How to Help Clients Tolerate Dysregulation and Come Back From Hypoarousal
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with Stephen Porges, PhD;
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with Stephen Porges, PhD; Bessel van der Kolk, MD; Pat Ogden, PhD; Ruth Lanius, MD, PhD; and Ruth Buczynski, PhD
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In listening to the experts discussing how to teach trauma clients to tolerate distress (Internal & external) & to come back from hyperarousal or hypoarousal, I had an experience with watching Michael Moore’s new movie, Fahrenheit 11/9 that was highly informative, but also totally overwhelming. My son & I are working through trauma from domestic violence (as I mentioned below), which is being triggered internally by various external events. The horrors that Michael depicted by showing the current reality of the political situation in U.S. and also the impact of corruption from the top down & abuse of authority, by key political figures in the world (current & past) in the name of capitalistic greed, also power over the poorest on the planet (genocides of various kinds), and including severe neglect of the issue of climate change etc, left us reeling. At the end of the movie, I felt more devoid of HOPE than ever, & wondered what is the use of working so hard to overcome past traumas on an internal level, when externally, no-one can in power be trusted, & it seems that there is no future, as the planet seems to be on a one way trip down into the abyss of darkness. The powers that be are NOT interested in taking positive action for the higher good of all who reside on Mother Earth. Interested in any comments from other attendees.
Just wanted to say, Thank You! Every time I have heard this segment I have been grateful for the recognition of how absence and neglect affect our processing. The talks help my understanding and reassures me that I am on the right track with my own efforts,and working with Mind-body medicine. The talks also help the person I take care of. Thank you all for the tools.
Pat Ogden described dealing with hypoarousal, using movement and also asking the client to describe sensations in the body during hypoarousal. I have an Occupational Therapy background, and I have been training in trauma to help myself and my adult son (who has been affected since “in utero”) to work through past traumas from severe domestic violence of many years. It is a daunting task to wear 2 hats, one as parent and one as therapist. However that is all that we have in terms of financial resources & also having been violated emotionally by therapists in conventional medicine and also in integrative medicine. In the case of conventional medicine, they are often not trauma-informed and are mostly NOT doing their own healing work. In integrative medicine, it was NOT doing their own healing and their baggage was unravelling in our (individual & family) therapy sessions. So we have to make do with me doing therapy for myself and also with my son (self-regulation & co-regulation), as this is a relatively safe environment, compared to therapy sessions with outside therapists. Admittedly this becomes somewhat more complex when IGT (Intergenerational Trauma) is stirred up, so I have to get myself back online to help my son.
My question: how do I deal with my son (who often goes into extreme freeze mode) and is unable to talk to describe his body sensations? Even at the best of times, he has “selective speechless terror,” mostly with authority figures (peers, management at work, even me) & is able to communicate verbally only with kids, as they often are non-judgmental & non-critical. Do I simply work with getting him to move & asking him to look at me, walk with me etc, in order to get his frontal lobes back online? We have done some neurofeedback, which helped him a lot with bringing his frontal lobes back online. However with recent harassment at work by a manager and loss of his job (working with kids) when he lodged a formal complaint, he has gone back to minimal verbal communication again (reliving trauma & abuse from his dad). Would appreciate any suggestions from other attendees.
I have been meeting with a mindfulness coach. Have am excited at how every one brought out and made connection with the sences and being so totaly in the present. “Get out of your (head) mind and into your sences” Is great. I can’t wait to share this info with my mindfulness coach, especially how and why mindfulness works with the brain and traumatic experiences. through out the webinar I was thinking up all kinds of mindfulness activities and exercises that I can use in my work. Thank you ever so much again!
I learned about hyperarousal vs hypoarousal, and the window of tolerance. I learned how skills like mindfulness, sensory deregulation and CBT can be used to up or downregulate during hypo or hyperaroused state. I learned that the distinguishing factor between manic Bipolar disorder and trauma related emotional dysregulation to be low need of sleep vs cannot sleep or get restful sleep respectively.
