Dysregulation, PTSD and Trauma: What it's like and how to deal, w/ Dr. Sharon Flynn PhD

Emotional dys·reg·u·la·tion: When emotions overtake you and make you unable to act in ways to help yourself, this is called dysregulation. It’s something that happens to a lot of people sometimes from trauma or PTSD, sometimes from the way you’re wired. I interview Dr. Sharon Flynn on what dysregulation is, what it’s from and some ways you can treat it. For more you can check out DrSharonFlynn.com xo Sarah May B

If you prefer to listen, here's the podcast version of this post on iTunes and Soundcloud. 

Sarah May: Hi friends it’s Sarah May and this is another episode with Dr. Sharon Flynn, PHD who was on my therapy episode. Hi Sharon.

Sharon: Hi Sarah, it’s nice to be back.

Today I’m going to ask a lot of questions about PTSD and trauma, because I have heard you have some training in this in particular.

I’ve done some training and quite a bit of work in this area.

Dysregulation: First, what is that?

Dysregulation is not an official diagnosis. It’s something we use to describe a person who is dealing with feelings, otherwise known as affect – which feel unmanageable. Sometimes the person can feel really anxious or sad or swing between the two, and the dysregulation part is that it feels extreme, overwhelming and the person is unable to bring it back to a normal level.

In other words, a mental freak out? Where you’re like on high alert?

Yes.

Can you discuss unique traits? I can imagine I would have a hard time knowing if I was dysregulated. Can you describe any anecdotes about that so someone can know if that’s happening to them?

I can try. You know you’re having a really hard time but then within 15 minutes you can bring yourself back down to normal and talk yourself out of things: you can say to yourself everything’s gonna be fine, I’ll be able to do this, I’ve done this before. Self-talk and behaviors “I am gonna take a walk, go to yoga,” those things that bring you back to your regular, mindful - you back to your most perfectly balanced self.

When those tools are pretty much out of reach – and you’re so overwhelmed with your “affect” or feelings, that you are so anxious and you can’t really leave the house or you can’t really make a decision – or you can’t really think things through to do what you need to do to move forward and out of it – I’d say that’s dysregulation.

So it’s like a torturous thought process that’s highly emotional that you can’t stop.

Yes, torture’s a good word for it. Doesn’t feel good.

So is that by nature the result of some sort of trauma?

It can be. But it can also just be the way a person is wired. It doesn’t have to be related to trauma – I mean specifically speaking about PTSD and trauma, it can be the result of the traumatic event because the brain has been rewired and reconfigured in such a way that that might be the go-to – if you’re upset about something, you might go to that extreme point because of the event and the rewiring in your brain.

So if it’s not from trauma it’s just somebody’s brain is formed that they’re on high when they get upset.

The brain could be formed that way or maybe there wasn’t a lot of skill building – how to emotionally self-regulate.

Like your parents were like, “Stop crying!” And you’re like, “I can’t cry!”

Instead of comforting and saying, I’ll give you a hug. Let’s say in grammar school someone beat you up on the yard. You could walk in the house and mom and dad could say, “Man up!” Or someone else could say, “Come sit down tell me what happened, are you okay?” To be more comforting to help a person get through it quicker - to help them stabilize.

So if someone is this way, would you be able to learn how to slowly train yourself out of being deregulated?

Absolutely.

That’s awesome.

That’s one of my favorite things to do in this line of work.

That’s cool. So what is happening in the brain? You said it’s basically a trigger state – or a heightened emotional state? Do you know what is actually happening in the brain when that happens?

I’m not a scientist – I’m not a brain researcher but you can look at – and I’ve seen many MRI’s – online with PTSD, and just MRI’s in general, where you can see sections of the brain light up that have been due to a trauma that are highly lit up and highly over-utilized when something is happening. And you can see in a normal brain that has not been traumatized what areas light up in the brain. It’s usually a smaller area in the brain. It’s the amygdala which is where our fear and fight or flight responses are – with PTSD that’s usually lit up and working in a huge really over reactive way. Whereas most people when they get upset about something that area is not in full gear. So there are changes but with some skills you can definitely learn how to manage these affect states or dysregulation.

