The window of tolerance is such an important concept when we’re working with trauma and dysregulation.
For clients who have experienced trauma, that window often becomes quite narrow.
They may space out and dissociate, or get too angry or anxious to focus. Or, they might fluctuate between hyper- and hypo-arousal. When they’re too far outside the window, it makes it difficult to continue the work of healing.
So what are some ways to help clients expand their window of tolerance and come back into it?
Ruth Lanius, MD, PhD and Bessel van der Kolk, MD offer some of their insights in the video below. Take a look – it’s under 5 minutes.
Ruth and Bessel, together with Stephen Porges, PhD and Pat Ogden, PhD focus on: How to Help Clients Tolerate Dysregulation and Come Back From Hypoarousal as part of the Treating Trauma Master Series.
Now we’d like to hear from you. What have you found effective in helping clients learn to self-regulate? Please leave a comment below.
I have developed a Mindful and Resiliency Toolkit for kids in foster care. We taught these simple activities as several summer camps this year and the youth loved them. If you are interested, you can get a copy of them here
https://www.dropbox.com/s/16gjmox550lqnb2/Mindfulness%20Moments%20Booklet.pdf?dl=0
I’m wowed by how good and wise this training is and how well put together; also how generous it is – a great deal of work must have gone into it. Some is familiar, some new; all of it is helpful. At the moment am still assimilating it but it’s very good to feel hopeful that the effects of trauma are not irreversible.
On self-regulation I have found that colouring-in can be soothing. The movement, selection of colour, feel of pencil in hand and sensation of the paper on skin help to provide strong focus on what’s happening here and now.
Me, too. I work with colors and a silhouette… It’s a 4 step map for registering the different stated of emoticonal dysregulation on a body based intervention.
Wouldn’t it be pretty wild if one’s regulation and emotions were all rooted in the balanced or imbalanced microbiome…. from natural birth vs. c-section, over-use of anti-biotics in the meat industry, toxic waste, plastics, sprays, etc., causing a GUT IMBALANCE and because the gut is in communication with the Brain through the vagus nerve, all sorts of MENTAL PROBLEMS (Alzheimer’s, Autism, Depression, protruded cases of PTS, Parkinson’s, Compulsions) and disregulated emotions (Greed, Rage, Jealousy, Lack of motivation), have arrived on the scene. What was once thought of as Mental problems are actually imbalances in the Microbiome.
Two things occur to me – it seems like accessing Self, as in IFS, is a way of regulation. Dick Schwartz and Loch Kelly held an online course last spring called ‘Accessing Self’ giving methods/meditations on how to do this. When I access Self, I find myself moved out of either hypo or hyper arousal (I have severe developmental trauma I am still working on).
The other thing I am wondering about is that I know I have heard Dick comment on how IFS avoids the whole window of tolerance issue by the nature of the IFS approach, but I can’t recall how/what/why. Anyone else know?
IFS?
Internal Family Systems.
I find that psycho-education relating to the window of tolerance can be an eye-opener. Folk with a strong visual imagination will ‘see’ it and notice how it can go up and down/in and out – like bag-pipes, perhaps.
I realise that the experience of the window can be flooded by ‘explanation’ and I am not too sure if I know how I discriminate those who ‘get’ it, from those I will hold back the information from. I am cautious and valued this short video as pointing to ways of relating differently to the experiences!
I have found body work and deep breathing with mindfulness as well as visualisations very helpful to expand my clients window of tolerance. It helps them move from chaos or rigidity to a safe place where trust and connection is possible
I am a physical therapist and I use ball throwing as well to help someone get into their body and feel safe to express. I also have my clients stand on a balance board while having a conversation about something they like. It helps them get into their core muscles and be able to express truth.
I recently tried the newest iteration of Thr Flash technique with a client who couldn’t tolerate thinking of the traumatic event without shutting down. This method was “more helpful than anything else we tried”.
The “SeeSaw” breathing lessons from the Feldenkrais Method of Somatic Re-education, not only expand the lungs but can lead to the development of new neurological pathways that over-ride pathways created during trauma. All the Feldenkrais lessons release habitual muscle-tension holding patterns.
Body scan or loving kindness meditation. Grounding exercises.
In my practice (Tom Robertson Therapy) I usually have the clients adopt a positive physiology – looking forward, not down, smile on their face (even if they don’t mean it) shoulders back and of course, deep breathing! In addition I use Emotional Freedom Technique (tapping) too. I find tapping is very powerful in most cases.
However, I do like the beach ball imagery described in the video and may incorporate it into the procecedure.
Thank you for your video. The description of what the window of tolerance is was well explained. I am a therapist and am disappointed at the lack of more practical ways that really help clients increase or return into their window that were offered.
I work at Dandelion Time in the UK. We utilise movement in the body to help families rebuild relationships and rhythmic sensory experiences to help them self regulate. We work largely outside in the natural world and we work systemically. Our work is experiential and I have found that kneading dough, using the shave horse in green wood work, digging in the garden, stroking a guinea pig, felting wool or simply walking offer opportunities for self regulation.
Thank you. Succinct grasp of the whole person dynamics with flexible options to ‘unwind’, expand and balance tolerance levels.
Thank you very much for this video! I found it very interesting! Working through conscious breathing, centering the attention in the body, in stillness or movement are two powerful keys to help clients learn to self regulate.
I teach clients slow micro-movement meditation whilst sitting. It takes 1-2 minutes. The shift before and after is very tangible enabling them to relax before moving into hypnosis.
Could you please elaborate on what micro-meditation is. It sounds interesting! Thank you.
As a healing practitioner and educator, I have designed an entire trauma-informed program for individuals and groups that includes nearly 50 different actionable techniques for emotion regulation, stress reduction, and, thus, building a bigger window of tolerance.
Based on Hanna Somatics, EFT (Tapping), Qi Gong, acupoints, breathwork, sound, and rhythm, I designed the Mindful Motion program (www.SomaticRelease.net) to bring people into their bodies in easy and comfortable ways so that the work of healing from trauma is accessible. Using Porges’ concept of the Social Engagement System, which allows us to use particular parts of our body to allow us to connect to ourselves and others, Mindful Motion is a mindfulness-through-movement program that has been shown to reduce the symptoms of PTSD, anxiety, and depression.
I have included all of the science behind how and why these evidence-based techniques work. I gathered my information from the writings of many experts: Eugene Gendlin, Bessel van der Kolk, Peter Levine, Daniel Siegel, Stephen Porges, Suzanne Scurlock-Durana, Candace Pert, Thomas Hanna, Tom Myers, Moshe Feldenkrais, Bruce Perry, and many others.
Thank you for bringing this information forward, NICABM!
I use boxing as a medium. I find it particularly empowering for women who often make a positive connection with their body for the first time post trauma. Coupling exercises are also great to bring clients into the present.
