How to Help a Client Come Back into Their Window of Tolerance with Bessel van der Kolk & Ruth Lanius
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- Опубликовано: 30 окт 2017
- Get the latest strategies on treating trauma in the short course "How to Help Clients Come Back from Trauma-Related Dysregulation" with Ruth Lanius and Bessel van der Kolk, together with Stephen Porges, PhD and Pat Ogden, PhD: www.nicabm.com/program/dysreg...
In this video, Ruth Lanius and Bessel van der Kolk discuss invaluable insights on how to support clients in finding their "Window of Tolerance".
In this enlightening video, they explore the concept of self-regulation and the importance of widening the window of tolerance for trauma survivors.
Learn practical tools to assist clients in returning to a state of balance, from observing body language to incorporating breathing and movement exercises.
For the latest insights and strategies on treating common client issues, subscribe to our RUclips channel and then visit us at www.nicabm.com/?del=YTOrganic...
Placing their own hand on the place of anxiety/tension and breathing into that place - being fully present with them as they reconnect with themselves
I’m not a therapist, but journaling and drawing what’s on my mind has been very helpful.
People who have come through their PTSD hopelessness to the other side, even if it is just a toe outside of that, can help others by sharing what has been helpful for them. Even if it were to only help one person, that would be one person on their way to getting out of that life-altering state of never-ending hopelessness that feels like an eternity.
I have been working with EFT Tapping since 15 years. It was an enormous help when I worked with traumatized people in large groups after huge earthquakes in Chile. EFT is my most important tool.
I’m not a therapist but I have learned for me, walking for 6min is very helpful
Could not agree more. Prior to PTSD and trauma I had no trouble relaxing if I needed to. PTSD has cometely changed that. I find I am hyper-aroused, I feel ALL the emotions, especially anger, sadness, frustration. Noise, crowds, traffic,, loud dogs, babies crying etc irritate me and I am always holding my breath without realising and clenching. To the point my neck has developed a pinched nerve over the years. I get tense, as this says, to the point I can't open my chest and take a deep breath. Running helps me discharge my pent up energy and come down into my window of tolerance but I miss having a much wider window. Not to mention yes all the cognitive issues that I face when hyper aroused. I feel unsafe resting and being still so unfortunately I only tend to to rest if I am physically sick and forced too. I miss being able to rest and be still and for it to feel good. Eg lay by a pool, meditate, or watch tv for hours on end. My brain wont shut up though and I never used to prior to PTSD get so hyper aroused and fed up and angry etc. The nerve and chronic illness, nightmares, endless medical/disability appointments, trying to mantain some type of work and present "calm", unhelpful, convoluted social government services that honestly deplete ones energy further also increases frustration too.
Arousing feeling is a nice feeling I like it
For younger children we have developed a breathing exercise based on the fairy tale of the big bad wolf and the three little pigs. The child is the big bad wolf and blows as fast as it can to blow the house from straw, wood and stone. After the stone house, which remains standing, even after blowing very hard three times, the child counts from 0 to 10 (or vice versa). After that we can usually talk again about their anger, sadness, fear. We also use a warm seed bag around their neck to calm them down.
this is amazing - thank you so much❤
This is a self-regulation breathing exercise I want to try. What is a “warm seed bag”?
@@CoryWillowTree it's a bag made of fabric and in it it's usually wheat seeds. You can heat it in the microwave and it keeps warm for a long time.
For trauma patients self regulation is very difficult. The window of tolerance, the window where you can move, is so incredibly narrow that living has become intolerable and difficult.
But it is about finding ways to widen that window of tolerance using the body because that is where all the emotional pain is stored.
Im done trying. I try and be mindful but being in my head is intolerable. Its torture.
Self regulation is nearly impossible. Maybe a few minutes.If u don't have this u don't understand.. my relationships are ruined and I can't work. I need help, like someone to take me by the hand and get me help. I have to wait for Medicare and hope to God I can find a way. My marriage is falling apart. I'm so tired. And tired of only the wealthy being able to get the help they need.
