How Trauma Gets Trapped in Your Body Part 2 | Vagus Nerve, Orienting Reflex and the Amygdala

Hey there, everybody. Welcome back to How Trauma Gets Trapped in youn Body, Part two, the Orienting Response. In part one, we talked about the vagus nerve. And I am breaking these up into what I call micro videos, really short videos, because this information is really dense and in order to really understand all this, how this happens, it's important to be able to digest each chunk. So in this video we're going to talk about the orienting response and the relationship between the orienting response, the vagus nerve and the HP axes. You may be thinking, well, we've already talked about the HPA axis. Well, yeah, but we also have the hpg, hypothalamic pituitary, gonadal and hypothalamic pituitary, thyroid axes. Yes, the vagus nerve is all wound up and in all, all of those axes. And whenever the HPA axis or your threat response system is triggered, it triggers those other two. So I collectively call them just the HP axes. In 1927, then again in 1960, Ivan Pavlov defined the orienting reflex as an interruption of ongoing activity by presentation of an unexpected state stimulus that triggers increased awareness and learning, otherwise known as the what is it? Reflex. And the technical definition is less important than just recognizing that whenever you're in a situation and your attention gets pulled, that's the orienting reflex. You can be sitting in class and you hear something outside and your attention gets pulled. The orienting reflex. People with ADHD a lot of times struggle because their orienting reflex is hypersensitive and their brain has a difficulty determining what is important to pay attention to and what is not. Initially, our orienting reflex presents when we're infants, between the caregiver and the baby. Newborns in the presence of a caregiver often orient to that person. Well, think about it. A newborn comes out the chute and it has never experienced any of this before. So everything is new. Everything is new sensations, new stimuli. So they are orienting all over the place. And they are just. A lot of times if you've been around little kids, you talk about them like they're sponges. They, they just absorb everything. Well, that's because that orienting reflex just keeps noticing all this new stuff. Since babies have little in the way of schema, they haven't experienced stuff, so they don't have those shortcuts in their brain. They don't have an autopilot, so to speak, their orienting reflex stays activated, especially if the caregiver's face is more expressive. Now think about not even not Just infants and those first few weeks or hours after birth, but even older children, they're sitting in the buggies at stores and they're looking around and they're absorbing stuff. And if you start making funny faces at them, you can almost guarantee that they are going to continue to watch you because they're trying to learn, they're experiencing that for the first time. They've never, maybe have never seen quite that expression, especially not quite that expression from you. So their brain is trying to process all of that. So they are regularly orienting as they get older and they've seen multiple people make whatever funny face and I'm not going to do it on camera, then that starts to become generalized and they expect, okay, when I see a person and they're making this face, this is what's going to happen. But until they've experienced it multiple times, it's still a little curious, it's still a little different. With each experience, the child forms schema or shortcuts that associate a feeling of safety, fear or pain with the expression. Even infants, they found if they associate a particular expression on their parents face or with being unsafe, with being handled roughly or with a caregiver that's not able to respond to them, then they will actually avert their gaze because it's too overwhelming to experience that at the moment. So it's kind of interesting. The point is that infants start forming schema and remember in the last video we talked about the vagus nerve and schema, how does that happen? The vagus nerve, which is connected all throughout your body, including in infants, takes in stimuli, reports it to the brain, the brain consults the schema and says, is this happy, is this safe, is this painful? What should I expect and how should I react? If the child is frequently alone, oftentimes they will not learn to interpret these stimuli and the world seems chaotic, unsafe, painful or overwhelming. So think about a child who never really learned to interpret people's facial expressions because either they were left alone with an electronic babysitter like the television, and they didn't really learn to connect facial expressions with particular moods, or maybe because of sensory integration issues, it was too painful to be around or too overwhelming to be around other people. So, so they spent more time by themselves, not necessarily isolated and, and definitely not necessarily neglected, but they, it was too overwhelming to, or be orienting to all this stuff. Think about how that impacts them in the future because they don't have those schema, they don't have reference points, points to understand the world nearly as effectively in adults, we continue to have the orienting reflex. Any change of stimulus with respect to the current schema results in an activation of the orienting reflex. Now what does that mean? I know I'm using all those behaviorism terms because