 Hello, Psych2Go viewers. Our guest for today's live stream is Emma McAdam. You may know her from the YouTube channel, Therapy and a nutshell, where she creates content centered on psychology and mental health. She's also a licensed marriage and family therapist. Emma's been a guest on Psych2Go before and we're so excited to have her here again to discuss the topic of derealization and depersonalization. Welcome, Emma. Thank you so much for joining us today. Hey, thank you so much for having me. I'm excited to be here. We are too. We're so excited to have you here. So can you tell us a little bit about yourself and your background? Sure, yeah. So I'm a licensed marriage and family therapist. I've been working in the treatment field since 2004 and I've worked in a bunch of settings like juvenile corrections. I worked in a wilderness, a couple of wilderness treatment programs, a couple of adventure treatment programs and residential treatment. And currently I do outpatient therapy in Utah. And how long have you been on YouTube? Let's see. I watched YouTube video up about six years ago. Wow, that's amazing. And I'm a big fan just on a personal level. Thank you, thank you. Yeah, I do love it. So yeah. Awesome. And just from starters, so just to begin on the topic, how do you define derealization and depersonalization disorder? I know those two terms are used interchangeably. So if you wanted to like define both separately, I just want to know like why people do it interchangeably as well, be interesting. Yeah. Yeah, so derealization is like where the world feels unreal. And depersonalization is where you feel like not a person or detached from your personhood. So if we break that down just a little bit, derealization often feels like when someone's experiencing really high anxiety, things might start to feel fuzzy or off. Things might like sounds might sound different or that time might feel really fast or really slow or they might feel kind of fuzzy and fuzzy. And so that's like derealization is like things just don't feel the way they normally do. Things don't feel real. Or depersonalization is you don't feel connected to yourself, to your body, to your mind or your soul. Like you feel like you're maybe floating above yourself sometimes. Or people, I've had one client who described this to me was like, I just don't feel like I'm a person. I don't feel like I'm like I'm a real person here. Like I'm looking at myself and being like, what is that? You know? Oh, that's interesting. What are the main symptoms to look out for in yourself or someone else? Mm-hmm. So usually, and I do wanna kind of make a distinguishing like to separate diagnoses here. So usually when we're talking about derealization and depersonalization, we're talking about when your anxiety gets so high that your body kind of creates this, or your brain and body kind of create what they call an airbag, where it kind of numbs or deadens your sensations or alters your sensation. So usually when we're talking about depersonalization, we're talking about it in conjunction with an anxiety disorder, sometimes a depressive disorder, and frequently with trauma. And trauma contributes to anxiety and depression. So the symptoms are, with those, you usually have a lot of anxiety, a lot of stress, things are building, things are mounting, or you're having a panic attack. And when they hit that climax of like kind of the worst, then your body creates this kind of like goosh, like in movies where you see people kind of separate out from themselves and things slow down, sounds different, or you just feel detached from a sense of reality, from your sensations, thoughts or emotions, or your sensations just feel really kind of weird. And those differences are important, right? And like diagnosing. They are. So when we do a differential diagnosis, a lot of people wonder like, does this mean I'm schizophrenic? Does this mean I'm like having a delusion here? And it's important to note that it's not, like derealization, depersonalization are connected with anxiety, depression and trauma. And schizophrenia sometimes has some similar symptoms, but they're not the same at all. Like that's a different diagnosis and comes with a lot of different symptoms. So if you're experiencing derealization, depersonalization, it's not schizophrenia, it's anxiety, depression or trauma. Okay, that makes sense. Because I was gonna ask, what does it have to do with childhood trauma? Especially because I know that for both disorders, dissociation is a major symptom. Yep, yep. So okay, I like to think of this from a polyvagal theory approach. So polyvagal is a body-based approach to understanding trauma. And if we look at your nervous system, when you're just doing your thing, your default setting is this safety mode, this rest, connect, digest, feed and breed, right? They say, so you're relaxed, you're able to enjoy connecting with people, you are interested in eating, your nervous system's kind of calm and it heals and stuff. And then when there's a threat, you bump up into this nervous system arousal or nervous system activation where you do the fight-flight-freeze response. And if you're gonna fight off that threat, you often have this heightened kind of, like your body goes into fight-or-flight mode, most people know what that is, but your heart rate pumps faster and your muscles get activated and all of that. And then the next step on this polyvagal ladder, actually I'm kind of doing it upside down, but you have this safety mode, you go into activation mode and when something is overwhelming, when the threat seems impossible to overcome, the third state of your nervous