@@MarciaB12 I can relate, and understand. You are not alone. One day at a time....................sending love 💜
It most certainly does become intolerable, and that intolerable, utterly hopeless existence that seems like it is never going to end, after 11, 12, and 13+ months of crushing severe depression, hypervigilance, and hopelessness, it begins to feel like there is no way of it. Some people can walk around like that for YEARS.
wow..havent thought of "getting into a rhythm" as a way of regulating, makes sense why dancing or music making is powerful tools for regulation!
Breathing slow and deep in a rhythmic cycle, using mindfulness techniques fr breath and body awareness and regulation, visual,imagery for creating a safe space, using Gestalt' approach for body work and metaphors to create safe feeling, comforting the nner child.
This completely confirms recent experiences.
I am reviewing NICABM videos that were watched only a few months ago, and notice that I am able to receive on a much deeper level now.
Your videos and outreach are making a difference.
Thank you.
Understanding this is a Massive Game Changer and explains so much !!!
the number one thing for me working in a dysfunctional medical system is to make sure I am regulated!
A practice of root grounding with the earth. When I am feeling overwhelmed and that I am not big enough to contain the overwhelm, I go to my connection with the earth, and go into feeling the huge capacity of the earth to hold it all, and then connect with a grounding root to the earth. Breathing my overwhelm into the earth.
Margo Stebbing I often forget about this one - thanks for the reminder.
Very interesting...can you please explain it further for me.
Keep a zip lock bag quarter to third full of water in fridge. When first distress sign noticed, take deep breath and place the chilled water bag over forehead, eyes, cheeks and nose - not covering nostrils. Breathe as slowly, deeply as possible. Certainly not 100 percent as in a magical release. However, almost always helps, as in able to more logically process, take appropriate adult action. Might only be seconds or could take a few minutes to be effective.
I have been a neurofeedback (NFB) and mild brain stimulation therapist specializing in traumatic stress since 1995. IME, the single most powerful intervention to increase window of tolerance in the NFB world is training down the right insula. The right insula plays a major role in regulating and informing how safe or unsafe we feel in our bodies.
How is this done?
There are dozens of ways to bring a pt. Into the feeling zone or processing zone .
Firstly determine if they are too anxious or too relaxed at that moment
Secondly determine their emotional age at that moment
After that its easy to devise a way to optimize their session by whatever their body beckons you to do or say. Like asking where their issue of the day seems to be located in their body and either have them touch or breath into that. Another is to summon a support figure of theirs in fantasy and have them use the figure for reassurance etc .
Literally dozens of ways to return the person to the safety or process zone field or "window".
I use “Touch Points” for myself. They are two little alternating buzzers, one for each side of the body. To self regulate I put them on full speed and put them just in front of my ears. This interrupts my OCD and PTSD. It works similarly to EMDR. Shortly after I put them there, I start to breathe more regularly. I keep them there until I can think more clearly. I also use them on low to sleep. I put them in the wrist bands that are provided and put them on my feet. They put me to sleep.
I do the same❤
I develop metaphors for visualizing exercises that can be applied to functioning contexts. Like picturing oneself "surfing" a panick attack. Mentally "shrinking" someone/where frightening to the client...
Yes I am a newly starting coach who is a trauma survivor myself and intuitively thought of shrinking someone as well. I am happy to hear that you use that. Do you find it effective for your clients?
Tapping, Emotional Freedom Techniques or Energy Psychology calms the body dramatically allowing clients into their window of tolerance and also, after completing these methods, these clients have their own Freeing spontaneous insights!
The basic eye exercise is an amazing tool (polyvagal theory) to help clients regulate their nervous systems. Also titration with pendulation between a small irritant and an inner resource (expanded on during session)
For such a short video this is really insightful, thank you for sharing this 🙏🏻
Dr. Ruth is amazing! I love her work
Wow. That's just incredible. I wish I had found competent people at the time.
Most of the time, the burden of bringing the self back to center falls upon the own individual. Most people don’t understand, recognize or acknowledge trauma. So more often than not, they don’t know how to help or can’t. When I realized this, I began the slow journey of re-parenting myself. I expected little to no understanding from those around me, so I really upped my knowledge and self care. This pandemic helped in that I have less responsibilities. If you are in a position to help yourself, please don’t delay. This is a long and slow process. And you really have to take care of yourself as you would’ve done to your child.
