Reducing Dysregulation

Join Dr. Regan for the second episode of a four part series on regulation and dysregulation on the autism spectrum. This episode focuses on three strategies to help reduce the frequency and intensity of dysregulation episodes for the autistic individual. 

 

Zur Institute webinar Feb 2022: ASD Interventions Across the Lifespan

 

Dr. Regan's Resources

Book: Understanding Autism in Adults and Aging Adults, 2nd ed

Audiobook

Book: Understanding Autistic Behaviors

Autism in the Adult website

Resources for Clinicians

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Hello everyone and welcome to this episode of the podcast,

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autism in the adult,

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I am your host,

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Dr Theresa Regan.

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I am a neuropsychologist,

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which means that I specialize in understanding how the brain impacts things like thinking,

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skills,

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emotions,

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behavior and personality.

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I'm the founder and director of an adult diagnostic autism clinic in central Illinois.

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And today we have the third episode in a series of four on the topic of regulation and dysregulation on the autism spectrum.

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In the first episode,

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we defined these terms where regulation is feeling just right in the area of alertness,

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attention and calm, and dysegulation is feeling too high or too low in these areas and when someone is not feeling centered with their emotions,

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they might have a fight, flight, or freeze reaction, and the freeze reactions might include shutting down,

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they might include physical expressions of stress, or what we call dissociation.

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Dissociation could include things like forgetting periods of time or feeling disconnected from the body or feeling that things around us are not real.

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In the first episode,

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we also reviewed that within the autism spectrum,

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dysregulation is more common than for those with different neurology.

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In the second episode of this series,

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we talked about how to reduce the number and intensity of dysregulation episodes by taking care of the nervous system on a daily basis using things like sensory inputs and other strategies and also watching how intense a life schedule the person is diving into.

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For our third episode,

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our focus will be on what to do when dysregulation hits.

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We all have dysregulated states... for the person on the spectrum,

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they may be more likely to have these and, even when we do all that we can do to support the nervous system,

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we're going to have periods where we're really not just right with regard to alertness or attention or emotional status.

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So when someone is dysregulated,

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they might appear to be sluggish or have difficulty getting going or unmotivated.

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That would be when their motor is running too low in the area of alertness and activation.

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This type of dysregulation is covered in previous episodes about exhaustion and autism, and momentum within autism.

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And I will post the links to these episodes below today,

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We're going to focus on the dysregulation that looks like anxiety,

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upset, anger,

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restlessness.

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These things that may manifest in fight, flight, or freeze reactions.

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So once there's a dysregulated state, there are things that I would recommend not doing and things that I would recommend doing.

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So we're gonna start with this category of what not to do.

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Many of the things that we have an instinct for when someone is dysregulated actually may make things worse.

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So what do we tend to do?

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Well,

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we might ask the person to talk about how they're feeling,

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why they're feeling that way,

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what triggered this really strong emotional reaction.

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We may reason with them about why they should be feeling or reacting differently.

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We might say things like,

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"Well they didn't mean it" or "it's not a big deal,"

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"don't overreact", or "it's your own fault because you know you did this rule breaking activity and now you have a consequence." Or number three, we may tell them to regulate better.

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So we may say to them calm down,

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don't yell,

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look at me while I'm talking to you ... when someone is overwhelmed by what is happening around them or within their own system.

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It's really not likely to be helpful in that moment to add demands to this person who's already overwhelmed.

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For the person on the spectrum,

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it's already going to be effortful for them to figure out what their emotions are,

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what triggered them, and to talk about them face to face and eye to eye with another person.

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And we also see that it takes effort to reason in the moment, to talk ourselves down, to try to regulate ourselves.

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Um and so it's probably not only not realistic for them to be able to do that when overwhelmed,

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but talking to the individual who's overwhelmed also just adds stimulus,

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It adds demand,

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it adds noise.

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And so to the extent that talking is just adding stimulus to the situation,

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I really would recommend being calm,

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being quiet.

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Not necessarily engaging with the person in the moment that they are overwhelmed.

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So in general I find it helpful to reduce talking at that point of dysregulation unless there's a safety issue that you're trying to quickly address but otherwise um I really would not recommend a lot of talking and reasoning and explaining during that period of time

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Other things that I would recommend not doing would be ... I would not take away possessions from them at this time.

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So don't try to take something out of their hands.

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Don't try to take something away from their space or their room...

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the place where maybe they find comfort. Objects are often very important to the individual on the spectrum.

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And when someone's dysregulated and overwhelmed,

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it's often not a good time to try to separate them from something that's that important to them.

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Likewise touching them or wrestling with them ...kind of getting into their space.

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Um It's generally again going to add stimulus to what they're trying to process.