system is this shutdown response. So the shutdown response, and sometimes people refer to this as freeze, but there's a type of freeze where you're like, and you're really keyed up and you're like frozen, but like really at like a high activation level. And the shutdown response is like a switch gets flipped and you go down into this very old nervous system reaction that protects you from a danger that you can't escape. So I'm sorry if this is getting a little too technical here, but this shutdown response essentially numbs your feelings, it helps you dissociate from your feelings. So let's imagine you're a little baby Impala and a cheetah is chewing on you, like you can't kick it away, you can't fight it off. The only thing your body can do is make you just shut down, detach, not move. Maybe the cheetah will get bored and you won't be feeling it so much when it's happening. And then you just jump up and run away. Like I've seen videos of this where this has happened. So the shutdown response protects you from big overwhelming threats that you can't escape. So if we compare that to childhood trauma, that's what your question was, childhood trauma. And I'm like, here, let me teach you about the nervous system, but. Thank you for that. So childhood trauma, if you think about being a little kid in a chronic trauma experience, like where your family is abusive, a CPTSD experience, then there's frequently these experiences you can't escape. They're frequently painful. You're frequently scared or you're unable to connect with someone for safety. So maybe people are yelling and you're all alone or maybe you're in threats of physical or sexual violence and you can't escape it. Your body is gonna shift from feeling safe to feeling activated. And it's like, well, I can't escape. There's nothing I can do about this. Let's dissociate to protect my human. That's what your brain will do. It'll trigger that dissociation response as a protective mechanism. And to protect you from those painful feelings, it can kind of like flip a switch that's like, okay, let's make you not feel real for a little while while these bad things are happening. And it's a good protective mechanism in the short term. But if it's a habitual response that becomes learned and you know how neural pathways work, the more you do something, the more likely your brain wants to do something. Eventually that defense mechanism becomes habitual and it's no longer helpful. So now maybe as an adult, you're in a work meeting and you feel a little stressed out. And then all of a sudden you like that switch gets right and you're no longer connected to yourself. And that can feel quite scary too. Yeah, and as a result when you dissociate, could you become emotionally numb? Is that what it is as well? Like a numbness, especially over time? Yeah, numbness is a really big part of it. Yep, so as you dissociate, yeah, emotional numbing is a big part of it. Emotional blunting or feeling separated from your emotions or shutdown. And then you mentioned in one of your videos on depersonalization that dissociating occasionally doesn't necessarily mean that you have the disorder. So how can someone tell the difference? That's a good question. I think in general, and we could pull up the DSM, we could pull up with the diagnostic manual says, but in general with these disorders, when they're persistent, when they happen frequently, when they're unwanted, and when they interfere with your ability to function in your life. So they're interfering with your ability to connect in your relationships or to do your job or to just feel okay in your life that usually indicates that it's time to get some help. Yeah, and so the feeling of being outside your body, I mean, is that common for everyone to experience or is that just something that happens to something? Can everyone like kind of relate to that? Really? You know, I think, I don't have the numbers on that. I don't know, but depersonalization, where you feel separate from your, from yourself is kind of a unique situation. And I was looking at some numbers and it said, up to 50% of people with depression have experienced some form of derealization or depersonalization. So it's more common than we think, yeah. More common than we think that they maybe would experience this. And then again, I think I read somewhere people with panic attacks, maybe 17 to 30% of the time experienced this feeling. And then how can someone be diagnosed with derealization or depersonalization? Like if they were wondering if they have it and they wanna find out. Yeah, yeah, you would definitely wanna work with a licensed mental health professional. So sometimes doctors would diagnose this, but in general, you'd go to a therapist or counselor with a degree and they would go through the checklist with you and decide if that diagnosis fits your situation best. And I was gonna ask, like, how is someone diagnosed maybe like if they don't know that they're going through it? Because a lot of people, like when I was reading about it, I was shocked. I was like, oh, this is something I think I might have experienced. And I didn't even know this was an actual disorder. So like, have you ever like diagnosed someone and then maybe they didn't realize they had it, you know, in that situation. So this is interesting because I really, I think of this as a good question. I've never personally diagnosed someone with this diagnosis for two reasons. One is because in my mind, it often just falls under the category of trauma. So when I'm working with someone with trauma, I think of this in the whole context of a nervous system approach. I think of this in