@@Ana-rb7ws That's excellent, wise advice. I'm at a much better place/moment now but appreciate you taking your time to write. Congratulations on your process and wisdom. Hope you're doing better by the day. God bless u.
@@Marcelube - I’m glad to hear that
@@Ana-rb7ws that's very kind of you. I agree 100%. I believe the point is people do not know the least about basic psychology and studying, to minimally understand what happens, is essential, in my humble opinion. Also because today I can recognize people in the spectrum and it surely helps me dodge unwanted bullets. Tough times to live and it will take a while until we see some change, at least 2 generations, I suppose.
I really appreciate your feedback. Be well.😊🙌🍀💖
When not being triggered the host is in control and there's no problem. Avoidance is in many situations the best option for a patient to be triggered. Once triggered there's no time to self regulate --- the switch goes just to fast, it's instantly.
But then nothing gets done to heal the trauma and the patient life is restricted.
Hence the need for creating "anchors" that the client can reach for during the activation episodes.
A quiet calm voice that enables and allows non-threatening touch. Sitting closely next to someone having a anxiety attack, will gently calm their nervous system. Your calm state will energetically influence theirs.
If alone, rinse your wrists under cold water. Then the forehead, temples, and back of neck.
Ruth Lanius, an amazing professional.
This is a great way of framing a certain kind of overwhelm that I feel.
Vagus Nerve is the key to regulation - it literally is the whole thing. Cold showers, deep breathing, Xen by Neuvania - all great tools for vagus nerve stimulation. It will change your life.
Thank you! Great video
I know several mind-body techniques including EFT, Heart Assisted Therapy, tap or touching down the fingers, TAT, Brief Energy Correction, EMDR, the butterfly, havening, TTT and I shift between them depending on what the client reports to is their reaction.
I love the beach ball idea!! Gonna bring that in for my group therapy
Hello Ruth, after a therapist sexually abused me while administering psychedelics I found I had way too much going on to try and take care of a therapist's feelings - something one has to do even in the initial call or interview - so I began a four year process of navigating the psyche through audible, books, swimming and more than 1000 hours of talking in front of a phone.
Talking to a front-facing camera on a phone for integration and articulation is superior to a therapist in five ways:
1) It is available 24/7 rather than scheduling time at the convenience of the therapist. It's way to dissociative to wake up with terrible feelings and be given the message: "The therapist is more important than you and these feelings so first we must hold them, then wait until the therapist answers their phone, then wait until they are available for the time they are available for." This simply can't contain the charge of PTSD. The phone is available as needed when needed.
2) The front facing camera provides real-time mirror feedback about what's going on in my body. I can see "what that guy over there" is going through through the eyes of the audience or witness, since I try and convey what's going on inside so that someone watching could be able to track it. I don't get to see my face normally in therapy.
3) It is free. When it is taking years to sort out and the future is uncertain because I'm getting to know a "new me" that can't perform as well as the "old me" the ideas of paying $250k in therapy is overwhelming. I made up to six hours of video a day to try and sort out what was going on and that's $1k a day while I can't work.
4) It's useful to others. It is too painful to live through this without any sense of purpose. The problem with the therapeutic paradigm is that it is one of "receiving service." I'm supposed to pay one therapist to fix another therapist's work and "receive" their expertise. But the whole thing feels off. I was given dysfunctional parents from war-injuries because my government did not want to pay to clean up their violations. Then I paid several therapists to help clean up my parents mess, needing to spend more money and time and grief that I didn't have because I could not work as competently as I would if I had good parents. Then I have to spend another set of money to fix the problems of an incompetent therapist. And I have to show up convenient for the therapist, rather than any individual in this process showing up in a way that is convenient for me. It was not convenient to be in any of these situations and it feels awful to be expected to be grateful and feel like a burden each step of the way, blamed by my parents etc. I want to be useful - and a therapist offers no doorway to being useful because no therapist has ever asked me what I can teach them or how they can improve and most bristle when I point out they can improve and don't want to shift out of their box. But the public in pain and trauma does provide doorways to be helped and to allow me to be useful. So by putting my videos on youtube it pivoted the narrative from "so unwelcome I have pay someone to listen to my feelings" to "I can help others feel less alone in their pain.