Tips for practice: Pay attention to client’s behaviour, posture, habits and level of engagement.
Be there in the present moment with client.
Centre yourself as a clinician to prevent vicarious trauma.
Use your 5 senses.
Find out what resources client uses to cope in the other times and build on it.
The comments are pure gems for anyone engaged in both practice and research. The comments clearly demonstrates the splendid resource for teasing out how this work knows no boundaries. As a retired clinical social worker, a full-time caregiver, and an avid lover of literature . . . this has been tremendously rewarding on all fronts.
Always always, thank you for sharing these methodologies and talk-back discussions.
I wanted to share another MINDFULNESS practice which helped me somewhere in my late
30’s to get a grip, if you will. I was guided to eat a very careful and cleansing diet, but
beyond the food–I was told to 1) Prepare my food myself, fresh 2) Be seated as I eat, no acceptions
(because I had always eaten in almost frenetic motion) 3) Chew every bite thoroughly before swallowing
4)Eat SILENTLY–no conversation, no radio, no TV (no texting today or reading emails).
Among many ideas, e.g., the window of tolerance, tolerating dysregulation and coming back from hypoarousal or being aware when hyperarousal occurs is critical to my work with adults who grew up with mentaly unwell parents which is based on my research at The University of Melbourne entitled: “Lives unseen: unacknowledged trauma of non-disordered, competent Adult Children Of Parents with a Severe Mental Illness”. It’s free to download. Just Google my name: Suzette Misrachi and you’ll get that + free e-publication updates aimed at busy doctors and mental health practitioners, which I then put on medium.com for anyone to access along with a resource website.
Thanks Ruth and colleagues for such an important series!
Hearing that the key to knowing how to tell the difference between PTSD and Bipolar makes perfect sense. That is very helpful.
I would like to lettering that think this is excellent presentation. Quite a bit of what I heard tonight. I have been doing, but I have been doing reservation lacking the accreditation that these Presenters process.I have been reading Bonnie’s anguish for quite a lot of time, At presentI haven’t used it. To the extent that the good Dr. brought me to believe in. I will future that I can see now that this is extremely important specially at the beginning when they walk into my office. I worked with several people online using either Skype , or Zoom, and I find it for me. As for filling as face-to-face. This window, we spoke of tonight I have to do some more work on it. I can say it I understand it quite a bit and I think it’s 1 of the keys that I’ve been looking for. When things seem to be hyper or below, particularly when I’m working with bipolar. The recap at the end. I really enjoyed because it pulled it all together for me and if I can I will rewatch this presentation due to the fact that I had to stop and reload page again. I myself have probably experienced. I don’t know how many of the scenario, along with being diagnosed as profoundly dyslexic. As you can see I’m using a voice to text and unless and I do extensive editing which I should do. This is what we get. I have had to have myself a lot of work with other counselors prior to my expanding my practice but has given me the most priceless piece of education that any practitioner may possess. That is, experience and empathy. One man that I worked with for quite a while and brought me around possess the same aptitudes as I do at this time. I have over 35 years as a lay counselor and I am at present working to acquire my own masters degree in counseling and become accredited. Therefore, gleaning all the information in becomes paramount. Thank you, Thomas Purcell
Thank you for inspiring me – I’ll remember the importance of breathing, movement and encouraging clients to distinguish between their trauma reacting minds and their thinking minds. I loved the description of “Shut up, be still and know what goes on inside” as an explanation of mindfulness … I plan to discuss this with my clients who are a little resistant to mindfulness and worried it’s a cult thing. Great advice on bringing clients back on line – I immediately thought of some of my patients who would benefit from this. In the end sections, great but simple advice about “observe your patient”, how they come into your room, how they are etc.
My clients comment on worsening nightmares and waking up tired …. please give some help on how to work with this, thanks
I’m grateful for these webinars, if I were still practicing I would definitely become a gold member. Retirement is good, and I do miss active engagement with our community. It is a good thing to watch it grow – it’s a great pleasure to see the growing integration of neurological and psychological bodies of knowledge and to see new insights coalesce into more effective treatment.
