Clients are best able to cope with stressors and triggers when they can manage the resulting emotions.
So how can we help clients who struggle to manage the anxiety, anger, and pain brought on by everyday stressors?
In situations like this, psychoeducation can be one of our best tools – and one helpful concept is “the window of tolerance.”
The window of tolerance is a concept originally developed by Dr. Dan Siegel, MD to describe the optimal zone of “arousal” for a person to function in everyday life. When a person is operating within this zone or window, they can effectively manage and cope with their emotions.
For clients who have experienced trauma, it is often difficult to regulate emotions and the zone of arousal where they can function effectively becomes quite narrow.
When a client is traumatized, it can be especially difficult for them to stay grounded in the present because the past is more vivid and intrusive. Someone constantly living in their past trauma is primed to detect threat — and enter into that state of defense. That means they generally have a very narrow window of tolerance.
The stress of a traumatic memory or trigger may cause them to be pushed out of their window of tolerance. Even seemingly minor stressors can cause a client to dissociate, get angry, or feel anxious – leading to states of hyperarousal or hypoarousal.
And this can make it difficult for clients to make progress in therapeutic sessions.
We created this infographic as a tool you can share with your clients. It can help you explain what’s going on when they’re feeling dysregulated.
Click the image to enlarge
If you’d like to print a copy for yourself, just click here: Color or Print-friendly
(Please be sure to include the copyright information. We put a lot of work into creating these resources for you. Thanks!)
You may already know these concepts well, but for a quick review . . .
What is Hyperarousal?
Hyperarousal is also known as the “fight, flight, or freeze response” and is a heightened state of activation/energy. It is when a client’s nervous system suddenly kicks into high alert, even when danger might not be present. A client may not feel in control over their actions when they enter this state. It can often be triggered by perceived threat, traumatic memories, or specific emotions. It is also one of the primary symptoms of post-traumatic stress disorder (PTSD).
Hyperarousal Symptoms:
- Angry outbursts
- Fear
- Anxiety
- Emotional overwhelm
- Panic
- Hypervigilance
- Tight muscles
- “Deer in the headlights” freeze
Often, clients who experience hyperarousal are stuck “on” which can make it difficult to form healthy sleeping habits, manage emotions, and concentrate effectively. Physically, their body may seem tense and on the brink of explosion, which can eventually result in angry outbursts and hostility.
What is Hypoarousal?
Hypoarousal is also known as the “shutdown” or “collapse” response. Like hyperarousal, it can often be triggered by feeling threatened, recounting traumatic memories, or feeling emotions associated with past trauma. Even a perceived threat can be enough to send a client into shutdown or even dissociation.
Hypoarousal Symptoms:
- Depression
- Numbness
- Emptiness
- Flaccid body
- Blank stare
- Inability to speak
- Dissociation
Hypoarousal is when a client has too little arousal as the result of an overloaded parasympathetic nervous system. It can impact a client’s sleep and eating habits, leaving them feeling emotionally numb, socially withdrawn, and finding it difficult to express themselves.
How to Help a Client Come Back into Their Window of Tolerance
There are many strategies for helping a client come back into their window of tolerance when they feel dysregulated. Depending on whether a client is experiencing hypo or hyperarousal, you will want to orient your interventions to suit the client’s needs.
Coming back from Hypoarousal:
It’s important to keep in mind that our nervous systems often take cues from one another. When working with a hypoaroused client, some simple ways to signal an increase in energy in the room include:
- Increasing vocal prosody
- Using engaged posture
- Utilizing a certain amount of joking or irreverence
- Physical movement, such as standing up or switching chairs
Other useful strategies to help a client shift out of a shutdown or dissociative state include:
Ask your client to describe three things in full detail
You can ask your client, “What are three things that you like to look at in my office?” This activity can help to anchor the client. It helps them connect back to the present moment and their relationship with the practitioner.
Using breath work to calm the nervous system
If you’re seeing that your client’s breathing is getting dysregulated, you can work on re-regulating breathing together with slow exhales.