I remember working with an autistic boy, who had also suffered from emotional and physical abuse. We used to roll a ball backwards and forwards between us at the beginning of sessions and that seemed to enable him to talk a little and be in the room with me before starting to use the musical instruments (I’m a music therapist, which is in itself a very body based type of therapy)
Thanks for these ideas. When I work with traumatized clients (craniosacral) I find that they often have difficulty bringing their awareness and their breath into their lower abdomen and lower back areas. As I hold my hands either beneath their feet or beneath their sacrum and coccyx, I help them to gently open their awareness to the first and second chakra areas, asking them to tell me what they feel there, pain or pressure or tension or nothing. Simply bringing awareness and breath to those areas has a way of bringing them into a deeper state of feeling grounded. While that is going on, I often will touch physically and with deep intention into the psoas, coccygeous, pyriformis and, if anger is an issue, liver, to create movement. Although I am grounded in the science of periodontal dentistry and cranial work, I believe that it is critical to recognize that much of our progress is still mysterious and operates outside of our best attempts at language.
I am also quite appreciating the series.
One alternative way to look at the idea of self-regulation is from Dr. Bonnie Badenoch. Here is a link to a free talk of hers that I love called, “The Myth of Self-Regulation.” Her jam is called IPNB–Interpersonal Neurobiology.
https://www.soundstrue.com/store/leading-edge-of-psychotherapy/free-masterclass-video1?sq=1&_bta_tid=338524539376000578196068934180673701318957347288589330246612452286412960856337485447204&_bta_c=ierw2wuju9h6dctwmcnc58nk3jrcr
Thanks so much for sharing this link!! I agree that the healing comes from the interpersonal RELATIONSHIP and that it is really about mutual regulation rather than strictly self-regulation!
yes! thank you for this link – what a clear and thorough presentation.
Deep breath in, exhale slowly and say out loud “calm” in an extended “Caaaalllllmmmmm”, noting the feeling in the body of the sounds and vibrations coming out, as they change with the letters of the word. Repeat with “Reeeeellllaaaaxxxxxxxx”, noting again the sensations of each part of the word. Repeat back and forth, and invite the client to use their own words. Clients can be initially self-conscious to this, so I do it with them, bringing more volume that can help them elevate their own chant.
I have found a lot of success bringing clients into a more regulated state by incorporating guided meditations with them. I utilize the Insight Timer App. which is fabulous. I also have my own favorite guided exercises for decreasing hyper aroused clients. One is called “painting the feeling” where clients locate where the difficult emotions are in their body and what color the feeling is and then choose a different healing color to paint over the other color with a “magic paint brush.” One exercise I find a lot of success with is the “mind screen.” I ask clients to close their eyes and picture a blank movie screen. Then I ask them to picture their fear or feeling onto the screen. Then we explore brightening and dimming the picture and shrinking and eventually disappearing the feeling. I use a “basket” of other tools with clients and explore with them what they find helpful and what they don’t. For example some clients like to smell certain aromas, squeeze stress balls, or hold a stuffed animal.
sipping ice cold water….slowly….and to follow the sensation
of water entering their stomach..while saying: “i am cooling
my anger”.
I work with veterans with PTSD and chronic pain in the Vet TRIIP program. (I am not a therapist but have benefitted greatly from NICABM wisdom and especially from Bessel van der Kolk’s expertise.) Before we can address physical challenges with a 2-hour session of Qigong, Reiki, massage, chiropractic and acupuncture, we always step veterans through gentle stretching and opening rib cages; breathing in essential oils for relaxation; and tapping for lowering stress. At other times we offer Qigong, relaxing breathing and yoga classes. We do not provide counseling, but our veterans report better success with Prolonged Exposure and Cognitive Behavior Therapy elsewhere after they have practiced techniques learned at Vet TRIIP. Veterans are more likely to show up and adhere to therapy when they feel empowered with self-directed techniques for feeling better and calmer.
Thank you for your continued gems.
When I work with trauma survivors I let them lead the way. I tell them right from the start that we won’t work on going back until they’re ready to do it and not until we build up our relationship and they feel safety and trust in our environment and in their own outside environment. We might spend quite a few sessions looking into this. I could be missing the boat here but I did not find my clients feeling out of control when we worked on earlier history. Again I and the resistor and they are the ones wanting to go deeper. They feel like they are the ones in control.
I have used some Bal-A-Vis-X activities with clients at the beginning of sessions to assist them with getting centered and engaged. It’s especially helpful when clients have arrived for the session in an agitated or dysregulated emotional state. The Occupational Therapist in our clinic provides us with the information and supplies.
Dear Dr. Buczinski,
I am not a professional therapist but have suffered in the past from panic attacks. These comments from Dr. Lanius and Dr. Bessel Van der Kolk are so accurate in describing that when you are either hyper aroused or hypo aroused you are out of the zone. What has helped in the past is just walking while concentrating on my breathing. The breathing is the key and sometimes after a lengthy time, I am back in the zone of rationality. Fortunately I have been in therapy and hopefully continue to work out whatever has caused the panic situations. However one can never be sure as these panics arise suddenly and often without conception or reasoning.
I am so glad that at least you have brought this to the public surface and that you and your colleagues have recognized a very troubling situation.
Many thanks for your dedication.
Best,
Harriet Porto
In my practice I work from epithelium and that’s the direction I taken from I know where they’re coming from I’ve been there I’m one of the lucky ones they aren’t until they can connect with their innermost self and find that power to just take one tiny step I recognize that window of Tolerance when I first began my practice we use the term short fuse or small cap today we look at those windows we also look at the mirrors in those windows
This is a fantastic series on trauma management. I am learning so much. Thank you Ruth and fellow trainers for all your collective wisdom, knowledge and generous sharing.
Tapping on the meridians as per thought field therapy and energetic alignment work which involves working with acupressure points and the energetic field.
I am a physical therapist in Connecticut and work primarily with pediatric clients. A treatment technique I use is based on rhythm as Dr. Bessel van der Kolk mentioned activates the primitive areas of the brain. It is called Bal-A-Vis-X: Balance-Auditory-Vision-eXercises. It is a series of exercises using sand bags and racquet balls and often the use of a Brain Buddy Balance board. These exercises create hundreds of midline crossings (brain stem, midbrain and frontal region) that create a steady rhythmic beat. They can be modified as needed for young and old as well as neuro-typical clients (anxiety especially) and those with various physical, cognitive or emotional challenges. It improves the tracking ability of clients and helps get them out of “ocular lock” which is often seen in clients who experience trauma. I have many children on my cause load who have experienced various types of trauma: multiple medical procedures, exposure to drugs or alcohol in-utero, physical and emotional abuse, etc. Bal-A-Vis-X is also a social activity as it can be done in pairs or a group (once foundational exercises are learned for proper technique) or it can be done individually. I see many children on the spectrum and incorporating rhythm into their treatment sessions improves eye contact in a non-threatening manner as well as assists in creating emotional bonds. A two year old I was working with loved music. While she was standing, I met her where she was and she allowed me to hold her hands. I began rocking forward and backward, rhythmically, and continued for several verses. She eventually calmed and sat on my lap and we continued rocking, forward and backward and then side to side. Our session was over and she looked at her mother and raised her hands to be picked up and her mother hugged her. Her mother began to cry. She told me at our next session that following the rhythmical rocking her daughter reciprocated her hug for the first time in her life. Rhythm is the foundation for healing. Thank you for this series and all your time and effort that will affect so many in a positive way. Blessings to all on your and your patient’s journies.
