Specialist Treatment for Depersonalisation & Derealisation
Feeling detached from yourself, disconnected from your emotions, or as though the world around you is unreal or dreamlike can be deeply unsettling.
For some people, these experiences are fleeting. For others, depersonalisation and derealisation become persistent and begin to significantly affect everyday life.
I am Dr Claudia Hallett, a highly specialist Clinical Psychologist and CBT psychotherapist specialising in the assessment and psychological treatment of depersonalisation and derealisation (DPDR/DDD).
Alongside my independent psychology practice, I am the Clinical Lead of the UK's national specialist NHS service for Depersonalisation and Derealisation Disorder at the Maudsley Hospital in London. I have over 13 years of clinical experience and have worked extensively with people experiencing persistent depersonalisation and derealisation.
My specialist clinical and research interest is in understanding the psychological processes that can keep DPDR going and using cognitive behavioural therapy (CBT) specifically adapted for depersonalisation and derealisation to support recovery.
What is Depersonalisation?
Depersonalisation is a feeling of detachment or disconnection from yourself.
People describe feeling as though they are observing themselves from a distance, functioning on autopilot, or no longer feeling fully present in their own body or life. Emotions may feel dulled or inaccessible, and familiar aspects of yourself can suddenly feel strange.
Some people describe looking in the mirror and feeling disconnected from their reflection. Others worry that their memories, thoughts or voice no longer feel like their own.
Although these experiences can feel frightening, depersonalisation is not the same as losing touch with reality. People experiencing DPDR are typically very aware that something feels different or unreal — and it is often this awareness that causes so much anxiety.
What is Derealisation?
Derealisation is a feeling of disconnection from the world around you.
Your surroundings may feel dreamlike, artificial, flat, distant or visually strange. Familiar places can suddenly feel unfamiliar and other people may seem somehow distant or unreal.
Many people with derealisation describe feeling as though there is a pane of glass between themselves and the world.
Again, the world has not actually become unreal. Rather, your experience and perception of it has changed.
Why do I feel unreal or disconnected?
There is rarely one simple explanation for depersonalisation or derealisation.
DPDR can occur in the context of anxiety, panic, stress, trauma, low mood or periods of significant emotional overwhelm. For some people, symptoms begin following cannabis or other drug use. For others, there is no obvious trigger at all.
One of the most important things I have learnt through my clinical work is that understanding what first triggered DPDR is not always the same as understanding what is keeping it going now.
Once people become frightened by the sensations of depersonalisation or derealisation, they can understandably begin monitoring them very closely.
Do I feel real today?
Do my surroundings look normal?
Why don't I feel like myself?
What if I never feel normal again?
This intense internal monitoring, alongside anxiety, rumination, avoidance and attempts to force feelings of normality to return, can sometimes inadvertently keep attention focused on the very experiences a person desperately wants to escape.
Understanding these maintaining processes is an important part of specialist CBT for depersonalisation and derealisation.
Is Depersonalisation dangerous?
The symptoms of depersonalisation and derealisation can feel extremely alarming, but they are not in themselves a sign that you are going “crazy” or losing touch with reality.
Many people I meet have spent months or even years worrying that their symptoms mean they are developing psychosis, have permanently damaged their brain or will never feel like themselves again.
These fears are understandable, particularly when DPDR has not been clearly explained.
A careful psychological assessment can help to make sense of your individual symptoms, understand the wider context in which they developed and identify the processes that may now be maintaining them.
Do some of these fears feel familiar?
I've created a free guide exploring six of the most common fears I hear from people experiencing depersonalisation — and some of the important truths that can help make sense of them.
6 Fears People with Depersonalisation Often Carry (and the Truth Behind Each One)
Free download. You'll also receive occasional emails from me with DPDR information, resources and updates.
Can depersonalisation and derealisation be treated?
Yes. People can and do recover from depersonalisation and derealisation.
Recovery does not necessarily mean reaching a point where you never experience a fleeting sensation of detachment again. Brief experiences of depersonalisation and derealisation are surprisingly common.
Instead, treatment often involves helping you understand the symptoms differently, reduce fear and preoccupation with them, and gradually reconnect with your emotions, body, relationships and everyday life.
The specific focus of therapy will vary from person to person because DPDR does not develop or persist in exactly the same way for everyone.
