July 31, 2025 • 42 mins
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Speaker 1 (00:10):
Okay, how's that?
Speaker 2 (00:13):
Looks great, Pega.
Speaker 1 (00:15):
All right.
Speaker 2 (00:16):
All right.
Thanks for joining us everybody.
Pega and I have been presentingtogether for a few years, off
and on now, and we love to tagteam things.
My name is Angie Heath.
I'm an LCSW.
Both of us are actually in EMDRand have an approved
(00:37):
consultants in EMDR.
I actively run virtual EMDRconsultation groups for several
years now, including some newbiegroups, those that have just
(01:00):
finished basic training, thoseintermediate levels and also
those for seasoned and certified.
Pega is also in the Atlanta area, mainly works with adults.
She loves working withclinicians who are interested in
exploring the self of thetherapist as it relates to their
work with clients.
(01:21):
She has two groups running, onewith the focus on the self of
this therapist and one thathighlights case
conceptualization andinterventions with the self of
the therapist lens, and both ofthese groups can count towards
group supervision hours for yourMDREA.
So Pega and I have teamed upever since we were part of Dini
(01:46):
Laliotis' Center for Excellencein EMDR Therapy and we have been
giving presentations andconsultation together on
trauma-related topics.
Our topic today is window oftolerance.
um, you can go into the next one, pega get good at this,
(02:11):
probably towards the end sotoday our goal is to give you a
nice review of the window oftolerance, how our nervous
system talks to us, strategiesfor people that have a small
window of tolerance and cluesfor clients in which zone that
they're in.
So the window of tolerance wasdeveloped by Dan Siegel.
(02:36):
He was the first one toreference the window of
tolerance.
Now you guys, everyone knowshas heard about it.
It starts with the, the optimalzone.
I'll start describing theoptimal zone first.
Um it, that's supposed to beour best state of arousal, in
(02:56):
which we're able to function andthrive in daily life.
Our capacity to learn andengage with others and ourselves
is at its best when we operatefrom this, that zone, that
window, the optimal zone ofarousal, or also it might be
called the range of resilience,is eventual vagal or social
(03:22):
engagement response.
That's the just the right zone,and and good vagal health is
associated with digest,digestion, sleep, engagement,
being able to think clearly,learn, be creative and also even
(03:48):
helps with our immune system.
So I'll go into the other zones.
In just a second you can go tothe next one.
Yeah, we all know that thewindow of tolerance is impacted
(04:11):
by trauma.
Each of us have our own uniquerange of tolerance.
Our window of tolerance is tosome degree defined by our
inborn temperament and naturallevel of physiological
reactivity.
The window of tolerance cannarrow due to factors such as
significant childhoodexperiences, neurobiological
(04:32):
factors, the types of socialrelationships and coping skills.
We always want to remember thatthe window of tolerance is not
a fixed state and is below ourconscious awareness, and we can
move up and down the autonomicladder in response to daily life
and different stressors.
(04:53):
But it is common for peoplethat have experienced pretty
significant, significant traumato alternate between the two
extremes or even can get ratherstuck on in one or the other.
And remember complex trauma istypically more developmental
(05:21):
trauma, more developmentaltrauma, some of those major
attachment figures, relationaltrauma, and it's more than just
a few situational traumaincidences Practically all of us
have had.
You know we all have had traumasomewhere in our lives.
But this is a case when peoplehave been chronically in an
(05:46):
overwhelmed state.
Our ability to regulate ourphysiological arousal is
eventually compromised and sothat's a big impact on our
window.
It takes less to be outside ofthe window with high reactivity
and we're more easilydysregulated.
So we want our patients or ourclients to continue to work with
(06:12):
us and see that their window oftolerance widens, and we try to
help them to learn skills andmanage emotional overwhelm,
their anger or their panic, andreduce the likelihood of
dissociation and disconnection.
(06:33):
So with chronic or severetrauma, we can have a narrowing
of the window of tolerance, canhave a narrowing of the window
of tolerance.
Triggers can lead to becomingdysregulated and landing outside
of the window of tolerance on aregular basis.
Trauma survivors can learn toturn away meaning like they're
(07:03):
going down into hypo and tuneout their autonomic defenses in
order to function.
The problem is that the turningaway which we all unconsciously
do when we get stuck inoverwhelm is a strategy that
(07:23):
expands over time.
That turning away expands overtime and so we get used to that
response more and more and itbecomes habituated.
And then there's a strongphobia of feeling and and
probably all of you clinicianshave experienced that, when
somebody really just can't umname feelings, can't feel
(07:45):
feelings, that's pretty blockedfrom them.
So the chronic narrowingresults in the window becoming
stuck and not able to moveflexibly.
Okay, thank you.
Hyperarousal results from thefight or flight response and is
(08:06):
characterized by excessiveactivation and energy.
This state is mediated by thesympathetic nervous system which
is preparing the body and themind to run away or to fight off
threat.
Internally, a person feelsenergized, with racing thoughts,
(08:27):
feeling very alert.
Externally, a person can beperceived as having difficulty
concentrating, irritability,anger and angry outbursts, panic
, having real high anxiety,easily scared or startled,
(08:48):
trembling and someself-destructive behavior.
We also want to mention thattonic immobility or frozenness
is actually part of this hyperaroused state.
It may not seem like it shouldbe the tonic immobility and that
frozenness, but it actually is.
(09:12):
An individual can seem tense,rigid in appearance, their fists
clenched, jaws clenched, frozen, frozen gaze and that tonic
immobility.
The next stage is the hypo,hypoarousal.
(09:32):
It occurs when the body is nolonger able to tolerate the
overwhelm of a hyperarousedstate.
So we go from hyperaroused,that superactivation, into hypo
and it moves into shutting downor dissociation.
This state is characterized bytoo little activation, with the
(09:54):
dorsal vagal immobilizationresponse, and it brings in that
feel, it um, that survival, andthat makes sense to us when you
think about it, that if yourfight or flight is not possible,
(10:16):
then collapsing and numbing andpassivity may be the most
effective survival strategyafforded to somebody.
And when we think aboutsomebody that has been
chronically abused.
As a child they were trapped,they were stuck, they didn't
(10:36):
have the strength, and so that'swhen some of those experiences
can lead to people having moredissociative or disconnection.
Internally, with thehypoarousal, the individual
feels exhausted, depressed, numb, foggy and disconnected.
(11:01):
Externally, they may haveshallow breathing or holding
their breath.
They may be kind of glassy-eyedor unfocused in their stare,
slumped posture, speaking slowlyor monotone, or just lacking
the ability to respond verballyor movement.
(11:25):
I call it kind of being prettytrancy.
They can get in a trancy mode,good.
So we also want to make sure toemphasize about how to widen
the window, and Peg is going tobe going into a lot of
(11:50):
techniques and strategies forthat, but overall we want to
widen the window, which it'skind of like trying to have
trying to stretch a rubber band,and we want to keep on doing it
over and over, to keep onhaving that rubber band or that
(12:11):
window get wider and wider.
Healing involves developing thecapacity to stay within the
window of tolerance.
We are cultivating mindfulnessof the different fluctuations in
our sensations and thoughts andemotions.
So we're asking people to trackthings like where do you think
(12:32):
you're in right now?
We're just trying to ask themto check in.
Where do you think you are atin that window right now.
You start to increase theawareness of the subtle signs of
dysregulation and help them andshow them they can engage in
self-care resources before theyget into some of the overwhelmed
(12:56):
or shut down.
I always like it with some of myclients when, um, when they're
just able to track things andthey're starting to recognize
that they're moving to some ofthe edges or moving outside,
that if they'll say you know,angie, I just I need to look
around the room right now, or Ijust need to name some objects,
(13:18):
or can we just toss, you know,the kush ball, um that I usually
have readily available in myoffice.
So learning what your window oftolerance feels like and how to
maintain staying within thatspace can help promote healing
from past traumatic experiencesso that people can safely have
(13:42):
emotions.
Now they can feel safe enoughto feel those emotions, they can
tolerate those emotions.
So we do that by helping themexperience going back to ventral
, going back to that optimalzone over and over.
Our window of tolerance ismalleable.
(14:04):
There are many ways to practicewidening it, but the first step
is to become aware of it.
So when you're in your window oftolerance, you're able to be in
a state of mindfulness andpresent, you're able to learn,
work, play and connect withourselves and those around us.
(14:26):
So we want people to connect,so we can learn.
We can help clients learn toturn towards our autonomic
defenses, our memories and ournegative relational experiences,
but this time without overwhelmand going back to ventral.
(14:48):
Vagal, like I said over andover, builds those pathways and
helps shift an overactiveautonomic nervous system.
So, just as a review here we'vegot the hyper arousal.
So, just as a review, here we'vegot the hyper arousal that's
when we have reduced rationalthinking, impulsivity, maybe
(15:12):
some poor behavior control, andthen that fight mode, easily
distressed, racing thoughts,restlessness we might see where
it feels like people are in thatpanic mode, the optimal zone
where we are able to thinkclearly, we're connected to our
(15:34):
body and our emotions, we'refully present, we're able to
think and feel at the same time.
And the hypo arousal that'swhen we're seeing more of the
low, the low affect, depressed,lethargic, numb, shut down,
(15:54):
having more absence.
I'm just, I just can't think.
I can't think or I can't focus.
Yeah, you're doing the nextpiece, pega.
Speaker 1 (16:20):
Yes, I am, thank you.
Thank you, thanks, angie.