Debbie,
Where can I see a video of that technique? I’m also interested at my son has autism and I call it swaying instead of rocking and I do it often with him. He always smiles when I do it with him. Let me know if you are awoof any other techniques for teens who are non verbal with autism. Thanks
MM, LCSW, LI
All from my personal experience with post traumatic stress and with a child who used to be on the spectrum. There is a natural tendency to rock and sway to self regulate just on their own within the so-called “autism spectrum” in fact that is a common symptom of diagnosis and it’s our bodies natural way of working on self regulating. Energy work and just shaking it out on purpose while pressing acupressure points or not also helps. Also grounding (earthing) over time has long term benefits of slowly self regulating.
Ms. Marino,
You can go to the website: bal-a-vis-x.com. There are three levels of training: Level A, B and Level C which is a three day conference taught by Bill Hubert the originator of Bal-A-Vis-X (BAVX). Bill is the only person that teaches the three day complete BAVX course. There are some videos on the website so you can see what is involved however please attend a course. I am a sanctioned practitioner in CT and with some patients treat only with BAVX and with others I infuse it into my treatments sessions. You can also overlay academics as they learn the techniques. I believe having as my tools in my therapy “bag”. I have found BAVX to be invaluable and the benefits are maintained.
The Long Island BAVX team is doing a training in Brooklyn in November. I recently co-taught for a Level A with modifications and academics two day training held at Hofstra University.
Please feel free to email me at: dwilkos@aol.com. I would be very happy to answer any additional questions and provide you with more information.
Music therapy could be helpful. The therapist would give your son accessible instruments to play and find a way of tuning in with his rhythms and pace and mood. Or they might just play music which entrains with his body movements, swaying or walking or whatever they might be. This can lead to other forms of non-verbal communication, including turn-taking which leads to increased awareness of oneself and others not to mention a great deal of pleasure in the experience of sharing.
I ask clients to start to breath OUT for longer than a count of six – this engages the vagus nerve to turn up the parasympathetic system, turning down the sympathetic – you can actually feel a warming in the upper chest when doing this! I watch the clients’ face and chest to see when calming may have happened. Then go through the senses, noticing one thing with each sense, then highlight how safe this moment is, nowhere to go, nothing to do but just be here, now…..
Thank you for all you do, to help us help our clients. I look forward to learning more!
I am a family therapist in Denmark, and have been working with developmental trauma in children and adults for some years. I am also a neurofeedback therapist and this is what I use mostly to help my clients learn to know and accept what emotions feel like in the body, and to regulate the nervous system to a calmer staten 🌿🧠🌿Thus being able to expand the window of tolerance.
I found the most effective mechanism for me, used by my psychologist when I was either dissociating or highly emotionally distressed, was to throw a scrunched up piece of paper back and forth and then to begin conversation.
It not only activated my motor cortex and frontal executive functions – planning, sequencing etc, it also forced me to multi-task and this helped ‘bring me back’ and calm down effectively relatively quickly on several occasions.
He is one of the main reasons I am now doing a conversion course in Psychology and hoping to become a Clinical Psychologist in the future.
Interesting ideas!
I like to use simple breathing as an exercise to self regulate emotions. Four breaths in followed by an eight count out and repeat fir several minutes. I encourage patients to practice mirning snd evening while expanding slowly the amount of time they focus on the exercise.
Thank you!!
In helping people learn to self-regulate, I make sure skills are available to try and that they know how to use them. Stress toys – play-doh, bubbles, stress balls, silly putty, tangles, koosh balls, fidget cubes, spiky balls. Instant ice packs for TIPP. Sensory things like scented lotions and sour candies. A self-soothe kit, like you make in DBT, can really help. The client has the control and that alone can be regulating. I’ll take clients on a walk if needed to reorient to the world, show them something new in detail. Play word games or memory games or puzzles. It all works. So does touch.
Breathing of couse is primary. But I offer a pre breathing perception experience to establish a physical container. Then I guide then inside.
This consists of bringing awareness to their form in the chair. Most importantlt what parts of the body are touching somehing: their back, the hands,the feet. They do this focusing their eyes on somehing they feel comforyable with in the room. It is an inner dance of awareness.
Timing the beginning of an episode and then the return to “normal” breathing and arousal states assists in the validation of “This too shall pass.”
The hypersrousal state is time limited when focusing on the breath.
Singing or chanting may aid the breathing process e.g Anusara yoga invocation has helped…repeated until breathing is calm.
Thank you!
I love what Bessel says.
I work as a Rosen method bodyworker on a couch but am sure I can adapt some of his tips for extending the window of tolerance. Certainly observing gait and posture from first moment of entering the room and for myself remembering basics of breath, tapping and beach ball.
Certainly the rib cage barely moves ….
This was excellent! I have recommended qigong, deep breathing, etc. to clients. Dr. van der Kolk’s point about Assessing the client’s window of tolerance in the very beginning is crucial as is regulating the therapy along with the window of tolerance. In the comments, people have mentioned other modalities that have helped them. It is so important to realize that everyone is different (no one modality works for everyone) & to help the client find what works for them. I like the beach ball analogy.
I use mindfulness techniques to help centre them in their bodies. When a client is hyperaroused, when they first walk into my office, I offer them a hot drink or a cold one, getting them to focus on whether they have sugar or milk etc. I talk briefly about their day so far, comment on the weather or introduce them to my cat who loves to sleep on a chair in the room. If they are dysregulated, I ask them to “see” mindfully five objects, “touch” mindfully four objects, “listen” mindfully to three sounds, “smell” mindfully two things and “taste” mindfully one thing. This brings them back into conscious awareness. They can then use this technique in other settings.
Truly holistic, lucky clients!
I have a client for whom it was helpful when I tossed her a ball to catch when she started to dissociate.
Especially helpful for many clients is the dog I have in therapy, I give clients some treats for him and ask clients to offer them to him when they start to leave their window of tolerance. For many clients a cool gel pack taken from the freezer is very helpful to regulate.
In addition, I introduce all kinds of grounding and dissociation-stopp techniques beforehand, so, clients know them and I can remind them when I get the impression they steer towards their window boundaries.
Clients who get very angry can either use the same techniques, and for many isometric exercises are very helpful to regulate rage (pushing and pulling). Or they can use settings for regulated anger expression. For this I use batacas with which clients can beat a table or a mat standing up on the wall. Or an overball clients can smash on the floor. It’s important this is not unregulated rage but regulated and verbally expressed anger. Clients are asked to not just make sounds but actually say what they’re angry about.
Winja this is all really interesting. I’d love to learn more about the isometric push/pulling exercises for rage. I googled and found these on Youtube (not specifically for rage) – are they the kind of thing you mean? What are your clients pushing or pulling?
https://youtu.be/IJ3y-5tssGU
What are batacas?
And can you help me understand why it’s not okay for clients to be smashing the overball on the floor and catharting rage – I still have a lot of conditioning that catharsis = good (it can certainly feel good!). Is it not a stage? that can be followed by more regulated expressions? I get that catharsis can be beyond the window of tolerance; I just wonder if it is *by definition*
If you ever read this I’d be grateful for your answers.
If others have comments that is also welcome!
Thanks 🙂
Great explanation on the Window Of Tolerance. Qi Gong is great. Also Jin Shin Jyutsu – Peter Levine wrote about it in his book IN AN UNSPOKEN VOICE.
The regulation of a client’s breathing is so vital to helping them calm their spirit, and be able to absorb the material and information they need to learn to be able to heal from trauma. We practice that in session; and I have also taught some clients tapping. Another calming exercise is to help them discover a word, or phrase, to use as a mantra to bring their mind and their body back to a calm state.