Use a cognitive technique of scaling (i.e., from zero to 10 . . .) to help clients learn to gauge their level of hyper/hypoarousal.
You may ask your client to scale their level of freeze, dissociation, etc. This can help them learn to better gauge the sensations they are feeling.
Orienting client to present time, present place by explicitly labeling cues of safety: “You’re in my office. It’s <date>, You’re with me, You’re safe.”
Repeating these types of grounding exercises can help elicit feelings of safety.
For more resources on working with the freeze response you can take a look here:
Working with the Freeze Response in the Treatment of Trauma with Stephen Porges, PhD
When a Client Is Stuck in the Freeze Response with Peter Levine, PhD
How to Help a Client Come Back from Freezing in a Session with Bethany Brand, PhD
Coming back from Hyperarousal:
When working with trauma in a session, there can be many perceived threats for clients that may cause them to brace up – or perhaps start to freeze up during the session.
When a client begins to shift into a freeze response, their muscles lock in against each other and that energy becomes stuck within them. You often begin to see them pulling inward and “becoming small.”
To work with this, it can help to have your client access that locked-in energy, one small amount at a time. The key here is to titrate therapy and move at a slow, gentle pace. This can be key to help keep a client from becoming overwhelmed in that moment.
On the other hand, a client’s energy might burst before you can help them manage it in a healthy way. In this case, they may find trouble finding a sense of containment. They may experience fear, panic, or a flood of emotions. Here, certain body-oriented methods may be helpful in re-centering them into the window of tolerance.
Effective strategies to help clients manage hyperarousal:
- Using diaphragmatic breathing
- Drinking from a straw
- Meditation
- Yoga techniques
- Healthy strategies for releasing anger
If a client is experiencing anxiety from hyperarousal, we created a tool based on the work of Shelly Harrell, PhD for practitioners to share with their clients. It breaks down four key strategies to manage anxiety and reduce residual stress.
How to Help Clients Manage Their Window of Tolerance
We want to help clients broaden their window of tolerance and increase their capacity to experience emotions (even intense ones) without becoming dysregulated. This first starts by helping clients recognize when they are experiencing emotions outside their tolerable zone – and gauging how it makes them feel and how it impacts their body.
Clients can begin to manage their window of tolerance by:
- Recognizing their window of tolerance and increasing their awareness of symptoms
- Widening their window of tolerable emotions
- Learn techniques for re-regulating when experiencing hypoarousal or hyperarousal
We’ve already taken a look at recognizing when a client is outside their window of tolerance (and how that can be expressed by hypoarousal and hyperarousal). But how can we help clients widen their window of tolerance?
Certain strategies such as body-based approaches and exposure-based strategies can be effective in helping clients widen their tolerance for intense emotions.
It can also be effective in helping clients reduce any shame they might feel from being easily dysregulated. This will open up their ability to explore and listen to their experiences without shame disrupting the healing process. Compassion-focused strategies can be effective in promoting self-compassion and self-acceptance when working to build resilience.
Part of equipping clients to take on potentially triggering experiences is giving them strategies to tolerate discomfort and distress.
If you would like to find out how the top experts in the field (like Peter Levine, PhD; Janina Fisher, PhD; Ron Siegel, PsyD, Shelly Harrell, PhD; and more) help clients build a greater tolerance for emotional distress, you can click here.
Helping Clients Stay Regulated Outside of Sessions:
We’ve taken a look at strategies for helping clients re-regulate and come back into their window of tolerance when in a session. But what about when they are not in your office? Clients will not always have you as resource, so it is important to equip clients with strategies they can use on their own.
- Breathwork – Using the mindful experience of breathing as an anchor to the body and the present.
- Guided Imagery – To start, in place of breathwork, a client might imagine themselves on a swing, paying attention to the internal feelings of the movement. The rocking motion of the swing actually brings the breath online in a different way, helping to circumvent certain triggers.
