I have been approached by many people recently about dysregulation. Students are dysregulating. So are educators. So are parents. So are families. So are individuals in relationships. So are workers. So are travelers. So are drivers of vehicles. So are folks across our nation.

Look at the above image. On the left side at the bottom (as you look at the image), there is order (not everything is identical importantly). Things are regulated. Items are in rows. Sure, there are some differences (like there are among us) but order is present. On the other side of the image, things are disordered. The squares are of different sizes and colors and they are not aligned. The spacing of the squares is off too. The squares are, then, what we can call “dysregulated.”

Ponder that idea as we consider what dysregulation looks like in individuals.

What Dysregulation Means and What Causes It

Dysregulation occurs when a person has an “outsized” reaction to a current event or trigger (outside the “norms” within our society), and they are then unable to control their behavior, at least initially. Dysregulation can take many forms, including shouting, hitting, agitation, extreme anxiety, throwing things (or oneself), nasty commentary involving vituperative words (and words can surely hurt). To be sure, dysregulation may look vastly different when exhibited by children, adolescents, young adults, more mature adults or seniors.

Consider the young child who has a temper tantrum. That is dysregulation. The youngster who holds his/her breath until he/she turns blue is dysregulating. The student who throws a chair or repeatedly pounds on a desk is dysregulating. The student who breaks a window or punches a hole in a wall is displaying dysregulation. The student or worker who disrupts a class or a work shift by throwing their body or their words around at others so that peers cannot do their respective work is dysregulated. The adult who screams and turns red and spews spit is dysregulated. The adult who taps his/her car on the back of another car to show displeasure with the other driver’s behavior is dysregulated. The adult who pushes in a line and tramples other to get attention is dysregulated. The senior who hits medical caregivers or a spouse is dysregulated. The senior who barricades an exit from a location is dysregulated. These are but a few examples.

If a person has “squares,” (meaning behavior patterns), dyregulation moves their squares into different places in space. Rather than some order (although note again that the ordered squares are NOT all the same), the squares fly out and flip out.

Not only can dysregulation take many forms but the reasons for the dysregulation are not uniform either (neither are the solutions). Individuals can be dysregulated due to mental or physical illness. Consider the impact of brain injuries as one source. Individuals who lack appropriate social-emotional learning can become dysregulated when they can’t manage their feelings with respect to a new situation. Individuals who are traumatized can dysregulate as a symptom of trauma, whether that trauma is occurring now or is older but is being retriggered by a current happening. And, the triggering trauma can occur from many causes (or multiple simultaneous causes) including sexual abuse, addiction, death, short and prolonged separations from loved ones, war, violence (including domestic outbursts), lack of parental love, care and security, neglect in early childhood.

It is these observations that should lead us to ask, when confronted with a dysregulated person of any age, NOT what is wrong with you but WHAT happened to you, noting a book of the same name co-authored by Oprah. To be sure, it doesn’t help to shout out “What happened to you?” in a nasty or demeaning or frustrated tone. How we enable someone to re-regulate who is dysregulated isn’t a one size fits all answer.

But, in our world today with its plethora of trauma, we would be wise to give educators, social workers, service workers, workplace leaders and healthcare givers tools they can try to re-regulate a dysregulated person. Sadly, we often don’t teach those skills.

That said, there are others who are very capable of re-regulating troubled kids and adults although they may not know or name the strategies they are using; life-experience has been their guide or instinct or personal experience. For this latter group, understanding why what they are actually doing that is working is helpful too. If you can name what works, then you have a way of understanding why a given strategy is beneficial and when it is best deployed. And, one can be prepared (more on that later).

One added note: Just getting angry is not being dysregulated. Anger is an emotion that is acceptable (and even good) to feel if the anger can be controlled. For example, someone who consciously writes an email that is angry to their boss or in a relationship is not dysregulating. It may be unwise or unnecessary and there may be better modes of expression but that is not dysregulation; this isn’t about NOT getting angry.

Rather, the dysregulation we are addressing here is about expressing feelings and emotions (often unidentified) in ways that are not within the norms of behavior of our society (other cultures may have different approaches) and are disruptive and uncontrolled and often generate both physical and psychological indicia.

Consider an adult who is so anxious that she/he cannot function; they cannot concentrate; they cannot work; they cannot communicate verbally or in writing; they are pacing and they are unable to identify what is troubling them; they are having a panic attack of sorts. This IS dysregulation. There may be many causes of which trauma is but one. To be clear here, anxiety per se is not bad; it is the height of the level of anxiety that can take it outside the range of what is healthy and manageable.

