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Dissociation Record Worksheet

Amanda Knowles

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On this page, we will provide you with a worksheet that is a Dissociation Record worksheet, which will help you record the triggers of your dissociation.

What is the Dissociation Record worksheet about?

Dissociation is an emotional state in which you feel detached and totally away from reality. The dissociation record is about keeping a track of those feelings and thoughts when you feel detached from reality due to some stress, trauma or tension.

How will Dissociation Record worksheet help?

This worksheet will help you record your thoughts and feelings about dissociation which will help you to identify what triggers your feelings of dissociation and how you can counter them 

Instructions on how to use the Dissociation Record worksheet.

When you have frequent thoughts of dissociation use this worksheet, think about what are the triggers and how you can cope with them.

Other  worksheets you may be interested in

Below are links to a few more worksheets which are closely related to the worksheet above.

Dissociation Worksheet Mental Health

Dissociation Worksheet Mental Health:version 2

Worksheet for Dissociation


On this page, we provided you with a Dissociation Record worksheet, which hopefully helped you to record the triggers of your dissociation.

If you have any questions or comments, please let us know.

You can download this worksheet here.

Mental help Resources

The worksheets on this site should not be used in place of professional advice from a mental health professional. 

You should always seek help from a mental health professional or medical professional. We are not providing any advice or recommendations here.

There are various resources where you can seek help.

You could use Online-Therapy if you feel you need counselling.

If you live in the UK then this list of resources from the NHS may help you find help.

If you live in the USA then you could contact Mental Health America who may be able to assist you further.

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Amanda Knowles

Amanda Knowled is an Applied Psychologist, with a deep interest in psychopathology and neuropsychology and how psychology impacts and permeates every aspect of our environment. She has worked in Clinical settings (as Special Ed. Counselor, CBT Therapist) and has contributed at local Universities as a Faculty member from time to time. She has a graduate degree in English Literature and feels very connected to how literature and psychology interact. She feels accountable and passionate about making a "QUALITY" contribution to the overall global reform and well-being. She actively seeks out opportunities where she can spread awareness and make a positive difference across the globe for the welfare of our global society.