I would say I am my own client and what is helping me is listening to music. Certain songs in certain situations. I after reading and hearing what you said I saw myself .
Music always helps me come back in the real world, helps me breath and be calm. But not any music. Lyrics and melody have to be in harmony. I am a big fan from U2, a band from Ireland. Their new album came out and it is doing its magic on me again. Just the first song “Love is all we got left” is my best therapy at the moment.
I wish I had the fund to bring my daughter to you. She really could use some understanding help. We lost our husband/father last year very sudden, lots of financial problems, way to much stress and now the fires here in CA took a big toll on her. I hope she will get better again. It is hard to see her suffer.
(She is 26 by the way)
Thanks for the info and I will save this link and hopefully share with my daughter.
I often have used breathing techniques as a way of grounding the client to the momemt.
It extremely effective ,
thank you- great practical suggestion- I work with kids and we practice breathing with bubbles and pinwheels- lots of fun- I tell them when they need to “gets the grumps out of the tummy” they can make believe they are making bubbles or making the pinwheel spin
Thank you!
I’m really loving this series. I am not a professional, but a would be client. I am educating myself as much as I can to aid my self in my recovery. For someone who is stuck is hypo arousal and suffers extreme dissacosiate, what would the best method for this person to monitor their self and bring them selves out of it? I find that if I can bring myself out I go straight to hyper arousal. I have window of tolerance but I’m rarely in it and the tricky part is catching the hyp arousal and dissacosiation in the first place which is difficult what is the best method to catch yourself instead relying on a therapist for this
One thing I use is to practise tuning into your body. If you can try to remember what was the feeling in your body b4 you disassociated. With practise you can increase awareness and take action b4 fight or flight kicks in. May just be a change in sensation in some part of the body. For me its mainly in my gut/tummy. Practise tuning in when “normal” to increase your awareness when it starts to change. Your body always knows b4 its a concious thought but it takes practise especially if wev disassociated from our body to protect ourselves. Good luck
My thing (as a prof and writer, not therapist) is to bring the focus to thinking, to look at logical consequences when people’s “window of tolerance” does not include tolerance of disagreement. “So what you are saying means . . . “
Elsa, not sure if I understood you correctly….?
I’ve had chronic complex PTSD since I was a child, then again as a teen, young adult, again in 1986, 2007 & 2017 & I can tell you as a thinking educated mature woman, that someone in a full blown PTSD reaction/relapse has absolutely no ability to think or exercise logic.
When the fight/flight response kicks in the autonomic response completely takes away all control & higher executive function shuts down.
When I’m having a PTSD flair, NOBODY can reason with me, let alone say, “So what you are saying means…” because I’m either running away in shock, wanting to attack someone, or end my own life.
PTSD is a horrible curse that attached to my life & robbed me of being able to function in any normal capacity. I cannot tell you how much I’ve suffered, however….
Yesterday November 1, 2017 was the 1st ray of hope I’ve had while watching the video claiming PTSD was not a life sentence, and that neuro-feedback is sound treatment. I’m very thankful to be taking this course because yesterday was I finally have hope that I CAN get my life back, even at this late age/stage of 61, to hopefully lead a more normal stable happy life. THANK YOU to all the presenters who’s dedication to this field & platform led to my miracle! Which I can now pass on to others!
The emotional & psychic pain when PTSD is fully activated is beyond description & ability to bare, beyond the ability to tolerate, beyond the capacity for most to want to live through. It completely overwhelms the person. The ONLY successful treatment I’ve found is neuro-feedback long for 3 months every day, which helped me re-connect my shattered self, back into my body/mind/emotions so I could begin to function once again. However that treatment doesn’t last forever, if the person is retriggered, they need it again.
I’ve tried EVERYTHING to overcome this relentless beast, and the ONLY treatment I’ve found with ANY success is neuro-feedback &/or bio-feedback.
All the drugs/alcohol to numb or knock you out, so you don’t kill yourself to escape the unbearable pain is only a temporary bandaid to get you through that particular PTSD crisis.
Unless a person has experienced PTSD for themselves, they simply cannot grasp the catastrophic impact in the person’s life & those around them. I understand why people take their own lives when they have PTSD. Without help they are doomed to a life of painful torture.
Terry, I, too, have chronic Complex PTSD, and indeed, it is a horrible thing. But there is HOPE!
I’ve tried EMDR, neuro-feedback, acupuncture, and scores of other things, not to mention medications. The best modality I’ve found is Phoenix Rising Yoga Therapy (PRYT). You don’t need to know yoga postures or be physically flexible.
Just as Dr. van der Kolk and many others state, trauma is held in the body. PRYT works with the body. I can’t express enough how amazing PRYT is. It has helped me so much, I’ve gone through two years of training to help bring this work to others with PTSD. If you’re interested in this modality, you can go to PRYT.com and find a Phoenix Rising Yoga Therapist in your area.
Sending you all my best on your healing journey.
Thank you so much Gina for responding with this helpful information about Yoga therapy.
I will make a decision to incorporate this into my lifestyle.
Thank you again for mentioning it.
You are welcome, Terry. I hope the modality is as helpful for you as it is for me.
Wishing you the very best,
Gina
Phoenix Rising has been a Godsend for me too. I’ve been doing it since ’14.
Terry, I have Complex PTSD as well. There are great Facebook groups where you’ll hear versions of our story and lots of tips. Have you read Pete Walker’s Complex PTSD book? Life-changing for me as was EMDR with an experienced trauma therapist in L.A. That he labeled what happened to me an atrocity was also huge for my recovery. Choices, safety, and connection (animal and/or human) are key. Will look into Phoenix Rising!
Feeling the painful emotion on the in breath and blowing it out and leaving it in the room on the out breath. Finding the client’s own self comfort movements. Progressive muscle relaxation. Opposition movement, so practising moving the body in a way that is opposite to hypo/hyper arousal, e.g. opening out the body.
Supporting the patient’s efforts to “change the things I can” is a well-worn principle of self-regulation. It puts the focus on what the patient can do in a simple practical way, getting back into authority over her day to day circumstances.
I find the stability ball helps likes to regulate. Holding ice can be affective for some as well. Throwing and catching a ball.
Can anyone recommend very good medications that help?
I like to incorporate some movement, so I meet them where they are at and then co-regulate them back into their window of tolerance. I work a lot with children so I need to rely more on the non verbals!
An example I use with children and parents if they are hyperaroused is a yoga breathing technique I call “Woodchopper” it’s great because it combines movement and breathing together. You lift up your arms on the inhale and on the exhale swing down like you’re chopping wood releasing a loud sound as you can! It often makes people laugh too which is a great way to discharge excess energy and connect. It’s nice to hang out with head between their legs at the end of their exhale as this switches them into their parasympathetic nervous system.
Hope this helps! I’m enjoying reading the comments and learning others tips too! Thanks for hosting this series 🙂
Often do breathing exercises during a session, and have used throwing a ball back and forth.
Me too!
