Self-Regulation

In the context of contemporary, neurobiologically informed psychotherapy, “regulation” refers to regulation of the autonomic nervous system (ANS).

Video: Trauma and the Nervous System

2:47

We will continue watching the rest of this video within the context of self-regulation of the ANS.

Self-Regulation

Self-regulation can be of two varieties: auto-regulation and co-regulation.

Auto-Regulation

In auto-regulation, the individual directs their awareness to their own embodied resources to increase ventral vagal nerve tone and inhibit the sympathetic nervous system OR to counter the effects of dorsal vagal activation by gently mobilizing the sympathetic nervous system.

Co-Regulation

Co-regulation is regulation through connection and occurs when we essentially share in the nervous system of another, as explained in the video above.

In individuals with attachment disturbances or (more severely) developmental trauma, the capacity for self-regulation is impaired. Someone in this case may exclusively favour either auto-regulation (consistent with avoidant or dismissive attachment), co-regulation (anxious or ambivalent attachment), or lack reliable access to either (disorganized or fearful-avoidant attachment).

Health Professional Tip

It is essential that the health professional have full and embodied self-regulatory capacity to model and teach auto-regulation and provide co-regulation to clients as needed and highlight the client’s default tendencies and emerging capacities. It is also important that health professionals be aware of their own tendencies to favour one or the other to monitor the transference and counter-transference in the therapy dynamic.

The Trauma Vortex and the Healing Vortex

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The Trauma Vortex

The core implicit experience of trauma (and particularly relational-developmental trauma) can be described as an unbearable black hole of aloneness, encompassing other unbearable emotional states such as helplessness, confusion, fragmentation, emptiness, shame, fear, and despair: a trauma vortex. The individual is at their most depleted, with no access to safety or emotional resources. Despite defensive strategies, this black hole has a pull to it. When approaching traumatic content in therapy, a client might find themselves moving into states of increasing dysregulation by its sheer pull. Its pull may also influence their habits and perceptual biases in everyday life, often culminating in psychopathology. The trauma vortex is associated with states of ANS dysregulation.

The Healing Vortex

On the other hand, there also exists a healing vortex. The healing vortex is often underdeveloped due to the pull of the trauma vortex, and therefore requires exploration in therapy as a counterbalancing force. The healing vortex is made up of the client’s elaborated resources and bolstered through increasing mindfulness of pleasant experiences (making pleasure a value), as well as an embodied sense of relational safety and connection. The healing vortex is associated with states of ANS regulation.

Trauma-Specific Skills

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Titration

Titration in the therapeutic treatment of trauma can refer to both staging of the overall therapeutic process—the arc of treatment and recovery—and to what happens in an individual therapy session.

Selection and titration of interventions in a treatment session is aimed to work at the edges of—but not beyond—a client’s window of tolerance with an aim to keeping the client in ventral vagal mediated social engagement throughout. Titration within a session ensures that the integrative capacity necessary for enduring therapeutic gains is present for the client at all times. The presence of a psychedelic medicine may expand the client’s window of tolerance such that titration is not required, however the invitation to titrate experience may slow it down such that it will organize and integrate more effectively.

Some examples of titration to modulate the intensity of emergent phenomena within a session are:

  • Inviting the client to see if they might put the scene they are describing on to a screen where they can press pause and make it bigger or smaller (creating more distance and control)

  • If exploring a challenging sensation in the body, encouraging the client to see if it is possible to just approach the ‘edge’ of the sensation and pause to give this description rather than going right into the centre all at once. This could be explained to the client as ‘dipping your toe in’ to test the waters rather than diving into the deep end.

Through experiencing titrations, a client simultaneously benefits from slowing down and pausing at the edges of discomfort (creating optimal conditions for processing trauma at the ‘edges’ of the window of tolerance), while also learning that this is even possible–gaining an experiential technique that, with practice, may assist with expanding their regulatory capacity when challenged.

Pendulation

Pendulation is an example of a titration mechanism a health professional can invite that involves the client moving back and forth between a highly resourced state and contact with dysregulating inputs (between the healing vortex and the trauma vortex).

For example, if the client is becoming anxious and distressed about thoughts, images or bodily sensations that are surfacing, the health professional can invite the client to contact a resource that has been previously explored in the felt sense. States of regulation and dysregulation are thus juxtaposed, with the client pendulating their attention between both while retaining present moment awareness and presence, connection with the health professional, and access to receptive and expressive language abilities. In this way, the client contacts potentially dysregulating material within themselves without becoming dysregulated, and the inner healing intelligence can work to naturally ‘metabolize’ the surfacing traumatic content through awareness, resource, and strengthening distress tolerance.

T-Zero

T-zero is the ‘core’ of a historic traumatic event that holds the most charge, and therefore has the greatest propensity to take a client outside of their window of tolerance. It is important to avoid guiding a client directly to T-zero but rather to consciously “work the edges”, meaning what happened before, and what happened after.

For example, if the client was in a car accident, the health professional could invite the client to see if they recall getting up that day, such as what they ate for breakfast (pre-trauma), and, likewise, to describe any memories from when they first registered that they were no longer under life threat. This ultimately serves as a titration for processing the implicit material and trauma energy contained within T-zero.

Awareness of the intensity of T-zero is also relevant to Preparation Sessions when the health professional is taking a client's history. It is not necessary to request a detailed narrative of the event, and in fact, this is contrary to trauma-informed practice. Rather, clients should be invited to speak in generalities, giving ‘just enough’ information to communicate the existence of significant past traumatic stressors.