The Window of Tolerance and PTSD

The Window of Tolerance and PTSD

Post Traumatic Stress Disorder (PTSD) can make you feel very helpless. At times you can feel you have no control of your emotions, thoughts, feelings and actions – however understanding more about how and why the brain works in the way it does, can provide comfort and feelings of empowerment over the condition. If if you know why you’re experiencing the symptoms you are, you can be one step closer to managing them too.

One incredibly helpful tool in understanding PTSD and it’s effects on the way you think and feel is ‘the Window of Tolerance’ – a concept to describe the ‘optimal zone of arousal for a person to function in everyday life’.

Living in your Window of Tolerance

The Window of Tolerance refers to the zone you can be in when your emotions are balanced and controlled, and you are thinking clearly and reacting rationally – you’re functioning at your most effective. When you are in your Window of Tolerance, you can manage everyday life well, including planning ahead, stress, pressure, and defusing perceived ‘threats’ to your emotional balance.

If you’re in this optimal arousal zone, you:

  • Feel and think simultaneously
  • Experience empathy
  • Feel ‘present’
  • Feel open and curious (versus judgemental and defensive)
  • Have awareness of boundaries (yours and others)
  • Your reactions adapt to fit situations
  • You feel safe

For some people, this Window is wide, and it takes a lot to drive them beyond it – they can manage stress and emotions quite easily. However, for people with PTSD, this Window of Tolerance can be much narrower and it can feel that more emotions and situations are intense and difficult to manage (find out how the brain can be changed y trauma here).  A narrowed window of tolerance may cause people to perceive danger more readily and react to real and imagined threats with either a fight/flight response (they go above the window) or a freeze response (they go below the window) more often and with more intensity than they used to expect.

What’s on either side of a Window of Tolerance?

Arousal is a word used to indicate your level of sensitivity. When you’re ‘inside’ your Window, your sensitivity (arousal) is regulated.

If you’re above your window, you’re hyperaroused, and if you’re below it, your hypoaroused.

In either of these states, people find it hard to process the world around them effectively. ‘The prefrontal cortex region of the brain shuts down, in a manner of speaking, affecting the ability to think rationally and often leading to the development of feelings of dysregulation, which may take the form of chaotic responses or overly rigid ones. In these periods, a person can be said to be outside the window of tolerance.’

In someone with PTSD, because their window might be so narrow, something ‘seemingly’ innocent or trivial to others, may tip them into hyper or hypo arousal very easily – these are often known as triggers.

Hyperarousal

When something stresses, upsets or frightens you, or you have a reminder of a traumatic memory, or specific emotion, your arousal level heightens, and you can tip outside of your window upwards, and your whole body can go into ‘alarm’ mode. This is called hyperarousal. (Hyper means higher than normal.) You may not feel in control of your actions and can get ‘stuck’ in this phase for quite some time making it difficult to sleep, manage emotions and concentrate. Physically, your body may be tense and on the brink of an ‘explosion’, which can result in angry outbursts and hostility.

This could appear as an instinctive flight or fight response, extreme distress, anger, feelings of being overwhelmed and flashbacks to trauma. Hyperarousal can occur quickly, and be hard to prevent or come back from and you may experience:

  • Angry outbursts and impulsivity
  • Fear
  • Flashbacks
  • Tension/shaking
  • Anxiety
  • Unable to rest
  • Emotional overwhelm
  • Racing thoughts
  • Feeling unsafe
  • Sleep issues
  • Panic
  • Defensiveness
  • Hypervigilance
  • Intrusive Images
  • May be very difficult to be in busy or crowded environments
  • Difficulty concentrating
  • Tight muscles
  • “Deer in the headlights” freeze

Hypoarousal

At the opposite end of your Window of Tolerance is a state of hypoarousal. (‘Hypo’ means less than normal.) – this is due to an overloaded parasympathetic nervous system.

Like hyperarousal, it can often ‘be triggered by feeling threatened, recounting traumatic memories, or feeling emotions associated with past trauma. Even a perceived threat can be enough to send you into shutdown or even dissociation’.

