Depersonalization and Derealization w/Dr. Claudia Hallett (Episode 177)

Dr Claudia Hallett 0:01

This oddness, this sensation of feeling disconnected from yourself. Not recognizing themselves in the mirror, looking at a body part and thinking, oh, that doesn't belong to me. The derealization, the sense of unreality of the world around me. So I just feel really detached from what's going on, feeling like you're trapped behind a kind of pane of glass or there's a veil between you and the outside world.

Drew Linsalata 0:25

So impossible to describe and know what someone else feels, that meaning-making mechanism in our brains. Like, oh, what does this mean? It's fertile ground for catastrophic interpretation.

Dr Claudia Hallett 0:34

People don't know what this is when they're experiencing it. You're going to be prone to catastrophic thinking and jumping to these kind of worst-case scenarios.

Josh Fletcher 0:42

If you are listening here and you have got DPDR, it's like, no, you can get to a good place with it. And you can always change your relationship. So that's something that can never be taken away from.

Drew Linsalata 0:52

Welcome to Disordered. This is episode 177 of the podcast. Today we're talking about depersonalization and derealization, otherwise known as DPDR. We have a special guest who we will introduce in a second. I am Drew Linsolata, one half of Disordered. I'm a therapist that specializes in treating anxiety and anxiety disorders, practicing in New York, former sufferer of the very things we talk about on this podcast, better now, author, social media guy, podcast host, guy who spends too much money on microphones. And I'm joined as always by my esteemed co-host.

Josh Fletcher 1:24

I'm Joshua Fletcher, also known as Anxiety Josh. I'm a psychotherapist based in Manchester in the UK, sufferer of many anxiety presentations, including DPDR. So I'm very excited for today's guest. Something we've spoken about before on this podcast, but it's nice to get someone else to shine a light on it, too. Absolutely. And um, yeah, I'm um love doing this podcast and episode 177, true. Like my gosh.

Drew Linsalata 1:51

Uh if you've listened to all 176 beforehand, you're definitely going to get better. Because if you can endure this, you you're good.

Josh Fletcher 2:00

Exactly.

Drew Linsalata 2:01

That's ERP. 100%. So, Josh, why don't you introduce our esteemed guest here?

Josh Fletcher 2:07

Oh, I think we'll escape her to introduce herself. That'd be really nice if we're joined today. Who are we joined by today?

Dr Claudia Hallett 2:13

You are joined by Dr. Claudia Hallett, who is a clinical psychologist based in London. And I am somebody who works exclusively all of the time with clients who've got depersonalisation, demonisation, disorder. So there is a specialist clinic for this in um London with the Maudsley Hospital. So it's something I've run and led for the last sort of eight years or so, and I also work in private practice.

Josh Fletcher 2:38

Oh wow. I didn't know there was a specialist clinic for DPD. No, I just saw a post you did online and I was like, oh wow.

Dr Claudia Hallett 2:49

Forget today.

Drew Linsalata 2:51

I mean, not that we're that, you know, audience is that I mean it's big enough. You're gonna have to build a new wing on this. So we'll we will, of course, at the end of the episode let you know how to contact Dr. all that stuff. So if you want to try to work with it. But uh okay, cool. I love it. Specializing in depersonalization and derealization. I mean, Josh, I mean, it I it's a thing that I I felt all the time. It's still, even though I'm 100% no anxiety disorder fully recovered, if I'm super stressed, I'm gonna feel it. It's a stress thing for me.

Josh Fletcher 3:22

I get DPDR now and then, usually stressed, uh, not sleeping, and all that. Um yeah, I sometimes still get it sometimes in like supermarkets and shopping centers. And I'm like, I don't it doesn't bother me, I don't really care. But it used to freak me out. And it was the very thing that triggered my anxiety disorder. Uh, that along with a panic attack, along with existential OCD, a really cool trifecta of things. Um, and the DPDR was one of them. Um, but let's get let's get uh the expert to talk about it. What what what is DPDR, um Dr. Claudia? And what kind of what are the some of the like common presentations that you see in the in in the specialist DPDR wing?

Dr Claudia Hallett 4:06

So I guess as you guys have talked about loads, this this oddness, this sensation of feeling disconnected from yourself will be the kind of depersonalization arm. So people use a lot of metaphors talking about like not recognizing themselves, themselves in the mirror, looking at a body part and thinking, oh, that doesn't belong to me, or sort of having this kind of disconnection from self is that depersonalization part, and then the derealisation part, which they kind of typically go hand in hand, but you've got the sense of unreality of the world around me, so I just feel really detached from what's going on in my environment or in my relationships, and can use sort of metaphors of feeling like you're trapped behind a kind of pane of glass or there's a veil between you and the outside world. So people typically tend to sort of use metaphors, I think, to convey their experience because they can be, as you know, both nodding, it's really hard to describe and pinpoint the kind of the essence of this feeling sometimes.

