79: Mental Health First Aid: Practical Strategies for Self-Regulation with Nicole Roma Thurrell
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Welcome to Therapy in the Great Outdoors, the podcast where we explore the business and practice of nature based pediatric therapy of all kinds. If you're an outdoor loving pediatric practitioner in the fields of occupational, physical, or speech therapy, social work, or mental health, this podcast will help you start and grow a successful nature based practice or program.
I am the ever honest, always a hundred percent real. You'll hear it all on this podcast. Dr. Laura Park Figueroa. I'm a pediatric OT with over 20 years of experience and I run a thriving nature based practice with profitable locations in two different states and multi six figures in revenue. I also host the free online community at therapyinthegreatoutdoors.
com to help you pursue your nature based therapy dreams too. Are you ready to take action on those dreams? Let's jump [00:01:00] in.
Whew. Hello everyone. It has been a week. Let me tell you. I am. So exhausted right now. And very much looking forward to next week. Would I am flying to California to do a three-day backpacking trip in Yosemite with a friend. I could really use some nature time right now. So. This week has been a little crazy.
We started summer camp here in Madison. And I've had to step in a little bit because we have a, a challenging group this week and I have team members leaving and I'm trying to hire team members. So that has been a challenge and the podcast is behind on production. And that has been a challenge and just. It feels like one of those situations where, when it rains, it [00:02:00] pours and I'm just trying to. Keep on keeping on and I'm telling myself that I can only do. What a human being can possibly do in a given Workday.
So. A lot of things are falling to the wayside this week and I'm just trying to stay positive and upbeat as possible. So. This episode. Is phenomenal. You are going to learn very. Specific. Things that you can take action on immediately. Like you will learn strategies that you can immediately use tomorrow in your next session with a child outdoors. Nicole Roma thrill Thurl is back.
I always have a heart. Her last name, rhymes with squirrel. And I, I always want to say the REL, but it's thorough. Like squirrel. So Nicole Roma, thermal is here and she is. [00:03:00] Such an engaging speaker. If you've listened to the last two episodes, you know, this is the third in our series on. Wilderness quote unquote, first aid.
She is the director of Institute for wild med, and you can hear all about her and her credentials, which are. Long there's a long list of credentials that she has. In the episode two episodes ago. So in part one of this series about risky play. So, if you haven't listened to that, go back and listen. But this is our third and final installment.
It is a longer episode because there was just so much goodness that Nicole had to share. So. I think that's it. I hope you're having a better week than I am and here's to. Brighter days ahead. All right. Let's dive into this great interview. Two. Perk up my spirits here.
Laura Park Figueroa: Okay. Welcome back, Nicole. Here we are
Nicole Roma Thurrell: It's [00:04:00] great to see you.
Laura Park Figueroa: about mental health first aid. I'm so excited. So tell me, last time we talked, you had said you were going to go to a conference to do a presentation about mental health first aid. So tell me how that went and then we can dive into some of the nitty gritty
Nicole Roma Thurrell: Yes, I am fresh back from Portland, Oregon, where I presented at the Natural Start Alliance conference. Natural Start Alliance is a subgroup of the North American Association of Environmental Educators. They have this small subgroup specifically for nature based environmental educators. So yeah, I got to spend a week with some of the most amazing people out there who are nature based preschool teachers.
And it went well. Yeah. So I, we did a wilderness first aid course in the Hoyt Arboretum, which was amazing. And then during the conference, that was a pre conference session. And then during the conference, I did a session on wilderness, mental health [00:05:00] first aid. And it really was my pilot of this program.
And we filled the room, we ran out of chairs.
Laura Park Figueroa: that's so great.
Nicole Roma Thurrell: My operations manager Molly and I, we set up 20 chairs and there were about 40 in stacks along the walls. And we're like, oh we won't, you know, we won't need those. It'll be a cozy group. There's five different sessions happening at the same time. Same time, we divided, you know, the total number by five and, and we're like, Oh, this should be good.
And they took down every chair from the walls and, and they were standing along
Laura Park Figueroa: Wow.
Nicole Roma Thurrell: Yeah. So it's clearly a topic that people are interested in.
Laura Park Figueroa: yes. I was just going to jump in and say that, that I've, I just said to someone this morning, one of our students that's working with us, like we used to get kids for OT in my profession 25 years ago when I started as an OT, we, we got kids who had fine motor or sensory issues. That was it.
Right. And now,
Nicole Roma Thurrell: or, yes,
Laura Park Figueroa: yes. [00:06:00] Right. So, and now we're getting more and more children who their, their main diagnosis, like the main reason that they're coming to OT is anxiety. Or not so much, we don't get as much depression, but anxiety is like the thing. Right. And that's a mental, it's a mental health thing.
We get a lot of, a lot of kids who have real difficulty with just positive thinking and, being in such a negative kind of headspace a lot of the time. Which is related to their mental health. Like my goal today for one of the kids at camp was I hope that he smiles. That is my, I want him to smile once today at camp.
That's in my brain, my little like mini goal for him as an OT. So I think it is a topic that all of us, you know, people listening to this podcast are really interested in because I think all of us are starting to see more kids come to us who have mental health diagnoses. So, okay, cool. That that's so
Nicole Roma Thurrell: there's so much to talk about here, the least of which I'm sure that you're aware of, that our mental state very [00:07:00] much affects our nervous system, which in turn affects our hearing, our sensory perception, And our facial muscles, and so much of that you see the effects of, so anxiety is what's going on, but it's having an impact on their entire social engagement system, which involves their.
Again, their, their sensory experience, their hearing experience, their ability to express themselves and perceive the world using facial cues and other cues of safety. So I'm very excited to dig in about that.
Laura Park Figueroa: yeah. So tell us, tell us what you talked about there. Like, give us a little overview of kind of the, the, what is, let's start with this. What is wilderness mental health first aid? Because I've said this in previous episodes. I think most of the people listening to this podcast are not doing like wilderness out there in the mountains kind of work.
Some might be, but define the term wilderness mental health first aid for us first.[00:08:00]
Nicole Roma Thurrell: I think of it as having three branches. The first branch is. Caring for your whole patient. So we teach a lot about hurt people and people know how to splint ankles and control bleeding and warm someone up who's hypothermic, but how do they treat the acute stress response their patient is having secondary to their injury?
