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
Hyperarousal
Anxious, Angry, Out of Control, Overwhelmed.
Your body wants to fight or run away.
It’s not something you choose – these reactions just take over.
Window of Tolerance
When you are in your Window of Tolerance, you feel like you can deal with whatever’s happening in your life. You might feel stress or pressure, but it doesn’t bother you too much.
This is the ideal place to be.
When stress and trauma shrinks your window of tolerance, it doesn’t take much to throw you off balance.
Working with a practitioner can help expand your window of tolerance so that you are able to cope with challenges.
Hypoarousal
Spacy, Zoned Out, Numb, Frozen.
Your body wants to shut down.
It’s not something you choose – these reactions just take over.
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.
Thank you, I am looking for strategies to try a get my clients into the window of tolerance
Teresa,
I suggest you ask your clients how you can help them get into the window of tolerance. They might not all be able to give you suggestions, but many of them can — and their suggestions might also be helpful for other clients. But be sure to remember your clients’ right to informed consent when trying any strategy They might be able to tell you that a strategy doesn’t work for them, or might be able to suggest how to modify it to be helpful for them.
Thank you Trudy for your useful suggestion, it makes perfect sense.
Tools to help patients are always helpful. Useful diagrams and ideas to print to help patients stay focussed are really helpful thank you
This is a fantastic resource, thank you for sharing! I am just wondering if it might be available in Spanish and/or if anyone knows of a similar graphic in Spanish.
Thanks!
Here are my reactions (as a client who has had counterproductive therapy) to the Window of Tolerance graphic:
First reaction: This is a good idea!
Second reaction: But it’s just saying the obvious (from my client perspective), so it could be patronizing for the therapist to introduce it to the client as a way of “explaining” something.
Third reaction: But I can see how it could be very good for facilitating communication between client and therapist. For example, if a therapist does something that is outside my window of tolerance, the graphic could help me try to communicate that to the therapist (e.g., by saying, “What you just said is outside my window of tolerance and in my [specify which] zone.”
Fourth reaction: But I find it hard to imagine any of the therapists I’ve tried adopting this graphic. One problem I’ve found repeatedly with therapists is that I think in “shades of gray”, while they seem to think in “black and white” terms. And I’m very visually/spatially oriented in my thinking, whereas therapists so often seem to be not just “word-bound” but often “label-bound”. But the graphic requires both the “shades of gray” and “visual/spatial” types of thinking.
Final conclusions:
1. This graphic can be a good “tool” for communication in therapy– but the therapist needs to be willing and able to use (or at least respect) the “shades of gray” and visual/spatial thinking that the tool requires.
2. So for some (maybe even many?) therapists, teaching the therapist to respect and use these types of thinking needs to be an important part of their training.
Please have another convention in the South at Hilton Head, SC
Your post says “…free to listen at the time of broadcast…” But there is only an pay-for-subscription option available when you click the links 🙁
Please advise how to sign up to listen live.
i have been using this info for a few weeks. People take a great deal from the image and the separation of hypo and hyper -aroused. They identify quickly the types of situations that put them in a different reaction. I look forward to what this awareness will contribute to managing reactions.
Thank You very much
Thank you
Fantastic tool. Thank you!
This is terrific. I have client that will really be able to use this graphic. Thank you for all your work and being willing to share it with us. You and your work are much appreciated.
Thanks for this tool. I’m looking forward to sharing and discussing it with a couple of people I work with. Pretty sure they’ll find visualisng the metaphor very useful. Shout-out to Sue Sibbald (@BPDFFS on Twitter) for sharing it.
I have not been opening your emails, WOW, have I missed out!!!
Thanks or all you provide. I have a client, 13 y/o, he’s been in/out of hospitals, residential.
This graph will be helpful to explain to him his outbursts and where I am trying to guide him.
Thanks again.
Catherine Parten, LCSW-S
Registered Play Therapist-S
cp.playtx@live.com
I’m not sure this is completely accurate. If someone has a wide window of tolerance, they can experience high levels of arousal which are not experienced as too much.
Lenora, exactly. Each person’s window is unique to them. Trauma counsellors help people learn to widen their window of tolerance, so they are not as often overwhelmed or shut down. Someone with a wide window of tolerance probably doesn’t need trauma counselling.
That sounds to me like saying functioning alcoholics don’t necessarily need recovery. There is still going to be extreme pain even if there is a huge window of tolerance with symptoms. I think I’ve spread mine out to be able to function very well during hypo and hyper arousal. I am fully functioning in both cases. All this coming from disillusionment with what is deemed socially acceptable behavior, so I’m trying to take me with a grain of salt. Don’t worry, going to counseling tomorrow.
This is absolutely wonderful. I really can use such a tool. Whoever put this together is talented. Thank you.
Many thanks for dong this. I had conducted a search to find a similar model, online. This one serves the purpose very well.