This discussion about dysregulation in the context of trauma isn’t about pathology or mental illness. Dysregulation is about responses that are not controllable, not understood, not manageable and that stand in the way of an individual processing what is happening in their mind and body. And oft-times (but not always), dyregulation is a behavior that bespeaks trauma.

Re-Regulation Tools in the Context of Trauma

Remembering that there is no one-size fits all solution to dysregulation, let’s start with this distinction: there are differing approaches to dealing with dysregulation where the individual dysregulating is presenting a danger to themselves or others.

In these situations, we need to create safety for everyone and that may well involve removing the dysregulated individual from the group (sub-optimal though that is from a trauma recovery perspective.) For situations where the dysregulation is disruptive and disturbing (in many senses), there are a differing set of strategies. It is this latter category of dysregulated individuals that we are focusing on here.

To be clear: Preserving safety for all has primacy; so again, if the dysregulation presents a clear and present danger to anyone (including the person dysregulating), then that takes priority. But, that is not our topic here.

Start with Prevention

Before we turn to dealing with a dysregulated person, I want to spend a few minutes (words/ideas) on our capacity to notice that dysregulation is on the horizon. This matters because it is easier to help someone who is on the road to dysregulation rather than someone who is already totally dysregulated. Think about it this way: if we can identify the tell-tale symptoms of a heart attack and intervene, that is vastly better than trying to restart someone’s heart after it has stopped beating.

To be sure, there may not be enough time to notice shifts or read clues and messages that are being demonstrated or evidenced by someone who will dysregulate. That said, it is always better to prevent dysregulation if possible.

Start with this reality: dyregulation is not as common if the “adult in the room” is calm and role modeling calm continuously. Dysregulation is also not as common when trust exists between the “adult in the room” and students/ workers/patients. Dysregulation is not as common if the “adult in the room” knows something personal and important about those for whom he/she is caring/teaching/serving/working. Dysregulation is not as common if the “adult in the room” has quality communication with those whom he/she is caring/teaching/serving/working.

Pause here for a moment. The just described actions/knowledge/activities can be viewed as tools to prevent dysregulation. But, and this is important, even with these tools, dyregulation can and oft-times does occur. It is no one’s fault. It often occurs without warning and without explanation (at least initially). Most of the time, dysregulation is done without intent; meltdowns are not planned for events. In a sense, it is similar to criminal law where intent matters before we punish. In the context of dysregulation, with rare exception, the “bad” behavior is neither planned nor intentional.

Finding Clues

Now, these are not the only tools that can help prevent or minimize dysregulation. Notice that the above suggestions are largely in the control of the “adult in the room.” What follows are concrete hints that the “adult in the room” can look for in those whom they are educating/serving/working. And, here’s an acronym to help one remember these clues — and they are only clues. Sometimes, the clues can lead down a false pathway. Sometimes they are suggestive but not definitive. Use them, recognizing they are neither the be-all, end-all nor a complete listing of possible clues. And, above all, don’t blame yourself if you miss or misunderstand a clue.

The acronym is: SHOW. As an overview (with explanations to follow), the “S” is for Square Sampling; the “H” is for Hypervigilance; the “O” is for ordered/disordered; and the “W” is for Wandering (eyes or body parts or the whole body). And the word “SHOW” has meaning too — because those who may dysregulate may SHOW their cards (so to speak) before they dysregulate fully and completely.

“S”

Square Sampling refers to how the “adult in the room” looks over and observes those who are there. It starts by looking in the 4 corners of a room and then creating a square as one looks down the back row, down the side rows and then across the front row. One might be amazing by what one notices if one observes with intentionality. (This works in all shaped rooms and all seating arrangements.)

I became familiar with this approach based on a video taken of me teaching some years ago where I was being critiqued (at my own request I might add). What I saw, and I never would have admitted this had I not actually seen it on tape, was that I taught primarily to the right side of the room and within that, I focused on those more of less between the front and the back. Are you kidding me? I would have said I teach to all corners of the room but I wasn’t doing that. The educator critiquing me said: teach (or speak when giving a presentation) to the four corners and develop eye contact with those in the four corners and then move inward. I surely had not been doing that.

While obviously this is not an engagement strategy for online learning or Zoom calls, it has real value for those working/teaching etc. in a room. And, I can vouch for the fact that it actually works to engage a group. People feel included and the person doing the Squaring can see who is not engaged. More on that in a minute.

“H”

Hypervigilance is not easily cultivated (and it has its downsides for sure). But, for those who have been traumatized, one of the after-effects is hypervigilance. Now, this means that if the “adult in the room” has had his/her own trauma experience that he/she has processed, it may be easier to detect dysregulation in others.

