How to Stop Derealization: A Comprehensive Guide to Reconnecting with Reality

A Note from The Center • A Place of HOPE

This article was written by our founder, Dr. Gregory Jantz, in the weeks before his unexpected passing on July 4th, 2025. Dr. Jantz was deeply committed to helping people find lasting healing through a whole-person approach to mental health. His insights, compassion, and dedication shaped everything we do at The Center, and this piece reflects the wisdom and care he brought to every aspect of his work. As one of the final articles he wrote, we are honored to share it in his memory and continue his mission of providing hope to those who need it most.

Have you ever felt like you’re living in a dream? Does the world around you seem foggy, distant, or “not quite real”? If you’re experiencing these unsettling sensations, you may be dealing with derealization, a dissociative symptom that can leave you feeling disconnected from your surroundings and questioning your perception of reality.

Derealization affects millions of people worldwide, yet it remains one of the most misunderstood mental health experiences. The good news is that derealization is treatable, and with the right strategies and support, you can regain your sense of connection to the world around you.

What Is Derealization?

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), derealization involves “experiences of unreality or detachment with respect to surroundings” ^[1]. When you’re experiencing derealization, the world may feel:

• Dreamlike or foggy
• Emotionally flat or colorless
• Distorted in size, shape, or clarity
• Like you’re watching life through a glass wall
• Fake or artificial, like a movie set

Unlike other mental health conditions, people experiencing derealization typically maintain insight; they know something feels “off” about their perception, which can make the experience even more distressing.

Understanding the Connection Between Anxiety and Derealization

Derealization is strongly linked to anxiety disorders, with research showing that as anxiety becomes more chronic and severe, the likelihood of experiencing derealization increases significantly ^[1]. Studies indicate that up to 66% of people who experience trauma will encounter derealization at some point in their lives.

The relationship between anxiety and derealization creates a complex cycle. When you’re anxious, your body activates the fight-or-flight response, flooding your system with stress hormones like cortisol and adrenaline. In some individuals, this heightened state of arousal triggers derealization as the brain attempts to protect itself from overwhelming sensations.

During periods of intense stress or anxiety, your brain essentially “tunes out” the overwhelming stimuli as a protective mechanism. This dissociative response exists as a survival strategy when faced with inescapable danger; disconnecting from reality can help preserve psychological resources. However, this adaptive response becomes problematic when it occurs frequently or in safe environments where no real threat exists.

Research conducted at specialized derealization clinics reveals that patients often develop specific fears about their derealization symptoms themselves. They may worry that experiencing derealization means they’re “going crazy” or losing control, which paradoxically increases their anxiety and makes future episodes more likely. This creates what psychologists call a “fear-avoidance cycle” that can perpetuate the condition.

The Neuroscience Behind Derealization

Recent neuroimaging studies have revealed fascinating insights into what happens in the brain during derealization episodes. Research suggests that specific brain regions may temporarily disconnect when derealization occurs, particularly:

• The cortico-limbic system, including the amygdala, prefrontal cortices, and hippocampus, which handles many behavioral and cognitive functions
• The anterior cingulate cortex, which handles high-level cognitive functions, such as decision-making and problem-solving, as well as psychological, emotional, and empathic responses
• Prefrontal structures, which handle such cognitive functions as reasoning, impulse control, and social behavior, as well as regulating other body functions

These areas are crucial for integrating emotion with cognition, empathy, and impulse control ^[2]. Understanding this neurobiological basis helps explain why derealization isn’t simply “in your head”; it’s a real neurological response to stress.

Common Triggers and Causes

Anxiety and Panic Disorders

Derealization frequently occurs during panic attacks or periods of heightened anxiety. The intense physiological arousal triggers the brain’s protective disconnection response, leading to feelings of unreality.

Trauma and PTSD

Trauma is one of the most significant risk factors for developing derealization. Research shows that approximately 66% of trauma survivors experience some form of dissociation ^[1]. Childhood trauma, in particular, can increase vulnerability to derealization episodes later in life.

Depression

Studies reveal that around 50% of individuals with depression also experience derealization disorder, compared to much lower rates in other mental health conditions ^[3]. This high comorbidity suggests a strong relationship between mood disorders and dissociative experiences.