So that's number one is treating hurt people who are also having an acute stress response and supporting their, their emotional state. The second aspect is supporting. Preparing, really, yourself as the caregiver. I can't tell you how many people say to me, I can take a test on first aid and I can ace it, but you put blood in front of me and I will freeze or I will faint.
And that is very clearly a state of the autonomic nervous system that can be adjusted and managed. So [00:09:00] how to manage oneself when they are the care provider is the second branch. And the third branch is really probably what's most applicable to your audience is when, when there's expected, because it's part of their biography or unexpected dysregulation in the field that we have the opportunity to work with and therefore support them in developing strategies to manage on their own going forward.
And like I said, sometimes this is expected because a person has anxiety, or various other, pieces of their biography that lead to dysregulation or it's unexpected. Perhaps you think you're working with someone who's, just coming to you because of eating issues with. with eating and you're there to support them with that.
And then being in nature, I know so many of us who are listening to this and who do this work, think of nature as this, this salve, this [00:10:00] balm, this healing, nurturing environment,
Laura Park Figueroa: Like a panacea that fixes everything. No, it's not.
Nicole Roma Thurrell: reality is, is sometimes it's very triggering, particularly to those with anxiety and other sensory integration issues.
You're asking a kid to put themselves in the mud? who has sensory integration issues. You know, you're asking kids who, again with sensory integration issues, to see bugs crawling on them. And these can be incredibly triggering to students, in ways and actually That's the work. So you are organically putting them in an environment to be upset and to be triggered and have opportunities to work through it.
So, in our minds, as nature based educators and therapists, like, we think it's this wonderful medium, and it is a wonderful medium. But the reason it's a wonderful medium is because it isn't. is triggering. Not because it is this salve and [00:11:00] balm of healing energy. It's because it's upsetting. So,
Laura Park Figueroa: Right.
Nicole Roma Thurrell: so that's, that, that's essentially what we're doing.
You know, caring for the, the hurt patient, preparing ourselves to care, and then helping manage dysregulation in the field.
Laura Park Figueroa: Yeah. I love those three things. So let me state them back to you. So I remember them. This is the strategy I try to use. Like, okay, let me try to remember the three things you just said. So I feel like you said it's the first thing is. It's a, it's a shift in our thinking of, we're not just treating the broken ankle that the child may have, or the scrape that the child may have, but also considering the mental picture that they're going through, the experience they're going through mentally, right?
So caring for the, the kid's mental health in the, in the context of a scary situation,
Nicole Roma Thurrell: well said.
Laura Park Figueroa: Which could be potentially scary for them. So care, the kid's mental health, and then. Prepping ourselves, our own mental [00:12:00] state, in order to be able to deal with things that are a little scary or triggering for ourselves.
And then self regulation in general, just the unexpected or expected disruption that happens to our nervous system when we're When we are outdoors in nature. So we had a kid this morning, this is a really interesting thing that happened at camp. Just an example of this. So a kid was having a hard time coming in, transitioning into the group.
And so I just kind of stayed and talked with them for a little bit, kind of far away. And one of the things he said, he asked what we were doing today. And I said, we were going to go over to the Creek. We're going to make boats and then go over to the Creek. And, um, He said, I don't want to go to those woods because that's where my hands got stinky yesterday. And I was like, Oh, really? Like, what did you, what, how'd your hands, how did your hands get smelly? What happened? You know? And he said, centipedes. I was like, I was like, Oh, you never, there's centipedes there. I've never seen one over there. You know, whatever I was just [00:13:00] talking to him. But then later on, one of the other therapists that was with us said to me, You know, I think he had like a certain hiking stick that he picked up that made his hands smell a certain way and it just made him really uncomfortable.
And think about how when we smell something gross, it just completely disrupts our nervous system. So it's just interesting how an example from yesterday of it just completely, he perseverated on it and he could not get past the fact that it smelled even when we tried to take away the smell probably, you know, so,
Nicole Roma Thurrell: I believe it. I believe that experience and I believe that that was really profound for him. I get it. I really, I personally get it.
Laura Park Figueroa: yeah, totally right. All of us can just any situation we've been in where we feel really uncomfortable. So, okay, how do we want to, how do we want to tackle these three things? Which one is one by one? Or do you want to talk about
Nicole Roma Thurrell: think the third one is probably most applicable to your group. [00:14:00] And the interesting thing is the foundational knowledge is really the same. Underneath of all of them. So I think perhaps talking about, yeah, again, that foundational knowledge that affects how we approach, any of them is the same.
So how about we
Laura Park Figueroa: Yeah, yeah. And if
Nicole Roma Thurrell: then,
Laura Park Figueroa: people want more, you know, if you really want to go into this topic, your Institute for Wild Med offers a wilderness mental health first aid course, so this is not going to be a course in like a 30 minute podcast, whatever.
Nicole Roma Thurrell: That's exactly
Laura Park Figueroa: can't go into
Nicole Roma Thurrell: that's why I started the conference talk. I was like, this is a 12 to 16 hour course for the wilderness level and a 5 to 7 hour course for the standard level. We have 50 minutes here and you and I have even less so we're really going to distill it down to hopefully some some [00:15:00] notions that you can take away that will affect how you approach kids and as well as some strategies I've got some very clear strategies.
Laura Park Figueroa: Yeah, that's great. I think just a few key takeaways. And just to increase, I think it's wonderful to talk about this topic, just to increase people's awareness of wilderness mental health first aid, even being a thing. You know, I think as therapists, most of us are pretty tuned into kids mental health.
Mental health states like in their nervous system regulation. But I do think it is a cool topic for those of us as therapists to make other practitioners more aware of and to make parents aware of. And so, yeah., so let's, let's talk about that. Let's talk about the, the third one, that self regulation piece.