Josh Fletcher 5:04

Yeah, I think that's really well put. Yeah, well, that kind of summarizes mine. My I always felt like I was like in the matrix or something. Just like, whoa, have I seen have I peered into the source code of this simulation I'm in?

Dr Claudia Hallett 5:19

People use so many references from yeah, you're right, sort of the media.

Drew Linsalata 5:23

It's really disturbing. I I think it's one of the best examples in the work that we do of why of how subjective experience can never be truly shared. Because we can't, we struggle to describe it, put words to it, and I think it leads us for me. I interpreted it as I have no idea what this is. It was such a disturbing feeling the first time it ever happened to me, and it was part of my first panic attack. I was like, oh, this must be what it feels like, like when you're leaving your body. Like I thought I was dying. That's what I assumed it was. It was terrifying. And I think because it's so impossible to describe and know what someone else feels, that meaning-making mechanism in our brains, like, oh, what does this mean? What's happening because of this? I need to know what this is. It's fertile ground for catastrophic interpretation.

Josh Fletcher 6:07

Yeah, absolutely. Yeah, um yeah, I it used to go, your your threat response, my threat response, I think just pieced everything together. It was like, this must be evidence that I'm losing my mind. My most common thought was like, Yeah, what if I'm going crazy? You know, do you hear those a lot in in practice?

Dr Claudia Hallett 6:26

Yeah, absolutely. There's a sort of really common ways that, as you say, people don't know what this is when they're experiencing it. So if you're anxious anyway, you're going to be prone to catastrophic thinking and jumping to these kind of worst-case scenarios. And, you know, I've broken my brain, I've got psychosis, I've died already, this is what death must feel like. You know, there's no alternative explanation out there because the medical professional you've spoken to just looks at you blankly, or the internet turns up some really scary responses. That's where people can land with just trying to, as you say, make sense of and find a meaning to this. And it can add then to people's overwhelming and anxiety with the condition.

Josh Fletcher 7:06

Yeah, I yeah, I just had sorry, I just had this uh really funny intrusive thought. I'm trying to imagine what the DPDR clinic looks like, and there's just loads of like surreal Salvador DALI artwork, everything just done intentionally to trigger everyone.

Drew Linsalata 7:21

That's it. They put their wall covering up on an angle just to mess with you.

Dr Claudia Hallett 7:26

Like to show people the NHS budgets did stretch it out far.

Drew Linsalata 7:31

The room, the room is not perfectly square on purpose.

Josh Fletcher 7:34

So like just purposely trolling everyone in there, like, are those hands really yours?

Drew Linsalata 7:40

See, I was thinking the opposite thing. Like the DPDR clinic waiting room is people just looking at their hands and pinching themselves, counting the bumps on the chair to make sure they're real.

Josh Fletcher 7:51

Yeah, yeah, yeah. Or or if I was in a sadistic mood, I'd I'd draw like a big long line that was five meters long, and I'd write, this line is one meter long.

Drew Linsalata 8:02

Wow. Yeah, I think um one of the things that I find most interesting is about DPDR2. And I'm maybe you you've seen this, Dr. Claudia. I don't know, but uh I'm not on TikTok, but I have like a 20 million view video on TikTok from what I did post it. And it's on DPDR, just explaining, hey, this is an anxiety symptom. I was shocked when a video gets that many views, you get a lot of comments. The number of people that said, Oh, I love that. So, like amazing the meaning we make of it. There are people like, oh, that's like a free acid trip. I don't even have to pay for that drug, and it feels I I love it. They like the feeling.

Dr Claudia Hallett 8:34

And those people will probably not be presenting to mental health professionals and needing treatment. And I think that that what that introduces is an alternative way of looking at this symptom. So that gives a sort of perspective that it might not be the symptom itself that's the problem, it's exactly the interpretation um that people make of it. And I often use that as an example. People talk about their drug-taking experiences as something that's kind of created this experience for them, but I remind them people pay a lot of money for those experiences sort of willingly and freely in their spare time. And so, again, it's not necessarily the experience that's the problem, it's people's interpretation and how that sits with their psychology.

Josh Fletcher 9:13

You must hear that a lot as well. Like, I just need the DPDR to go away, and then I will feel better.

Dr Claudia Hallett 9:21

Um which makes a lot of sense, doesn't it? If someone's terrified of it, they just don't want that experience, it's pretty natural.

