Dysregulation and Stress Response provided by Ryan Slobodian, MC, CCC, CSAT from EHN Canada

This was a great refresher for me which I will share. I also learned a few things and some sparked some info of my own which I will share. First I would like to share that I really enjoyed this session. Also if any of my peers want the slides, just ask. The speaker provided an example of a military member, after a few over seas tours, eating at a restaurant and having a terror response when a car backfired. That made me think of how any police person who sits in a restaurant is always mindful to have his or her back against the wall to view the opening of someone entering. This is often misconstrued as a result of trauma. I would say this is very much in tune with training and experience as a safety precaution. There is a difference to being safety prone and experiencing a terrifying response, such as this soldier experienced. He spoke about ADHD patients who were using cocaine to regulate themselves. I find that more often than not, unfortunately, clients have more faith in street drugs than actually going for a diagnosis and getting the medication they need. Medication and diagnosis is all too often thought of as a weakness and there is also a mistrust of the system. Self medicating with alcohol and drugs from the streets have them sometimes think, that they can quit anytime and take as much or little as they need. Unfortunately we have too many deaths now a days to refute that. The speaker also talked about couple therapy and how emotional it can be the first few sessions rather than provoking thought. I can attest to that. It is a rarity that someone comes to me in couple therapy or even family therapy, where tensions are not high. Everyone thinks they are right and emotions are triggered and it does take time to diffuse all that anger. Sometimes it can be directed at the therapist (transference). It is always imperative for the therapist not to have that trigger anything in response (countertransference). The speaker spoke of triggers and to process it. He spoke of the fight and flight response most of us have knowledge of. In the freeze response our heart is beating quite high. He spoke about the fawn response which is appeasing, one adapts to the environment to keep safe. He used an example of a guy constantly being beaten by his brothers. He therefore uses manipulation as a safety feature. You may ask, “how is it keeping you safe?” . Then he mentioned faint/flog and this I have to admit was new to me as a trigger concept (as well as fawn. I am used to fight/flight and freeze as a part of my own studies.) Faint/flop is a surrender and at the extreme one totally shuts down. This made me think. One of the things I have studied pertaining to therapists is how they sometimes fall asleep in sessions. I used to think that this was terrible. That is because I always looked at it from an ethic perspective. As a therapist you should live what you preach, sleep well etc….and be alert for your clients. I thought that until I met a therapist at a seminar years ago and she told me how overwhelmed she once was by what a client was telling her that she passed out. She was horrified. Now I understand. This is not fight/flight/freeze or fawn. This is faint/flop. I don’t know if I shall ever meet that therapist again because she is from out of town, and everything is on line these days because of COVID, but this also is a pointer for me to not judge, not even my peers. Therapy, science, knowledge is always a growing sphere. When one is triggered there is a memory activation. The speaker has worked with men taking care of their mothers. How to fix mom? Who to be there for her today? When one is triggered, they should go into an area where it is safe. If triggered, regulate first. Once regulated, relate to others. Regulate by breathing, mindfulness, tapping, music, dance etc…incorporate that daily. Unfortunately I find that challenging for clients to keep up, but it is very important and so basic. For the military vet, he or she may be super vigilant even where there is no danger. Note that “super” being the operative word. There is work to be done to get used to being calm. A compassionate approach should be utilized. Utilize exposure treatments. Now, I shall stress that if someone is going to do this, they should be therapists. In one province which is not regulated I was informed by a vet, that he was placed in a room, by himself to watch war movies. I couldn’t believe it. Of course there were consequences and ultimately I advised him to get a good lawyer. I know that there are provinces where there is very little training and that needs to change. So much damage can be done. The speaker continued to state that it could take 20 sessions to trust a therapist. A client may also have been abused by a therapist. There is physical health, emotional health and spiritual health - trauma detaches from spiritual health. There is connection to self and others (shame disconnects). The speaker stated that hope is essential and I most fundamentally agree. He said that stuff is going to repeat and it is about getting on the next highway. Curiosity is important. Identifying triggers. eg - cologne triggered a man who was abused by is father wearing cologne. I have heard Vets sharing how difficult it was when bbq triggered the smell of burning bodies during war. Emotional pull is very powerful because it has kept them safe for so long. Even though it is understood, there is a need to make changes. The speaker mentioned regulating with peers, teaching emotional regulation skills, developing a daily grounding practise, mindful awareness of emotions and body sensations. Identify the triggers, understanding procedural learning ( such as masks). Police and EMS should have grounding techniques. De-briefing groups after an event and have mental health resources. Peer support - going for a drink is not good because it connects alcohol to feeling better. A person getting angry all the time - learning to deregulate, children abuse, soldiers overseas. What do you think?