When a client struggles with emotional triggers, finding ways to help them disrupt that automatic cycle of reactivity can be difficult.But according to Rick Hanson, PhD, there are three key practices that can help a client regain a sense of safety and calm – especially when anxiety gets triggered.
He takes us through them in the video below. Check it out – it’s just four minutes.
Click here for full transcript
By resourcing clients with effective ways to strengthen their sense of safety and connection, we can begin to expand their toolkit for managing an emotional trigger.
For more expert strategies for working with anxiety check out the NICABM short course with Stephen Porges, PhD; Peter Levine, PhD; Pat Ogden, PhD; Richard Schwartz, PhD; Rick Hanson, PhD; and 13 other top-experts.
Now I’d like to hear from you. What have you found to be helpful in working with a client’s emotional triggers?
Please share a comment below.
What have I noticed helps my anxious clients? The most immediately effective way is breathing from the diaphragm, breathing in and then breathing out for 2 counts longer. This helps them to restore a sense of calm and control in the therapy room and they report that it works for them in their outside world too.
I like to say that music is another of my passions. and I use it joyfully to emphasize the qualities of my customers playing an instrument. Singing is also a way of working one’s breath, but it may require good attentive lessons
It is oebvious that one can see an immedicate result when one implements what Rick Hanson practically described here. Although what he reefers to as “primal” and the image of “monkeys in the cityes” stays unclear to me. Like to hear more about the long term goal of acceptance and modality. Will be interested in discoovering more about his other work.
Sometimes, I have found it useful to “overreact” to a client’s anxiety. I offer them deep breating. I may have them find a place in my office that is most safe (some have chosen a corner of the room or couch). I may offer pillows until they say they have enough. I may ask them if there is anything I can do to make them feel safe. I use the word “safe” not “comfortable”.
The attitude and voice tone are are all important. I am modeling how to accept thier feelings, then I can gently ask for some information about what is going on. This lets me know what to do next. It they are beginning to disocate, by asking a couple of “over the top” questions it forces the to keep some here and now awareness so they can answer.
Modeling caring and compassion, first they respond to those characteristics in me, then they can begin to tap into those resoures in themselves both in and outside of the session (with some more work).
When working with emotional triggers, sometimes it is hard for my patient to access their thinking brain when the cortisol and adrenaline is pumping. I have found that with highly anxious patients, I will have them take off their shoes and socks and get grounded. I’ll have them close their eyes and practice the art of being grounded (sometimes with some guided imagery).
I like very much how you handle this. Thanks.
Rick Hanson’s description of assisting a client in their experience of fear is so very helpful. His information resonates with similar experiential events that happen with my clients. As an Acceptance and Commitment therapist, I use similar techniques with hand movements that describe fusion and defusion as I take my clients on the journey that he describes in the video. I take the client from the external and future environment of fear and dread to the internal, present experience of peace and calm. Acceptance of the present feeling is key to growing out of it. Thanks so much for this short video – very helpful to confirm other clinician’s experiences with this important topic.
I agree, bits by bits you can surely help clients overcome their fears by showing them the way to healing. Thank you Rick Hanson .
Great! Thank-you.
Thank you for sharing these great tools!
Quite right, Linda, articulating helps, especially in writing.
Ask the client to describe the trigger and label the feeling that accomplices it. Articulating seems to help.
Support and presence will counteract the irrational fear.
First, I have to acknowledge that I am anxious, angry, full of rage. I have to be aware that I have these feelings and name them as such. I have to come in touch with them; truly feeling them in my body. I go one step further and focus with my mind or “third eye” on the feelings. Then, as if I am doing a body scan, I breath in filling your head, neck, chest, and whole body. I follow this with a long, slow exhale, slowly forcing all the breath out through my softened eyes, body and nostrils, sort of like slowly deflating a beach ball. Slowly, I do it a second time___ do it a third time___ each time seeing if I am aware of the stress, tension and fear being released__ the head clearing; the neck, shoulders and arms relaxing; and the eyes softening__ then I will know if I am coming into a place of calm__ a wide open space.
