How depersonalisation keeps itself going
A maintenance-cycle explainer on how frightening meanings, anxiety, checking, self-watching and avoidance can keep feelings of unreality going, and how the cycle can loosen. Based on Hunter et al. (2003): the cognitive behavioural model in plain words, with a checklist of what I do and a reflection added.
Written by Tarun Vermani, Trainee Clinical Psychologist Updated
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How depersonalisation keeps itself going
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Why the feelings can get stuck
Feeling detached from yourself or feeling that the world is unreal is common, and for most people it passes on its own. For some people it gets stuck. If that has happened to you, it is not because you are weak or not trying. There is a cycle that can keep these feelings going, and the things you do to cope can, without you meaning them to, become part of it. This sheet shows how that cycle works and how it can loosen.
If you haven't had these feelings checked by a doctor, or they change or feel different from usual, see your GP. If you think something is medically wrong right now, get urgent help.
How the cycle works
It often starts at a time of stress, panic, exhaustion or after using drugs such as cannabis. A spell of feeling unreal comes along, as it does for many people at times like these.
The feeling is so strange that the mind tries to make sense of it, and it can land on a frightening meaning: 'I am going mad', 'my brain is damaged', 'I will never feel real again' or 'I am losing control'.
Frightening meanings bring anxiety, and anxiety itself makes the feelings of unreality stronger. Stronger feelings then seem to prove the frightening meaning. Round and round it goes.
On top of this, you start to watch yourself closely. You keep checking how real you feel and comparing it with how you used to feel. The more you turn your attention inwards, the more the feelings stand out, a bit like how noticing your own breathing makes it hard to stop noticing it.
Things that can keep it going
People do many things to cope with these feelings or to stop them getting worse. They make sense, and they can bring a little relief. The trouble is that they keep your attention on the feelings, and they stop you finding out what really happens. Avoiding places and people also shrinks your life, which can leave you with more time to notice how you feel. Tick any that you notice yourself doing.
How the cycle can loosen
The cycle can loosen when its parts are worked on one at a time, usually with a therapist.
Understanding the feelings: knowing they are common and recognised, and that the fear of going mad is part of the cycle, can take some of the threat out of them.
Testing the frightening meanings: with your therapist, you can look at what you fear the feelings mean and find out, through small experiments, what really happens.
Cutting down checking and self-watching: gradually checking less, and letting the feelings be there without testing them, gives your attention a chance to move elsewhere.
Turning attention outwards: practising putting your attention on the task in front of you, the conversation you are in or what you can see and hear.
Getting back to life: stepping, bit by bit, back into the places, people and activities you have avoided.
Looking after the basics: sleep, and cutting down cannabis, alcohol and other drugs, can lower the background level of the feelings for many people.
At first this can feel uncomfortable, and the feelings may not change straight away. For many people they fade into the background as life fills up again.
Over to you
Write a few lines to bring to your next session.
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When to use ‘How depersonalisation keeps itself going’
‘How depersonalisation keeps itself going’ is a psychoeducation handout based on cognitive behavioural therapy (CBT). It draws on core CBT skills used right across the model, with presentations including depression, anxiety, OCD, trauma and low self-esteem, rather than being tied to a single diagnosis.
It is designed to be read within therapy rather than as a standalone self-help tool: a therapist introduces it and discusses it with the client. You can preview the full handout above, then assign it for clients to read between sessions on any device or download it as a print-ready PDF. Where a short reflection is included, it offers space to respond to the reading.
How it works
Most people work through it in around 8 minutes. It moves through five short sections to read:
- Why the feelings can get stuck: Feeling detached from yourself or feeling that the world is unreal is common, and for most people it passes on its own. For some people it…
- How the cycle works: It often starts at a time of stress, panic, exhaustion or after using drugs such as cannabis. A spell of feeling unreal comes along, as it…
- Things that can keep it going: People do many things to cope with these feelings or to stop them getting worse. They make sense, and they can bring a little relief. The…
- How the cycle can loosen: The cycle can loosen when its parts are worked on one at a time, usually with a therapist. Understanding the feelings: knowing they are…
- Over to you: Write a few lines to bring to your next session.
The handout can be read on a phone, tablet or computer, or downloaded as a print-ready PDF. If it includes a reflection, answers entered on the Formulate platform are saved automatically and shared back with the therapist for review before the next session.
The CBT approach behind it
‘How depersonalisation keeps itself going’ introduces a CBT approach that involves mapping how the parts of a problem connect and keep it going (formulation). The aim is not positive thinking but a clearer, shared understanding of what keeps a difficulty going and practical, testable ways to change it.
Because it is a CBT tool it stays focused on the here-and-now links between thoughts, feelings, the body and behaviour, and it works best as one part of a wider course of therapy rather than as advice or a diagnosis.
Evidence & sources
This handout is grounded in established cognitive behavioural therapy theory and practice. Key sources include:
- 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. doi:10.1016/S0005-7967(03)00066-4
- Hunter, E.C.M., Baker, D., Phillips, M.L., Sierra, M., & David, A.S. (2005). Cognitive-behaviour therapy for depersonalisation disorder: An open study. Behaviour Research and Therapy, 43(9), 1121-1130. doi:10.1016/j.brat.2004.08.003
- Medford, N., Sierra, M., Baker, D., & David, A.S. (2005). Understanding and treating depersonalisation disorder. Advances in Psychiatric Treatment, 11(2), 92-100. doi:10.1192/apt.11.2.92
- World Health Organization (2025). 6B66 Depersonalization-derealization disorder. ICD-11 for Mortality and Morbidity Statistics (version 2025-01). https://icd.who.int/browse/2025-01/mms/en.
For use alongside professional support
Formulate provides educational CBT resources for use with a qualified therapist. They are not a substitute for professional assessment, diagnosis, or crisis care.
If you need urgent help now:
- Emergency services: 999 — if you or someone else is in immediate danger
- NHS 111 (NHS 24 in Scotland): 111 — choose the mental health option for urgent help, in England, Scotland and Wales (in Wales, press 2)
- Lifeline: 0808 808 8000 — for urgent help in Northern Ireland, free, day or night
- Samaritans: 116 123 — free, day or night, 365 days a year
- Shout: 85258 — text SHOUT, free, day or night
- SANEline: 0300 304 7000 — 4pm–10pm, every day
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