Thank you for the opportunity to understand helping people who are traumatized. I am the retired person that you mention in your video. I retired at age 59. I am a retired registered nurse having 40 years of practice caring for people at their bed side. I also have bipolar one disorder which I have been able to take better very good care of myself through counseling, my psychiatrist, family support, depression bipolar support groups in America. Your Free online teachings have added tools for self-care and helping a
Others heal as well. I appreciate the education which you all have shared with me today. Thank you much!
This research and practice is extremely valuable! Given there is a large population with ADHD, that is predisposed to trauma thru their neurovariant stimulation apparatus and behavioral patterns, how can this work be fine tuned for them?
Trust importantance of connection to aide the healing journey. Deeply exhaling, walking in the natural great beauty and remembering the role of acceptance in growing tolerance. Thank you all. Ruth, I’ve watched you for years. This production is top quality. Very well done!
I work with people who have fetal alcohol spectrum disorder, many of them are traumatized. Observation and repetition work best as talk therapy doesn’t stick. I look forward to next week. Thank you
What a fantastic session. I am a mindfulness teacher for trauma survivors and I’m so grateful that you shared this vital information about connecting with the body and the breath and using the body and nature to come back into the WOTolerence! We have had these resources all along, there is far more right with us than wrong with us ! Keep up the good work and I eagerly await the next session .
Thank you to Ruth Lanius for beginning to talk about Comprehensive Resource Model/CRM. More depth on this approach would be greatly appreciated in future programs!
Many thanks, for such a clear description of the ‘Window of tolerance’ and how to help folk self-regulate when they are at the edges or further away.
Ruth Lanius’ explanation of working with sensory experience and stepping into emotion, in order to deal with affect at root, then gently engaging the thinking brain in a top down way is very useful and powerful. I will be using this and also Bessel’s references to the huge challenge our clients face, in focusing so as to be able to learn and grow from new information.
I work in a team of arts psychotherapists, with children and young people whose self-regulation challenges resulting from trauma can lead them to exclusion from schools if untreated. Some of those without support have eventually found themselves on a relentless trajectory into the youth justice system.
Through working with the arts therapies we have constant opportunity to offer new and exciting sensory experience, combined with relationality or ‘contact’, in imaginative, creative ways in a safe physical space. CBT is not successful with most of our clients who have need for a much more sensory ‘bottom up approach’, involving creative non-verbal means as well as verbal, to help them find their own personal ‘resources’ to recover from trauma as suggested.
We have difficulty in communicating why and how we often successfully enable our young clients to change – ‘to notice, be present, and increase tolerance of distress’. We attempt to explain to school leaders who tend to see ‘bad behaviour’ and not the adverse experiences which are powering the ‘behaviour’. Sometimes people conclude that what we do must be a mystery, magic or simply unbelievable. But the changes in our clients are based on psychotherapy – and the processes you all so eloquently describe. The master class gives me new language to communicate what we do. I can’t thank you enough for this.
I will be using all this information with – most importantly – my clients, but also with my therapist colleagues and when communicating with senior managers and people in our systems (headteachers, teachers, social workers and others) who seek to understand better how to support the traumatised children they are concerned about, they refer or might refer to our team of therapists.
Thanks again.
I’m looking forward to next week!
I’ve learned about the training late (and joined the series for 1st time tonight) as I was in rural Uganda giving training, including to children regarding Emotional Action Planning (EAP) and healthy coping skills. My key take away today is the importance of a combination approach to dealing with trauma. I will add the information learned today to the workshops I give at prison on Emotional Action Planning by adding a segment on the effects of trauma and how to widen the window of tolerance when dealing with trauma. The Pastors of East Africa deal with many people who struggle to cope after decades of war in the region and so I’m sure my colleagues there will benefit from the information. I’ll be glad to share it with them. Thank you so much for this training.
