Dissociation is a coping mechanism that enables patients to compartmentalize aspects of their experiences in response to an overwhelming or stressful event [20][21][22]. There is a broad spectrum of dissociative disorders, of which defensive exclusion, when stress levels become too high, is widespread: many people experience dissociation during their lives. Becoming so absorbed in an activity that one loses awareness of the surroundings is a form of dissociation or an escape from reality. After an accumulation of adverse events, individuals with early childhood trauma can learn to use dissociation as a way to deal with stressful experiences. Dissociative disorders occur when dissociation becomes distressing and problematic and affects daily life functioning, for instance, in derealisation (feeling detached or separate from the world) and depersonalization (feeling disconnected from yourself or parts of yourself). Dissociation might also facilitate identity alteration and confusion, as in Dissociative Identity Disorders [20][21][22].

Taken together, dissociation is a maladaptive coping mechanism that can be persistent and can interfere with developing a coherent view of self, others, and the world. In the treatment of dissociation as a transdiagnostic factor, a tailored, multimodal intervention focusing on identity integration and adaptive coping styles is required [23][24][25].

Experiencing childhood adversity has detrimental effects on affective empathy [26][27]. Research with fMRI suggests that in individuals with low levels of affective empathy, the mirror neuron system is altered [28]. Furthermore, research found that adolescents with weak cognitive empathy manage to compensate for or develop this social cognitive skill [29]. However, as far as affective empathy is concerned, it seems as if disruptions to affective empathy last a lifetime [29].

Reviewing the literature, the protective nature of PCEs appears to align more closely with cognitive empathy (requiring perspective-taking and imagination) than affective empathy (feeling someone else's distress). One possible explanation might be the fact that cognitive compensations for empathy do not require a properly functioning mirror neuron system, as is the case for affective empathy.

Early childhood trauma can cause hypervigilance and a disturbed balance between excitation–and inhibition [30]. This disturbance increases SOR and the intolerance to stress and sensory stimuli. A clinical trial by Cracknell et al. [30] suggests a high-dose Vitamin-B6 to support inhibition and restore the disturbed brain balance. Interventions, such as ReAttach [14], aimed at improving sensory processing, are important to reduce and prevent SOR in the future.

Individuals with early childhood trauma can develop Early Maladaptive Schemas according to Young's schema theory [31][32] when their basic affective needs are not met. Young [31][32] mentions five basic affective needs:

• Secure attachments to others (safety, stability, nurturance, and acceptance);

• Autonomy, competence, and sense of identity;

• Freedom to express valid needs and emotions;

• Spontaneity and play;

• Realistic limits and self-control.

Young [31][32] described five EMS domains with eighteen maladaptive schemas:

- Abandonment;

- Mistrust/abuse;

- Emotional deprivation;

- Defectiveness/shame;

- Social isolation

Impaired Autonomy and Achievement

- Dependency/incompetency;

- Vulnerability to harm/illness;

- Enmeshment/undeveloped self;

- Failure

Impaired Limits

- Entitlement/grandiosity;

- Lack of self-control/self-discipline

Other-directedness

- Subjugation;

- Self-sacrifice;

- Approval/recognition-seeking

Hypervigilance and Inhibition

- Negativity/pessimism;

- Emotional inhibition;

- Unrelenting standards;

- Punitiveness

Correcting maladaptive coping strategies is difficult, since individuals with maladaptive coping styles focus on schema-congruent information rather than seeking exposure to experiences contradicting them. Besides, due to biological changes through adverse events, such as inflammatory responses, updating and correcting maladaptive schemas is difficult for the brain [33].

Negative EMSs predict helplessness, hopelessness, and worthlessness [31][33][34][35]. A recent study showed that the schemas of Defectiveness/Shame and Social Isolation / Alienation were strongly associated with depression. Schema-congruent information, thus the prediction of being inferior, unlovable, or not belonging, leads to maladaptive coping styles, including avoidance, overcompensation, or surrendering [36].

In contrast, securely attached persons are aware of their negative affect and process distress with self-compassion and ask for help if they need support [37].

Individuals who have experienced early childhood trauma see themselves, others, and society through different eyes because of their life experiences. They often feel different from people who have not experienced so many bad things and are less able to identify with the unburdened individuals. If they engage in well-being comparisons to better-off standards, they may perceive themselves as falling short, accompanied by feelings of inadequacy or self-doubt [38][39][40]. These negative thought patterns can lead patients to become trapped in a vicious circle of fear [41]. These negative thought patterns can lead patients to become trapped in a vicious circle of fear [41]. An external locus of control reinforces these aversive comparisons, which can lead to confirmation of maladaptive schemas, making it even more challenging to adjust [39][42][43].

The avoidance of experiencing or expressing emotions is a defense mechanism that helps individuals with early childhood trauma create a seemingly calm external presentation and maintain the appearance of emotional stability. This coping style just masks the underlying emotional turmoil within. Affective isolation [20] and denial of traumatic memories and events will not fool the body: emotional experiences have a deep impact on our bodily states. Multisensory integration of exteroceptive, proprioceptive, and interoceptive sensory inputs may lead to dysfunctional threat perception and experiences [44][45]. According to Giraud et al. [45], the somatosensory system could be considered a mediator/gatekeeper through which emotions pass with a dissociable effect of arousal and affective valence.

Research has shown that simple bodily exercises can enhance embodied cognitive restructuring [46], suggesting the integration of body-oriented exercises into existing protocols or as a complement to the treatment regimen.

ReAttach Affect Coaches can help clients develop more self-control by offering exercises that introduce the ReAttach technique. A first, simple exercise is to have the client regulate their own arousal by drumming at a fast tempo or pressing with the index and middle fingers. The Forgive and Forget Hood can be used as a self-regulation exercise to clear the mind and the W.A.R.A. to learn how to decrease sensory overresponsiveness or negative affect.

We advise ReAttach Affect Coaches to first use the New Mind Creation procedure [50], including checking all the conditions that must be met before applying the New Mind Creation technique:

With an activated mirror neuron system, social cognitive training enables the ReAttach Affect Coach to help patients develop affective empathy by training cognitive empathy under optimal arousal and sensory integration.

ReAttach utilizes identifications to transition adaptive skills from an external locus of control to an internal locus of control, thereby bringing them within the reach of learning ability.

In the early childhood trauma protocol, extra attention is paid to identification with a loving observer who can look lovingly and attentively at all aspects of the self. The purpose of this is to enhance the internal organization of patients, enabling a coherent sense of self.

As mentioned earlier, it is imperative to pay special attention to body-oriented interventions that help release the negative, embodied emotions held in the body through a combination of identifications and Cognitive Bias Modification (CBM) [14]. The patient can integrate these somatic experiences by engaging in motor imagery of actions to release the body's fight, flight, or freeze responses. In a sustained flight response, a patient might run very fast during motor imagery, kick or hit very hard during a fight response, and warm up and bask in the sun during the freeze response. All these examples aim to integrate traumatic somatic experiences.

In the New Mind Creation session, ReAttach Affect Coaches focus on filling the gap between optimal development and the current neuropathways the patient has been walking to promote secure attachment and Growth Mindset [50]. Although the primary goal of the New Mind Creation is to promote secure attachment, the technique can also be applied after training to facilitate cognitive restructuring within a secure attachment framework. An example is learning to trust schema-incongruent information (during NMC) or being able to tolerate the exposure of toxic shame while taking the perspective of the mirror image and looking to the inner self (CBM1/NMC combination). Practicing exploration during the NMC is a boost for the Growth Mindset and is promising for patients with early childhood trauma or complex problems.