In this instance, you dip down outside your window of tolerance, and your reaction to a perceived threat or deep distress could be a natural instinct to freeze, shut down and become emotionally withdrawn. Hypoarousal can manifest as physical lethargy, emotional numbness and not wanting to talk to people or carry out tasks you normally enjoy and you may experience: 

  • Depression
  • Emotional numbness
  • Emptiness
  • Feel disconnected
  • Low energy
  • Flaccid body
  • Memory loss
  • Shut down
  • Physical lethargy
  • Disabled cognitive processing ‘I just can’t think’
  • Blank stare
  • Feelings of shame
  • Inability (or lack of desire) to speak
  • Dissociation
  • Slow digestion
  • Blood pressure may drop

Managing PTSD and your Window of Tolerance

‘I think of the Window of Tolerance as the ultimate compass for the healing journey. Most trauma survivors spend a lot of time on a superhighway to hyperarousal or hypoarousal. Perhaps you’ve experienced rapidly changing emotions — ‘going from zero to a hundred’ — to a state of anger/rage, to a state of panic, or to being shut down and numb. Maybe you have heard this said about you, or you describe yourself that way. Think of developing your Window of Tolerance as getting off that superhighway of rapid defence response.

Instead, you start a new path towards a more peaceful YOU. Maybe it starts as a tiny path. You get a little way in the Window before something startles you back to your rapid and automatic response to threat. That’s okay!

The more you practice living within the Window of Tolerance, and the more you identify when you are outside the Window, the wider the new path becomes. You’re less often on the superhighway, and more often on a peaceful path of your own creation. And that’s a nice journey to be on.’

So, if you have PTSD, you can use the concept of a Window of Tolerance to focus on three things.

  • How can you stay within your Window?
  • How can get back within your Window, when you start to experience hyper and hypo arousal?
  • How can you widen your Window?

Let’s look at each one. Keep in mind that you may need the support of your therapist, to achieve these goals.

Staying within your Window of Tolerance

Everyone’s experience of trauma is uniquely their own, and the things that can upset and trigger you on a daily basis are equally personal to you.

However, by gaining self-awareness of your triggers and stress points, you can take steps to manage or avoid them, to keep inside your ‘calm space’ or Window of Tolerance. Grounding and mindfulness can also help people remain in their window, in the present, by calming and soothing themselves enough to effectively manage extreme arousal.

What can help is incorporating practices into your life which start you at a good point, and ensure that you’re well within your window to begin with.

The Window of Tolerance Guide shares some of these practices for being in the ‘here and now’ and to help you stay within your window. ‘These exercises take less than a minute to do. They’re great in the morning when you just wake up, or as a break from work — anytime throughout the day — as a way to increase emotional regulation and relaxation.

  • Centering Exercise Put one hand over your heart, and rest your other hand on your belly. Lengthen your spine. Take several full, slow breaths. Notice the fullness of your body as you let your breath come and go.
  • Grounding Exercise Stand, in a relaxed position, focusing attention on the sensations in your feet. Put weight on different areas of your feet: front, back, sides. Then play a bit with movement — bending your knees, moving up and down. Sense the ground through your feet and legs.
  • Alignment Exercise Take a little time to become aware of how your body aligns in a vertical direction: your ankles on top of your feet, your legs on top of feet and ankles, the pelvis resting on your legs, torso on pelvis, your head supported by shoulders and torso, arms hanging off your torso. Then imagine that you are being lifted by the top of your head. Also imagine the feeling of gravity pulling in the opposite direction on the bottom of your spine. Next, shift from feeling stretched to allowing your spine to collapse. Repeat several times these two movements with the flow of your breath — expand on the inhale, and then collapse on the exhale.
  • Walking Exercise Bring all your attention to your body as you walk (and out of your head and worries). Notice how your feet hit the ground, how your feet roll, the movement in your knees, and corresponding sensations in your hips and shoulders. Play with your usual gait. Practice pushing off with your feet, or walking at different paces. Notice the corresponding changes in body sensations.

The following simple breathing exercises are also great to do throughout the day, whether during your commute, waiting in line, transitioning between work and play, or when giving yourself the ultimate treat — meditation!

  • “Simple breath” Imagine while you are inhaling that your breath is going all the way down to your pelvis. Then let the breath expand in your lower belly. When you exhale, let the breath escape effortlessly. Repeat 5 to 10 times.
  • “Bell jar breath” Inhale a breath. When at the top (or end) of the inhale, imagine a rounded quality. Then let the inhale roll over into the exhale. Notice where the breath rolls — front, back, side to side (wherever it seems to go). Repeat 5 to 10 times. This breath is also useful when feeling hyperaroused.
  • “4 x 4 x 4 breathing” Inhale deeply for four counts, then exhale for four counts, and repeat the cycle for four minutes several times a day. I find this a good practice to do before starting work or appointments, and while commuting. It’s also a great way to get back in the Window of Tolerance after stressful experiences. You can use your smartphone to time yourself so you can give full attention to your breath.’

