Motor and the Art of Anxiety Regulation 

 

Picture yourself in your home, clinic or program. You are with your speller, you have the lesson your speller chose to work on. That lesson is the framework that guides the back and forth communication between the two of you. You are using speech and your nonspeaking partner is spelling to communicate. Your primary purpose is to help your student to learn and use motor skills to point and spell.

It’s an open secret that this picture disguises a very sophisticated, nuanced interplay between these two people engaged in learning. We all know that spellers navigate a complex neural universe1 that includes, but is not limited to

    •  A sensory motor landscape, where the feedback loop works faultily. It is constantly changing and uneven in its connectivity. It makes it challenging for spellers to exercise the correct grasp, hold, point, cross their midline, eye gaze, maintain joint attention etc.
    • The mind-body disconnect – or apraxia. Praxis or purposeful motor involves having an idea or thought, creating a plan and executing the motor to match.  For spellers, a planned movement doesn’t get reliably and consistently translated into a motor action. 
    • The same mind-body disconnect doesn’t allow them to reliably express the emotions they experience. When emotions are heightened, purposeful motor, used to express emotions gets hijacked by older established, automatic motor loops – pulling, pushing, self-injury, fleeing, rocking, flapping and the list goes on.
    • And then the picture gets even more complicated because some of these actions are sometimes used to regulate the sensory motor feedback disconnect.

 

S2C, Spelling to Communicate, I-ASC, Autism, nonspeakers

During an S2C session, all learners need a balance between 4 systems – emotion, sensory, motor, cognition (the lesson based on presume competence) in order to engage in learning.  Picture yourself, in a learning environment. You learn best when all these systems have you centered. You can stretch yourself to tolerate suboptimal conditions under each, but this utilizes your head space, and your energy levels. This blog is about how to restore a learner to a degree of emotional balance when they are coping with heightened anxiety. This anxiety is posing a problem to an already overloaded neural system, while the two of you are engaged in a learning session.

Anxiety is an emotional state that most spellers experience.2 Teen and young adult years become especially challenging as spellers grow into hormonal bodies and the expectations that adulthood brings. Some spellers have a formal diagnosis of anxiety disorder, and are on medication to help with chronic and acute anxiety. Some have other mood dysregulation diagnoses. This is why during an S2C session when a speller and you are working together it is not uncommon to have an occurrence of anxiety at levels that take a speller out of the balance in emotional, motor, knowledge, and sensory systems.  Sometimes, the session can become an exercise in the regulation of emotions where you are supporting your learner to get regulated enough to get back to the motor and learning goals of the session.

As an S2C practitioner it is a major focus to support our speller in coping with their anxiety. We work as co-regulators3 in joint de-escalation. We also work as coaches, helping spellers acquire the necessary skills to initiate and use their chosen coping skill. It is part of what we do when we see a trigger coming and we help distract, redirect or help cope with an anxiety episode. However, analysis of what is causing anxiety, and an evaluation of anxiety as a diagnosis is the purview of a trained psychologist and psychiatrist and not part of what should occur within an S2C session. Before you begin work with a speller, you would be familiar with their personal and medical case history.

Before we get into how to help your speller cope, you’ll need a ready reckoner to help you understand the level of anxiety your learner faces. I’ve internalized a tool developed by Joseph Wolpe, in ‘The Practice of Behavior Therapy’, 1969 called Subjective Units of Distress or SUDS. SUDS is a 10 point numeric scale used by medical and health care professionals to assess the intensity of emotional distress a patient is experiencing.  I use this tool because it prevents me from seeing anxiety in black and white terms. It stops me from thinking ‘My student is anxious and cannot learn’. ‘My student is anxious and we will not meet goals in this session’. Instead when I use the SUDS scale I can say to myself.  ‘My student is moderately anxious, I can help him regulate and get back to the lesson’ or, ‘My student is highly anxious, I can get his anxiety levels down’. You could use the SUDS scale available via an internet search or the one modified here to use as a reference tool.

