The Goldilocks problem in trauma therapy
introduction
The "Window of Tolerance" is a concept used often in trauma therapy, coined by Dan Siegel, that describes an optimal zone of arousal to function at our best and manage emotions well. This is very important to keep in mind during therapy, and is something that trauma-informed providers are assessing frequently.
We all have a Window of Tolerance. Remember, anxiety is a common phenomenon, and stress is not uniformly bad. We can not only operate okay under low to moderate levels of anxiety, we can often excel there. It may take something extreme to push you outside of your window and really affect your functioning. However, when you've been through something traumatic, this window tends to get much narrower. As a result, your body more easily slides into the margins by quickly ramping up or shutting down in response to anxiety.
Outside of this window we find two broad categories. One is hypoarousal, where you may feel detached, shutdown, numb, slow, or limp (low muscle tone). Home of the "freeze" reaction. We can't do therapy when you are not in the room. If you seem suddenly very distant, confused, or foggy, we do not plow ahead with whatever we were talking about. We try and get you back into the room first.
Above this window is hyperarousal, where you enter the "fight or flight" reaction. You might be breathing fast, heart racing, sweaty, with your thoughts racing 100mph. We also can't do good therapy here, you're overwhelmed and distracted.
Both hypoarousal and hyperarousal are physiological responses ingrained in all of us, for good reasons, and can kick in without our conscious intention. For example, this is good if your body needs to increase blood flow and oxygenation to mobilize itself to run from a threat immediately, without being bogged down by pesky executive functioning and analytical reasoning.
Parts of your brain are responsible for constant threat assessment like a smoke alarm (called the amygdala). Trauma makes the alarm much more sensitive and makes the ear-piercing beep harder to turn off, especially for stimuli that were associated with the trauma. This alarm tells your nervous system "go go go!" over something relatively harmless, e.g. walking into a busy grocery store. Some people with PTSD have been shown to have and enlarged amygdala because it fires so often. It all happens before anything hits your conscious awareness because, evolutionarily, it has to be faster than you can think. Predators have been around much, much longer than calculus problems, so these systems are embedded deeply in our brain development.
what does this mean for trauma therapy?
This means we both have to pay attention to your anxiety level, moment by moment, so that we can keep within your Window of Tolerance where you can be your most effective self. If you are a little anxious and fidgety, that means that we are touching on something important but you aren't overwhelmed. This is the zone where you can experience a difficult emotion or talk about a big issue and we can work together toward your goals.
It means that we can learn grounding and then put it into practice.
It also means that I will be totally understanding if your emotions fluctuate widely and the pace feels slow. This is normal. "Slower is faster". You're actually doing great.
How can you tell if I'm in hypo/hyperarousal ?
It's not always obvious. I ask. I check in frequently and recognize that only you can really tell how you're feeling. However, it's likely that you are not fully aware of how you respond to your anxiety in the moment. Maybe there's a small welling of anxiety in your chest and then you sigh, clench your jaw, bounce your leg, or nervously laugh: you know you do it generally, but you don't catch it in the moment. Most of us do not, it's largely unconscious. A good therapist is careful to notice these things, either highlight them or file them away, and then adjust in order to avoid steamrolling over you.
how do i even get started?
Wherever you are is fine and good to start. With trauma we usually start talking about the idea of talking about it, whatever it is. From there you're in the driver's seat, and I'll bring a few suggestions. If you have any kind of question, I'd recommend you schedule a free consultation or reach out to me at justin@wittpsychotherapy.com or 210-660-8080.
Learn more about the trauma therapy that I offer in San Antonio, Texas