That was an informative session. Thank you! One of the experts commented on gestures of care – her example was of giving a “shivering” patient a sweater during the session. What do you do with a patient whose dissociative trigger is, in fact, the therapeutic relationship itself? When consciously experiencing feelings of increasing trust, safety, and the stability of the therapeutic relationship the patient reacts by shutting down?
As a side note, the commoness of Fitbits and smart watches has made it interesting to see what happens during dissociation. A patient may internally feel overwhelmed or panicked, while they are physically hypoaroused and experiencing bradycardia.
I like learning about brain organization. As a Vietnam veteran with years of PTSD this knowledge meshes well with my personal experiences, With new learning, I both understand myself better and sit more comfortably with others.
I find that it really helps me to hear this information over and over again, from the many courses I have done with NICABM over the years. Each time I listen, it brings it into a sharper focus as to how it relates to different clients I work with. I found today very helpful on the topic of dissociation/hypoarousal, which I find much more challenging to work with that hyperarousal.
Thank you for offering us this for free, it is a great gift! I hope that I can afford to purchase the series by next week, when it finishes!
This video lesson has been an elegant reminder of all that encompasses the being who is coming to me for massage therapy. So much of the medical massage that I have provided feels like I am relying on unspoken and unvoiced cues. I am more than aware of my lack of training in the area of trauma, and over the years have stood in amazement of what dignified and responsive touch can accomplish where no roadmap was provided. These human instruments we have been given are astounding in their ability to heal. Thank you for the window to the soul you are providing us!
Hi Ruth
Today I was able to see the video for the first time. This was possible thanks to my Osteopathy teacher Alain Gehin ( Barcelona )
who gave me the link to this Trauma Program.
I do like a lot the comprehensive style of the program, the variety of topics related to the occurrence, development , work and resolution of trauma.
This body of work that you give resonates in my practice , specially by being centered, present and zero in the sessions.
The ideas presented in Breathing exercise and gently guiding the client to reconnect in the conversation/connection with gentle attitudes, is helpful.
Just want to comment that the audio in the interview with Dr Pat Ogden was difficult to catch, there is a distortion in the voice.
I am thinking of getting the gold subscription , just want to know how practical it would be to apply it in my osteopathy practice ,which is a hands on work.
Much thanks to you, and congrats for your beautiful work.
Marcos Baumann , PT, DC , Osteopath
Santiago – Chile
I give counseling for nutrition and self-care for severely ill patients and their relatives. I often find traumatic response either to recent or childhood situations. I already offer choices and let the patient lead and choose in the counseling process, but after this session I will more closely watch their breathing and intervene actively when they approach the edge of their window of tolerance. This often happens when they want to tell me details about a traumatic situation during the first session. I already use tapping, acupressure, body and breathing exercises and will suggest them earlier and more actively. Up to now I only worked with the body, breathing or tapping after the first session.
Liked the point about sleep to differentiate bipolar vs trauma. Appreciate the discussion about helping people to accept the present. The discussion about helping people come out of hypoarousal as well as identifying the precursors to entering hypoarousal added some ideas for me.
Thanks Ruth! Lots of interesting ideas and approaches to healing trauma as usual. I was reassured by the welcome you extended to laypeople like myself. I was also inspired by the reminder that “Trauma isn’t a life sentence. It can be healed” and that healing trauma is important beyond the well-being of the individual. Thanks for your support of our healing process.
I am a therapeutic parent with a handful of severely traumatized boys ranging in age from 11 to 27. I just want to thank you for allowing lay-folk to participate, and to reinforce how very helpful and informative these sessions are. Most of the healing I focus on as a dad deals with attachment, and today, for example, hearing ideas about how to help my 25 year old who frequently suffers from hypoarousal in his studies at University of Wisconsin. Even among clinicians, I have found that so FEW practicioners really grasp developmental trauma AND the hope for progress. Your teams’ work is a welcome breath of fresh thinking. Thank you! DanB
I will try to help them get out of thier mind and getting into thier senses, by being present in the room and observing whats happens, maybe taking a walk in the nature and being minfull of the smells, temprature and all living organisms around them.