How does CBT for depersonalisation and derealisation work?
Cognitive behavioural therapy (CBT) is one psychological approach that has been specifically developed and adapted for depersonalisation and derealisation, with promising research results.
However, specialist CBT for DPDR is not simply generic anxiety treatment with a different label.
A detailed individual formulation is important. This means developing a shared understanding of what may have contributed to your symptoms and, crucially, what might be keeping them going now.
Treatment may involve working with:
catastrophic interpretations of DPDR symptoms
anxiety and threat monitoring
repeated checking of feelings, perceptions or sense of reality
rumination and attempts to “work out” the experience
avoidance and withdrawal
emotional disconnection
patterns of attention and self-focused monitoring
sleep, stress and wider psychological difficulties
gradual reconnection with meaningful activities and relationships
Therapy should be tailored to the individual rather than assuming that everyone with DPDR needs exactly the same set of techniques.
How does CBT for depersonalisation and derealisation work?
One of the central aims of CBT is to develop a clearer understanding of the cycle that may be maintaining your DPDR.
For example, noticing a feeling of unreality may trigger the thought:
Something is seriously wrong with my brain.
This can understandably increase anxiety and lead to more monitoring:
Do I feel real now?
The more closely you monitor your internal experience, the more unusual or unfamiliar it may begin to feel. This can then appear to confirm the original fear that something is wrong.
CBT can help you identify and gradually change these cycles.
Importantly, therapy is not about telling yourself that the symptoms aren't there. The experiences are very real and can be profoundly distressing.
Instead, the aim is to understand and change the processes that may be amplifying and maintaining them.
I have also published clinical guidance on common misconceptions about CBT for depersonalisation and derealisation. The paper is an open-access, empirically grounded clinical guidance paper and explicitly addresses under-recognition and under-confidence in CBT for DP/DR.
How is specialist CBT for DPDR different from generic CBT?
Depersonalisation and derealisation are often poorly understood.
Many people I work with have previously received treatment for anxiety or depression but felt that their experiences of detachment and unreality were not fully recognised.
Others have been repeatedly encouraged to use grounding techniques without a clear understanding of why, when or how a particular strategy might help them.
Specialist treatment begins with a detailed understanding of DPDR itself.
It also recognises some of the common dilemmas that can arise in therapy. For example, a strategy intended to help someone feel more present can sometimes become another way of repeatedly checking whether they “feel real yet”.
This is why the function of a behaviour matters as much as the technique itself.
My clinical and academic work focuses specifically on understanding these processes and improving psychological treatment for depersonalisation and derealisation.
Do I need a diagnosis of Depersonalisation-Derealisation Disorder?
No.
Some people meet diagnostic criteria for Depersonalisation-Derealisation Disorder (DDD), while others experience significant depersonalisation or derealisation symptoms alongside anxiety, panic, trauma-related difficulties or other psychological problems.
You do not need to arrive in therapy already knowing exactly what is happening.
A specialist psychological assessment can help explore your experiences and consider whether DPDR is the primary difficulty or part of a broader clinical picture.
How do I find a therapist who understands depersonalisation and derealisation?
If you are looking for a therapist for depersonalisation or derealisation, it can be helpful to ask about their specific experience of assessing and treating DPDR.
You might ask:
How often do you work with depersonalisation and derealisation?
What psychological model do you use to understand DPDR?
How do you adapt therapy specifically for these symptoms?
A therapist does not necessarily need to describe themselves as a “DPDR specialist”, but they should be able to explain clearly how they understand the symptoms and how their proposed treatment relates to your individual difficulties.
About Dr Claudia Hallett
I am a highly specialist Clinical Psychologist and BABCP-accredited CBT psychotherapist and supervisor with a specialist clinical and research interest in depersonalisation and derealisation.
I am the Clinical Lead of the UK's national specialist NHS service for Depersonalisation and Derealisation Disorder at the Maudsley Hospital in London.
I have worked in specialist mental health services since 2012 and have extensive experience assessing and treating people experiencing DPDR.
I also write, teach and publish academically on cognitive behavioural approaches to depersonalisation and derealisation.
Through my independent online psychology practice, I provide specialist assessment and CBT for adults experiencing depersonalisation and derealisation.