Dr. Bethany Brand, one of the leading researchers in the world on dissociative disorders, joins Lisa today to discuss her remarkable work in the field of trauma. Dissociative disorders were long thought to be nearly impossible to study or treat, but Dr. Brand’s research is not only debunking common myths but creating tools for therapists and patients to manage dissociation. She tells us about her groundbreaking TOPDD (Treatment of Patients with Dissociative Disorders) Study, how it was developed, ran its extraordinary results, and what research still needs to be done. Lisa and Dr. Brand also discuss the importance of trauma-informed therapy for patients experiencing dissociation, and the need for dissociative disorders to be a more prominent part of conversations about PTSD. Join us for this fascinating, inspiring conversation.
Dr. Bethany Brand Links:
Dissociative Experiences Scale: http://traumadissociation.com/des
Study -Lyssenko et al:
Dissociation in Psychiatric Disorders: A Meta-Analysis of Studies Using the Dissociative Experiences Scale:
https://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.2017.17010025
Dr. Bethany Brand Bio:
Bethany Brand, Ph.D. is a clinical psychologist practicing in Towson, Maryland. As an expert in trauma, she specializes in the assessment and treatment of trauma related disorders including posttraumatic stress disorder and dissociative disorders.
Dr. Brand is a Full Professor of Psychology at Towson University and maintains an independent practice in clinical psychology in Towson, Maryland. Additionally, she serves as an expert witness in criminal, civil, disability, and employment matters. Dr. Brand conducts research on the assessment and treatment of trauma related disorders, including the assessment of feigned dissociative disorders.
Dr. Brand also provides consultation and supervision of psychology students, postdoctoral fellows, and licensed mental health professionals. She has presented research papers and clinical trainings around the world.
Dr Bethany Brand is a clinical psychologist practicing in Towson, Maryland. As an expert in trauma, she specializes in the assessment and treatment of trauma related disorders including posttraumatic stress disorder and dissociative disorders. Dr. Brand is a Full Professor of Psychology at Towson University and maintains an independent practice in clinical psychology in Towson, Maryland. She also serves as an expert witness in criminal, civil, disability, and employment matters, and conducts research on the assessment and treatment of trauma related disorders. She also provides consultation and supervision of psychology students, postdoctoral fellows, and licensed mental health professionals, and has presented research papers and clinical trainings around the world.
You can learn more about her and her work at https://bethanybrand.com/ and https://topddstudy.com/
Bethany and I have connected many times through our work with the ISSTD, where she & her research have been recognized for their significant contributions to the fields of trauma & dissociation. I got to know her a little better when we were both presenting at a conference in Sydney in 2015, and I’m telling you, she is SMART, WARM, and hilarious. Her passion and dedication to healing are palpable, which is why I’m so excited to share her with you today. Let’s welcome her to the show!
This episode was produced by Bright Sighted Podcasting
FULL TRANSCRIPT BELOW
- This transcript was auto-generated
Lisa Danylchuk 0:02
Welcome to the How we can heal podcast. My name is Lisa Daniel Chuck and I'm a psychotherapist specializing in complex trauma treatment. I'm a graduate of UCLA and Harvard University, and I'm thrilled to share these reflections on how we can heal with you today. Today, our guest is Dr. Bethany brand. Dr. Bethany brand is a clinical psychologist practicing in Towson, Maryland. As an expert in trauma, she specializes in the assessment and treatment of trauma related disorders, including post traumatic stress disorder and dissociative disorders. Dr. Brandt is a full professor of psychology at Towson University, and maintains an independent practice in clinical psychology in Towson, Maryland. She also serves as an expert witness in criminal civil disability and employment matters, and conducts research on the assessment and treatment of trauma related disorders. She also provides consultation and supervision of psychology students, postdoctoral fellows and licensed mental health professionals and has presented research papers and clinical trainings all around the world. You can learn more about her and her work at Bethany brand.com. And atop DD, study.com. Bethany and I have connected many times through our work with the International Society for the Study of trauma and dissociation, where she and her research have been recognized for their significant contributions to the field of trauma and dissociation. I got to know her a little better when we were both presenting at a conference in Sydney in 2015. And I'm telling you she is smart, warm, wise and hilarious. Her passion and dedication to healing are palpable, which is why I'm so excited to share her with you today. Let's welcome Bethany to the show. Dr. Bethany brand, I am so excited to have you on the how we can heal podcast. It's a privilege to have you here. And I'm excited to share you with people who know about you and your work. And with people who don't know about you and your work, because it's pretty amazing.
Unknown Speaker 2:00
You're so kindly so thank you.
Lisa Danylchuk 2:03
I just, I just speak the truth. So I want to start with, I feel like there's awareness about dissociation is growing. You know, I'm in the yoga world, too. And people started to learn about trauma because they got on their yoga mats. And they were like, What is this? It's happening? What am I processing? And then people started to become more aware of like, well, what is this thing that that's different? Then maybe an activation trigger? What is this sort of going away? And even more, you know, I don't think there's as much awareness of di D, but they're starting to be an awareness of dissociation. So I'm curious for you, when did you you've been researching dissociative disorders for a long time. Now, when did that start for you? When did that question around? How can I measure this? How can I research this? How can I contribute to the field? Where did that seed sprout from?