5) The powerlessness of PTSD is compounded with therapists cutting off the time when I'm not done. When I need to talk 3-6 hours a day to sort things through and they want to cut me off it is turning the absence of full container on their part into me being a problem with the same unhealthy message in the culture: "your feelings are too much." By being able to talk as long as my body could talk and come out of that process clear on what's going on, I feel accomplishment. I bought a phone that could record for 10 hours straight so I was never interrupted.
In short, creating media was the only way I could find to integrate and process the amount of feelings that are/were there. It's an ongoing journey. In the process I have created a MAP that I think many will find useful in diagnosing and understanding, if not healing trauma: understandtrauma.com/map-to-explore-trauma. If any of you take time to learn from this map and a client benefits I would enjoy hearing what was useful. I am making a documentary about sexual and therapeutic abuse and would also like to interview anyone who feels they can help people in that state.
Please tell me that therapist was sent to prison
"It feels awful to be expected to be grateful and feel like a burden each step of the way, blamed by my parents etc. I want to be useful - and a therapist offers no doorway to being useful because no therapist has ever asked me what I can teach them or how they can improve and most bristle when I point out they can improve and don't want to shift out of their box..." One hundred percent. The biggest limitation with therapy. Freud didn't really do us any favors.
"The powerlessness of PTSD is compounded with therapists cutting off the time when I'm not done. When I need to talk 3-6 hours a day to sort things through and they want to cut me off it is turning the absence of full container on their part into me being a problem with the same unhealthy message in the culture: "your feelings are too much." By being able to talk as long as my body could talk and come out of that process clear on what's going on, I feel accomplishment. I bought a phone that could record for 10 hours straight so I was never interrupted." One of the biggest hinderances with a top down, talk only approach to trauma recovery is that the reason it takes so much time is that it doesn't address the very impt, and even more impt, bottom up, body/physiological level of trauma. I'm a manual therapist (mostly utilizing a Biodynamic Craniosacral Therapy informed approach) in practice since 1995, now specializing in trauma recovery. My clients experience miracles, some without any talking at all, because we are normalizing their autonomic nervous system. There are many problems with the lack of effectiveness of the classic professional psychotherapy model. If polyvagal informed, hands on therapy was accepted and included along with talk therapy, people would move exponentially faster in their recovery process.
I agree with all your points. I think the cost of healing is crazy and I can't stop just because my time is up so I get my healing from youtube learning videos. I like the details you have added to your plan.
thank you so much for validating yourself, me and millions of others
This needs to be taught to millions of people now....says ,DR.DJ.DEB.USA......Music ....🎼🎵🎶🎶🎤🎧📻🎸🎹🎹🎹📲🥁🎻🎺💾💽🖥️💻💻🔌📠📟
i am am slowly learning about Window of Tolerance I want to get more information on this. Thank you, 15/6/2020
My window of tolerance...👌
I’m helping a client. That client is me 😬
Wishing you much success and that your "client" experiences a full recovery. It takes a while.
EFT (tapping) therapy calms the amygdala in the brain in minutes, it is the most powerful tool to help with self regulation. My books Energy EFT For Teenagers and Happy Tapping with Mia & Charlie are being used to help children & teenagers at home and in school to feel calm, less stressed and anxious and help with the pressure of exam nerves, bullying etc Every school needs tapping, every child would benefit from gently offloading their anxieties & stresses daily, as they happen and not carrying around the emotional burden of things that do not emotional support them .
Yoga and daily meditation can do wonders
How many days/months/years of yoga did it take for you to completely heal your PTSD? Thanks in advance, and yes I do know it is different for everyone, but I'm interested in your experience having had PTSD.
you need comments from clients too.
I am a psychotherapist and I integrate yoga to my seesions. Yoga has the three poles of "tamas" (cool), "rajas" (hot) and "sattvas" (centered). I practize for several minutes till my clients are in a "sattvic" state of alive and calm centeredness. Only than therapy can work!
How this can help a severly dissociated person, and also fully anxious?