S2C, Spelling to Communicate, I-ASC, Autism, nonspeakers

I-ASC Anxiety Levels Ready Reckoner

Signs of Heightened Anxiety

Intense emotions, physiological cues – rapid breathing, tensed muscles, inability to attend to task. Increased vocalizations, impulsive actions, restlessness, repetitive actions. 

Signs of Moderate Anxiety

Heightened emotions, some physiological cues – breathing changes, tensing – ability to attend to task is diminished. 

Signs of Low Anxiety

Irritability, evidence of discomfort, ability to maintain tasks with co-regulation 

Before you begin to help anyone regulate, you need to examine your own emotional state. All of us can be unaware of transmitting our own emotions onto others. Bring your neutral, accepting, non-judgmental, calm approach. Make sure your body, tone of voice project a sense of calm and confidence. Slow down your movements and the rate at which you speak. And because we always presume competence, we don’t dumb down the content of what we say.

How to co-regulate a speller in a highly anxious state

Anxiety is experienced in the mind, with worry thoughts and in our body4 through a physiological response5 that kicks in via the autonomic sympathetic nervous system. For example, the heart beats faster pumping blood to the limbs, breathing is faster. When my student is experiencing high rates of anxiety, and is unable to get to what we need to do, the first thing I do is remove any additional demands on him. By this time, I’ve already observed the response their sympathetic nervous system has kicked in and have assessed if they are in a physiological response of fight, flight or freeze. When your student is in this state, you need to be aware that they are fully occupied by their emotional state. Your role as co-regulator is to do two things. One – Calm the anxiety in the mind, ( See step 1 and 2 below )  Two – relax the body that is revved up by the sympathetic nervous system. (Step 3 and 4 below) You do the latter by asking them to engage in a set of automatic motor responses that do not require any planning or execution from their cortical brain. Here’s what you can do – 

Step 1. Validate their experienceValidation is important, it communicates to the other person that their actions and emotions make sense and are acceptable in the situation. It takes the pressure off them, they will no longer feel that they are failing at a task, and that you are not judging or labeling them.  Tell them that what they are going through is tough and hard on them. Here are some sample phrases you can use.

‘You got this, it’s going to pass. What you are feeling is tough. This is hard to tolerate, It is temporary, it will pass. What you are feeling now, does not define who you are.’ 

Use language that is non-specific and does not label the reason why they may be feeling anxious, in line with the scope of an S2C practitioners role. 

Step 2. Ask them to name their emotion for themselves IN THEIR MIND. (Don’t ask them to spell it for you. That’s too high of a demand) Naming the emotion gives control back to the speller7, they are no longer the emotion, they are outside looking in. This allows the cortical area of the brain,which we use to think and act, to come back into action.  This allows the reasoning part of the brain to take control from the , and takes over the amygdala, where the anxiety response is seated. Here is some language you could use.

‘I want you to take a step back, inside your mind and observe yourself. Now scan your body and your mind. Look at your emotions. Find a name or names to describe them. You don’t have to do anything. Just give it a name and set it aside. Now tell yourself, that you got this, and it will pass. It is hard right now, but it’s going to get better’.

It’s hard not to jump in and problem solve, and interpret emotions for spellers. S2C practitioners don’t tell their spellers what they are feeling or interpret their feelings for them – That is the opposite of presuming competence.

Step 3. Go into motor routines that are reflexive and automatic, and place no demand on the speller.  Remember to tell your speller that you are using grounding techniques to help them in the moment.

Why are you doing this? This is because whether your speller is in flight, fight or frozen mode. Their autonomic, sympathetic nervous system is also using motor automaticity. You are providing a competing automatic motor action that they can switch to. Once they do this, they regain control over their motor and their body slows down and gradually their emotions level off. The amygdala is the seat of emotions and practised automatic actions, and the cortical brain is where we develop a thought/idea and translate it into purposeful action. Your goal as a co-regulator is to help them switch them back into using their cortical brain.

