Occupational therapy is helping adults and teens find their inner balance
Bouncy swings hang over a large green mat, and one wall is dotted with fluorescent climbing apparatus. A blue and orange tunnel rests against the opposite wall. It’s a typical occupational therapy room, also known as a sensory gym, with one major difference — the client. With the therapist, stands 27-year-old Shevy. With painstaking effort, she’s intently focused on keeping her balance while standing on an exercise ball.
Shevy is one of the adults and teens turning to OT to help them find inner balance. These adults are experiencing life–altering changes through their OT sessions. Their treatment is based upon the rapidly evolving understanding of the different components of the brain and how they impact a person’s ability to succeed at all stages of life.
Imagine a mother who struggles to compute her reactions to touch, a highly sensitive sense. She doesn’t cope well when being touched and may therefore get angry when her kids do so. She probably struggles to overcome this reaction and gets upset with herself when she makes no progress.
Yet, she’s not really capable of changing her instinctive response simply by willpower. Her body is experiencing a fight/flight/freeze/appease (autonomic) reaction. Her brain has (incorrectly) interpreted this information as dangerous, and she’s reacting reflexively.
“Imagine the impact this has on her children and on her perception of herself as a mother when she can’t provide her children with the basic emotional need of being touched,” says Dinah Leiter, founder of the kid-focused multidisciplinary therapy practice, Kid Clan in New Jersey, as well as the Tops therapy practice for adults and teens. “Shame and anxiety are common in such a scenario. It’s imperative to understand the link between the body and its reactions to realize this isn’t simply about emotion.”
Dinah is passionate about the profound impact OT offers, not just for kids, but for teens and even adults. “First, you need to understand the complex functioning of the brain,” says Dinah. “The brain is made of different parts. They have different functions and impact our interactions and abilities differently. Adult OT works deep within the most automatic part of the brain — the brain stem.”
The brain stem regulates the involuntary physiologic functions your body needs to stay alive, like breathing, digesting food, and circulating blood. It’s also where the fight/flight/freeze/appease (FFFA) reaction occurs, our knee-jerk reaction to threat.
While this part of the brain is reflexive and functions without thinking, it needs to be operating optimally for a person to use the more conscious of their brain voluntarily.
A leading expert in this field, Dan Siegel, uses advances in neuroscientific discoveries to explain further integration across the brain’s region, allowing for “whole-brain” optimization. When all the connections in the brain are wired correctly, the brain can function in an integrated, harmonious way to formulate appropriate responses to stimuli.
An ardent fan of Siegel’s work, Dinah has found that OT offers powerful support for this process. Her work with adults and teens primarily focuses on integration or what’s known as self-regulation.
“Self-regulation is how our bodies adjust to what our current environment demands. For example, when we’re going to sleep, we relax and become drowsy. In contrast, if we’re going skiing, then we’d need to be very alert and energetic.
Reflexes are involuntary physical reactions that originate in the brain stem, and in fact, begin to develop in utero,” explains Dinah. As the prefrontal cortex develops, these “primitive” reflexes usually become integrated within the first year of life. The brain receives millions of messages constantly. All these must be screened, enhanced, and organized usefully for meaningful output, allowing appropriate self-regulation.
Most people’s reflexes are fully integrated as the infantile reflexes are replaced by higher-level reflexes, but for some, this system is out of sync. “Sometimes, these responses or reflexes elicit reactions and dominate when they’re not needed. This makes functioning under normal circumstances confusing and challenging. Messages are interpreted incorrectly, and the brain’s automatic response doesn’t properly prepare the person for the correct reaction to the stimulus,” says Dinah. This impacts emotions and relationships on every level.
Lack of integration can present in a myriad of ways. We’re all familiar with our five senses: sight, hearing, smell, taste, and touch. But there’s also three lesser-known senses: vestibular sense, interoception, and proprioception (see sidebar). Every person presents different strengths and weaknesses in all these areas. Yet, those who turn to OT often share that their difficulties were already present in childhood. Things just “weren’t right.”