Firstly,I’d like to thank you for this series.I am really enjoying it and learning alot. In my practise I help clients do mindful breathing ,being in the moment , notice their thoughts as a neutral observer and with compassion. I help them retrieve memories of soorhing images ,whether it’s a beautiful place in nature or a loving person or pet , I help them locate their anchor in their body that’s the most planted in their chair. All the while I go back to the breathing.i help them get contained in a safe place .we imagine an invisible forcefield around themselves that’s protective of them . After a short while they’re breathing deeply , limbs feel heavy ,and they’re in a very calm peaceful state . It’s from this place that healing begins as we explore the different physical sensations in their body. We identify constructions and expansions and pendulate between the two. Interception and self awareness follows.
Forgive typos. Constriction ,interoception
Deep breathing
I love ‘the window of tolerance’ notion
I feel as if I’m among friends and love how the work now has come full circle and the body is acknowledge I feel the work is validated from my original four year body psychotherapy training 30 odd years ago with Gerda Boyesen ‘Biodynamic Psychology’..
Then as now I listen to the peristaltic gut sounds which indicate the freeing of the emotional stress The quality of the gut sounds is another way of viewing ‘the window of tolerance’ and wyhen working with an individual using touch can monitor the progression and strength of the response. It is an acquired art from that original training which I still use but now more generalised to with facilitating training work with a group.
Watch for breathing is a fundamental.,At a time when I see the breathing is changing, people may talk about being hungry. Another way is I ask people exaggerate there breathing by blowing out as they drop their shoulders.Using a soft ball underarm to catch the ball – hands out ‘soft hands’ like the cricketers and do it non verbally. this can bring a switch of hemsipheres, help hand/eye coordination and improve regulation quickly.
Yes play dough or modelling clay is also very powerful. I have one child who hardly ever expressed her creative play other than babbling,can now explain what shes doing while she develops her models.\
This explains the increased “passing of wind” when a child is shifting and relaxing in session haha! Biodynamic psychology sounds really interesting. Thanks for sharing
I am in the process of my PTSD/developmental trauma recovery journey. And, with my SE therapist we have expanded my window of tolerance. A huge indicator for me knowing when my body is again regulating itself now has been the return of & activating of peristaltic sounds/movement. The first time I heard/felt it I was shocked, as I realised it was many months since I had heard that! (After being in a crisis state). And now, when I noticed I’m “off” and “out of sorts” I lay still and in my mind say “I’m here body. I’m listening”. And after a period of time, I feel my nervous system “start up” and go through a series of movements (body initiated) and once I start to hear my tummy grumble I know we’re “away”. And things are settling. And the fearful/dread/anxious tone to my whole being (thoughts and body sensations) is lifted and dissipates. And I feel relief and calm again. And yes…I again start passing wind. Which makes me giggle that my body farts to calm itself. Hehe!
You’re not alone LOL! I can relate personally speaking but also professionally I work with children and the play room is nearly always with a faint aroma of farts after sessions. And you can’t get more authentic than children! Thanks for sharing your story. I enjoyed reading it. Inspiring & funny! 😉
Oops Repeating myself a little! Sorry! Nap time!
Wonderful to hear about saying to our body that we are ready to hear them and then how responsive it can be, farts and all!
Such fun reading all the comments about beach balls! I just finished offering a 3 day professional accreditation training in EFT/tapping in Toronto, Ontario, Canada where we integrated a majority of what this video spoke about. I’m enjoying how this field is becoming more and more integrated. Thank you NICABM, I know that you have contributed greatly to this integration
Wonderful information and ideas. Thanks so much. When I was working with children I used kneading and molding of clay as a grounding non-verbal communication by modeling whatever clay shape the child made: round balls, snake shapes, etc. With older children I used Baroque music or coloring books with crayons while I modeled their breathing and then slowed mine (to slow theirs). With agitated or anxious adults I modeled deep breathing while avoiding eye contact and moving my swivel chair rhythmically. I wish I had heard these ideas about the “window of tolerance” and how to expand it back then. How much more helpful I could have been!
never underestimate the power of playdough…especially with children!
As a Primal Therapist we have used exercise such as light jogging to either bring people down into the primal zone by running off excess tension or bring people up into the primal or feeling zone by elevating their repressed or lowered vital signs.
My initial go to activities include: 1.Thirty second self-calming activities like three long exhales, tensing and releasing set of muscles, sipping a hot beverage. 2. Grounding (right now I see, hear, smell, taste, feel). 3. Diaphragmatic breathing. I find it’s important to get them to practice in session each visit as well as encourage daily practice.
Mindfulness Meditation
Perhaps in Buddhism they say “return to the moment” or “follow your breath” to return to the window (or open the window) For instance : Tara Brach uses R.A.I.N. and Pema Chodron uses C.A.L.M. to return to the moment and regulate the breathing of panic.
My son inadvetently bastardized their acronyms into P.I.N.E. : Pause the panic…Inhale slowly…..Notice the panic…..Exhale slowly and “let go” of or “accept” (panic?).
For some it is easy to notice that you are no longer in the moment (large window). For others it is impossible (small window). Perhaps meditation is the “exercise” that strengthens the “muscle” that either opens the window or squeezes us through the smallest opening. Or maybe meditation just helps us remember our favorite acronym.
On my recovery journey and with clients I treasure the Tibetan Buddhist mind training and it’s modern forms like RAIN. I use tapping, SE, EMDR, Yoga and Qi Gong, but the deepest transformation of creating a safe place and inner safe caregivers for me, provided Tibetan Guru Yoga practice.
‚Feeding your demons’ by Tsültrim Allione is an easy 30 Minute practice with breath and body awareness, visualizations to dissolve recurring intense feelings like panic, anger or simply the dissociated feeling of not being in the body. It‘s a very ancient technique brought into a modern self-help form on CD. It‘s amazing tool to get from intense negative emotion or body sensation to aresouceful, connected state in half an hour and it can become a journey of creating inner safe places and connections that evolve during the healing journey. Book and CD are available. In different bookstores and online in several languages.
Working with cancer patients I find breathing exercises to be helpful. I also borrowed a technique from a psychiatrist in Wisconsin who has his patients participate in a breathing exercise which calms them and offers an opportunity to discuss issues more thoughtfully rather than emotionally.
A big soft cushion or even a very big cuddle-able teddy bear can help expand the rib cage and allow more expansive breathing while safely hugging something to protect the threatened abdominal area/viscera/core.
That’s a great idea and point! Thank you
There are so many ways to bring people back to a space that is both present and tolerable. Some clients really lke the em-wave/Heart Math work so much that they buy the device, but even without it the basic approach and practice is very helpful. Autogenic progressive relaxation is a simle method that is easy to learn. Lots of different yogabreathingvtechniques tha clients can reinforce and practice at home with plenty of toutube videos to help them. The main work I offer is different than these though: Sensory Awareness work as taught by Charlotte Selver. It’s focus is more on what is happening versus trying to change it. More about first becoming aware of how we embody any given state in any given moment, following it versus trying to control it and discoverng how it unfolds on its own. How breathing is happening and how we might allow itmore fully in a natural way. Also our relationship with gravity that lets us feel our own weight and the support under us—how mch we are anle or not to let ourselves literally be supported. Also arts-based seems to get us out of a ‘head’ experience that is separate from the rest of our bodies. We tend to get more to the core emotions I think and the arts themselves create a container that crystallzes our experience in very unique ways. Visual imagery, music, movement, sounding, poetry, story-tellng, dramatic play—one or some or all can be explored in spontaneous and dynamic expressions that bring something new into the room. There is a natural window of tolerance that comes when a person chooses what structure feels the safest for them.