Breathing is motor activity

Breathing is an elemental and automatic action. Yoga and meditation practice is centered around breath control.  Breath control is at the root of calming one’s mind and managing emotions. Racing thoughts are matched by shallow and faster breathing. Slow measured breath is linked to slowing down thoughts and emotions. Use paced breathing to a count of 10. You can also do more complex cycles – Breathe in for a count of 4, hold your breath for a count of 4, expel your breath for a count of 4.

Breath control is hard for many spellers. You can teach them to blow/ exhale forcefully. Blowing out, purposefully, resets the pace they are breathing in, and acts to control breath. Coach your speller to blow at something, a tissue, a pencil or their own hand held up to their mouth. It makes it easier when they have a target. Get your speller to blow in time to a slow count of 10. You can also place the flat of your palm over the diaphragm and gently push in to help them expel their breath. Roll up a sheet of paper and make a straw for them to blow at scraps of paper. 

Other motor activities

    • Pacing to a rhythmic count of 10, up and down the room you are in
    • Looking at 5 different things in the room, as you point to them
    • Placing pencils you collect in your hand, on the window sill, one by one
    • Clapping softly to a steady beat, tapping to a rhythmic count
    • Swaying gently side to side 
    • Gently unfold a finger at time (form a fist first) to a rhythmic count
    • Squeezing a stress ball to a rhythmic count or beat

Repeat this till the speller’s emotions are de-escalated enough for you to switch to a coping strategy for a moderate anxiety level. You can also count down from 20. You’ll find that a count of 10 goes by very quickly.

Each speller varies, but you will be successful in helping regulate anxiety levels and come into a more moderate level of anxiety. At this point you can switch strategies to those recommended for that level (step 3 and 5 below, would be a go to).  However, if the trigger is not removed, or the speller is in a place where they take a long time to return to baseline, your entire session might become geared to emotional regulation. You can consider switching to full body exercise circuit routines to help manage emotions.

How to co-regulate a speller in a moderately anxious state

When your speller is experiencing moderate anxiety levels, you can work on any of the following strategies.

Step 1. Validate their experience (see details under how to regulate a speller in a highly anxious state)

Step 2. Ask them to name their emotion for themselves in their mind (see details under how to regulate a speller in a highly anxious state) 

Step 3. Replace thoughts – push away emotions with imagery 

Replace thoughts with anything else

Recite multiplication tables, count the tiles on the floor, name the colors on the clothes you are wearing.

Push the emotions away using imagery

Ask your speller to imagine the thoughts draining away from the top of his head, down his back, along the calves, seeping below their toes. Now they are standing on top of the thoughts. Now they are surfing on top and in charge, the thoughts may rise up again, but they can ride them with their surfboard. Use any imagery that works for – Build a wall around the emotion, the emotion climbs on a T-Rex and leaves the room. 

Step 4. Lower the demand

You can just read the lesson and skip all the questions. You could place the letter board by the speller so they can initiate a conversation when they want.

You can ask only known and/or semi-open questions. Make sure you let your speller know you are only doing this temporarily and giving him space to feel better. If possible, ask them if they are onboard with this coping strategy.

Step 5.  Increase motor opportunities via VAKT’s. 

Purposeful motor activities are a great way to mitigate moderately heightened emotions. VAKT’s are activities that use visual, auditory, kinesthetic and/or tactile to improve motor skills. You find relief in planning and executing an undemanding motor activity. Doing a load of laundry, unloading the dishwasher, going for a walk, calling a friend. 

Here are some unplanned VAKTivities that you can throw into any lesson

    • Let’s look up the statistic for sea turtle migration
    • Let’s find some synonyms for this word in the dictionary
    • Will you write that number with me, on a post-it? Let’s go put it on that wall now
    • Will you draw this diagram with me? 
    • Let’s read this sentence out loud together.
    • Can you fold this keyword sheet for me? Put away these books?

Step 6. Don’t forget your body engagers!8

Any S2C practitioner will carry body engagers with them on home visits, or have them handy in their clinic. This is the perfect go to for these times. Remember to only do well established body engagers. 

