In a Nutshell – think Treat for Shock
Domains to consider:
*These vary significantly from person to person, part to part, and the same person at different times. Actions that help ground and support one person may make the crisis far worse for another. Always ask first, or if the person is unable to communicate verbally, test different approaches in the smallest possible ways and assess their reaction to help you work out what they are responding to the best.
Touch & Proximity
For some people, nothing is more supportive in a dissociative crisis than the opportunity to be near other caring people, or to have physical contact with someone safe.
Normalising the situation vs. Engaging the distress
To talk about normal things and be along side the person, having a coffee or discussing the game will settle some people. Others need to share their distress and feel heard and validated. Sometimes people need both, just at different times or in a particular order.
Change vs Stability
Changing body posture or getting out of that room or building can help some people to move out of severe dissociation. Others need everything to stay as much the same as possible while they navigate the dissociation.
Sensory supports vs Minimising sensory input
Some people find extra sensory input in the form of smells, sounds, or sensations to be very reducing of dissociation in a crisis. Others are easily overloaded by extra sensory input.
Identify and remove triggers
In some crises, it’s simplest to simply work out what the trigger is and get rid of it. It can be as simple as the song that’s playing on the radio. In others, the triggers are impossible to avoid, really complex, or internal. Sometimes once the dissociation has been triggered removing the trigger won’t help and other ways of reducing it need to be pursued anyway.
For some people, supporting them to engage a grounding technique will be the most effective. Different people (and different parts) find different grounding techniques most helpful. We’re all more familiar with calming techniques such as breathing exercises, but for some people these make anxiety and dissociation worse, and an intense approach is more helpful. Some people are using harmful grounding techniques (such as self harm) to try and cope with their dissociative crisis, or to try and trigger a safe level of dissociation when they feel suicidal.
Doing vs Being
Swinging into action is always tempting but sometimes the best approach is ‘Don’t just do something! Stand there!’ Be with the person. Be connected. Be patient.