Medical Conditions

Several medical conditions can contribute to derealization, including:

• Migraine headaches
• Epilepsy
• Sleep disorders
• Hormonal imbalances
• Certain medications

Substance Use

Both substance use and withdrawal can trigger derealization episodes. Cannabis, hallucinogens, and even caffeine in sensitive individuals can precipitate feelings of unreality. Interestingly, research shows that certain neurotransmitter systems are implicated in derealization, including glutamate NMDA receptor antagonists, cannabinoids, and opioid receptors ^[1].

The “Long COVID” phenomenon has also brought attention to derealization symptoms. Some patients recovering from COVID-19 report experiencing brain fog and derealization, possibly due to reduced serotonin levels caused by viral persistence in the body.

Personality and Psychological Factors

Certain personality traits may predispose individuals to derealization experiences. Highly sensitive people who tend to be introspective or have difficulty regulating emotions may be more vulnerable. Additionally, those who naturally use dissociation as a coping mechanism during stress may be more likely to experience derealization episodes.

Research has identified that individuals with higher levels of emotional abuse in their history and certain attachment styles show increased vulnerability to dissociative experiences. This doesn’t mean you’re destined to experience derealization, but understanding these risk factors can help in developing targeted prevention strategies.

Proven Strategies to Stop Derealization

1. Mindfulness and Grounding Techniques

Mindfulness is consistently recognized as the most effective immediate intervention for derealization episodes ^[4]. These techniques work by anchoring your awareness in the present moment and engaging your senses.

The 5-4-3-2-1 Grounding Method:

• Identify five things you can see
• Name four things you can touch
• Listen for three things you can hear
• Find two things you can smell
• Taste one thing

Sensory Grounding Strategies:

• Hold an ice cube or splash cold water on your face
• Touch different textures (soft fabric, rough bark, smooth stone)
• Listen to music with clear, distinct sounds
• Use strong scents like peppermint or lavender
• Focus on specific details in your environment

2. Breathing Techniques

Deep, controlled breathing helps regulate your nervous system and interrupt the fight-or-flight response that often triggers derealization ^[5].

4-4-6 Breathing Pattern:

• Inhale deeply through your nose for 4 seconds
• Hold your breath for 4 seconds
• Exhale slowly through your mouth for 6 seconds
• Repeat for 5-10 minutes

This pattern activates your parasympathetic nervous system, promoting calm and reducing anxiety.

3. Cognitive Behavioral Therapy (CBT)

Research has demonstrated that CBT specifically adapted for derealization can be highly effective. A recent study showed significant improvements in derealization symptoms with medium effect sizes across multiple measures ^[6]. CBT’s focus on the relationship between thoughts, feelings, and behaviors makes it particularly powerful for derealization.

The CBT Model for Derealization:

Many people with derealization develop what researchers refer to as “catastrophic attributions” regarding their symptoms. They might think thoughts like “I’m going crazy,” “I’ll never feel normal again,” or “Something is seriously wrong with my brain.” These catastrophic interpretations actually increase anxiety and make derealization more likely to occur.

CBT for derealization focuses on:

• Identifying and challenging catastrophic thoughts about derealization symptoms
• Developing coping strategies for managing episodes without panic
• Addressing underlying anxiety and trauma that may trigger episodes
• Building tolerance for uncomfortable sensations without fighting them
• Behavioral experiments to test the feared consequences of derealization

Cognitive Restructuring Techniques:

One key CBT strategy involves learning to respond differently to derealization symptoms. Instead of thinking “This feeling means something terrible is happening,” you might learn to think “This is an uncomfortable but temporary experience that will pass.”

Therapists often use “attention training” techniques, helping patients learn to focus their attention externally rather than becoming absorbed in monitoring their internal state. This interrupts the cycle of symptom-focused attention that can maintain derealization episodes.

Homework and Practice:

CBT for derealization typically includes regular homework assignments, such as:

• Practicing grounding techniques daily
• Keeping a symptom diary to identify patterns
• Gradually exposing yourself to situations that might trigger mild derealization
• Challenging negative thoughts about symptoms

4. Movement and Physical Activity

Physical movement can help reconnect you with your body and the present moment. Research indicates that regular exercise reduces stress hormones and improves mood, potentially decreasing the frequency of derealization episodes ^[7].