Excuse the one-finger typing typos!
Elizabeth thank you for your encouragement.
If I could just get to a point of being regulated more days than not, I’d like to write a book to therapists. I would tell my life story of trying every possible type of therapy, every possible modality, self help book, workshop, course, retreat, support group, … I’ve “flown to the moon” and back countless times in pursuit of a life worth living.
By some miracle I’m still alive. Everyone I know has urged me to be a writer. Perhaps my story is worth telling? Perhaps therapists ( and others) would be fascinated by the resilient thread that has kept me trying and trying and trying incessantly all my life? Despite multiple traumas in utero, during infancy and throughout my life?
I have told myself that I could only write a book once I’m “cured” so as to offer the world my magic potion solution. Yet as I realize more and more, trauma never goes away, it only perhaps gets managed, with hard work and practise. So maybe a spellbinder book success could be achieved by enticing the audience with all the ways I tried and managed to save my own life, one dorsal vagal shutdown at a time…….The cat with a thousand lives.
Mary, you may already have a title there: The Cat with a Thousand Lives.
I’m a student in a certification program through ROOTS Institute, the education arm of One Heart Wild Education Sanctuary. a 501c3 nonprofit in Silverdale, WA, training to become a certified practitioner of Animal/Equine Assisted Self-Regulation and Self-Development. There we have learned that the basis of our work with clients is the Window of Tolerance, working with a client to understand what that is, giving them tools to figure out where they are in their own Window of Tolerance at any given moment, how they would describe what that feels like, where they feel that in their body, and give them tools to help them come back into their Window when they are feeling dys-regulated, such as breathing exercises, or grounding exercises, or something as simple as taking a walk in nature and asking them to notice and say 5 things they can see, 4 things they can hear, 3 things they can touch, 2 things they can smell, 1 thing they can taste. This gets them out of their thoughts, and into the present moment, after which they can do a breathing exercise to ascertain where they are in their Window, and begin to move forward. Or working on the ground with a client and an animal with whom they resonate, asking them to notice things about the animal, and how that makes them feel as they learn to touch the animal, and breathe with the animal. Often, they walk with the animal, or talk to the animal, or just hug and pet the animal, and sharing the intimate relational moment with another being is so calming that one can see that they have become regulated. At that moment, I ask how they feel and what changes they have noticed in themselves, and ask them to remember how that feels, and suggest that they take a picture of that with their body and their mind and make it a touchstone, an anchor to which they can return when when they are feeling out of tolerance. We have found that this works quite well.
We use the works of many of the speakers in this series as our textbooks in our curriculum, especially Bessel Van der Kolk’s, The Body Keeps the Score.
Thank you so much for creating this series as it is so important to understand the neuroscience of trauma….and so much of it also translates to other species! Almost all of our 30+ animals have been adopted/rescued from traumatic situations, and they are healing along with our clients! We also have a trauma-informed, trans-species psychology-informed certification path for Animal/Equine Assisted Psychotherapy clinicians.
Roby,
So true about other species.
My husband and I adopted an 11 month old rescue dog two years ago tomorrow. We were told she had a loving home but was relinquished because of her barking in a suburban area (she’s a beagleXfoxhound!)
From a Day 1 she was utterly hyper-aroused, made no barking or normal dog communication sounds apart from growling and couldn’t bear to be touched. We’ve been on an intense and intensive journey with her, with a dog behaviourists and a local dog club to help. We had to tune into her, and to her triggers.
We began by using a traffic light guide, rewarding social behaviours when she was in the green zone, coaxing away from triggers when she was in orange zone (we had to be super quick here, with catching green and orange zones to provide positive experiences). Red zone just had to be contained the best we could without further trauma and these were most common and it took awhile to learn what she was reacting to, because it could be a long way off.
After a couple of months, she began to find her very loud voice and we began to see tiny muscles in her facial expressions and ears. The subtly and range of voice and body language has increased over a year or so. She began to tolerate touch, then enjoy it a bit. Now, she asks for more pats. She used to curl up in a tight ball, now she’s happy to lie on her back or spread out on her side.
It’s been sometimes heart breaking to realise how much trauma she must have suffered but the reward is a beautiful, expressive, tuned-in dog (with attitude she is safe to express). Occasionally, she gets a fright, or sees a type of person or dog and goes into a melt-down (she isn’t aggressive, she just noisily tries to scare the boogeyman or boogeydog away). These meltdowns used to be daily, now it’s maybe every few months. Many ‘dog’ people who knew her from the start are amazed at how far she has come.
My background is that I suffered developmental/complex PTSD and complicated grief. While therapy over decades has brought much healing, my relationship with this amazing survivor dog and learning about & tuning into her behaviours, and reading her zones and triggers, has given such rich insight and extra healing and grounding. We have had to be her advocate at times when others had no faith in her. It’s been a tough journey though…Not for the faint-hearted.
I found slow deep breathing helps a LOT to calm the body/mind when a person is in a hyper-aroused state. I help people come out of their head & re-connect to their body by getting them to focus on their heart beating, to assist in self-regulation. This re-introduces them to getting in touch with their internal autonomic functions & self-regulate, after trauma has disconnected their body/mind to far out.
I have not had success yet, with tapping. Not sure if I’m doing it incorrectly….?
deep breathing and MINDFULLNESS
I am a music therapist in advanced practice. I am a music therapist and RN an LMFT
Like Bessel, I watch the client and match their energy before I begin. Then I make slow purposeful nonverbal intervention using elements of music.
I use breathe, movement , singing to them/with them and Drumming.
Sometimes I ask them to go underneath my grand piano while I play relaxing slow music. It gives them a sonic rest and neurological reset.
Hi ,
I am unable to sign on to the free viewing as it happens ….
I sign up but am unable to find a email to subscribe to in my email /junk mail
It is very frustrating as i would like to watch them .
Thanks
Maida
Hi Maida,
I’m so sorry for the frustration. I just sent you an email to help. Please let me know if it does.
And if you didn’t receive my email, please do reach out to us at respond@nicabm.com, or give us a call at 860-456-1153. I want to make sure you get access to the free broadcasts.
Best,
Lauren
NICABM Staff
I love the ball backwards and forwards-I find balloons are good, especially for kids, as they are able to reach them easily and there is no fear of getting hurt, or being clumsy.
We play balloon tennis.
Thanks for the reminder about the window of tolerance. Great to know the ways of helping calm the primitive part of the brain to give clients those practical tips. Working with traumatised children and their carers, this is so important to keep in mind.
I think that breathing techniques are an excellent way to help a client self regulate.
Mary, my heart goes out to you as you described so aptly your excruciating suffering. Many, many people have complex developmental trauma their history. You are dealing with it so well and are in charge of hurting self, even if it is hard and you need to do it (use helpful soothing techniques) time and time again. Believe me, this is not in vain. The hurt becomes less and less as you grow into a new competent self. Only the memory remains, as a wisdom to be shared. I hope you will truly find yourself when you share yourself in service to others, less fortunate and similarly suffering souls. Believe me living is by far better, and truly the only only option, as you have so much to give, and to receive form other, loving persons. Forget the blaming family. They don’t understand and don’t appreciate. Probably hurting themselves, so expecting more of others.
yes with clients I use breath exercise, TRE tension release exercise (David Berceli) and meditation. I do all these myself too. Post eartgquakes in Christchurch TRE in particular is very effective at returning the body-mind to baseline calm.
