State-dependent Functioning in NMT
State-dependent Functioning is another NMT-related concept which I have found helpful in my practice and that families have also found helpful to develop more empathy toward their children in acute crisis.
In a nutshell, state-dependent functioning posits that depending on one’s stress-level, one has more or less access to a full rational and empathetic brain. The more stressed we are, the less we can think clearly.
Bruce Perry’s stress continuum goes as follows:
Calm
Alert
Alarmed
Fear
Terror
Bruce Perry has then distinguishes two adaptive options as two main responses to stress he observed:
-the arousal continuum, from calm to full fledge attack (you may think of the fight trauma response)
-the dissociation continuum, from calm, to passing out (you may also think of shutting down or play dead as a way to response to stress). I will write another article about dissociation eventually, but I will keep it within Bruce Perry’s view of dissociation within this article.
How is this idea useful?
The main point of this idea is that if someone is in a calm state, they can learn and reason, will want to connect, and be open to suggestions. At other states, they will be less and less so inclined.
This makes it tricky when for instance my gut-reaction to my dysregulated child is to want to help them see why they are not reasonable by talking to them.
If one takes a state-dependent functioning approach, the goal will be to regulate and connect with them first, before talking and reasoning. This links with another NMT concept called the 3 Rs: Regulate, Relate, Reason.
Arousal Continuum
The arousal continuum is what I pictured as a volcano in the picture below. It is what one can easily see as this is very externalized, such as defiance, flight, and ending in flight when there is no other way to cope and the stress is too high.
The arousal continuum has the following states:
Reflect: The stress level is low which allows access to higher levels of thinking such as abstract thinking, planning, creativity, and feeling connected to others
Flock: the stress increases and now one may be looking at how other people are reacting to whatever is increasing the stress (is your friend also freaking out about this weird noise, or are they okay?) and may be more likely to follow the group. It can also be shown as hypervigilance. The thinking becomes more concrete. Behaviors one may see may be sassiness, “no”, increased in body movement, etc.
Freeze: The stress continues to increase and the behaviors one may see may look like pacing, increased tensions in the body, balled fists, increased opposition and resistance, shorter sentences, laughing (even though it is not funny), illogical or unreasonable
Flight: In this state, the person may run away from you, become defiant, speak louder, throw a tantrum, use verbal aggression, starts air punching or trying to get you to back off from their personal space (if we imagine this as an invisible bubble around the person, this bubble tremendously increases in size the more stressed someone gets)
Fight-Aggression: In this state, the person will attack and rage. Of note, in my experience, this state can be mixed with a dissociative state, which means that the person will not entirely remember what happened.
Robyn Gobbel has used Bruce Perry’s ideas and adapted them in a child-friendly way using the analogy of the watch dog. (She uses the owl brain for the calm state, the watch dog for the arousal continuum, and the opposum for the dissociative continuum, see a link here). I really like her approach where she uses other ideas and theories to support the families she works with. She also has an online community called the Club and a podcast.
Two main ways to react to stress are via the arousal or dissociation continuum. Each continuum has different levels of stress. In NMT’s heuristic of the brain, the higher the stress level, the less you have access to your brain. The brain is color coded to match the different states. For instance, aggression and fainting are both on the highest ends of each continuum and these are reactions that dictated by the brainstem, while the pre-frontal cortex, is offline.
Dissociation Continuum
The dissociation continuum is what I pictured as an iceberg above. In my head, the deeper it goes, the colder it gets then people shut down more and more and sometimes faint.
Just like the arousal continuum, Bruce Perry has five distinct states within the dissociation continuum:
Reflect: Could be seen as day-dreaming
Avoidance: A person will seem distracted or off-task, with flat affect and facial expression, seeking not connection with others and wanting to be away
Compliance: This state is very tricky, as it seems like the person is doing what is asked of them. In children, this would be seen as a positive state, rather than problematic and could thus easily be missed. The clue that the person may be in that state is that they will comply more like a robot and you may still not feel connected and they will not really understand what they need to be doing, or they will not make a lot of sense. Robyn Gobbel also says this can sounds like a lot of “I don’t know”.
Dissociation: I believe Bruce Perry sees this state more as what one would think of when thinking about dissociation, where a person experiences depersonalization (they feel like they are outside of their body), or derealization (what is happening does not feel like it is happening to them). Usually a person will look blank and not respond. Robyn Gobbel calls it the shut-down state and describes it as people looking down, drawing their limbs to themselves, looking pale, and at times crying unconsolably.
Fainting: This is the most extreme and highest level of stress. In my experience, I have encountered fainting only in younger children (five and under), but that does not mean it needs to be limited to that age. This is seen as complete non-response and fainting that is not due to another medical condition.
How is this helpful in practice?
What the concept of state-dependent functioning proposes is a paradigm shift from “will not” to “cannot”. People can when they are in a calm state, but beyond that state, it becomes harder and harder to do something.
That means that the dysregulated person needs help to decrease their stress levels. If you recall from the article on trauma and neglect, unfortunately it is more difficult for people who may be sensitized to stress as they will go from the low end to the high end of the continuum quickly and stay in a high level of stress longer than people with more resilient nervous systems.
Another major implication of the state-dependent functioning is also that the higher the stress level, the more people will go back to old ways of behaving and reacting, they will regress. That means that to respond to the person in a helpful way, we need to think about not their chronological age, but their developmental age in that very moment.