Effective Movement Strategies:

• Gentle yoga or stretching
• Mindful walking
• Progressive muscle relaxation
• Dancing or rhythmic movement
• Swimming or other aerobic activities

5. Lifestyle Modifications

Supporting your overall mental health through lifestyle changes can significantly reduce derealization episodes:

Sleep Hygiene:

• Aim for 7-9 hours of quality sleep nightly
• Maintain consistent sleep and wake times
• Create a calming bedtime routine

Nutrition:

• Eat regular, balanced meals to maintain stable blood sugar
• Limit caffeine and alcohol
• Stay adequately hydrated

Stress Management:

• Practice regular relaxation techniques
• Set healthy boundaries
• Engage in enjoyable activities

Advanced Strategies for Long-Term Recovery

Understanding Your Personal Triggers

Successful derealization management often requires developing a deep understanding of trigger patterns. Research from specialized derealization clinics indicates that patients who identify their specific triggers tend to have better treatment outcomes ^[7].

Common Trigger Categories:

Environmental Triggers:

• Fluorescent lighting or certain visual patterns
• Crowded or overwhelming spaces
• Sudden changes in temperature
• Specific sounds or music

Emotional Triggers:

• Conflict in relationships
• Work-related stress
• Feeling criticized or judged
• Anticipatory anxiety about future events

Physical Triggers:

• Fatigue or sleep deprivation
• Hunger or blood sugar fluctuations
• Hormonal changes (menstrual cycles, pregnancy)
• Illness or physical discomfort

Cognitive Triggers:

• Overthinking or rumination
• Focusing intensely on internal sensations
• Comparing current feelings to past episodes
• Anticipating or dreading derealization

The Importance of Window of Tolerance

Understanding your “window of tolerance” is crucial for derealization recovery. This concept, developed by trauma specialist Dan Siegel, refers to the zone where you can experience emotions and sensations without becoming overwhelmed or shutting down.

When you’re within your window of tolerance, you feel present, grounded, and able to cope with life’s challenges. When you move outside this window, either into hyperarousal (anxiety, panic) or hypoarousal (numbness, dissociation), you’re more vulnerable to derealization episodes.

Expanding Your Window of Tolerance:

• Gradual exposure to mild stressors in controlled settings
• Regular mindfulness practice to increase body awareness
• Somatic therapy techniques to release stored tension
• Breathing exercises to regulate your nervous system
• Progressive muscle relaxation to build body awareness

Addressing Comorbid Conditions

Research indicates that derealization rarely occurs in isolation. A comprehensive study of 223 patients with derealization found high rates of comorbid conditions, including depression, anxiety disorders, and trauma-related symptoms ^[8]. Addressing these underlying conditions is often essential for recovery from derealization.

Depression and Derealization:

When depression co-occurs with derealization, treatment becomes more complex. The emotional numbness of depression can exacerbate feelings of unreality, while derealization can worsen depressive symptoms by making it difficult to connect with positive experiences.

Anxiety Disorders:

Generalized anxiety disorder, social anxiety, and panic disorder frequently co-occur with derealization. In these cases, treating the underlying anxiety disorder often leads to significant improvement in derealization symptoms.

Trauma and PTSD:

When derealization stems from trauma, specialized trauma-focused therapies like EMDR, trauma-focused CBT, or somatic experiencing may be necessary. These approaches help process traumatic memories while building tolerance for intense emotions.

Professional Treatment Options

Psychotherapy

Several therapeutic approaches have shown promise for treating derealization:

Cognitive Behavioral Therapy (CBT): Research indicates that CBT specifically adapted for depersonalization-derealization disorder is the most effective treatment approach, with studies showing significant symptom reduction ^[8].

Trauma-Focused Therapy: When derealization stems from trauma, specialized approaches like EMDR (Eye Movement Desensitization and Reprocessing) can be particularly helpful.

Dialectical Behavior Therapy (DBT): DBT skills, particularly distress tolerance and emotion regulation techniques, can be valuable for managing derealization episodes. The “TIPP” skills (Temperature, Intense exercise, Paced breathing, Paired muscle relaxation) are beneficial during acute episodes.

Somatic Therapies: Body-based approaches like Somatic Experiencing or Sensorimotor Psychotherapy can be beneficial for trauma-related derealization. These therapies focus on helping you reconnect with your body and process traumatic experiences through physical sensations rather than just verbal processing.

