1 00:00:00,102 --> 00:00:03,202 The most useful information in the therapy room is not what the 2 00:00:03,202 --> 00:00:07,322 client says with their words, it's what they say with their body. 3 00:00:08,332 --> 00:00:14,142 In this episode, we get into self-regulation, what it means to regulate 4 00:00:14,152 --> 00:00:17,082 yourself on a nervous system level. 5 00:00:17,452 --> 00:00:22,402 You'll learn two main ways that we do it, top-down using the thinking 6 00:00:22,402 --> 00:00:25,322 brain, and bottom-up using the body. 7 00:00:26,232 --> 00:00:30,412 Why top-down tricks maybe work in the moment, but don't 8 00:00:30,412 --> 00:00:31,672 solve anything on their own. 9 00:00:32,682 --> 00:00:36,672 And, uh, you'll hear a session with a client whose hands were saying 10 00:00:36,672 --> 00:00:40,012 something that her voice was not saying. 11 00:00:41,112 --> 00:00:45,332 I'm Justin Sunseri, a therapist, self-regulation coach, and Polyvagal 12 00:00:45,372 --> 00:00:47,792 Institute editorial board member. 13 00:00:48,442 --> 00:00:54,222 You're listening to Stuck Not Broken Book one, Trauma and the Polyvagal Paradigm. 14 00:00:55,112 --> 00:00:59,302 One quick note before we begin, this is an audiobook. 15 00:00:59,312 --> 00:01:01,502 It is meant to be heard in order. 16 00:01:01,792 --> 00:01:04,172 Each episode builds on the ones before it. 17 00:01:04,282 --> 00:01:09,672 So if you're finding this just now, welcome first off, but also, yeah, go 18 00:01:09,672 --> 00:01:14,092 back to the beginning, and this episode is gonna make a lot more sense once you 19 00:01:14,092 --> 00:01:16,502 have the context of the other episodes. 20 00:01:16,786 --> 00:01:20,696 And if you do wanna support the show or would rather read, this 21 00:01:20,696 --> 00:01:25,576 book and the next two are available now in both digital and softcover. 22 00:01:26,096 --> 00:01:27,936 I'll put a link in the description. 23 00:01:28,356 --> 00:01:32,996 And thank you ahead of time if you do choose to support the show financially. 24 00:01:34,436 --> 00:01:40,676 Now, last time we covered the vagal brake and the two skills 25 00:01:40,676 --> 00:01:46,026 that come from strengthening it, uh, pendulation and titration. 26 00:01:46,826 --> 00:01:51,546 This time we get into the main benefit of having a stronger 27 00:01:51,586 --> 00:01:54,116 vagal brake, self-regulation. 28 00:01:56,030 --> 00:01:56,820 Regulation. 29 00:01:58,290 --> 00:02:03,090 Regulation loosely refers to an individual's ability to reach a 30 00:02:03,130 --> 00:02:05,890 calm enough emotional baseline. 31 00:02:06,410 --> 00:02:11,400 There's way more to this on many levels, but this is the basic idea for now. 32 00:02:12,230 --> 00:02:16,940 Even if the person isn't entirely happy or social, we could say that they are 33 00:02:16,940 --> 00:02:22,170 well enough regulated if they can exert self-control over their behaviors. 34 00:02:23,170 --> 00:02:27,420 They have enough capacity to notice what's happening within them emotionally 35 00:02:28,160 --> 00:02:33,470 and can then use their conscious thoughts to self-soothe in some way. 36 00:02:35,040 --> 00:02:41,330 If somebody has lost access to their conscious awareness and their capacity 37 00:02:41,330 --> 00:02:47,730 to direct their behavior within the contextual rules and social norms, 38 00:02:48,650 --> 00:02:51,600 they are in a state of dysregulation. 39 00:02:53,090 --> 00:02:57,620 Their emotions, behaviors, and thoughts are out of control and have 40 00:02:57,630 --> 00:02:59,880 overwhelmed their conscious mind. 41 00:03:00,890 --> 00:03:05,900 These individuals have exceeded their limits to tolerate and to cope with 42 00:03:05,970 --> 00:03:07,480 whatever's happening inside of them. 43 00:03:09,060 --> 00:03:13,950 Autonomically, dysregulation looks like defense for a reason. 