Let’s take Shevy’s experience. A successful physical therapist from Los Angeles, she always felt like something was wrong with her, but never knew what it was. “I avoided summer camp; I couldn’t dance or balance. I never learned to ride a bike.” Yet more impactful than her lack of coordination and fluidity of movement was her ongoing struggle with her environment and her inability to regulate her moods.
As a child, she was socially and academically successful, so her parents attributed her moodiness to her personality. “I had constant meltdowns, and would get overwhelmed and cry a lot,” Shevy says.
In adulthood, certain events would send her into a tailspin. “I hated weddings, all the noise and movement. Dating was awful, I would freeze up with anxiety days before. Being among children and their noisiness would get me into a bad mood. And I thought this was all my fault.”
Aryeh, a 43-year-old science teacher from Jerusalem, describes himself as “hypersensitive” for as long as he can remember. “Auditory input in particular was very hard for me to process. Sudden loud noises such as thunder terrified me; I’d hide in my bed with my blanket over my head. Just the sight of a balloon sent me into panic from fear it would pop. I was also supersensitive emotionally; I’d feel things very deeply.” As an adult, Aryeh was diagnosed with chronic fatigue syndrome — his entire body was in a constant state of exhaustion.
Shevy and Aryeh’s experiences demonstrate the often-ignored link between reflexive sensory self-regulation and emotional regulation. In addition to emotional sensitivity, there are other ways dysregulation can manifest.
Rabbi Dan Lieberman, current Chief Rabbi of West Australia, says that his childhood and teenage years growing up in the UK were marked by his extreme inability to concentrate, no matter how hard he tried.
“I hated school. I was a daydreamer, constantly looking out windows and my teachers tortured me,” he recalls painfully. “I was intelligent, but couldn’t focus. Interestingly though, I wasn’t diagnosed with ADHD.”
When reflexes are integrated, there’s a dynamic equilibrium of the emotional, intellectual, and physical. When this isn’t the case, the brain will try to compensate in other areas to find its equilibrium.
Imagine a child sitting in the classroom. If he’s bored, then his intellectual component isn’t balanced and he’ll automatically try to regulate it. He might start fidgeting or rocking his chair, using the physical input to balance out the low demand on his intellect. Such constant disruption may force his teacher to use tactics, which are ineffective and mostly counterproductive. When this cycle continues, the emotional impact can be devastating. An otherwise intelligent child is labeled as a troublemaker, and his entire identity suffers.
The Battle Plan
So, what’s the solution? For Rabbi Lieberman, his break came when he attended yeshivah in Johannesburg after high school. “The rosh yeshivah recognized my difficulty and shared that he’d been going for OT with great results. He suggested I try it.”
The occupational therapist was an expert in adult sensory integration and immediately recognized fundamental gaps in Dan’s ability to regulate.
There are constant instances throughout daily life that require us to move one arm or leg across the middle of our body to perform a task. Dressing, hygiene, sports, even writing, all require these tasks. When a person finds it challenging to cross the midline, it indicates his left and right brain hemispheres are not effectively working together, making simple tasks overwhelming or impossible.
“I was a classic case; I could not cross the midline; I was rooted to the floor. Basically I was completely out of sync,” explains Dan.
“I had to start from the beginning and learn how to walk and move properly,” Dan says. “We did a lot of breathing work and awareness of my body in space.
Shevy only sought OT treatment after traditional therapy methods were unsuccessful. “I started classic psychotherapy because I thought I was too emotional and moody. But despite years of therapy, I still struggled to access these skills in the moment,” explains Shevy. “I understood cognitively what was required, but I still couldn’t do it. I was anxious, nervous, and uneasy.”
After being evaluated by a competent OT who worked with adults, Shevy was told she had poor sensory and reflex integration.
Dinah explains that OT is often the missing link when other traditional therapies aren’t as effective as desired. “We work from the ‘inside out.’ Talk therapy works within the cognitive brain. It’s valuable, but for some, like Shevy, they are still stuck in old patterns despite years of pursuing this route. The missing component is the ‘Body Work.’ If your body is not in cahoots with your brain, your daily life takes the toll. Ideally, a multidisciplinary treatment, working as part of a team along with other modalities, gives dramatic results.”
