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Guest Blog | The Window of Tolerance


We are so grateful to Cliona Vaughan - relational integrative counsellor, for putting together this article explaining the 'Window of Tolerance'.


Striking a chord - supporting a loved one with cancer

When Jo, CancerPal's founder, was supporting her Mum through cancer, she found that she was far more irritable and short-tempered than usual and whilst these feelings were completely understandable, and to be expected, given the situation, she used to get even more frustrated with herself if she snapped at friends, family members and sometimes her Mum. Cliona explained the 'Window of Tolerance' to Jo and it immediately resonated. She began to understand her emotions, recognise what was happening to her and most importantly identify strategies to help her cope and ultimately stay within her own Window of Tolerance. We really hope this article will help you do the same, whether you have been diagnosed with cancer, or are supporting a loved one through their diagnosis.


Introduction to the Window of Tolerance

The Window of Tolerance is a model founded in neuroscience (the scientific study of the nervous system), which is commonly used to understand and describe normal brain/body reactions.


The concept suggests that we have an optimal arousal level when we are within our Window of Tolerance that allows for the ups and downs of emotions experienced by human beings. We may experience hurt, anxiety, pain and anger that brings us close to the edges of our Window of Tolerance, but generally we are able to utilise strategies that keep us within our Window. Similarly we may feel exhausted, sad, or shut down for a period of time but we are generally able to shift out of this.


Times of stress and crisis, like a cancer diagnosis, can drastically disrupt how we function. Adverse experiences often mean that our emotions are heightened and our Windows of Tolerance shrinks meaning that we have less capacity to ebb and flow and a greater tendency to become overwhelmed more quickly.

If you are going through a cancer diagnosis yourself, it can be helpful to understand your Window of Tolerance and what it looks like when you move outside of your Window as well as learning some strategies to help you move back into your Window as quickly as possible.


If you are supporting a loved one going through cancer, it can be helpful to recognise your loved one’s Window of Tolerance. Recognising the signs that someone is struggling with their emotions, helps us to better support them and using the Window of Tolerance is one way of doing this. However it’s important to understand where you are in your own Window of Tolerance before you consider supporting another person.


What is the Window of Tolerance?

Developed by Dan Siegel, a Clinical Professor of Psychiatry, the Window of Tolerance describes the best state of ‘arousal’ or stimulation in which we are able to function and thrive in everyday life.


When a person is within their window of tolerance, it is generally the case that the brain is functioning well and can effectively process stimuli. That person is likely to be able to reflect, think rationally, and make decisions calmly without feeling either overwhelmed or withdrawn.


During times of extreme stress, like a cancer diagnosis, Siegel states that people often experience periods of either hyper- or hypo-arousal.


Hyper-arousal results from the fight or flight response and is characterised by excessive activation/energy. It can present as difficulties concentrating, irritability, anger and angry outbursts, panic, constant anxiety, easily scared or startled or self-destructive behaviour.


Hypo-arousal results from the freeze / flop drop response where there is a sense of shutting down or disassociating. This can present as exhaustion, depression, flat affect, numbness and disconnection.

We all have different ‘windows’, due to factors such as: significant childhood experiences, our neurobiology, social support, environment and coping skills. The size of our windows can also change from day to day, but the wider we can make our window, the less likely we are to experience anger, frustration or feel flat, low and lacking energy.


Graphic illustrating the Window of Tolerance
Graphic illustrating the Window of Tolerance

Our Window of Tolerance can also be affected by environment. People are generally more able to remain within their Window when they feel safe and supported. If you’re going through a cancer diagnosis yourself, it’s so important to ensure that you have a strong support network around you,

whether that’s family, friends, support groups, other patients, your medical team etc. And if you’re supporting a loved one through cancer, then you’re doing a fantastic job of ensuring they feel safe and supported – although it’s equally as important to ensure you have your own support network in place too.


The Window of Tolerance, mental health and cancer

The stress of a traumatic or otherwise negative event, such as a cancer diagnosis may have the effect of ‘pushing’ a person out of their window of tolerance. People who have experienced a traumatic event may respond to stressors, even minor ones, with extreme hyper- or hypo-arousal.


As a result of their experiences, they may operate with a Window of Tolerance that has become more narrow or inflexible as a result. 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 or a freeze response.


People who frequently operate outside of their Window of Tolerance may experience mental health issues, such as depression and anxiety. A person who is often in a state of hyper-arousal may develop symptoms of post-traumatic stress, such as flashbacks nightmares, and derealisation. A person who is often in a state of hypo-arousal may dissociate, have memory issues, and experience feelings of depersonalisation.


Managing the Window of Tolerance

There are a number of strategies and techniques that can help you return to your Window of Tolerance and we have included some general guidance below but they key is to figure out what works best for you or your loved one.


Try different things and find out what works well for you. At times some activities may be down regulating / grounding while at other times the same activity may be stimulating.


Practice strategies on a regular basis when you are calm as this will build your capacity to access them when you feel yourself becoming overwhelmed.



Activities aimed at decreasing arousal

Grounding and mindfulness techniques considered beneficial by many mental health experts, can often help people remain in the present moment. By focusing on the physical sensations currently being experienced, people are often able to remain in the present, calming and soothing themselves enough to effectively manage extreme arousal.

- Diaphragmatic breathing (deep and slow tummy breathing)

- Drinking from a straw

- Throwing a squishy ball at a wall

- Jumping on a trampoline or trampette

- Weighted blanket

- Warm water

- Shaking or stomping out excess energy

- Exercise

- Listening to or playing soothing and calming music

- Comforting food


Activities aimed at increasing arousal

- Anything that stimulates the senses

- Smelling essential oils (smell is the fastest way to the thinking brain)

- Chewy or crunchy food

- Movement

- Jumping on a trampoline or trampette

- Rocking chair

- Weighted blanket

- Dancing and music


Whether you are a patient or are supporting a loved one through their diagnosis, we hope this article helps you to recognise and understand the wide range of emotions you may be experiencing.



https://clionavaughantherapy.co.uk

If you want to find out more about how you can support a loved one with cancer, sign up to receive our Cancer Support Toolkit.


Sources

· www.goodtherapy.org/blog/psychpedia/window-of-tolerance

· Jersey Psychology and wellbeing service

· Dezelic, M. (2013). Window of tolerance- trauma/anxiety-related responses: widening the comfort zone for increased flexibility. Retrieved from http://www.drmariedezelic.com/#!window-of-tolerance–traumaanxiety-rela/ca9e

· Mindfulness and the window of tolerance. (n.d.). Retrieved from http://www.stmichaelshospital.com/pdf/programs/mast/mast-session1.pdf

· Ogden, P. (2009, December 7). Modulation, mindfulness, and movement in the treatment of trauma-related depression. In M. Kerman (Ed.). Clinical pearls of wisdom: 21 therapists offer their key insights (1-13). New York: Norton Professional Books.

· Trauma, power-based violence, and sexual health. (n.d.). Retrieved from https://sapac.umich.edu/article/trauma-power-based-violence-sexual-health

· Waters, F. S. (2016, March 28). Healing the fractured child: Diagnosis and treatment of youth with dissociation. New York: Springer Publishing Company, LLC.