Category: Chronic Pain

How Do You Tell If Your Nervous System Is Dysregulated?

A person’s nervous system generally spends most of the time with the parasympathetic (ventral vagal) nervous system activated to bring the nervous system to a calm state. When a person faces an emergency situation or crisis their sympathetic nervous system gets activated and after the crisis is over, the parasympathetic (Ventral vagal) nervous system brings the nervous system back to a normal state and calms it down.

When a person’s nervous system is dysregulated, this process does not work as it is supposed to. A dysregulated nervous system easily turns to “danger” responses such as fight, flight, freeze or fawn. A person with a dysregulated nervous system can be agitated or shut down. Also, their nervous system has trouble returning to a calm, parasympathetic state.

What are the Signs & Symptoms of a Dysregulated Nervous System?

A person with a dysregulated nervous system won’t have all these signs and symptoms, but if you recognize a pattern of some of these symptoms in yourself, you may have a dysregulated nervous system:

  • Difficulty relaxing
  • Hypervigilance
  • Seem to be caught in a “fight or flight” trauma response or stuck in a “freeze or fawn” trauma response.
  • A person who is a “People-pleaser.”
  • Engages in “toxic positivity” to the point where they become out of touch with their own vulnerable emotions and the emotions of others.
  • Thrill-seeking behaviours
  • Auto-immune disorders and diseases, irritable bowel
  • Constantly on edge, overwhelmed and/or overstimulated.
  • Frequently snappy, irritable, and reactive
  • Chronic pain and illness; unresolved aches and pains; somatization
  • Highly sensitive to sensory stimuli
  • Sleep problems (disrupted sleep, insomnia) and daytime fatigue
  • Chronic attention and concentration problems; executive dysfunction
  • Cravings and extreme appetite changes
  • Immune and hormonal symptoms/compromised immune system (keep getting sick)
  • Skin and gut conditions/ Digestive Issues/Nausea
  • Highly sensitive to other people’s emotional states
  • Constantly anxious, agitated, stressed and/or worried.
  • Hard time controlling your emotions or the inability to feel emotions.
  • Executive dysfunction
  • Stonewalling
  • Depression
  • Elevated or irregular heart rate.

What can Attribute to a Dysregulated Nervous System?

  • Traumatic experiences
  • Adverse Childhood Experiences (ACEs)
  • Childhood trauma, especially chronic childhood trauma
  • Witnessing Domestic violence
  • Medical trauma
  • Chronic stress
  • Lack of social support
  • Unfavourable living experiences
  • Chemical imbalances
  • Experience-dependent plasticity, resulting in a constellation of symptoms and functional impairments.

What can be done to Regulate a Nervous System that has become Dysregulated?

Some people need help to get back to a regulated state and techniques such as breathing exercises, using music to regulate, using exercise to self-regulate, grounding techniques, and many other techniques.

A person’s nervous system can get stuck in a dysregulated state, in this situation a person needs help to get to a regulated state. For these people, the relaxation, breathing, and grounding technique might not work to get them back to a regulated state or they take longer to create the effect that is desired.

  • Polyvagal Theory gives a theoretical basis to understand how you can train your nervous system to regulate.
  • Safe and Sound Protocol is an approach based on filtered music that is based on Polyvagal Theory to help a person regulate their nervous system. It can be adjusted to the unique needs of a person’s nervous system.

References:

Tanasuggarn, Annie. (November 5, 2022). The Health Risks of a Dysregulation Nervous System. Psychology today: https://www.psychologytoday.com/us/blog/understanding-ptsd/202211/the-health-risks-dysregulated-nervous-system

Hogue, Loren. (August 10, 2022). 9 Signs You have a Dysregulated Nervous System. Link-in: https://www.linkedin.com/pulse/9-signs-you-have-dysregulated-nervous-system-may-considered-hogue/

Elbers, J., Jaradeh, S., et al. (2018). Wired for threat: Clinical Features of nervous system Dysregulation in 80 Children. https://doi.org/10.1016/j.pediatrneurol.2018.07.007

Window of Tolerance

The Window of Tolerance was first coined by Dan Seigel to describe the “optimal zone of arousal for a person to function in everyday life.” This window is the state where a person can effectively manage and cope with their emotions, and readily receive, process, and integrate information. When in this window, a person can adapt and respond in a way that fits the situation.

When you leave the Window of Tolerance, the reactions take over. They are instincts built within your body from evolution (they are instincts that helped out ancestors to survive and were passed down to us) and past experiences. They are about what was helpful then, but they may not be helpful now. For trauma survivors, these reactions are the story of their survival. They are reactions that were not integrated into the system, so when something similar happens in the present they come back feeling like they are in the present moment, but they are tied to the past.

When you are outside your “Window of Tolerance,” you are not able to think properly and that is because your prefrontal cortex (the thinking/reasoning part of the brain) in the brain has shut down to allow the survival part of the brain to take over. Before you can think about the situation, you need to get back to your “Window of Tolerance.” There are various techniques to achieve that, including grounding skills.

Hyperarousal is a heightened state of activation/energy and is often referred to as the “Fight, flight, or freeze response.” The person’s nervous system is on high alert and primed to respond to danger. This may appear as:

  • Angry outbursts
  • Panic
  • Hypervigilance
  • Fear
  • Tight muscles
  • Anxiety
  • “Deer in the headlight” freeze

When you experience chronic hyperarousal, you may experience:

  • Emotional overwhelm
  • Impulsivity
  • Hypervigilance
  • Reactive
  • Racing thoughts
  • Angry
  • Feeling unsafe
  • Defensiveness
  • Panic

Hyperarousal can be helped through deep breathing, orientation grounding techniques, and self-soothing techniques.