Group Therapy: Research consistently shows that group therapy settings can be particularly beneficial for individuals recovering from derealization. The Center • A Place of HOPE emphasizes group therapy because it helps combat the isolation that many people with derealization experience. Being with others who understand your experience can be profoundly healing and reduce the sense of being “the only one” dealing with these symptoms.

Medication Considerations

While there’s no FDA-approved medication specifically for derealization, certain medications may help when derealization occurs alongside other conditions:

• SSRIs: May help when anxiety or depression contributes to derealization
• Lamotrigine: Some studies suggest potential benefits, though results are mixed ^[9]
• Anti-anxiety medications: May provide short-term relief during acute episodes

Emerging Treatment Approaches

Repetitive Transcranial Magnetic Stimulation (rTMS): Some research has explored rTMS as a treatment for derealization, particularly targeting the temporal parietal junction, which is involved in self-perception and body awareness ^[9]. While still experimental, early results show promise.

Mindfulness-Based Interventions: Structured mindfulness programs, such as Mindfulness-Based Stress Reduction (MBSR) or Mindfulness-Based Cognitive Therapy (MBCT), have shown benefits for dissociative symptoms. These programs teach systematic approaches to present-moment awareness that can be particularly helpful for derealization.

Neurofeedback: Some practitioners use neurofeedback to help regulate brain activity patterns associated with derealization. While research is limited, some individuals report benefits from this approach.

It’s crucial to work with healthcare professionals who understand dissociative disorders, including medical professionals, as some medications can potentially worsen derealization symptoms. For example, certain anti-anxiety medications, while helpful in the short term, may increase dissociative tendencies if used long-term.

Medication Considerations by Symptom Profile:

• Anxiety-driven derealization: SSRIs like sertraline or escitalopram may help
• Depression-related derealization: Antidepressants targeting both serotonin and norepinephrine
• Trauma-related derealization: Medications should be used cautiously, with therapy as the primary treatment
• Sleep-related triggers: Sleep aids may be helpful, but dependency risks must be considered

When to Seek Professional Help

You should consider reaching out to a mental health professional if:

• Derealization episodes are frequent or persistent
• Symptoms interfere with work, relationships, or daily functioning
• You experience significant distress about the episodes
• You’re also dealing with anxiety, depression, or trauma
• Episodes are accompanied by thoughts of self-harm

Building Your Support Network

Recovery from derealization often benefits from a strong support system. The isolation that many people experience with derealization can worsen symptoms, as the condition already creates feelings of disconnection from others.

Types of Support:

Professional Support Team:

• Primary therapist specializing in dissociative disorders
• A psychiatrist familiar with derealization
• Primary care physician for overall health
• Support group facilitator

Personal Support Network:

• Trusted family members educated about your condition
• Close friends who understand your experience
• Peer support from others with similar experiences
• Online communities (with appropriate boundaries)

Educational Support:

Many people find that educating their support network about derealization improves their relationships. When loved ones understand that derealization is a legitimate neurobiological response to stress, not attention-seeking or “being dramatic,” they can provide more effective support.

Consider sharing reputable resources about derealization with your support network. This helps them understand:

• What derealization feels like
• What helps and what doesn’t help during episodes
• How to respond supportively without reinforcing symptom focus
• When to seek additional help

Creating Your Personal Recovery Plan

Developing a personalized approach to managing derealization involves several key components that work together to support your recovery journey.

Phase 1: Assessment and Understanding (Weeks 1-4)

Symptom Tracking: Keep a detailed journal documenting:

• When episodes occur (time, duration, intensity)
• Potential triggers (environmental, emotional, physical)
• What helps or worsens symptoms
• Your overall mood and stress levels

Professional Assessment: Work with a qualified mental health professional to:

• Confirm your diagnosis
• Identify any underlying conditions
• Assess for trauma history
• Develop initial treatment goals

Phase 2: Skill Building (Weeks 4-12)

Grounding Technique Mastery: Practice various grounding techniques daily, even when not experiencing derealization. This builds your “muscle memory,” so these tools are readily available during episodes.

