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.
Click here for full transcript
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.
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… 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.
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.