Josh Fletcher 9:29

Yeah, and of but of course, you know, the old psychology trope, you know, like what you resist persists. It certainly applied to me, maybe you drew. But the more I obsessed, and there's always a massive crossover between health anxiety, OCD, and DPDR because everyone's obsessing and compulsing over it. But in general, it's like I become so frightened about it. Uh, you you just you can't seem to to do it. So what are the kind of I don't want to I want to frame this like correctly. I don't want it to be accusator of people going through this stuff. But in general, like and I can list some of my own, but like what are some of the main things that you hear and work with that it's people desperately trying to feel better, but it's kind of kind of maintaining or keeping DPDR's importance.

Dr Claudia Hallett 10:16

I guess the things that I see, you know, people who come for help for this are people who are really preoccupied by it to the point where they can't function and live a life that's meaningful to them. They've got really trapped in, as you say, maybe the obsession over it. Um, but there is a kind of a difference in how people experience it, whether it's sort of episodically, like you've talked about in a kind of panic attack type way, where this comes and goes with different stresses or at different um experiences, versus I guess in in our specialist kind of service, we'd see people who who've had it kind of chronically for you know this 20, 30 year period, and maybe it's less of a sort of anxious relationship that they have to it, but more of a kind of like depressive one or yeah, similar.

Josh Fletcher 11:04

Yeah, a lot of mine are often um yeah, did it hinged on the obsession. I couldn't stop looking at it. You know, it would probably be sometimes in the 18, 90 percent of my day, my waking day, was staring at it. And um, my compulsions are often like checking, is it better, is it worse, I'd avoid stuff like that. Is that is that kind of things that you hear in the in the practice?

Dr Claudia Hallett 11:29

Um and what you just said, actually, where you've got to with understanding it is actually this is more of an OCD kind of way of framing it, can be so revelatory to people because again, remember the symptom is just so overwhelming that they've got no frame of reference. But actually, if there's a story there with their obsessional thinking which has kind of had taken different forms in the past, and this is maybe a new iteration of the way that their brain gets really hooked on to an obsession, and then there's a kind of compulsive cycle, it can really just give people that that reference of, oh yes, I do know that that's the way that I can land with obsessional thinking this is another version of something that I've been doing for quite a while.

Drew Linsalata 12:11

And when it when it's so uncomfortable though, people will often, I'm sure you see this, you know, well, okay, it's not really the the experience or the physicality of it or whatever, it's the story you tell around it and the way you stare at it and you compulse over it. But the feedback is always, and I had this too. It was so scary to me that I would have argued the same thing. If I was in your clinic, I probably would have said this to you, like, yeah, but yeah, but it's so scary. How am I supposed to not make it the most important thing in the room? How how are you supposed to not just stare at it and try to fix it? It's so, but it's so scary, which is true.

Dr Claudia Hallett 12:44

And and and if we're really scared of something, we're gonna keep a really close eye on it. So I think over the course of therapy, you have to develop a less threatening or anxiously attached relationship to it as a concept because you're right, people come in at the start of therapy absolutely terrified of this symptom and having no other conceptualizational way of sort of relating to it at all. And so the point of I guess psychology and kind of what we call like a formulation is giving people a more compassionate understanding of why it totally makes sense that that symptom showed up for them when it has, and that can start to lessen their fear association with it, I'd say.

Josh Fletcher 13:19

Yeah, a lot of it is fear of DPDR, it was for me, and I think Drew as well, like sometimes you'll get it, or sometimes I will just get it, but I just don't care. Right because I know it will pass, it doesn't mean anything. That's just what my brain does when it's stressed, you know. It's a bit like I used to use an analogy like if I've just had three pints of Guinness, I'm not gonna then worry why the room looks a bit far away, I look a bit off, and I look everything's dissociated. No, that's fun. I've paid for that dissociation, you know. Uh, and but sometimes I don't want to feel dissociated since I and it's usually because of stress. I mean, mine was like massive stress, stress upon stress upon stress and stress, and then suddenly, you know, um it's weird asking to go into your GP though, isn't it? What do you say to your GP? He thought I was losing my mind.

Drew Linsalata 14:07

I couldn't describe it. Uh my doc my my doctor gave me the confused dog, like head tilt, like what you know, another doctor who was very concerned, which was great for the anxious person who sees it as disintegrate. I saw it as disintegrating, like my personality. I don't know what it was, I was disintegrating. And that doctor was like, maybe want to send you for a psych consult. And I was like, No, like why are you saying that to me? Didn't understand it at all. Probably meant well.