There are times I am too wrapped up with emotion and suffer; then it might be time to talk with someone, go for a walk, take a shower, listen to favorite music; just be gentle, kind and caring to myself. All of this might be easier said than done. These remedies might be unattainable immediately but the breathing usually is a starting point. Over time and with practice I hope for the best. There is comfort even in the thought I am not the only one facing these feelings. I am not alone.
There are many good suggestions for dealing with anxiety, in this video by Rick Hanson and in this Comments section. One method can’t fit all, as we know from dealing with our individual clients. I have created a resource of self-soothing tools for my clients to explore when managing anxiety, stress, and difficult emotions. Each person can find what works best to calm anxiety.
Have a look and feel free to share with your clients. These don’t replace therapy but they can be a useful aid for self-soothing.
While this is all useful, it falls into bandaid category. There also seems to be an assumption that all anxiety is conscious.
In my experience of 40 years on the frontlines working with every imaginable type of trauma, there is always an early repressed trauma driving reactions to later ones often with same theme. There are many paths to uncovering and transforming it. I teach an 8 week online course in this for healthcare practitioners. Get in touch if you’re interested.
As a therapist and mindfulness teacher I use a process of: Breathe, Body, Thoughts.. slow rhythmic breathing to calm the nervous system is step 1 always, notice body sensations of anxiety and also feet, seat, posture, and only from there, notice the story, the fear, the thoughts.
What a good idea, that I can use well, to think about this process in one step, all-in-one. When stress hits, and being unconscious, i go back to my breath, ignore the body and go straight to my thoughts, can make awonder . Because it is important to stop and calm the nervous system before feeling or being in contact with the feelings of anxiety, and vice versa. in anytime it’ll passd
Great to be reminded of what we can do when anxiety comes. We can do this with ourselves and then help others with what has worked with ourselves. I learned recently that when I notice I am anxious I put both my hands gently on my heart, one hand over the other, and then this small action activates the vagus nerve to quieten down my amygdala in a very short time. I am being held metaphorically and actually to activate my own capacity for loving presence.
I already used it with a person I mentor who is having an anxiety attack. It came in a very timely manner fir her.
When I was experiencing anxiety my therapist would just say ‘don’t do that’. For example I was reading very triggering material for a class and expressed how deeply it was effecting me and taking it in, she said ‘just don’t take it in.’ But didn’t ask me about my anxiety or what it was bringing up or why I was taking it in so I ended up feeling more anxiety. When I expressed I felt fear all the time she said it was because of my father’s mental illness and that’s how I viewed the world. But the fear I was feeling was deep in my body, fear around my own body and trauma. I was already in a fear pattern with my therapist so I didn’t ask her more questions. These were all sessions over the phone. I wish I’d worked with someone experienced in SE and trauma and the body.
I have been following Dr. Claire Weekes. She teaches us to
Face Accept Float Let time Pass
In other words, when anxiety is triggered do not fight it! Allow it to be there by Facing it.
Accept that it is there then allow your body to Float through it. Let time pass and by not fighting it will dissipate.
Talk to the anxiety when Facing it , say “ Bring it On” and breathe thru it.
This method is the key to recovery. When we fight it we make it worse. Everyone has some anxiety, it’s a natural reaction to fear, it’s how we think about it that prolongs it.
Many have had successful recoveries from anxiety following this method!
I bought Claire Weekes book years ago when I was in my 30’s and suffering from panic attacks. Now my daughter has OCD and she’s learning how to face her fears. Claire was way ahead of her time <3
To guide them to look for the good that is also present in the situation.
When we are hurting it’s hard to realise there is a hidden gift in It, for our self.
Thank you for your great seminars Ruth.
Over the years they have helped me immensely.
You were my hidden gift when I needed extra support to under stand myself during a traumatic period if time in my life.
Thank You. Thank You. Thank you.
It is also good to note that feelings come and go. They don’t stay forever.
I am enjoying Rick Hanson clip. I am new to EFT, IFT, or grounding techniques consisting in step out of your head and look around for 4-3-2-1 concrete objects placed outside. What I love the most and it is very familiar, super easy to use is the basic breathing technique : counting 1o 3 second when inhaling and counting to 5 second when exhaling. Simple, and quick fix. I love this the best.
what a wonderful site. thank you for putting out such helpful material. I will definitely be coming back to sharpen my skills.