Body is where emotions are felt , so Breath with a whooosh sound 2-4-6 rhythm and Tapping as well as mindful walking are excellent ” Bottom Up ” techniques.
Thanks for excellent tips
I work with children and we play games jenga, connect four, uno. I also have lots of tactile objects, find toys in rice, create and guess with playdough. This kind of play is non-threatening and really works to help them get into that window and open up! I’ve heard it called INCA (inherently non-clinical relational activity).
I work with children in class. I have found call and response rhythmic clapping is a tool to focus and delight children. Breathing, visualisations centre and calm children and clients. Listening to nature or sounds can help too.
I’ve been studying Organic Intelligence (oganicintelligence.org) for the past three years which is all about human empowerment and nervous system and physiological relation. I think you would find this approach very relevant to your discussions about therapy and trauma.
YES, T have found BREATH calls to BEING…A particular breathing practice, presented as the Governor Vessel Breath, is integrated with the deep relaxation of Spinal Resonance… http://apogeeacutone.blogspot.com/2016/02/spinal-resonance-entrainment-harmonics.html YES, the Window of Tolerance becomes expansive.
Quantum Healing
I found breathing into the belly very helpful as well as 4x4x4 breathing a nice soothing breathing exercise. I try to teach them self calming tech pretty early
getting them into nature or playing ball, basketball, pingpong, etc..any kind of ball!!
I enjoyed this video. I think how you describe the process is right on target. In my own life, I have experienced a window of tolerance and it is narrow for those who have experienced multiple traumas. A big bag of different techniques for helping someone learn to tolerate emotional dissonance is really important. Some techniques may work with some, but not others. Sometimes the timing can effect the effectiveness of a technique being used. When someone is outside that window of tolerance, the anxiety, grief, or anger can be too great to hear what someone else is saying, or even see what is in front of them. Even sensation can be totally absent for a time.
Nature can help bring the intensity down through mindfulness and breathing exercises. Holding a stone or flower can help refocus on the here and now. Guided imagery can help, singing or chanting to one-self. Having the client focus on what is going on in the body when they are unaware can be helpful. Parts being asked to do things can help. It all involves education, practice, and hard work, for every person involved.
A previously chosen essential oil;lavender, bergamot, literally ‘grounding’ themselves eg a student doctor in a anatomy dissection room (compulsory to pass her exams) with her mother just having been diagnosed with breast cancer, to focus on her feet grounded on the floor and her eyes focussed on the feeling of the dissecting tools in her hand…
This approach of attention to breathing, walking, movement is exactly what dance movement therapists do.
I am not a practitioner, but a person in trauma treatment. My therapist has these squishable feather throw pillows on her couch that I really like, and that enable me to really REST into the space. If I start to dissociate in treatment, she will often initiate a short game of “catch” with one of these pillows. This is always successful in re-grounding me and returning me to the present and into my body. It is a bonus that I personally have such a fondness for these pillows.
I’m going to start the tub cage breathing at every session
Thank you
The area where I practice has the highest incidence of trauma in Los Angeles county so I shall pass this on to staff
For some of my clients even before I do any breathing exercises I offer them DoTerra Whisper essential oil. It’s very calming. Then I can move onto the breath.
I have the god fortune of including horses in my clinical practice with clients. Clients learn to breath by breathing with the horses and while physically feeling the horses rib cage expand and contract. The window of emotional tolerance is also expanded while leading clients while they are riding a therapy horse. The natural bilateral movement of the Horse helps emotional regulation as clients are encouraged to engage there sitting bones, tap to the horses natural rythmn and align head, shoulders, hips and ankles. (Allowing the body to find a place of rest) The warm physical contact with the horse activates attachment hormones which also supports an expanded window of emotionl tolerance.
These clips are so encouraging and validating. Thank you for sharing!
Thank you.
Another way to use balls – I developed and teach a method of body awareness and myofascial release called Bodymind Ballwork, which is very effective at bringing clients into their body. We use balls of varying sizes and textures, and there are techniques for any part of the body, so we start with choosing one that is within the window of tolerance. The ball creates a massage-like pressure which can be very gentle at first. The client might be sitting in a chair, standing near the wall, or lying on the floor. The client is completely in control of the process, I am just the guide and witness. People experience their body in a new way, with less held protective tension and easier movement.
I find that making direct observations in a calm direct voice and begin demonstrating in my own physical non verbal presence an observable stance for the client to follow.
KINDLY LEAVE THE TIME OF THE TALKS AS WELL AS THE DATE…MANY THANKS
Hi Jane,
The free broadcasts are Wednesday evenings at 5pm and 6:30pm ET. We also do additional replays on Thursdays throughout the day at 10am, noon, and 3pm ET.
Next week will be the last week in the free series, so if you aren’t yet signed up, I hope you’ll do so now! Here’s the link to the registration page: http://www.nicabm.com/treatingtrauma2017/info/?del=custsvc
If you have other questions, please do let me know — but I do hope this helps!
Best,
Lauren
NICABM Staff
As a Somatic therapist, I consistently use the body as a resource for supporting clients in cultivating more awareness of sensation–of using the body as a resource for “making friends” with sensation, and learning to follow sensation, creating a flow–a dance–with their body’s natural response mechanisms, and then learning how to become “partners’ in that dance. I do this by using mindfulness exercises, sometimes movement exercises, depending on the client’s openness, breathing, and also noting the co-regulation of the therapeutic relationship–supporting them in feeling and receiving my presence as an attuned support person, and inviting them to imagine something like “training” their nervous system as if they were training different muscles in their bodies. I used to be a personal trainer (and massage therapist and dance teacher) so I use a lot of language related to strengthening our bodies as we speak of strengthening their nervous system, their heart…
I think the reparative therapeutic relationship is also foundation of increasing one’s window of tolerance, since the original inability to regulate emotion most often occurred due to relational trauma and subtle misattunement, we need to heal “in relationship” – so the foundation of my work is also related to personally having a “strong enough” nervous system that my clients can experience the co-regulation that they should’ve felt in early relationships–the modeling that can set them up for successful regulation of their own nervous system.
Thank you for sharing this information. I will apply it into my practice.
Acknowledging the response in both perception and neuroception of fear and engage in a heart centered breathing exercise to establish coherence.
Thank you!. I have used this beach ball concept. It is important to figure out if your client is primarily visual, or auditory or tactile. A tactile client would respond to having a blanket or s soft stuffed toy given to him or her. A visual client would respond to paying attention to different colours in the room and a primarily auditory client would likely respond to music or the therapist’s voice.
The majority of us respond to visual cues (80 percent). Only five percent of the population is primarily auditory, but in my experience, many survivors of childhood trauma are because they had to rely on auditory cues to keep themselves safe.
Thanks you again for reminding us therapists to respect the client’s window of tolerance.
Walking in nature.
Counting backward from twenty, breathing slowly and deliberately with each number. If I’m very dysregulated, I add things to distract me from my unbeatable emotions of terror such as also observing and naming things in my environment, whether indoor or outside in nature.