Dr Claudia Hallett 14:36

I mean, you're you're speaking to you know, this point of underrecognition and underdiagnosis of this condition that so many clients have have gone through that cycle of like, how do I put it into words to get the under other person to really understand the kind of essence of what I mean? Because there's often a misdiagnosis of, oh, it's just anxiety, it's just panic, or it's get depression, and and they're kind of on this pathway that just doesn't really fit for them. And and it can take, I think, up to 12 years for somebody to kind of get an accurate diagnosis for you know depersonalization, derisation disorder, because it can exist as a symptom within other conditions, but it can also be a disorder in its own right that warrants kind of specialist support for it. So I think we're getting better. You know, this podcast is a testament for people actually talking about it and recognising it, and that will go some way to educating others in the mental health professional field and the GPs at sort of local level to just have an increased awareness of what it is that they're looking out for when kind of patients walk in and and speak to these symptoms and then they can go, oh yes, that's a dissociative kind of presentation, and there's a there's a name for that depersonalization.

Drew Linsalata 15:41

Can we talk about that for a second, Dr. Claudia? Because I I think people watching and listening are listening, I promise, we won't post the video. But like people listening are probably gonna wait, did she just say depersonalization disorder? I I know that a bunch of years.

Josh Fletcher 15:54

Yeah, a load of people are like, oh no, this is now special. Oh no, right.

Drew Linsalata 15:58

So can you can you fill us in?

Dr Claudia Hallett 16:01

Because disorder just means, you know, as we've you've talked about very, you know, eloquently about the the diagnostic manuals that we use as clinicians to try and sort of like find a rubber stamp name for something that we can kind of all know what we're we're talking about, and the goalposts kind of move with that quite a lot. But I disorder just means look, this is something that's bothering you to the extent that you can't live your life in a meaningful way. It's persisting, it's fairly chronic, and it's like the main focus of that's a good description of a disorder.

Josh Fletcher 16:31

I like things just yeah, I've got a disorder, yeah, yeah, yeah, yeah. If something's annoying me and it's chronic, and I can't leave it alone. Yeah, that's it. So let's learn, let's learn to leave it alone.

Dr Claudia Hallett 16:42

Because there's stigma attached to the word disorder, isn't there? If we kind of sit with that and think actually people are, oh, now I've got a disorder, and it I think it can then kind of start those wheels of like catastrophizing, and it's always gonna be like no hope, and I can never get any better from that.

Josh Fletcher 16:58

Yeah, but we we don't believe that. I mean, that's why we named our podcast disorder. It literally means not in order. Yeah.

Drew Linsalata 17:06

Right, the fear, fear before the the threat. Like it's legit. But and and I think especially in a world, and I promise I'm not gonna rant, you all know me, but in a in an environment where it is we are in an environment rich with nervous system and healing narratives, DPDR disorder sounds like my brain and my nervous system are legitimately broken down and somehow must be healed, or I'm gonna feel like this forever. You ever encounter that kind of thing? That's interesting.

Dr Claudia Hallett 17:34

I mean, I think the words themselves are really unhelpful to play against that as well, because they're very confusing and nonsensical. And so if we just shorten to DDD or DPDR, you know, that can kind of maybe alleviate some of that anxiety. But I think you make a good point.

Drew Linsalata 17:51

Triple D.

Dr Claudia Hallett 17:52

Triple D, the DDD.

Josh Fletcher 17:54

Um, and obviously people listening to this now are like, okay, we've heard this, we've got through it. Or um Drew and I right now, you I mean, you pract your the practice there uh and that organization exists because you must see a lot of people get better, right? You must see people get to good place.

Dr Claudia Hallett 18:08

The NHS is still commissioning us to support people, so you know our outcomes are are good for people, but I think I mean it touches on you know the recovery point that you guys mentioned earlier of what people are sort of hoping for and expecting by the end of treatment. You know, it's not a place where we cure depersonalization and no symptoms ever return.

Josh Fletcher 18:29

Look at this fruit bowl and that's normal. You are you are cured, yeah.

Dr Claudia Hallett 18:34

But we can help people with their psychology around it and sort of like getting back to a meaningful functioning life where this isn't the main obsession for them anymore and it's not got that yeah.

Josh Fletcher 18:45

In my experience, it goes away. Like I've worked with so many people over the years as a therapist, it will go away. But the irony is it goes away when it's not important, yeah. It never goes away when it's important, but when you prioritize other things in your life, like not that, not compulsing, Drew says values and stuff, the brain kind of just shifts it down the gears, and then it just doesn't become important. Like and then don't get me wrong, it will flash up now and then, but like thankfully, my threat response doesn't fire off when you know when it does matter because of all that response prevention work, I believe, Drew, uh, and stuff like that. There's so much response prevention around it that the brain's just decategorized it from mega danger to meh. Yeah.