44 00:03:15,040 --> 00:03:20,460 The defensive states are overactive without the vagal brake to 45 00:03:20,500 --> 00:03:22,040 calm them and to contain them. 46 00:03:23,210 --> 00:03:23,980 Someone in dysregulation 47 00:03:26,650 --> 00:03:33,000 is anxious, avoidant, isolating, angry, rageful, panicky, overwhelmed, and more. 48 00:03:35,740 --> 00:03:36,950 Self-regulation 49 00:03:38,245 --> 00:03:43,215 Regulation isn't just about what someone does in the moment of need. 50 00:03:43,843 --> 00:03:48,383 It's also about creating the capacity to tolerate greater distress. 51 00:03:49,443 --> 00:03:52,913 Regulation within an individual is something that can be 52 00:03:52,923 --> 00:03:54,353 built and strengthened. 53 00:03:55,333 --> 00:03:58,213 On the individual level, regulation results from 54 00:03:58,213 --> 00:03:59,763 strengthening the vagal brake. 55 00:04:00,463 --> 00:04:01,553 That's self-regulation. 56 00:04:02,663 --> 00:04:07,073 Self-regulation is the ability of an individual to regulate their 57 00:04:07,073 --> 00:04:11,343 state, to stay anchored in safety, and to reduce defensive activation. 58 00:04:12,253 --> 00:04:16,523 You might know it as distress tolerance or the window of tolerance. 59 00:04:17,233 --> 00:04:22,023 The vagal brake is the underlying biological mechanism. 60 00:04:23,633 --> 00:04:28,383 Traumatized individuals have a more difficult time with self-regulation. 61 00:04:29,233 --> 00:04:34,123 They are stuck down their polyvagal ladder in a state of defense. 62 00:04:35,383 --> 00:04:40,043 They wouldn't be stuck if they could self-regulate into safety on their own. 63 00:04:41,633 --> 00:04:46,153 By definition, trauma is not only being stuck, but also lacking the 64 00:04:46,153 --> 00:04:49,143 capacity for effective self-regulation. 65 00:04:50,443 --> 00:04:54,833 In Path one trauma, self-regulation is difficult when freeze is triggered. 66 00:04:55,713 --> 00:05:01,623 In Path two, self-regulation is chronically a problem due to constantly 67 00:05:01,623 --> 00:05:04,673 existing in a stuck defensive state. 68 00:05:06,563 --> 00:05:12,463 There are numerous ways to self-regulate with no singular correct answer for 69 00:05:12,503 --> 00:05:15,033 any specific person or situation. 70 00:05:16,043 --> 00:05:19,823 Some things are generally helpful, like slowing your breath 71 00:05:19,823 --> 00:05:21,233 on the exhale from your belly. 72 00:05:22,473 --> 00:05:25,733 But this type of breathing isn't helpful when you're too dysregulated 73 00:05:25,763 --> 00:05:27,743 to breathe into your belly. 74 00:05:28,523 --> 00:05:33,783 I'll break self-regulation down into two main avenues: top-down and bottom-up. 75 00:05:36,388 --> 00:05:37,868 Top-down regulation 76 00:05:39,808 --> 00:05:43,438 Top-down regulation is from the brain to the body. 77 00:05:44,088 --> 00:05:49,088 Top-down uses conscious thoughts to increase emotional regulation directly. 78 00:05:49,868 --> 00:05:54,238 We tend to focus on this type of regulation in our more Westernized 79 00:05:54,688 --> 00:05:56,588 medical way of viewing mental health. 80 00:05:57,478 --> 00:06:02,168 We assume that if we can change the thoughts in our brain, our level of 81 00:06:02,168 --> 00:06:04,308 regulation will change along with it. 82 00:06:05,388 --> 00:06:10,568 And there is some truth in that, but it's definitely not the entire picture. 83 00:06:12,008 --> 00:06:14,518 Top-down regulation can be helpful, though. 84 00:06:15,458 --> 00:06:19,078 There might be things you're already doing that you find helpful. 85 00:06:20,058 --> 00:06:24,658 Some common practices are counting categorical objects or colors in the 86 00:06:24,658 --> 00:06:31,928 environment, counting backward from ten, thought replacement, reframing 87 00:06:31,928 --> 00:06:36,888 and normalizing, affirmation, or maybe just focusing on a game or a puzzle or 88 00:06:37,288 --> 00:06:38,818 phone binging just a little bit more. 89 00:06:40,498 --> 00:06:45,998 These skills direct your thoughts away from whatever is distressing you. 90 00:06:47,248 --> 00:06:53,028 They take your conscious attention away from the internal pain or the anxious, 91 00:06:53,578 --> 00:06:55,328 ruminating thoughts, for example. 