It is possible to experience hyper- or hypoarousal that is so intense that the brain doesn’t function properly anymore. We can’t be mindful and we can’t use our grounding tools. In these cases it is possible to work through the senses and the body. The measures taken here are not regulation tools. They are only meant to interrupt extreme dysregulation and re-activate our brain enough so we regain access to proper regulation and self-soothing. Through awareness for early warning signs the necessity for these interventions should quickly decrease over the course of therapy as we learn how to regulate ourselves before we enter the deep end of a stress response. What I am sharing is a crutch that should not be used any longer than absolutely necessary.
We will go through the different senses and give you some examples of what could be used.
Taste
- jalapenos
- horseradish
- mustard
- wasabi
- ginger
- sour candy
- ice cubes, maybe even made from lemon juice
Smell:
- smelling salts
- vinegar
- grounded pepper
Don’t use any cleaning agents or chemicals that could burn your airways!
Hearing:
- hit the table with your flat hand
- blow up a ballon until it pops (helps with breathing too…)
- fill a can with stones or marbles and use as rattle
- use a whistle
- listen to loud music
Vision:
- look into bright lights (don’t use the sun, that is dangerous!)
- move something bright and colorful about 10-15 inches in front of your face, it should be in the center of your (probably limited) field of vision
- don’t let your eyes rest anywhere, keep moving, don’t look down
Touch:
- ice packs or really cold water (don’t use ice for too long, especially when you can’t feel your body. It can cause frost bite!)
- a spiky massage ball
- a rubber band on your wrist that you can flick
- muscle burn from difficult positions (like holding a squat)
- put a stone (or better marbles, less risk of hurting yourself on edges) into your shoe and walk around a little
- peppermint oil
- use a weighted blanket
- wax strips: be old-fashioned, don’t shave above the knee, keep it for when you need the pain to clear your head
Pain is one of the most effective ways to interrupt extreme states, that is why we self-harm when its getting too much. It isn’t recommended coping but it is also not forbidden, if we run out of options. What we can do is make sure that we are not hurting ourselves in a way that causes real harm.
Other options that include the body
Balance:
- stand on a balance board (maybe on one leg?)
- stand on your toes (maybe on one leg?)
- yoga poses like half moon, headstand, dancer, tree, triangle, or warrior III
Movement:
- unskilled dancing ( I prefer Taylor Swift’s “shake it off” for this)
- go running ( with self-control)
- jump, maybe with an imagined jump rope or on a trampoline
- sit against the wall as long as you can and then 5 seconds
- stomp your feet a few times, if you are scared, see if you can turn it into anger
- put your hands on the wall and try to push it away as hard as you can
- run upstairs and downstairs a few times
- use high impact bodyweight exercises like burpees, jump squats, jumping lunges or something else that feels difficult for your fitness level (hyperarousal)
- Yoga (hypoarousal)
- Qi Gong (hypoarousal)
Movement is actually regulating and not just an interruption of a stress response. It is my prefered method.
Bilateral stimulation:
- juggling
- complex exercises that need you to coordinate left and right
- playing air drums: get the beat down with your foot, cross your hands, go!
Caution!
Extreme interventions are often experienced as harmful or violent by trauma survivors. They can increase a stress response when they give us the feeling that we aren’t safe in this moment. Using extreme stimulation has been a trauma therapy trend in the last decade but therapists are returning to more gentle and time consuming ways to manage dysregulation because they are safer, less harmful to the therapeutic relationship and they don’t add to our stress. Many survivors are triggered by these methods or their sensory system gets overwhelmed. Especially patients with autism shouldn’t expose themselves to hurtful sensory stimulation. Gentle approaches take more time but they are effective.
People with DID who use intense stimulation will be in danger of scaring inner parts and losing their trust. Hosts sometimes have a tendency to dissociate in response to the inner experience of parts or inner voices and use these tools to try to silence them. That is not therapeutic. DBT skills are also not an appropriate tool to stop dissociation that happens to shut out the inner experience of parts. The moment we stop drawing all our attention somewhere else, the voices and the dissociation will be back.
If you insist on using intense sensory measures
The correct way to use intense stimulation is as short as possible. The moment we are aware enough to move into regulation and self-soothing skills we should do that instead. We explain how to properly chain skills over here. When we don’t feel safe because our senses tell us that we aren’t safe there is no way we can calm down. It is just natural to slide into higher levels of dysregulation if the use of extreme stimulation doesn’t stop. I have seen Ts practically torment patients this way because they didn’t make an effort to offer real co-regulation and grounding and the patients could not stabilize. I personally think that with the growing influence of highly effective body work, these interventions will lose their importance. This trend will end, eventually. Until it does, I want you to be informed about the downsides.
I have personally found some value in this during a time when no better treatment was available. It can effectively interrupt extreme states. Sometimes that is exactly what is needed. But just because it is possible doesn’t mean that it is always necessary or good.
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