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The Window of Tolerance and Massage Therapy

A concept that was presented to me about a year ago was The Window of Tolerance. About 8 light bulbs turned on when this concept landed in my lap and a whole pile of things began to make sense. Typically, Window of Tolerance (WoT) is a concept used to discuss psychological problems such as trauma disorders and anxiety being triggered by experiences the individual finds very difficult. However, it can be applied to basic understanding of human beings and the concept of tolerance.

The WoT is basically exactly what it sounds like, a space within which a person can tolerate things. The size of the window determines how much discomfort a person can tolerate and still remain regulated. By “regulated” I mean, in essence, calm, cool, and collected. When we self regulate, we are ensuring that, despite experiencing something difficult or uncomfortable, we can keep our emotions in check and maintain a physiological state of alert and calm. Experiences that remain within the WoT are experiences through which the person can remain alert and calm. Experiences that go beyond the WoT will tend to lead towards dysregulation or, at least, make self-regulation much more difficult to maintain.

For some people, the WoT is very large and flexible; there is lots of room for trials and tribulations, and the window is capable of expanding to accommodate more difficult experiences. For others, especially those with trauma disorders, anxiety disorders, chronic illnesses including chronic pain, people doing the lions share of care giving (ie caring for a sick spouse, child, or parent), or people living with chronically difficult social problems like poverty and racism, this window can be very small and very rigid. Another analogy one could use is bandwidth; there's just too much on the band already and there is not enough room left for more. When an experience goes outside of the WoT, we have to work harder to remain regulated. For some, complete dysregulation happens. This can look like going into a fight or flee response with outbursts of emotion, or going into a freeze and please response with dissociation from the situation or attempts to befriend or appease the offending source of discomfort.

This concept is valuable to RMTs because we often are working with people who are dealing with a very full (or limited) WoT. Pain, depression, anxiety, trauma, and chronic difficult social and health conditions are exhausting. Many people may choose to seek out massage therapy to help them relax (ie regulate) which is wonderful and just as many people may find themselves rather surprised when the massage does not in fact provide the soothing and comfort they are seeking but instead challenges a WoT that is already strained.

RMTs can not always predict how a person will respond to their care. It's fair to say that we can not predict this at all, nor are we in a profession that includes identifying and caring for psychological troubles as part of our scope of practice. However, we most certainly can learn to gauge and inquire about this WoT through simple question asking and careful observation. Asking how someone is doing and waiting for a full response, is one way. Observing movement patterns (guarded? Strained?) and getting to know some of their back story (are they care-giving to higher-needs persons? Has there been a death in the family? Is work a stressful situation?) can give us some clues as to how well a person is managing. Of course, if a client comes in and is obviously angry, upset or anxious, we can safely assume that the WoT is small and our work will need to keep in mind the persons ability to cope with what can sometimes be a stimulating, painful experience.

While we all want to try and see movement towards patient goals in every session, we sometimes need to understand that along the way we may encounter secondary goals that are smaller, shorter term but more urgent than the initial complaint. Often, the solution to this can look like choosing a treatment approach the puts soothing the nervous system (the guardian of the WoT, if you will) at the forefront. By doing so, we may be able to reduce some of that “rigidity” and facilitate self regulation by, in essence, helping to open the window for a moment and provide some respite from what may otherwise be suffering.

The original concept and phrase were coined by Dr. Dan Siegel, a Psychiatrist in the US. This image was created by Dr. Marie Dezelic, copyrighted in 2013.

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