the whole context of a trauma-informed care. And for me, like the thought of dissociation, depersonalization, derealization is a symptom of PTSD and we're treating PTSD. So usually the label that we go with if we want to get funding. So I'm also kind of, the second reason is I'm kind of like at arm's length with diagnoses. I have a love-hate relationship with diagnosis. Diagnoses are absolutely helpful when we want to communicate with other people, when we want to get funding for our treatment, when we want to do research, diagnoses and labels are really helpful. And when people over identify with a diagnosis and say, well, this is who I am. This is how I am. This is something permanent about me. Then diagnoses can create a little bit of learned helplessness and a little bit of, cause a little bit of harm there. So that's one of the reasons why I don't, I'm kind of arm's length with diagnoses like these. But understanding the symptoms and giving the symptoms a name, like, oh, this is a dissociative episode. This is what dissociation or derealization is. And there's a name for it. Now someone can come to me and say, well, I had a derealization episode or I'm experiencing derealization is something that's really helpful for people. So going back to what you said, have I ever diagnosed someone with this? There's definitely been times where I'm working with someone with PTSD and I'm like, and they're having a dissociative episode where they're feeling derealization or something like that. And I'm like, hey, this is what you're experiencing. Did you notice what led up to it? Let's talk about the triggers. Let's talk about what's going on mentally for you or the stressors you were having that led to things getting so overwhelming that your body decided, oh, let's protect my person by triggering this response. So definitely helpful to add that languaging. I've never worked with someone who experienced these symptoms all by themselves. And I know there are people like that. I saw a video, I think it was on the BBC. There was a YouTube video from the BBC about someone in England who they just have felt like depersonalization for years, years and years. And that's kind of their only diagnosis that they mentioned. But for me, I usually kind of put it as a subdiagnosis under depression, anxiety or PTSD. It's perfect that you touched on that because I was about to ask that. What causes derealization and depersonalization? I know you said childhood trauma is a big one. So if you could expand on that and also maybe some other possible causes for it. Yeah. I mean, I worked with a client who had bipolar disorder and when he was hypomanic, so he had bipolar too, when he was hypomanic, which is a low mania, he just felt like highly energized for like a week, twice a year. He just felt like a lot of energy, went out and bought some stuff and like was excited. And then for the other like six months of the year at a time, six months and then a week and then six months of the week. He would just feel kind of like low and down and dead and numb. And that would be like in that situation, I do think it was bipolar that was really directly contributing to those feelings of derealization. Like he just felt kind of numb, numb, numb. And in that situation, bipolar is probably a better diagnosis for him. I think in general, when we look at how stress works, depression is usually preceded by high levels of stress and an anxiety disorder is essentially about stress and PTSD is about chronic stress. Well, see PTSD, like when we talk about childhood trauma, abuse and neglect, PTSD by itself can be a short-term stress, a very acute stress that then becomes chronic by the way we look at it. So what causes depersonalization and derealization? My conceptualization of it is when your nervous system gets overwhelmed by stressors that you aren't resolving. So you've got these things coming up in your life, maybe with anxiety disorders, it's like worry. And you just worry and you worry and you worry. This is the main stressor that causes generalized anxiety disorder and you're constantly worrying and worrying and worrying. Then eventually the long-term effects of that is that your internal mental reserves and your physical reserves get worn down and you don't have the ability to kind of face those worries anymore. And your body's like, I'm overwhelmed. Life is too overwhelming. My human is too overwhelmed. We've got to revert to this shutdown state to protect my human. And so that kind of triggers that derealization experience. And with depression, I think chronic stressors, well, first off, internal stressors like beating yourself up, constantly telling yourself you're a bad person. And that can also stem from having been told you're a bad person or being mistreated as a child, right? But just constantly feeling like everything's awful, catastrophizing, so these cognitive distortions. These are all essentially stressors. They're threats. Your body perceives them as threats. Your brain perceives them as threats. And with depression, I think my favorite conceptualization of depression is when your system gets overwhelmed by adversity, it goes into, again, like a kind of a shutdown state. So, yeah. I love that you brought that because I think that you're the first person on YouTube to actually really sort of lump it in in a good way, like lump it in with childhood trauma and complex PTSD, like even in our own videos, I've never seen the connection and now I see it, like the stress makes someone dissociate and I can see how it would cause that. And I was gonna ask, so when it comes to disassociation, what are the, from what you've