Trauma, Dissociation, And Grounding (Archived)

This evidence-based guide, written for clients, offers information and strategies to understand and manage dissociation in the context of trauma, focusing on grounding techniques and therapeutic interventions.

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Guide (PDF)

A psychoeducational guide. Typically containing elements of skills development.

Overview

Dissociation can be complex and intimidating even for experienced mental health professionals. Often associated with traumatic experiences, dissociation manifests in various forms and can pose significant challenges in therapy. Understanding the evolutionary and adaptive nature of dissociation provides useful insight into how it can help individuals survive extreme situations. This guide is designed to demystify dissociation and equip clinicians with practical tools and strategies to manage dissociative symptoms in traumatized individuals. It includes three sections focusing on why dissociation occurs, its manifestations after trauma, and actionable strategies for managing dissociation.

Why Use This Resource?

Dissociation is a critical consideration in trauma therapy, offering insight into clients' coping mechanisms. This resource provides:

A comprehensive understanding of the dissociative process and its adaptive significance.
Practical strategies for identifying and managing dissociative symptoms.
Insight into the connection between trauma experiences and dissociative reactions.
Techniques for enhancing client awareness and resilience through grounding exercises.

Key Benefits

Insight

Offers detailed explanations of dissociation and its role in trauma survival.

Tools

Provides clinicians with worksheets and exercises for client use.

Strategies

Outlines grounding and awareness techniques to manage dissociation.

Adaptability

Flexible integration with various therapeutic modalities focusing on trauma.

Who is this for?

Post-Traumatic Stress Disorder (PTSD)

Clients exhibiting re-experiencing, avoidance, and hyperarousal symptoms.

Dissociative Disorders

Including dissociative identity disorder, depersonalization/derealization disorder.

Anxiety

Where dissociative responses interfere with reality orientation.

Complex Trauma

Especially those with histories of prolonged interpersonal trauma.

Integrating it into your practice

Identify

Recognize symptoms and triggers of dissociation in clients.

Educate

Provide psychoeducation about dissociation and trauma responses.

Assess

Utilize provided worksheets to track dissociative episodes.

Ground

Implement sensory and cognitive grounding techniques.

Process

Facilitate narrative or exposure therapy for trauma processing.

Monitor

Evaluate the effectiveness of interventions and adjust strategies as needed.

Theoretical Background & Therapist Guidance

Dissociation is a psychological response to overwhelming trauma, allowing individuals to psychologically distance themselves from experiences that would otherwise be too intense to process. It is a survival-oriented adaptation—part of the body’s evolved defense system—that can interrupt awareness of pain, threat, or emotional overwhelm (Schauer & Elbert, 2010). While this mechanism is protective in the short term, chronic or unintegrated dissociation can interfere with memory, identity, and emotion regulation, and is commonly observed in individuals with post-traumatic stress disorder (PTSD) and complex trauma histories (Holmes et al., 2005).

Dissociation exists on a continuum—from mild detachment and daydreaming to severe depersonalization, derealization, and identity fragmentation. In the context of trauma, it often emerges during the "freeze," "fright," or "flag" stages of the defense cascade, when active escape or resistance is impossible. At these moments, dissociation reduces awareness of threat-related cues by disrupting sensory, emotional, and narrative continuity (Schauer & Elbert, 2010; Brewin et al., 2010).

Cognitive-behavioral conceptualizations emphasize that dissociation can become reinforced when it prevents emotional processing of trauma memories. Clients who experience dissociation may avoid trauma-related thoughts, images, or environments—interfering with recovery and maintaining PTSD symptoms (Hunter et al., 2003). Dissociation is also linked with disrupted autobiographical memory and difficulties in constructing a coherent personal narrative.

Effective treatment requires careful attention to safety, stabilization, and pacing. Grounding techniques - which bring attention to the present moment through sensory or cognitive engagement - are essential tools for reducing dissociative symptoms and widening the client’s window of tolerance. These techniques enable clients to remain present during distress and prepare them for deeper trauma processing work, such as written exposure therapy (Sloan et al., 2012; Wisco et al., 2013) or trauma-focused cognitive behavioral therapy (TF-CBT), with or without imaginal exposure (Spence et al., 2014).

By understanding dissociation as a functional survival strategy, therapists can approach it with compassion and precision—supporting clients to reconnect with themselves and their experiences, safely and gradually.

What's inside

Comprehensive guide explaining the nature of dissociation.
Worksheets for recording and understanding dissociative episodes.
Grounding and stimulus discrimination exercises.
Strategies for written exposure therapy.
Therapist guidance for managing and integrating dissociative experiences.

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FAQs

Dissociation is a process where a person feels detached from reality, often as a protective mechanism during trauma.

While PTSD involves a cluster of symptoms like flashbacks and hyperarousal, dissociation specifically refers to detachment from reality or self.

Grounding techniques are strategies designed to bring an individual back to the present moment, reducing dissociation by focusing attention on sensory or cognitive tasks.

Yes, without proper training and understanding, attempting to process trauma can heighten dissociation, making grounding and safety assessments critical.

How This Resource Improves Clinical Outcomes

This resource supports clinicians in effectively managing dissociative symptoms associated with trauma. It can:

Enhance clients' understanding and coping skills.
Reduce the frequency and intensity of dissociative episodes and facilitating therapeutic progression.
Expand clients' windows of tolerance through grounding techniques.

References And Further Reading

Brewin, C. R., Gregory, J. D., Lipton, M., & Burgess, N. (2010). Intrusive images in psychological disorders: Characteristics, neural mechanisms, and treatment implications. Psychological Review, 117(1), 210-232. https://doi.org/10.1037/a0018113

Holmes, E. A., Brown, R. J., Mansell, W., Fearon, R. P., Hunter, E. C., Frasquilho, F., & Oakley, D. A. (2005). Are there two qualitatively distinct forms of dissociation? A review and some clinical implications. Clinical Psychology Review, 25(1), 1-23. https://doi.org/10.1016/j.cpr.2004.08.006

Hunter, E. C. M., Phillips, M. L., Chalder, T., Sierra, M., & David, A. S. (2003). Depersonalisation disorder: A cognitive-behavioural conceptualisation. Behaviour Research and Therapy, 41(12), 1451-1467. https://doi.org/10.1016/S0005-7967(03)00066-4

Schauer, M., & Elbert, T. (2010). Dissociation following traumatic stress. Journal of Psychology, 218, 109-127.

Sloan, D. M., Marx, B. P., Bovin, M. J., Feinstein, B. A., & Gallagher, M. W. (2012). Written exposure as an intervention for PTSD: A randomized clinical trial with motor vehicle accident survivors. Behaviour Research and Therapy, 50(10), 627-635. https://doi.org/10.1016/j.brat.2012.07.001

Spence, J., Titov, N., Johnston, L., Jones, M. P., Dear, B. F., & Solley, K. (2014). Internet-based trauma-focused cognitive behavioural therapy for PTSD with and without exposure components: A randomised controlled trial. Journal of Affective Disorders, 162, 73-80. https://doi.org/10.1016/j.jad.2014.03.009

Wisco, B. E., Sloan, D. M., & Marx, B. P. (2013). Cognitive emotion regulation and written exposure therapy for posttraumatic stress disorder. Clinical Psychological Science, 1(4), 435-442. https://doi.org/10.1177/2167702613481066

Unified Protocol For Transdiagnostic Treatment Of Emotional Disorders In Adolescents

Trauma, Dissociation, And Grounding (Archived)

Download or send

Guide (PDF)

Overview

Why Use This Resource?