My name is Patrick Martin and I am new to blogging and Pinterest. I am a mental health therapist and I started my blog to help raise mental health awareness. I appreciate the opportunity to join your group board. Thank you for your time.
Very deep, slow, rhythmic breathing…
It is an amazing program, really. I am a graduate student in psychology and find an overwhelming amount of mesmerizing information here for my thesis on fear, depersonalization/trauma. Thank you very much.
Very good n interesting skill. Thank you! It makes sense.
Somehow I seldom think tranquilizers does it well only in public speaking they overly use them and then tell you to reduce its too addictive. It only and awkwardly gets worse
Being conscious of the posture is key to feeling strong and tall. Curving the shoulders of the upper body stress how tense a person is victimized or not Since yoga released my tension and ache I am a great believer that the posture easily creates a sense of relief and good breathing habit
Great resources! Could we may be see what researches have been done in therapies for ADHD to back these up? This is the toughest issue for children today
The only way to know is to check back. Does anyone know when the new recording will be out?
Yes, absolutely ! I can’t find other resources so this is the only place for me, but is there any other format ?
I think the course is still online, but no more lectures on this topic, I believe.
Are there more lectures following?
Why does the DSM-5 chapter on anxiety disorders not include obsessive-compulsive disorder ?
Adding Feldenkrais to one’s life will bring remarkable results.
Identify the source of the anxiety, psyed. and supportive presence
I ask them what worked for them in the past and reflect on what it was that actually helped them. Remind them that they have survived until now and done really well overall.
When did “resource” become a transitive verb?
In addition to what Rick Hanson said about “the feeling of being strong” is how helpful weight training has been to me as a woman in my sixties. It is hardly ever mentioned to women in general as advice. It is a real feeling of empowerment and psychological well being to be training my core and upper body to have greatly increased strength. It is hard to describe that feeling in words. But I have that as another very helpful tool in dealing with anxiety.
Yes, yes, yes! I constantly tell women about the power of strength training (& yoga for strengthening, ie. Holding poses).
Thank you for sharing your story.
I hope it encourages more women… like me… to empower themselves with inner psychological strength that comes from outer physical strengthening.
It has been on the forefront of my mind but your story has sealed my decision.
You just never know how you may impact others when you share a story.
Thanks again
I use a Mindfulness practice.
Several of my clients respond beautifully and gratefully when we practice a Loving Kindness Meditation.
Followed by very brief journaling.
Today I saw a young adult who I’ve been working with for at least 5 years.
First I saw the client every week individually and in Group 2x a week.
We used a lot of ACT & Sandtray.
For the past 3 years the client will call me for a “tune up” maybe every couple of months.
Today the client wanted to use coloring pages and we put on Insight Timer and listened to Kristin Neff.
I watch the client’s face and body as the shoulders began to relax,
occasionally eyes closed and coloring stopped,
then moved to a small smile ? followed by a long gaze at me and a big sigh.
The client left smiling and breathing deeply.
I felt better too!
Eugenia Cottrell,Mdiv,LCSW,RPT
Infant Mental Health Therapist
I love this.
I really like this ‘here and now’ approach to dealing the anxiety. Simple and effective.
Thanks
I try to understand what they’re scared of. Ex. I had a student who blamed me for things because she was scared she would fail. I told her that I’d not done what she thought and reassured her that she had studied these things and that she would be asked to do what we did in class.
She would be asked ON THE TEST to do what we did in class. She would not be tricked.
Thank you. Get resource hearing these reminders.
I am using EFT tapping with amazing results. It is efficiently and effectively addressing decades of countless misperceptions that have caused tremendous anxiety and fear based paralysis of moving forward in many life realms. For the hypersensitive and hyper vigilant client this truly is affording them emotional freedom to live.