How to transition and co-regulate  a speller from high anxiety to moderate anxiety

Let’s take one of the strategies listed under regulating someone in a high anxiety state and look at ways in which you can bridge yourself and your student back into the lesson. Your goal is to change the level of motor activity in the following two step process:

    1. When your speller is in a state of an amygdala based motor response, where you see heightened heart rate, fast and shallow breathing  accompanied by a flight or fight or freeze  – shift the response to motor movements that are practised and overlearned. These motor responses have been learnt due to repeated use and myelination of motor neurology, therefore making it a low demand response. 
    2. Next, move from the practised and automatic motor response state to one that needs use of praxis – forming a thought/idea, creating a motor plan and executing it. 

You are helping them switch out of an amygdala based response state that anxiety puts them into, to a purposeful cortical response state. Here’s what that progression can look like

    • Pacing to a count of 10, rhythmically
    • Pacing backwards to a count of 10, rhythmically
    • Ask them to help you rip up paper and make a paper trail of  stepping stones. Stepping on these as you count. ( You can lay the trail to end or pass where you usually sit and spell)
    • Write numbers on the stepping stones with your speller. Resume walking on them.
    • Skip over stepping stones with odd numbers 
    • Rip up paper and write letters a – g, place a fresh trail of stepping stones. OR Experiment with sitting while doing a body engager. Spell one three letter word using the letters a-g at each stepping stone. OR Experiment with sitting while reading a couple of lines of the lesson

Once you are back in your usual place, assess anxiety levels and co-regulate according to their emotional level. 

You can, if you work regularly with this client, work in collaboration with their psychologist or psychiatrist, to teach them to initiate grounding techniques using motor. You can help by getting them involved in identifying their own anxiety level and choosing the coping mechanism that works for them. Help them build a tool kit and they will choose from it, with decreasing prompt levels, when they need to use it. 

Have you heard that question about a skill that people often ask? Is (teaching/cooking, etc.) a science or an art? I think it’s a rhetorical question, because really it is always both, and a boatload of failed attempts lead to being skillful!. My guess is that the question really signifies that the skill in question is a complex one. Just like co-regulating someone with anxiety is – it is a fine, fine skill, with many branching opportunities you can work on, to restore your speller to the balance they need, in order to learn.

Lakshmi Rao Sankar, S2C Practitioner

 

  1.  Autism, Sensory Movement Differences and Diversity. Martha Leary and Ann Donnellan, 2012
  2.  An update on anxiety in your with autism spectrum disorders. Roma, Vasa; Micha, Mazurek.Current Opinion in Psychology,  March 2015
  3. Co-regulation: The Physiology of Trust. Deborah Spengler. I-asc.org, February 12, 2020
  4. The difference between worry, stress and anxiety, Emma Pattee,  New York Times, February 2012
  5.  How the Fight or Flight Response system works. Cherry Kendra, Verywellmid.com, August 18, 2019
  6. DBT Skills Manual for adolescents, Jill H Rathus, Alec L Miller. 2013
  7.  Putting Feelings into words, Affect labeling disrupts Amygdala activity in response to affective stimuli. Lieberman Mathew et al, Psychological Science, 2007
  8.  Invasion of the Body Engagers. Giorgena Sarantopolous, I-asc.org, November 13, 2019
  9.  You can build this progression from any learnt, automatic motor response.

 

Resources: 

DBT Skills Manual for adolescents, Jill H Rathus, Alec L Miller. 2013

The mission of I-ASC is to advance communication access for nonspeaking individuals globally through training, education, advocacy and research.  I-ASC supports all forms of augmentative and alternative communication (AAC) with a focus on methods of spelling and typing. I-ASC currently offers Practitioner training in Spelling to Communicate (S2C) with the hope that other methods of AAC using spelling or typing will join our association.

Posted By on Wednesday, April 29th, 2020 in Advocacy,Education,Families,Motor,Nonspeakers,S2C,Spelling to Communicate,Training

One response to “Motor & the Art of Anxiety Regulation”

  1. Barbara says:

    This is just fabulous!!! Impressive too! Such useful info!!! Lakshmi… you ROCK!!!!

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