Adventure/nature therapy...if you are able to create more of an interest to be outside their bodies ....it helps broaden the window of tolerance...and then some.
I been traumatised my entire life why from. Ripple effects of childhood abuse couldn't feel safe with my mother she abused me couldn't feel safe with my x partner he abused me and brainwashed my kids to hate me for no reason I can barely breathe today though I try from the alarm feelings of what they did to me
Let them talk for 20 minutes to half an hour, so they feel "heard"; then (when online) visualisations and grounding exercise and bring them in the "here and now"; empower them by taking them out of their own thought-patterns for a while. When physically close I hold their hands for a while. Very little talk, an extremely slow guided meditation, then slowly release their hands. Make them aware that "right here, right now" I am safe; life is good and I am in control of what is happening. 10 minutes after-chat, in which most go back into their mind-constructs and I gently remind them what they are doing. It's mainly about the awareness of the eternal now. Indians call it "clean out the chit", which, when pronounced slightly different becomes funny and thus easy to remember.
Interesting, Walter.....though I would sense holding a client's hands when they are not in a state to fully consent to be a boundary rupture. It can feel pretty intimate for many. There are less intrusive ways to contact body parts, such as foot against foot or leg against leg, sitting side by side. Another is the top of their arm (deltoid).
I like your approach and contact Walter. In my pit of pain I find touch to be essential.
As a client I would want a therapist who would be interested in finding a more effective way than spending 20 minutes (to half an hour!) on just talking for the sake of talking, essentially I have the thought that his is wasting valuable time. Surely there are more effective techniques out there to swiftly get me back into my window of tolerance. If there is a way to get the desired result within say 5 mins, by using different techniques, which I'm sure is possible, think of how much more progress can be made without say an extra 15-25 mins on (according to my thoughts) 'un-necessary expensive chit-chat.'
Big problem here with hand-holding; that would feel WAY to intimate for me and i would definitely feel the power differential interfering with my voicing a preference. And I'm a pretty assertive person. I wouldn't even want to have to field the question, "Is it okay if I hold your hands?" (Ew.) A speaker I heard talked about working through her trauma with her prison therapist, and though the therapist would not touch her, she would rock back and forth with the Ct as the Ct retold her stories - so she mirrored her body actions and that helped the Ct feel held. This was the Ct who was the speaker.
This will make for great evidence where the predator openly acknowledges his behavior and yet still continues to sit around doing it. Enjoy your conviction and rooming with a murderer. Unfortunately I don’t like in a small town with no crimes. Our prisons are full of all kinds of predators
Any tips for hypo-arousal? I have been relatively successful with hyper-arousal, but hypo-arousal is still too confusing...
Just sit with them, hold their hands or a single hand on their back between the shoulders and slowly allow your breathing to harmonise. Don't expect anything, don't try to "fix" anything, just be there with them. If they can handle it, (or you?) sit them in front of you with their back against your chest for say half an hour or until they start to smile and get up. There's a profound lack of trust in life / other human beings in general in hypo arousal.
@@waltermessines5181 Thank you for your response.
I am not a therapist and this is for me. I have been applying these mindfulness approaches, being with the feelings etc. But when I am hyper-aroused, none od this makes sense to me, I have minimum motivation and ability to focus on anything, in particular emotions.
I was told about these methods many years ago and for many years I thought they would lead to fruition, but their results have been minimal for me.
@@ajakowski Occupational therapists assist people with hyper and hypo arousal to improve their functioning through the use of sensory modalities and sensorimotor activities to calm and alert the nervous system. In the case of hypoarousal we would be looking at more alerting activities to improve focus, energy, mood etc. These types of sensory inputs are very unique to each individual and we spend time exploring people's preferences. There are some 'powerhouses' in our sensory systems such as proprioception (deep pressure and activities that use muscles against resistance) that can work quickly to increase and sustain alertness without having to think when motivation is low. Mindfulness is excellent for some but it does involve your mind. The advantage of sensory modulation is it works without having to think - which is great when we're overwhelmed, very emotional or exhausted. For an introductory video check out www.mudanca.com.au I hope that helps:)
Yes coffee or combo vitamins C and B complex prior to session or both. Alternatively verbal or body provocation making sure the client is suitable for this step. Another is to stress them in some physical way such as holding a tough position for a few minutes. Another is to focus exclusively on their body and do a body scan of tense spots or unusual spots or what their body feels. Ie body focus mostly as opposed to cognitions and analyses
@@waltermessines5181 If my therapist were a man and suggested this, I would have done it but never gone back. I have a hard time reading situations with men, understanding my own feelings, and an intense fear of being abused. What do you do or say to your clients to help with things like this?