All right, so thank you, angie.
So hopefully some of this stuffmay be familiar to some folks.
We wanted to make sure to gointo enough detail, in case this
is brand new to you, to get asense of where the window of
(16:42):
tolerance comes from and whyit's important to really get a
sense of where people are,because they'll end up in your
office, you'll see this in themand it's really helpful, like we
said, to be able to understandit, put words to it, describe it
to clients.
This is it.
Put words to it, describe it toclients.
This is the beginnings ofworking with it.
Practically Some of the stuffthat I'm going to say have been
(17:06):
Angie's.
Already said them, but it'sworth repeating.
So why is it important inpsychotherapy to have a client
manage their window of tolerance?
So typically, especially ifyou're working with folks who
have a trauma history, like wesaid, their window of tolerance
can be very narrow and it canbecome stuck where people have
(17:27):
learned to adapt, to go fromhyperarousal to hypo, and then
that just becomes their newnormal, unfortunately, and they
can become pretty dysregulatedquickly.
They're unable to focus intreatment and more likely to
avoid therapy.
So that's one reason whysomeone might suddenly start to
(17:49):
miss sessions or, to quote,forget.
It may be that you might haveto have a conversation with them
about what is it like to be inthe room with me, and so we'll
kind of bring that back up again.
And so, as a therapist, yourtendency might be to and we've
all done this right.
So considering a client couldbe considered resistant, or
(18:14):
they're just not listening, oryou have these great things you
want to offer them, but they'renot available for it.
Keep in mind that one of thereasons why we would want to
help people widen their windowof tolerance is that they can
actually stay present with youin the therapy room so that they
can absorb the things thatyou're telling them.
(18:34):
Sometimes clients may feel likethey're not doing things doing
therapy right.
They're not getting it.
Again, it's not so much thatthey aren't, it's that their
nervous system hasn't reallybeen addressed um and really
focused on in this way for themto feel like they're able to
absorb the material in a new andmore effective way.
(18:56):
So in the trauma world, whichis where Angie and I do our work
, again, the very narrow windowof tolerance translates to being
ungrounded, which means thatpatients are not going to have
the capacity to processdifficult memories.
This is why we work on it inour space, because we're
(19:20):
processing memories with peopleutilizing EMDR, and anyone who
jumps into EMDR withoutassessing for the window of
tolerance first, they're goingto likely not see success.
Client is going to start tofeel like I'm doing something
wrong, I'm not getting therapyright, and it really doesn't
help with the rapport in theroom.
(19:42):
So, all in all, this isfoundational.
So a couple of things to keep inmind.
You want to be able to practicethe tools we're going to give
you while you are in the optimalzone.
So I say we're using the wordyou a lot because we as
clinicians, we have to be ableto know where we are in our own
(20:03):
window of tolerance.
We may become overwhelmed, wemay become dissociated.
So anything that we talk abouttoday, I would highly recommend
trying it out on yourself first,if you haven't already.
But so the exposure really isfor you to start first.
And we do talk a lot about,especially with the self of the
(20:24):
therapist piece where are you inyour window?
Sometimes you're mirroring yourclients and sometimes you
yourself can become triggered byyour clients and go outside of
your window.
So keeping that in mind,triggered by your clients, and
go outside of your window.
So keeping that in mind, ofnote, the therapist and therapy
itself may become associatedwith danger, like I said, due to
(20:45):
the content of the therapy.
So if my client says, well, Idon't want to come to you
because every time I come to youwe talk about difficult things,
right?
So then I can't tell you howmany times some of my clients
say just driving here I startedto feel my heart racing, right?
So helping them to manage theirwindow and get back into their
window even before they comeinto the room is important.
(21:05):
They may become nervous comingto therapy and suddenly
experiencing a shutdown.
If you remember, this is why wesort of showed you that graph
twice, that red sort of movementthat you saw.
The line, the squiggly line, isthe experience of the client,
so how they can go outside thewindow and become hyper and then
(21:27):
hypo.
One of the folks that taught mea lot about the window of
tolerance is an approvedconsultant, craig Penner.
He talks about the mostpowerful work that you can do is
really at the edges of thewindow of tolerance, where there
is both activation andresilience.
(21:49):
So the client is about to leavetheir window and they can
tolerate presence enough to beable to recognize oh, this is
what's happening to me.
So those are the moments whereyou want to really catch them
with clients.
So keep that in mind, that it'sreally at the edges of the
window that you might be doingyour best work, because the
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client will get it.
Oh, this is what happens to mewhen I become overwhelmed, and
then I'm overwhelmed and I can'tthink straight, my heart races,
and then I go into shutdown andnow I can't remember anything.
So let's kind of keep going.
So that's why you do it.
So this is worth repeating nomatter how helpful you think
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you're being, if the patient isnot grounded or inside of their
window of tolerance, the patientwill be unable to retain any
information or integrate any newinsights from processing.
So keep that in mind whenyou're doing the thing, like the
kush ball, asking them to lookaround, ground themselves,
notice what's going on in theirbody, you really are doing good
(22:56):
clinical work, so don't try toskip over that.
That is the work.
All right, I am having a hardtime with this, but I'm getting
there, okay.
So, sensitive, okay.
So from this point on, what wereally want to do is just give
you something you can take homewith you.
You can, you know, print outthese purple pages, have them
(23:22):
around just as a reminder ofthings you can utilize in the
room with the client.
Ground immediately, and oftenso when you start to notice that
the person is becoming hyperand leaving their window or hypo
and leaving their window pause.
Check in with them, utilizeyour voice.
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Your voice can be reallyhelpful in helping them to
ground, to remember where theyare, who you are and even the
words you're safe now.
I use it often when I'm doingreprocessing with clients.
If they're in the past and youknow, in EMDR we talk about
having one foot in the present.
That's what this is.
Having one foot in the present,even when you're reprocessing
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the past, so you're safe now isan actual fact.
Use that to help them ground soand orienting to the present
moment, teaching them to do thesame, focusing on the here and
now.
What year is it, what month isit?
What day is it?
So you might have beenpracticing that all the way at
(24:29):
the beginning of your training,and here it is again, so kind of
the mini mental status, butright there in the room, so kind
of the mini mental status, butright there in the room, asking
them, not being afraid to sayhow old are you, where are you?
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The more you do, the more theywill internalize your voice and
they'll start to ask themselvesthat very same question.
Anchoring people.
So the one is to orient them tothe present and then anchor
them to the present.
Orient them is where are you?
I'm here, I'm here with you,I'm here now.
Anchoring them is reallyhelping them really get a sense
of their entire body is here inthis present moment.
That's why we use that 5, 4, 3,2, 1, using the five senses.
(25:12):
If you've never done it before,maybe take a moment and try it
now.
So it's a great way to remember.
Uh, to help a person ground anduse a using this nice little
infographic on the right side.
Here you can see um kind of goaround in a circle what do you
(25:33):
see?
What do you smell?
What do you taste?
What do you touch?
What do you hear?
Usually the five.
What do you taste?
What do you touch?
What do you hear?
Usually the five, four, three,two, one.
It's easier to say what do yousee, five things typically stick
to things like shapes andcolors.
So give me five colors, fiveshapes in the room, just
whatever they notice, tell themnot to think too hard and just
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go with it.
And then maybe four things theyhear, hang on one second Pega
yes, yes, Can everybody see theslides?
Speaker 5 (26:04):
or did they go away?
Oh no, I can see them.
Speaker 3 (26:10):
I can see them.
Speaker 4 (26:11):
I can see them yeah.
Speaker 5 (26:13):
Yeah, there's two tabs at the top, so one says
meeting and one says Pegasscreen.
Make sure you're on the onethat says Pegas screen.
Speaker 4 (26:20):
Okay.
Speaker 5 (26:24):
Hopefully that helps.
Speaker 1 (26:25):
Sorry to interrupt, oh, no problem, I'm glad you
caught it.
Okay, so great, let's ground.
So notice five things.
You see, just name colors foryourself in this moment.
Bring yourself back into thispresent moment, listening to my
voice.
Maybe notice four things youmight hear.
Maybe not if the room is quiet,but there might be some distant
(26:49):
sounds, traffic, the clock,someone's breathing, my voice.
Maybe three things you cantouch.
Sometimes I'll just say touchyour shirt, feel your shirt,
notice what you're sensing,notice the texture of your pants
.
I like this this is what mymentor would say kind of go
(27:12):
vertically first and then gohorizontally and notice what you
sense.
So really bring that into theroom.
And then two things you smell.
You'll hear me say this againand again, but I've got
essential oils in every roomoffice that I have every room.
I hand it over to them, I havethem.
Smell it, but even the smellthe back of your hand.
(27:35):
Then maybe smell your shirt,notice the difference, really
getting into those subtleties.
And then one thing you taste.
Maybe they just say coffee, ifit's the morning, or have a
piece of gum, have some sourcandy, have it available so they
can really ground and get intothe moment candy, have it
(27:58):
available so they can reallyground and get into the moment.
This I really appreciated frommy research really using your
own hand to rub out your joints,so noticing the sensation, it
kind of feels nice anyway, butit really helps with
proprioceptive awareness.
So what's around me and how amI engaging with my environment?
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Where are my hands right now?
Where's my body?
What's the positioning of mybody and the joints?
Rubbing out your joints helpsyou to get real clear with
what's in this present moment.
Okay, let me not.
There we go.
All right, here we go.
So then we kind of wanted toseparate it out a little bit
hyper versus hypo arousalthere's my cute little
(28:43):
infographic on essential oilsand always, always, always
breathe.