When hyper and hypo arousal starts – how to get back within your window

Growing your self-awareness can also help in identifying the first signs and symptoms that you are becoming alarmed, worked up and overwhelmed due to hyperarousal, or beginning to shut down due to hypoarousal.

Knowing what can help you ‘tip back’ inside your Window, can help immeasurably.

For example, Music can help some people prevent hyperarousal – it can calm and ground them. However, music can help at the other end of the scale too. When you feel the beginnings of lethargy and a desire to hide away, lively music can lift you.

If you feel yourself tipping out of your window, you can try these techniques to help get back in your window (but bear in mind, that different things work for different people)

  • If you feel hypervigilant ‘Lengthen your spine while taking full breaths. Pay attention to the rise and fall of breath as it alternatively fills and empties the chest and/or belly.’
  • Release your anger (try one of these)
    • give yourself a 10-second hug by wrapping your arms around yourself and holding tightly
    • stretch your arms out in front of you to relieve that tension built up
    • shake it off to relive that stress
    • take a drink of water to cool yourself down and calm your nerves
  • Breathing exercise: Pause for a moment, take a long and slow deep breath, inhale with your nose and fill your lungs, hold the breath for 3 seconds, exhale with your mouth and count each breath and do at least 10 deep breaths
  • Meditate: Being mindful and meditating go hand in hand as it helps to regulate emotions and thoughts and relives stress by calming you down
  • Using thoughts ‘Name your reaction to yourself as a defense response, thus reframing the experience. Say to yourself, “This is just a memory,” or “I’m just triggered right now.” You might also try saying to yourself, “I can be here — right here, right now.”’
  • Practice yoga: Yoga is the practice of controlling the mind and body and can improve your concentration, reduce stress and relieve any physical tension built-up
  • If you feel the impulse to hurt yourself or someone else ‘Push against the wall without aggression, and instead focus with awareness on a sense of grounding, starting with your feet and then moving through your body. Breathe full breaths, and keep bringing your thoughts back to your body sensations and away from the focus of your desperation, anger, or rage.’
  • Feel less overwhelmed ‘Sit in a chair with your feet fully planted on the ground or stand with your spine fully extended. Then slowly scan the environment, naming the objects within your field of vision’
  • If shaking or trembling ‘Take full, yet slow and easy breaths. No need to breath too deeply, though. If you can, sit in a chair or on a sofa, and wrap a blanket or comforter around yourself. Some people feel better if they also cover their heads’
  • If your heart rate increases ‘Take your attention away from the heart region by paying attention to the sensations in your feet. Notice the feeling of being grounded and connected to the floor or earth beneath you.’

When you experience hypoarousal symptoms you can activate your body with these techniques:

  • Activate your senses (tap into your five senses) perhaps with a 'warm bath, massage, aromatic candles or scents, music or natural sounds or tasty food'
  • “Shaking off the freeze” ‘Begin by slowly jumping off the ground, and shaking the arms out when feet land back on the ground. Take full breaths, mindfully inhaling when you jump, and exhaling fully when your feet land back on the ground. You can also say something to yourself like, “I’m safe. I’m letting go.”
  • Grounding exercises - you can find many 'tried and tested' grounding techniques from people with PTSD & C-PTSD here.
  • If you feel numb ‘Gently squeeze your forearms with opposite hands. Also increase awareness by noticing the environment through the five senses. What do you see, hear, smell? If you can, try touching or tasting something mindfully.’
  • If you have a ‘collapsed’ feeling in the body ‘Try pushing firmly against the wall with your arms fully extended, your head up, and using your energy to ground down through the feet. Notice the feeling of sturdiness in your body as you push.’
  • If you feel disconnected or are experiencing depersonalisation ‘Start by slowing the pace of whatever you are doing. Then firmly but gently squeeze the forearms, calves, thighs — whatever feels enlivening to you. Try also “Walking Exercise” above.’
  • If you feel frozen or panicked ‘Sit comfortably in a chair or sofa, and wrap yourself in a comforter or blanket. Begin to focus on taking full, slow breaths, continually bringing your thoughts back to the present moment. Create a mantra for such moments, such as “I can be present and watch the waves of energy go by without getting caught in the story.”’

Expanding your Window of Tolerance

From a growing awareness of the above two points, comes information you can use to make your tolerance levels stronger and wider.