Hypervigilant folks can detect early on if something is off in the tone, style, atmosphere in a room. Hypervigilant folks can sense when a person is struggling, sometimes before the person him/herself may realize. The hypervigilant person can look around a room and get a feeling about those in the room who are stressed or anxious or struggling. A hypervigilant person can detect when a personal relationship is going off the proverbial rails (don’t I know!). It is as if their own trauma has given them a telescope that allows them to recognize trauma in others.

“O”

The “O” can best be understood by returning to the image at the start of this article. If the “adult in the room” observes that someone is struggling to find something in their backpack or desk or purse or, alternatively, their things are all disordered as they unpack and get ready to start their day, this might signal that what preceded entry into school or the workplace or the medical setting was not optimal. We get anxious and flustered and stressed when things happen to us and we carry those feelings with us into where we are going.

By way of example, if a child has witnessed a huge fight between her caregivers at breakfast and was also rushing to get to the school bus, that child may enter school not ready, willing and able to learn. She/he needs to process and reset based on the breakfast that occurred. And, the child may not realize how affected he/she was by what she/he witnessed. (Infants are often aware of parental stress too even if they lack the words to express what they are hearing and seeing and sensing and smelling. An example would be a new mother struggling to nurse. The infant can sense the struggle and that may account for the infant’s crankiness and unease. Yes, it could also be a wet diaper or an allergy to the supplemental formula.)

My book released in 2020 is titled Trauma Doesn’t Stop at the School Door references the just described phenomena. We may not know what is happening to us, we may not have words to describe it or we may even have normalized it. But, we carry an invisible backpack wherever we go and some backpacks are bigger than others. For a remarkable story about the invisible backpack of one individual, read Calvin Trillin’s Remembering Denny, a book that even on re-reading captures my heart.

“W”

The “adult in the room” can also gauge whether folks with whom they are working are engaging with them. Are someone’s eyes wandering? Are they focused on the outdoors, not what is going on in the room? Are they looking down? Are they glued to their devices (phone; Ipad etc)? Are they fidgeting too much in their seat or have trouble getting seated? (This is why fidget toys work.)

The just described wanderings may (but not always) suggest that a person has experienced something untoward or remembered something untoward recently. When we disengage or when we don’t connect, that is a signal because our brains are wired for connection. When we disconnect (which is one of trauma’s hallmarks), wandering is what we do.

These wanderings — the inability to connect with another person right then — are a message. It is not a message “to leave me alone.” Indeed, it is a message saying “I need you to connect with me.” The problem, of course, is that on the surface it appears that the affected person wants to be alone; but, that is a facade for the reality that they feel alone and want to find an anchor, a way to connect again. And, if a person stays disconnected, it is way easier to dysregulate.

Bottom line: If we see one or more indica of SHOW, we have a warning sign that a person is struggling. And, before things get totally dysregulated, we can try to connect through words or eye contact or a touch on the shoulder (being cautious about touch in many settings).

Sometimes, if the adult in the room senses lots of children/adults with SHOW symptoms, they can pause what they were doing and engage people in an exercise that lowers anxiety and stress and even distracts someone from where they were sitting mentally. And, one other point before we move on, NOT seeing SHOW is not a sign of failure; it is often hard to see/hear/ experience. And also, in some instances, SHOW may not even occur or may be simultaneous with the dysregulation.

Self-Identification

One added point. There are opportunities to help those who could dysregulate self-assess and even see the clues in their own behavior that signal that a “meltdown” is approaching. These folks can then reach out to the “adult in the room” to message: “I am about to dysregulate. Help me.” These individuals can even ask for objects like fidget toys that will allow them to find a way to pause; they may decide to do a breathing exercise.

To be sure, this requires substantial pre-dyregulation intervention. But, the self-messaging has value and is, at the end of the day, what we hope most folks can learn to do. Elementary school teachers actually teach students emotional regulation as part of what they do regularly, even in a context not involving trauma.

While beyond the scope of this article, there are strategies that can be taught to individuals who are likely to dysregulate. They can use a hand signal of a flipout (fingers open and stretched into a fan). They can have a key phrase or word: “It’s happening” or “I’m flipping.” And eventually, the controls can become internalized.

But, there is a caution here. If someone who is dysregulating sublimates the desire or finds a way to cabin the uncomfortable feelings he/she is having, that is not success. The absence of processing and naming and understanding is damaging. There are people who don’t and can’t get in touch with their feelings but rather than dysregulate, they unconsciously hide those feelings. Then, the feelings can emerge later in unrecognizable forms of insecurity and anger and guilt and anxiety. The latter can produce many negatives, including the ability to move forward freely and unconstrained.