So those are the two things toremember.
You know, kind of the sense ofsmell, bringing that into the
room and the breath, bringingthat into the room and the
breath, but using yourself tohelp a person ground, trying to
(29:04):
make eye contact with the client.
I know eye contact, especiallywhen a person is overwhelmed,
can feel overwhelming to theclient.
Sometimes folks can experiencethat as a little bit aggressive,
especially if they're havingtrauma memories.
So be you know, be gentle withthem and get to know your
clients.
But if they can make eyecontact it's helpful because
they can really remember wheream I right now, who am I,
(29:26):
especially if they associate youwith kindness, gentleness, your
voice, if it tends to be gentle, it can really help them ground
using strong sensations.
So holding a piece of ice, ifyou know about you know doing
some work in with marcialenehan's dbt.
She's got a lot of this stuff.
(29:47):
There's a lot of overlap herewith grounding ice cube if
that's not available again, likeI said, maybe a mint, something
sour smelling an essential oilpeppint, eucalyptus, lemon.
A couple of my clients feelvery overwhelmed with sensations
and say, okay, that's toooverwhelming to my system and
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others absolutely love it.
So you really just get to knowthem, helping them to take some
deep, slower breaths, deeper,filling all the way into their
lungs, holding for a moment,really feeling the expansion in
their rib cage and their abdomenand then slow breath out,
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trying to see if you can makethe exhale longer than the
inhale.
I love this strategy that Ilearned from Ariel Schwartz.
She kind of has given me a lotto work with.
So I you know I have her in thereferences section but pressing
your two feet into the ground.
If you happen to be able to dothat now notice pushing your two
(30:51):
feet into the ground or againsta wall and really engaging your
muscles.
Ground or against a wall andreally engaging your muscles, so
that's really helpful too.
Again, with proprioception,noticing yourself in time and
space, and then pairing thatwith an exhale.
So exhaling while you push intothe ground can be helpful With
(31:13):
tonic immobility that Angiebrought up.
When they feel really frozen orstuck, they have control and
that they have the capacity towork with their nervous system.
Another thing I really enjoy isencouraging to them to just
(31:47):
shake, shake and release,release what's been held in
their nervous system for a verylong time.
Again, it reminds them I'mpresent, I'm here, I'm safe now
and I have control, I have thecapacity to do something
different.
So there's that.
Let's see.
Oh, come on, all right, here wego.
(32:12):
I have to be really gentle.
Here we go, like with clients,um, otherwise the system gets
overwhelmed.
So hypo arousal.
So when hypo arousal kicks in,this is a time where you really
want them to get grounded intothe room, that you can ask them
to move their muscles again,stretch, stand up, walk around.
(32:33):
Slowly and gently, they mightfeel a little dizzy because
they've been in hypo.
They might feel like eveneverything feels blurry.
So you might want to really askthem to be gentle, ask them to
look around the room stretch,and one of the things I really
like is having them notice theedge of a picture frame and ask
(32:58):
them, especially if you're, youknow, virtual, just sort of say,
notice the edges of yourcomputer or laptop, whatever
they're looking at you on, is itblurry?
And if it is blurry, see if youcan focus in until it's no
longer blurry, until it becomescrystal clear Again,
internalizing some of the powerand the capacity that they have.
(33:21):
A couple of things that Iwanted to mention about the
hyper or the hypo is helpingthem and we'll talk a little bit
about this actually to createwhatever you create with them in
their room.
Make a list of it with them sothat they have that to take with
(33:42):
them outside of the room anduse that Kind of like I said use
these purple sheets foryourself, create something with
them some of the room and usethat Kind of like I said use
these purple sheets for yourself, create something with them,
some of the things they reallylike or the things that they go
to.
I'll say to my client all right, we know what smells feel good
to you.
Go to the store, go to theWhole Foods, go to the CVS there
(34:04):
are essential oils everywherethese days.
Grab a bottle for yourself, putit in your bag.
If you know that certaintextures feel good, go out and
grab that and put it in your bag.
Have it available to you.
All right, here we go, and okayso here's the outside of
sessions, some things to.
(34:28):
In addition to maybe creating alittle go-to bag or box where
they can put in the things, thetextures that feel good, the
smells that feel good, thetastes, like having gum or candy
available, we wanted to offerexcuse me, excuse me a couple of
(34:54):
what's now being termed it'skind of a cool word vagal toning
comes up in polyvagal theoryAgain.
Ariel Schwartz, one of myfavorites, who talks about this.
She uses this a lot, theconcept of vagal toning and the
reason I like it is becausepeople tend to say, all right, I
got to go to the gym and, youknow, lift my weights or go for
a jog or, you know, maintain myhealth.
(35:16):
Well, vagal toning is a way forthem to maintain their vagus
nerve, maintain their optimalzone of arousal, so you can kind
of bring it into their dailyself-care.
And I'm just going to see if Ican show you a video or, let's
see, I'm going to show you.
(35:38):
If you don't know what thebutterfly hug is, I'm just going
to ask you to go ahead toYouTube and look it up.
Here you see this image we haveon the side, where this image
is holding, if you can see me,is this really squeezing the
arms and tapping.
This is the version of thebutterfly hug that I've found
(35:59):
online.
But to be true to our EMDRworld, where the butterfly hug
comes from, we also like to sayput your two fingers, two hands.
Actually, this talk aboutproprioception.
It's very hard to do handsfacing your face If you're, if
you're able to do it now, andthen hook your thumbs.
So that takes a lot of mentalenergy to figure out how to
(36:24):
bring your hands in your face,hook your thumbs and then bring
them right underneath yourcollarbone and then tap left
right.
It's quite a soothingexperience for people.
We use it for soothing, we useit for resourcing, strengthening
, but it has a real soothingeffect.
So if we do have time, I'llshow you the silencing the alarm
(36:50):
.
If we don't, because I knowwe're kind of short on time
today silencing the alarm isanother one that comes from
Robin Shapiro.
She has done massive work forour field, for the field of EMDR
, for ego state therapy, andI'll show it to you.
But again, you can go onlineand find it.
(37:11):
Basically, you're going to againtalk about proprioception.
You're going to take your lefthand, bring it to your right
eyebrow and then you're going totake your right hand and bring
it to your left eyebrow and thenyou're going to slowly trace
through the back of your ear,very, very slowly, as you
(37:33):
breathe down your neck, keepbreathing in and out through
your shoulder, right downtowards your elbow and out
through your hands.
And then one other personcalled it or like releasing the
yuck or removing the yuck.
So I really like that whenyou're feeling overwhelmed,
(37:55):
you're feeling thoseoverwhelming feelings, taking
that and doing that about 10times, actually really slowly
breathing and helping the personmove the yuck out of their
system.
So more vagal toning exercisesare listed here.
You can do some twisting andmoving and utilizing your five
(38:20):
senses.
One of the things about EMDRthat's in the title is eye
movement.
In the title is eye movement.
So in when it comes to vagaltoning, you really want to ask
the person to move their eyesfrom the white end of the left
side of like the kind of thewhite end of their eye I forget
what that's called, not thepupil but the other stuff all
(38:44):
the way to the other white oftheir eye.
So noticing that the white comeout of my eyeballs kind of
strange, but yeah, so all theway to the left and all the way
to the right, and then you alsoadd on gentle twists to the left
and right.
And here this last one is lyingdown with your hands interlaced
(39:06):
on your back and then againmoving your eyes from left to
right, slowly, noticing yawning.
One thing that was sointeresting about this one is
that you're actually resettingyour vagal, your nervous system,
your vagus nerve, drinking asip of water, noticing it,
(39:28):
hydrating yourself, so reallyhelping them to connect with
their body.
And let's see where are we.
Here we go, signs that a clientis grounded.
They're back in their window,their breathing is smooth and
regulated.
They may start to make eyecontact with you more readily,
(39:48):
if they typically do.
They're engaging inconversations more and they're
able to say that they aregrounded.
So don't be afraid to ask themfrom zero to 100, how grounded
do you feel in this moment?
Typically they can tell.
Sometimes they'll say, oh, Idon't know what the right answer
is, and of course there is noright or wrong, it's just their
(40:09):
subjective experience.
But you can compare.
If they're at a 50 or a 60, tryto implement some of these
tools and typically they canmove up 70, 80, 85.
That's a pretty good difference.
And so here's the referencepage and just a little bit about
Angie and me, in case you allwant to get in touch with us.
(40:30):
If you're.
You know I think we can talkEMDR all day and talk trauma all
day, so we've got a lot ofresources for you and just
wanted to say thank you forspending the evening with us and
we've enjoyed speaking with youabout this really important and
really exciting topic.
I'm not sure if there is timefor questions but we still have
(40:54):
a few minutes.
Speaker 5 (40:57):
Are y'all good with me dropping the link to the PDF,
to the slides in the chat forparticipants?
Okay, awesome For those who ask.
Speaker 1 (41:04):
I'll do that right now and I'll stop share.
Does that feel okay?
Speaker 5 (41:10):
Perfect.
Speaker 1 (41:11):
All right.
Speaker 3 (41:19):
All right.
Did anybody have any questions?
Speaker 5 (41:21):
What was the video that you referenced?
The butterfly hug, oh yeah.
Speaker 1 (41:26):
Yeah, yeah, yeah.
I mean, if we do have time Ican show it to you.
You want me to?
Speaker 5 (41:31):
do that.
