Intrusive responses of fear and avoidance commonly experienced in specific phobia and PTSD-related flashbacks are conceptualized as the result of latent dissociative structures of neural organization and psychodynamic functioning activated by current events. The dissociative structure—here described as a dissociated ego state (DES)—reflects a fracturing of executive functioning resulting in a delimited aspect of self that is not under cognitive control or subject to cognitive inhibition by the self of daily experience, and is the psychological construct behind intrusive symptoms associated with specific phobia and PTSD-related flashbacks.

Use of a mindful attentional state permits regulated access to the DES (therapeutic engagement without risk of emotional dysregulation) so that dissociated cognitive resources can be recovered and the dissociated structure deactivated. This may relieve maladaptive responses and behaviors associated with the DES in a profound and durable way, without the need for exposure to or recovery of traumatic memories. Based on this understanding, a 9-step intervention is introduced, along with case examples from two veterans suffering from PTSD symptoms who gained rapid and durable relief and a pilot study showing beneficial and durable impact of this intervention on symptoms of needle phobia.

This dissertation is comprised of 3 articles. One paper has been published, and 2 have been accepted by peer-reviewed academic journals. Together, these papers propose the psychodynamic etiology and neuroscientific structural changes associated with DES-related conditions, along with a 9-step intervention process. Together, these papers suggest that a mindful intervention targeted at resolving DES-based responses to prior traumatic events intervention may offer a low distress, low cost addition to current best practices in the treatment of some PTSD and specific phobia symptoms, and deserves further research.