Nicole Roma Thurrell: So this might be 101 for a lot of your listeners, but I do think that I can offer something really fresh. So if this begins to feel like one on one, I urge you to stick with us to see how the trail diverges from what I think [00:16:00] is the conventional thinking around the nervous system. So what's one
Laura Park Figueroa: we all need to go back to a 101 always. Always. We always need to go back to one on one. It's so easy to forget the basics when you're in the flow of the work. So great. I'm, I'm on
Nicole Roma Thurrell: Okay, so 101 is that we have an autonomic nervous system, autonomic synonymous with automatic. These are the things that our body does to keep us alive and regulated. And we don't even have to think about it at all. We digest, we breathe our heart pumps. It's out of our consciousness. We don't even have to think about it until it becomes a problem, you know, until we get hungry or until we get nervous, but our thinking doesn't make it happen.
It just brings it into our awareness. So that's the autonomic nervous system. Great. And then, so, what we all think about as the parasympathetic nervous system, I like to borrow from Stephen Porges and [00:17:00] his polyvagal theory, calling this the green state of activation. And this is where we are relaxed, we are receptive, we're able to learn, we're creative, we're compassionate, we problem solve, we work together, we're relational, pro social, we use the Many, many more muscles in our face to express ourselves.
We're able to perceive when others do the same. Our hearing is wide open to be able to perceive the human voice, despite background noises. This is the green state. We're, we're, we're good. The yellow state,
Laura Park Figueroa: Calm and
Nicole Roma Thurrell: yeah, yeah. Uh, rest and restore, you know, is, is some more thoughts about the green. Now the yellow is.
The sympathetic nervous system, what you've all heard of, it's fight or flight, and this is where we are in the danger zone. Something in our, I don't want to say our awareness, but something in our perceptive [00:18:00] apparatus has sensed that it is not safe for, for many different reasons. For that child, it was, those are the same trees.
where I picked up a stick that made my hands stinky, and that likely began to arise for him before it even came into his consciousness. You brought it further into his consciousness, likely, with the discussion that you had. And this is where we are activated. We are, our heart rate goes up, our respiratory rate goes up.
We become monotone. The muscles in our face are not, you know, our face is flat. Our voice is flat and our hearing completely changes so that we don't hear the human voice with background sounds. We're attuned to hear low rumbling sounds, which is for those of us who get very agitated by heating systems and weed whackers and leaf blowers.
I'm raising my hand right now. We are, we're likely perhaps you know activated [00:19:00] at that level so that our hearing has changed. And many people are diagnosed with auditory processing disorders who, for whom it has begun with their autonomic nervous system. It's often not anatomical in any way. It's, It's an autonomic nervous system response.
And we are not pro social. We are not problem solving. We're not creative. We're not learning. We're not healing our bodies. We're not taking in new information. That's the fight or flight. Now, this is where it starts to get, I find, very interesting. This third state that Stephen Porges talks about is the red state.
And this is the freeze or faint state. And he really distinguishes this from the yellow. Many prevailing theories just Clump them together. Sympathetic nervous system. If I don't
Laura Park Figueroa: or freeze. You hear that all the
Nicole Roma Thurrell: freeze, faint, you know, they just toss them all in together. But he really postulates that this red state is, is very distinctly different.
And it's really even a different part of the vagus [00:20:00] nerve that is activated in the state that causes us to freeze and faint. And he suggests that it is our most activated state when we really, truly feel that there's an immediate life threat because evolutionarily, it served our reptilian ancestors, to, to freeze.
They were either less likely to be caught by predators, or if they were, the death was less painful. So we are preparing ourselves for immediate death in this case. And this is so fascinating to me because a lot of our society doesn't acknowledge this. This is diverging a bit here, but I think it really drives the point home that there are states that when talking about, say, sexual assault, they say, if someone didn't fight, Or push back that it wasn't a no.
And so what I'm saying here is [00:21:00] that many people, because they are so activated, activated beyond the fight state, they are frozen. And this is actually mistaken for consent. Like
Laura Park Figueroa: Yeah.
Nicole Roma Thurrell: freeze faint is mistaken for consent in courts in our country. And so people, it's just, it's really
Laura Park Figueroa: Yeah. That's really
Nicole Roma Thurrell: It's fascinating and, and really something that we need to,
Laura Park Figueroa: and heartbreaking in many ways.
Nicole Roma Thurrell: chilling.
Every time I say it, it makes my hair stand up everywhere. And so I, I, again, I know that that diverges from our topic, but I can't resist because it truly drives the point home, how off base we are about what faint freeze is. And if we think that's consent, we couldn't
be more wrong
Laura Park Figueroa: yeah,
Nicole Roma Thurrell: And so,
Laura Park Figueroa: yeah, it may not, it may not look as, because like the example you gave of like a sexual assault situation, that is a, that is a, [00:22:00] well, in my mind, I feel like that's clear. Like, if someone is just laying there, you should know they're not giving consent, but, but with a child, you know, if we take it into like what we would actually be doing in therapy,
very interesting to think about if a child is in that frozen state, right? And, and, it's, it's, we just need to be very noticing of that. Like it's, it's something where the child, if a child is frozen, right? A lot of times when they're in the fight or flight, we can see that it's very clear they're running away or they're hitting or they're biting or whatever, but the child who is quietly withdrawn and.
shutting down might get overlooked in the mix of a large group of kids, all who have some kind of need and are demanding your attention. And so I think it's really important that you gave that example because it will help us remember, it will stick in our minds, right? To be, to be noticing of [00:23:00] children who may be in shutdown.
Nicole Roma Thurrell: for making that connection and making that bridge. And I'm realizing now that there were two words that I didn't use that I often use when I outlined that red state, and you used one withdrawn and the other is dissociated. So, when you see kids who are withdrawn and dissociated. in all likelihood, they are very much activated in the, it's called the dorsal vagus is activated.
And that is, you know, that is arguably even a deeper state of feeling threat than that yellow state that is much more demonstrative that you'll notice much more easily. So thank you for making that bridge.
Laura Park Figueroa: Yeah, I think the colors are helpful too, like to, to think of, you know, cause we're all kind of familiar with a stop sign or a green, you know, green, yellow, red, whatever. Yeah, so okay, so those are the states.
Nicole Roma Thurrell: So,
Laura Park Figueroa: how do [00:24:00] we, let's, let's move into some
Nicole Roma Thurrell: yeah, yeah. So I just want to take a moment before we do strategies real quick to Illuminate the prevailing theory. And as a social and emotional learning teacher that I am in high schools, I've been teaching this a long time and I've been teaching the prevailing theory. And this has just really rocked my world to learn about Stephen Porges theory because the prevailing convention is parasympathetic nervous system is good.
