Living with DID: Improving Sleep

It is very common for people experiencing dissociative disorders to have trouble sleeping. This can be for all the reasons that non-dissociative people have sleep problems such as drinking caffeine or alcohol; poor sleep routine; disturbed sleep-wake patterns; or too much screen time close to bedtime.

However people with dissociative disorders typically have other additional reasons for sleep problems. These include:

  • Traumatic nightmares and flashbacks;
  • Child parts feeling scared at night;
  • Activity of Dissociated parts during the night, including parts who feel they don’t get enough ‘out’ time during the day; and
  • Flashbacks (even hallucinations) when you are on the cusp of sleep or waking.

Steps to Help

Firstly look at your basic ‘sleep hygiene’.

‘Sleep hygiene’ is a rather strange expression psychologists use to describe good sleep practices. While people with DID often need specific practices to help them get to sleep, attending to general healthy sleep practices can also help. This includes: developing a ‘bedtime routine’ that begins an hour before bedtime; turning off screens 45 minutes before bed; avoiding caffeine in the afternoon; avoiding alcohol; getting enough exercise etc. See you counsellor or psychologist to discuss your daytime activity. It might be necessary to speak to them about working internally with parts to develop a healthy daytime routine, as that often helps sleep as well.

Make sure parts have time during the day

Talk inside, using whatever method works for you, to establish unmet needs and unexpressed desires. Make sure parts have a chance for expression during the day. Sometimes there will need to be a compromise, as there are only 24 hours in the day, no matter how many parts you have. This is where the concept of a timetable, rostering or ‘taking turns’ comes in handy. Most child parts can understand this and can wait if they know that they too will soon have ‘their turn’ for an activity.

Prepare your bedroom

Your bedroom should be a nice place to sleep and should feel safe and comfortable for all parts, especially the child parts. Tips to help include:

  • Removing items from the bedroom that might be triggering. This DOES include screen devices. Not only do screens disrupt sleep but they also can be used by various parts to look up or research things which can be triggering. It is easier to put them away or disable the internet during the night.
  • Ensure that there are soothing items for the child parts. This could include a soft toy, a soft ‘cuddle blanket’ or soothing music.
  • Sometimes child parts benefit from the creation of “safe anchors” in the bedroom. These are items in the bedroom that are safe, attractive, soothing or reminders of the present. See the separate information sheet on creating safe anchors.
  • Consider ‘background noise’ carefully. Scared parts often want some background noise in order to sleep. However the TV or radio are not good for sleep. In addition topics and content can change quickly, meaning that you can be exposed to something scary when you least need this! It is better to play a steady, droning ‘white noise’ or a special relaxation/nature noises recording. You may also like to create your own soothing music playlist. Classical music can be very soothing, particularly Baroque music, but there are also many lists of ‘relaxation music’ available on the internet.


Prepare all parts for Sleep

Child parts, in particular, often live in the past and feel like they are still at risk of being traumatised. It is essential to work with them and find ways for them to feel safer at night.

Ask inside – what do you need to feel safer at night? Ideas might include: a special soft toy, a special blanket, quiet nature sounds. Sometimes it helps to try a creative approach. Child parts sometimes need child-like and play based steps to feel safe. Some child parts like to put a “guardian” soft toy in front of the door to “protect” them. This could be a lion or a dragon. Other child parts like to cuddle this toy in bed with them. It doesn’t really matter if adult parts don’t believe in this. What matters is that by doing the ritual they show the child parts that they care and want to soothe them. This helps the child parts feel heard, cared for and therefor safer. Work with your therapist to discuss these ideas and explore this.

Remind the child parts/traumatised parts that they are safe, that the time of abuse is now over. This might include developing a saying such as “It is 2017. I am now 36 years old and I live in XXX. I live in a nice house and that doesn’t happen here.” Work with your therapist to develop these statements.

Develop a ‘safety anchor ritual’ for the bedroom. This involves looking around the bedroom and focussing on items and objects from the bedroom that did not exist in your childhood bedroom. This reminds the child parts that they are in the present time and is very grounding for all parts. Do this step by step with your therapist.

Consider creating a safe place in your head for child parts/traumatised parts. This could be a special room in a house or some other special place. Scared child parts can choose to go there at night.

Use creative visualisation to soothe yourself before sleep. Creative visualisations are best developed with your therapist or somewhat planned out first. In this step you visualise a special place for yourself that feels nice and calm and as safe as possible. It is important to imagine yourself at this place using all your senses. Examples of places include a garden, the beach, a park, a special room that can be as secure and impenetrable as you want it to be. Your therapist can also provide some examples of pre-written visualisations which you can adjust to suit your needs.