seen, what are the emotional and physical manifestations of that? Well, dissociation is interesting because it's like leading up to dissociation or depersonalization, derealization, leading up to it, the emotions are often big, intense, loud emotions, like fear, stress, shame, shame is a big one, discouragement, and so, or especially anxiety, agitation, and fear, right, the aspects of fear. So as people lead up to dissociation, there's generally this like building and building and building and building and when people don't have the resources or they don't have the support network or they don't have the skills to take those emotions one at a time and process through them and work through them and resolve them. So let's say you're like your little kid and your parents are fighting and screaming and it's scary all the time in your house and they don't let you talk to anyone or you don't know, you don't have words for it, right? Those emotions get bottled up and they just build, they just build and then, and we're super resilient, like humans are super resilient. We all have an inherent ability to resolve emotions, to resolve stress, but the problem is when it happens too fast for us to manage, we get overwhelmed or when it happens for too long. We have like reserves and we have reserves and we're resilient and we keep trying and then at some point our body's like, okay, that's enough. Like I'm not gonna be dealing with this anymore. We gotta protect your brains. Like I'm gonna protect my human by just like detaching and it's not like people do it on purpose. It's not like people do it intentionally. It's just something that happens. And so a lot of times people can feel kind of out of control about it. Like this is something that happens to me, really messes me up. Oh, one of the other features that I forgot to mention is kind of a loss of time. People feel like they don't, they lose time. Like they forget stuff, they don't store memories or they feel like time passes really fast. Like everything's happening so fast, I can't deal with it. And I also heard that memory loss is associated with it. Yeah, that's one of the things I meant. Yeah, like by, yes, memory loss, absolutely. Thanks for clarifying. That's kind of what I was trying to say. Yeah, and so with dissociation, when one dissociates, what is dissociation and what is it not? Like we already explained like what it is, but like sometimes people will say like, I'm daydreaming, I dissociated. Is that the same thing or? So humans are just, it's a good question, Michelle. So humans were really good at suppressing, avoiding, distracting ourselves from our feelings. We're really good at avoiding threats. We're really good at doing this in lots of creative ways. And daydreaming can be one of those, but so can defense mechanisms. Like me, like, oh, if I make a mistake at work or I'm a little nervous about my ability to perform at work, I might create a defense mechanism like blame, like, oh my gosh, I hate my boss. He's such a jerk. As a way to protect myself from feelings of anxiety around my ability to perform. And I made a list the other day of all the ways that we kind of are really good as humans at avoiding our feelings. And that can include daydreaming. It can include just mental avoidance, suppression, trying not to think about things, blaming lots of defense mechanisms, like blaming ourselves, blaming other people, making reasons, intellectualizing, and just straight up distraction. In addition to like other things like keeping really busy, like just staying really busy with something else. So I would consider all of these, even coping skills can be a form of just distraction and avoiding our feelings. I'm gonna try and cope. I'm gonna, even meditation can be used as a form of like coping. And in the short term, these things can work really well just for a moment. And then, but in the long term, if we engage in them too much, they become habitual and they stop us from living our life. They stop us from engaging with our problems and solving them and living our life direction because we become kind of dependent on them. So I would consider like daydreaming and other kind of short term distraction things as more of avoidance skills or maladaptive coping skills or defense mechanisms. I wouldn't necessarily consider daydreaming. It depends on how it's used. So if you're sitting in class and you're bored and you start daydreaming, and boredom isn't uncomfortable emotion, right? But you use daydreaming to like escape that boredom. Is that dissociation? Maybe, because if the situation got more intense, like the teacher all of a sudden like dropped a loud book or like started yelling at the class, you'd pop right back into reality. Yeah, I think that's the main difference. Yeah, right? Like it's like a lot of these distraction techniques, they aren't at the peak of your emotions. They're like all of the long-term little emotions. Whereas if you're having a trauma response or like a really strong dissociation response, the world can be burning and you're still just kind of like locked in a little bit. Because it's not, it's like at the peak level of nervous system arousal or nervous system activation is when that dissociation derealization happens. Now I do think it's possible to have it at a lower level and a chronic level like these people who experienced depersonalization for years. They might feel like a low level dissociation. I'm not gonna deny that that's a real experience for people. But in general, I would consider this like, if we look at, I'm doing this mental chart of like, okay, safety, activation shutdown. And like it usually happens