Sympathetic nervous system is bad. That's one aspect of the prevailing convention. The second aspect is that they're a binary. Constantly antagonizing each other for center stage, that it's one or the other. We are either in parasympathetic nervous system or in sympathetic nervous system and that we should, and then the third piece is that we should be doing everything we can to stay in the parasympathetic nervous system.
So here's where it all gets spun on its [00:25:00] head. At the conference, What I did was to highlight this next thing we're going to talk about is we played a tag game hawks and chickadees where the chickadees had their little nest and they had to dash out into the field and gather food and get back to their nest with the food and as you can imagine the hawks were to tag the chickadees and upon being tagged the chickadees were to play dead and they can be revived by the Or resuscitated when other chickadees came to them and looked at them and smiled and touched them and they all went back to the nest together.
And when I came back, when we came back from it, I said to the group, okay, so chickadees, you know, what state were you in? And as you can imagine, it was, you know, yellow and red, like we were under threat and we were being chased and we had to get food for survival. And I was like, yep, totally. I saw that too, but I also saw a lot of laughing.
[00:26:00] And I saw a lot of smiling, and I saw a lot of, like, very subtle facial gestures, and I saw you problem solving together, and I saw compassion and pro social behavior. So, interesting. Like, I really agree. And I saw red, too, with the play dead. Okay, okay, I scripted that part, but you still did it and experienced it.
So, how fascinating that you were in the yellow and red states, But you're also in the green states. And this is where it's really turned on its head for me, is this idea that we can be engaged in activities that activate both the green plus yellow, or green plus red, or green plus yellow plus red. And Stephen Porges postulates that the more we engage in activities that combine states The better we are at getting in and out of the various states, the less likely it will be that we are stuck in yellow.
If we practice yellow, green, yellow, green, I'm [00:27:00] under threat, ah, I'm being saved, ah, you know, the more we can combine them, the better we are at getting in and out of them, which makes us generally more resilient and responsive humans, but it also makes it much less likely that our lives will be taken over when our yellow is activated, which it will be.
It will be.
Laura Park Figueroa: Yeah. Yeah, you can't go through life and not
Nicole Roma Thurrell: Right. And it's good for us. I mean, it was designed to keep us alive and activated. And. It deserves our respect and appreciation, but it's when we get stuck in it that it becomes a problem and that becomes our baseline state to have, you know, increased heart rate, increased respiratory rate, not using our ears and face, not perceiving the world accurately.
That's not good to get stuck. And the suggestion is that the more we combine them, the more we are likely to be able to be responsive to our environment, which is just the It's amazing to me and we as nature based therapists and educators get to do that as part of our [00:28:00] therapy or as part of our response to someone's dysregulation.
So it might be that you're engaging in these activities because of dysregulation. It might be that you're doing it preemptively as a treatment measure.
Laura Park Figueroa: Yep.
Nicole Roma Thurrell: So that's
Laura Park Figueroa: I think the key, the key difference with kids, I think is that their frontal lobes aren't fully formed. Like as adults, I feel like we can, 'cause I've had a lot of those moments lately. We were just chatting before we got on about how I've been this week I've been like, I just wanna burn everything to the ground of my businesses because it's just been a really stressful week.
Right. With just a lot of different things going on. And, I think as adults, like as an adult, I've had. Many years of a mature brain to be like, I can't look at my computer anymore. I'm getting so overwhelmed. I want to cry. I need to put the computer down and I need to go take a walk with my dog or, or I'm really hungry and my brain can't think right now, I need to get something to eat to fuel my brain so that I can come back to this work, like, [00:29:00] We naturally as adults do these things that, honestly, sometimes we don't.
Some, I feel like sometimes social media, like you find yourself scrolling and you're like, why am I feeling so crappy about myself? It's like, Oh, because that's what Instagram has made for to do for us is make us feel crappy about ourselves. It's so horrible, but kind of true. So, so we, as adults have the ability to mostly know how to self regulate or know what works for us.
But the kids we're working with do not. know how to do that. And that's kind of our job, I feel like, as therapists and educators to help them find what works for them, like, to, to get back into a place where they feel good. I would, I want to circle back to your, to your story because I did, while you were saying that, I was like, no, they weren't in, they weren't in red or, you know, Yeah, I mean, maybe a little bit, but like, really they're having, they know they're safe, really in the context of a game where you feel this like intensity or whatever, [00:30:00] you really do know that you're safe.
Now, I don't know if kids would have that response to a game. Sometimes kids can feel it more deeply, I think, than we, than we do, or they can't kind of understand that they're not really, maybe their nervous system can't understand they're not really at risk of, of danger. Right. So yeah, it's, it's an interesting, It's an interesting example because I was like, Oh, interesting.
They said they were in a different state than I would have liked from observing, like hearing you tell the story, I thought, thought that they would have
Nicole Roma Thurrell: So you just hit the sweet spot and the sweet spot is when you truly at your core know that you're safe, but at the same time you're activated.
Laura Park Figueroa: yeah,
Nicole Roma Thurrell: And you do like playing tag, like, yes, of course, you know, you're safe. You know, like you could say, I am safe. I am not at risk, but it's, it's not for those of you only listening, I'm pointing to my head right now.
It doesn't. So this is another fascinating piece of information. [00:31:00] Approximately 80 percent of the nerve fibers that are communicating signals of safety gather their information from the body. Only about 20 percent are gathering information from the brain and the conscious awareness of safety. So, yeah, my conscious awareness knows that I'm truly safe, but that's only affecting 20 percent of the fibers.
Fibers. 80 percent is there are people chasing after me. Yes. And my body is running and I'm, you know, like trying to protect my front, my back. And I'm, you know, so my body is. Gathering the, gathering and communicating the most information. And it's, ahhh you know,
Laura Park Figueroa: yeah, yeah, yeah,
Nicole Roma Thurrell: You really want to have both present, but it's mostly the body that's giving the information.