The goal of sensory therapy is simple: to help the brain process information usefully, utilizing the body’s comfort to access higher functioning abilities. Once a person feels grounded and settled in his body, he can then make conscious decisions and complete tasks successfully.
Let’s go back to the mother who found her children’s touch irritating. A program designed to regulate her sensory input of touch lets her process these stimuli in a safe way. A therapist may include in her regimen deep touch, brushing, and balancing movement. This teaches her to be aware of her own body’s signals to regulate herself. With time, her children’s physical touching won’t set off an FFFA response, triggering anxiety and anger. She’ll then be able to display her affection to her children comfortably. With this clear and practical approach, she’s relieved of her intense feelings of shame and guilt, and her children get the affection they desperately crave.
Like most good treatments, there’s no one-size-fits-all approach. “The length of therapy varies on the case and individual. It typically involves a variety of targeted exercises designed to retrain the brain to integrate sensory input,” emphasizes Dinah. “The focus depends on where the deficiencies lie and the impact can be profound and far-reaching.”
Dina stresses that the therapist would ensure that the client does different forms of activity focusing on the same goal. If they were working on movement, they’d move the client around in different ways. One session may involve bouncing on a swing, another time head exercises. Bike-riding, rollerblading, and other varied forms of movement could be included.
Therapists want to give the client a whole repertoire of sensory experiences. Breathing and calming techniques may also be a component, depending on the system that needs addressing.
The final stage of therapy would be treatment from the “outside in,” utilizing activities to empower the client to regulate himself in his daily life. Once someone’s body intuitively recognizes his comfort zones, he can tap into it through relevant sources. One person may find the balancing poses in yoga powerfully regulatory, while another may crave high-resistance weight-bearing sports.
Dan describes the interesting activities he performed as part of his therapy sessions. “I’d stand on a ball and try to catch a soccer ball while keeping my balance. There were also a lot of breathing exercises. Rewiring the brain isn’t simple. The sessions were exceptionally demanding and I was exhausted afterward.
“I did notice one stark improvement right away. I’ve always struggled with insomnia and suddenly I was sleeping deeply and for longer.”
Plenty of Perks
Better sleep was just the beginning. Both Dan and Shevy articulated that once they understood how their brain was wired and how it influenced their psyche and actions, this led to a powerful paradigm shift.
“I was able to be kinder to myself,” explains Shevy. “It wasn’t a question of lack of effort or an inherent personality flaw like bad middos. I was able to see my struggles as external to my essence. It’s about my brain and body working together.”
With therapy, so many of Shevy’s experiences suddenly now made sense. Her inability to handle noisy situations, her fears, and her emotional intensity.
“My nervous system was on constant high-alert. It was like everyone and everything was dangerous. I was scared of trying new things. I never learned to drive. My life was all about protecting myself.” This type of constant vigilance takes its toll. So much energy was being devoted to fending off these perceived threats.
Aryeh also found the awareness of his condition very liberating. “I now understand why I was so sensitive to noise, why I found just keeping up with regular activities so challenging. My chronic exhaustion now makes perfect sense — my body was in a constant FFFA mode of high-alert, so of course I was exhausted.”
Dinah explains that for such people “so much energy is expended trying to hold it all together — to hold their temper, to be calm, to be productive. They’re fighting their neurological wiring with superhuman efforts.”
As therapy progressed, Dan began to harness the incredible power of the cognitive ability he’d been blessed with. Always viewing himself as a chronic daydreamer, his newfound ability to concentrate and focus amazed him. Suddenly he could succeed.
“Part of my therapy was setting goals for myself. With this help, I was able to achieve all of them. I’d never have thought it possible that I could get semichah, and I now have an MSC in mental health and am studying dayanus.” Dan’s innate potential has found actualization; when the brain’s wired properly, the sky’s the limit.
The impact on Shevy’s life has been similarly monumental. While her surface appearance professionally and academically may not have changed much, her entire inner existence has shifted from constant nervousness to ease and comfort, something she never thought was possible. Regular scenarios that had sent her into an emotional tailspin are now manageable.