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So now I have touch-stimulus, and I have people in my space, and that is often likely to increase this dysregulated state.

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Again just kind of thinking how much information is coming at this individual who's already overwhelmed.

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So it's a lot of stimulus to come at them all at once, and to be in their space or to take away some of the possessions that are important to them...

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So during a period of dysregulation,

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the general concept to follow is that reducing stimuli and demand in that moment may help the individual become better regulated, but adding things that are stimuli to them that they have to process ...

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adding your speech, adding...

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being in in their space,

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taking away things that are comforting to them...

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that's likely to increase the dysregulated state.

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Another thing that you can do to help not increase this escalation of being overwhelmed is don't respond to the individual with heightened emotion.

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So emotional atmospheres can feel very intense and overwhelming to the individual on the spectrum.

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And when the person is already overwhelmed by their own emotions, it's really even more overwhelming if they have to react to and process your emotion that is coming toward them... it adds so much... this feeling of being overwhelmed.

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I would recommend staying very calm and even and predictable.

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I would make sure not to respond with reactivity, or unexpected statements or behaviors that they also have to react to and process.

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If you do approach the person with high reactivity,

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you're really asking them again to deal with a lot of new unique intense stimuli coming at them and to deal with your reaction as well as their own.

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And this is likely to increase this escalation of ... you know, feeling so upset or dysregulated.

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The goal that we've talked about so far is this goal of reducing what the person is having to process in that moment when they're already dysregulated.

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We'd like to take away some of the intensity of the situation to help them be able to recenter, to regroup, and in addition to reducing intense inputs around the individual.

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The focus should be on adding inputs that are regulating, that are calming, that are centering... these may be things like sensory inputs.

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And we talked about some of the strategies for this during the last episode.

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But, for example, an individual on the spectrum may really like pressure inputs or movement inputs.

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So an individual when dysregulated may be calm or help center themselves when they use a weighted blanket, or maybe they know that if they soak in a tub,

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they feel a lot more centered after that.

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Some people recenter by lifting weights,

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doing yoga,

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swinging ... these pressure inputs into the muscles and joints and the movement that the body has through space when it's doing things like swinging or bike riding.

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Those experiences may be calming,

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they may be centering for the individuals so if you can add calming and centering inputs without talking,

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this can really help getting back to a regulated state.

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And the second thing that can be centering for the individual is being able to do something that's soothing or filling for them.

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So thinking about this individual,

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what do they lean towards doing ... that

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they seem to find rejuvenating.

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Someone may really feel calmed and soothed when they are building a model of a boat or a car or when they're building something with legos,

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another person may love sorting through their collections or sorting through images on Pinterest,

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looking at various colors that are so ... they're just so compelled by these colors,

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they capture their attention and it's almost like they just fill,

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fill this person up ... and they feel so rejuvenated.

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A third person may love to listen to history podcasts or to watch a favorite movie,

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even one that they've watched 100 times,

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It may be their go-to movie when they want to regroup and settle back to the center.

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In these moments of being uncentered and wanting to recenter,

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it's very likely that familiar things will be more calming than new things.

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So um a lot of times if people watch what they're drawn to on a difficult day,

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it may give them this information.

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This when they're a detective about their own reactions, about what they go to when they do need to have a recentered moment.

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And one person may know that on difficult days they tend to watch the same particular movie or another person may know that on difficult days they tend to go for this same food pattern of eating that this is their go-to when they want to soothe and calm and recenter so far.

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We've talked about the importance of reducing stimuli and demand during a dysregulated episode and the impact of increasing familiar and soothing inputs during these episodes ... because the first goal that we want is for a recentering ... The final thing I would recommend is that the individual and those who are family or friends should try to work out ahead of time

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some type of game plan,

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a strategy for coping when the individual is dysregulated. Because during that episode, the brain is overwhelmed and it's not going to be great at thinking "What should I do?"

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You know,

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what should I do during this episode to feel better?

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So all this detective work ahead of time about what is calming and soothing and filling to me, and what is draining and overwhelming ... can be done ahead of time.

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People do it all different ways.

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Some of them make a list that they can look at when they are dysregulated ... of things that they can do to feel more centered.

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Oh yes,

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you know,

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I wouldn't have thought of this,

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but I can take a walk outside of the weather permits and I actually do feel better then.

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Sometimes people make a box ahead of time of items in it that are soothing.

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They might have a lava lamp in there that they can just watch,

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they might have a stress ball.

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Uh there might be slime or different scents like lavender or vanilla that are soothing or calming.

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So this detective work ahead of time can be really helpful and then adding cues to the person

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either from familiar people who can say,

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hey,

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I wonder if it would feel good for you to do this or to have it in the environment,

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like a list or a box of items...