- Positive Containment Imagery – An example of positive containment imagery might be to have a client imagine a chest, or whatever their choice of container might be. Then, they can imagine arranging the intrusive thoughts or images in that chest or container, and locking it securely until they’re ready to process them more fully.
- Safe Place or Sacred Space Imagery – Finally, there is safe place or sacred space imagery. They can base this place on any real, fictional, or imaginary location where they feel calm or content, and can design it at will. By giving the client an image where they have complete control, it can reduce a sense of helplessness or uncertainty in life.
For more strategies you can use to help clients who’ve experienced trauma, be sure to check out the Treating Trauma Master Series.
You’ll get insights from Bessel van der Kolk, MD; Dan Siegel, MD; Pat Ogden, PhD; Stephen Porges, PhD; Peter Levine, PhD; Allan Schore, PhD; and Ruth Lanius, MD, PhD.
Now we’d like to hear from you.
How have you worked with the window of tolerance with your clients? Could this help you in your work? Please leave a comment below and share your experience.
Alas it costs money.
As a patient, I need this information, but it’s not available.
95% of all mental illness in our province is handled by GP’s because most people can’t afford therapy.
As an institution, you need to make all this knowledge available. Doing so might triple the number of peple who can self heal.
In the article you write: Hyperarousal is also known as the “fight, flight, or freeze response” and is a heightened state of activation/energy.
Isn’t ‘freeze’ a state rather belonging to hypoarousal?
Many thanks for the article and the graphic.
I would love to see your definition of Hyperarousal to include the fourth F – Fawn. You include Fight, Flight & Freeze, but Fawn is equally important as I have learned. I have Complex PTSD, and because of my childhood trauma AND my genets, Fawn was generally my only choice. Please include it here so that folks like myself will see how we operate in the Window of tolerence. Thank you very much.
I just looked up “fawn”. Seems to suggest people pleasing as a way to deal with trauma through avoiding conflict. I think I used to relate to this behaviour until I realised that I was not the one that did anything wrong. It was healthier for me to set boundaries, and understand that I’m worthy of more. I work in Mh recovery and I’m sorry but I don’t feel this response would be empowering, in fact I think it would be more harmful than positive
Thanks so much for offering this diagram. A friend of mine is a child advocate with CASA and related a story yesterday that made me think of the window. I wanted to help him understand what he is seeing.
Thanks again!
Thanks for sharing!
It’s very useful and I’ll of course include the copyright information.
Understanding this infographic tool – window of tolerance help me to self reflect and now I am aware of how to get out of the hyperarousal or hyperarousal state and stay in the safe window of tolerance. Also how to support my colleague at work to do so. This was documented so clear and straightforward. Keep on doing the good work. Thank you.
Olah Brown (Registered Nurse).
London
Would it be okay to use this diagram on a blog for my counselling website? It’s just such a clear diagram. I will of course include the copyright information.
Hi Trevor, You are welcome to do so – just be sure to give credit to our company and be sure you let those you share it where they can find it on our website!
Hi my name is Nancy Lizotte. I was referred to you by my worker at CMHA . Her name is Linda. She told me that this would be very helpful to me to get help in dealing with a lot of Trama in my life. I’m not quite sure how this works or how to go about it. Can u please get back to me and explain everything to me. My email address is nancylizotte123@gmail.com or my cell number 289-828-8276. Hope to hear back from you. Thanku
If I include the copyright information, can I use your infographic in a chapter on trauma-informed practice in a manual about Violence Against Women? The manual is created for and by not-for-profit organizations. It will not be printed and will not be sold. Thank you.
Hi Jo-Anne, yes. Just please be sure to include the copyright information. We put a lot of work into creating these resources for you. Thanks!
This Window of Tolerance infographic is going to be a very useful tool to share with clients. Thank you so much for making it freely available!