Create a “Sleep Kit”. This can be a box or a container which has all the things you and your parts need to help them feel calm and reassured. This box could contain photos, pictures of beautiful places, a recording of soothing music or sounds, a special blanket, pillow or soft toy, a smooth stone or beautiful crystal to look at or touch, a memento of a positive experience, something beautiful a special friend gave you etc.


© Kate McMaugh Psychology, 2017

  • This resource has been developed based on:
    Suzette Boon
    Kathy SteeleOnno van der Hart (2011) Coping with Trauma-Related Dissociation: Skills Training for Patients and Therapists, W. W. Norton & Company
  • Janina Fisher Webinar Program Level 3: Working with Trauma related complexity and dissociation and Level 4: Advanced topics in Trauma and dissociation
  • Lots of feedback and ideas from clients!

Treating Anxiety: A Whole Brain Approach

Anxiety is a horrible feeling that can leave people feeling overwhelmed and crippled by its power. It is one of the most common reasons people come to therapy.

However if you want to beat your anxiety – it really helps to understand how anxiety works in your brain. If you can understand what your brain is doing, you are better equipped to change your brain.

First of all – some basic brain facts need a diagram:

Basic brain facts

In this diagram the lighter coloured, outside part of the brain is the cortex. It’s the ‘grey wrinkly stuff’ most of us think of as the ‘brain’. This area controls the ‘higher functions’ of language, thinking, planning and problem-solving. This part of the brain uses language and has a concept of time.

The coloured sections of the brain (eg hypothalamus, amgydala, hippocampus) make up a very important part called the Limbic system. This area functions through emotions and body sensations. It is responsible for rapid responses to help us stay alive and function. This includes pleasurable responses, but specifically in relation to anxiety, it also kicks in during times of stress. It controls the ‘fight, flight or freeze’ responses when we are in danger.

Both parts of the brain play a role in anxiety and, unless we treat both, anxiety remains lingering in our lives.

The Cortex is the area most people are thinking about when they think of anxiety. This is the section of our brain that worries, over thinks things and may ruminate when we are anxious. Traditional therapies such as CBT can help treat this aspect of anxiety.

But sometimes therapists overlook the Limbic System. I call this “amygdala anxiety”. This anxiety is characterised by vague feelings of uneasiness, a sick feeling in the stomach, even when there is no obvious danger. You may feel like your anxiety doesn’t have a specific, logical cause but it hangs around anyway.

The cortex causes the thinking symptoms of anxiety, but the amygdalae (we have two of them in the limbic system) are responsible for the other horrible symptoms: sweaty palms, pounding heart, rapid, shallow breathing, tense muscles and upset tummies.

The cortex and the amygdalae talk to each other and reinforce the anxiety. For example, fast breathing and a pounding heart sends a message to the cortex that the body is in danger. This sets the cortex off on a round of frantic worry! Unless we treat both the cortex and the amygdala, anxiety is likely to continue.

It is also important to realise that the Cortex and the Amygdalae operate on completely different timetables. Any treatment needs to take this into account. The cortex is slower, but the amygdalae’s rapid response – geared to survival – can throw you into a panic well before the cortex has time to sort out fact from fiction.

An example to illustrate: If you were out bush walking and you saw a stick that looked like a snake, you might gasp and jump backwards. Your heart will pound and your breath will come in short sharp pants. This is your limbic system (eg amygdalae) working. Then you look again, your brain realises it is a stick and computes: stick= harmless = calm down. This is now your cortex talking. It might run late, but it’s helpful!

However the amygdalae can also override the cortex. A typical example will be someone who had childhood trauma. These people will have over-active amygdalae – they needed this to survive childhood. However as adults, even though a logical rational part of their brain will know the danger is over, their amygdalae will keep on red alert, constantly sending danger signals to the cortex. This can also happen for people who just had an ‘innate anxiety’ as a child, even without an obvious trauma. For these people their overactive amygdalae keeps triggering the cortex to worry.


The good news is your brain can be re-wired!

So how do we treat anxiety to make sure BOTH parts of the brain are calmed?