Speaker 1 (41:31):
Yes, absolutely yeah go ahead.
All right, one second, okay,this is fun.
Back to technology.
One sec, let me just not.
Okay, how did I Actually?
(41:54):
I can just find it so.
So the one of the videos.
Well, I'm looking for thisthing.
Um, one of the videos is on thebutterfly hug.
Here we go, I found it.
And the other one is onsilencing the alarm.
So I think the butterfly hugmight happen to be shorter.
So I'll just go to that pagereal quick.
Here we go.
Speaker 5 (42:19):
While she's pulling it up.
If you missed any portion ofthe presentation, it will be
available to Step it Up.
Members, we did record it.
Speaker 1 (42:31):
Go ahead.
I'm sorry.
Speaker 5 (42:34):
No, you're good, you can play the video.
Speaker 1 (42:36):
Okay, I was going to say this Erica Bonham has really
great resources on vagal toningso I would highly recommend her
and actually some of hermaterial under vagal toning that
comes from some of the stuffshe's written, so I just wanted
to credit her and actually letme see here if I can do this and
(43:03):
that.
Speaker 2 (43:07):
No sound here, Pega.
Speaker 1 (43:11):
What did you say, Angie?
Speaker 2 (43:12):
No sound.
Speaker 1 (43:14):
Oh no, I don't know how to do that piece.
Speaker 5 (43:18):
I may have to do it for you just because, oh gosh,
I'm sorry, it's not a problem,because I have mine set up so
that sound will play.
Speaker 1 (43:27):
Okay, you want to go ahead and do it?
Yes.
Speaker 5 (43:31):
It's Erica.
Speaker 1 (43:33):
B-O-N, yeah, erica B-O-N-H-A-M and butterfly hug
and I'll stop.
Share if you want, I found it.
Speaker 3 (43:45):
People are dumping their $500 pressure washers for
this $50 tool.
Is that me?
Speaker 5 (43:50):
No, it's me.
Speaker 3 (43:51):
It's an ad playing.
Speaker 5 (43:52):
I'm trying to let it go so I can pause it.
It's about a sprayer.
Okay, now I'll screen share.
Speaker 3 (44:05):
And if you're familiar with Ian, so one of my
favorite resources for resettingthe nervous system is just
called the butterfly hug.
And if you're familiar withEMDR therapy eye movement,
desensitization and reprocessingtherapy this is a very common
resource that we teach in EMDRand it's just crossing your arms
(44:28):
over.
You can sometimes add somecompression If that feels good.
You can do your butterfly huglike this, or you can just tap,
or sometimes people like justtapping on either side of their
heart, right, left with theirfingers.
So you, you get to decide whatfeels the best for you.
So I like my shoulders and it'sjust tapping to.
(44:50):
You know, your, your, I'm goingto try to mirror you right,
left, right, left.
You can add rocking if thatfeels good, or you can add eye
movements if that doesn't causetoo much dizziness or activation
.
So when you're using this as acalming resource, you want it to
(45:15):
feel good.
You want it to feel soothing,not too activating.
So if you're getting activated,if it's bringing up stuff, put
this away and do a differentresource, okay.
So just taking a deep breath,just three or four taps on each
(45:37):
side, and that can be a reallygreat way of resetting your
nervous system.
Speaker 5 (45:49):
Awesome, and I'm going to drop that link to that
video in the chat too.
Speaker 1 (45:53):
I was going to say, if you want to also add the
other one, what was the otherone?
The silencing, the alarm.
That's right under um.
I can actually let me see here.
I can add it, if you'd like, tothe chat.
Okay, at least you'll have itOkay.
Speaker 2 (46:14):
Okay, that's the one with calm with Kyle.
Yeah, he's got a lot of greatYouTube videos about resetting
the vagus nerve and stuff andcalming with panic and all kinds
of stuff did anybody haveanother question, or do y'all
(46:36):
want me to go ahead and playthat video?
Speaker 4 (46:39):
I had a question, um, I'm I am new to uh emdr and so
one of you guys mentioned thecush ball.
Can you guys go into moredeeper into that and like what
that is and the technique for itand why?
Speaker 2 (46:55):
Yeah, um sorry, I have it right here.
This is my little cush ball, um,but I keep those things handy
on my on my tables in my office.
Sometimes in EMDR I'm using itas as the bilateral but playing
(47:19):
catch with anything.
It doesn't have to be a pushball with a pillow, with a
Kleenex.
Sometimes Kleenex is real goodbecause when you crumple it up
it doesn't keep its form and soit kind of keeps you on the ball
a little bit.
Or tossing a pencil back andforth, just anything that's soft
(47:41):
can be tossed back and forthand it's just another way of
grounding to be able to kind ofbe able to get access,
especially if somebody is kindof moving to the edges or moving
out of their optimum zone.
So it's just another way ofit's probably one of the
(48:02):
quickest way I've found of beingable to get people back present
quickly.
Speaker 4 (48:10):
Thank you for that.
I appreciate it Go ahead Debbie.
Hi, thanks and thanks to allyou guys.
This is awesome.
What about some more subtlesigns, like they appear to be,
you know, I'm thinking like arestless foot, like kind of
(48:33):
tapping their leg, fidgeting,you know kind of that fidgeting,
and just some of those moresubtle sounds, signs of checking
out or being overwhelmed.
What are some of those signs tolook that, to look out for,
that are maybe a little bit moresubtle?
Speaker 1 (48:52):
Well, what I appreciate is that you're
actually able to kind of tune inand notice that with your
client Right.
And so sometimes it's in thecollaboration between you and
your client where you can figurethat out together and to even
(49:15):
say, oh, notice, you know, ifyou're noticing them having some
kind of repetitive pattern,bring it up to them and just say
notice what.
That is what happens for you inthat moment, and then you know
again.
You become a team around this.
I think that's the mostimportant thing.
I know that a lot of timesclients can feel like they're
underneath the microscope whenthey, when you just point out,
notice your leg, notice your arm, notice your shoulder.
(49:36):
I try to, I try to be kind oflight about it and just kind of
bring some levity and lightnessso that they don't feel like
they're being interrogated.
But a lot of times it'sfascinating.
One of the things you brought upthe foot because sadly, people
(49:59):
had to manage their emotions inthe context of the complexity of
their abuse.
A lot of people tense theirfeet and they have no idea
they're doing it until you startto bring that awareness to
their body and many people say,yeah, I didn't even realize how
(50:21):
quickly my feet get tensed andguess what?
You won't notice because theyhave shoes on.
So as you start to give themthis language and really point
out like, notice your shoulders,notice your arms, eventually
they'll start to be able torealize, wow, my hips are tense.
You know, for us we may not beable to see the subtleties, but
(50:43):
it's good, debbie, that youbrought that up, because it's
really in the collaboration withyour client that that helps,
does that help Absolutely, thankyou.
Speaker 4 (50:56):
Just to add to that, sometimes I've tried to notice
and maybe I've said you know,what do you think your foot is
holding, what do you think is,and you may have a better
approach.
But a lot of times I've gottenback like, oh you know, I just
do that, you know, that's justthe thing I do like, and kind of
dismissive, like oh yeah, Iknow I tap my leg, no big deal,
(51:16):
and they're not curious about itso I don't know if you have a
suggestion on trying to helpthem get curious about that.
Speaker 2 (51:24):
I think that's just part of, you know, stretching
the window a little bit more, ofeven just asking the question,
helps them to kind of get alittle bit mindful.
And just having that awarenesscheck in with my clients on a
(51:45):
regular basis, like, how are wedoing right now?
Like, as we're discussing this,what is coming up for you?
Or you know, every once in awhile I'm going to just ask you,
you know, is my voice startingto get a little distant?
You know, how present are youin the room right now For people
(52:06):
that tend to go down, right now, for people that tend to go
down, drop down into the hypo,if they're starting to get still
, that's a huge sign they'regetting a little too still.
Then I might just have somecuriosity of, like, how is
everything going?
Can you just, can we just checkin?
(52:26):
Um, you know, I, I use the wordtrancy Are you feeling a little
trancy?
Um, am I starting to lose you?
Um, especially in these heavydiscussion points?
Um, so yeah, um and um, if I,if the racing, um, the eyes
(52:51):
start to kind of dart around orit feels like they're on the
edge of some of thathypervigilance, you know, I'll
say, you know, let's just do alittle Q&A.
Could you use a little bit ofextra grounding before we
continue on?
So we're just asking them to doa little pausing and checking
in.
How are you doing?
Speaker 4 (53:11):
Yeah, Thank you.
Speaker 2 (53:15):
Thanks a lot, thank you Great questions, you guys.
Speaker 5 (53:24):
Anybody else have any questions?
Okay, Awesome presentation.
That was fantastic.
I know Kate is veryappreciative of that.
I know everybody that attended.
That was really greatinformation because I don't
(53:45):
think, you know, not everybodydoes EMDR but a lot of people do
do trauma work, and so y'allreally did a fantastic job of
tying that in for those of uswho don't do EMDR.
But amazing.
Grab the links out of the chat.
I'll give you like another 30seconds because once they're
gone, they're gone and I hopeeverybody has a fantastic
(54:05):
Wednesday.
Speaker 4 (54:07):
Thank you.
Thank you too.
Bye, fantastic Wednesday.
Speaker 5 (54:09):
Thank you, you too Bye-bye.
Thank y'all.
Speaker 3 (54:15):
I love the hearts.
Thanks for coming.
Thanks for coming.
Okay, how's that?