Regards,
John Foran,
Psychologist, CBT & EMDR therapist (Netherlands)
Thank you for these resources, they (along with Dr Van Der Kolk’s book The Body Keeps The Score) are helping me to make sense of myself and the world around me after many failed attempts at therapy and multiple misdiagnosis, over many decades before being diagnosed with c-ptsd. Finally I feel understood and understand. Thank you for not giving up and for your dedication to survivors of trauma. We now have a voice.
Hi
I am psychotherapist at hospital in Taiwan.
Could i translate the picture to traditional chinese?
Best regards,
Li
Hi Kuei, yes you may translate the infographic for your own use. Just please be sure to include the copyright information. We put a lot of work into creating these resources for you. Thank you!
I love the work of Bessel , Siegel, and Levine so I’m looking forward to exploring options for the Treating Trauma master course
Thank you so much to share this resource with us for free.
Thank you for sharing this information.
Thank you for the free resource! But like what others have said, why was dysregulation removed? I very much prefer that version too. Is is possible for that version to be reuploaded?
Thank you again!
Thank you for sharing this information
Thanks for sharing.
Can you provide the window of tolerance graphic in a Spanish translation, please?
Thank you for providing these wonderful resources. They are extremely helpful in explaining the concepts of stress and trauma to students and clients, also in the context of Mindfulness training.
This is a wonderful resource that I use with clients! Is it possible to access this and the rest of the PDF’s on window of tolerance and other resources in Spanish?
Thank you so much for your support.
Thank you! Was just wondering why I felt line checking myself into a mental institution after a hyperarousal moment. I looked up online to remember my « window of tolerance « and found your helpful too… illustrations helped. Funny how after repeated childhood sexual abuse (CPTSD) can bring your moods on a roller coaster ride even 40 years later. ?
Though not a licensed mental health practitioner, I learn so much from your and your colleagues’ resources, knowledge, skills, and experiences. Wonderful. Thank you. Also, your offerings are helpful for me and, thus, help me help my clients…conflict resolution and communication practice + a spiritual companion practice. Thank you, again! Best wishes to you always in all ways.
Thank you for sharing this information. At present I’m doing the “how to deal with fear” program. I find that Psycho-education helps the client have a new informed perspective of their thoughts and feelings. challenging clients risk assessments and the reality of their thoughts.
I like that this is just very simple and clear.
Very helpful thank you!
Very useful!
But I prefer your 2017 version of it
I do too! I’m wondering why the dysregulation sections were removed…
Do tou havw a copy of the 2017 with those parts I could possibly use?
thank you this will help many many of my clients
Much gratitude to the NICABM team for this infographic. These summaries are a great visual support for all of us.
Thank you!
Thank you NICABM team for your generosity! This is good, simple and useful!
Thank you and all the experts again. This infographics is so simple and clear. It helps me to show my clients clearly the emotions (hyper or hypo) they were in to understand why they were behaving as such. It definitely helps in my client work. Thank you for your kind generosity.
Thank you so much for the Info-graphics. They are so helpful!
Hi Ruth 🙂 love this diagrams -my clients’ really can identify with them, especially male clients…….maybe it helps them process the information better?…..thanks again to al your colleagues for this trauma series!
Kind regards
Caroline
Thank you! It really useful infographic. I will propose it to my director. I work in a company which produces content, so right cooperation with client one of the most important parts of success.
Thank you for the detailed and informative Window of Tolerance.
It helps me to know I can be in the window zone no matter how small or large it is at any given time. It doesn’t have to be, ‘I’m all in’ or ‘I’m all out’. I like that.
Please notify me of new posts
Hi! Do you have this infographic in Spanish or Somali?
I love this infographic and use it regularly with clients. Do you have it in other languages, I am particularly interested in Spanish and Somali. Thank you.
This is very helpful to share with clients and helping with psycho-education.
It helps them to make sense out of the frightening feelings they have when their body takes over. I have found using it alongside a trauma informed perspective rapidly reduces the shame they feel at getting lost in these states.
Thank you
Thank you, this visual will be of great help!