Overregulation is not a gift and it is as damaging as dysregulating although vastly more socially acceptable. But the price tag is high because overregulated individuals will, down the road, need to let the sublimated/repressed feelings out and if they have persisted since childhood or over decades of a flawed relationship, then the later release has deep consequences. Relationships and marriages and work can be disrupted or even terminated. So, helping an overregulated person disinhibit is a task worth undertaking, but it requires in most instances professional help and time.

Strategies for Re-Regulation in the Context of Trauma

What follows are a set of strategies that can be tried to re-regulate an individual who has become dysregulated due to trauma, remembering that there can be many other causes of dyregulatory behavior. Trauma is our context here. They are not listed in order of importance or success; they can be combined; they can work for some folks and not for others; they can be adjusted based on race, gender, ethnicity and culture. These strategies are fluid in the sense that context matters; causation matters; the affected individual’s experiences and levels of processing matter. And, recall too that these are not strategies for when there is a real threat to the physical safety of the dysregulated person or others in their midst.

Calm

As noted earlier, it is critical that the dysregulation not dysregulate the “adult in the room.” Re-regulation requires that the dysregulation be seen for what it is: a behavior that is a cry for help or attention or engagement. If the “adult in the room” becomes dysregulated too, that makes matters worse and things escalate. Yelling or even tone or body language of the “adult in the room” can exacerbate an already volatile situation.

Processing in Place

Since a mainstay of trauma is disconnection, it is best to help the person who is dysregulated to process in place rather than removing them from the room. We are prone to “punish” those who act out by separating them, putting them in a corner, sending them to a principal or a supervisor. We even try ignoring them, hard though that is. All of these activities truncate connection when what we need to establish is connection.

Processing in place is not easy but it has many benefits. For starters, it builds connection. Second, it enables others witnessing the dysregulation to see how re-regulation can happen. It also does not pathologize the negative behavior; it sees it for what it is: a response to (a behavior caused by) trauma.

For processing in place, it may be useful to bring in a third party who can help either with the person dysregulating or the others in the room. To be sure, this needs to be part and parcel of institutional culture; one can’t “cold call” someone to help. If trained, the person helping can enable processing to happen faster since there are more hands on deck so to speak.

With processing in place, the dysregulated person is helped by the adult in the room to re-regulate through a series of interventions, as described below. The key here is to let the dyregulated person know that you know how to handle this and many people actually are wonderful at re-regulation, whether learned by experience or through instinct. And, while they may not have a name for the intervention they are providing, many adults can help other re-regulate.

A note: After the re-regulation process succeeds, the person who is successful in intervening may feel a bit strung out or fatigued or stressed. That is only natural as crises often hit the people helping after-the-fact. Think about medical emergencies or crisis management; the events can be handled but there are after-effects.

Asking Questions

The adult in the room can ask the dysregulated person some questions, phrased well and with a tone that is not demeaning or angry or anxious or frustrated. Consider questions like: “Is there anything I can do to help you?” or “Do you want me to get you something? or “Is there some music I can play that will make you feel better?” or “Do you want to share what is upsetting you?”

Not every dysregulated person is willing or able even to address these questions. They may be too out of sorts to listen; their cognition may be shut or shutting down. Their limbic system may be overloaded. Their diecephalon region may not be sending signals for re-regulation but instead may be disabling the management of emotions and body impulses. Their primitive brain stem with the five “f’s” may be at work: fight, flight, freeze, fawn and faint.

So, the asking of questions only works if a person who is dysregulating can process the questions.

If Questions Don’t Work, What Might Work Instead

If questions are not a useful tool, the adult in the room can try distraction. Consider providing some sort of object to squeeze or some object to spin or turn. Consider clay. Colored pencils may work to enable someone to draw. Consider puzzle pieces that can be put together or paper clips that can be connected to each other.

Any activity that allows for distraction and connection are beneficial. I have thought about (but have not used) bean toss games where the dysregulated person throws bean bags into a wooden stand, often depicting something fun or funny. Throwing itself is useful. Aiming for something (other than a person) is helpful. Using one’s body is helpful.

Connection, the end goal here in addition to re-regulation can be fostered in many ways. The dysregulated person has likely disconnected from you and the planned work/activity/assignment. You can connect at a physical level by approaching someone gently. Soft touch works too, messaging “I hear you” and “I am here for you.” Physical activities that allow for and enable connection are quality surrogates; putting together Legos or connecting straws or pipe-cleaners can help. And it helps if these strategies have been explained before dysregulation occurs; in other words, we can educate ourselves about dysregulation so we recognize it and know that someone will come to our aid.

