Dysregulated
Stress
Patterns:
What
To
Do
When
Stress
Activation
Patterns
Arise
In
Your
Practice
Bill
Bowen’s
presentation
to
the
Returning
Veterans
Project,
May
15,
2010
“All
the
chemicals
that
were
secreted
originally
to
insure
your
safety
continue
to
get
secreted,
but
because
the
situation
is
over,
all
these
actions
that
your
brain
and
body
are
programmed
to
do
have
nowhere
to
go,
and
you
start
reacting
as
if
you
were
back
there
at
the
trauma…
you
keep
having
physical
reactions
that
have
nowhere
to
go,
that
are
inappropriate
for
the
current
time.”
‐
Bessel
van
der
Kolk,
MD
•
Trauma
is
an
event.
Once
that
event
is
past
what
remains
is
the
stress
response
resulting
from
that
event.
•
Human
stress
response
is
a
reaction
to
perceived
external
or
internal
threat.
This
is
an
integrated
physical,
emotional,
and
psychological
response,
internally
created,
to
protect
one
from
danger.
Stress
Continuum
•
Most
client’s
presenting
therapeutic
issues,
actions,
or
reactions
occur
somewhere
along
a
continuum
of
stress,
from
optimal
functioning
to
survival
functioning,
from
daily
stressors
to
high
levels
of
dysregulated
traumatic
stress.
•
Stress
responses
can
be
useful
in
helping
a
person
rise
to
meet
challenges
or
conversely
can
be
damaging
to
health
and
well‐being.
•
Stress
responses
vary
from
person‐to‐person
and
situation‐to‐situation.
What
is
stressful
for
one
person
may
or
may
not
be
stressful
for
another
person.
•
Organizational
patterns
and
activations
associated
with
stress
vary
depending
on
a
person’s
resources
to
manage
stress.
These
patterns
are
formed
and
conditioned
by
a
person’s
life
experiences.
1
Stress
Threshold
• There
is
a
threshold
of
stress
activation
(Stress
Threshold)
on
the
continuum
of
stress
responses.
• The
Stress
Threshold
exists
at
the
margin
where
optimal
functioning
transitions
to
survival
and
defensive
functioning.
• The
Stress
Threshold
forms
at
the
point
where
adjustments
and
compensations
to
stressors
no
longer
allow
a
person
to
function
in
a
more
integrated
and
optimal
way.
• The
location
of
a
Stress
Threshold
will
vary
depending
on
context,
i.e.
a
person
may
have
a
high
threshold
for
physical
stress
but
a
lower
threshold
for
emotional
stress.
• The
Stress
Threshold
is
a
functional
expression
of
core
psycho‐physical
organization.
Beliefs,
attitudes,
feeling
all
influence
a
stress
threshold.
• Stress
levels
below
the
Stress
Threshold
can
have
a
positive
affect
on
a
person
(Eustress).
• As
a
person
nears
the
Stress
Threshold
alert/alarm
states
begin
to
manifest.
• As
a
person
crosses
the
Stress
Threshold
fight/flight
states
of
arousal
begin
to
manifest.
• Stress
levels
near
or
above
the
Stress
Threshold
have
a
negative
affect
on
a
person
(Distress).
• Higher
states
of
arousal
above
the
Stress
Threshold
lead
to
increasing
activation,
dysregulated
traumatic
stress
responses,
and
eventually
immobility
responses
of
freezing
or
collapse.
Stress
Activation
Triggers
• Past
breaches
of
the
Stress
Threshold
are
remembered
in
the
nervous
system
and
form
stress
triggers,
which
when
stimulated
result
in
a
re‐activation
of
stress
responses.
• Stress
triggers
can
be
anything
that
re‐stimulates
or
reminds
a
person
of
a
traumatic
event.
This
can
be
a
physical,
emotional
or
psychological
re‐stimulation.
• Common
triggers
are
images,
sounds,
smells
or
even
tastes
that
a
person
associates
with
a
traumatic
event.