So, you know, as you can talk all day about how safe you are and if the body's giving signals, otherwise. it [00:32:00] will cause one to be activated. And hopefully that, yeah, there's some, some brain there that does know that it's safe. Another piece of this is this is, it's not at all about how safe you think you are.
It's about how safe you feel. So for example, if there were five people at the top of a ropes course, All 100 percent safe. Double check the harness, double check the carabiner, double check the rope in the spin static device. I mean, we've double triple checked everything. Everyone is 100 percent safe.
People would have various Feelings of safety, some to the degree to which they are frozen, some hyperventilating, some, you know, discolored in their face, and there's GI issues. GI issues is all about that dorsal vagus experience. The dorsal vagus connects right down into the [00:33:00] gut if you look at it anatomically. So, five people all 100 percent safe in their brains. Huge variety in actually how they feel. And the important part of all of that is how they feel dictates their autonomic state, not how they think. We can tell them all day how safe they actually are, and that will have very small effect on the autonomic nervous state that they're in.
It's all about how they feel.
Laura Park Figueroa: Yeah, yeah, because you can't change that for them. It's not something we can reason
Nicole Roma Thurrell: certainly not in that state, certainly, yeah, maybe later, or maybe with a whole lot of front loading before, but yeah, it's, it's not what really moves the needle for people who have phobias or for people who are highly activated, and, and I like to say in relative to that, body before brain. So when it comes to interventions, it's all about interventions that signal to the body or that cause the body to [00:34:00] signal to the neuroception that they're safe, as opposed to talking through it.
That's my last resort is, is reasoning and logic and talking through things. The more we can do on the body level, what those 80 percent of the fibers will be saying, Oh, well, if this person's just, Sitting around breathing like this, things must not be too bad. Or if they're drinking tea right now, things must not be too scary.
Or, you know, any of these interventions that we're going to talk about should cause the body to communicate a message to the neuroception so that the neuroception says, Oh, well, if they're doing that, things must not be too bad. Let's settle down. Let's downshift. Let's downregulate into the green. No need for this.
Laura Park Figueroa: yeah, this is very like the those embodied experiences I think are so children are lacking a lot of embodied experiences, especially experiences where they're safe, but can play around with risk. Like we talked [00:35:00] about that on the episode a couple weeks ago to this week's episode when we're recording this, but a few weeks ago, once this comes out, um, about risky play being so important.
And this ties in, I think, because that's an embodied experience, right? That might bring up some of these type of feelings for them. So, okay. Body before brain. I love that. I think that's awesome. I think that's a good little, like, nugget for us to remember as we work with kids outdoors. What other strategies should we
Nicole Roma Thurrell: So I have two underlying principles to the strategies. One is match their energy. So, if you have a kid who's really withdrawn, shut down, I probably wouldn't start with a wild game of tag. Conversely, if I have a kid who's really physically dysregulated, biting, kicking, spitting, it's not time for a mindfulness activity.
Laura Park Figueroa: Right.
Nicole Roma Thurrell: You know, the disparity between where they are and where I want them to be is way too [00:36:00] great. We have to meet them where they are and then downshift from there or upshift from there. So Please keep that in mind. Try to match them where they are. It can almost be like offensive to try to do a mindfulness activity with someone who's kicking, spitting, and biting.
All right. And then the second piece, and this, this is what I'm hoping is really going to stick. Rhythmic, Repetitive and relational. Rhythmic and repetitive and relational. Rhythmic and repetitive and relational. Anything we are gonna do should be all three of those things. And so, for example, I used to teach in nature based kindergarten and we would have the parents drop off bags of coffee beans.
Every week and the kids would hand grind the coffee beans and the parents would walk away. They all had to switch to French press because that's what the grinder was. But we had a cast iron coffee grinder and the [00:37:00] kids would be grinding the coffee. And that is rhythmic and is repetitive. And it is relational.
I'm doing this together. I'm doing this for my parents to have their coffee. Like it's purposeful as well. If purposeful is just a bonus on any intervention that we do. So,
Laura Park Figueroa: That's a big thing in OT is purposeful, full activities, like something having meaning and purpose
Nicole Roma Thurrell: So if I'm grinding coffee, if we're, our job is to grind coffee for all the families to use and they're really going to use it and the kids smell it and they see it and they see their parents drinking it in their favorite mug on their way to school, that that purpose is really driven home to other things that are almost identical, but just for other ideas, grinding wheat, so getting a wheat grinder where the kids can be grinding the wheat and then making something with that flour.
And Apples, making applesauce, like using a ricer to grind the apples. It is rhythmic. It is repetitive. It is relational, especially if multiple kids have their hands on it at the same time, or the [00:38:00] child is sitting in your lap to do it. That is, it's a very warm experience. So those are just three things that come right to mind when I offer that mantra for us.
But I should back up because. Breathing is, is really, so I kind of have buckets, if you will, of treatment. So breathing gets its own buckets. Another bucket is for kids who are really activated, heavily, you know, strongly in the yellow, so high energy. Another bucket is very low activation, that red state.
Another bucket would be mindfulness. And then I have another bucket for just really novel things, purpose. There's reason behind them, but they, they just,
Laura Park Figueroa: Right. Right.
Nicole Roma Thurrell: breathing, the amazing thing about breathing is, well, it's the one aspect of our autonomic nervous system that we actually have control over. And when we inhale, our heart rate increases.
And when we exhale, our heart rate decreases. [00:39:00] And when we exhale, there are receptors in our respiratory system that are activated and they downshift, they downregulate right into the green when those receptors are activated. So there's very good reason to do breathing activity and I recommend doing it regularly so that it becomes a touchstone for when you need it.
If the first time you're ever reaching for these activities. is in the moment of dysregulation, they're not going to be very effective for you. If you're, you know this, if you're having a panic attack as an adult and now, oh, I'm going to try that mindfulness activity I read about but never tried before, it's highly unlikely to work for you.
There's no neural pathway for it. There's no,
Laura Park Figueroa: no. It's unavailable.
Nicole Roma Thurrell: to you. You are offline in that way. So, so many of these activities that I can share are most valuable when you have already done them and when you do them regularly. So, I don't know, do you want to talk about a couple breathing [00:40:00] activities or do you feel like folks already have a bunch in their quiver?
Laura Park Figueroa: I do. No, I want to talk about a couple, but I want to
Nicole Roma Thurrell: Yes, please.