I thought you did an excellent job of integrating and explaining the segments from the separate presentations, Ruth. Thank you,
Thank you so much. I cannot afford gold subscription as I just started up my practice in a new city, but I have read books by most of your authors, and do EMDR with trauma clients, and I love that you are bringing all the important relevant details to me in a summary. From these texts. Thanks again! I will use this with clients most certainly.
“Lose your mind and come to your senses” was most helpful today. Observing clients.
Thank you.
One specific point: this session gave me more scientific background for the efficacy of finger-raking the midline of the head, an exercise I heard first by Donna Eden and that has always had also a grounding effect on me. This is something that can easily be done by students themselves on themselves, by also expanding the rib rage and impacting breathing (which you again pointed out here). It looks harmless enough to go under the radar of resistance, and can be a simple exercise for continuous processing of classroom reality for better performance and realizing more of one´s potential. Even remembering it as one more act of self-care in recess can help me be a calmer, more confident, collected and compassionate and even a more feminine leader, as it also increases my receptivity, flexibility and responsiveness. Much gratitude, with a smile on my face: Gracias!
Hello,
Took so many notes during this last video, Tolerating Dysregulation and Coming Back From Hypoarousal. I have been teaching yoga for 15 years and recently been certified to teach mindful meditation. I am using these videos and my mindful meditation training to work with trafficked women in a Trauma Sensitive Yoga (TSY) class setting in a recovery home. These past 2 videos have given me so many tools and confirmation that I am doing the right thing in helping these women. Yoga teachers like me who teach TSY and/or any other style of yoga, also use these tools when a yogi has a deep emotion arise during class or meditation. Different breathing practices, grounding the body techniques, connecting the emotion to a body part and staying with it, and paying attention to what’s happening in a nonjudgmental way are all strategies used on a daily basis in my yoga classes. :0)
I am so thrilled that these videos are available to me at this time in my career, so thank you!
Mindfully,
Terri Rucker
The ideas from this session will be very useful in the classroom. It´s also a bit scary for me to move back into working with many individuals in a sometimes rather rigid and constricted context with diverse stimuli. I feel more confident about it now that I´ve seen and experienced myself the depth of recovery and flexibility that can be achieved by applying what you teach, combined with individual coaching and physical therapy. I´ve used both free access and paid programs from your institute. During this particular session, this thought came to me with a feeling of gratitude and confidence and softness: I will not be able to be there for everybody or know what is going on with everybody. What I can do and aim for is to be an example how we can get to know ourselves more and thus becoming more kind and present and resourceful and fullfilled and confident towards others and with each other. Thank you so much!
I am primarily bodyworker but I move into the mental integration by encouraging presence and awareness while I attend to the body of the client.I felt affirmed by the assertion that it is crucial to be able to articulate something of what the one is noticing as one touches into the edges of dysregulation. The ideas of Focusing infused with bodywork seems to correlate with this. I like the idea of connecting the dorsal vagal state of deep relaxation with tapping back into social engagement. I use the bottom up approach of stimulating facial nerves with gentle touch and a bit of coaching (sometimes). I also love the affirmation of the importance of our own mindfulness skills and our own development of interception that can assist our work with clients in guiding them into these awareness states.
Using the excellent content from today’s session I want to improve my observation and calibration skills. I also want to pay more attention to helping clients describe what’s happening in their body in the present moment to help them soothe, re-engage their cortex and notice that they are in the here-and-now not the there-and-then.
Noticing the body and breath first of all and spending time with the person downregulating arousal. Hypo-arousal is still my biggest problem with one certain client. Nothing I do seems to get past the client’s defenses which she is very well aware of having. So that continues to be the area I would like more information on. I also really appreciated the information on sleep and bipolar d.o. vs trauma effects.
Thank you Dr. Ruth and associates for this great content.
It resonates with my experience with my clients and has added value to me being better equipped to work with clients who are traumatized. Thanks for your clarity in presenting the information also.
