The Window of Tolerance and Chronic Illness

Source: Katie Willard Virant

For people living with chronic illness, finding equilibrium can be challenging. Pain and fatigue cause us to mistrust our bodies. Relational and economic security also can be foreclosed or interrupted by chronic illness. I’d like to examine these realities using the lens of Dr. Dan Siegel’s “Window of Tolerance” model. For many people, this model can be helpful in naming and managing our emotions.

The Window of Tolerance

In short, Siegel posits that “there is [a] range of optimal arousal states in which emotions can be experienced as tolerable and experience can be integrated” (Corrigan, Fisher, & Nutt, 2010). We will explore this idea using a visual metaphor.

Picture a window overlooking a pleasant scene. Maybe your window overlooks a garden, or a beach, or mountains. Make it yours—whatever gives you pleasure.

Spend a bit of time imagining yourself gazing out of this window. Feel all the sensations associated with this experience. If it’s sunny, feel the warmth on your face. If it’s snowing outside, press your hands to the windowpane and feel the invigorating chill. When you’re ready, come back to the page and continue reading.

How did you feel as you looked out of your window? I’m wondering if you felt alive and engaged, interested in the beautiful scene you experienced. Perhaps you felt less preoccupied or anxious than usual; maybe you felt a peace that can be hard to come by.

On the other hand, maybe you felt overwhelmed and couldn’t picture any scene that allowed your mind to experience pleasure. Or maybe you kept getting distracted by your worries or pain. Or maybe you’re so fatigued right now that it all felt too much. That’s OK! The Window of Tolerance model names and explains these sensations, too.

In, Above, and Below the Window of Tolerance

As you have surmised, the window of tolerance is a way of visualizing a place of emotional regulation. When we are in our window of tolerance, we are engaged in what we are experiencing. Our bodies are neither too tense nor too dissociated; our minds are neither rigidly seeking control nor checking out entirely. We feel good.

There are times when we are not in our window of tolerance that we feel jittery, anxious, overwhelmed, and panicky. Perhaps when you tried to create your inner window in the exercise above, it stressed you out instead of creating a feeling of well-being. Maybe you got anxious or frustrated. What you experienced is called “hyperarousal.” You were operating above your window of tolerance.

There are also times when we’re outside of our window of tolerance that we feel numb, empty, and sluggish. Perhaps when you tried to experience your inner window, you couldn’t connect to it all. Maybe you had a hard time even seeing the point of trying. What you experienced is called “hypoarousal.” You were operating below your window of tolerance.

Determining and Adjusting Your Baseline

It’s important to note that our nervous systems are designed to fluctuate. We are meant to respond to our environments, meaning that there are times it makes sense to be above (hyperaroused) and below our window of tolerance (hypoaroused). However, for people with lots of stressors (including people living with chronic illness), their nervous system can get stuck in hyper or hypoarousal instead of moving back into the window of tolerance (our ideal baseline).

Where does your nervous system usually sit in the continuum described in the Window of Tolerance framework? Do you tend to mostly live in, above, or below your window? If your baseline is not located inside the window of tolerance, then it’s time to take steps to adjust your baseline.

If you’re operating above your window of tolerance (in hyperarousal), you’ll want to find ways to move your baseline down. Take some slow, deep breaths. Relax your shoulders. Slow your thoughts down. Let your energy settle.

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If you’re operating below your window of tolerance, you’ll want to take actions to move your baseline up. Physical activity—even moving your body in your chair—is helpful. Noticing your surroundings, taking in the world through your senses, can bring you back into your body and animate you. Your task is to bring your energy up.

Don’t overthink this, and don’t get discouraged. I ask my clients to imagine a thermostat. If you can take action to move the dial a degree or two, that’s fantastic. Gradually, as you repeat this process, your nervous system will become adept at responding to your cues and move the dial more easily. Eventually, your efforts will shift your baseline.

Using the Window of Tolerance Model

Become accustomed to checking in with yourself multiple times a day and asking, “Where am I at this moment on the Window of Tolerance continuum? Can I adjust my emotional thermostat to move myself closer to the window of tolerance? Do I need to down-regulate or up-regulate?”

Keep a record of activities that help you move closer to the window of tolerance. Experiment with activities like exercise, hanging out with friends, watching TV, making art, lying on a yoga mat and relaxing your body, and sitting in your yard looking at birds. Which activities feel particularly helpful for you?

This is a lifelong journey, and you will see results over time. At first, it may feel cumbersome, but it will feel easier as you continue to practice. Remember—even a small movement of the emotional thermostat is a win worth celebrating.