If you were suffering from this, what would be the process like – even if it’s basic – what would be the process in teaching someone to overcome a state of dysregulation.

I think the first thing is to identify that that is what the problem is, because so maybe people come into me and say, “I don’t know what’s wrong with me, I can’t make a decision” and being hard on themselves because they haven’t learned these sills. Because it is hard when you’re dysregulated when you’re overly anxious or depressed about something – to really pull on resources you don’t have. SO I think the first step is identifying that that’s what’s going on with you and it’s not part of a mood disorder, because sometimes if you’re really depressed or anxious – like with bipolar disorder, with mood swings that are driven by chemicals in the brain, you should have that assessed properly because you do need to build skills with those diagnosis anyway. But there can be different approaches.

So if someone is suffering in particular from dysregulation, how would you begin the process of teaching them how to manage it?

I would first go over current coping skills. I would ask my client about what they do if they are upset right now – what they do to self-soothe because that’s a big one. What techniques do they use to manage yourself when you’re feeling really upset? And usually I hear that people don’t have a lot of skills with which to draw on and that’s not because it’s anyone’s fault. It’s not a deficit- it’s just that so many people aren’t’ taught these skills. They can’t be pretty simple skills.

Like what’s an example?

Breathing.

Mindfulness and breathing exercises?

Yeah, we forget to breathe when we’re upset. I know we’ve seen the extreme with people getting a paper bag in a movie or something? That’s an exaggeration for the most part but it’s a simple reminder that we need to breath. When we are anxious our heart rate and rate of breathing increase. And we forget about that, and that’s the first thing you can do to calm yourself down.  

So really basic.

Really basic.

And let’s say someone’s learned four or five different tools they can use to calm themselves down, what would you say is the average amount of time that it takes to actively train your brain out of this state?

I can think about that for a moment. I think the answer would be – for me – as quickly or as long as it takes you to… understanding the skills is not the hard part, but actually utilizing the skills when you’re having a hard time. Once you can actually use those skills when you’re having a difficult time. Once you have learned those and can apply it and learn you’re functioning in a way that you’re satisfied with. The difference is if you’re dysergulated, it usually interferes with your ability to function in a way that you want to in relationships, life or in every area. So once you learn some skills and learn what’s behind it – then you are ready to go. There are some therapies that are more cognitive and skill-building instead of just traditional talk-therapy. Something like dialectical behavior therapy or cognitive behavior therapy. Have you heard of those?

Yes, and I love CBT. I do feel like at least personally, it’s totally as soon as it’s worked once. As soon as it’s been something you’ve practiced and you’ve seen a result –that isn’t the same thing you’ve seen every time, like you’ve like “holy fuck it’s never gonna work” and then you keep trying anyway, and then you’re like, “I’m okay – I made it..” all it takes is seeing it once and then you have enough faith to just keep trying and keep applying it. I personally had the experience that after that first time – you’ve already crested the hill and you just have to keep running and then it gets way easier. After I would say a month, I felt dramatically different. Like I had finally understood my own power to the point that I could use the tool, whether or not the dysregulation was happening, I could use the tool and trust that it would do something about it. I think that is the most essential part of using a tool – is seeing that first time when you’re like, “Oh – I do see that it’s gonna work.” Changes everything.

What you’re talking about I think Sarah is – this is where the brain research comes in, supports your experience and what you’re saying, once you start to use these skills – you’re actually retraining your brain. I’m sure most people have heard of neuroplasticity at this point. It means essentially that we can rewire our brains. So something like skill building and using a different path instead of remaining anxious over and over again – if you do something different, it will actually start to change the circuity of the brain. Which is fascinating.

Totally – it makes me also think of OCD. OCD is reaffirmed by the … when you actually enact the compulsion it makes a thousand times stronger. Even if you change the behavior, it just weakens that interaction in your life. Like “I am going to walk out of the door, even though I’m freaking out..” it changes the way that thing controls you just because you have not acted on it. Such a cool thing. I digress.

That’s what you’re saying you’re retraining your brain by doing something different.