Hypoarousal is a “shutdown” or “collapse” response. It can either come directly from leaving the Window of Tolerance or come after going through a Hyperarousal state after leaving the Window of Tolerance. It comes from too little arousal and an overloaded parasympathetic nervous system. Hypoarousal can appear as:

  • Depression
  • Blank stare
  • Inability to speak
  • Numbness
  • Dissociation
  • Emptiness
  • Flaccid body/paralysis without obvious cause (trauma)

When you experience Chronic Hypoarousal, you may experience:

  • Numb
  • No feelings
  • Ashamed
  • “Dead”
  • No energy
  • Disconnected
  • Not present
  • Passive
  • Unable to think
  • Shut down
  • Unable to say “no”

Hypoarousal can be helped through movement, reminders of the present moment and location, focus on one of the 5 senses, and re-regulating the breath.

While stress and trauma can shrink your window of tolerance there are strategies that you can use to expand your Window of Tolerance. Grounding and mindfulness skills can be used to return to the window of tolerance. Processing trauma through specific modalities such as EMDR, Internal Family Systems, Somatic Experiencing, and Sensorimotor Psychotherapy can help to widen a person’s window of tolerance.

The National Institute for the clinical application of Behavioural Medicine has a useful infographic on their website as well as good information about the Window of Tolerance. https://www.nicabm.com/trauma-how-to-help-your-clients-understand-their-window-of-tolerance/

A book that describes well how the Window of Tolerance works with people who have been traumatized is Janina Fisher’s book “Transforming the Living Legacy of Trauma.”

What is Chronic Pain?

What is Chronic Pain?

There are many definitions for Chronic Pain, but essentially it is pain that remained after an injury is healed or should be healed. It is different from acute pain and needs to be treated differently. The nervous system is much more involved in chronic pain. Chronic pain is a holistic condition and can be affected by many things, such as physical activity, problems within muscles and joints, nutrition, sleep, stress, temperature, past trauma, emotions, and thought patterns.

Chronic pain is often increased or caused by an overactive nervous system. The body uses pain to alert you to danger, but for many with chronic pain, the alert system is extra sensitive and either overreacting to stimuli (intense pain from stepping off a curb) or reacting to stimuli that are not dangerous (seam of pants rubbing against leg with no skin damage). With Chronic Pain, a person often has to pace themselves and plan ahead to avoid pain increases.

How can counselling help with Chronic Pain?

Counselling by helping a person figure out how to cope with the pain, plan strategies to minimize pain increases, figure out priorities, change thought patterns, identification of the cause behind pain increases, manage emotions, create boundaries to better manage pain, learn skills to help them communicate their needs, and find validation for the struggles with chronic pain.

Internet Resources

PainBC https://painbc.ca

Pain BC is a non-profit based in BC. It is has a huge number of resources for self-management of pain, education opportunities for health professionals, and supports for those with chronic pain. It is a truly amazing website to support those with chronic pain.

Tame the Beast https://www.tamethebeast.org

Tame the Beast is a website that is a collaboration between a pain scientist (LM), a pain physiotherapist (DM) and a professional communicator (SC). It shares a number of pain stories as well as providing pain education.

Pain Revolution https://www.painrevolution.org

Pain Revolution is an Australian website that has a lot of information for pain education, as well as handouts explaining pain. It has a good number of resources on it.

Pain Canada https://www.paincanada.ca

Pain Canada is a resource for Canadians, both those with pain and those professionals treating people with chronic pain.

Chronic Pain Centre of Excellence for Canadian Veterans https://www.veteranschronicpain.ca

Chronic Pain Centre of Excellence for Canadian Veterans is has monthly webinars about chronic pain, resources for those with chronic pain and those supporting those with chronic pain.

Further Reading

Rethink Chronic Pain – Dr Gaetan Brouillard

Rethink Chronic Pain is a book written by Dr Gaetan Brouillard, who is a Pain Specialist based in Montreal. This book takes on a multifaceted approach to pain including an explanation of pain, the biological and environmental causes of pain, nutritional influences of pain, natural supplements for pain, ways to treat pain through complementary health approaches (reflexology, acupuncture, etc.), and psychology. It is great in offering some ideas of what next to try and educating on what could be going on with your pain situation.

Change Your Brain, Change Your Pain – Mark Grant

Mark Grant is a Psychotherapist that has specialized in EMDR treatment of chronic pain. This book is great of educating the reader on the connection between chronic pain and trauma. It also offers 15 audio downloads that readers can use to help heal their pain. Headphones are required to get the most out of the audio tracks as they are set up for bilateral stimulation (different sounds to each ear). There are a number of tracks that are set up for using with a trusted partner, for those tracks you may not get as much out of the experience if you don’t have a trusted partner.

Explain Pain – David S. Butler & G. Lorimer Moseley

Explain pain is an excellent book by one of the top researchers in chronic pain. It does a good job on explaining the mechanisms behind chronic pain and what adjustments a person with chronic pain can make to reduce their level of pain.

Recommended Youtube Channels

Dr Andrea Furlan https://www.youtube.com/c/DrAndreaFurlan

Dr Andrea Furlan is a pain specialist in Toronto and has many educational videos about pain on her Youtube channel.

Madeleine Eames https://www.youtube.com/channel/UCoNQEC-w_DlFPTiypnhcARQ

Madeleine Eames is a psychotherapist and mindfulness teacher in Kelowna, BC and has many videos about the chronic pain and psychological and mindfulness resources.

Recommended YouTube Video