• Persons,
locations,
objects,
actions,
qualities,
behaviors,
anniversary
dates,
etc.
that
remind
a
person
of
a
traumatic
event
can
be
triggering.
2
Symptoms
and
patterns
associated
with
high
stress
and
trauma
• Intrusion:
flashbacks,
traumatic
memories,
nightmares,
disturbing
body
memories,
intrusive
voices,
images
or
thoughts.
• Avoidance:
numbing,
disassociation,
staying
away
from
people
and
activities
that
might
remind
one
of
a
past
trauma,
avoiding
talking
about
what
happened.
etc.
• Arousal
problems:
Feeling
either
hyped
up
or
shutdown,
feeling
pressured
or
out
of
control,
chronic
depression,
hyper‐vigilance,
anxiety,
panic
attacks,
etc.
• Behavior
problems:
Emotional
volatility
or
withdrawal,
hyper‐sensitivity,
addictions,
inappropriate
impulses,
behaviors
that
keep
one
from
safe
and
satisfying
relationships,
activities,
jobs,
etc.
• Physical
Symptoms:
Sleep
disturbances,
headaches,
muscular
tensions,
gastrointestinal
problems,
respiration
difficulty,
adrenal
burnout,
fatigue,
chronic
illness,
eating
disorders,
etc.
Chart
for
tracking
long
term
developmental/characterological
overview
of
stress
response
patterns
3
Chart
for
tracking
a
client’s
short
term
­
daily
stress
responses
as
the
Stress
Threshold
is
crossed
Polyvagal
Theory
• The
Polyvagal
Theory
of
Dr.
Stephen
Porges
is
useful
in
understanding
how
to
help
modulate
the
dysregulated
arousal
states
of
clients
affected
by
high
stress
level
responses.
• In
Porges’s
theory
he
uses
the
term
Polyvagal,
to
distinguish
in
mammals,
between
the
two
main
branches
of
the
vagus
nerve,
the
older
dorsal
system
and
a
newer
ventral
system.
Each
branch
originates
in
the
area
of
the
medulla
and
provides
inhibitory
input
to
the
major
internal
organs
including
the
heart.
However,
each
does
so
in
service
of
distinct
evolutionary
functions.
4
• The
more
primitive
part
of
this
system,
the
unmyelinated
vagus,
is
part
of
the
reptilian
system.
This
is
the
Dorsal
Vagal
Complex,
which
is
associated
with
the
inhibitory
freeze
response.
The
newer
system,
the
Ventral
Vagal
Complex,
myelinated
vagus,
is
associated
with
facial,
vocal,
and
neck
muscles,
and
forms
part
of
a
social
engagement
system.
The
Ventral
Vagal
regulates
the
heart
and
the
bronchi
to
promote
calm
and
self‐soothing
states
as
well
as
inhibition
of
sympathetic‐adrenal
influences.
• The
Ventral
Vagal
Complex
can
have
an
inhibitory
effect
on
the
mobilization
of
fight/flight
responses.
This
is
using
the
newer
neural
“circuits”
to
inhibit
the
older
ones
thus
promoting
calmer
states
and
healthy
connection
with
others.
This
is
sometimes
called
the
Vagal
Brake.
When
this
neural
brake
is
released
hyper‐vigilance
and
higher
stress
activation
states
arise.
• According
to
Porges’s
Theory,
because
of
evolutionary
pressures,
the
human
Autonomic
Nervous
system
has
evolved
and
adapted
from
early
primitive
reptilian
responses
through
three
stages
involving
the
assessment
of
safety
or
danger.
• These
stages,
beginning
with
the
earliest
and
most
primitive,
are
Immobilization
(freeze),
Mobilization
(fight/flight),
and
Communication
(social
engagement).
These
stages
are
thought
to
be
hierarchical,
with
response
strategies
to
threat
dictated
by
the
newest
neural
structures
first
allowing
social
engagement,
if
that
fails
then
falling
back
on
older
defensive
structures
calling
for
fight/flight
and
eventually
freezing.