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Ideally the individual will have a sense over time of when a dysegulated state is coming on.

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So for example,

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if they lean toward starting to shut down or disassociate during difficult times or difficult conversations,

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they may start to catch themselves when their mind starts to go blank and they're talking to somebody.

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They also may have a sense over time of when this happens at home,

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it often helps me to do these kinds of things-- and when it happens in public,

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I've learned to do these other kinds of things.

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Being able to recognize dysregulation, know

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what you can do to help recenter, and getting to the point where you can communicate briefly to other people around you about what's happening...

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that can really add another layer of growing into maturity with these strategies ...That, as we communicate with other people,

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we can really stabilize these situations and these relationships.

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So for example,

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if you are becoming dysregulated during a meeting at work, and you realize that you're headed for a meltdown,

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it's generally very acceptable and professional in most work settings to step out...

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if you offer some type of explanation...  walking out of the room without explanation would not be considered okay or professional,

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but someone may use a very generic explanation and just say,

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"You know,

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I'm starting to not feel very well,

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I just need to get some air" or the person may have the kind of relationship with their boss where they've discussed some things already that helped them in intense situations at work.

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So in that case the person might say,

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"You know,

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I can see that I'm really feeling passionate about this topic,

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but I also want to be able to hear what you have to say and ways in what your opinion is different from mine.

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And I think I just need to step out to regroup for a few minutes,"

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or if the strategy has to do with reducing the intensity of the conversation and a few minutes of stepping out is probably not going to be enough to regulate.

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They may say to their boss,

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"You know,

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I can feel myself getting really passionate about my own opinion,

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but I know that your perspective is important too,

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and I'm wondering if I could take time to gather my thoughts and to send them to an email so that I've kind of processed them and they're organized.

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I'd really love for you to hear them,

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but I also would like to read your thoughts.

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If you could send them to me.

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I find that a lot of times when I'm processing information that's really important to me having time to mull it over and having some time to get organized with my thoughts before a discussion with my colleagues really helps.

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Then I would like to come back and talk more about our opinions and talk them through."

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Sometimes the addition of time to process and removing this face to face intensity of the moment can help a person stay centered while still communicating about difficult things.

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So this could be a technique that's done in a workplace,

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in a school setting, or even just as part of a friendship or partnership when you're both having this intense conversation about something that you disagree on.

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But it's very important,

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you know,

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being able to have time and space to process before you come back together can help stabilize that interaction.

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It especially helps if you can let the other person know that the reason you're stepping back is because you do want to be able to process differing opinions and that their their opinion is important to you,

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even though you disagree with it.

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Um that it kind of helps show that you want there to be a good exchange.

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If you're walking out,

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sometimes people feel like they're not even committed to a good exchange.

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So what ... what good is this partnership?

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But if you can say it's because I really want to process things well, and I really want to hear your thoughts even though I can feel myself getting too passionate about the topic right now.

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Sometimes that puts in perspective that this is someone that does want to make this exchange of ideas work.

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That is a summary of someone who has gone on a long journey of figuring out what it feels like to them when they're dysregulated ...

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what kinds of things they can do to try to salvage that interaction and recenter in particular settings, and how they can communicate that to other people with experience and detective work and being mindful about kind of planning and sorting these things out the individual and those around him can develop communication about the strategies that work best and knowing these things and communicating about them can stabilize different interactions over time.

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So we've talked now about several ways to approach periods of dis regulation.

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One thing I will end up emphasizing here is that these are all general statement and of course there are also exceptions to every general principle and I can't address every type of situation,

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but all I can say certainly is that these are general things I've noticed that do help or don't help.

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Focus should also always be on the person's safety in that moment,

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if there's something unsafe that needs to be stopped,

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that's really something to immediately intervene with.

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But in general reducing stimuli and demand and increasing soothing inputs can be really helpful.

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I don't want to leave the impression that I don't think the autistic individuals should ever experience challenge in his or her life.

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So we all benefit from this appropriate level of challenge with support and that helps us grow, and the topic during this episode happens to relate to whether adding challenge and demand to the individual while they're dysregulated is generally fruitful ... and that's when I think it's just the wrong timing.

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So challenge should be added when the individual is fairly centered and regulated, and that's why working on regulation first can be beneficial --

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so that goals with some challenge can be added once regulation has improved.

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Now our next episode will be the final in our four episode series on regulation and dysregulation.

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In the 4th and final episode,

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we'll talk about how to recognize when someone is trying to regulate themselves, and what to do and not do in those situations.

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So thank you for joining me, and I hope to catch you next time for the final episode of the series on regulation.