn’t trapped in unreality; her brain was creating the feeling of unreality.

Grounding techniques specifically for derealization focused on intensifying contact with reality. Sophia used strong sensory experiences: splashing cold water on her face, eating sour candy, listening to music and describing instruments she heard, touching rough textures and describing the sensation, looking at colors and naming every shade she could see. These intense sensory engagements pulled her perception toward reality.

She also used cognitive techniques affirming reality: saying out loud “This is real. I am in my actual apartment. These are actual objects. This is genuinely happening.” Verbal affirmation of reality countered the derealized perception. At first this felt absurd—she was trying to convince herself of what she already knew intellectually. But over time, the affirmations helped bridge the disconnect between intellectual knowledge and felt experience.

Physical grounding was powerful. Sophia would press her feet hard into the floor, feeling the pressure and weight. She’d touch solid objects—walls, furniture, her own body—and describe: “This is solid. This is real. I can feel it.” The physical sensations provided evidence of reality that helped counter the derealized perception.

Anxiety management was necessary because anxiety about derealization was making it worse. Sophia was catastrophizing: “I’ll be stuck in unreality forever,” “I’m going crazy,” “I’ll never feel normal again.” These anxious thoughts increased her distress, which increased dissociation. Cognitive restructuring addressed these thoughts: “Many people recover from derealization. Treatment helps. This is temporary, not permanent.”

Gradually reducing safety behaviors helped. Sophia had been constantly checking whether things felt real, asking others for reassurance that she wasn’t crazy, and avoiding situations where derealization was worse. These safety behaviors paradoxically maintained derealization by keeping her focused on the symptom. Gradually, she practiced tolerating derealization without checking or seeking reassurance, allowing the symptom to be present without fighting it.

Processing the original trauma—the car accident—was important. Sophia had been avoiding anything related to the accident, which maintained hypervigilance and dissociation. Gradual exposure to accident memories, driving, and accident-related stimuli, always with grounding to prevent complete dissociation, allowed processing. As the trauma was processed, the protective derealization decreased.

Over months, Sophia’s derealization gradually decreased in intensity and frequency. She had periods where the world felt real, then periods of derealization, then longer periods of reality. The derealization episodes became shorter and less intense. After a year of treatment, she was mostly free of derealization, experiencing it only briefly during high stress. She had her life back.

Practical Guidance for Therapists

Therapists working with dissociative symptoms benefit from specific knowledge and approaches.

Screen for dissociative symptoms routinely. Many clients have dissociative symptoms that go unrecognized. Include screening questions: “Do you ever feel disconnected from your body?” “Do you lose time or have gaps in memory?” “Do you feel like you’re watching yourself from outside?” “Does the world sometimes feel unreal?” Don’t assume absence of these symptoms without asking.

Learn to recognize dissociation in session. Watch for: glazed or distant eyes, sudden flatness of affect, changes in speech patterns (slower, monotone, or disconnected), delayed responses or confusion, the person seeming “not there” or hard to reach, or reports of not remembering previous sessions. When you notice these signs, pause and address: “I notice you might be dissociating. Let’s ground for a moment.”

Make grounding central to treatment, not peripheral. For clients with dissociative symptoms, grounding isn’t a quick technique mentioned briefly—it’s a core skill practiced extensively and used constantly. Teach multiple grounding techniques, practice them in session, assign grounding as homework, and check in about grounding regularly.

Slow your pace significantly. Clients with dissociation need slower pacing than standard protocols. Spend more time in assessment and stabilization. Don’t rush to trauma processing. Check in constantly about whether the person is present and within their window of tolerance. If they dissociate in session, stop what you’re doing and ground them before proceeding.

Work within the window of tolerance. Learn to recognize when clients are within their window (present, able to engage) versus outside it (hyperaroused or dissociated). Adjust your interventions to keep them within the window as much as possible. This prevents treatment itself from triggering more dissociation.

Integrate body-based approaches. Dissociation fundamentally involves disconnection from the body. Consider integrating somatic techniques, referring to yoga or movement therapists, or learning basic body awareness practices. Cognitive and behavioral work alone is usually insufficient without addressing the somatic component.

Recognize when to refer. Severe dissociation, particularly Dissociative Identity Disorder or extensive dissociative amnesia affecting functioning significantly, often requires specialists in dissociative disorders. If you’re seeing complex, severe dissociative symptoms and standard adaptations aren’t helping, refer to someone with specialized training.

Be patient with progress. Dissociation that developed over years or decades won’t resolve in weeks. Progress is often slow and non-linear. Clients may learn grounding techniques and still dissociate frequently. This isn’t treatment failure—it’s the nature of working with entrenched trauma responses. Maintain long-term perspective.