Speaker 2 2:50
Well, in graduate school, I started with my Masters on sexual abuse and risk factors in families that were sexually abusive. And in the process of grad school, Frank Putnam called into my department and asked for anybody who'd want to volunteer on his longitudinal research study. He was not well known at that point. I mean, yeah, pretty old. This going back aways, does anybody want to help him change the world, his Longitudinal Study of girls who've been sexually abused, comparing them to girls who are not sexually abused, and he and his team found out all kinds of things about that? Well, he's an expert in dissociation. So I was lucky to hear about it that I was skeptical, to be honest in the beginning, because of all the media stereotypes about di D, and, but I got very interested. And then on internship at George Washington University Hospital, I met my first person who said that they had di D, and I reached out to Judy Armstrong at Sheppard Pratt, who was doing some of the first research studies on site testing and di D. And then I was fortunate enough to land a postdoc there, and I got my training, and how do you work with D ID and trauma related disorders? And I kept thinking, We need research in this area. There's not enough research and there wasn't, you know, yeah, I started there in 93. And then I left. That was a full time job, a postdoc for two years and attending for four more years after that, five more years after that. And I became a professor at Towson University where I finally needed to do research and I felt like this is my opportunity. So that was back in 1998, that I started thinking about me thinking about what research needs to be done and how to do it when there's no funding in the field. For research on dissociative disorders.
Lisa Danylchuk 4:41
It sounds like there were some pivotal moments in there Frank Putnam, you know landing the postdoc, right kind of step by step you can kind of see how you look at the path that you know, in retrospect, and it all fits together, right when you're going in this direction, just the opportunity to take a deep dive in into dissociation into dissociative disorders. And from a research perspective, it's like there were all these little steps leading you into that direction. I'm curious if there was, was it mostly just that there isn't enough research in this area? Or was there anything else that motivated you to do the research that you've done?
Speaker 2 5:16
I'm actually not a statistician. I don't think that way. I'm not all that great with running my own analysis. But I think about studies we need to do this. I wonder if this and that's just how my brain works. And then Frank Putnam, Garn Watson, we were at a conference together years later, and I was already doing the series of studies where I compare people with dissociative disorders to those who are imitating faking.
Lisa Danylchuk 5:46
Yes. important
Speaker 2 5:48
research that as a whole nother line of research. And Frank said to me, we need somebody to do a treatment study. We have not had treatment studies in this field, the last one had been 9097. And like, Frank, there's no funding. How do you do research when there's no funding, like, treatment research is expensive millions of dollars, but it got me thinking, and he was willing to be a consultant without charge as rich Lowenstein and ruthless Aeneas and these other incredibly brilliant, gifted, compassionate motivated people were and so we figured it out.
Lisa Danylchuk 6:23
That's amazing. So tell us about the top DD study what it's been going for a long time. Now, as far as I understand it, you have a lot of iterations and things that you've studied over the years? When did it start? And what was the focus?
Speaker 2 6:36
So tap D D stands for treatment of patients with dissociative disorders. And probably most of the listeners know, there's been some debate for some time about whether people can even dissociate trauma memories, some very vocal critics who publish a lot say, No, that's not possible. They're wrong, but that is what they write. And the preponderance of research shows that actually, you can dissociate traumatic memories, and they can come back later, you can get snippets of them later. So I was interested in that. And then when Frank talked about top TV, I needed to start or we as a team needed to start because that same group of critics who challenged that dissociation, that just that traumatized members can be dissociated. They also say, or at least they used to write, they've softened on this, because of the research that they said, they used to write that if you treat dissociative disorders, especially di D, you'll make it worse. If you pay attention to dissociation. And if you talk to people who say they have di D, they don't really necessarily even believe in di D. You'll make them worse. They'll have more amnesia, they'll hear voices more, they'll make more parts. They say it's all a socially constructed disorder, just as created by cultural influences, not trauma. So we had to start at the basics, which our first study was what's called a naturalistic study, where we just followed patients and their therapists, both the patients and therapists reported on how the patient was doing over time filling out validated questionnaires over 30 months. So we didn't interfere with the treatment and we didn't change the treatment. We didn't start treatment, they were already in treatment with the provider who bless them both were willing to be in the study. We didn't have any money to pay people. And in that study, we showed all kinds of improvements. So these patients did not get worse. They stabilized self harm, self harm went down suicide attempts, trended down hospitalizations went down. PTSD symptoms and dissociation, both decreased quality of life went up, adaptive functioning went up, they felt some periods of joy or positive emotion, which they'd been not having very much of. They were using drugs less often. So no way. Were they getting worse. So that was the first step science has to move and these little steps it builds on itself. So we refuted all those myths. And then the next step after that was to do an intervention study. So we created this online treatment program. It's an educational program. There are not nearly enough therapists who know how to treat dissociation, not nearly enough. And so we wanted a twofer. I wanted to help the individuals living with dissociation and I wanted to help we as the team of top DD researchers wanted to help train more clinicians about how you help dissociative folks, especially that first stage of treatment, just getting stabilized learning to to manage symptoms and not be so self attacking, self harm and suicide attempts. So we created this program and which we're now calling the program finding solid ground. Nice. And it was in that first iteration of that online study, both patients and therapists had access to 45 different videos, which were their short little educational videos that I made like 10 to 15 minute videos, explaining step by step, what trauma does to folks what dissociation is, why it's an adaptive response when you're being traumatized, especially if you're a little kid and don't have other ways to protect yourself. Yes. And then things like why self harm is so common and poor self care, so common amongst highly traumatized people. And we build on like that, and then gradually moving to safety, and how you might get safer. And that basically, when people are being unsafe, they're meeting some need. For an example, if somebody's hurting themselves, let's say and this is a trigger