An Interview with Psychologist Bethany Brand
Dr. Bethany Brand is a Clinical Psychologist and Professor of Psychology at Towson University. She is an expert in trauma and specializes in the assessment and treatment of trauma-related disorders, including PTSD and dissociative disorders.
Amelia Worley: Thanks for joining us today for this installment of the Seattle Psychiatrist Interview Series. I'm Amelia Worley, a research intern at Seattle Anxiety Specialist. I'd like to welcome Dr. Bethany Brand. Dr. Brand is a professor in the Department of Psychology at Towson University. She also maintains an independent practice in clinical psychology, specializing in the treatment of trauma disorders, including dissociative disorders and post-traumatic stress disorders. She has numerous publications on trauma and dissociative disorders, including one of her most recent publications on the topic, “An Examination of the Relations Between Emotional Dysregulation, Dissociation and Non-suicidal Self-injury Among Dissociative Disorder Patients.” Before we get started Dr. Brand, can you please let us know a little more about yourself and what made you interested in studying trauma?
Bethany Brand: Yes. Thanks for having me. Well, if we go way back, I had a friend in high school and she had been traumatized, and so had her sisters, and they had very different responses, and it just intrigued me trying to figure out how could people go through similar traumas and have very different outcomes? So then when I was in graduate school, I started pursuing it more seriously and asking supervisors if I could treat trauma. Then, I did my master’s and my dissertation on trauma. When I looked for my first position after grad school, I found a postdoc at Sheppard Pratt, and at that point they had a trauma disorders unit that was just opening. So, in that case, I was at the right place at the right time, and I got to work on their unit, which had mostly people with serious dissociative disorders, so I got great training early on.
Amelia Worley: Wow. So, to begin, would you mind defining what dissociation is?
Bethany Brand: Sure. Dissociation is a disconnection of what are normally integrated psychological constructs or functions. So, for example, a person may feel disconnected from their body. They may literally see themselves at a distance and be looking down on themselves, or they may feel very numb when they should have emotion. It's an emotional time. They're talking about something with that they might normally feel terrified about or ashamed about, and they feel nothing. So, that's that kind of disconnection. You can also have disconnection from your environment. So, it may be they're in a place that's familiar or with somebody they know well, and suddenly they don't look familiar or they don't recognize fully who that person is. They have some sense that they know them, but they can't really place them. They may have a disconnection in their memory where they feel like there's gaps in their memory.
They can't recall, it might be hours, days, or even potentially, from childhood. There might be years that they really don't recall. Within their identity, they may have a sense of being kind of fragmented where they feel like, more than people who are non-dissociative because we all have parts, but they may feel like they act so differently, seem so differently, behave so differently that at different times they feel as if they're almost different people, although nobody can have more than one person inside them. It's states, dissociative-self states. They also may have disconnection from behavior. So, they may find themselves doing something, see themselves doing it, and they literally can't stop what they're doing. Those are just some of the examples.
Amelia Worley: How is dissociation linked to trauma? Are some traumatic experiences more likely to cause dissociative disorders?
Bethany Brand: Yes, they are. So, we know that if it's particularly life-threatening, you might be more prone to dissociation. We know that children are more likely to dissociate, and they lose that ability a little bit over time. So, for example, if there's ongoing childhood abuse, and especially if it's done by a caretaker, somebody who's in charge of the child, should be protecting them, and instead they're betraying them, we know from betrayal trauma theory that they're more likely in those situations to dissociate. So, it's particularly severe, ongoing trauma, but it can even happen for a one-time really serious car accident. Like I know somebody who, when they were in a car accident, they were actually seriously injured, but they didn't feel any of the injury. It wasn't, they hadn't had nerve damage. It was that they were at for a little while having what's called very traumatic dissociation, which is dissociation during the actual trauma itself.
Amelia Worley: Wow. How might someone know whether or not they're suffering from trauma-related dissociation? What does it feel like?
Bethany Brand: It's a good question, but it feels very different according to which one of those constructs is, they're disconnected from. So, do they, generally speaking, have emotions? Do they generally feel like the body is theirs or do they sometimes feel like that's not my body? It's not like, it's not a person getting older and looking at themselves thinking, that's not how I look. It's more profound than that. Like they might look child-like, or they may feel like they look at themselves and suddenly they look decades older, and it just, it's a strange sensation. They may look in a mirror and not recognize themselves. If a person is, has experienced or is experiencing a number of the things I've talked about, problems with feeling connected to their body, connected to their emotions, connected and oriented and aware of their surroundings, that probably means that they don't dissociate much.