Laura Park Figueroa: that will like, hit this home for the people listening so that they'll remember what you just said. When I was in labor with my first child, we have a joke in our family that nurse Mary turned my delivery around because nurse Mary said to me, I was, I was probably getting close to transition.
If you've not had a child, that is where things heat up and it gets very painful and very intense in, in labor. And, She, she came over to me between contractions and she, I had been, when the contraction came, kind of breathing like, you know, like I was just kind of like panicking. Right. And she came over to me in between contractions.
Again, that's if you haven't had a child, that's when things don't hurt as bad. They just hurt kind of mildly. And she said, [00:41:00] Laura, I'm a little concerned that if you continue breathing the way you do, it's going to be really challenging for you. And so on your next breath, when, on the next contraction, I want you to breathe in and breathe out as slowly As you possibly can. And it changed my entire delivery. I mean, it was like, Oh, this is a very different experience than hyperventilating, you know? And, and it's exactly what you just said, which is when you breathe in your heart, it speeds up and when you breathe out your heart, it slows down. Especially if you're trying to breathe very slowly out, right?
It's just, when you said that, I was like, that's what nurse Mary told me 22 years ago, you know? And it, it really did. change my perception of pain
Nicole Roma Thurrell: yes.
Laura Park Figueroa: when I was in the middle of the most intense part of delivering my first child. And so, just a really good example [00:42:00] there. And also the other thing I wanted to say was, we often do in, the more, energetic groups, we often do lion's breath with kids.
And that's like a very active kind of way to teach. Deep breathing where you breathe in and raise your hands over your head and then you're like (exhale) You know and like really Take get the breath out and it's fun. I think it's like a really kids tend to be very engaged in that, in that one. And it's a good way to kind of like bring the group back together with a breathing activity that can be a little, even if things are a little intense or feeling intense, somehow kids tend to be able to, to access that breathing exercise.
Cause it's kind of a vigorous one. So those are the two things I, I thought of while you were talking, I was just sitting over here, smiling like, Oh, nurse Mary and lion's breath.
Nicole Roma Thurrell: And so just two things to add on to what you said. So not only did it bring your heart rate down, but that long, slow exhale really [00:43:00] lit up those receptor sites on your bronchioles, which give the message to the vagus nerve to downshift into green. So it, it really will shift this, the autonomic nervous state.
And then I also just want to point out something that was a little contrary to what I said, and that you perhaps hadn't practiced that before. And somebody was able to approach you when you were in that activated state. And they were with their tone of voice. And perhaps I'm imagining that she touched your shoulder.
So with, with touch and with. tone of voice and with face and they were able to access you despite that you likely hadn't practiced that before and maybe you have practiced breathing before, but they were able to access you in a really activated state and I really appreciate that and I hope that this is a huge buzzword in the OT community.
It definitely is in the nature based teacher and educator community, but co regulation [00:44:00] is, you know, Where it's at, you know, we, we are built to mirror the autonomic nervous state of those around us. And if we are able to regulate ourselves, then we're well on our way to supporting someone else in regulating.
And I always like to say, if we're not co regulating, We're probably co dysregulating. So we want to get a handle on that.
Laura Park Figueroa: right,
Nicole Roma Thurrell: So yeah, I'm really appreciating Nurse Mary for that.
Laura Park Figueroa: Nurse Mary, I think of her sometimes. I'm like, you know, she, she was older. She might even be gone from us by now. And I never got to tell her how amazing she helped me, like,
Nicole Roma Thurrell: Yes. So great. Any breathing activity that will, so let's just imagine the classic rectangular breathing. So knowing what you now know, listeners, about what our heart does on an Inhale versus an exhale, if we're breathing along a rectangle, what shall we do on the short ends if we want to [00:45:00] downshift into green?
Yes, we probably want to breathe in during the short end and breathe out during the long end. In during the short, out during the long. Yeah, good.
Laura Park Figueroa: I love that. I don't know that I'd heard of rectangle breathing. I've heard of kids doing like the, the, kind of like an infinity sign, like a figure eight, like, and, and breathing, but I love the rectangle because of the forcing the, The breath out being longer. It's like a good
Nicole Roma Thurrell: yes, yes. Likewise, I've heard of the rainbow where you breathe in for half and out for half, and that's going to give you a net zero change on your heart rate. So I, I will often talk about a sun dog if you've ever seen a circular rainbow where you breathe in just for the, till you get to the peak. So that's just 45 degrees and then breathe out for, you know, the remaining circle.
So you could do something similar with the infinity.
Laura Park Figueroa: time you're breathing out [00:46:00] and or a fourth of the time you're breathing in. Great. Those are great visuals for people to
Nicole Roma Thurrell: It's also really sweet to have the kids lay down in a circle and I would, if it, if they are activated or at risk for activation, I like to put the heads toward the middle and the feet toward the outside. People can feel vulnerable with heads out. feet in and place a pine cone or something on their belly and then they watch the pine cone or their boat that they made rise and fall and that's really speaks to the body piece and you don't have to get in their brain at all and talk about diaphragmatic breathing and you know you just let that go and the the object on their belly does it all for them it teaches the diaphragmatic breathing that we don't have to with our words at all.
And again, the more we can do body before brain, the better.
Singing Singing which I'll spare you any sort of guided singing, but Okay,
I'm laughing [00:47:00] because today at camp I tried to sing and the kid was like that's a baby song. And I was like oh okay I didn't know and I was like do you want to try
Laura Park Figueroa: this other one I know and another kid was like
I don't like songs with hand signals. And I'm like, ok I guess I'm not going to sing any of my songs right now. It's like, this is not going well.
Nicole Roma Thurrell: fine then.
Laura Park Figueroa: They have to really want to
Nicole Roma Thurrell: So read your audience.
Laura Park Figueroa: Yeah. Read to the audience, y'all. This is what we're learning on the podcast interview today. Read your audience.
Nicole Roma Thurrell: Blowing bubbles is a really, you know,
Laura Park Figueroa: Yeah, that's a great one.