warning, but let's say somebody's cutting themselves, they're doing it for a reason, it usually works pretty well to change emotions change state, you know, some people do it to cause themselves to numb out and dissociate, others do it to get out of dissociative state or all kinds of other reasons. Our number one reason for some later research we did recently, is that for dissociative patients in our study, they said their number one trigger for self harm was to get the manager in some way PTSD symptoms, stop the awful pictures, the stop. Okay, so we taught in that program, the online program about other ways that are safer to manage PTSD symptoms, so they didn't have to use self harm. And we taught them about grounding, and had them work on developing plans for what worked. And we just encourage and encourage and encourage them to keep trying, try and find your own ways to manage grounding, we gave over 100 suggestions, but then we wanted them to try it out. So each week, there was a video with some educational material, and then a journaling exercise where they could write and try and apply it to themselves. And then a practice exercise where go out and try it this week. And each client, therapist dyad team could figure out the pace at which they wanted to proceed through the material. And we had this great idea that we give them access to those 45 modules for a year. And then we followed them for a year because then research is supposed to follow them after the intervention to see does the improvement endure. We got we got feedback really fast from therapists and clients like we can't get through all these materials that fast. And because I want to lose access to this material, we don't want to go through it. But we don't want to miss the later portions. And so we went back to my ethics board. And we asked permission to allow them to have access to it for two years and no follow up. We had to I mean, so this is one of our mottos. It's learned together, heal together, work together, learn together and now heal together. So we as researchers want to work with clients, and their therapist, to learn how to best help these individuals living with dissociation. We also want them for those who have self states, dissociative self states, to learn to work together inside themselves, help each other and heal together. So it's multiple layers of feedback and collaboration. And so they were telling us like, too fast, we need longer, slower. Okay, you got it. So that was that first study. And once again, the results were very similar to the naturalistic study is that people who stuck out the program for a year or two years, they showed decrease symptoms of all sorts, decreased self harm, decreased dissociation, decreased PTSD, you know, just these great things and improved emotion regulation. They were learning how to identify and tolerate. And our idea was gradually to help them not be so terrified and phobic of emotion and their bodies. But we did less on that, because that's a big topic, but many people. Yeah. And it seemed to be really helpful. We got lots of feedback from people and the data showed it to so then that was the naturalistic study, then the online study where we tried out for the first time a version of finding solid ground. And then we got feedback about ways to improve it, not just the one I told you about where we made it longer, but other kinds of feedback too. So we did some revisions, and then we made the new program which were Now running it's the first round I get a little choked. Yeah, sappy about this big nuts happy. It means something. This is the first randomized control trial that's ever been run for people around the world who have dissociative symptoms, and their therapist. So it's a called a randomized controlled trial and RCT. And in the science world, you have to have RCT studies to prove that your treatment works. So you compare the treatment, you want a study to another treatment, and you have to randomly assign people to groups. And if the one that got the treatment, you're studying show improvements compared to the other group, then scientifically, it's valid to say the treatment caused the change.
Speaker 2 15:52
So we're running an RCT where now, we shortened the program, because that was that was a lot for people to cover. And you know, in two years time some therapists move or clients moved, or people lost their insurance, or all kinds of things happen, tried to boil it down to what we figure are the 30 most important lessons, and there's 30 videos, along with 30 journaling and practice exercises. And we've got right now as of yesterday, it was 167 dyads. from around the world. And like truly we're getting global representation. Nice making their way through the study. And we've gotten about another six months to recruit. So I literally have goosebumps,
Lisa Danylchuk 16:38
that's incredible. It's huge. It's so significant and so impactful. So I can understand why, you know, I just even hearing it and thinking of not only the people who are in the study, but all of the people that that then impacts right, once you collect the data. And once you kind of draw some conclusions, share that with the clinical community that goes out to people who, you know, when I think of folks who are dealing with dissociative disorders, I think that the people who have been the most harmed, often at the hands of other human beings, right. And so the so I get passionate when people talk about PTSD, but don't talk about dissociation, I feel like, well, you're if you say, oh, you know, this is good for people with PTSD. But it's really only good for people who, you know, had a pretty well adapted ish, or however we want to call it childhood had a single event happen in their 20s 30s. And they're, you know, they deserve treatment 100% We all deserve help and support and we want to understand PTSD, but but when folks in the science space, or the clinical space are like, Oh, I don't really get dissociative disorders or I don't know about that. Like, we're also just neglecting the people who have been the most harmed. And so I get chills thinking about the attention that you're giving to this really important and hard to look at, right? Sort of in a meta way. Right? It's hard to look at, because it is about the people who've been you know, exploited and harmed in these really horrific ways that are, you know, difficult, challenging, practically impossible without dissociating to live through. Right. Very difficult even to be with as a therapist and sort of, quote, unquote, treat from that perspective. And even difficult, I think, for people in mainstream science or mental health or definitely mainstream society to, to believe, right or to, to want to lean towards because we don't want to it's harm. It's, it's hurtful. It's distressing, right? For anyone, even I think hearing some of these stories, which is why we do things like give trigger warnings, right? It's like, it's upsetting. So when I hear you talk about that, I just think of the depths of healing that can come from paying this really skillful attention, not only to what's happening to, to cause Association, what, what shows up, you know, in the aftermath of it, but also, how are people treating it? What's working? And then how can we share that information like that, to me is just so much healing amplified. Right. So, I mean, like, of course, it's emotional and you get chills, I think when you understand what that means, right? Or you've been sat with any person who has been through some of these horrific things and really gotten a sense of it. You know, it's, it's profound and impactful.
