For many people suffering from anxiety disorders, particularly panic disorder, some of the most unsettling symptoms can be feelings of unreality. These sensations—formally known as depersonalization and derealization—can be profoundly disturbing, yet they’re often overlooked in treatment.
Depersonalization involves feeling detached from yourself, as if you’re observing your body from the outside or experiencing your emotions from a distance. Derealization is a similar sensation of detachment, but directed toward your surroundings, making the world seem unreal or dreamlike. For the 71% of panic disorder patients who experience these symptoms, finding effective treatment approaches is crucial.
The Challenge in Treating Unreality Symptoms
A pioneering study by Dr. Brett Deacon and colleagues at the University of Wyoming tackled a significant challenge faced by therapists: how to effectively evoke these sensations in a controlled therapeutic setting. This approach, known as interoceptive exposure (IE), is a cornerstone of cognitive-behavioral therapy for anxiety disorders.
While therapists have established methods for triggering physical panic symptoms like racing heart or dizziness, evoking feelings of unreality has proven much more difficult. The traditional techniques of mirror staring (looking at your reflection) and dot staring (focusing on a dot on the wall) often fall short in clinical practice.
The Study: Finding Better Methods
Dr. Deacon’s research team compared 11 different exercises for their ability to trigger depersonalization and derealization sensations in university students with high anxiety sensitivity (a key risk factor for panic disorder). The researchers found five exercises that performed significantly better than the traditional approaches:
- Hyperventilation (5 minutes): Breathing rapidly and deeply with short breaks
- Hyperventilation combined with spiral staring: Rapid breathing while gazing at a rotating spiral
- Hyperventilation combined with strobe light: Rapid breathing while watching a strobe light effect
- Brief hyperventilation (1 minute): A shorter version of the hyperventilation exercise
- Strobe light alone: Watching a strobe light effect in a darkened room
These techniques were particularly effective at producing the sensation of detachment from one’s surroundings (derealization), with the combination of hyperventilation and visual stimulation proving especially powerful.
Why This Matters for Your Mental Health
This research has important implications for anyone struggling with anxiety disorders, particularly those who experience these unsettling symptoms of unreality:
For Those Seeking Treatment:
If you experience depersonalization or derealization during anxiety or panic episodes, this research suggests that comprehensive treatment should include exposure to these specific sensations. When consulting with a therapist who specializes in cognitive-behavioral therapy for anxiety disorders, you can ask specifically about interoceptive exposure techniques for these symptoms.
For Those in Treatment:
If you’re already in therapy for panic disorder or other anxiety conditions, but your treatment hasn’t addressed these particular symptoms, consider discussing these findings with your therapist. The study reveals that addressing these sensations directly through exposure may be an important component of complete recovery.
For Understanding Your Symptoms:
Perhaps most importantly, this research normalizes these often frightening experiences. The ability to induce these sensations temporarily in a controlled setting demonstrates that they are harmless, temporary states—not signs of losing touch with reality or “going crazy,” as many sufferers fear.
The Bigger Picture
Dr. Deacon’s work contributes to a more comprehensive approach to treating anxiety disorders. By identifying effective methods for triggering these difficult-to-evoke but common symptoms, therapists can help patients:
- Learn that these sensations, while uncomfortable, are not dangerous
- Reduce fear of these experiences through controlled exposure
- Develop confidence in their ability to cope with these sensations when they arise
This study serves as an important reminder that successful anxiety treatment often requires addressing the full spectrum of symptoms—not just the physical sensations like racing heart or shortness of breath, but also the more subtle and often more disturbing cognitive experiences like depersonalization and derealization.
For anyone who has ever felt “unreal” during an anxiety episode and worried about what it might mean, this research offers both validation and hope: these experiences are common, understandable, and, most importantly, treatable.
This blog post summarizes research from: Lickel, J., Nelson, E., Hayes Lickel, A., & Deacon, B. (2008). Interoceptive Exposure Exercises for Evoking Depersonalization and Derealization: A Pilot Study. Journal of Cognitive Psychotherapy: An International Quarterly, 22(4), 321-330.
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