Very much useful for my clinical work!
Thank you so much for sharing this wonderful, well thought out and helpful material. I also printed out last week’s helpful tool that you offered and have found time to watch two of your video presentations. I really appreciate you making this material free for those of us on low incomes it is a great resource and so generous of all of those involved. I am in my first few years of practice, I love my work. I have traveled a long and complex road myself and enjoy assisting others on the journey to a better experience of life as they become self aware.
Regretfully during the broadcast my pregnant daughter called me having lost her window of tolerance with a baby already overdue 1 1/2 weeks. So i dissociated into the strong, coaching mother high soul functioning part to return her to a state of balance. But then i forgot the last broadcastreplay. Guess my brain still somehow offline. Thinking about it outside whilst walking my dogs, then when home completely lost the info until the end of the broadcast. Tks for the infographics. What i miss under the FREEZE/hypoarousal is the feeling of not existing at all and the body completely shutting down, unable to breath, yet somehow whilst choking and suffocating there still is this soul that will not let me die and after a difficult struggle breathing returns. The not existing feels extremely scary. Possibly this link between soul and body can be severed. Laurence Heller describes my kind of trauma, where people remain in the dimension of the soul and do not incarnate as babies. Having made the choice to do so, i miss all the clear abilities i used to have and am not there yet to be comfortably incarnated. The extreme dissociating was too taxing on my physical health. That said looking at my soon to be a mother daughter, i can see i did things right despite.
This is the best time to get this info. My family gathering during the Holidays have been quite aweful most of the time. Exposure to stressful relationship is something I can be quite antsy about. My down time is when I shut down and go into the hypo- mode. No good coping skills for now, just space for myself as isolating to put things in perspective . The results are very mild to some kind of effective. It is hard to get into the window zone and have a good time.
Thank you so much for these wonderful tools and aides to help us in the work we do with our clients! I am so appreciative of your work and your commitment to helping clinicians become better at what they do, in order to improve the lives of our clients.
Beautifully done. Wish I’d had this before I retired. My rendition on the White Board was so humble—but it still was a huge benefit for clients to learn about how our reaction tendencies were formed by experiences (therefore one is not intrinsically flawed) and reaction tendencies can be altered by new, appropriate experiences. (Many still believe the myth that one is stuck with tendencies formed before the age of 5).
Thanks for your amazing contribution to our work and humanity, Ruth! Without your work many would not yet know of what’s available due to the “new” understandings of the brain and the body/mind connection. Best, RaNae
In the absence of conscious awareness, “one IS stuck with tendencies formed” by age six. Fortunately, we don’t have to stay “stuck”.
Due to trauma from my childhood the effects have been a roller coaster of emotions. I still get flashbacks of sexual abuse from my brother and father. How due you you deal with them in a healthy way?
Thank you so much Ruth. I am already identifying clients I can use this with. I do appreciate the many things you share with us especially the recent video series.
Thank you for this handout. I think it will be helpful as I work with clients. It also helps illustrate what was in the video for this week.
Wonderful graphic! I find the Window of Tolerance discussion itself is extremely useful for clients in developing mindfulness and learning to self-regulate outside of sessions. The discovery that they can learn to self-monitor, and gradually build their own toolkit of accessible ways to re-enter their window of tolerance, goes a long way to help my trauma-recovering clients internalize that “that was then; this is now; now is different.”
Really enjoying the series and this week’s presentation was the best yet. Thank you!
What is in your toolkit, if you don’t mint sharing.
Thanks for this graphic. A helpful resource that would also be great in a public education campaign. So many have no idea that they can learn how to manage their own window of tolerance and that will reduce stress and expand the capacity to respond rather than react.
My personal experience in therapy was that therapists wanted to be in charge of this concept. They missed the mark so many times. Re-traumatizing could have been avoided or repaired more easily if we had worked together to understand and work with my window of tolerance.
The trauma master series also is a terrific resource for life coaches like me to better recognize and communicate the life coaching process and its difference from therapy. Perhaps this can be added to the master class.
Thanks for your work.
Thank you! I have a sheet I developed for this which is similar but not nearly as pleasing to the eye!
This program is amazing to watch but the infographics will be very helpful in the future as well.
excellent visional great for teaching – thank you
This will be a helpful tool to help parents and caregivers better understand what is happening with their youth and sometimes with themselves. Thanks for sharing
As someone who experiences hypoarousal, it’s helpful to read the line, it’s not something you choose – your body takes over. From this chart and the video yesterday, I see now that one way to help my recovery is to pay attention to the early signs of getting sleepy and instead of closing my eyes for a bit, get up and move around, do a chore, etc. Then I can come back and see what the trigger was.
Very helpful. I am going to list this as my tool. Thanks.
Thank you so much for sharing !!
What a wonderful tool! Thank you for your generosity!