Dr Claudia Hallett 19:31

Yeah, and I think that's a really lovely hopeful message to give to people where there's a sort of episodic presentation and it's kind of fear-based with the OCD loops that you were talking about. I think what can be discouraging sometimes for people who've got more chronic presentations is this kind of like expectation that it will therefore there is hope of it never being experienced again. But actually, they've lived a life sort of 40 years in in this way, and there's a lot of childhood attachment work there that actually is a lot of about it being a protective response that has been a necessary coping for them, and so to actually want to get rid of it, I I don't know whether that's actually a mutual goal that we would argue is is something that's necessary. So there's sometimes a slight difference in your conceptualization of the DPDR, depending on whether it's that sort of episodic way that you've both sounded like you've experienced and kind of recovered or got better from, and somebody where there's a bit more of a kind of a narrative of attachment trauma.

Josh Fletcher 20:28

Oh, yeah, absolutely. And it's trauma, it's sorry, Drew, like it's trauma. Like I mean, I put episodically, but I remember having it for three months non-stop. Like that was my reality for three months. It was very odd. Uh, but there are people, yeah, you work with people for uh uh that have had it for a very long time. Um it's interesting that as you were saying that, Claudia, this and I see this in practice and as a therapist a lot, it yeah, it's your conceptualized relationship with the so for some people it's wanting to be nurtured and saved, for some people it's perfectionists. Uh, we did an episode called Just Wanting to Win. Sometimes you just want to win. You feel like you've had something taken away from you, and there's hidden drivers of just wanting to win and beat a symptom. And I've won when insert symptom goes away. DPDR today, but it could be cardiophobia, it could be metaphobia, it could be something, whatever it does, whatever. Uh, but it's interesting, your relationship with the symptom is subjective often to the individual. It's not just fear, it's the drivers behind it, in my experience, anyway.

Dr Claudia Hallett 21:32

The the battle analogy is actually really good. You know, I can hear that kind of like tug of war, like I want to win against DPDR in that, and actually to drop the rope and let go of that battle. It's like a really big what? I I don't have to, I'm not in a fight. I I could drop the fight with it. Is it blows people's mind, and actually there's quite an ambivalence to that. Like, no, I'm I'm in this for the fight. Thank you very much. So that can be hard.

Drew Linsalata 21:58

I tend to try to shift people out of out of the battlefield and into the classroom. Like what if we turn this into a classroom and how to interact with this in a more productive way and you know find more need of mean meaningful narrative around it. I think one of the things that you might be addressing, Dr. Claudia, that we tend to not or uh because it doesn't show up for us, is the person who and we do see it. They're like on the fringe of the DPDR group in our audience and our I think our practice, or at least my practice, is the chronic presentation. You know I I have had this every waking moment for the last 17 years. And I think that it's hard for people to hear the message sometimes that that we might be saying because yeah but what about when it does it's not episodic. It's just there. What's the difference in your in your work or in your view of that?

Dr Claudia Hallett 22:45

I mean but both both clients get the same sort of like understanding you know framework around that like let let's look at when they started for you whether that was in kind of childhood or you know once when you were 20, what are the the factors that go into that as a kind of way of of needing to cope and respond to what's happened to you in in the world and so people will have early life experiences where they've just had to have that way of kind of distancing if we're looking at it through the psychological lens of being a protective mechanism from overwhelm and their kind of early life experiences have been incredibly overwhelming and a way to psychologically cope and function in this world has been to adopt a kind of dissociative you know protection that's caught got them through and they've they've survived and and and managed the last 30 years with that as a sort of shield that's rather than actually being something to fight and let go and wanting to let go of we start to reframe it as something that's been a really helpful necessary coping.

Josh Fletcher 23:51

I like that what what what drew you personally to this specialism interest.

Dr Claudia Hallett 23:57

I was working in anxiety and trauma and did my sort of specialist placement in my final year of my doctorate and my my research on that so we just I just happened to be training in a um clinic where there was a a specialist clinic next door called depersonalization disorder thought that looked interesting because it fits with my kind of trauma interest and sort of stayed the course.

Drew Linsalata 24:24

Oh I know I'm talking talking like I've done research yeah yeah all my extensive research into DPDR I I did an episode of the anxious truth years ago where I just like hey this is the way I came to cons I literally I I I formed my own sort of formulation of it that helped me change the compulsion and obsession about it was it's just a different my brain just perceives me and the world a different way. The world and me are still the same just the perception of it seems to have changed and stuff that normally I'm not aware of came to the forefront and that felt weird like I don't normally perceive myself and now I do like very strongly and it's weird. I don't know I have no research to back that up I said it in those episodes years and years ago like I I I made this up it seemed to work for me but I don't know how much of that like you said you're trying to help somebody reconceptualize or formulate what this is so they can change the way they deal with it. Is that something you try to teach people? Like you got to find a meaningful narrative around this and then work with it.

