Noticing trauma responses: the development and validation of the autonomic response screening tool for counselors (ARSTC)

UNCG Author/Contributor (non-UNCG co-authors, if there are any, appear on document)
Madeleine Morris Lowman (Creator)
The University of North Carolina at Greensboro (UNCG )
Web Site:
DiAnne Borders

Abstract: Trauma can impact all people of all identities, and mental health professionals are experiencing an influx of clients presenting for services with symptoms related to trauma (Webber, Kitzinger, Runte, Smith, & Mascari, 2016). According to the U.S. Department of Veterans Affairs (2016), an estimated 6 in 10 men and 5 in 10 women will experience a traumatic experience in their lifetime. Roughly 8 million adults meet diagnostic criteria for Posttraumatic Stress Disorder (PTSD) in a given year (U.S. Department of Veterans Affairs, 2016), and trauma is considered a public health crisis by the U.S. Department of Health and Human Services (2003). In response to this increasingly prevalent concern among the population, it is imperative that counselors are trained to effectively recognize and treat trauma symptomology. Porges’s Polyvagal Theory (PVT; 2018) offered a conceptualization of trauma responses that could prove useful for counselors. Porges outlined the physiological underpinnings of how one’s autonomic nervous system (ANS) responds to stress. PVT explores three types of stress responses: social engagement, sympathetic arousal (fight/flight responses), and dorsal shutdown (freeze responses). These responses are connected with various symptoms that correlate with trauma, and they offer one lens for conceptualizing how clients present to counseling for trauma. Within the literature, authors are conceptually connecting symptoms of psychopathology with ineffective autonomic regulation and vagal dysregulation (DePierro et al., 2013; Fiskum, 2019), as outlined by Porges (2011), but there is limited empirical literature on applying PVT to counseling. Thus, autonomic regulation is an important - but overlooked - factor at play within counseling and trauma treatment. Because autonomic regulation is tied to which trauma response a client experiences (and exhibits in session), it is important for counselors to have a way to screen for it. In the current study, visual markers indicative of autonomic regulation related to the social engagement, fight/flight, and freeze responses were organized into the Autonomic Response Screening Tool for Counselors (ARSTC). These items did not categorize into the specific trauma responses as outlined within PVT, but they did seem to be representative of two broader yet distinct nervous system processes: sympathetic and parasympathetic processes. These analyses suggested initial evidence for the validity the ARSTC, specifically related to changes in heartrate variability (HRV) between the ARSTC categories of social engagement and freeze, and fight/flight and freeze. Limitations of the study and implications of the results are outlined, and offer a launching point for both counselors and researchers to continue exploring the role of autonomic processes and PVT at play in counseling session.

Additional Information

Language: English
Date: 2020
Autonomic regulation, Body language, Observational screening tool, Physiology, Polyvagal Theory, Trauma counseling
Psychic trauma $x Diagnosis
Psychic trauma $x Treatment
Autonomic nervous system

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