when we're in the shutdown response, not when we're in like the mid-level emotional activation stage. So does dissociation sometimes like severe dissociation, maybe cause someone to be in a catatonic state almost? Is that almost what it sounds like? They're catatonic. It can, yeah, it can. If it's like severe trauma and grief. Yep, I've definitely worked with people who have kind of dissociated shutdown, not known where they were. We were talking to them. We were gently touching them and they weren't able to connect. They weren't able to re-engage. That's heartbreaking honestly, just thinking about it because I've seen that too. And so what are some treatment options that you recommend in a situation like that? So there's two things here. So the first thing is like, oh, if you are in a dissociative episode or you feel yourself dissociating, what can you do? And then what's the long-term option? I'm gonna start with the long-term option because a lot of times if you read articles on the internet, they all kind of say the same thing. Well, look at this. I'm going into the short-term option. Okay, all the articles on the internet here's the short-term answer to dissociation, right? The short-term answer is try to calm your nervous system down. Practice deep breathing. Use your senses to connect to your environment. So there's a lot of grounding skills. Most people who watch a lot of psychology stuff would know, but like re-engage with your senses. So one of the things they say is like, you can put a mint in your mouth or even better if you put something sour in your mouth and I'll tell you why. It's all about the nervous system. When our nervous system is relaxed, we release saliva because we're releasing digest, we're doing our digestive stuff, rest and digest is the parasympathetic response, the calming response. So you put something sour in your mouth that releases, you get the saliva in there and then it also triggers your nervous system to calm down, which is pretty interesting to me. So you could taste something, you could feel something, like this is when I'm working with clients who are actively dissociated. I'm like, what do your pants feel like right now? And they'll like pat their legs and they'll touch their pants and they'll feel the texture. They'll touch their face. You do sight, sound, touch, taste, smell. You're like, oh, what can I smell? What can I hear? And you try and reengage with your senses because often the present moment is safe. If we can re-remind our nervous system that we are safe, that'll help us calm down. So deep, slow breathing and sensory stuff are kind of the main treatments in a dissociative episode when you're right in the middle of it. The long-term solution is learning to process emotions. It's learning to work through those emotions so that they don't build up. So like if you've got a ton of stressors, like let's say you have stressors from your childhood, those aren't in the past, they're in the present moment. In the present moment, you have feelings of shame pop up or in the present moment, you have memories that are really painful that you haven't worked through or in the present moment, a little, like something outside happens, like maybe your husband gives you a piece of feedback that's like a little bit of criticism and you feel like a little kid again who's getting yelled at, right? And so in the present moment, you're having this reaction and you don't know how to solve this problem. You don't know whether you're a good person or not. You don't know whether, you don't know how to work through a relationship communication issue. So the solution to that is like learning to work through relationship problems or the solution to the job experience is like, oh, learning to either develop the skill you need at work or learning to treat yourself with so much kindness and respect that you can handle it even if you aren't good at something, right? So these are like all just, I just break them down into like the tiniest little skills and where do we learn to do these things? I mean, I think people are awesome. People who are learning these skills on the internet, people who are reading books and improving themselves, but really going to therapy can be one of the fastest ways to like learn these skills because it's hard to learn them on your own. Absolutely. We're like expected to know, right? But like unless you have someone who's like taught you that since you were growing up, it can be really difficult. And so is it almost like a way of preventing dissociation in the future to like knowing how to process emotions, grief, all of that. It helps prevent that dissociation in the future. Yep, absolutely. You can build skills and it's literally like a muscle to like work through really big emotions. I read a book by someone who, she was writing about somatic experiencing therapy. She's a trained somatic experiencing practitioner and she had had some childhood trauma. She learned these skills. She was practicing as a therapist and unexpectedly her husband died. And she said because of all the skills she had, she was so good at feeling her emotions and working through them that she was okay. Like of course she was sad and she was really good at feeling that sadness. And of course she felt grief and she was really good at feeling that grief. And so it didn't take her into this panic danger mode. It was like, oh, I am capable. I don't need to get overwhelmed. I'm capable of feeling these feelings and being okay. And I'm not saying that in a way like everyone should be fine when they experience grief. I don't mean it like that. I mean like we can just get really