I'm just a lay person but what I find alarming with all the videos I've seen so far is that they conflate "returning to your window of tolerance" with emotional regulation. Your window of tolerance is essentially a measure of the sufficiency of your schema to understand and accommodate the world around you. Emotional dysregulation is the *consequence* of this schema being inadequate. "Returning to your window of tolerance" means returning to a context where the world makes sense to you again -- which then causes emotional equilibrium. This distinction is crucial. Malformed schemas at the earliest levels of development are the cause of most behavioural issues (big statement, I know). This is what should be kept in mind at all times -- what is the core perception of the being in front of me?
You're conflating the window of tolerance with something it is not. It's a body thing, not a cognitive thing. No, you're not returning to a context, you are settling down the fight or flight response so the brain can make sense of things emotionally AND rationally.
Can these techniques help someone who is addicted to methadone? I am watching someone circle the drain and his psychiatrist said that they can't treat him (work on his trauma) until he comes off methadone and has a stable environment. He is an illegal migrant / failed to get asylum. And the authorities won't give him a place in an institute because he is not a legal resident.
Laurena Lau ••hi there,
Im sorry to hear of the struggles your friend is going through... Ive been using Energy Clearing, for about 1 1/2 years, to drop over 50mgrms of methadone.
After well over a decade. It can be very psychologically addicting and scary to come off this heavy duty painkiller and reface all those traumas that triggered drug use to begin with.
Blessings
••modern psychology is often backwards, unfortunately thats why ppl rarely recover that way, and just end up medicated for ever..
Mindfullness Meditation can also be a Very Powerful ally to recovery from substance abuse.. It talks about creating that place of safety initially before facing the trauma. Its just how our bodies work. Rushing him off to fast could create more trauma. I really wish traditional Psych and Medicine understood these aspects. I personally went through over 23 years of extreme substance abuse.. i got myself off, by myself, for myself... it takes massive amounts of inner~strength. My 'support' comes solely from the Divine. I am also a very Spiritual person now (not religious,lol) and i love animals, so my kitty has giving me purpose and meaning outside of myself to live for... Anyhow, thats what got me through the brunt of it...
You seem like a careing friend. Help your friend find their joy, even if its in a very small way to begin with... That is truly the Only way, to successfully change our life🌼🐱😊
Yes definitely. In fact it is crucial to do this. If the person has been using drugs as a means of coping (suppressing) with their emotions then taking this away without giving them alternative methods of regulation is just like taking away their crutch and letting them fall.
Who else is the client?
Can you do a part two to this video, its not as informative as I was hoping
Hi Michael, I apologize it was not as informative as you were hoping. Here are some free resources from our website that might contain information you are looking for: www.nicabm.com/blog/
@@nicabm thank you so much, I LOVE ur content and I’m still dedicated to all ur resources and wish I could go they ur certifications
Tell them to lengthen their spine.
yes re-frame it.
👍
I punched myself in the face giving myself a concussion. I had to go back to my father.
Exposing 📲🖥️💻💻📠📟 SEXUAL PREDATORS ONLINE IN PERSON, ETC...IS VERY IMPORTANT.... THANKS 🤩😇😇 😻😻 🙉 FOR YEARS FOR HEALING AND CHILDREN TRAUMATIZED BY ABUSERS WHO ARE NOW TOP PROFESSIONAL DOCTORS, THERAPISTS, PSYCHIATRIST TOO....4/14/2020😘😘😍😎🤗🤩🤩😘😘😍😎😍😘🤩🤗🤗🤗🤗🤗😗😙😚😍🤩😘
Obsoletely nothing. I'm screwed.
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