Tag: Psychoeducation

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 are Grounding Techniques?

Grounding Techniques are strategies that can bring an overactive nervous system down. They are different ways of calming a nervous system.

There are different types of grounding techniques. Not all of these work for everyone. You may need to try a number to figure out what works or combine a few of them to help to calm your nervous system down. There are some techniques that fit into more than one of these categories.

You may need to pick out some that work for different situations. When you are dealing with trauma from childhood experiences it may be more effective to match the grounding technique to the age you were when the trauma first happened or the needs that were neglected during the trauma (such as love, safety, stability, comfort, validation, and acceptance). For example, if you have a trauma trigger that is connected to your 7 year old self, a grounding technique that would be comforting to a 7 year old may be more effective than something that an adult is more likely to do (wrapping yourself in a blanket may be better than exercising indoors).

Grounding techniques can be used to bring someone from a hyperarousal state back into their window of tolerance. Some may work for people in a hypoarousal state. They are an essential resource for trauma recovery. It can be good to have a card with the grounding techniques that work best for you in different situations, so you can reference it when you are not able to think straight and enable yourself to get back on track.

I have a separate blog post with examples of the different types of grounding techniques.

Observation Techniques are grounding techniques that help to calm the nervous system by focusing on identifying and describing objects in the environment. For example, you may pick an object in the room or outside the window and start to describe it in different ways until your system starts to calm down.

Somatic Techniques are grounding techniques that help to calm the nervous system by focusing on sensations and/or movements in the body. For example, you may focus on the feeling of your feet pressing onto the floor.

Breathing Techniques are grounding techniques that help to calm the nervous system by focusing on the breath, control of the breath, and/or sensation of breathing. For example, you may focus on prolonging (slowing) the exhale as you are breathing.

Distraction Techniques are grounding techniques that help to calm the nervous system by distracting yourself from what is causing the nervous system to be overactivated. For example, you may watch funny Youtube videos.

5 Senses Techniques are grounding techniques that help to calm the nervous system by using your senses to calm the nervous system. For example, you may focus on the taste of a candy or the scent of a particular scent.

Self-Soothe Techniques are grounding techniques that help to calm the nervous system by soothing the nervous system through activities that are comforting to your system. For example, you wrap yourself in a soft blanket and focus on how soft the blanket feels around you.

Present Moment Techniques are grounding techniques that help to calm the nervous system by alerting it to the present moment during trauma triggers. When you are triggered by trauma the past comes back and feels like the present, so reminding yourself what the present moment is can calm the nervous system. For example, you may name today’s date and location.

What is Somatic Experiencing (SE)?

Somatic Experiencing (SE) was developed by Peter Levine and focuses on addressing the effects of trauma. It focuses on releasing people from where they may have been stuck in a traumatic event. For example, someone may develop chronic pain in a body part that was hit in a motor vehicle accident. The reason for that pain may not be physical but may be due to not going through certain processes that release the traumatic energy and therefore the energy stays in the body and creates tensions and pain.

The purpose of Somatic Experiencing is to help the body release the traumatic energy and to enable it to self-regulate.

The focus of Somatic Experiencing is to help the client find places of safety so that the client can experience sensations relating to traumatic events in a safe way and be able to process the trauma.

Somatic Experiencing can be very helpful for trauma and other conditions that involve a dysfunctioning nervous system from trauma.

Further Reading

Trauma Healing https://traumahealing.org

This is the official website for Somatic Experiencing. It has resources, information on trainings, and a place to look up therapists who have passed their official trainings.

Official Youtube Channel https://traumahealing.org/c/SomaticExperiencingInternational

Recommended Books

Healing Trauma – Peter Levine

This book is a simple little book that is a 12 phase Healing Trauma program. It provides the necessary information that is important to trauma healing but not all the science behind it (if you want the scientific background read Waking the Tiger or In an Unspoken Voice for that information). It includes a CD with 12 guided Somatic Experiencing exercises. There are a variety of exercises or modifications that you can use for each of the 12 phases.

In an Unspoken Voice – Peter Levine

This book summarizes Peter Levine’s work in trauma. It explains the science behind the strategies of Somatic Experiencing, why some people develop PTSD and others don’t, what you can do to lessen the chances of developing PTSD after a traumatic event, and what you can do to release the trauma that has become trapped in the body after a traumatic event.

What is Internal Family Systems (IFS)?