• Porges
states,
“The
perception
of
safety
determines
whether
the
behavior
will
be
prosocial
(i.e.
social
engagement)
or
defensive.”
"Our
nervous
system
reacts
differently
to
the
same
stimulus,
depending
on
our
psychological
state."
• According
to
Polyvagal
Theory
the
nervous
system
assesses
whether
the
environment
is
safe,
dangerous
or
life
threatening.
Depending
on
this
assessment
different
actions
will
be
taken
(i.e.
if
perceived
as
safe
social
engagement
and
calming
can
occur,
if
dangerous
mobilization
of
defensive
strategies
like
fight/flight
will
occur,
if
life
threatening
then
immobilization
defenses
like
freezing
will
occur.
• This
safety/risk
detection
is
autonomic,
occurring
below
levels
of
conscious
awareness.
• Porges
further
says
“To
effectively
switch
from
defensive
to
social
engagement
strategies,
the
mammalian
nervous
system
needs
to
perform
two
important
processes:
1)
to
assess
risk,
and
2)
if
the
environment
is
perceived
as
safe,
to
inhibit
the
more
primitive
limbic
structures
that
control
fight,
flight,
or
freeze
behaviors.”
• Porges
suggests
that
we
can
utilize
our
higher
cognitive
processes
to
calm
the
stress
response
through
social
interaction
by
using
our
facial
muscles,
making
eye
contact,
modulating
our
voice
and
listening
to
others
5
Healthy
Responses
that
Support
Client
with
Elevated
Stress
• Alter
or
leave
the
stressful
environment,
set
appropriate
boundaries
(this
is
immediate
first
aid).
• Decrease
stimulation,
manage
thoughts,
emotions,
and
physical
tensions;
increase
healthy
physical
lifestyle,
relaxation,
supportive
interpersonal
connection,
containment,
centering
and
grounding
(this
is
first
aid
and
stress
management).
• Increase
awareness
and
understanding
of
how
one’s
stress
triggers
and
responses
manifest
and
are
organized
(self
awareness
and
therapy
can
help
with
this).
• Increase
optimal
functioning
by
creating
internal
and
external
physical
and
psychological
options/resources
for
reducing
stress
activation
and
improving
stress
coping
skills
(supportive
social
networks
and
therapy
can
help
with
this).
• Raise
Stress
Threshold
through
core
reorganization
&
transformation
(i.e.
long
term
therapy).
Guide
to
Clinicians
When
Client’s
High
Stress
Responses
are
Triggered
• Stay
mindful
and
track
carefully
the
clients
stress
responses/reactions.
• Stay
present
and
in
appropriate
contact
with
the
client.
• Stay
open,
compassionate,
non‐reactive,
and
well
bounded.
• Support
the
client
in
down
regulating
high
stress
arousal.
• Help
the
client
contain
and
understand
the
triggering
experience.
• Refer
the
client
to
other
appropriate
resources
for
on
going
support
and
transformation
of
high
stress
responses.
Support
the
client
in
down
regulating
high
stress
arousal
by:
• Take
charge
of
the
down
regulating
process.
• Stop
any
process
that
accelerates
activation
of
stress
response.
6
• Have
client
make
direct
external
safe
visual
contact,
away
from
internal
stress
focus.
If
direct
eye
contact
with
you
is
activating
have
client
stay
in
visual
contact
with
a
part
of
your
body,
i.e.
shoulder.
• Work
with
client’s
respiration
pattern
to
reduce
Sympathetic
Nervous
System
arousal.
• Work
with
grounding
and
centering.
• Work
with
containment.
• Hands‐on
work
and
movement
work
can
sometimes
be
valuable,
but
can
also
be
re‐activating.
Use
with
consideration
and
caution.
• Work
with
recognizing
safety
and
orienting
towards
safety.
• Allow
and
support
the
natural
discharge
of
physical
and
emotional
energies.
Do
not
encourage
a
cathartic
release
of
emotions.
• After
arousal
has
settled,
talk
with
client
about
his/her
experience
if
appropriate.
Help
client
understand
his/her
experience.
7