I would love to learn more about the response cycle. Lisabeth Wotherspoon
Lw310@columbia.edu
I relate that our intuitions can instantaneously integrate and process all of our inner and outer environments, and just as instantaneously suggest options as necessary. I literally ask the question, “What should I do?”, then wait to see if my intuition comes up with options. If something occurs to me I use my gut to decide whether it is useful, or dangerous, or just ok. “Should I do this? Should I not do this? Is it ok?” All yes/no questions. “Should I worry about this? Is this OK? Should I go home now? Should I say goodbye to my host first? Etc.” Making a decision, by answering the question, makes it much easier to commit to an action that might otherwise be plagued with doubt or fear. I say that the answers may not be right, but they are best we have, and making mistakes helps our intuition do better next time. I encourage patients to let their brains do what they are best at…processing information quickly, using all data available. I have heard it said that if our brain’s ability to process information was contained in a computer lab it would be the size of the Empire State Building. Probably dated now, but maybe a quarter the size. Have a nice day!
I can write to you as both the client and professional. It has helped me to have a personal understanding of what my clients are going through. It gives me an advantage to be able to choose the right words for the right situation. Being able to empathize with them helps. So they don’t feel like they are going through the pain alone. When you tell someone you empathize with them you are telling them you feel their pain. It’s as real to you as it is to them. They take great comfort in that.
I write as a client rather than as a therapist. When I’m anxious I’m aware of racing heartbeat, agitation in abdomen etc and focussing on these bodily sensations increases my anxiety. Feeling feet or sitting bones connected to the earth/chair can work. Imagining a hug from my favourite person sometimes works. I’m not sure what a felt sense of safety feels like in my body so feeling into my body when I am safe would be useful. Some information which Ruth sent out recently [What happens in the brain during a potentially traumatic event] showed the the eye sends a message of threat to the brain stem. Would a strategy of looking around noticing that all is safe and calm [no threat] help to calm the system?
I appreciate the videos and the opportunity to discuss this with you -B
Yes looking around would definitely help. There’s a strategy where you use your five senses and you ask yourself what do I see, what do I hear, what do I feel as in touch, what do I smell what do I taste? When I’ve had really high anxiety I’ve done that repeatedly until my system calms down.
Thank you, Michelle, I’ll try that.
Hello B M, I would agree with your observations on focussing on the sensations of anxiety within your body only serve to increase the anxiety and that focussing on the feet or sitting bones etc -‘grounding’ can really help with anxiety. You mention looking around and noticing that all is actually safe in your environment may be helpful and that reminded me of a sort of visual/mental grounding practice that may help here Essentially you ask yourself to find (for instance) 5 green things, 4 square things, 3 animals, 2 tall things, 1 round thing. I hope this may be a helpful experiment for you to try, E
Being able to remain calm and model deep breathing and reassuring client that anxiety will pass while commenting on the process.
I want to tell you that your method is likely the most positive one for clients to benefit from. Just observing not making critical comments and middling breathing is s great way to make a clients day better.
Think that it is just temporary, things will get better.
Excellent focus on being present, strong, and unburdened with extra anxiety. Thank you for this gift of knowing presence.
I’ve developed a “Response Cycle”, which was originally an “Anxiety Cycle”, but it works with anger, stress, etc. as well. I always begin with the body, because that’s where the fight or flight experience is felt. I believe that the second and third suggestions that Rick made would be more effective after quieting down the physical, sympathetic alarm. After quieting the body, I teach clients to develop skills in working with the thoughts, emotions, images and behaviors that can either feed the anxiety or break the cycle. I’d be happy to share the image of the cycle if you would tell me how. Andrew Seubert (seuberta@mac.com)
HI, I also teach and assist the above when working with anxiety – I would love to see your model. Could I email you? Thanks Sandy
I’d like to see the model as well, Andrew. Rick, thank you for providing this and also for sharing that you have a basically anxious temperament. Hearing that actually deactivated some of the secondary responses I have to my own anxiety. What I find challenging is when I’m trying to sleep, my resources and guard are down, and anxious thoughts in the mind can take over. Loss of sleep further increases anxiety. Learning to work with this tendency and trait is my work and a big part of my own life.
Andrew: I also, as a couple of others here would like to receive a copy of your “Response Cycle” printout. edoc95@gmail.com
I would live to learn more about the response cycle. Lisabeth Wotherspoon
Lw310@columbia.edu
I would like to receive a copy of your Response Cycle printout, too.
Thanks for your willingness to share!
Response cycle request please! ellaglenniewalker@gmail.com (:
Thank you Andrew for your resources! Love meeting somebody who uses Gestalt therapy too! (and EMDR)