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Tracking Potentiating States of Dissociation: an Intensive Clinical Case Study of Sleep, Daydreaming, Mood, and Depersonalization/Derealization

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Tracking Potentiating States of Dissociation: an Intensive Clinical Case Study of Sleep, Daydreaming, Mood, and Depersonalization/Derealization View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Frontiers - Publisher Connector ORIGINAL RESEARCH published: 17 August 2016 doi: 10.3389/fpsyg.2016.01231 Tracking Potentiating States of Dissociation: An Intensive Clinical Case Study of Sleep, Daydreaming, Mood, and Depersonalization/Derealization Giulia L. Poerio 1, 2*, Stephen Kellett 3 and Peter Totterdell 2 1 Department of Psychology, University of York, York, UK, 2 Department of Psychology, University of Sheffield, Sheffield, UK, 3 Centre for Psychological Services Research, University of Sheffield and Sheffield Health and Social Care NHS Foundation Trust, Sheffield, UK This study examined in real time the role of sleep and daydreaming as potentiating states for subsequent dissociation in depersonalization/derealization disorder (DDD). Research and theory suggests that dissociation may be exacerbated and maintained by a labile sleep-wake cycle in which “dream-like” mentation intrudes into waking life and fuels dissociative symptoms. We explore and extend this idea by examining the state of daydreaming in dissociation. Daydreaming is a state of consciousness between Edited by: dreaming and waking cognition that involves stimulus-independent and task-unrelated Dalena Van Heugten-Van Der Kloet, Oxford Brookes University, UK mentation. We report the results of a unique intensive N = 1 study with an individual Reviewed by: meeting diagnostic criteria for DDD. Using experience-sampling methodology, the Mark Blagrove, participant rated (six times daily for 40 days) current daydreaming, mood, and dissociative Swansea University, UK Caroline L. Horton, symptoms. At the start of each day sleep quality and duration was also rated. Bishop Grosseteste University, UK Daydreaming was reported on 45% of occasions and significantly predicted greater *Correspondence: dissociation, in particular when daydreams were repetitive and negative (but not fanciful) Giulia L. Poerio in content. These relationships were mediated by feelings of depression and anxiety. [email protected] Sleep quality but not duration was a negative predictor of daily dissociation and also Specialty section: negatively predicted depression but not anxiety. Findings offer initial evidence that the This article was submitted to occurrence and content of daydreams may act as potentiating states for heightened, in Psychopathology, a section of the journal the moment, dissociation. The treatment implications of targeting sleep and daydreaming Frontiers in Psychology for dissociative disorders are discussed. Received: 22 April 2016 Keywords: daydreaming, mindwandering, dissociation, depersonalization, sleep, emotion, experience-sampling Accepted: 03 August 2016 methodology, clinical case study Published: 17 August 2016 Citation: Poerio GL, Kellett S and Totterdell P INTRODUCTION (2016) Tracking Potentiating States of Dissociation: An Intensive Detaching from one’s immediate surroundings when engrossed in an exhilarating novel or Clinical Case Study of Sleep, Daydreaming, Mood, and experiencing the energized focus of “flow” at work, are examples of dissociative experiences that Depersonalization/Derealization. can occur in everyday life. Although, typically viewed on a continuum, clinical forms of dissociation Front. Psychol. 7:1231. are not simply reflective of psychological absorption. Dissociation in dissociative disorders typically doi: 10.3389/fpsyg.2016.01231 involves substantial ongoing problems in integrating thoughts and feelings into consciousness Frontiers in Psychology | www.frontiersin.org 1 August 2016 | Volume 7 | Article 1231 Poerio et al. Daydreaming and Dissociation and memory, with associated poor psychosocial functioning they actually occur during wakefulness. We address this gap by (Waller et al., 1996). Prevalence estimates for dissociative examining the state of daydreaming in dissociation, which can disorders range from 4 to 29% of the population and typically be conceptualized as a state of consciousness in between fully- involve two common aspects of dissociation: depersonalization focused waking thought and sleep mentation (i.e., dreaming). (i.e., feelings of disconnection from one’s self such as feeling We draw on existing research and theory on daydreaming and like a robot or automaton) and derealization (i.e., feeling emotion to extend theoretical ideas about dream-like mentation disconnected from ongoing reality, as if the world is distorted (daydreaming) as a potentiating state for heightened dissociation. or moving in slow motion; van der Kloet et al., 2012b). Recent To ensure external validity