Remember, behavior is the language of trauma.

One can also use affective statements like: “I understand…” or “I appreciate” or “I recognize” or “I see that” or “I am worried that.” These are all ways to message: I care, I know you are struggling and I am here. The use of the “I” allows for connection and showcases care.

One can also use feeling identification strategies (it is good if there has been a development of understanding and expressing and recognizing feelings both positive and negative): “I can see that this isn’t easy for you.” or “I can see that you are angry and frustrated.”

Another added tool is choice. Part of the problem with dyregulated people is that they are out of control and feel that they have no control. One way to restore control is to move the locus of control to an internality.

One can do this by giving the dysregulated person a choice: Would you like to move your seat or take a break for a few minutes? Or: Would you like to do something else for a few minutes or have a drink of water? Or: Would you like to move to my desk and I can move to yours or do you want to stand and balance on one foot for a few minutes? Or: Do you want to do the 4×4 breathing exercise (four in — hold for four — four out — hold for four) or listen to music for a few minutes with your headphones? Or: Do you want to play that game on your phone for a bit or send me a text? Or: Do you want to do the 3–2–1 breath exercise (inhale for three — hold for two — release for one) or jog in place?

Now the choices have to be realistic and ideally, they promote regulation. Balance does that. Changing physical space does that. Breathing in a pattern does that. Physical activity that is within bounds helps. Art helps. Distraction helps. Stress toys help.

If At First You Don’t Succeed

Not all strategies will work and not all strategies will work immediately. When someone is dysregulated, time seems to change for them and everyone around them. Even if the event is only over several minutes, it feels and seems and is experienced as a much longer time. (Time has this odd behavior; the same length of time can move fast or slow or evenly, depending on context and feelings and cognition.)

One activity to try in advance is measuring time with students/workers. Use an egg timer. Have them guess with their eyes closed when a minute has passed or three minutes. Silence makes this exercise hard. If music is playing or talking is going on, it is also hard. What the exercise shows people is the fluidity of time.

Indeed, I keep several sand timers available. One is 15 minutes and one is 30 minutes. I use them (even seeing them helps) to remind myself that time changes depending on mood, context, emotions,

Create a box or bag with feelings in it that are identified. There are emoji dice. There are Kimochi. There are cubes with feelings showing. When a person is dysregulated, let them find (identify) what they are feeling by looking into a mixed bucket of feelings. That is easier than actual naming.

Another option is to have a bucket of feathers available. Allow the dysregulated students/workers use feathers on their wrists or neck or arms. The tactile sensation helps calm the autonomic nervous system. Pre-prepared trauma toolboxes help too. The adult in the room can say: Just pull out your break box (or whatever one calls it) and use it for a few minutes.

Another option is to have dysregulated folks do something with their non-dominant hand or leg. For example, have someone trace their dominant hand with their non-dominant hand. Or balance on one’s non-dominant leg. Or write something with one’s non-dominant hand. The bottom line is that these activities require one to pay attention to something other than one’s current behavior (because otherwise the task cannot be done) and they open new neural pathways that allow someone to connect better to themselves and others.

Prepare Prepare Prepare

I have often said in the context of trauma memorials or anniversaries that planning is key. Once the anniversary arrives, it is too late to plan. The same is true in the context of dysregulation. If one is prepared for it to happen, then one is better able to handle it. This means identifying strategies and techniques before there are problems. They can be part of teacher training or workplace training.

And, it is wise to share them in advance with other affected groups — including the potential dysregulated individuals themselves. If they know in advance what guidelines exist and that if there is a breach how that will be handled, they are already in a better place. And, those who might become dysregulated need to know that they are not bad; it is their behavior that is troubling. And, they need to know that they will be supported as they navigate traumatic symptomology — including dysregulation.

We live in a world in which many people are dysregulated. Rather than pathologize it, we would be wise to share how to handle it. That will provide us with a vastly better way of navigating forward.

To return to the image at the start of this piece (which appears below again), we can become disordered. And we feel better when we are ordered (not as in over-orderly or over-regulated or hyper-neat or compulsive). We can sense and feel when our “squares” get jumbled and when they do, we are asking others — without words — to help us. And, with training, the adults in the room can help and the rewards are wide spread, not only for the individual dysregulating but for those witnessing it and those with whom the dysregulated person will engage later that day and into the future.

PS. To the person with this piece of art hanging in his home, I hope it brings you a sense of order when your world feels disordered.

https://karengrossedu.medium.com/behavior-is-the-language-of-trauma-ab9ba15b7071