good at feeling. Absolutely, I could see that. Like if you know how to process the emotions then it can prevent like a more severe response later on. Yeah, absolutely. Yep, so like I look at some of these clients I've had who've experienced like CPTSD. And so like they'll start experiencing these little stressors like a little bit of work. Like work is stressful and then there's a little problem with their husband and that's stressful. And like, oh, they're worried about money and that's stressful. And you know, the childhood environment they grew up in they never learned to manage money. They never learned to like just basic like a basic skill like showing up to work on time. And obviously they're getting in trouble at work because they don't have that consistency. And that is one of the symptoms of trauma, right? Like disorganization. Like our executive functioning goes down. And then maybe they also feel kind of really shameful because of this childhood abuse. And it's like, as we work in therapy we teach life skills like, oh, how to set an alarm clock and how to show up and how to go to bed on time. Like how to regulate your schedule as much as like how to regulate your emotions. Like, okay, let's talk about shame. What are you ashamed of? Like shame dies in the sunlight. How do we process shame? What's the truth about this situation? Who was really at fault? And pretty soon that shame reservoir goes from like 10 to like, eh, like two. And all of a sudden every day they don't have all these like mountains of shame that they have to deal with. Their life is less stressful. And they're having less and less dissociative episodes as time goes on. Absolutely. And so that brings me to our audience segment where we answer your viewer questions. I'm really excited for this. Let's begin. So Kayla asks, Emma. So every time I see happy couples I dissociate because of my traumatic experiences with a really bad relationship. How do I overcome this? Ooh, such a good question. Yeah, it's a really good question. Thank you, Kayla. So the first question I would ask if I was doing therapy with this person which obviously this is not therapy, this is education but we're talking about like the treatment plan. So what would we do? We'd look at what's that feeling? What's that feeling you have that seems overwhelming when you see other couples? And is it sadness or is it guilt? Like I don't know. Is it grief? And then I would say, can we get good at working through that feeling? What would it look like if we allowed, what would it look like if you allowed yourself to feel that feeling for one minute? Wow. What would it look like if you made space for that feeling? And this is a really practical skill from acceptance of commitment therapy. It's called willingness. And I'm not trying to plug my own channel but the reason I made my channel so people could learn these skills. So if you Google willingness or if you search willingness in YouTube you'll probably see some videos of mine come up. And the idea is you create a present mode. Like so how do you feel feelings instead of dissociating with them, right? How do you feel feelings instead of dissociating? You get present with them, you expand. You like make space. Like I can handle feeling this intense amount of sadness and we don't judge feelings as good or bad. We accept them. We get curious about them. So you pretend like you're a scientist who has never felt sadness before and you're like taking notes on it like, huh, where do I feel sadness in my body? Huh, if I were describing sadness to someone what would it be like? We have what Buddhism calls a beginner's mind or we're just really curious about it. And then you can also just soften your body as you feel it. Like you just like open up and make some space while you feel these feelings and you would practice feeling your feelings instead of dissociating from them. That's the short answer. The acronym I just used there was peace. So like present moment, you get present instead of distracting yourself you stay here in the now, expand, accept, curious. I can't remember what the other E is. You'll have to watch one of my videos for it now that I'm bringing up my own acronym. That's why you're the expert. That's why I write things down. Right. If processing that grief or sadness from that old relationship feels so hard, there's a lot of tools that we use in therapy to do it. One of them is talking about it. One of them is letting people cry. Like, so sometimes people are like, oh, I can't feel that feeling because if I did I'd cry. But what would happen if you let yourself cry? Right, they have this that I can't show these feelings. And then the third one I would say is journaling, right? So like, okay, write about it. And if writing about it sounds so hard, do it for one minute. That was a really long answer for a short question. No, it's perfect. And I just wanted to ask Emma on that. So does processing the feeling, or I mean just sitting on the feeling and just allowing yourself to cry, does that help you process it? Sometimes yes and sometimes no. Emotion processing is more than one step. And so you can kind of feel the difference between feeling your emotions and moving forward and feeling your emotions and getting drowned by them. And I think working with a professional can help you know if you're moving forward with them because sometimes when you are moving forward with them it does feel like you're drowning. But if you're feeling them, I would say include movement because that third stage of the nervous system where you're in shutdown is immobilization. So if you're feeling them and you feel like