This just happened to me yesterday.
I was walking home from an errand and the sun had set so it was dark in the city streets. This gave me a gloomy feeling which led me to gloomy thoughts of a future of perpetual intolerable loneliness.
I began having a crescendo of panic thoughts arpund my extreme fear of my future and fell immediately into suicidal thinking, as often happens, and the panic became quite extreme.it felt like the thoughts themselves would kill me.
So I began breathing deliberately while counting backwards. Then added observation of the colors of fall leaves at my feet as I walked. A grounding sense of calm wasted over my panic in such a way that I could get myself home without a total breakdown.
I find this method works in very similar way as having a paramedic who, while helping in a crisis situation, whether for physical or mental only emergency crisis, will say things or ask questions (hopefully with caring soothing and confident voice) to distract the wounded or distressed. This can help distract from the physical or emotional pain quite effectively.
It’s much harder to do this for oneself of course. Very very hard actually. I am only starting to learn to do thus and it’s taken a lifetime. The block to achieving a calmer state is the background voice screaming that I want to die. So there’s little left in me that actually “wants” to help my situation. Escape from the pain via leaving this painful world entirely is the loudest voice. This voice is excruciatingly terrorizing.
Thanks for this topic.
Thanks to all of you therapists who are working hard to help people like me.
When are they going to change the damaging label BPD to Complex developmental trauma? I know that Bessel van der Kolk has tried but the powers that be at DSM keep blocking it from happening. I pray for the day when he finally succeeds. Then maybe my entire extended family can stop shaming and blaming me, the victim of multiple infancy traumas, including physical and psychological abuse. The label BPD only blames the victim, while the perpetrators are given free reign to blame the victim! Please Bessel, keep working toward changing the BPD label. Thank you. I’m grateful for all this new work being done on trauma.
I agree about the label BPD, Mary. It’s an awful label which doesn’t add any valuable insight into the cluster of symptoms and why they might be expressing in that way.
As you suggest, the label invites blame especially from non professionals who do not understand the theoretical basis of it. I’ve had this explained by a clinical psychologist a couple of times and still don’t get it.
Also this label invites self-blame (as if that’s not already an issue!). A non-professional person diagnosed with BPD will hear the bit about personality disorder. Personality has to do with who we are, our identity, how we understand ourselves in relation to others etc. If we get a label indicating a disorder in our personality that just reinforces the sense of being fundamentally flawed and hopeless. Great! Because we really need to feel more of that!
Now. ‘ dysregulated’ – I can see sense in that term… But not of personality…!
Dysregulation of some primal neural and hormone driven reactions is not defining who a person is at an essential level & what they enjoy, love etc; but rather how they function in relation to an environmental/social trigger perceived at a deep level as a profound threat.
For hyper aroused clients I ask them to keep their hands where they are and without moving, try to find their pulse in two different areas in their body. I then will ask them what they are currently experiencing relative to 3 minutes ago……
I coax breathing better — uses rib swing, upper lung as well as lower lung, full exhales — the gap between inhale and exhale. I teach the physiology of breathing sometimes, too. Using a “flat and calm” — Alexander Technique hand I help people have more awareness throughout their bodies, inside and out. I have a floor series of movements — lying on the back — that regulates the ANS. Its called the Daily Dozen and I have used it now with ages 16-90 in universities, acting conservatories, and private practice. It does calm people down, bring them into their bodies, and helps them find better alignment (posture in motion). Sometimes I use tremoring induced by deep breathing and stressed Asanas. I teach Sensory Awareness meditation and walking meditations. Sometimes I call the sensory contemplations. I share people’s books when I feel that this will help. I have found that by teaching people about their structures, their Vagus nerve system, and their brain to body and body to mind connection, they are able to make quicker and efficient and deep progress in their psychotherapy sessions. I am a somatic movement therapist, and support psychotherapy through my work.
I always start a session with “what would make a client feel safe in the session” : physical safety : do they need to change anything in the environment of my office (seating , pictures that the client may find disturbing to him or her …..)
then safety in their relationship with me as a therapist; what do they need from me…
then proceed to mindful breathing to expand capacity of self-regulation .
From the onset with their paperwork for entry I give clients a handout on handling the five senses and activities they can do if anxious throughout the week to take home. I request they try to be aware of their five senses when they leave the office and also when they come in next week. i have an office at a marina and it is a wonderful restful environment with seals, herons and seagulls to take the assignment to rebuild their connection to the outside world of nature. At the intake of course I find out what they are interested in as far as their activity level and what they are interested in. I also give them an exercise to tap slowly their thymus gland three times times three and to repeat twice again throughout the day, to introduce them to their bodies and calm that area as it often is easily aroused. I also ask them if they do any exercises or any activities or sports to begin to see if there is a physical outlet for their arousal mechanism. It seems to be affective. Of course I play these suggestions by ear depending on what is encountered at the first session. It has been pleasant as they mention it once in awhile as counseling progresses. Some clients have been cut off from their bodies for years. I have been at my office for nine years and I find that ones office is important. I have found drawing calms children down and good avenue for those who have been sexually abused. they seem to like to be drawing when talking about things that are difficult at first as long as we process toward the end, coupled with TFCBT that uses writing. I have had teenagers who have an abuse history who cannot talk about the abuse, but give them pencil and paper and they can write for 20 minutes without stopping. This technique was taught to me and my staff from the local hospital specialist who trained many for years in our area area. We use a lengthy questionnaire to score the many traumas a person has encountered in their life and even though it is focused on sexual abuse mainly, I have used it with many traumas and discover that many come in with a specific trauma but when doing this questionnaires, it is really something else entirely that they realize is the main source of their anxiety. When all else fails I ask them to go for a walk. It worked for Shapiro, and there is a lot of background of that left and right eye movement that helps them calm down, using that EMDR tool. I have always thought it has something to do not just the left and right eye movement but patterning of the arm and leg movements from neonatal work I have done with infants. Just coordinating this arm and leg movement helps with the brain as my music therapy has taught me for coordinating clients thought patterns in their bilateral movements.
I have used tapping (Eft.) And had some incredible results.
I do a healing drumming circle and it help self regulation by making them realize they can learn or create sounds that is calming effortlessly just by trying after learning a few tones. Thanks for the video it explains a lot
Hi, thanks for an exellent seminar.
I mainly use Meridian tapping, and some bilateral stimulation movements to help clients self regulate.
And the combonation with TRE, Tension & trauma releasing exercises is very helpful to work ” bottom to top”
In order to integrate and organize with ’top to bottom’ insights.
Thank you for this video. I agree that only when the client can feel safe work can start. In very difficult hyper arousal I find it works being quiet, taking care of my own breathing, grounding and center to allow the client to find the safe place. Discreet observation and very slowly introducing calm movements that can be copied
Now I can explain to my partner how things are looking for me
That was very helpful
Reading prewritten comments about compassion and reassurance.
I have used a variety of distress tolerance activities to assist clients in getting back to the present. Some of these include blowing bubbles, squeezing a stress ball, and breathing exercises. Two minutes of mindfully focusing on something else brings clients back to a tolerable level to proceed with therapy.
Heart Assisted Therapy (J. Diepold)
Throwing a ball forth and back
stand on the floor and jump up and down
Mention a number of things in the room that are a certain color, etc.