I want to thank you for this wonderful trauma series broadcast. I have struggled with PTSD and dissociation over the past few years and have had two very different therapeutic experiences. I was perpetually outside of my window of tolerance with the first therapist and became more and more dysregulated as it progressed. The second therapist is very experienced and trauma-informed. Watching this series has helped me to understand the crucial differences between their approaches and why the second experience has been so much more successful. As a client, I want to let all of the therapists out there know what a difference a deep understanding of trauma can make. Not only has it saved my life, but it has also greatly impacted my husband and four children as a result. Thank you to all of the therapists that practice using these approaches and understandings. It makes all the difference!
I was really pleased to be able to see this week’s session – it’s the first I’ve seen. There wasn’t a moment of the seminar that wasn’t helpful. Most of the theories, and a number of the techniques, have been introduced to me by a very skilled therapist. Whatever the issue I’m dealing with – medical, surgical, or in therapy – I’ve always tended to seek information. For surgery, it might be to help me make a decision about whether to have it, the technique being used, or questions to ask about the best ways to prepare or rehabilitate. That the information you covered was very consistent with both my therapy experience and the theories my therapist mentions and provides reading material on, is reassuring (though I need little of that with this excellent clinician) and also leaves me with a feeling of contentedness, and trust, as I recognise that apart from the acts of our relationship, my therapist understands and trusts my intellectual interest and ability. For someone who is often trying to escape from the current of emotions dragging me out to sea, the intellectual perspective provides some much needed distance.
It is good to understand the neuroscience behind the workings of the Window of Tolerance.
the Infographic you provided is excellent
I really like the new way Topics have been organized , especially the way you refocus the take home points after each Expert’s discussion
Much Obliged for your wonderful vision and Presentation
This may sound funny, but I realized today that I am applying both bottom-up and top- down approach with my clients, your program is amazing, thank you for your efforts and passion to make life easier for everyone.
This was an awesome presentation! I especially like the “Window of Tolerance” segment. I will use this information in my practice to help clients understand their window and how they can learn to self regulate.
I think the Window of Tolerance (WOT) is something I can utilize in several ways for clients who are not traumatized.
Thanks to all the presenters for this series.
I liked what /bessel said, that most of us are patients. I liked, was it
Bill, who emphasised observation- a useful tool for use at any time. But I liked best of all what Ruth said, that when you work with a traumatised client, you change the course of civilisation, because you will reach that person’s whole family and all their contacts- this touches on all the meanness and cruelty in the world, which it’s so desperate to reduce
Very interesting. I hope there will be more talk about the actual methods of trauma treatment. There has been some and I would like more, in particular in the form of actual therapeutic sessions conducted by your experts. If you are not going to show that in the remaining sessions, is there another offering in which you will show much more of it? Theory is needed but needs to be complemented by extensive observation of practice. It was said, for example, that some people experience a high frequency of traumatic flashbacks due to self-loathing but it was neither explained nor shown what a therapist can do to counter that. I don’t think it is enough to simply ask a client if he is doing that because he hates himself for past crimes.
Thank you, Ruth and all of the expert team.
Fabulous and truly life changing!!! I’m recovering from a pharmaceutical brain insult as well as a 30-year multiple sclerosis journey – entangled with parenting a 28-year-old adoptee with Fetal Alcohol Syndrome. To say I’m traumatized and so is the rest of my family is an understatement.
I am working with a counselor and have embarked on a season on healing to hopefully kick MS back into remission for the umpteenth time. I also own a parent training business and work with many adoptive and foster parents training them in the work of the late Dr. Karyn Purvis who was our mentor and teacher for nearly 18 years.
This knowledge will help me help parents who are in the trenches with kids from hard places. It will change generations to come as well as my own family will be starting a new generation at the birth of the new year as we welcome in our first grandchild, a grandson!
I still can’t believe y’all did this for free. This Texas gal with Connecticut roots, Ruth, is so grateful!!!
Blessings,
Deb
wondering how to incorporate going to beautiful outdoor spaces when our Northern Canadian winter is harsh and long…any ideas ?