you're drowning with them, try to take some action, like paint them, draw them, sing them, listen to a song about them, write them down. So like we just wanna avoid immobilization when we're drowning in a feeling. Yeah, we just wanna take some action. And then Alexis asked a really great question. What is the connection between ADHD and dissociation? Hmm, I'll be honest, I don't know. I will take a stab at it and say that if we wanna process emotions, it requires a couple of different steps like we were just talking about. And if we take, if we look at how ADHD affects the brain, a lot of it's executive function which is impulse control and motivation and making yourself do things you don't wanna do and organizing your thinking. And so with ADHD, it's hard to remind your brain what you're trying to focus on. With ADHD, so that's what the role of executive function in your brain is, is to kind of choose like, okay, I wanna be eating ice cream but I'm gonna choose to go for a walk or I should be working on my paper and instead I wanna watch TikTok. And so like the executive function kind of, the executive function part of your brain helps you do the things you don't wanna do. It helps with impulse control and motivation and stuff like that. So if you were dealing with dissociation and ADHD, then it might be a little bit harder to redirect yourself from this habitual learned response of dissociation. Like, oh, you've just been dissociating over and over and you need to break that neural pathway to shift your attention back to the present moment would be a little bit harder when you have ADHD because of that executive function piece. That makes sense. Thank you for clarifying that. And then Tasme asked, I don't wanna butcher your name but Tasme asked, I'm somewhat disconnected, detached all the time. Is it dissociation? It's happened for more than a year. So would you say that's dissociation? So dissociation is connected with OCD and that can happen, OCD is no longer in the chapter on anxiety disorders in the DSM like they are a little bit different but OCD is connected with high anxiety and high anxiety about thoughts. So if someone with OCD, if this is really OCD where you're having this thought or an intrusive thought and it just keeps replaying and replaying and replaying and replaying and you're focusing on that that can cause extreme distress and that could do two things, right? One of them is like a hyper focus on that thought or a hyper focus on fighting that thought where you get just as engaged in a process of distracting yourself from the thought by like doing all these rituals to not think of it whether they're mental or physical whether it's hand washing or whether you're counting in your head or doing something in your head to like avoid that thought or the other thing that can happen is your nervous system just gets so activated so anxious about this thought or so anxious about the situation that it does kind of trigger that switch and flip you into dissociation. So if you've been feeling like you're in dissociation for a year I would say like, oh yeah, let's treat that like let's definitely treat that like go get some help or start to learn the skills to deal with that thought differently and there are like practical skills you can learn to not get engaged in those thought cycles. And again, I don't mean to toot my own horn but we do have a course on managing intrusive thoughts on my website if people wanna take that course or I mean there's videos on intrusive thoughts out there if you wanna learn like some really practical skills, acceptance and commitment therapy teaches you to disengage from those thoughts a little bit and it's shown to be effective. Thank you and then Elsa asks how do you know if it's derealization or if you're choosing to disengage and it kind of fades out during an uncomfortable situation and you're getting lost in your thoughts. So is the question here I'm wondering if the question here is like, oh, is derealization something that happens to you and is disengaging something that you do? Yeah, I think that's why it's like, how does she asking kind of like, how do I know if it's like a choice? So if I'm doing it like, or if it's just something that's happening to me. Yeah. And I would say, I don't know but what does matter is what you can change. So we look at we say, what is in your control right now? And I think sometimes people have this idea with derealization or with any diagnosis that a diagnosis, like especially mental health diagnoses that a diagnosis is something that happens to you and that everything else is your choice. And the truth is it's a lot fuzzier. I'm certainly not gonna blame people for their diagnoses. Like it's not your fault if you're experiencing a mental health condition but there's usually quite a bit you can do about it. So I would worry a little bit less about like, oh, is this something that happens to me or something I could do something about? And I would instead focus on, well, how is, I would ask these questions. How is it impacting your life? Is it impacting your life negatively? I would ask the second question would be, what do you want your life to be about? What are your values? And this is all straight from acceptance of commitment therapy. This is the work we do in acceptance of commitment therapy. What do you want your life to be about? Is this dissociation or disengaging? Whether it's derealization or just you're choosing to disengage. They overlap, right? It's a spectrum here. It's not just like one of them is something that just happened to you. It's like the spectrum of like, okay, biology, psychology and your