Speaker 2 (00:13):
Looks great, Pega.
Speaker 1 (00:15):
All right.
Speaker 2 (00:16):
All right.
Thanks for joining us everybody.
Pega and I have been presentingtogether for a few years, off
and on now, and we love to tagteam things.
My name is Angie Heath.
I'm an LCSW.
Both of us are actually in EMDRand have an approved
(00:37):
consultants in EMDR.
I actively run virtual EMDRconsultation groups for several
years now, including some newbiegroups, those that have just
(01:00):
finished basic training, thoseintermediate levels and also
those for seasoned and certified.
Pega is also in the Atlanta area, mainly works with adults.
She loves working withclinicians who are interested in
exploring the self of thetherapist as it relates to their
work with clients.
(01:21):
She has two groups running, onewith the focus on the self of
this therapist and one thathighlights case
conceptualization andinterventions with the self of
the therapist lens, and both ofthese groups can count towards
group supervision hours for yourMDREA.
So Pega and I have teamed upever since we were part of Dini
(01:46):
Laliotis' Center for Excellencein EMDR Therapy and we have been
giving presentations andconsultation together on
trauma-related topics.
Our topic today is window oftolerance.
um, you can go into the next one, pega get good at this,
(02:11):
probably towards the end sotoday our goal is to give you a
nice review of the window oftolerance, how our nervous
system talks to us, strategiesfor people that have a small
window of tolerance and cluesfor clients in which zone that
they're in.
So the window of tolerance wasdeveloped by Dan Siegel.
(02:36):
He was the first one toreference the window of
tolerance.
Now you guys, everyone knowshas heard about it.
It starts with the, the optimalzone.
I'll start describing theoptimal zone first.
Um it, that's supposed to beour best state of arousal, in
(02:56):
which we're able to function andthrive in daily life.
Our capacity to learn andengage with others and ourselves
is at its best when we operatefrom this, that zone, that
window, the optimal zone ofarousal, or also it might be
called the range of resilience,is eventual vagal or social
(03:22):
engagement response.
That's the just the right zone,and and good vagal health is
associated with digest,digestion, sleep, engagement,
being able to think clearly,learn, be creative and also even
(03:48):
helps with our immune system.
So I'll go into the other zones.
In just a second you can go tothe next one.
Yeah, we all know that thewindow of tolerance is impacted
(04:11):
by trauma.
Each of us have our own uniquerange of tolerance.
Our window of tolerance is tosome degree defined by our
inborn temperament and naturallevel of physiological
reactivity.
The window of tolerance cannarrow due to factors such as
significant childhoodexperiences, neurobiological
(04:32):
factors, the types of socialrelationships and coping skills.
We always want to remember thatthe window of tolerance is not
a fixed state and is below ourconscious awareness, and we can
move up and down the autonomicladder in response to daily life
and different stressors.
(04:53):
But it is common for peoplethat have experienced pretty
significant, significant traumato alternate between the two
extremes or even can get ratherstuck on in one or the other.
And remember complex trauma istypically more developmental
(05:21):
trauma, more developmentaltrauma, some of those major
attachment figures, relationaltrauma, and it's more than just
a few situational traumaincidences Practically all of us
have had.
You know we all have had traumasomewhere in our lives.
But this is a case when peoplehave been chronically in an
(05:46):
overwhelmed state.
Our ability to regulate ourphysiological arousal is
eventually compromised and sothat's a big impact on our
window.
It takes less to be outside ofthe window with high reactivity
and we're more easilydysregulated.
So we want our patients or ourclients to continue to work with
(06:12):
us and see that their window oftolerance widens, and we try to
help them to learn skills andmanage emotional overwhelm,
their anger or their panic, andreduce the likelihood of
dissociation and disconnection.
(06:33):
So with chronic or severetrauma, we can have a narrowing
of the window of tolerance, canhave a narrowing of the window
of tolerance.
Triggers can lead to becomingdysregulated and landing outside
of the window of tolerance on aregular basis.
Trauma survivors can learn toturn away meaning like they're
(07:03):
going down into hypo and tuneout their autonomic defenses in
order to function.
The problem is that the turningaway which we all unconsciously
do when we get stuck inoverwhelm is a strategy that
(07:23):
expands over time.
That turning away expands overtime and so we get used to that
response more and more and itbecomes habituated.
And then there's a strongphobia of feeling and and
probably all of you clinicianshave experienced that, when
somebody really just can't umname feelings, can't feel
(07:45):
feelings, that's pretty blockedfrom them.
So the chronic narrowingresults in the window becoming
stuck and not able to moveflexibly.
Okay, thank you.
Hyperarousal results from thefight or flight response and is
(08:06):
characterized by excessiveactivation and energy.
This state is mediated by thesympathetic nervous system which
is preparing the body and themind to run away or to fight off
threat.
Internally, a person feelsenergized, with racing thoughts,
(08:27):
feeling very alert.
Externally, a person can beperceived as having difficulty
concentrating, irritability,anger and angry outbursts, panic
, having real high anxiety,easily scared or startled,
(08:48):
trembling and someself-destructive behavior.
We also want to mention thattonic immobility or frozenness
is actually part of this hyperaroused state.
It may not seem like it shouldbe the tonic immobility and that
frozenness, but it actually is.
(09:12):
An individual can seem tense,rigid in appearance, their fists
clenched, jaws clenched, frozen, frozen gaze and that tonic
immobility.
The next stage is the hypo,hypoarousal.
(09:32):
It occurs when the body is nolonger able to tolerate the
overwhelm of a hyperarousedstate.
So we go from hyperaroused,that superactivation, into hypo
and it moves into shutting downor dissociation.
This state is characterized bytoo little activation, with the
(09:54):
dorsal vagal immobilizationresponse, and it brings in that
feel, it um, that survival, andthat makes sense to us when you
think about it, that if yourfight or flight is not possible,
(10:16):
then collapsing and numbing andpassivity may be the most
effective survival strategyafforded to somebody.
And when we think aboutsomebody that has been
chronically abused.
As a child they were trapped,they were stuck, they didn't
(10:36):
have the strength, and so that'swhen some of those experiences
can lead to people having moredissociative or disconnection.
Internally, with thehypoarousal, the individual
feels exhausted, depressed, numb, foggy and disconnected.
(11:01):
Externally, they may haveshallow breathing or holding
their breath.
They may be kind of glassy-eyedor unfocused in their stare,
slumped posture, speaking slowlyor monotone, or just lacking
the ability to respond verballyor movement.
(11:25):
I call it kind of being prettytrancy.
They can get in a trancy mode,good.
So we also want to make sure toemphasize about how to widen
the window, and Peg is going tobe going into a lot of
(11:50):
techniques and strategies forthat, but overall we want to
widen the window, which it'skind of like trying to have
trying to stretch a rubber band,and we want to keep on doing it
over and over, to keep onhaving that rubber band or that
(12:11):
window get wider and wider.
Healing involves developing thecapacity to stay within the
window of tolerance.
We are cultivating mindfulnessof the different fluctuations in
our sensations and thoughts andemotions.
So we're asking people to trackthings like where do you think
(12:32):
you're in right now?
We're just trying to ask themto check in.
Where do you think you are atin that window right now.
You start to increase theawareness of the subtle signs of
dysregulation and help them andshow them they can engage in
self-care resources before theyget into some of the overwhelmed
(12:56):
or shut down.
I always like it with some of myclients when, um, when they're
just able to track things andthey're starting to recognize
that they're moving to some ofthe edges or moving outside,
that if they'll say you know,angie, I just I need to look
around the room right now, or Ijust need to name some objects,
(13:18):
or can we just toss, you know,the kush ball, um that I usually
have readily available in myoffice.
So learning what your window oftolerance feels like and how to
maintain staying within thatspace can help promote healing
from past traumatic experiencesso that people can safely have
(13:42):
emotions.
Now they can feel safe enoughto feel those emotions, they can
tolerate those emotions.
So we do that by helping themexperience going back to ventral
, going back to that optimalzone over and over.
Our window of tolerance ismalleable.
(14:04):
There are many ways to practicewidening it, but the first step
is to become aware of it.
So when you're in your window oftolerance, you're able to be in
a state of mindfulness andpresent, you're able to learn,
work, play and connect withourselves and those around us.
(14:26):
So we want people to connect,so we can learn.
We can help clients learn toturn towards our autonomic
defenses, our memories and ournegative relational experiences,
but this time without overwhelmand going back to ventral.
(14:48):
Vagal, like I said over andover, builds those pathways and
helps shift an overactiveautonomic nervous system.
So, just as a review here we'vegot the hyper arousal.
So, just as a review, here we'vegot the hyper arousal that's
when we have reduced rationalthinking, impulsivity, maybe
(15:12):
some poor behavior control, andthen that fight mode, easily
distressed, racing thoughts,restlessness we might see where
it feels like people are in thatpanic mode, the optimal zone
where we are able to thinkclearly, we're connected to our
(15:34):
body and our emotions, we'refully present, we're able to
think and feel at the same time.
And the hypo arousal that'swhen we're seeing more of the
low, the low affect, depressed,lethargic, numb, shut down,
(15:54):
having more absence.
I'm just, I just can't think.
I can't think or I can't focus.
Yeah, you're doing the nextpiece, pega.
Speaker 1 (16:20):
Yes, I am, thank you.
Thank you, thanks, angie.
All right, so thank you, angie.
So hopefully some of this stuffmay be familiar to some folks.