Speaker 2 19:33
Yep. I agree. 100%. This time around. We are expanding who we're including. So in the other studies I talked about, we included people who had been diagnosed with dissociative identity disorder, di D, or what's called other specified dissociative disorder. This time we're also trying to see does this program And the finding solid ground program, does it help people who have complex PTSD or the dissociative and the or they don't have that boat, or the dissociative subtype of PTSD. So basically, going back to what you were saying, what we know is that people who have that whole cluster of disorders tend to have had much more severe trauma, much more childhood trauma, and they dissociate, they have more problems with things like self harm, with relationships, often suicidality at times, and because of all of that, they don't get included in standard PTSD treatment studies. They don't meet criteria for the other studies, which means that those studies results, don't help us know how to help people who have been more harmed, as you were saying, and have more symptoms, more adaptations, more struggles. So it's exactly I agree with you 100%, that these are the folks that really need the help. And we as a mental health field have not done a very good job. And there have even been some that have been harmful. I've done some other studies where we asked people living with dissociation about their experiences in treatment, trying to get treatment, and the number of them that are saying things that they've been treated to risibly men called a liar, saying they're making it up, that disorder doesn't exist. It's shocking. It's awful. So our field needs to get a whole lot better about understanding trauma and getting the word out there amongst clinicians.
Lisa Danylchuk 21:37
And a lot of times when I share teach about what is trauma informed mean, I come back to you know, and this is true in the medical world, and in mental health as well. Our bottom line is usually to try to do no harm, right? Like, at the very least, let's try to do no harm. But it happens in a lot of ways. And it can happen just as a result of say, someone going through a whole Doctorate of psychology and not learning about trauma,
Speaker 2 22:05
right, or what they learned, like, I've done some studies examining what psychology textbooks say about trauma and dissociation. And a lot of times we're finding there are books that are just propagating myths, and not research based information about dissociation. And it's just, it's wrong, it's hurtful. It's hurtful to these people and the end the future therapists as they're studying, like, they're gonna go out and practice with this, you know, bogus ideas, that's they could be harmful.
Lisa Danylchuk 22:35
And this isn't like, even 1020 years ago, you're talking about, you're talking about still people who are in school today. Right? But it's challenging it is. And I remember looking into different programs and going okay, well, there's a, you know, this is a Doctorate of psychology, there's a course on CBT, there's a course on DBT. There's nothing in the curriculum about trauma, and just sort of scratching my head. And as you know, I grew up with a mother, who's a trauma therapist, so I'm just sitting here, am I gonna be the one in class that's like raising? What about? What do you think that impacts the body? How do you think the body is impacted impacted their emotions and their experience and their way? And to me, I mean, because again, our brains develop in these environments and sort of create internal worlds. To me, I'm like, it's so obvious. And I also think people who didn't grow up with a, you know, professional drama therapist, parent. Once you learn it, it's like this light bulb. And you go, Oh, that makes so much sense. And for a lot of folks, that's Oh, that I make so much sense. Other people around me makes so much sense, right? So many things fit into when you understand trauma. And I think when we're, you know, trauma informed, dissociation, informed, attachment informed. It's like this big frame to the puzzle. And then you can just start putting pieces where they fall. And then the picture gets really clear. And you go, Oh, okay, this is what's happening. Rather than just having that little piece and going, oh, there's this, you know, relational issue, or there's this mood issue, right, you start to put it together, and you go, Oh, and this is where, you know, and I know, Bruce Perry, and Oprah wrote a book that focuses on what happened to you that question, what's wrong? We started to look at, Whoa, what happened is a really big, you know, what's happening and what's the environment? And you know, I always like to throw in the question, well, so what's right with this person? What's right with their adaptation, right? How are they adapting to perhaps a really toxic or horrific or traumatic environment? So, yeah, get passionate about this stuff with
Speaker 2 24:36
me too. Thank goodness, right? I mean, that's what it's gonna take to change the world. It's gonna have to be a lot of passionate people working for it,
Lisa Danylchuk 24:44
to ship that understanding. And so I'm curious, when do people ask you about how to differentiate like, okay, there's PTSD and the subtype, the dissociative subtype now, which is in the DSM, and then there's, you know, sort of dissociative disorders or di D or DD. Nos, do people I asked you to differentiate those and what, what's your perspective there?