choices all add up to make this. So what do you want your life to be about? Is this interfering with it? And then third, what can you do about it? So either way, whether it's intentionally kind of disengaging with reality because it's painful, or that's just such a habitual response that you learned over the last 20 years of childhood trauma that you can't really stop yourself from doing it. Either way, the same treatment approach is I want to learn skills so that I can be intentional about what thoughts and feelings I act on. I want to learn skills so that I have more flexibility in my life so that I can live the life I dream. So if I want to be engaging with my family, I want to be engaging with my family, but I have these old memories that make me feel ashamed. And then I just shut down and then I disconnect from my family. I'm like, okay, I want to learn to work through these old memories and the shame so that I don't disengage when I'm hanging out with my family. And so I would just ask yourself the question, what can you change? And it would be learning to be more present with your feelings. Thank you, Emma. And then Hannah asks, how do I express what I'm feeling to other people? I have autism and it makes it hard for me to express my emotions. I think this is a great question. It is a great question. And I think it's a really hard question even for people who are neurotypical. It's hard for us to like, I don't even know how neurotypical I am, but it's hard for a lot of people to express and explain their emotions. How do I express what I'm feeling? If we were to take this from like just baby steps, the first thing I would say would be like, let's get words for what you're feeling. Let's develop words for what you're feeling. And it could be helpful to even just print out a list of all the emotions. And like in a situation, you could like circle the ones you're feeling and be like, yeah, this, this, this, right? Or the other thing, one of my new favorite apps, and these are not sponsored in any way, but one of my new app, my new favorite apps is called Lotus Bud and it's free. And what it does is just throughout the day, it just prompts you to check in with yourself and your body. So like you can set it to go off a couple of times an hour or just one or two times a day. And when it goes off, it would, you could say, okay, how can I identify what I'm feeling? What am I feeling right now? So Lotus Bud goes off, it chimes. You say, okay, right now I'm feeling excited. And then you find the word for that and just practice finding words for it. That would be the first thing I would say. Now, the second thing, like people express feelings, we're not talking about just identifying, that's the first step is like noticing, naming what you're feeling. And then the third step would be actually putting it into some other form of communication that other people can understand. And the easiest one is words, but for a lot of people that's not the easiest one. And if you're neurodiverse, it might include art or music or memes or emoticons or sometimes like you just find a meme that just like speaks to your experience. And you could share that with other people. So there's a lot of ways to express your feelings. Isn't that such a good feeling when we find a meme we can relate to? Right? You're like, oh boy, it's so relatable. That's facts. And then Ms. T asks, how can someone support someone with derealization, depersonalization? This is a really, really good question because I think that we need to like, we need that education to like support people. Yeah. So if someone's right in the middle of an episode or like a dissociative episode or they are like feeling unreal, like helping them reconnect to the present moment, like redirecting your attention. Hey, it looks like you're zoning out a little bit. Can we come back to the here and now? Like giving little prompts like that might be helpful or learning yourself as a parent, right? You could learn these skills yourself, like how to get grounded, how to ground your nervous system, how to get present, how to practice a little bit of mindfulness in a healthy way. And then you could teach those to your kids with younger kids. Like sometimes when my kids are really upset, I'll help them just notice like a physical sensation. Oh, can you feel how soft that blanket is? Can you feel your teddy bear? And then on an emotional level, connection is the opposite of dissociation. So connecting with someone on a real emotional level is the opposite of dissociation. And connection is one of our greatest forms of safety, dissociation is a defensive mechanism when we feel like we're in danger. So connecting with them on an emotional level is kind of an antidote to dissociation. So having real conversations with them, making eye contact with them, hugging them, touching them, asking them how they're doing, checking in with them on their emotions. All of these forms of connection are grounding for the nervous system. Awesome, thank you for that. And I just wanted to give a shout out to this person, to this viewer before I end the segment. Antonio said, I love it when two of my favorite channels collab. Aw, thank you. Thanks Antonio. Thank you so much. And so that concludes our stream and our interview today. Thank you so much Emma for being here. You're a friend of the channel and everyone was like requesting you on this topic. So thank you so much for being here today. That's cool. Thanks so much for having me, really appreciate it. Awesome. Well, thank you to our amazing intelligent viewers for being here today. It was amazing and we'll see you on the next one. Bye. Bye.