Therapeutic Window of Tolerance

In this excellent example, borrowed from Ogden, Minton and Pain we can see what happens when our nervous system becomes activated in either hypo or hyperarousal.

As Pat Ogden describes, we need to understand the therapeutic window of tolerance so that we can better understand what is happening to us when we are experiencing distress. As we become more familiar with our nervous system and understanding when we are ON or OFF, we can also make better decisions about pacing ourselves with trauma therapy as well. Sometimes in trauma therapy, our nervous system can get triggered and we either experience hyperarousal, hypo arousal or both at the same time.

It is not unusual for people who have suffered complex trauma, such as childhood abuse to be incorrectly diagnosed with bipolar.  Sometimes this ON and OFF looks similar to the up and down of bipolar.

For survivors of complex trauma, triggers in the present can remind one of the past, thus activating our nervous system to believe that it is under attack which then moves one into either hyper or hypo arousal. Ultimately treatment involves knowing when we are activated and then using grounding skills to help us return to an optimal level of tolerance.

Certain coping or regulating behaviours become understandable if we do not know how to deactivate our nervous system.   Ask yourself, when I am in hypo-arousal,  what behaviours that are not good for me, so I find myself doing? Am I abusing lots of caffeine or stimulants? When I am in hyperarousal or ON, am I abusing alcohol, or other depressants to help calm me down? Am I using food to help calm me?  We may also be driven by addictive behaviours when our nervous system is in hypo or hyperarousal.  Gambling, sex, and shopping are other examples.

For those person suffering or stuck in hypo-arousal, there may be a need to ACCESS feelings in which case substance abuse, extreme sports, taking dangerous risks helps us to turn ON or feel alive.  Persons in hypo arousal often speak to the phenomena of being numb, flat, with no access to feelings or feeling shut off.

For more information on this, please read Sensorimotor Psychotherapy. Interventions for Trauma and Attachment by Pat Ogden and Janna Fisher.