Yeah, and it’s that simple. You don’t even have to agree with yourself. YOU can just do it anyway and things will change in your body. It’s amazing. So what would you tell someone who’s suffering from dysregulation currently – and let’s say it’s not just from trauma, let’s say it’s from a life of having difficulty managing and maybe this person has tried to get help before or they’ve tried meds or they don’t like yoga. Lets’ say they’ve tried a bunch of different things and they can’t get a handle on it. What steps would you tell them to take?

I think given the fact that the person that’s coming in to see me has tried other options, I would definitely not repeat them. I might do a little background data collection to see if there’s anything that may have been missed in their lifetime that could be affecting their current dysregulation, but with someone like this I would start with skill-building manuals. One of my favorite is dialectical behavior therapy – DBT, which comes with a manual and each sheet is a tear out for yourself – has a skillset on it. And you’re supposed to learn this skillset – and they’re pretty simple. And then the difficult part is learning on how to use them and utilize them when you’re feeling dysregulated. And you said you like CBT – what is it that you like about it?

It feels very much like it’s tailored to individuals. You’ll have a worksheet page that’s like, “When you’re having really overwhelming anxious thoughts, here’s a list of 300 possible solutions or actions you could take to soothe yourself. And it’s like weird shit – like “take a bath and listen to an 80’s romance song.” Like it’s for anybody. You can think of a solution that’s perfect for you, and I think it’s a fine tuning process. Think about what you like and then try a bunch a stuff – like if you hate yoga, then that will not be a part of your solution. It might be running fast on a treadmill listening to punk. I love that it’s such a customized format of healthy medicine.

I think that’s really interesting what you’re saying – what dialectical behavior therapy is more of a manual, and you’re talking about creating your own skill set and what works for you, and I think that’s a brilliant idea.

The CBT manual I have is like a book that allows you to fill in things yourself and what you would do.

That sounds great because you can be pretty creative with it. If someone is so overwhelmed and can’t even think about that that’s more step by step which the DBT manual is. There’s an app for that now, which is kind of cool so you can have it on your phone and use it when you need it. I am in no way affiliated with any of this.

My friend and I talked about how cool it would be to have a service where you could have like –you know how they have Uber. Like if you could call somebody or text some service and they would come and hang out with you and just make sure you got out of the house. Like a house mom or something. You’re like, “Help I am freaking out!” And they’d be like “Alright, let’s go hiking.” Like a bestie.

Or someone to come and sit with you? That’s a great idea, and you’re describing what’s missing – that if everybody had good enough parenting ,and I’m in no way blaming this on your parenting. I don’t mean it that way. But if you did – ideally you would have had someone sit with you, through every different feeling state – not even dysregulated feelings – just every experience, and sat there and talked you through it and helped you change your mood by dancing or singing or playing the piano, whatever – talking a walk, you would probably not need that buddy. But I love that idea.

Most people don’t realize when they’re having those freak-outs – or when they do something that doesn’t make sense to them, for example, if you’re extremely jealous and when somebody talks about past lovers it drives you insane and makes you feel like you’re going crazy because you’re so threatened by it = that’s a form of dysregulation that’s so confusing, that you might think, “I’m just a really jealous person,” and you would not know to go to a therapist, or you wouldn’t know that maybe there’s something your parents did to you that made you intolerant to feelings of vulnerability, for example. And I think so many people have those types of baggage from their parents. Like parents that were either incapable because of their own shit, or they were too busy, or they were exhausted depressed or whatever, who made them feel like they couldn’t have these feelings – and those ramifications as an adult – are so baffling that you just assume it’s just who you are. So I think that first description is so valuable, if anyone is listening and is like “I have sort of panicky feelings that I can’t talk myself out of” maybe it’s because you’re suffering from dysregulation. 

And there’s just no need to suffer. I see that as suffering. It feel like suffering to me, and there are ways to get out of it. And asking someone to help you with it is probably a great start.

Totally. I know like, you’re not going to trim your own trees, you hire a person to do the things you’re not good at – therefore, why not hire a therapist? Any last words of inspiration or hope?

You can change. You will get through this and you can change it and feel a lot better.

Yay. Hope you enjoyed this, and if you did it please share it, and don’t forget to smile.