Dr Claudia Hallett 25:23

Yeah and and it's really bespoke it's really individual so I think sometimes the danger of things like social media is like just do X and then Y will happen and you'll be kidding. And that's why I've been like sufficiently angered enough to to venture into the social media space to be like nuance and and other things can also be true. And um yeah it's but it's a very individual where people land with their meaning of what's so bad about this DPDR experience for me. And that's then the work of like okay so what they then go on to do with that hyper monitor and focus on their symptoms ruminate on the onset event like have a load of safety behaviors that can kind of keep that symptom under control secret assurance from the internet like all of those are really individual ways that then that fear of the DPDR plays out.

Josh Fletcher 26:10

Yeah what's the what's the balance here and this that's something I'm very passionate about like there's a balance and and I as a psychotherapist and Drew there what's the balance between like reflecting on like origins and roots and things like that because Drew and I tend to not really focus on that we do and it's a if it's applicable if it comes naturally into the therapy really but what's the balance and particularly with social media in mind of almost obsessing and ruminating about origins of DPDR and actually focusing on the here and now because there are some therapists out there in different modalities that will that will almost kind of enforce their modality onto why you've got DPDR and I've seen it's very damaging for people like no you've got DPDR because you've not resolved this and that and yada yada yada which puts the onus on the on the client which then just makes them more obsessive compulsive and self-critical where's the balance between exploring okay maybe this is where it's at or maybe this is my attachment for those where attachment it is applicable it's not for everyone and kind of just kind of dismissing a lot of those narratives online. I see a lot of counselors particularly in the UK we're not we're not regulated here loads of counselors saying with utter authority no this is this because this is trauma and you must address the trauma and blah blah blah and I'm like that's so reductive and it's so like you're not making your own conceptualization and formulation of each client there. What's the balance there between that?

Dr Claudia Hallett 27:46

Sorry that was long-winded where's the balance between looking at the orange and dealing with the here and now well I mean social media is not the place for for balance so there's there's other agendas at play there when people position themselves online like that. But in the therapy room with your therapist where your hypothesis testing and trying out things between you of like they might have your therapist might have seen a pattern that you might not have seen yet and they might share that with you and say I wonder if it's something to do with this or have you looked at it through this lens before and that may or may not land with you and that's a conversation to sort of have as a dialogue of like actually I hadn't seen that and that does fit or no not that's not quite right. And so we we hypothesis test and we kind of it's a collaborative exercise right where you try and think where's this conceptualization gonna land for you that gives you a okay yeah totally makes sense now why I've developed this and I can see why I've ended up sort of in in these traps and cycles because of the way I've been sort of relating to it. So there is no one size fits all that's the beauty of the work of the therapy thing we do and social media is is very different from that.

Drew Linsalata 28:53

Yeah I I think we need to spend five minutes just rage baiting Dr. Cloria because I I I hear the I got sufficiently angry to venture into social media and you've mentioned it a few times like I just encountered my very first I did not know that this person existed I'm sure they're not the only one DPDR coach. I I have a person in my practice who was who hired a DPDR coach she's working so hard you guys can't see the video she's literally about to explode and that the experience was not a good one because it was a what I did this and this is how you fix DPDR and when the question came up and then we hear this all the time but I it doesn't that doesn't see me landing or am I missing something it became no no you're just not following the program right as if there is a program that fixes DPDR.

Dr Claudia Hallett 29:41

Yeah it does upset me and I I'm I'm I'm to the dark side so professional look at the professionalism because look vulnerable people are at the heart of you know Jay and Day out who I sit with in my clinic room who have been desperate to get themselves rid of this symptom. And so if you have somebody shouting very loudly on social media that they've got the cure that's marketing to a really vulnerable client group and I think that's that's really unethical and that's really disrespectful and that's really unkind ultimately you know there there is a professional code of conduct that we follow as mental health professionals in in in the work that we do. And that's our responsibility on on social media as well to sort of like speak to things that we think are are going to be exacerbating people's distress and where there's a sort of marketing agenda there for somebody else whereas actually the nuances in I guess what we're talking about where there is distress that's a very individual you know tailored piece of work that somebody's got to do and if it was easy as just follow these three steps you know services like ours wouldn't exist or yours either.