Unknown Speaker 25:04
Yes, they do. You know, in
Lisa Danylchuk 25:06
complex trauma and developmental trauma and there to write all that
Speaker 2 25:10
in together. So there was this big meta analysis done recently, a meta analysis is when some researchers gather up all kinds of studies that have examined the same thing using similar enough methodology that they can combine their data. And what they ended up basically showing us is something that a lot of us were trained in some years ago, but there's data and it's, you know, it's always very compelling. When there's a lot of data from around the world over decades, that shows something that's like, okay. So there's a continuum of dissociation found, it's not just in trauma disorders, it's not dissociation, I shouldn't say the name of the author, the first author is Lysenko, I Sanko. And all found that dissociation occurs in most, a little bit. And most of the disorders recognized in the DSM, bipolar was the lowest level way down here. So I'm making a continuum, if anybody's looking at their screen, at the lowest level was bipolar. And then at the very highest level, all the studies amassed that showed that the people with di D had the highest level of dissociation. So they use it the most tends to be the most frequent and most severe highest levels, according to this measure called the dissociative experiences scale. And then a step away from that dropping down a bit was overall dissociative disorders. And then borderline personality disorders in here somewhere, but PTSD is in there. And so you can the trauma related disorders at the highest level of dissociation, but others don't. Yeah, it's really interesting. And then there's moderate levels. For example, when people have panic attacks, they often have dissociation. So that doesn't mean they have a decision of disorder, it means that under stress, parts of their brain start acting differently, they dissociate. And people you know, who have schizophrenia have some dissociation that's higher than, you know, down here at the end of the continuum bipolar. And so one of the things I suggest to clinicians, or clients or individuals out there, if they want to have a sense for how, you know, roughly a sense for where the person's level of dissociation is, there are questionnaires they can fill out. You know, I think for many individuals living with dissociative symptoms, it's helpful to actually talk to a clinician and look at that together to figure out what that means. But the one I mentioned dissociative experiences scale, actually, I don't think I said its name. That's Frank Putnams. Measure, it's the most used personnel, it's the most used self report measure of dissociation in the world. And that's what Lysenko and his group study. And you can find that online. It's out there.
Lisa Danylchuk 28:05
Yeah, and we can find a link and put it in the show notes as well. So folks can go directly to that. So in your research, or in your, you know, analysis of research, I know, you put together this finding solid ground and you know, had a lot of training and videos, it may be for folks who are just getting exposed to the world of dissociation of dissociation, what have you found to be the most effective treatments or sort of go to modalities or, you know, ways to train therapists what stands out on that side?
Speaker 2 28:37
Okay. So the group of us, a subset of the top DD, researchers did just publish the program called Finding solid ground. So there's a therapist book. So if there's any clinicians out there who want to start learning about dissociation, that's one of the good books, there's other ones out there too. And then there's a patient workbook that goes with finding solid ground workbook. So you don't have to be in the study to get access to that program. But the videos are only available through the research study, we hope at some point that they seem to be effective. In this RCT, maybe we'll figure out a way to also make those available. Anyway, so what we emphasize in that program, and I'm empathy, and I'm, I'm emphasizing the program because right now, it's the only evidence supported treatment program for love for people with high levels of dissociation. So, we emphasize main skills, including getting grounded learning ways that instead of dissociating, get grounded and present reality of being aware of the current date where you actually are your current age and this is the harder part is for some people is being in their bodies, bit by bit and we teach that and little steps. So it's not overwhelming. So grounding and why they might want to be grounded. But we also recognize throughout the program, there's really good reasons you've not wanted to be grounded. So we have them journal about that. What are the reasons you've not wanted to be grounded? How does being ungrounded are dissociated, help you? We want that to be acknowledged. And urine therapy, they can talk about that and show the workbook writing, share it with their therapist if they choose. But also, then we present some potential downsides to being dissociated. Like, I'm still doing therapy with clients. So I was talking earlier today, with the client. She's so disconnected from her body that she doesn't feel thirst. So she can go 1718 1920 hours without any intake of liquids. Like, that's so unhealthy, right? So I have to calm myself down.
Lisa Danylchuk 30:59
But self regulation P says that there, what's happened with my body? Let me just regulate that first. And then we'll come back to what's at hand.
Speaker 2 31:07
Because I care about her and I want her kidneys and the rest of her to last a good, long, healthy life. But we teach things like that we teach about healthy needs, and what are they in the program and how to get healthy needs met safely. So not just their self harm, not just through dissociation, but other ways. So emotion awareness, acceptance, regulation, grounding. What are healthy needs? And how do you get them met? And then how do you manage symptoms like PTSD and dissociation? Those are just crucial elements of the first stage of treatment for complex trauma. So for dissociative disorders, folks, or people with PTSD, whether it's, I mean, the more we'd help highly with a lot of types of PTSD, but especially complex PTSD, or the dissociative subtype, where they really did develop the ability to tune out not know not feel not remember as a survival technique.