Cognitive Restructuring: Learn to identify and challenge unhelpful thoughts about derealization. Common cognitive distortions include:

• Catastrophizing (“This will never end”)
• All-or-nothing thinking (“I’m either completely fine or completely disconnected”)
• Mind reading (“Everyone can tell something’s wrong with me”)

Nervous System Regulation: Develop a toolkit of strategies to regulate your autonomic nervous system:

• Daily breathing exercises
• Progressive muscle relaxation
• Cold water therapy
• Gentle movement practices

Phase 3: Integration and Relapse Prevention (Months 3-6)

Lifestyle Integration: Incorporate recovery strategies into your daily routine so they become a natural part of your life. This might include:

• Morning mindfulness practice
• Regular exercise schedule
• Consistent sleep hygiene
• Stress management techniques

Relapse Prevention Planning: Develop a specific plan for managing setbacks:

• Early warning signs of increased vulnerability
• Specific interventions for different levels of symptoms
• When to contact your support team
• Strategies for getting back on track after difficult periods

Phase 4: Long-term Maintenance (6+ months)

Ongoing Growth: Continue developing your understanding of yourself and your triggers. Many people find that their relationship with derealization evolves over time, progressing from fighting it to accepting it, and eventually experiencing fewer episodes.

Regular Check-ins: Maintain regular contact with your treatment team, even during stable periods. This helps catch potential issues early and provides ongoing support for continued growth.

The Role of Whole-Person Care

At The Center • A Place of HOPE, we understand that derealization doesn’t exist in isolation; it affects your entire being. Our Whole Person Care approach addresses the symptoms of derealization and the underlying factors that contribute to dissociative experiences.

Our comprehensive treatment model considers:

• Emotional well-being: Processing underlying trauma and anxiety
• Physical health: Addressing medical factors that may contribute to symptoms
• Spiritual peace: Finding meaning and connection
• Relational happiness: Rebuilding connections with others
• Nutritional vitality: Supporting brain health through proper nutrition
• Intellectual growth: Understanding your condition and developing coping skills

Frequently Asked Questions

How long do derealization episodes typically last?

Derealization episodes can vary significantly in duration. Some last only a few minutes, while others persist for hours or days. With proper treatment and coping strategies, episodes typically become less frequent and shorter over time.

Is derealization dangerous?

Derealization itself is not dangerous, though it can be highly distressing. However, if episodes are frequent or severe enough to impair your functioning, seeking professional help is essential. If you’re experiencing thoughts of self-harm, contact a mental health crisis line immediately.

Can derealization be cured completely?

While there’s no simple “cure” for derealization, many people achieve significant improvement or complete resolution of symptoms with appropriate treatment. Research from specialized derealization clinics indicates that, with proper treatment, most individuals experience substantial improvement in the frequency and intensity of episodes.

The prognosis for derealization is more optimistic when treatment begins early and addresses any underlying conditions that may be contributing to the symptoms. Many individuals learn to manage their symptoms so effectively that derealization no longer significantly impacts their daily life. Some people achieve complete remission, while others develop such effective coping strategies that occasional mild episodes don’t cause distress.

It’s important to understand that recovery isn’t always linear; you may have setbacks during stressful periods, but this doesn’t mean you’re not progressing.

Will medication help with my derealization?

Medication responses vary significantly among individuals. While there’s no specific medication for derealization, treating underlying conditions like anxiety or depression may help reduce episodes. Always work with a knowledgeable medical professional when considering medication options.

How can I explain derealization to my family and friends?

Explaining derealization can be challenging since it’s an internal experience. You might describe it as feeling like watching life through a foggy window or experiencing everything as if it were happening in a dream. Sharing educational resources can help your loved ones better understand your experience.

Your Path Forward

Remember that experiencing derealization doesn’t mean you’re “losing your mind” or that something is fundamentally wrong with you. It’s a treatable condition that many people successfully overcome with the right support and strategies.

Recovery is possible; you don’t have to face this journey alone. Reaching out for help, whether through professional treatment, support groups, or trusted relationships, is a sign of strength, not weakness.

If you’re struggling with derealization and want to explore comprehensive treatment options, The Center • A Place of HOPE can support you. Our experienced team understands the complexities of dissociative experiences and can help you develop an individualized treatment plan that addresses your unique needs.

Take the first step toward reconnecting with reality and reclaiming your life. You deserve to feel present, grounded, and fully engaged with the world around you.

References