We wanted to make sure to gointo enough detail, in case this
is brand new to you, to get asense of where the window of
(16:42):
tolerance comes from and whyit's important to really get a
sense of where people are,because they'll end up in your
office, you'll see this in themand it's really helpful, like we
said, to be able to understandit, put words to it, describe it
to clients.
This is it.
Put words to it, describe it toclients.
This is the beginnings ofworking with it.
Practically Some of the stuffthat I'm going to say have been
(17:06):
Angie's.
Already said them, but it'sworth repeating.
So why is it important inpsychotherapy to have a client
manage their window of tolerance?
So typically, especially ifyou're working with folks who
have a trauma history, like wesaid, their window of tolerance
can be very narrow and it canbecome stuck where people have
(17:27):
learned to adapt, to go fromhyperarousal to hypo, and then
that just becomes their newnormal, unfortunately, and they
can become pretty dysregulatedquickly.
They're unable to focus intreatment and more likely to
avoid therapy.
So that's one reason whysomeone might suddenly start to
(17:49):
miss sessions or, to quote,forget.
It may be that you might haveto have a conversation with them
about what is it like to be inthe room with me, and so we'll
kind of bring that back up again.
And so, as a therapist, yourtendency might be to and we've
all done this right.
So considering a client couldbe considered resistant, or
(18:14):
they're just not listening, oryou have these great things you
want to offer them, but they'renot available for it.
Keep in mind that one of thereasons why we would want to
help people widen their windowof tolerance is that they can
actually stay present with youin the therapy room so that they
can absorb the things thatyou're telling them.
(18:34):
Sometimes clients may feel likethey're not doing things doing
therapy right.
They're not getting it.
Again, it's not so much thatthey aren't, it's that their
nervous system hasn't reallybeen addressed um and really
focused on in this way for themto feel like they're able to
absorb the material in a new andmore effective way.
(18:56):
So in the trauma world, whichis where Angie and I do our work
, again, the very narrow windowof tolerance translates to being
ungrounded, which means thatpatients are not going to have
the capacity to processdifficult memories.
This is why we work on it inour space, because we're
(19:20):
processing memories with peopleutilizing EMDR, and anyone who
jumps into EMDR withoutassessing for the window of
tolerance first, they're goingto likely not see success.
Client is going to start tofeel like I'm doing something
wrong, I'm not getting therapyright, and it really doesn't
help with the rapport in theroom.
(19:42):
So, all in all, this isfoundational.
So a couple of things to keep inmind.
You want to be able to practicethe tools we're going to give
you while you are in the optimalzone.
So I say we're using the wordyou a lot because we as
clinicians, we have to be ableto know where we are in our own
(20:03):
window of tolerance.
We may become overwhelmed, wemay become dissociated.
So anything that we talk abouttoday, I would highly recommend
trying it out on yourself first,if you haven't already.
But so the exposure really isfor you to start first.
And we do talk a lot about,especially with the self of the
(20:24):
therapist piece where are you inyour window?
Sometimes you're mirroring yourclients and sometimes you
yourself can become triggered byyour clients and go outside of
your window.
So keeping that in mind,triggered by your clients, and
go outside of your window.
So keeping that in mind, ofnote, the therapist and therapy
itself may become associatedwith danger, like I said, due to
(20:45):
the content of the therapy.
So if my client says, well, Idon't want to come to you
because every time I come to youwe talk about difficult things,
right?
So then I can't tell you howmany times some of my clients
say just driving here I startedto feel my heart racing, right?
So helping them to manage theirwindow and get back into their
window even before they comeinto the room is important.
(21:05):
They may become nervous comingto therapy and suddenly
experiencing a shutdown.
If you remember, this is why wesort of showed you that graph
twice, that red sort of movementthat you saw.
The line, the squiggly line, isthe experience of the client,
so how they can go outside thewindow and become hyper and then
(21:27):
hypo.
One of the folks that taught mea lot about the window of
tolerance is an approvedconsultant, craig Penner.
He talks about the mostpowerful work that you can do is
really at the edges of thewindow of tolerance, where there
is both activation andresilience.
(21:49):
So the client is about to leavetheir window and they can
tolerate presence enough to beable to recognize oh, this is
what's happening to me.
So those are the moments whereyou want to really catch them
with clients.
So keep that in mind, that it'sreally at the edges of the
window that you might be doingyour best work, because the
(22:13):
client will get it.
Oh, this is what happens to mewhen I become overwhelmed, and
then I'm overwhelmed and I can'tthink straight, my heart races,
and then I go into shutdown andnow I can't remember anything.
So let's kind of keep going.
So that's why you do it.
So this is worth repeating nomatter how helpful you think
(22:34):
you're being, if the patient isnot grounded or inside of their
window of tolerance, the patientwill be unable to retain any
information or integrate any newinsights from processing.
So keep that in mind whenyou're doing the thing, like the
kush ball, asking them to lookaround, ground themselves,
notice what's going on in theirbody, you really are doing good
(22:56):
clinical work, so don't try toskip over that.
That is the work.
All right, I am having a hardtime with this, but I'm getting
there, okay.
So, sensitive, okay.
So from this point on, what wereally want to do is just give
you something you can take homewith you.
You can, you know, print outthese purple pages, have them
(23:22):
around just as a reminder ofthings you can utilize in the
room with the client.
Ground immediately, and oftenso when you start to notice that
the person is becoming hyperand leaving their window or hypo
and leaving their window pause.
Check in with them, utilizeyour voice.
(23:45):
Your voice can be reallyhelpful in helping them to
ground, to remember where theyare, who you are and even the
words you're safe now.
I use it often when I'm doingreprocessing with clients.
If they're in the past and youknow, in EMDR we talk about
having one foot in the present.
That's what this is.
Having one foot in the present,even when you're reprocessing
(24:07):
the past, so you're safe now isan actual fact.
Use that to help them ground soand orienting to the present
moment, teaching them to do thesame, focusing on the here and
now.
What year is it, what month isit?
What day is it?
So you might have beenpracticing that all the way at
(24:29):
the beginning of your training,and here it is again, so kind of
the mini mental status, butright there in the room, so kind
of the mini mental status, butright there in the room, asking
them, not being afraid to sayhow old are you, where are you?
(24:49):
The more you do, the more theywill internalize your voice and
they'll start to ask themselvesthat very same question.
Anchoring people.
So the one is to orient them tothe present and then anchor
them to the present.
Orient them is where are you?
I'm here, I'm here with you,I'm here now.
Anchoring them is reallyhelping them really get a sense
of their entire body is here inthis present moment.
That's why we use that 5, 4, 3,2, 1, using the five senses.
(25:12):
If you've never done it before,maybe take a moment and try it
now.
So it's a great way to remember.
Uh, to help a person ground anduse a using this nice little
infographic on the right side.
Here you can see um kind of goaround in a circle what do you
(25:33):
see?
What do you smell?
What do you taste?
What do you touch?
What do you hear?
Usually the five.
What do you taste?
What do you touch?
What do you hear?
Usually the five, four, three,two, one.
It's easier to say what do yousee, five things typically stick
to things like shapes andcolors.
So give me five colors, fiveshapes in the room, just
whatever they notice, tell themnot to think too hard and just
(25:55):
go with it.
And then maybe four things theyhear, hang on one second Pega
yes, yes, Can everybody see theslides?
Speaker 5 (26:04):
or did they go away?
Oh no, I can see them.
Speaker 3 (26:10):
I can see them.
Speaker 4 (26:11):
I can see them yeah.
Speaker 5 (26:13):
Yeah, there's two tabs at the top, so one says
meeting and one says Pegasscreen.
Make sure you're on the onethat says Pegas screen.
Speaker 4 (26:20):
Okay.
Speaker 5 (26:24):
Hopefully that helps.
Speaker 1 (26:25):
Sorry to interrupt, oh, no problem, I'm glad you
caught it.
Okay, so great, let's ground.
So notice five things.
You see, just name colors foryourself in this moment.
Bring yourself back into thispresent moment, listening to my
voice.
Maybe notice four things youmight hear.
Maybe not if the room is quiet,but there might be some distant
(26:49):
sounds, traffic, the clock,someone's breathing, my voice.
Maybe three things you cantouch.
Sometimes I'll just say touchyour shirt, feel your shirt,
notice what you're sensing,notice the texture of your pants
.
I like this this is what mymentor would say kind of go
(27:12):
vertically first and then gohorizontally and notice what you
sense.
So really bring that into theroom.
And then two things you smell.
You'll hear me say this againand again, but I've got
essential oils in every roomoffice that I have every room.
I hand it over to them, I havethem.
Smell it, but even the smellthe back of your hand.
(27:35):
Then maybe smell your shirt,notice the difference, really
getting into those subtleties.
And then one thing you taste.
Maybe they just say coffee, ifit's the morning, or have a
piece of gum, have some sourcandy, have it available so they
can really ground and get intothe moment candy, have it
(27:58):
available so they can reallyground and get into the moment.
This I really appreciated frommy research really using your
own hand to rub out your joints,so noticing the sensation, it
kind of feels nice anyway, butit really helps with
proprioceptive awareness.
So what's around me and how amI engaging with my environment?
(28:18):
Where are my hands right now?
Where's my body?
What's the positioning of mybody and the joints?
Rubbing out your joints helpsyou to get real clear with
what's in this present moment.
Okay, let me not.
There we go.
All right, here we go.
So then we kind of wanted toseparate it out a little bit
hyper versus hypo arousalthere's my cute little
(28:43):
infographic on essential oilsand always, always, always
breathe.