Practical Guidance for People with Dissociative Symptoms

If you experience dissociative symptoms, understanding them and learning to work with them can significantly improve your quality of life.

Understand that dissociation is a trauma response. You’re not “crazy,” “broken,” or defective. Your brain learned to disconnect as a way to cope with overwhelming experiences. That was adaptive when you needed it. Now it’s creating problems, but it’s understandable and treatable.

Learn to recognize when you’re dissociating. This is crucial. Build awareness of what dissociation feels like for you—foggy, disconnected, unreal, distant, numb. Notice early warning signs before dissociation becomes severe. The earlier you recognize it, the easier it is to intervene.

Develop a grounding practice. Find grounding techniques that work for you and practice them regularly. Don’t wait until you’re severely dissociated—practice when you’re present so the techniques become automatic. Keep grounding tools accessible: ice packs in freezer, strong mints in your pocket, textured objects to touch.

Track patterns. Notice when you tend to dissociate. What situations, emotions, or stressors trigger it? Understanding your patterns helps you anticipate and prepare. If you know phone calls with certain people trigger dissociation, you can plan to ground before and after.

Be patient and compassionate with yourself. Learning to stay present when you’ve dissociated for years is difficult. Progress is slow and there will be setbacks. This doesn’t mean you’re failing—it means you’re working with deeply entrenched patterns that take time to change.

Find a therapist who understands dissociation. Not all therapists are trained in recognizing and treating dissociative symptoms. Look for someone with trauma training who explicitly addresses dissociation. If your current therapy isn’t helping, it may not be that you’re “treatment-resistant”—it may be that the treatment needs to be adapted.

Build your support system. Let trusted people know about your dissociation so they can help recognize and respond to it. Having external support when you’re disconnected makes a significant difference.

Remember that presence is possible. Even if you’ve dissociated for years, you can learn to be more present. It requires work, patience, and appropriate help, but many people significantly reduce dissociation and reclaim presence in their lives.

Finding Specialized Treatment for Dissociative Symptoms

Living with dissociative symptoms—feeling disconnected from yourself, your body, or reality; losing time; or being unable to stay present—creates profound distress and interferes with every aspect of life. Understanding that these symptoms are trauma responses and that specialized treatment can help you reduce dissociation and increase presence offers hope that you don’t have to continue living disconnected from your own life.

At Balanced Mind of New York, our therapists understand dissociative symptoms and know how to adapt CBT to address them effectively. We recognize that standard approaches often don’t work for dissociation and that specialized adaptations are necessary.

Our approach includes comprehensive assessment for dissociative symptoms that often go unrecognized, psychoeducation about dissociation as trauma response, extensive teaching and practice of grounding techniques, working within your window of tolerance to prevent triggering more dissociation, building awareness and recognition of dissociative states, carefully paced treatment that doesn’t rush into trauma processing, body-based interventions to reconnect with physical experience, and titrated trauma processing when appropriate.

We understand that dissociation fundamentally involves being disconnected from present awareness and that this makes standard therapy approaches challenging. We adapt our pace, constantly monitor for dissociation, and prioritize grounding and presence as foundational skills before approaching other interventions.

We offer both virtual and in-person treatment options. For clients with dissociative symptoms, both formats can work well depending on individual preferences. Virtual therapy allows you to engage from your own familiar environment, while in-person treatment provides face-to-face connection that some find grounding.

Whether you struggle with depersonalization and feeling disconnected from yourself, derealization and feeling the world is unreal, dissociative amnesia and losing time, emotional numbness and disconnection from feelings, difficulty staying present in important moments, or symptoms that seem to come from “going away” mentally, specialized treatment can help.

You don’t have to continue living disconnected from your life. With appropriate treatment that understands dissociative symptoms and provides tools for staying present, you can learn to reduce dissociation and engage more fully with your experience, relationships, and life. Presence is possible, even if it seems distant now.

If you’re ready to work with therapists who understand dissociative symptoms and how to treat them within a CBT framework, or if you’d like to learn more about our trauma-informed approach, contact Balanced Mind of New York today.

Balanced Mind of New York Specializing in working with dissociative symptoms using adapted CBT Expert treatment for depersonalization, derealization, and dissociative amnesia Virtual and in-person appointments available Comprehensive grounding-focused approach for trauma-related dissociation Therapists trained in recognizing and treating dissociative symptoms Contact us to schedule a consultation and begin reconnecting with present moment

Dissociation protected you when you needed protection. Now you can learn to be present safely. With specialized support that understands dissociative symptoms and provides effective tools for managing them, you can reclaim presence and connection with your life. We’re here to guide that process.