Josh Fletcher 30:53

Yeah that's really important. So be careful with listeners out of there or the DPDR coaches and stuff where lived experience for them applies universally. It's important. I had a bad experience though and I know many others I've had a bad experience in therapy with therapists and counsellors who have told me what my DPDR is with nothing and told me you know which was the last major OCD theme I ever had actually which was caused by my own counsellor who told me that being dissociated was because I needed to heal old wounds. And so I obsessed and compulsed I and bear in mind I went into my training happy I was very happy person you know and then it and then that no no you need to keep being introspective keep doing that keep going through traumas keep going through and the DPDR dispere and it just a bonfire honestly it was an absolute cluster ball of nonsense and then only realized when someone said sounds pretty OCD you've got there I'm like I know but it came from a not even a DCDR coach. There's annoying idiots are one thing but then when you come from a trusted authority so make sure I think my point is make sure if you're listening that they're informed by what they're saying and particularly if you're a member of disordered and you get here are the anxiety disorder informed as well there's a lot of stuff that you can do in the here and now and when it's trusted with a professional like Dr. Claudia you can go and do that where it's relevant.

Drew Linsalata 32:26

You know one of the things I I find interesting this conversation I'm sorry for stepping on you Claudia is what I'm getting from you and I'm loving this is when we talk about anxiety disorders, you know, like social anxiety is in the it's in the group but it's like the weird stepcousin of anxiety disorders because there's often other things that we got to talk about when when somebody has that social anxiety. Same thing with this one it this isn't just like every other anxiety symptom. I don't care that your heart is racing yeah I know your body's scared and doing but DPDR may be more nuanced than some of the other symptoms like air hunger or whatever when you say hey sometimes if it's a chronic presentation we got we might want to look at like well when did it start what was the precipitating event that matters so I'm finding that maybe I've learned today that DPDR could be a little bit more of a nuanced symptom as opposed to the other ones that we tend to like all the symptoms are the same. I have been guilty of saying it's just a symptom like every other I don't know if I'll say that anymore.

Dr Claudia Hallett 33:25

I'm glad we've maybe even expanded your conceptualization today then that's really good to hear because yeah it does exist as a symptom within different anxiety disorder presentations. So I might be listening to someone's story and thinking actually what's really going on here is there's kind of social anxiety is the main thing for you but you're getting episodes of like DPD or symptoms of DPDR within these social interactions but because it only exists within this kind of paradigm of when you're socially interacting and there's a lot of you know other things that would make me think conceptually this fits within a social anxiety piece of work then that's how I'm gonna kind of be thinking and going the the treatment in in that vein but it's not ignoring the DPDR. I think the the thing that people really feel I think strongly and rightly so is that this DPDR symptom gets ignored in the work that they do with their therapist. So it's then treated like as purely social and we kind of ignore the fact that you also said that you feel very disconnected from yourself and from the other person. It has to be integrated into the formulation and the the treatment when you're with a clinician then I think that does a lot of good for somebody to feel contained and and heard.

Drew Linsalata 34:31

Yeah I think in social anxiety it's the whole like yeah that social anxiety firestorm that happens if you go to a social event or something's coming up yeah it's an anxiety response like all the other stuff like panic disorder agoraphobia OCD but maybe it's because of what you see in the mirror your conceptualization of yourself may fuel that. And with DPDR I'm just drawing a parallel between the nuance on that and the nuance now in this one particular that I always seen as a symptom but like okay but it might not just be a symptom we might have to look deeper into it a little bit more.

Josh Fletcher 35:03

I'm just loving that that's all yeah okay also no no no of course uh also as well uh and you you you'll obviously get this as well but like it can be a symptom this disclaimer can be a symptom of PTSD as well and that does need its that does need its specific intervention.

Dr Claudia Hallett 35:21

Yeah can I raise my hand on that point so I can swear you you know you you you outqualify us please it's it's it's more I think I've just got multiple hats on in this conversation of thinking when I um teach and train other clinicians on this actually their main anchor point for dissociation is typically within a PTSD framework because of the way that we're taught and trained about dissociation is this very specific subtype of of a PTSD presentation where there's a dissociative component. So when you're in the room with somebody and they're recalling their memory they might be sort of detaching and you see that visually as a sort of like process and experience and all they're doing is thinking back to their memory but they're not being able to retain their presence and focus in in the um in the therapy room but that's typically like the average therapist's like only benchmark for dissociation so they automatically make this link with oh someone's got dissociation they must also have PTSD and now I'm going to run down a PTSD treatment pathway. And that's a problem because it's not always the case.

Josh Fletcher 36:20

Yeah maybe maybe but not always vast majority of members of disordered I would say that is not applicable. You know absolutely most people listen to this podcast will say no I it just came from nowhere I don't know where it came from and then it's in my only oh I can only call from my experience as a therapist uh it's usually obvious when it's the the the traumatic PTSD things like oh this is this is happening here in this specific moment or this that and this and that ah you know whereas sometimes people like oh sometimes I just am at dinner and I dissociate you know there was nothing trauma evoking about the peas.