“I’m much better at dealing with noise now. While I don’t love attending weddings, I manage, and kids’ noises don’t make me irritable like they used to.” Shevy’s ability to enjoy and be present constantly has greatly enhanced her life.
“I started art classes and am more open to new things. I learned to drive. I’m more confident now that I have a sense of my body and space.”
The confidence in her ability to navigate even objectively threatening situations with calmness still amazes her.
“A few months ago after an OT session, I was driving home and it started snowing heavily. I never would’ve driven before; I’d probably have walked home,” laughs Shevy. “But I drove all the way home. It was amazing.”
For all those affected, what’s clear is this: It’s never too late to rewire broken connections.
We’re constantly bombarded with situations and sensations forcing our bodies to react, often without the time and benefit of focused thought. Therefore, your body has a reflexive system built in to allow you to automatically respond to constant triggers.
One response is the rest/digest response. This allows you to self-soothe when feeling threatened. It relaxes your body and inhibits or slows many high-energy functions. It lowers the heart rate, promotes digestion, and can even be responsible for a soothing crying jag.
Conversely, your body also has a fight/flight/freeze/appease reaction (FFFA), which is a heightened alertness of senses. This is your body’s automatic, built-in system designed to protect you from danger. For example, when you hear the words, “Look out!” you’ll instinctively move, narrowly missing a flying baseball sailing in your direction. Or upon seeing a bear on a hiking trail, you’ll freeze until it moves on.
In both scenarios your system’s reacting reflexively. This isn’t a deliberately thought-out reaction, but a rapid-fire, automatic, total-body response that allows our bodies to make heroic and rapid responses to protect ourselves from perceived danger.
However, occasionally, communication goes awry and the brain incorrectly interprets non-threatening signals as dangerous.
For example, someone who finds noise threatening may yell at her child for singing his parshah song at the top of his lungs (fight). Another person may avoid going to a wedding or leave early because they don’t feel comfortable around unfamiliar people (flight). And a third may not be able to respond to her boss when asked a demanding question (freeze).
These automatic responses to input mean that instead of being able to access cognitive and deliberate functions of the brain, the body is trapped in an ever-present fight for survival.
Meet the other three senses:
-Vestibular sense is involved in body position and movement of the head. It comes from the vestibular system in our inner ear and is activated when there’s a change in gravity or when your head moves. Without your vestibular sense, you’d constantly be dizzy. It helps you focus and feel centered, allowing you to keep your body upright when jumping or shifting positions.
-Interoception helps you understand and feel in tune with what’s going on inside your body. People who struggle with the interoceptive sense may have trouble knowing when they feel hungry, satisfied, hot, cold, or thirsty.
-Proprioception is your body’s ability to sense its location, movements, and actions. It’s the reason you’re able to move freely without consciously thinking about your environment.
To understand how our brain works, it’s helpful to know the main components of our most powerful organ.
Cerebrum: The cerebrum is the largest part of the brain, and composed of right and left hemispheres. It performs conscious higher functions like interpreting touch, vision, and hearing, as well as speech, reasoning, emotions, learning, and fine movement control.
Cerebellum: The cerebellum’s function is to coordinate muscle movements, maintain posture, and balance.
Brain Stem: The brain stem acts as a relay center, connecting the cerebrum and cerebellum to the spinal cord. Many of its functions are automatic, such as breathing, heart rate, body temperature, sleep and wake cycles, digestion, sneezing, coughing, and swallowing.
To Give You a Sense
How is your brain message center working? Take a look at this simple checklist to see if perhaps you, too, would benefit from rebooting your brain. Do you:
- Have trouble falling asleep and staying asleep?
- Have difficulty controlling knee-jerk reactions, such as
- Have constant unexplained irritability?
- Have trouble being flexible, “letting go” of insults or
- Have extreme sensitivity toward textures, tastes, sounds,
- Have difficulty with impulse control?
- Have many emotional meltdowns?
- Have difficulty completing tasks or staying on track?
- Have difficulty with balance, are often “clumsy”?
(Originally featured in Family First, Issue 714)
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