Nicole Roma Thurrell: they don't know that it's any sort of breathing activity, but they are doing a breathing activity. For some groups, this won't be appropriate, but it was very sweet when we did this amongst adult nature based educators synchronized breathing where we sat in a circle, eight of us.
to a circle. And we didn't talk at all. There was no talking allowed. That's the nature of the activity. And we synchronized breaths by watching each other's clavicles and mouth and ribs or belly, depending on how [00:48:00] safe a group might feel looking at each other's chest. You may have to say , we're going to watch each other's clavicles right here.
That would be like the safest place. It's, it can be uncomfortable to have someone stare at another's chest, but it was very sweet. And when we finished the group, the first comment, um, from A man in the group big giant man as a preschool teacher. I was like, yes, we need more of you out there. But his comment was, that was so intimate.
That was so,
Laura Park Figueroa: Hmm.
Nicole Roma Thurrell: that was so warm and sweet and intimate. And so we nailed it. It was rhythmic. It was relational. It was repetitive, it was, it was all there. And the group just, there was such a calm in the room after it. It was really sweet. Yeah. So that's the breathing bucket. I'm sure folks have their own and they're a dime a dozen.
You can find them out there, but please just. Modify them as needed based on what you now know. We want more exhalation than inhalation. We want longer [00:49:00] exhalation. And be thoughtful about using it when your audience is ready.
Laura Park Figueroa: Yeah, that's great. Those are good. Those are good little strategies I mean even today I'm like I'm going back to camp in a minute. I'm like, I want to try some of these right now
Nicole Roma Thurrell: I'll probably make, as part of the online course that is just about to launch that you mentioned, I'll have tiny, you know, two minute tops videos for, you know, 10 20 different breathing activities. Yeah,
Laura Park Figueroa: that's
Nicole Roma Thurrell: be looking forward to
Laura Park Figueroa: love it.
Nicole Roma Thurrell: And then the yellow bucket, do you have a question before we talk about yellow bucket
Laura Park Figueroa: Well, no, I just, I want to be mindful of time. So I'm like, I know we've been, I, I, I said we were going to be like 30 minutes, but we're just like going, I mean, this is so great. I just want to be mindful of your
Nicole Roma Thurrell: maybe we just share like two from the remaining buckets that are pretty quick.
Laura Park Figueroa: let's share a couple more from the remaining buckets. I love the bucket
Nicole Roma Thurrell: remember the yellow, the high energy one, this is used when that's what you are seeing in front of you. [00:50:00] Items like skipping rocks. And I trust you'll do your own risk analysis and safety management.
That's a whole, you know, that's a different topic. But skipping rocks is great. Collecting firewood, breaking firewood. Many of you probably do this where you have a stump out in the field and you have a little basket of nails that hangs off the stump and the hammer and the kids hammer in the nails into the stump.
That's really great. Another thing that I love, and I'll finish this bucket with this one. I'll. Two, they're almost exactly the same. One is smashing acorns. You just get a big piece of plywood, like a 4x4 piece of plywood. Kids will sit around it. They can wear their little safety glasses. And they smash it with a big rock.
And the intention with smashing it is to be able to yield the meat. And you can make acorns. flour out of the acorn meal and you can make ultimately make something out of it. Yeah, which would be really sweet to do this activity say on Monday at camp and then on Friday and if you don't have the facilities to bake something you can [00:51:00] do it at home and you bring it in on Friday with what they made.
So smashing and it's I'm sure you can think of how from an OT perspective it can be therapeutic and also from a regulatory perspective it's therapeutic and the same would go for yeah for smashing rocks. Again, risk analysis, manager safety, safety glasses, but it's It's cathartic and rhythmic and repetitive and kids are doing it together and they're sharing what they find inside the rocks.
Really good activities. For the yellow,
Laura Park Figueroa: that's great. I gotta get some safety goggles. I have them in California, but I don't have them here in Wisconsin. We're getting our supplies all dialed in here, so. Safety goggles will be on the list for some rock snapping to be happening at camp this week.
Nicole Roma Thurrell: Yes, indeed. And yeah, you can get a set of 10 of them for, you know, they're really reasonable. So, yeah. For
Laura Park Figueroa: yep.
Nicole Roma Thurrell: So for those in the low energy, the [00:52:00] withdrawn, dissociated, the red state, that dorsal vagus state, things like just walking is really helpful. This is where I mentioned the flour grinding and the coffee grinding and the applesauce making.
These just like really rhythmic and repetitive, yet not, you know, Super like overstimulating, like, ah, that's too much. I don't want to do that. It's only going to make me withdraw more if you try to invite me into this space that's really active. Finger knitting. I don't know. This is another thing I'll make a little video on, but it's so simple.
I think my children made miles. Of finger knitting in their nature-based preschool and it's just, it's very rhythmic and kids will do it for for so long and it really can pull them, especially if you get them in a group. They're like a bunch of old ladies at a knitting club, you know? Then they start talking and they're chatting and they're engaged relationally, and that [00:53:00] just can be very soothing in that state
Laura Park Figueroa: Yeah, so finger knitting, if people aren't familiar with it, it basically is all you need is yarn and your hand to do it. You start it with some loops around the fingers. I'm sure you can find a YouTube video on this. And then all the child does is just It's like a continuous, like, pulling of a new loop over each finger of the hand and then you go back and you pull another loop over each finger.
It's very simple. It's so easy. Kids as young as like, I mean, typically developing kids as young as three could probably do it. And, but it, you know, it, it is like a very simple activity and it basically makes this long rope of knitted yarn, essentially. Long, long rope. of knitted yarn. I had so many of them around my house when my kids were younger.
So it is a really great activity to do that even kids who don't have, it's not like [00:54:00] knitting with needles where it's very, I mean, I, I used to knit and I couldn't even, I'm visually spatially, not very, it's not a strength of mine and yeah, it's just hard. And so I, I feel like finger knitting is, is my level, my, my accessibility level for knitting, so it's definitely something that kids can do and they
Nicole Roma Thurrell: Great. Thank you. There's even a, so what you describe is almost an advanced version of finger knitting. There's also a very basic that you take just a single strand and you reach your fingers through a loop and you pull the running end through the loop. It ultimately ends up looking like a braid, just a very simple,
Laura Park Figueroa: I love it.