Treating Amygdala Anxiety

Specific treatments are needed to calm the amygdalae to make sure they stop sending inaccurate danger signals to the cortex. If we do this we can ‘get in first’ and get on top of anxiety. To treat amygdala anxiety we have to understand that the amygdalae don’t have words or a good sense of time. The amygdalae can only learn through body sensation and body action. Examples include:

  • Grounding exercises;
  • Breathing exercises to encourage a slower and deeper breathing;
  • Muscle relaxation;
  • Starting practices like meditation, yoga and tai chi;
  • Developing a great understanding of amygdala triggers (a therapist may be necessary for this explorative work);

The next most important things to remember is that the amygdalae don’t learn by people (you, or someone else) just speaking to them.  They can only learn through experience. Therefore it is vital that the amygdalae get new experiences. For example if someone is so scared that they are afraid to go outside then the amygdalae never get a chance to learn that the outside world is mostly pretty safe. Every time the fearful person avoids the outside world the amygdalae get a mental ‘pat on the back’, a reinforcement that they are doing the right thing. Next time they continues doing the same thing, in an even stronger manner!

HOWEVER if that person gradually tests going outside and realises they are safe the amygdalae get to learn that the outside world is safe. The same applies to all sorts of fears such as bugs, public speaking and night time. An important part of beating anxiety is pushing through the fear barrier to teach the amygdalae about safety. As already said we can’t do this with words alone – as the amygdalae just can’t ‘hear’ them.

Some people refer to these as ‘exposure therapies’ but I don’t think this is a soothing and useful expression. The thought of being ‘exposed’ is enough to make most of us anxious! I would rather think of them as ‘practicing new activities’ or ‘giving your amygdala a new experience’. A therapist can help guide you through a gentle and gradual program.

Treating Cortex Anxiety

Once amygdala anxiety is reduced the cortex is less triggered, but it is still important to work on cortex anxiety. This is done through strategies such as:

  • Reminding yourself that your cortex is not always right. Develop a healthy scepticism about thoughts. Develop the ability to notice them, analyse them and choose a response, rather than immediately reacting;
  • Identifying unhelpful thoughts;
  • Developing more rational thoughts and arguments against unhelpful thoughts;
  • Using programs such as ‘Wise Mind’ strategies; and
  • Using mindfulness and thought de-fusion to combat worry and rumination.

Getting More Help

Anxiety can be a very entrenched problem and be hard to shift. However it is possible to re-wire the brain. A useful self help book is: Rewire your Anxious Brain by Catherine Pittman and Elizabeth Karle.

Sometimes people find it helpful to see a mental health practitioner to get support in reducing anxiety symptoms. A counsellor, psychologist or mental health social worker may be a great help in getting on top of anxiety using a ‘whole brain approach’.


© Kate McMaugh Psychology, 2017

Grounding through the feet

This simple grounding exercise can be done anywhere. Once it has been practiced, it can be done in minutes. It can be done when you are busy doing something stressful, such as giving a speech, facing a conflict or waiting in line for a long time.

  • Put your feet firmly on the floor
  • Feel your feet on the flGrounding through the feetoor. Can you feel the floor under your feet? Is it smooth floorboards or carpet? Do you have shoes on? What do your feet feel like in your shoes?
  • Wriggle your toes. Notice how they move. Notice if they feel stiff or relaxed. Do they hurt in places? Do they feel light or heavy?
  • As you wriggle your toes and feel your feet, take several deep breaths. Imagine your breath going all the way down to your toes and then breathe out slowly.
  • Keep focusing on your feet and how they feel on the floor. Imagine your energy going down to your toes with each breath.
  • When you are ready, bring your attention back to the room. Look around you and notice where you are and what you are doing.

Eating for Good Mental Health

Increasingly research is suggesting there is a link between mental health and diet. The body and the mind are linked. Diet affects levels of neurotransmitters that influence mood, sleep, activity and motivation. In addition a poor diet can make us feel tired, sluggish and flat. This can increase feelings of depression. People sometimes also get depressed if they are overweight, due to negative feelings about their body.

For good mental health follow these dietary tips.

  • Eat healthy Food


    Eat a diet that is high in unprocessed foods i.e. foods which are close to how they appear in nature. Examples of unprocessed foods are meats, fish, eggs, milk, tofu, fruits, vegetables, nuts, seeds and whole grains such as oats, brown rice and grain substitutes such as quinoa. Some foods such as cheese and milk undergo some processing but are still quite healthy.

