Physical Calming

Turing times of distress there is typically physical as well as cognitive (thought process) hyper-arousal.  When trying to calm it usually very difficult to calm the mind without calming the body first.   People who try to think calming thought  when hyper-aroused often find it difficult because the brain will typically operate in 'survival mode' when distressed.  What I mean by that is when highly aroused, the brain diverts emphasis from frontal lobe functions (complex thought) to parts of the brain more involvedwith alertness and quick decision amking.  There usually is not much time for slowly developing complex thoghts during emergenices and when people are distressed that is what the brain perceives the situation to be.  Therefore in order to restore the frontal lobe and allow for well thought out decision, the brain has to come out of this emergency state.  Physical calming activities are able to slow the body enough to allow the brain to return to it's typical functioning.   

For many people the easiest way to slow the body is through slow deep breathing.  Breathing slowly and deeply serves the dual purpose of slowing arousal while supplying more oxygen to the brain.  However, for breathing to be effective in calming, it has to be  deep, slow, and most importantly soft.  When I try to teach deep breathing to many of my clients (especially children), they respond by taking and hard deep breath and blowing out the air forcefully. They typically know how to breathe deeply but not softly or slowly.  This type of breathing increases arousal and is counterproductive to calming.  People with autism often need a concrete way of gauging the speed of their breathing.  I will often ask my clients to count to 5 in their head for each breath in and each breath out.  If visual guidance is needed the person can count with their fingers or follow a digital counter.  Breathing softly is often the more difficulty concept to teach, but I can usually get the point across with a simple analogy.  Have the person imagine they are blowing bubbles.  For young children they can actually blow bubbles which makes it more enjoyable. and gives the child visual feedback.  The idea is to imagine or actually try to blow a large bubble     
because a softer controlled breath is needed in order to blow a large intact bubble.  Once the breaths become soft and slow, initial calming can usually be achieved in 5-10 breaths, although some people may need longer depending upon their excitement level. 

For those who have difficulty with deep breathing, physical calming can still be achieved through sensory integration techniques.   In addition ot removing the stimulation frothe environment or the person from the stimulation, certain types of stimulation can actually enhance calming.  In particular, anything that applies deep pressure to the joints can have a calming effect.  Examples include draping with a heavy blanket, a firm hand the shoulder, squeezing a ball or pillow and exercise.  Deep massage could also be helpful, although that may be difficult to administer during times of distress. Also, activities where the person can tense their muscles then relax them can have the same effect.  These types of activities take  about 15 minutes before the person becomes visibly calmer.  Once physical calming occurs, then it is easier for the person either to think more clearly of a solution for themselves or be guided through problem solving and coping statements by others.  The cognitive elements of sutiational be explored during the next post.

Stopping the Escalation of Emotional Distress

Because people with Autism tend to have sensitive nervous systems, emotional reactions tend to come much more quickly and are stronger than those who are more typically developing.  As a result, when a person with ASD becomes upset, the nervous sytem goes into almost immediate overload which make any type of rational thought virtually impossible.  It makes absolutely no sense to try to problem solve with a person when they are in this state.  Therefore, before any real coping can take place the person much first be able to recognize when the person is experiencing stress and STOP the escalation.  Typically this involves stopping the current activity and going to a quiet place for calming.  This could be as simple as going to the restroom, getting a drink of water, or taking a short walk.  Once in the quiet area, the low stimulation will help slow the person's arousal and put them in a state where they can begin physical calming activities.   

The first step in this process is recognizing when one is in distress.  When teaching someone to recognize signs of distress in oneself, be aware of the physical signs.  These include increased heart beat and breathing, muscle stiffness or pain, and stomach upset.  Also, thoughts may be moving too quickly which makes decisions and activities that are normally done easily more difficult. When a person starts to feel this way they should immediately stop what they are doing, find a quiet place (perhaps excusing oneself to the restroom of water fountain) and engage in some type of calming procedure until typical physical and mental functioning is returned. 

When recognizing distress in others, look for behavior that is atypical for that person or any sudden changes in behavior.  General signs to look for include increased motor activity, restlessness, or agitation.  This could include pacing, fidgetiness, and hyperactivity.  The person may seem unusually stiff or tense, and not move as fluidly as they typically do. Also, their speech may get louder or, in contrast, they can become more quiet/withdrawn than usual.  The person's need for routine and sensory functioning may additionally be more sensitive during these times.  There may also be more talk about preferred interests, repetitive speech,obsessive thought, or stereotyped behavior.  A change in sleep patterns or appetite may also be noticed, along with the mentioning of events previously associated with distress.  In fact, many people with Autism will recall a distressing past or association in order to communicate current distress.  If the distress is recognized early, the person can be prompted or redirected away from the distressing activity (temporarily) and engaged in calming activity without major incident. 

The next post will review specific calming activities. 

Steven C. Altabet, Ph.D.