Dr Claudia Hallett 36:59

You know I think that's it's why it's really important to get a sort of professional assessment on you know what is what is this that I'm experiencing and where does it sit sort of relative to a clinician's understanding of mental health difficulties. But I think people can read online think oh there's a trauma link I've definitely got to have had some big traumatic experience and then they get really obsessional about trying to find the big T trauma or the multi-separed traumas like you should like my OCD literally did that it was trying to find the big T and the weird thing is I've been through trauma wasn't even linked to my DPDR at all I'm just rehashing trauma.

Josh Fletcher 37:34

I'm like do I have to go for this again I feel like I'm alright with this now you know as as as alright as I can be you know trying to put out one thing to fix the other the other you know I'm trying I I don't know what I was trying to do. I'm putting putting the radiator on to try and make ice cubes I don't know what I'm doing.

Dr Claudia Hallett 37:51

Yeah so I hope that helps people then to sort of feel like you know this may not be trauma related and actually trying too hard to find a trauma might be part of the anxiety that's kind of causing them distress about it.

Drew Linsalata 38:03

Thank you isn't it so nice I know a professional that says that you can stop like searching for discount codes on bilateral stimulation light bars for home use you don't need that maybe so yeah one we're like 36 minutes in and I'm I'm cognizant of Claudia's time so we should probably have a part two because we got 36 minutes in and we never asked the question because I know that you guys are you're asking it in your own head it's just fine which is but how does she do this with people so we should probably have you come back and do another 30 minutes on sort of how but how do you do it but how does she treat it so we probably want to talk about that.

Josh Fletcher 38:42

But there's no magic technique it's subjected to the individual poof and there's a rabbit poof and there's flowers no uh but you can get better from it uh and we see it every day Chloe sees it every day Drew sees it every day um for me you know I got better when I realized that wasn't the problem it was it was triggering my anxious response that was the problem it was my misfiring anxious response that made me feel that DPDR was the problem um same as well though the obsessional later particularly around somatic or inwards experiences I've had the same relationship I did had with DPDR I had with tinnitus or tinnitus if I'm not tinnitus tinnitus say it right man yeah yeah aluminum foil and um is yeah and it was the same thing once the tinnitus goes away I can then feel anxious nope nope nope it was always the anxiety it was always the anxiety it was never actually the symptom visual snow another one no I'm getting these things in my eyes and once they go away I'll feel fine um no it was never that you know and um yeah I think uh if you are listening here and you have got DPDR it's like no you can get to a good place with it and you can always change your relationships like that's something that can never be taken away from you.

Drew Linsalata 39:59

Got anything to wrap up from the clinic before she explodes with rap.

Dr Claudia Hallett 40:04

I think you know I I'm so happy to have this conversation on so many levels because the main thing that people come and say is how alone and isolated they feel with this like they're the only one in the world that's ever experienced this and nobody can understand it. And that shame kind of around it and the stigma I think too just keeps people really stuck for a really long time. So it is brilliant to have resources like this that you can signpost people to and go hang on, there's a whole community of people out there the work of Unreal Charity who I'm you know very close with they they do such great work as well if people don't know about there's a specific DPDR charity in the UK who run free peer support groups for people who are you know a wonderful a wonderful space to to get um plugged into if people need that sort of sense of community because I think it's all about reducing isolation and stigma with this so people can have the resources that are sharing accurate evidence based information.

Josh Fletcher 40:57

I didn't even know about this charity. I didn't even know there was a specialist DPDR wing.

Drew Linsalata 41:04

There's like 4,000 miles of ocean that excuses me you live there dude like you didn't know I know yeah I know God well I'll tell you what we'll do is if you guys go to disorder.fm slash 177 or just look in the the description and whatever podcast app you're we'll make sure we have all of Dr. Claudia's links and a link to Unreal Charity but what a great resource I know he exists very good thank you so much for joining us.

Dr Claudia Hallett 41:28

Thanks for having me.

Drew Linsalata 41:29

We'll have you back for part two if you're willing.

Josh Fletcher 41:31

Looking forward to it yeah uh well thanks guys for hanging out appreciate it if you want to send in a did it anyway or ask us questions you can go to disorder.fm what else happens at disorder.fm uh if you want to be part of the community app you can you can join there's loads of resources workshops did it anyway feeds brave stuff um it's not mandatory it's just if you want a little bit of extra uh community to go along um we've also written a book on health anxiety called the disordered guide to health anxiety follow us on social media are you on the socials I am reluctantly now because the earlier point oh I'll for what what's the what's what's your tag doctor Claudia Hallett and I try and uh bring the new ones shall we say to the DPD for you Claudia Hallett go follow Dr. Hallett I will link it yeah I will link you for sure uh that's cool anyway yeah thanks guys and thank you so much for taking time out to to speak to us. Absolutely see you next week