Internal Family Systems (IFS) Therapy was developed by Richard Schwartz in the 1990s after he began hearing clients speak about inner parts within themselves. He looks at these parts as an internal family in the mind, where some parts have certain goals while other parts have other goals. Each part has its own likes, dislikes, burdens, and history and is thought to play a role in achieving self-preservation. Parts have healthy, productive or extreme roles and those with extreme roles may benefit from therapy.

There is a Self that is the seat of consciousness at the core of each person. The Self is often hidden by the different parts, especially the extreme or wounded parts which are trying to protect it. The goal is to unburden those parts and create a trusted, healthy, harmonious internal system that is coordinated by the Self.

Internal Family Systems is an evidence-based practice and has been found to be effective for the improvement of general and mental well-being. It can be used to treat:

  • Trauma
  • Physical, emotional, or sexual abuse
  • Compulsive behaviours
  • Depression
  • Bipolar
  • Body Image issues
  • Anxiety
  • Phobias
  • Substance dependency
  • Chronic pain

Internal Family Systems can be used to understand why certain behaviours keep happening and for more extreme behaviours (substance dependency, self-harm) figure out if those behaviours are still needed and what could be done instead. Some of the parts may be living in the past when the circumstances were different and Internal Family Systems can be used to bring those parts into the present where those extreme behaviours are not needed anymore. Internal Family Systems can be a powerful tool to work with trauma, especially developmental trauma.

Further Reading

IFS Institute https://ifs-institute.com

This website is the official website for the practice of Internal Family Systems. It has resources, ways to find a formally trained IFS therapist, training and learning options, information about the theory, and research about IFS.

No Bad Parts – Richard Schwartz

This is a book written by the founder of Internal Family Systems, Richard Schwartz, for the general public. It explains the IFS theory and why it works for trauma and other struggles. It also includes techniques and exercises.

What is Trauma?

Trauma is what happens when the nervous system gets overwhelmed. When the nervous system is overwhelmed, things (emotions, thoughts, self-beliefs, etc.) do not get stored in the brain properly, and everyday things trigger them to manifest like they are happening in the present when the emotion, physical sensation, and/or perception is actually coming from the past.

Traumatic memories are “less likely to be recalled in a clear, coherent narrative” and more likely to be “remembered in the form of sensory elements without words, ” such as emotions, changes in breathing or heart rate, body sensations, tensing, or feelings overwhelmed (Fisher, 2021).

What are some of the symptoms of Trauma?

  • Numbing
  • Decreased concentration
  • Anxiety, panic attacks
  • Depression
  • Irritability
  • Headaches, chronic pain
  • Loss of sense of “who I am”
  • Emotional overwhelm, mood swings, emotion dysregulation
  • Insomnia
  • Shame, guilt, self-blame and worthlessness
  • Nightmares, flashbacks
  • Substance abuse, eating disorders, self-destructive behaviour
  • Feeling unreal, out of body
  • Hypervigilance, mistrust
  • Denial, disbelief, shock
  • Few or no memories
  • Loss of a sense of the future, hopelessness
  • Loss of interest in things you used to enjoy
  • Isolation, withdrawing from others

What works best for Trauma?

Trauma can be very individual and unique. So what works for one person may not work for another. It should involve both top-down (thinking/brain-based strategies) and bottom-up (somatic/body-based) strategies. There are some strategies like EMDR that involve both top-down and bottom-up strategies that have evidence to work for different types of trauma.

The problem with top-down approaches (CBT, some DBT skills) is that they don’t work when someone is hyperaroused or hypoaroused because when you are in those states, you cannot think properly. If someone is hyperaroused or hypoaroused they need to come back to a place where they can think clearly before using these skills. These skills can be useful to people who have been traumatized but they need to be used at the right times and be complemented with bottom-up strategies.

Recommended Reading

Peter A. Levine – Healing Trauma

This book has a good summary of trauma plus it comes with a CD that has 12 Guided Somatic Experiencing exercises.

Bessel Van der Kolk – The Body Keeps the Score

This is an incredible book that describes the experience of trauma, how trauma affects the brain, and different treatments for trauma that have been successful. Bessel Van der Kolk is one of the top experts in trauma. This book has been an NYT bestseller and can probably be borrowed from your local library.

Transforming the Living Legacy of Trauma – Janina Fisher

This is an incredible workbook that has the essential psychoeducation about trauma as well as step-by-step strategies to start to heal the trauma and cope better with triggers. Janina Fisher is one of the top experts on 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