But if sometimes their surroundings look far away, even though let's say, if they're hand looks like it's a mile away, like their arm has suddenly grown, there's really a huge distance, that's a type of depersonalization. Or if, let's say they're talking to a therapist and suddenly the room looks foggy, that's derealization. The world around them looks different. Or they can't hear their therapist speaking, even though there's nothing wrong with their hearing, that's a type of derealization. So, if somebody's experiencing any of these things, that might give them some indication that they possibly have trauma-related dissociation, and of course, have they been exposed to some kind of trauma? That's a prerequisite for trauma-related dissociation.
Amelia Worley: So, what can trigger dissociation in an individual after the traumatic event has occurred?
Bethany Brand: It may be that they're just hearing a sound that reminds them, a trigger. It could be a sound, an image of the light being a certain way. They might hear, they might smell a certain smell. Smells are very, very likely to trigger traumatic associations. So, it's when they feel triggered that then they may also start to dissociate. So, I'm careful, I'm a little cautious that some listeners might be a little triggered about what I'm going to say. So, I'm going to advise them if they want to just tune me out for a minute, but let's go with the example of smells. So, if somebody was traumatized by somebody who'd been drinking alcohol, if later, they smell alcohol, they can be triggered by that, and start to have their heart race, feel terribly vulnerable, like something dreadful is going to happen, or they may do that for a bit, and then disassociate, start feeling numbed out, kind of like things around them looking surreal in some way, or they might just really rapidly go to a dissociative state.
Amelia Worley: That's really interesting. In your publication I mentioned earlier, “An Examination of the Relations Between Emotional Dysregulation, Dissociation and Non-suicidal Self-injury Among Dissociative Disorder Patients”, you talk about how this idea of emotional dysregulation. Can you explain what emotional dysregulation is, and how it relates to trauma-related dissociation?
Bethany Brand: Yes. So, you know how we like to have very big terms in our field? Emotion dysregulation is basically difficulty dealing with emotions. Okay? So, people who have got, who've experienced a lot of trauma, whether they're highly dissociative or not, they tend to feel too much or too little. So, for example, let me go back to that past trigger example I gave you. Maybe that person normally has normal feelings. They can feel some happiness, some sadness, some anxiety before a test, whatever. But when they get around, let's say they are abused by a man. When they get around men, then they start feeling really scared. Their heart starts to race. They feel like, oh, I've got to watch behind me. I've got to watch this guy. That's feeling too much. The opposite can also happen where they feel too little. The examples I gave where somebody is numbed out, they don't feel connected to their body.
So, emotion regulation is when you have the capacity to know what you're feeling. They can identify the emotions, and emotions, how do we know we're feeling emotions? It's in our bodies. So, if somebody's angry, they might feel I'm imitating it for anybody who's not watching the video. I'm clenching my hands. I'm kind of raising my shoulders. I'm tensing up muscles. A lot of people feel that kind of muscle tension and agitation energy in their body when they're angry. If you're feeling, if you go back and forth between too much feeling, too little, if somebody starts getting angry and they're very uncomfortable with that emotion, they may shut it down and disconnect from their body. Maybe anger is very scary, because maybe they were in a relationship that was physically abusive, and so they disconnect if there's anger. So, what happens when somebody's traumatized, trauma by its definition, it's overwhelming.
They may feel at risk for their life, and so the feelings are huge, way, way, way too big. Like that example I gave earlier with somebody who had peritraumatic dissociation, if you're so terrified, sometimes the brain, it's an automatic kind of a brain-based response, may start shutting down emotion. The person's not willing it to happen. It just starts to happen. Parts of our brain start kind of metaphorically going offline. They're not very active. So, later on, if that happened during trauma, that the person started dissociating when they felt too much, if later on after the trauma, they're starting to get overwhelmed with feeling too much, they may get scared of that, and at first, they may consciously, like, I don't want to feel this. I don't want to feel this. I don't want to think about this, and they kind of push it away.
That's normal PTSD is you try and push away emotions and remembrances and memories, images. But over time, if somebody's also disassociated or starts to learn to dissociate, they can numb out and disconnect. If they avoid thinking about something enough or it's so awful, they really just, they're, they don't go there in their minds. Over time, they may have less access to that memory, and so they start maybe having the memory problems I talked about earlier. So, emotion regulation is intricately tied in with dissociation, because dissociation is a way of dealing with emotion, and a terribly threatening situation.
So, what we've looked at in some of these studies is, can we teach people who have very high levels of trauma-related disassociation other ways to identify what they're feeling, to not be so afraid of emotions, help them learn how emotions are helpful, and how to healthfully manage them in a range that's tolerable, so they're not flooded. They're not numbed out. They don't have too much or too little emotion. We found in this treatment study we did with dissociative disorders, folks, that as you teach them emotion regulation skills, then dissociation began to decrease some. They weren't needing to dissociate so much. We also found that self-harm decreased, PTSD symptoms decreased. Helping people learn to regulate their emotions is a really fundamental, crucial skill, in other words.
