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Practitioner Article: The Emotional Rollercoaster

An excerpt from The Emotional Rollercoaster: Applying the Low Arousal Approach

To Persons Who Engage in Behaviours of Concern, a recently published pracitioner article from Studio 3


The Low Arousal Approach is a crisis management system that was originally developed in the early 1990’s in the UK (McDonnell, 2019). The approach stresses that people are expected to alter their own behaviours to develop effective crisis management responses with individuals. This requires a highly reflective approach (Schon, 1987) where individuals are often expected not to directly challenge people who are highly distressed.

One element of the Low Arousal Approach is that we often expect people to tolerate behaviours of concern by not interacting and stepping back. This can sometimes be viewed by supporters as ‘giving in.’ When an individual is being verbally hostile this may lead to a supporter feeling out of control and helpless. Practitioners of the Low Arousal Approach are often expected to ‘ride the emotional rollercoaster’ (McDonnell, 2019).

Low Arousal Approach utilises proactive strategies: once it is clear that an individual is experiencing high levels of arousal, a distraction or redirection technique can be employed to avoid a crisis situation. In times of crisis, we should adopt a relaxed and confident presence, reduce verbal communication - especially demands - and show empathy towards the person experiencing the crisis. It is a carer-orientated intervention that emphasises reflectiveness, acceptance and empathy, as well as the impact of trauma and how that should shape our view of the person displaying behaviours of concern.

Understanding the Low Arousal Approach from an academic perspective can be very different from applying it in practice. The remainder of this article will focus on a distressed individual with a diagnosis of autism and the reflections of his support worker.

George: An Example

The following anonymised example clearly shows how difficult it can be to engage with someone who is struggling to understand a world that is both unpredictable and chaotic (Vermeulen, 2012).

George is an adult who is in his mid-thirties. He lives independently in his own flat. George has recently been receiving regular support for 5 hours each day after a year of going without any support. His anxiety related to autism and prolonged isolation sometimes prevents George from taking part in new recreational and daily living activities. George will often refuse to visit unfamiliar places and to do activities or chores. He will then report being bored and having nothing to do. George has a limited understanding of his own emotions and how stress may affect him. He will use language such as ‘I’m stressed’ and ‘I’m anxious,’ but often struggles to understand these phrases. He is not able to recognise that his own internal emotional states are responsible for the way he sometimes might feel about certain activities. Consequently, George attributes his struggles externally to the incompetence of others, mostly his family and support. At times of very high stress, George will get verbally and emotionally abusive and blame others for the situation he has found himself in. George tends to have a ‘narcissistic’ view of the world, but, in reality, this means he struggles to take other people’s perspective into account.

Applying the Low Arousal Approach: A Support Worker’s Reflections

George’s support worker was trained and supervised in the Low Arousal Approach. At the time of writing, this person has supported George for approximately nine months. Initially, in the first two months, there was a ‘honeymoon’ period where there was relatively little challenge presented by the individual. As their relationship developed, George began to view his support worker in a much more adversarial manner. There was then a period of approximately three months where the individual would be openly argumentative and look for his support worker to provide him with solutions to his day-to-day issues. This also coincided with his support worker and other members of his family discussing his autism diagnosis. At the time of writing, it seems clear that George does not always view his diagnosis as positive. George has commented, ‘If I could cure my autism, I would.’ At the time of writing, the relationship between George and his support worker is viewed by the authors and his family as positive. His support worker has most certainly become more accepting of George and is considered to be an experienced Low Arousal practitioner. The following involves a number of key questions that were raised by supporters and friends. Continue reading...

Written by:

Karolina Morgalla, BSc, MSc, Assistant Psychologist, Studio 3

Andrew McDonnell, PhD, Consultant Clinical Psychologist and CEO, Studio 3

Carl Benton, RMN, Clinical Manager, Studio 3

Tarendeep Kaur Johal, Assistant Psychologist, Studio 3

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