and clinical credibility, the theory research and theory proposes that dissociative disorders are is tested in an experience-sampling study with an individual maintained and exacerbated by a labile sleep-wake cycle. In meeting diagnostic criteria for DDD (American Psychiatric this cycle, imaginative, “dream-like,” mentation intrudes into Association, 2013). waking life, which, in turn, contributes to dissociative experiences and symptoms. In this paper, we present an initial test and Daydreaming as Dream-Like Mentation extension of this theory by examining the role of daydreaming Daydreaming (also variously referred to as mindwandering, in dissociation. Specifically, we view daydreaming as a form spontaneous thought, off-task thinking, stimulus-independent of dream-like mentation and examine its relationship with thought) can be defined as mental content that is both stimulus- sleep, mood, and dissociative symptoms in a unique experience- independent and task-unrelated (Stawarczyk et al., 2011). sampling study with an individual meeting diagnostic criteria Daydreaming is stimulus-independent because its content is not for depersonalization/derealization disorder (DDD; American directly related to the processing of the immediate environment Psychiatric Association, 2013). (i.e., it is internally generated) and it is task-unrelated because its content is unrelated to the progression or completion of the current goal(s) in the external environment. Thus defined, Dissociation and a Labile Sleep-Wake daydreaming is estimated to occupy between a third and a half Cycle of waking life (Klinger and Cox, 1987-1988; Killingsworth and The etiology of dissociative disorders has historically been Gilbert, 2010), during which thought operates in a more free- proposed to reflect either coping with early childhood flowing, diffuse, and less directed manner than during other adversity/trauma (e.g., Sanders and Giolas, 1991; Gleaves, kinds of waking mentation (e.g., the deliberate and fully focused 1996; Bremner, 2010) or social learning/expectancies (e.g., thought involved in calculating one’s monthly finances; Klinger, Lilienfeld et al., 1999). However, more contemporary approaches 2009). (e.g., Watson, 2001; Lynn et al., 2012; van der Kloet et al., 2012b; Several researchers have noted parallels between the van Heugten–van der Kloet et al., 2014) highlight the important daydreaming state and dreaming/sleeping states (e.g., Raichle, role of sleep experiences for the proximal development and 2009; Christoff et al., 2011; Fox et al., 2013; Klinger, 2013; severity of subsequent dissociation. According to this model Wamsley, 2013), supporting the notion that daydreaming “sleep-related deficiencies in cognitive control may promote lies in the middle of the sleep-wake mentation continuum an influx of imaginative, dreamlike mentation in daily life that (e.g., Hartmann, 2010; Montangero, 2012). Daydreams show contributes to dissociative symptoms such as depersonalization substantial similarities with dreams both in terms of their and derealization” (van der Kloet et al., 2012b, p. 167). A content and neurophysiological basis (see Fox et al., 2013; labile sleep-wake cycle is proposed to promote dissociation by Wamsley, 2013, for reviews). Both daydreaming and dreaming “pushing” sleep-like mentation into waking consciousness, which involve activation of the default-mode network, which is a core then fuels fantasy-proneness, and is associated with cognitive network of regions including the medial prefrontal and cingulate failures, and feelings of depersonalization/derealization. cortex, the medial temporal lobe, the lateral parietal cortex, and Several studies support the close association between sleep areas of the cerebellum and striatum (Buckner et al., 2008). disturbance and dissociative symptoms. Correlational research Domhoff and Fox (2015) have recently conceptualized dreaming consistently shows that sleep disturbances (e.g., unusual sleep as an intensified form of daydreaming because of the increased experiences) are positively correlated with dissociation (e.g., activation in areas of the default mode network that support Watson, 2001; Levin and Fireman, 2002; Agargun et al., sensorimotor imagery in REM sleep relative to the “resting” 2003; Giesbrecht and Merckelbach, 2004; Koffel and Watson, states characteristic of daydreaming. These authors further 2009a) and experimental studies demonstrate that dissociative suggest that “people can indeed drift into dreaming during symptoms are heightened by sleep-wake cycle disruptions periods of relaxed wakefulness and mindwandering” (p. 349) (Giesbrecht et al., 2007; van Heugten–van der Kloet et al., 2015). which mirrors suggestions that “dream-like” or even dreaming Although, this research indicates that sleep disturbances may mentation can enter consciousness during wakefulness through exacerbate dissociation, research has yet to fully identify
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