So those are the two things toremember.
You know, kind of the sense ofsmell, bringing that into the
room and the breath, bringingthat into the room and the
breath, but using yourself tohelp a person ground, trying to
(29:04):
make eye contact with the client.
I know eye contact, especiallywhen a person is overwhelmed,
can feel overwhelming to theclient.
Sometimes folks can experiencethat as a little bit aggressive,
especially if they're havingtrauma memories.
So be you know, be gentle withthem and get to know your
clients.
But if they can make eyecontact it's helpful because
they can really remember wheream I right now, who am I,
(29:26):
especially if they associate youwith kindness, gentleness, your
voice, if it tends to be gentle, it can really help them ground
using strong sensations.
So holding a piece of ice, ifyou know about you know doing
some work in with marcialenehan's dbt.
She's got a lot of this stuff.
(29:47):
There's a lot of overlap herewith grounding ice cube if
that's not available again, likeI said, maybe a mint, something
sour smelling an essential oilpeppint, eucalyptus, lemon.
A couple of my clients feelvery overwhelmed with sensations
and say, okay, that's toooverwhelming to my system and
(30:08):
others absolutely love it.
So you really just get to knowthem, helping them to take some
deep, slower breaths, deeper,filling all the way into their
lungs, holding for a moment,really feeling the expansion in
their rib cage and their abdomenand then slow breath out,
(30:31):
trying to see if you can makethe exhale longer than the
inhale.
I love this strategy that Ilearned from Ariel Schwartz.
She kind of has given me a lotto work with.
So I you know I have her in thereferences section but pressing
your two feet into the ground.
If you happen to be able to dothat now notice pushing your two
(30:51):
feet into the ground or againsta wall and really engaging your
muscles.
Ground or against a wall andreally engaging your muscles, so
that's really helpful too.
Again, with proprioception,noticing yourself in time and
space, and then pairing thatwith an exhale.
So exhaling while you push intothe ground can be helpful With
(31:13):
tonic immobility that Angiebrought up.
When they feel really frozen orstuck, they have control and
that they have the capacity towork with their nervous system.
Another thing I really enjoy isencouraging to them to just
(31:47):
shake, shake and release,release what's been held in
their nervous system for a verylong time.
Again, it reminds them I'mpresent, I'm here, I'm safe now
and I have control, I have thecapacity to do something
different.
So there's that.
Let's see.
Oh, come on, all right, here wego.
(32:12):
I have to be really gentle.
Here we go, like with clients,um, otherwise the system gets
overwhelmed.
So hypo arousal.
So when hypo arousal kicks in,this is a time where you really
want them to get grounded intothe room, that you can ask them
to move their muscles again,stretch, stand up, walk around.
(32:33):
Slowly and gently, they mightfeel a little dizzy because
they've been in hypo.
They might feel like eveneverything feels blurry.
So you might want to really askthem to be gentle, ask them to
look around the room stretch,and one of the things I really
like is having them notice theedge of a picture frame and ask
(32:58):
them, especially if you're, youknow, virtual, just sort of say,
notice the edges of yourcomputer or laptop, whatever
they're looking at you on, is itblurry?
And if it is blurry, see if youcan focus in until it's no
longer blurry, until it becomescrystal clear Again,
internalizing some of the powerand the capacity that they have.
(33:21):
A couple of things that Iwanted to mention about the
hyper or the hypo is helpingthem and we'll talk a little bit
about this actually to createwhatever you create with them in
their room.
Make a list of it with them sothat they have that to take with
(33:42):
them outside of the room anduse that Kind of like I said use
these purple sheets foryourself, create something with
them some of the room and usethat Kind of like I said use
these purple sheets for yourself, create something with them,
some of the things they reallylike or the things that they go
to.
I'll say to my client all right, we know what smells feel good
to you.
Go to the store, go to theWhole Foods, go to the CVS there
(34:04):
are essential oils everywherethese days.
Grab a bottle for yourself, putit in your bag.
If you know that certaintextures feel good, go out and
grab that and put it in your bag.
Have it available to you.
All right, here we go, and okayso here's the outside of
sessions, some things to.
(34:28):
In addition to maybe creating alittle go-to bag or box where
they can put in the things, thetextures that feel good, the
smells that feel good, thetastes, like having gum or candy
available, we wanted to offerexcuse me, excuse me a couple of
(34:54):
what's now being termed it'skind of a cool word vagal toning
comes up in polyvagal theoryAgain.
Ariel Schwartz, one of myfavorites, who talks about this.
She uses this a lot, theconcept of vagal toning and the
reason I like it is becausepeople tend to say, all right, I
got to go to the gym and, youknow, lift my weights or go for
a jog or, you know, maintain myhealth.
(35:16):
Well, vagal toning is a way forthem to maintain their vagus
nerve, maintain their optimalzone of arousal, so you can kind
of bring it into their dailyself-care.
And I'm just going to see if Ican show you a video or, let's
see, I'm going to show you.
(35:38):
If you don't know what thebutterfly hug is, I'm just going
to ask you to go ahead toYouTube and look it up.
Here you see this image we haveon the side, where this image
is holding, if you can see me,is this really squeezing the
arms and tapping.
This is the version of thebutterfly hug that I've found
(35:59):
online.
But to be true to our EMDRworld, where the butterfly hug
comes from, we also like to sayput your two fingers, two hands.
Actually, this talk aboutproprioception.
It's very hard to do handsfacing your face If you're, if
you're able to do it now, andthen hook your thumbs.
So that takes a lot of mentalenergy to figure out how to
(36:24):
bring your hands in your face,hook your thumbs and then bring
them right underneath yourcollarbone and then tap left
right.
It's quite a soothingexperience for people.
We use it for soothing, we useit for resourcing, strengthening
, but it has a real soothingeffect.
So if we do have time, I'llshow you the silencing the alarm
(36:50):
.
If we don't, because I knowwe're kind of short on time
today silencing the alarm isanother one that comes from
Robin Shapiro.
She has done massive work forour field, for the field of EMDR
, for ego state therapy, andI'll show it to you.
But again, you can go onlineand find it.
(37:11):
Basically, you're going to againtalk about proprioception.
You're going to take your lefthand, bring it to your right
eyebrow and then you're going totake your right hand and bring
it to your left eyebrow and thenyou're going to slowly trace
through the back of your ear,very, very slowly, as you
(37:33):
breathe down your neck, keepbreathing in and out through
your shoulder, right downtowards your elbow and out
through your hands.
And then one other personcalled it or like releasing the
yuck or removing the yuck.
So I really like that whenyou're feeling overwhelmed,
(37:55):
you're feeling thoseoverwhelming feelings, taking
that and doing that about 10times, actually really slowly
breathing and helping the personmove the yuck out of their
system.
So more vagal toning exercisesare listed here.
You can do some twisting andmoving and utilizing your five
(38:20):
senses.
One of the things about EMDRthat's in the title is eye
movement.
In the title is eye movement.
So in when it comes to vagaltoning, you really want to ask
the person to move their eyesfrom the white end of the left
side of like the kind of thewhite end of their eye I forget
what that's called, not thepupil but the other stuff all
(38:44):
the way to the other white oftheir eye.
So noticing that the white comeout of my eyeballs kind of
strange, but yeah, so all theway to the left and all the way
to the right, and then you alsoadd on gentle twists to the left
and right.
And here this last one is lyingdown with your hands interlaced
(39:06):
on your back and then againmoving your eyes from left to
right, slowly, noticing yawning.
One thing that was sointeresting about this one is
that you're actually resettingyour vagal, your nervous system,
your vagus nerve, drinking asip of water, noticing it,
(39:28):
hydrating yourself, so reallyhelping them to connect with
their body.
And let's see where are we.
Here we go, signs that a clientis grounded.
They're back in their window,their breathing is smooth and
regulated.
They may start to make eyecontact with you more readily,
(39:48):
if they typically do.
They're engaging inconversations more and they're
able to say that they aregrounded.
So don't be afraid to ask themfrom zero to 100, how grounded
do you feel in this moment?
Typically they can tell.
Sometimes they'll say, oh, Idon't know what the right answer
is, and of course there is noright or wrong, it's just their
(40:09):
subjective experience.
But you can compare.
If they're at a 50 or a 60, tryto implement some of these
tools and typically they canmove up 70, 80, 85.
That's a pretty good difference.
And so here's the referencepage and just a little bit about
Angie and me, in case you allwant to get in touch with us.
(40:30):
If you're.
You know I think we can talkEMDR all day and talk trauma all
day, so we've got a lot ofresources for you and just
wanted to say thank you forspending the evening with us and
we've enjoyed speaking with youabout this really important and
really exciting topic.
I'm not sure if there is timefor questions but we still have
(40:54):
a few minutes.
Speaker 5 (40:57):
Are y'all good with me dropping the link to the PDF,
to the slides in the chat forparticipants?
Okay, awesome For those who ask.
Speaker 1 (41:04):
I'll do that right now and I'll stop share.
Does that feel okay?
Speaker 5 (41:10):
Perfect.
Speaker 1 (41:11):
All right.
Speaker 3 (41:19):
All right.
Did anybody have any questions?
Speaker 5 (41:21):
What was the video that you referenced?
The butterfly hug, oh yeah.
Speaker 1 (41:26):
Yeah, yeah, yeah.
I mean, if we do have time Ican show it to you.
You want me to?
Speaker 5 (41:31):
do that.