Amelia Worley: So, continuing on that idea, can you talk a little bit about the most effective treatment approaches for trauma-related disassociation?
Bethany Brand: Yes. So, the study I was just referencing indirectly is one called “The Treatment of Patients With Dissociative Disorders.” It's TOP DD, and that's for people who have really serious dissociative symptoms. We're in the process of doing a randomized controlled trial treatment, where we're checking out the program I was just referencing. So, we get people who have very high levels of dissociation, plus their therapist, who agree to be in the study. We have a number of videos where we teach them what trauma does in general, various symptoms related to trauma, then we get to dissociation what it is and how that was helpful, but also how in adulthood, when you're safer, if you're safer now, how it can get in the way. So, somebody not always knowing what they're feeling, maybe they're tuning out some important clues from their body, from their mind that a relationship's not safe, but if they're not in touch with their emotions, they may not feel that.
So, we know from research that people with lots of dissociation have high rates of being re-traumatized in adulthood. So, it's really important to help them learn to identify their emotions, and to gradually use less dissociation. So, we're, in that program, that's some of things that we're teaching and that's in general, whether somebody's in that treatment study or whether they're working with a therapist. The therapist, generally speaking, teaches them what dissociation is, the symptoms of PTSD, because they often have both. Then there's a technique called a grounding technique. So, let me, and I'm talking this out loud, just in case somebody can't see the screen. Dissociation’s on a continuum. At one end of the continuum is somebody is grounded and oriented in present reality. They can feel their body. They know where they are. They know what the date is. They're really hooked into present reality.
The other end is profoundly dissociated, where they don't necessarily, they don't recognize where they are. They're not feeling their body. They're really severely dissociated. Then in between, there's this whole range. What a therapist can help a client learn to do is recognize the early signs that they're beginning to dissociate. So, they might feel spacey or tingly. Those are just examples. So, the client learns when they start recognizing that warning sign, then they use these grounding techniques, and I'll just explain a very basic one that lots of people know. You can use this with panic attacks, all kinds of things, not just disassociation. But you put your feet on the floor. I'm going to do it, because when I teach people, I always do it along with them. So, I'm pushing my feet into the floor, and trying to really notice what that feels like. That is using muscle movement, contractions, and trying to get them to feel that part of their body, assuming they're okay with feeling that.
Then I would also be having them look around where they are. If it's a Zoom therapy session, look around the room where they are. If we're meeting together, look around my office and find something that they can describe with all the senses. So, I've got a cup of water here. If they've got something to drink, can they feel the weight of the cup? Can they feel the coldness or the warmth, taste it, using all their senses? That actually helps wake up metaphorically, the parts of the brain that have shifted, and kind of gone offline while they're dissociating. So, you use the senses, all five senses to get the brain back online in the normal way that it should be. Those are grounding techniques. So, a therapist would be teaching them grounding techniques and having them practice that in session, and then also, out of session. Those are just some of the basic tools we use when folks have got a lot of trauma-related disassociation.
Amelia Worley: Wow. Lastly, do you have any advice or anything you want to share with our listeners suffering from trauma-related disassociation?
Bethany Brand: Yes. I would say one of the most important things you can do is to learn exactly what I was just talking about. Learn grounding techniques, and practice them, and learn healthy ways of taking care of yourself emotionally. So, many, many, many people who've been terribly traumatized feel ashamed of themselves, feel dirty. They feel like they're bad people. That's, those are symptoms of being traumatized. It's not the reality of who they are. It's a symptom. So, hopefully they can start thinking about that, looking into that. There are good books out there to read for trauma recovery. If somebody has a really serious, a lot of dissociative symptoms, if they have a therapist, if they want, and they can look into this treatment of patients with dissociative disorders study, TOPDDstudy.com, and we have that website. They can go there and look and see if we're still running the study.
There's also a professional website that has a lot of information for consumers and therapists. I'll say it slowly. It's ISSTD. It stands for the International Society for the Study of Trauma and Dissociation. That organization does a lot of training for therapists, and they have frequently asked questions on their website about disassociation. They have some questionnaires, people could even try and fill out and find out do they seem to be scoring fairly high, and learn a little bit about, do they have dissociative symptoms, where to go to get help. They have a Find a Therapist page on that website.
Amelia Worley: That's great. Well, thank you so much, Dr. Brand. It was wonderful having you on our series today.
Bethany Brand: Thank you so much. It's been an honor to be here.
Please note: The views expressed by the interviewee are for educational and informational purposes only, are not meant to diagnose or treat any condition, and do not necessarily reflect the views of Seattle Anxiety Specialists, PLLC.
Editor: Jennifer (Ghahari) Smith, Ph.D.