You continue to inspire me with your generosity. Thank you.
As someone who who has had PTSD for 50+ years, it is a blessing to have these wonderful people and this organization help me to understand my issues. In the early 60s and decades following that, this information was not available. You have helped me so much and I thank you, thank you, thank you.
I love this. As a client I find it very reassuring to see that what feels like a chaotic inner experience has a pattern and order to it. I’m less scared of what happens to me.
Thank you! I can use this with my patients. Very useful information.
Thank you for your gathering experts together for your trainings. Thank you for the visual aids.
Thank you for the work you do. The results that I am seeing in myself are incredible. I had my jugular veins opened in 2011 (CCSVI treatment for Multiple Sclerosis. 50% stenosed either side). It took about 2 years for the flashbacks to become completely disabling.( I had survived the sexual abuse that started from age 6 or 7, (Dads best friend). Being stalked for several years. And everytime I would go for treatment I would be victimized all over again. With the help of a Functional Medicine Doctor I have been given the tools to help myself. These include neurofeedback, an introduction to The Body Keeps The Score, accupressure, yoga, talk therapy, rescuing my self as a child, 432 hrz music, hypnosis, etc… My therapist felt that I would benefit from NICABM as I only get to meet with her once a month. I would like to sign up as a Gold Member, unfortunately I have no support from family or friends and being disabled I live on very limited funds. Once again thank you for sharing. I understand what you are teaching from a trauma patients point of view and want to share it with the world. THERE IS HOPE FOR US, AS I AM PROVING TO MYSELF WITH EVERYONES HELP. Love and Light to you all.
a simple way to help folks understand what is going on—why they are finding things harder than before, and there’s a way to stretch it tolerance out again—not completely but effectively.
It is not just the left. Have you seen the Raging Right ?
Yes, I’ve seen images of the Raging Right. Way way way smaller than the raging Left, from my extensive attention to this. Also, in my extensive experience as well as attention, those you call the right are often the Reasonable – using logic, facts. Here is one experience. I was one of about 50 people who went to a Freedom of Speech event. Easy-going people, maybe 50 of us – most also older. I’d say the average age was about 60. I got there an hour early. About 300 angry slogan-shouting Raging Left (Communist, in large part) people were already there, many very young. (I’m not saying any age group is better or worse – but the age difference was noteworthy.) A few of the Freedom of Speech people went to the slogan-shouters, tried to talk. Rage. A few attacks (them to the Freedom of Speech people) if they were able to get past the police holding them back from attacking. There were already at least 30 police officers keeping the Raging Left people from attacking (not always successfully). Soon there were another 50 riot police in full gear holding back the Raging Left people. What did we do? Well, it started with singing Oh Canada. This is the second time I’ve witnessed something similar. The first time a friend and I went to an event we had heard of. Again, several hundred slogan-changers – and loads upon loads of riot police to protect people from the slogan chanters. In that case, the group holding the event did not show up. If you like, I can send you a full account. It is on my blog, including photos. And there’s a video of the first event I mentioned. I can see if I could dig that up.
Thanks Merna….well said.My little addition is that it involves change,which is not easy,effortless or enjoyable.Get a little comfort with the uncomfortable….the essence of expanding the window of tolerance…N-j0y..nAz
Great infographic! Thank you.
a lovely tool, thank you so much!
Thanks – this makes it clear what to be aware of
great explanatory image, thank you.
What a helpful informative diagram to explain the range of Window of tolerance towards hyper and hypoarousal, highlighting importance of observation of Therapist to support the client and the pace for their recovery.
Thank you.
This is a nice infographic and interesting theoretical concepts but how do you enlarge the window of tolerance? It would be great to see the peer reviewed research behind this.
Mike,
I’m not sure of how this is done by engaging with a Counsellor, however personally, I believe the way to expand the window of tolerance is to firstly become aware of how tolerant you are, what triggers the intolerance and what you are tolerant of. Each of us will bear things to different degrees, based on our own experiences etc.
Once you have awareness – then it is a matter of creating situations where you can expand your levels. This may mean bringing things into your comfort zone area slowly at first until you feel less threatened or worried about them.
Everyone has a stress level limit and its about gently and with awareness increasing what you can accomplish. Make it fun, put yourself in situations where you actually are tolerant and increase those things, as well as becoming aware of what you aren’t tolerant of and gain experience and knowledge about why you arent.
Hope this makes sense and is helpful.
I believe it was Dan Siegel who developed the Window of Tolerance. You can find out more info in his book: Siegel DJ (1999) The Developing Mind. New York: Guilford.
Corrigan, Fisher and Nutt (2011) also review the Window of Tolerance model of the long-term effects of the severe emotional trauma associated with childhood abuse. It can be found here:
DOI: 10.1177/0269881109354930
Really useful infographic and a great teaching tool.