  • Avoid highly processed foods. This includes most packaged foods, fried foods, take-away, lollies, sugar, alcohol etc. For example, it is better to buy plain Greek yoghurt and add some fruit, nuts or honey at home than it is to buy an already packaged and flavoured yoghurt in the supermarket as these usually have more additives and sweeteners than you would add at home. Many purchased bakery products, including breads, are now highly processed and unlike the healthy traditional foods they once were. Eat sweet foods and alcohol as special treats, not as part of your daily diet.
  • Eat protein with every meal, including snacks. Eat protein from a variety of sources including eggs, meats, fish, milk, cheese, Greek yoghurt, tofu, tempeh, quinoa and legumes. Some research suggests increasing protein in the diet may be linked to reduced anxiety and depression. Amino acids in protein foods are precursors for neurotransmitters that control mood. (Precursors are chemicals that help make another chemical.)
  • Healthy fats are strongly associated with good mental health. It is especially important to increase your intake of omega-3 and 6 fats. These are found in oily fish such as mackerel, salmon, pink rainbow trout, anchovy and tuna. They are also found in flax seeds, chia seeds and walnuts. However non-animal sources of these fats do not appear to be as well absorbed as animal sources.
  • Eat at regular intervals and don’t skip meals or snacks. Dips in blood sugar are associated with changes in moods such as depression and anxiety and also affect concentration and memory.
  • Consider supplements of Vitamin Bs, magnesium and Zinc to reduce anxiety. Vitamin D and Fish oil supplementation are linked to improved mental health and reduced depression.
  • Chromium and Selenium deficiencies are linked to depression and anxiety. Brazil nuts are high in selenium and only 4-5 nuts can help make up dietary requirements. Chromium is found in wholefoods such as corn, sweet potato and apples. However chromium is depleted by a diet high in white grains, flours and sugars. There is some controversy around the use of selenium and chromium supplements. While these may be an option, it generally appears safest to try and get these micronutrients through diet.
  • Always combine a healthy diet with regular exercise. Exercise has been shown to have a significant positive effect on depression, stress and anxiety.
  • This is a general guide only. Consider seeing a nutritionist/dietician for expert advice.

Staying Present in Everyday Life: A Guide for Trauma Survivors

When dealing with trauma humans tend to utilise both approach and avoid strategies: sometimes focussing intently on trauma (even unwillingly in the form of flashbacks or nightmares) and at other times completely ignoring trauma (eg ‘forgetting’, going numb, shutting off feelings).

Sometimes trauma survivors think about the past, even when they don’t want to.  They can ‘get lost’ in memories, or ‘go away in their head’, ruminating over a distressing event. They sometimes tell their story over and over again, especially to therapists, thinking this will heal them. They may also have bad memories, nightmares and flashbacks. Many also read about other people’s trauma on this internet or in books.

But this is often not helpful. The truth is each time the mind goes over the trauma event it reacts like the survivor re-experiences the event. The body is flooded with the same stress and trauma related hormones. The brain reacts in the same way – it shuts down with fear! The survivor feels more and more upset. Hearing the stories of other people can also be upsetting.

While, in therapy, processing trauma can be very healing, this needs to be done at the right time, and with the guidance of a professional. This type of trauma processing is very different to ruminating or re-living trauma.

Often when outside of therapy, trauma survivors need to learn to live in the present, not the past. They benefit from learning to spend time ‘staying in the present’. This doesn’t mean denial or suppression of trauma memories or stopping all trauma processing. It just means giving yourself a break, having balance in your life.  It means not letting the past steal your present.

Some examples of ways to stay present in everyday life include:

Gardening – sit walk or stand in your garden, breathe in the air, smell the scents of plants. Dig in the soil and feel it in your hands. Notice if it is soft or hard, warm or cold. Touch small plants. Notice how they feel. Observe how plants change with the seasons, how they grow and watch flowers and fruit develop. Feel the sun on your skin. Listen to the sounds of birds and lizards as they go about their daily lives.

Cooking – enjoy the smell of foods as you chop them and cook them. Listen to the sounds as they cook. Enjoy the feel of pastry or dough in your hands. Remember to taste foods too.

Walking – enjoy the sun on your skin and the feeling of the breeze. Notice the feeling of your feet on the ground. Notice your body as you move. Notice the scenery around you. You may see birds, flowers and trees as well as buildings and cars. Listen to the sounds around you.

Patting your pets – stroke your pets and feel stay in the presenttheir fur underneath your hands. Feel their bodies in your arms or on your lap. Listen to the small sounds they make as they communicate. Watch your pets as they move, play and snuggle.

Watch a comedy on television – enjoy something light-hearted. Laughter releases all sorts of hormones that reduce stress.

Get outside in nature – Go and sit in a local park, go to the beach for a walk or swim. Look at your surroundings. Notice the small things: the flowers, a snail, a small lizard sun-baking. Smell grass. Listen to the sounds of the birds. Being nature is healing and soothing.

In all these activities it is normal for your mind to start thinking again. You may have memories of trauma, or you may start to worry about something. When this happens, just acknowledge it and bring your attention back to the activity you are doing.

This is a gentle process so be kind to yourself. Start with little practices, just minutes at a time and build up. Be creative- find your own activities t focus on and stay present.