Lisa Danylchuk 32:07
Yes, there's two sort of mantras that I use a lot with folks. And one of them is what's happening right now. And you know, there can be a lot happening right now internally with PTSD or dissociation, but like really physically in the environment, what's happening right now, you know, okay, well, the, the lights on, and the trees are swaying and right, sort of just any neutral thing to step into what's what's actually happening right now. Because usually, if you're in a therapy session, the immediate environment is kind of neutral or safe enough. Right. So what's happening right now, and also a good one that goes with that is, that's not happening right now. Like something else that maybe it's a worry based on trauma? Or maybe it's a flashback, or maybe something? Oh, that's actually not happening right now. And then the other one that I was thinking of, as you're talking is, what do I need right now? Right? Because once we sort of get more, and that's not even quite going into, because, you know, as much as I love yoga, and meditation, I know I'm not going to dive right into the body and just sink in there. Like, let's just start well, what do you need right now? Oh, I need rest, or I need a break, or I need some water. Or I can't tell you the amount of times I've been with a client and you know, I'll maybe have a sense of like, what did you eat today? And then they stop and go. Coffee near like, it's 2pm. And it made me some food, it'd be a good idea. Right? So just going back to some of those sometimes really basic needs, like you were saying water, food, sleep, sleep can be disrupted as a result of a lot of these things, right. So that can be a tough one. But just going back to like maybe a breath, maybe a little stretch, maybe just noticing I'm clenching a lot and shaking a little bit of that out. I mean, all of these things, the more somatic and embodied they are, the more you work towards them over time. But just coming back to that, what's happening right now, what's not happening right now. And what do I need right now, those I found to be like on repeat resonate with everything that you're sharing. So save the name of the book, again, for folks who are looking for it,
Speaker 2 34:15
finding solid ground, if you search for those keywords, it'll show up both the therapists book and the workbook. Overcoming obstacles and trauma treatment is the second part. You know, we often have colons
Lisa Danylchuk 34:29
always the extra time.
Unknown Speaker 34:30
We need to get it in there.
Lisa Danylchuk 34:36
So you're doing the randomized control trial right now, you said you've got about six more months of recruiting?
Speaker 2 34:40
We think so. I mean, we didn't expect maybe even after a year to have this many people we love it. And stats, the higher your sample size, the more able you are to find effects, because you have more power for any stats people out there. So I think we'll go for a full year. Given that we can probably run the stats now, but we really, we weren't big enough subgroups for each of those other disorders I talked about. Yeah. And you know, we need more men. There's not as many men, it's it's harder to recruit men into mental health treatment studies.
Lisa Danylchuk 35:14
Yeah, for a whole host of reasons we could get into. But I want to, I'm curious about you mentioned having the researchers brain and the research studies just popping up, I would guess that you're like five research studies ahead in your brain of what you want to do next, and what you want to do next, and what you want to do next? Is there any of that that you can share with us now of what what you feel like comes next? Well, I
Speaker 2 35:37
actually have five lines of research that are currently going. So one is analyzing current day textbooks again, to see if our earlier studies have helped shape the textbooks. And if not, we're going to be writing the publishers and the authors once again, saying Guess what? You are out of step with evidence and research. Yeah, last time, the trauma division of the American Psychological Association gave out awards to the best textbooks, we're doing everything we can to change textbooks and what people learn. So that's textbook series, I'm still analyzing the data from that. Here's what genuine dissociative disorders look like. Here's what imitated dissociative disorders look like. So I'm still publishing some stuff there. And where that helps, is figuring out for the mental health clinicians, which are valid measures that are good at picking up on and describing dissociation. Not that many on dissociation. But some end up there are what are called validity sub scales on some tests. And if you endorse too many symptoms, like if you endorse some, let's just say a questionnaire has questions about depression, anxiety, feeling suicidal, maybe hearing voices, maybe having flashbacks, all kinds of things that go along with trauma, if they include a bunch of symptoms, or experiences the world around you feeling unreal, if they endorse enough of those items on one of these validity scales, that test may then classify them incorrectly, as exaggerating symptoms. Okay, I'm doing a lot of work. My research team and I are doing a lot to try and show these are the tests that are actually valid with dissociative disorders. These are the ones that are not and should not use with dissociative people, because they have used too many items that are elevated or that go along with being exposed to trauma, where that becomes really important in the criminal justice arena, I do some forensic work. And sometimes those people end up a highly dissociative person who ends up there at trial may show no emotion. And sometimes the prosecution says, Look, this person has no emotion, they're antisocial. They're a sociopath. Right? That's a whole nother line of work where I try and with different attorneys, different teams actually help people, their lives be saved. Nice. So that's another one in terms of top DDL, I want to get into the other two areas, but in terms of the top two. So it will take us a couple of years to analyze all the data first, you know, we have to recruit for another six months. And then you have to clean the data for a while organize and do all sorts of work to the data and start analyzing it and then publishing it usually takes two or three years. So believe it or not, the RCT results are not going to be out for quite a while. But of course, we're already dreaming about next steps. This finding solid ground program is about the stabilization of people with high dissociation related to trauma. We are getting lots of requests for can you help with other things too? Can you figure out make a program for other things. So we did a little bit in terms of helping people with PTSD, maybe we maybe will make a program that's specifically about that. We've also heard requests about help me understand and help my client who has dissociative self states. Maybe we can figure out a way to do that. That's not too triggering. It's awfully hard to make these programs because we're not seeing these people face to face. We can't assess Yeah. Are we going too fast? Are we going too slow? Is this this explanation even fit this individual or not? So it is really tricky as the creator one of the creators of this program to figure out how to do that in a way that's helpful, but not too much.
