Low Arousal and Self Control
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- Hillary Moody
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1 Low Arousal and Self Control Bo Hejlskov Elvén: No Fighting, No Biting, No Screaming. Jessica Kingsley Publishers 2010 Hejlskov Elvén, Veje & Beier: Udviklingsforstyrrelser og psykisk sårbarhed. Dansk Psykologisk Forlag Bo Hejlskov Elvén Clinical Psychologist Control and restraint I never saw a restraint that looked as controlled as this picture - In my experience restraints are characterised by chaos Still the most used argument in favour of physical restraint is taking control of the situation Control and restraint I believe that most staff members restraining service users actually believe that they are solving a problem in the best possible way
2 Problem solving Challenging behaviour and conflicts are often reciprocal problem solution - I have a problem that I solve - My solution becomes a problem for somebody else that he or she must solve - In a way he or she becomes a problem for me to solve... This kind of conflict can only be solved by one of us using solutions that do not become a problem for the other Solutions We would like to teach the service users to use solutions that do not cause problems for us It would be more logical that we find solutions that do not create problems for the service users In order to avoid powerlessness and lack of control Both being key issues in both the Low Arousal Approach and in restraints The Principle of Control You have to have self control in order to lend somebody else control of a situation
3 The Principle of Control Everybody wants to avoid lack of control in order to avoid - Severe anxiety - Hitting - Kicking - Biting - Throwing of furniture - Severe self harm The Principle of Control That's why everybody has solutions and strategies in order to keep self control - Refusing or taking a long time - Lying - Running away or stepping backwards - Spitting, hitting out or screaming - Threats - Biting one's hand or cutting one's arm - Bad names, scratching or other social behaviour Lies: Talwar: Described in Bronson & Merryman: Nurture Shock. Authority The relation between My prime minister and me - He has more power over me than I have over him - Which gives me the right to think and say that he is an idiot - He s not allowed the same, though - If he does anyway he will lose power and authority
4 The Principle of Control That's why everybody has solutions and strategies in order to keep self control - Refusing or taking a long time - Lying - Running away or stepping backwards - Spitting, hitting out or screaming - Threats - Biting one's hand or cutting one's arm - Bad names, scratching or other social behaviour Not dangerous Lies: Talwar: Described in Bronson & Merryman: Nurture Shock. Affect Regulation Chaos Affect Regulation
5 Affect Regulation Chaos Affect Regulation Kaos The Principle of Control That's why we must strive to - Make sure the service user keeps his or her self control - Help the revive user regain his or her self control if he or she has lost it - Use methods that helps the service user lend control to us Sjöwall, Roth, Lindquist & Thorell: Muliple Deficits in ADHD: Executive Dysfunction, Delay Aversion, Reaction Variability an Emotional Deficits. Journal of Child Psychology and Psychiatry. In Press.
6 Affect and control There are nine basic affects - Interest - Distress - Anger - Weariness - Fear - Joy - Shame - Surprise - Disgust/dismay Introduction to affect theory: Nathanson: Shame and Pride. Darwin: The expression of emotion in man and animals. Further readings: Paul Ekman, Silvan Tomkins Affect Contagion Affect is contagious - we feel other's affects Using mirror neurons Mirroring muscle tension Research by Rizzolatti and colleagues. Affect Contagion All children are born with the ability to mirror affect It is the basis of empathy development People with special needs do not have a standard empathy development They do not develop the ability to separate their own from somebody else's affect In dementia, psychosis and brain damage that ability is lost Lombardo MV, Chakrabarti B, Bullmore ET, Sadek SA, Pasco G, Wheelwright SJ, Suckling J; MRC AIMS Consortium, Baron- Cohen S. Atypical neural selfrepresentation in autism. Brain Feb;133(Pt 2): Epub 2009 Dec 13.
7 Affect contagion Chaos Low Arousal Approach Simple measures - Avoid prolonged eye contact - Avoid a marked body language - Avoid touching the service user with tense muscles - Defuse - Keep calm, even in chaos
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