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5. Limbo Pro: Regulation

Folks who experience trauma spend their days dodging a stick in the road. They take more complex routes. They beg and plead for detours. They squeeze, stretch and bend to avoid. They are in essence, avoiding a snake they’ve never even named. Until one day, they look and they realize it’s a stick. The snake that they’ve spent years avoiding was a stick. That to me, is the way trauma sits in the middle of our lives. It’s the way that trauma makes us run, hide, escape, deny, fill, lose, weep, dance, sex, drink, drug, lie, manipulate, hate, love, attach and sink. That is why up/down regulation is important. When you spend your days dodging snakes, you find yourself surviving below your center. Regulation, is about getting back to your middle. 

With regulation, the window of tolerance is going to be the main starting point in understanding your client. If a client is in the hyperarousal zone, there are signs that you as the clinician can look out for. These signs include: shaking, defensiveness, anger and impulsivity. When a client is in this space, therapy is going to take a backseat to what the client is experiencing. The main priority is to calm the client and get them back to the center or the “optimal arousal zone”. When a client is here, they are balanced. They're feeling and thinking is on one accord, they are more empathetic, they are aware and conscious of boundaries and they are mindful (in the present moment). When a client is in hypoarousal mode, they lack energy, experience guilt or shame, have little to no physical movement and can completely shut down. It is important when dealing with clients who have experience extreme trauma, grief and loss that we understand their window of tolerance and work to start identifying the snakes as sticks.

There are a number of interventions that I feel will be productive with clients who are in the hyperarousal and hypoarousal zone.

Firstly, it is important for clients to create space for themselves to feel, take notice of what they’re feeling/experiencing, name what they’re feeling, accept the emotion and practice mindfulness.

Here are a few interventions I find interesting:

1. Cognitive Reappraisal (CBT)

    CBT is working with the client in a conscious effort to change a negative thought pattern in hopes of changing the client's feelings and behaviors. With this intervention, the work will be to get the client to change or reframe thoughts and ideas about themselves or a situation that aren’t beneficial. The focus of CBT will be to start with an event, move to the client’s thoughts during the event, their feelings of the event and the behaviors as a result of the event. By understanding the client's "narrative" of a situation, you can help them rebuild their story and their normal pattern of self-talk. 

    2. Visualization techniques

    Visualization techniques are when the client uses their imagination to create a mental picture that will motivate a change on one end and increase emotional confidence on the other. Creative visualization techniques allow the client to rehearse a scenario in the way that they would want it to unfold in their lives. These Positive visualizations give the client the motivation and life goals that they want to attract in their lives. Visualization exercises act as a tool to reduce stress. Visualization techniques can show up in a number of ways:

    -Vision Boards

    -Envision yourself for achieving a goal.

    -Positive self-talk

    -Rehearsal/Role play

    3. Body Awareness & Mindfulness

    It is important for clients to be aware of their bodies and how it reacts to certain triggers, situations or sensations. With mindfulness, it’s also important that clients are paying attention to their thoughts and feelings without judgment or belief. The thoughts are just that- thoughts and they shouldn’t dictate in this moment how they client thinks or feels about themselves or where they are. The main mindfulness tool that I plan to use is:

    Guided Therapy/Imagery technique

    The clinician will give a verbal prompt to the client. The prompt will direct the client to focus on imagery using their senses to build the image. For instance, the clinician may ask the client to envision a peaceful place including the aroma, the sounds and other small sensory details. The guided imagery will help to impact the client’s body and mind causing the breathing to slow and become more controlled. This should create a sense of calm and relaxation for the client.