Speaker 1 (41:31):
Yes, absolutely yeah go ahead.
All right, one second, okay,this is fun.
Back to technology.
One sec, let me just not.
Okay, how did I Actually?
(41:54):
I can just find it so.
So the one of the videos.
Well, I'm looking for thisthing.
Um, one of the videos is on thebutterfly hug.
Here we go, I found it.
And the other one is onsilencing the alarm.
So I think the butterfly hugmight happen to be shorter.
So I'll just go to that pagereal quick.
Here we go.
Speaker 5 (42:19):
While she's pulling it up.
If you missed any portion ofthe presentation, it will be
available to Step it Up.
Members, we did record it.
Speaker 1 (42:31):
Go ahead.
I'm sorry.
Speaker 5 (42:34):
No, you're good, you can play the video.
Speaker 1 (42:36):
Okay, I was going to say this Erica Bonham has really
great resources on vagal toningso I would highly recommend her
and actually some of hermaterial under vagal toning that
comes from some of the stuffshe's written, so I just wanted
to credit her and actually letme see here if I can do this and
(43:03):
that.
Speaker 2 (43:07):
No sound here, Pega.
Speaker 1 (43:11):
What did you say, Angie?
Speaker 2 (43:12):
No sound.
Speaker 1 (43:14):
Oh no, I don't know how to do that piece.
Speaker 5 (43:18):
I may have to do it for you just because, oh gosh,
I'm sorry, it's not a problem,because I have mine set up so
that sound will play.
Speaker 1 (43:27):
Okay, you want to go ahead and do it?
Yes.
Speaker 5 (43:31):
It's Erica.
Speaker 1 (43:33):
B-O-N, yeah, erica B-O-N-H-A-M and butterfly hug
and I'll stop.
Share if you want, I found it.
Speaker 3 (43:45):
People are dumping their $500 pressure washers for
this $50 tool.
Is that me?
Speaker 5 (43:50):
No, it's me.
Speaker 3 (43:51):
It's an ad playing.
Speaker 5 (43:52):
I'm trying to let it go so I can pause it.
It's about a sprayer.
Okay, now I'll screen share.
Speaker 3 (44:05):
And if you're familiar with Ian, so one of my
favorite resources for resettingthe nervous system is just
called the butterfly hug.
And if you're familiar withEMDR therapy eye movement,
desensitization and reprocessingtherapy this is a very common
resource that we teach in EMDRand it's just crossing your arms
(44:28):
over.
You can sometimes add somecompression If that feels good.
You can do your butterfly huglike this, or you can just tap,
or sometimes people like justtapping on either side of their
heart, right, left with theirfingers.
So you, you get to decide whatfeels the best for you.
So I like my shoulders and it'sjust tapping to.
(44:50):
You know, your, your, I'm goingto try to mirror you right,
left, right, left.
You can add rocking if thatfeels good, or you can add eye
movements if that doesn't causetoo much dizziness or activation
.
So when you're using this as acalming resource, you want it to
(45:15):
feel good.
You want it to feel soothing,not too activating.
So if you're getting activated,if it's bringing up stuff, put
this away and do a differentresource, okay.
So just taking a deep breath,just three or four taps on each
(45:37):
side, and that can be a reallygreat way of resetting your
nervous system.
Speaker 5 (45:49):
Awesome, and I'm going to drop that link to that
video in the chat too.
Speaker 1 (45:53):
I was going to say, if you want to also add the
other one, what was the otherone?
The silencing, the alarm.
That's right under um.
I can actually let me see here.
I can add it, if you'd like, tothe chat.
Okay, at least you'll have itOkay.
Speaker 2 (46:14):
Okay, that's the one with calm with Kyle.
Yeah, he's got a lot of greatYouTube videos about resetting
the vagus nerve and stuff andcalming with panic and all kinds
of stuff did anybody haveanother question, or do y'all
(46:36):
want me to go ahead and playthat video?
Speaker 4 (46:39):
I had a question, um, I'm I am new to uh emdr and so
one of you guys mentioned thecush ball.
Can you guys go into moredeeper into that and like what
that is and the technique for itand why?
Speaker 2 (46:55):
Yeah, um sorry, I have it right here.
This is my little cush ball, um,but I keep those things handy
on my on my tables in my office.
Sometimes in EMDR I'm using itas as the bilateral but playing
(47:19):
catch with anything.
It doesn't have to be a pushball with a pillow, with a
Kleenex.
Sometimes Kleenex is real goodbecause when you crumple it up
it doesn't keep its form and soit kind of keeps you on the ball
a little bit.
Or tossing a pencil back andforth, just anything that's soft
(47:41):
can be tossed back and forthand it's just another way of
grounding to be able to kind ofbe able to get access,
especially if somebody is kindof moving to the edges or moving
out of their optimum zone.
So it's just another way ofit's probably one of the
(48:02):
quickest way I've found of beingable to get people back present
quickly.
Speaker 4 (48:10):
Thank you for that.
I appreciate it Go ahead Debbie.
Hi, thanks and thanks to allyou guys.
This is awesome.
What about some more subtlesigns, like they appear to be,
you know, I'm thinking like arestless foot, like kind of
(48:33):
tapping their leg, fidgeting,you know kind of that fidgeting,
and just some of those moresubtle sounds, signs of checking
out or being overwhelmed.
What are some of those signs tolook that, to look out for,
that are maybe a little bit moresubtle?
Speaker 1 (48:52):
Well, what I appreciate is that you're
actually able to kind of tune inand notice that with your
client Right.
And so sometimes it's in thecollaboration between you and
your client where you can figurethat out together and to even
(49:15):
say, oh, notice, you know, ifyou're noticing them having some
kind of repetitive pattern,bring it up to them and just say
notice what.
That is what happens for you inthat moment, and then you know
again.
You become a team around this.
I think that's the mostimportant thing.
I know that a lot of timesclients can feel like they're
underneath the microscope whenthey, when you just point out,
notice your leg, notice your arm, notice your shoulder.
(49:36):
I try to, I try to be kind oflight about it and just kind of
bring some levity and lightnessso that they don't feel like
they're being interrogated.
But a lot of times it'sfascinating.
One of the things you brought upthe foot because sadly, people
(49:59):
had to manage their emotions inthe context of the complexity of
their abuse.
A lot of people tense theirfeet and they have no idea
they're doing it until you startto bring that awareness to
their body and many people say,yeah, I didn't even realize how
(50:21):
quickly my feet get tensed andguess what?
You won't notice because theyhave shoes on.
So as you start to give themthis language and really point
out like, notice your shoulders,notice your arms, eventually
they'll start to be able torealize, wow, my hips are tense.
You know, for us we may not beable to see the subtleties, but
(50:43):
it's good, debbie, that youbrought that up, because it's
really in the collaboration withyour client that that helps,
does that help Absolutely, thankyou.
Speaker 4 (50:56):
Just to add to that, sometimes I've tried to notice
and maybe I've said you know,what do you think your foot is
holding, what do you think is,and you may have a better
approach.
But a lot of times I've gottenback like, oh you know, I just
do that, you know, that's justthe thing I do like, and kind of
dismissive, like oh yeah, Iknow I tap my leg, no big deal,
(51:16):
and they're not curious about itso I don't know if you have a
suggestion on trying to helpthem get curious about that.
Speaker 2 (51:24):
I think that's just part of, you know, stretching
the window a little bit more, ofeven just asking the question,
helps them to kind of get alittle bit mindful.
And just having that awarenesscheck in with my clients on a
(51:45):
regular basis, like, how are wedoing right now?
Like, as we're discussing this,what is coming up for you?
Or you know, every once in awhile I'm going to just ask you,
you know, is my voice startingto get a little distant?
You know, how present are youin the room right now For people
(52:06):
that tend to go down, right now, for people that tend to go
down, drop down into the hypo,if they're starting to get still
, that's a huge sign they'regetting a little too still.
Then I might just have somecuriosity of, like, how is
everything going?
Can you just, can we just checkin?
(52:26):
Um, you know, I, I use the wordtrancy Are you feeling a little
trancy?
Um, am I starting to lose you?
Um, especially in these heavydiscussion points?
Um, so yeah, um and um, if I,if the racing, um, the eyes
(52:51):
start to kind of dart around orit feels like they're on the
edge of some of thathypervigilance, you know, I'll
say, you know, let's just do alittle Q&A.
Could you use a little bit ofextra grounding before we
continue on?
So we're just asking them to doa little pausing and checking
in.
How are you doing?
Speaker 4 (53:11):
Yeah, Thank you.
Speaker 2 (53:15):
Thanks a lot, thank you Great questions, you guys.
Speaker 5 (53:24):
Anybody else have any questions?
Okay, Awesome presentation.
That was fantastic.
I know Kate is veryappreciative of that.
I know everybody that attended.
That was really greatinformation because I don't
(53:45):
think, you know, not everybodydoes EMDR but a lot of people do
do trauma work, and so y'allreally did a fantastic job of
tying that in for those of uswho don't do EMDR.
But amazing.
Grab the links out of the chat.
I'll give you like another 30seconds because once they're
gone, they're gone and I hopeeverybody has a fantastic
(54:05):
Wednesday.
Speaker 4 (54:07):
Thank you.
Thank you too.
Bye, fantastic Wednesday.
Speaker 5 (54:09):
Thank you, you too Bye-bye.
Thank y'all.
Speaker 3 (54:15):
I love the hearts.
Thanks for coming.
Thanks for coming.
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