Lisa Danylchuk 39:43
I mean, I think that's the biggest challenge especially when it comes to education around this is that that attunement, going back to being attachment informed that attunement to someone and that nonverbal and at times verbal communication around too much too little. Are we going the right pace is such a big part of it. He kind of trauma treatment. So I feel like that's a piece that from a research any The further you stand back from that first dyad, right, even in the diet, it can be challenging to figure out but then the further you step back, the more challenging it is to figure that out. Is this too much? Is this too little? And that's something I'm constantly sort of leaning into and out of like, okay, is this too much? Is it Oh, that's too much. Okay. And that's, oh, no, maybe that's too little. Okay. You're just constantly trying to refine it. So yeah, the further you step back, the harder that's gonna be,
Speaker 2 40:31
that's exactly right. We've, one thing I didn't mention is we've had people with lived experience who have, for example, we had a panel of people with di D, who reviewed all of our materials and gave us feedback on it before we even launched that online study. And then the CO Pio of the top DD study, his name is Dr. Hugo Shilka. He ran pilot groups with patients at a state psychiatric hospital to get live feedback as he actually did the program. We learned a lot from that. So this new program is adapted. But we would have to go through that whole process again, of getting lots of feedback, trying it out. It's, it's not a fast process.
Lisa Danylchuk 41:15
It is not and I just kudos to you for the diligence and the patience that goes into all of that. I mean, I spill water trying to water my plants too fast. If I'm the right person to be on here to like, go
Speaker 2 41:31
around known for my energy and zeal. So careful with my clients and with the study.
Lisa Danylchuk 41:39
Take a few deep breaths and reel it in, right. And just one step at a time.
Speaker 2 41:44
That one study, I thought it was perfectly reasonable to ask people to do 45 modules a work it's a 52 week, year, that gives him time for illness and vacation.
Lisa Danylchuk 41:59
Then you get the feedback, and you go fine to you. Okay, chunked it down to 30. Modules, right? Yeah, learn and you guys out there are learning are trying? Well, I mean, it makes me think too, that you just can't rush healing as much as we want to. Because there is so much. I mean, as as a individual, you know, trying to healing something personal, we often want to like get to the end, right? Because it's uncomfortable. It's painful. Same thing with things like this. There's so much discomfort and pain and, and suffering at times even at stake that we're like, Come on, let's just, let's just get it done. Let's just know the answer. Let's just move forward. And so that pacing for all of us can be a challenge just to you know, have a lot of energy for something and then maintain it over time makes me think of like running an ultra marathon or something where you know, you know, you got 30 miles, you know, you got 50 miles, no rush, you just got to take it one step at a time.
Speaker 2 42:57
So do you mind if I jump in there? Because it's a perfect, what you've just said, Go? Clinicians, of course want to help clients get better as soon as possible, right? Of course we do. There's no absence of people reaching out to us for therapy, we, you know, if somebody gets better and moves on, we can feel that that time, there's a group that are pushing hard to create Ultra brief treatments, even for di D. And they've written that they about a case where they report they've cured di D and eight sessions. That is so extremely alarming to me. Yeah, they say they didn't need to do any stabilizing therapy. And yet, what they describe is that this person had been in treatment for years MDR treatment, that they had been in treatment and gotten sober with drinking, and they don't acknowledge that was stabilizing, and that in order to do those things, that person had to make a lot of progress, but they say they the authors poopoo that prior treatment and say didn't help. And then they ate ultra marathon days. They did EMDR and prolonged exposure every day.
Lisa Danylchuk 44:11
Okay, I have something to say about my opinion. I have this picture of a friend, a friend of a friend, you know, I actually do enjoy or used to I don't really do long runs as much anymore. But I used to love going on the trails all day. And so I have friends who are ultra marathon runners, right? And we run to the top of this mountain nearby called Mount Diablo. And sometimes seasonally it has translates. I'm not the biggest fan of trainers. So I have this picture of her holding a tarantula in her hand, right? And she's going like this and for folks listening, I'm kind of leaning back and like gritting my teeth, she's like leaning away from it holding it in her hand like Right. And that to me, I always use this when I'm teaching and I asked permission for it because I think you know, my friend posted on Facebook or something else like that picture. That's a great Yes. So I I just asked folks I'm like, Okay, if prolonged exposure is measuring, is trying to measure trauma symptoms, right? Oh, your symptoms went away. And I don't know the study you're describing. But if this if the go to for someone is to dissociate, which is essentially to make the symptoms of trauma go away, right to use an internal, you know, method or switch or way of managing to not feel right, exactly. So fragile in your hand, and someone says, oh, I don't feel anything, you bring it closer. I don't feel anything. I don't feel anything. Well, my first question is, are you dissociating? Right? Do you love tarantulas? Or are you dissociating? And so when I hear about prolonged exposure studies, I'm always curious. And I'd be curious about this one that you're sharing now? How are they measuring for dissociation? And how are they measuring improvement? Because if you're measuring improvement as symptoms going down, well, what are those symptoms? Are those symptoms of intrusions? Are those symptoms of anxiety are those symptoms of hyper arousal? Because I would expect those to go down with exposure. Right? I would expect dissociation to go up. So are you also measuring and you were saying this was treating di D. Right, and eight sessions? So I'd be curious, what how are they measuring that that resolution? What did it look like? Because what I've seen way too often, is folks go into some kind of treatment, that's, you know, the clinician really believes it's going to make them better. They believe it's going to make them better. They go in, and then they just leave feeling numb, which can look on a measure standpoint, like better, but is not better, is right back where you started from, and maybe even backsliding, if folks have been sort of learning to manage the in between a little bit better, right. So always think about transplant the hand, like bringing it closer is going to, you know, maybe bring more and more and more hyper arousal. And then a certain point, if dissociation especially as your go to clamp it down, you feel nothing and be like it's fine. The Trans was in my face, I'm fine. And what is that that's dissociation? Right? Or that it's just a different way to cope that we might not be measuring. So super important. And I'm glad you brought that up. And I'm not saying this just to you know, I haven't read the study that you're talking about. So I don't know. But I would be really curious about a lot of these things, too. I'd be really curious about that. Right? Especially because of the relational components of treatment that, you know, I've seen for so many years for so many people. So I know we got to wrap up soon. And I'm just curious if there's a lot of what you've said is probably this, but what do you wish everyone knew about trauma and dissociation, you have so much experience? You've had your eyes and hands and so much research? What do you wish everyone in the planet knew about these things?
