By Nancy Keeley, Interaction Practitioner
We all experience anxiety. Perceived threats (real or imagined), cause our brain to release chemicals, such as adrenaline and cortisol, which prepare our bodies to either escape from or confront the supposed danger. The resulting sensations, such as a thumping heart, quickened breaths, sweating, muscle tension and churning stomach are all body responses vital to our survival when faced with a real threat. Fortunately, most of us rarely experience life threatening danger, however, many aspects of our day to day life can be anxiety inducing. New experiences can cause fear and doubt. Will they be pleasurable or not? I might get hurt, feel embarrassed or fail. We also draw on memories, often remembering the unpleasant scenarios and outcomes more than our more successful and positive experiences. Our creative imaginations maypredict negative outcomes. In brief, anxiety (whether caused by a man eating lion or a job interview) manifests from fearful uncertainty and perceivedlack of control. Added to this, we may have doubts about our own abilities to manage the situation at hand.
Most of us have coping strategies, and find ways to calm ourselves. We take deep breaths to slow our heart rate, we try to rationalise, we may change our environment by, for example, going for a walk in nature, we may distract our thoughts with an activity, or we talk to people to seek facts and reassurance. We may also seek the comforting presence of our friends…people we connect with and who support and value us.
Most of the people visited by Us in a Bus have profound and multiple learning difficulties and complex needs. All find generic communication challenging and without a doubt, most experience anxiety. We, their support team of family, friends and carers, do not have a full picture of their life experiences. We observe their responses and self-expressions (body language and actions, words/vocalisations, facial expressions) and sometimes make assumptions based on their reactions and our knowledge of them. We can’t fully understand, and they are unable to clearlycommunicate their choices and internal emotions. Their limited understanding or our typical language may also cause them to feel uncertain about our expectationsof them and what will happen next.
In addition to this, most people with learning difficulties experience the sensory world differently. The main senses are vision, audition (hearing), olfaction (smell), gustation (taste), touch, vestibular (balance and movement), proprioception (body sensation – knowing where it is and the force of movement) and interoception (internal sensations). One, several, or all of the senses may be affected and the person can have heighted, lowered or variable experiences. This, together with the aforementioned communication difficulties can result in feelings of uncertainty, lack of control, fear and anxiety.
There are many wonderful resources and specialists available to support both communication and sensory difficulties. Visual timetables, objects of reference, picture exchange, choice boards, Makaton etc. all provide much needed communication support. Sensory profiles, carried out by Occupational Therapists, and an array of sensory equipment including weighted blankets, swings, and ear defenders can positively support the sensory system. The person’s support team, the people who care about and for them, can also ease the feelings of anxiety with their knowledge, consistency, patience and appreciation.
So how can Intensive Interaction also reduce anxiety?
Intensive Interaction offers the unconditional positive regard and support of friendship. It involves being with someone and connecting without an expectation or demand, finding ways for them to lead the direction and pace of the time together. This can initially be challenging for the person who may, on seeing/hearing feeling you, expect a functional activity or entertainment such as personal care, baking or watching TV together. There may be a period of adjustment whilst the person adapts to his/her control of the interaction and there may be some initial anxiety. However, this is overcome as trust, friendship, curiosity and mutual regard develops.
The basic principles of Intensive Interaction are: –
- Be relaxed and unhurried. There’s no goal. Have a relaxed posture and allow the interaction to flow naturally.
- Observe. Find out through observation what the person does and likes. Do they rub their fingers together? Rock? Vocalise? What do they look at? Does this indicate any sensory feedback seeking or avoidance?
- Tune-in. What is their energy? Relaxed, unhappy, playful or quiet? Show your empathy in your body posture, facial expressions and voice. If they seem anxious, would it be better if you moved away slightly, or to the side?
- Notice and respond. Mirror actions and echo vocalisations. They don’t have to be exactly the same, but do need to be well timed and similar enough to ensure that the person has the opportunity to understand the connection. Their own actions and sounds should not impact on any of their sensory sensitivities, and might in fact support sensory soothing. Mirroring and echoing will also be familiar and therefore easier to process. Sometimes they may be very quiet and still. On these occasions, noticing what they are looking at and mirroring their breathing pattern can be very relaxing and connecting.
- Pause and wait. Having responded, hold the space and wait for their next self-expression. They lead the interaction, are in control and will begin to have a certainty of what will happen next through their own actions. In addition, people with complex needs often need more processing time.
- Embrace repetition. Don’t feel compelled to drive the interaction forward. Repetition is predictable and safe, and demonstrates that you will wait until they want to change the interaction. Again, they are in control.
- Stop when you’re told to. This may be expressed through a vocalisation, action, or by them moving away. It doesn’t mean that the interaction can’t be revisited, sooner or later. There may be many reasons for the discontinuation, including processing time, or other external or internal influences.
These principles support a person centred approach to connection and engagement. The pace and content is conducted by them, thus reducing fear of confusion, unpredictability and uncomfortable sensory experiences. Leading interactions, and having self-expressions shared and valued promotes feelings of empowerment and, hopefully, a desire for more self-expression. In addition, our unhurried empathy demonstrates our interest in understanding the person we’re engaging with. Being understood results in feelings of being supported and valued.
With consistency and over time (or sometimes very quickly), trust develops and anxiety reduces. It is then that interactions can be further explored, whilst maintaining the basic principles. We can sing songs that celebrate actions and vocalisations, stopping, starting, and changing in pitch, tone and volume when conducted by the person. When mirroring and echoing we can respond with playful vocalisations and overly animated expressions. We can introduce pieces of equipment that we think will support self-expressions, interests and/or sensory needs. We can also facilitate small group interactions, sharing everyone’s self-expressions and interests. Our experience indicates that all of these developments further broaden interests and an understanding of the people around them.
So…. how can Intensive Interaction reduce anxiety? By providing a predictable, meaningful and safe base to explore preferences, self-expressions and the people around them, which then promotes increased self-confidence, self-worth, control, understanding, and self- expression. This increases the prevalence of emotions that directly oppose anxiety, leading to greater contentment and security.