92 00:06:57,038 --> 00:07:02,068 The problem with these grounding skills, if, if we wanna call them that, is that 93 00:07:02,068 --> 00:07:04,888 they don't solve the underlying problem. 94 00:07:05,958 --> 00:07:08,618 They can be helpful in the moment when you need them, sure. 95 00:07:10,058 --> 00:07:13,838 However, the problem will resurface because there's more to 96 00:07:13,838 --> 00:07:16,498 dysregulation than simply thinking. 97 00:07:18,752 --> 00:07:23,002 The other problem with this is that it can become a battle. 98 00:07:24,452 --> 00:07:28,422 When people use these cognitive techniques, they're trying 99 00:07:28,422 --> 00:07:30,842 to fight off other thoughts. 100 00:07:32,092 --> 00:07:36,082 In a state of dysregulation, it's difficult to maintain the thoughts you 101 00:07:36,082 --> 00:07:39,342 want and banish the ones that you don't. 102 00:07:40,522 --> 00:07:45,872 It can create a frustrating experience that ultimately makes things worse. 103 00:07:46,671 --> 00:07:49,521 I recommend using these top-down regulation skills 104 00:07:49,551 --> 00:07:51,651 as an initial intervention. 105 00:07:52,511 --> 00:07:55,421 Give yourself an affirmation or use a cognitive skill to 106 00:07:55,421 --> 00:07:56,891 distract yourself when needed. 107 00:07:57,741 --> 00:08:02,751 Once defenses are reduced enough, use bottom-up regulation skills. 108 00:08:04,997 --> 00:08:06,427 Bottom-up regulation 109 00:08:07,918 --> 00:08:10,608 The brain and body communicate with each other. 110 00:08:11,118 --> 00:08:14,468 We aren't simply top-down brain communication machines. 111 00:08:15,068 --> 00:08:19,388 Our bodies send signals to our brains, just like our brains 112 00:08:19,398 --> 00:08:20,678 send signals to our bodies. 113 00:08:21,538 --> 00:08:25,238 The vast majority of communication between the two goes from the body to the brain. 114 00:08:26,298 --> 00:08:29,908 If you want to get more technical, the brain stem receives both the 115 00:08:29,958 --> 00:08:32,508 top-down and bottom-up communication. 116 00:08:33,008 --> 00:08:36,458 It's that middle point that receives neuroreceptions 117 00:08:36,758 --> 00:08:39,238 and shifts polyvagal state. 118 00:08:40,738 --> 00:08:45,398 So bottom-up regulation is from the body to the brain. 119 00:08:46,288 --> 00:08:51,138 We can calm our emotions by sending signals from our body upward. 120 00:08:52,428 --> 00:08:55,838 Bottom-up regulation includes utilizing our muscles and senses 121 00:08:55,838 --> 00:09:02,298 or being consciously aware of and actually experiencing our emotions 122 00:09:02,988 --> 00:09:04,578 and our internal sensations. 123 00:09:06,328 --> 00:09:11,678 Central to bottom-up regulation is the ability to be consciously 124 00:09:11,678 --> 00:09:13,098 aware of what's happening. 125 00:09:14,648 --> 00:09:19,528 Regulating from the body doesn't mean we simply move around and 126 00:09:19,528 --> 00:09:21,248 that somehow that fixes anything. 127 00:09:21,938 --> 00:09:26,858 No, it means that we direct our conscious awareness to the experience 128 00:09:26,858 --> 00:09:29,398 of the body and listen to what it says. 129 00:09:30,958 --> 00:09:35,368 Conscious awareness of our experiences means at some point, maybe not 130 00:09:35,408 --> 00:09:42,518 immediately, but at some point that we actually feel our feelings and 131 00:09:42,518 --> 00:09:47,938 listen to the impulses the body has about what it wants to do next. 132 00:09:49,678 --> 00:09:52,278 Feelings are not just feelings. 