For someone with PTSD, this is where therapy like CBT can be a great help. This is because you may need professional intervention to undo some of the changes that trauma has created in your brain, and to defuse triggers.

With activities and therapies such as yoga, meditation, martial arts, surfing, running, Tension & Trauma Releasing exercises, Journalling, and Tai Chi  you can increase emotional regulation capabilities which can lead to a wider window of tolerance and prevent dysregulation.

An important thing to remember is that most therapists will make sure you are sitting comfortably and safely ‘in your Window’ before they start. This provides the best opportunity for making progress with sustainable healing, as you will be more responsive and have clear thoughts – so staying within your window in everyday life is equally important. 

There are a variety of ways we can increase our window of tolerance and we especially love these ones from the Mind My Peelings blog:

Practice Mindfulness

Being mindful helps to deal with undue stress and emotions by paying attention and staying in the present moment. It’s not about stopping any unwanted stress or anxiety, but rather allowing those moments to pass without your body reacting in a negative way.

You can practice mindfulness by:

  1. Building Awareness
    • focus your attention
    • identify what you are feeling
    • ask yourself why do you feel that way
    • question why those feelings matter
  2. Be More Open
    • let yourself feel everything, be open to both positive and negatives
    • don’t push away unpleasant thoughts or emotions
    • let negatives flow and pass through your mind
  3. Be More Accepting
    • accept feelings of both positive and negative experiences
    • avoid judgment or censoring of your thoughts and feelings
    • don’t be ashamed, embrace it instead
  4. Be Present
    • stay in the present moment and focus on what you are currently doing
    • pay attention without judgment
    • avoid multitasking as this is mentally draining

Increase Happiness

There are four happiness chemicals that your brain releases when you feel good. These chemicals are known as DOSE. When you are happy and have a positive experience, your window of tolerance will naturally expand.

By understanding how each of the chemicals works, you can trigger the release of one of the chemicals to improve your happiness.

Here are some examples of activities you can do to “Get Your Daily DOSE of Happiness”:

  1. Dopamine
    • make a to-do list (each time you tick off a task you increase dopamine levels)
    • create something such as writing, music, arts and crafts
    • meditate
  2. Oxytocin
    • physical touch, cuddling, hugging, and even eye contact
    • socialising with friends and family
    • listening to music
  3. Serotonin
    • getting sunshine outdoors
    • cold showers
    • getting a massage
  4. Endorphin
    • laughter and crying
    • eating dark chocolate or spicy foods
    • creating music or art

Reduce Shame

It is common for everyone to experience shame from time to time. But if you are constantly feeling embarrassed and self-critical, it can be debilitating to your mental health.

Here are five simple steps to reduce shame:

  1. Name your shame
  2. Listen to how you speak to yourself
  3. Write about your shame
  4. Tell someone you trust
  5. Reframe it by using affirmations and self-compassion

Build Resilience

Resilience is important for adapting in the face of adversity, trauma, tragedy, or stress. Building up your resilience will directly expand your window of tolerance and improve your ability to deal with difficult life experiences.

  1. Build Connections
    • prioritise relationships by connecting with those close to you
    • join a group and build one-on-one relationships
  2. Foster Wellness
    • focus on all three aspects of health, not just one or two of them (physical, mental, and social)
    • Avoid negative outlets (masking your pain with substance abuse)
  3. Find Purpose
    • look for opportunities for self-discovery
    • take steps towards your goals (long term and short term goals)
    • embrace change and be optimistic
    • help others (supporting a friend, volunteering, connecting with support groups)

Physical health and your window of tolerance

Finally, it’s important to realise that your general health plays a role in this concept too. For example, does someone you know become ‘hangry’? This term was coined for getting cross when you’re hungry – and you can see how your physical feelings can also hugely impact your emotions. 

Clearly, your Window of Tolerance will be easier to manage – and you can self-regulate more successfully – if you get sufficient sleep, good nutrition, fresh air and exercise. Not always easy with other PTSD symptoms, but where you can, try to prioritise these and you’ll feel the benefits throughout your life.


It’s important to note too, that while choosing your PTSD recovery path you need to address both the symptoms and the underlying condition.

NICE guidance updated in 2018 recommends the use of trauma focused psychological treatments for Post Traumatic Stress Disorder in adults, specifically the use of Eye Movement Desensitisation Reprocessing (EMDR) and trauma focused cognitive behavioural therapy (CBT).

Please remember, these aren’t meant to be medical recommendations, but they’re tactics that have worked for others and might work for you, too. Be sure to work with a professional to find the best methods for you.

 

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