Speaker 2 47:50
Wow, I cannot just boil it down to one thing that I wish everybody understood that dissociation is an extremely common way to survive incredible stress, including trauma. And that you can learn to befriend your body and your emotions and gradually heal. If you for a time had to dissociate a lot. Because when you dissociate a lot, you're disconnecting from all kinds of good feelings, and you're disconnecting at some level from other people, you're disconnecting within yourself. So, so much of life's richness they've had to disconnect from. And it's an amazing thing as a clinician to see people starting to connect and feel emotions feel good. Learn to gradually make some healing healthy relationships. It's incredible. It's awesome. It's inspiring. People can heal from trauma and dissociation. It's possible, but not rapidly. It takes work, but it can happen.
Lisa Danylchuk 48:59
Well, the next thing I was going to ask you is what you would say to someone who maybe is realizing they're struggling with this personally, or, you know, a friend or a family member. So I think that message is spot on of just knowing that it doesn't often happen immediately, especially if there's been a long history sort of leading towards what people are experiencing. But it is possible, totally
Speaker 2 49:18
possible. And especially if you can find a therapist, if you can afford therapy, get into therapy with somebody who has been trained in trauma and dissociation 100%.
Lisa Danylchuk 49:29
And I'll put the istd find a therapist link, as well in the show notes. What brings you hope,
Speaker 2 49:36
doing this work, changing the world and saying, Look, this treatment helps. It helps a lot of people I get the emails from some of the participants. There's a woman in Norway, who asked to go through the study, she kind of laughed it and within that two year period, and she's completely changed her life. She has written a book about it, she talks about it now not everybody's going to have that kind of reaction. but it has made huge differences for people who actually do the work with a therapist who helps them do the work. We haven't yet tested it. With people doing it on their own. We don't know. I'm there.
Lisa Danylchuk 50:12
Yeah. Yeah, that would be more challenging.
Unknown Speaker 50:15
It would be a lot more. Yeah.
Lisa Danylchuk 50:16
It's like trying to do EMDR on yourself.
Unknown Speaker 50:20
Do your own hair cut, especially the back part.
Lisa Danylchuk 50:23
Right, like it looks fine. Right?
Unknown Speaker 50:25
The front side looks good. My bangs right. Okay.
Lisa Danylchuk 50:31
I was just gonna say how can people connect with you? How can they support your work, donate to top Diddy.
Speaker 2 50:36
They can go to top DD study.com. And I have a website to Bethany brown.com. So I have all kinds of resources on there. I have a bunch of publications listed all sorts of things. Also, for people who want to learn more about trauma or who want to teach about trauma, I keep up a website called Teach trauma.com There's all kinds of evidence based summaries of research. There's PowerPoint slides, professors, teachers can use the materials, people who train other clinicians can use the materials. There's all kinds of free good stuff. They're
Lisa Danylchuk 51:11
amazing. And that was teach trauma.com Okay, comm Great. Thank you so much, Dr. Bethany brand, I just am so grateful that you exist in this world and that you're doing all the work you're doing. I know you're doing it with other people, so shout out to them too. Just so appreciate all the dedication and consistency. And I hope you get a break yourself too. Sometimes, more than the five minutes I'm about to give you right now.
Unknown Speaker 51:37
I'm a gardener I kayak. I do self care too.
Lisa Danylchuk 51:40
Good. I'm glad it's been a blast
Speaker 2 51:42
talking to you. Thank you for the work that you do and getting word out through your podcast and your books. Thank
Lisa Danylchuk 51:48
you. Thank you so much. Thanks so much for listening. My hope is that you walk away from these episodes feeling supported, and like you have a place to come to find the hope and inspiration you need to take your next small step forward. For more information and resources, please visit my website how we can heal.com There you'll find tons of helpful resources and the full transcript of each show. You can also click the podcast menu to submit requests for upcoming topics and guests. I look forward to hearing your ideas.
Comments are closed