133 00:09:53,328 --> 00:09:57,958 Being in a state of dysregulation is not random, even if it feels that way. 134 00:09:59,598 --> 00:10:03,858 And even if you can't identify a specific antecedent to the 135 00:10:03,858 --> 00:10:09,088 dysregulation, there's something in your system that needs to be felt, 136 00:10:09,618 --> 00:10:12,288 experienced, noticed, and listened to. 137 00:10:13,738 --> 00:10:17,798 There might be an impulse in your body to do something. 138 00:10:18,898 --> 00:10:23,808 And if you can mindfully attune to this, then bottom-up regulation can happen. 139 00:10:25,128 --> 00:10:31,478 As you feel and act on the impulse, the defensive state will shift, and 140 00:10:31,668 --> 00:10:34,668 Polyvagal ladder climbing can continue. 141 00:10:36,938 --> 00:10:39,438 Maria slumped in my office chair. 142 00:10:40,618 --> 00:10:42,558 She told me she felt nothing. 143 00:10:43,678 --> 00:10:46,788 She felt numb, disconnected, and empty. 144 00:10:48,048 --> 00:10:52,158 She was describing a state of shutdown, but said she didn't 145 00:10:52,158 --> 00:10:53,838 know why she felt that way. 146 00:10:55,118 --> 00:10:57,128 But her hands told me something different. 147 00:10:57,948 --> 00:11:02,218 Her hands were fidgety, tense, and squeezing each other. 148 00:11:03,598 --> 00:11:06,588 Unlike the rest of her, her hands had a lot of energy. 149 00:11:07,398 --> 00:11:11,378 The problem was Maria focused on the experience of shutdown dysregulation. 150 00:11:12,458 --> 00:11:17,008 She didn't focus on her body's attempt to self-regulate, starting in the hands. 151 00:11:18,528 --> 00:11:23,838 Yes, she was primarily in shutdown, but sympathetic fight activation 152 00:11:24,238 --> 00:11:27,158 was surfacing through her hands. 153 00:11:28,708 --> 00:11:33,008 I simply brought her attention to it and asked her to describe what she felt. 154 00:11:34,548 --> 00:11:37,938 Noticing and describing is not a complex intervention. 155 00:11:38,458 --> 00:11:42,818 It's really just prompting the conscious mind to focus on a particular experience. 156 00:11:44,098 --> 00:11:49,178 When she focused on her hands, she got very quiet and very attentive. 157 00:11:51,038 --> 00:11:55,598 She squeezed her hands a, a couple more times, and then they went still. 158 00:11:57,058 --> 00:12:02,698 She told me, "Something's happening. I feel the energy coming up my arms." 159 00:12:04,108 --> 00:12:09,138 As she continued to focus and describe it, she sat upright and her eyes widened. 160 00:12:10,058 --> 00:12:13,498 We continued the session and, and noticed that as the energy coursed 161 00:12:13,508 --> 00:12:18,948 through her, she eventually could smile and exist in her safety state again. 162 00:12:21,496 --> 00:12:27,766 Maria's example is a small, simple, momentary self-regulation story. 163 00:12:29,296 --> 00:12:35,836 Part of Maria's success was due to mindfully experiencing the self-regulation 164 00:12:35,846 --> 00:12:38,126 impulse within her to squeeze. 165 00:12:39,506 --> 00:12:40,736 But another part helped. 166 00:12:41,626 --> 00:12:43,736 She had somebody safe with her. 167 00:12:46,422 --> 00:12:49,912 That is self-regulation, top-down and bottom-up. 168 00:12:50,652 --> 00:12:53,182 Thoughts and body working together. 169 00:12:53,514 --> 00:12:55,794 Next time, co-regulation. 170 00:12:56,844 --> 00:13:01,124 What happens when someone else's nervous system does some of the 171 00:13:01,134 --> 00:13:04,184 regulating work for you or with you? 172 00:13:04,484 --> 00:13:08,124 If you want to take this chapter further, the written book has journal 173 00:13:08,124 --> 00:13:13,074 reflections for it, along with primary source quotes and no ads. 174 00:13:13,924 --> 00:13:18,104 It, and the next two books in the Stuck Not Broken book series, 175 00:13:18,744 --> 00:13:21,674 are linked in the description if you'd like to support the show. 176 00:13:22,314 --> 00:13:23,374 Thank you so much for listening.