Nicole Roma Thurrell: Yeah. And they're working
Laura Park Figueroa: Okay. Then I need to, I need
Nicole Roma Thurrell: JV.
Laura Park Figueroa: I need to know this because this is the even easier version of finger knitting than I was familiar with.
Nicole Roma Thurrell: So it's, it yields a different product. And so that's a great start. It's probably more accurately known as finger crocheting because it looks like what [00:55:00] you do with a crochet hook. And so that's a great start. And then what you described could be the. Varsity, finger knitting,
Laura Park Figueroa: Yeah, right. Varsity version for our, for our 10 year old this week who keeps telling us he's the oldest kid at camp. We could be like, well, you get to do the
Nicole Roma Thurrell: yes,
Laura Park Figueroa: version then.
Nicole Roma Thurrell: yes. So those are thoughts. And then also just, y'all, food, water, tea, these really signal to the
Laura Park Figueroa: Yeah.
Nicole Roma Thurrell: oh, yeah. If they're sitting around drinking tea, and I already said this a half hour ago, things must not be that bad. Perhaps we can downshift. Maybe we don't need to be in yellow. We can be in green.
And then once, once they begin to stabilize, then you can start using some more rationalizing with them. Which,
Laura Park Figueroa: That, that is really interesting to me because I, one of the things that I Years ago, when I developed the Contigo approach, my nature based therapy approach that I teach, I, I put in the, [00:56:00] in the rubric for the approach, I have a part about the aesthetics of the environment. Like I'm really big about the aesthetics of the environment being part of what we think about when we do nature based therapy with children.
I don't like plastic. I don't like there to be like asphalt around. Like I want it to be like a setting that, that feels in, in my brain. I was thinking of it more from an aesthetic standpoint. Like you're, it looks visually appealing, but I think the underlying reason for that was because it helps our nervous system feel comfortable.
Right? There go your heart. Yay!
Nicole Roma Thurrell: That's right. And that's, you know, those of us, you may have all have different philosophies about Waldorf education, and that's totally fine. But if we call to mind the classroom space, indoor or outdoor, [00:57:00] many of us. Just thinking about it and seeing pictures of it, it is very soothing to the nervous system.
The colors that are chosen, the organization, the, it's so true. And for so many of us, what signals safety is the same. We have a remarkably safe, similar signal system for safety. Now we vary greatly in what signals danger because of our past experiences. So that, that would signal danger to your participant because their hand got smelly.
You know, that's going to be a trigger for them in a way that it won't be for others. Safety tend to be pretty universal and what you're describing is an aesthetic and a visual experience that just cues safety left and right. It's going in without even there being an awareness piece. It actually does speak to that 80 percent that it's just, we're taking it in.
Laura Park Figueroa: Right, right. You just come into [00:58:00] the environment and feel a certain way and you're not, you don't have words for it or not talking about it. It's just like how you feel when you're there. Yep. We've been talking a lot this week about the, the location where we're having camp is kind of a more centrally located park where I could get a permit for a shelter.
And then there's a couple of other parks like right around it within walking distance that are more wild kind of spaces, but we've kind of been hating that. meeting at the more built environment because the first day of camp they just all gravitate to the playground because it's what they know how to do right but it doesn't it doesn't really get them out into the woods and invite them out into nature and so it's been a challenge this week to kind of have that be the meeting place So we may be changing where we meet next year, which is fine, right?
We could still preserve the shelter for emergency, like lightning storm or something, and then meet somewhere else. So it's just, it's good to think about these things, I think, because it does impact the experience that the kids [00:59:00] have when they, when they come into your program. We need to be thinking about how it's making them feel and how it, what, what does it communicate to their nervous system when they, when they first arrive?
And the parents, what does it communicate to the parents nervous systems when they first arrive? Right. So
Nicole Roma Thurrell: safety and trust keep us in the green. And when we're in the green, we are learning and growing and healing.
Laura Park Figueroa: Yes.
Nicole Roma Thurrell: And, and when you have that aesthetic the same every day as well, it creates a predictability when a student's like, I was expecting to see this there and it was there.
(Gasp) That's not a conscious process, by the way. I'm speaking, I'm saying what their unconscious mind is observing.
Laura Park Figueroa: Yeah. Right. Right.
Nicole Roma Thurrell: Completely.
Laura Park Figueroa: Children.
Nicole Roma Thurrell: So
Laura Park Figueroa: Well, thank you, Nicole. This was like an amazing episode and I feel like there were so many takeaways for people that are super practical. Like tomorrow we can all go out. [01:00:00] In our nature based therapy session and try one of these ideas. So to help keep our kids more, I was going to say online.
That sounds like a weird way, a weird way to talk when we're talking about the nervous system and embodied behaviors, but available for learning and connection. So,
Nicole Roma Thurrell: Great.
Laura Park Figueroa: yeah, thanks for being here. And thanks so much for all of your time. I mean, you, you are now the, the most featured guest ever on the 79 episodes I've done
Nicole Roma Thurrell: I'm honored.
Laura Park Figueroa: because I don't think anyone else has been on three times.
So, and rightfully so, you are just very wise. And I'm so thankful for you for volunteering your
Nicole Roma Thurrell: Thank you so much for having me. It was a pleasure. Please do put my contact information in the notes. And if anyone has questions or if there's any way I can be a resource, I would be more than happy to.
Laura Park Figueroa: Great. And that reminds me, the code is TGO20 to get 20 percent off of institute for wild meds courses. And you can go there as a listener. Nicole, [01:01:00] thank you for that little discount for everyone.
Nicole Roma Thurrell: All right. Great to see you. Bye.
Laura Park Figueroa: Hey, before you go, I have a freebie for you I compiled a list of peer reviewed research studies that can inform nature based pediatric practice for occupational, physical, and speech therapists, as well as mental health specialists. I divided the list into those different professional categories as well as included some references that are applicable to any nature based therapist.
So if you want to get a copy of this reference list to inform your work, you can go to therapyinthegreatoutdoors. com backslash april 2024. Because that is about the time when I compiled the research. I plan to make many more of these lists in the future to help you all stay up to date on research that can inform your work with children outdoors.
Now go, get outside, connect, reflect, and enjoy therapy in the great outdoors. [01:02:00] Bye!