I think it's important, but basically what that says is if you are in an environment and you experience something unexpected, then it will trigger the orienting response. If you are at a campfire and you're smelling smoke, you're probably not going to orient to it and go, oh my gosh, what's going on? If you're sitting in your living room and you start smelling smoke, the stimulus is the same, it's smoke. But it is in a different situation. It revolves around a different schema. You have schema that tell you what to expect to smell in your home. You have schema that tell you what to expect to smell at a campfire, seeing a co worker at work versus in the airport. You could be sitting at your desk at work and John could walk by you and you hardly even notice. You just kind of see it out of the corner of your eye and you're like, yeah, that's John, whatever, keep doing your thing. But if you're at the airport and John walks by, you may be like, whoa, wait a minute, John, what are you doing at the airport too? That's that orienting reflex. Saying something is out of place here doesn't necessarily mean it's bad. It's just your brain saying it doesn't compute. It may not be surprising to see your roommate at home in the evening, but if you're home during the day and they're supposed to be in class and they suddenly walk through the door, it could be startling, it could trigger that orienting reflex because you're not expecting them to walk through the door. So let's talk a little bit more about the orienting reflex and trauma. During a traumatic event, a person's orienting reflex is supercharged. When you're experiencing a trauma, your brain becomes hyper aware of of stimuli in the environment, which makes sense. Your brain's going, okay, I want to take good notes because I don't want to freaking be here again. So I'm going to be aware of all the things that may indicate that a problem or a threat is coming. Very survival oriented. I get it. So all of the associated stimuli may become coded in that memory. Well, that can be a problem too. The brain forms a schema or expectations related to that memory and all associated stimuli that guide responses in the future. So you may be involved in a traumatic event, whatever it is, and there's a smell, somebody's wearing a particular cologne, and your brain files that with the trauma scan. Even if that person who's wearing that cologne is not directly threatening you, that smell is associated with that trauma. And so when that smell is received in the future, goes up to the brain through the olfactory nerves and everything. And the brain says, oh, I remember that smell. That smell reminds me of this time. And so I'm going to put you on high alert now. Orienting reflex is different than the startle reflex. The startle reflex, also known as the Moro reflex, occurs in infants in response to loud noises, intense light, sudden movements, or a sensation of falling. Think about yourself. Even as an adult, if you feel like you're falling, what do you typically do? Put your hands out. That's that Moro reflex. If there's a loud noise, what do you typically do? Try to cover your ears. If there's an intense light. Oh, gosh. That's. That movement of your arms in a protective stance is the moro reflex. In adults, the startle response occurs when there's a sudden, intense and unexpected stimulation. Oh, my gosh. Right now, the. Like two lots down from our office, they are doing construction, and unfortunately, they have to blast the limestone. And every time they blast the limestone, it literally shakes the building. I can feel the vibrations in my chair, and we're on the ground floor, and it. I jump out of my skin every time. That's the startle reflex. Yes, it's the moro or the orienting reflex, too, because I'm like, what is that? But they are occurring together. Same thing. When you hear a car crash, you will probably startle and orient to the sound of whatever you heard. The adult startle response is stronger in people with underlying anxiety or ptsd. It makes sense. People with underlying anxiety or ptsd, they tend to be more hypervigilant. They tend to feel less safe. They tend to also have a HPA axis threat response system that is at least minimally activated. Most of the time, it's very hard for them to relax, so they're already primed and. And then when something happens, they respond with a greater intensity than people who don't have anxiety or ptsd. The startle response is often associated with a stress response. Fight or flee. The orienting reflex is responsible for figuring out what is going on or maintaining awareness under stress. So orienting reflex can be associated with hypervigilance when a person is feeling unsafe or stressed. Or threatened, they are more aware, they are more sensitive, their sensory threshold is turned down or turned up, turned down. They become more aware, more sensitive to stimuli in their environment. Sometimes we call this hypervigilance. So when anything happens, they tend to be more triggered by it. So somebody with ptsd, for example, who's at the gym, may be on a treadmill, but every time somebody walks past them, they're turning their head to orient just to make sure, is this safe? Am I in a safe place? And that is our body's way of trying to protect itself. If you've experienced threat before, if you've been experienced trauma before, then you may be more hyper vigilant to protecting yourself from other people in the future who may harm you. And that's based on that old schema. In the presence of unexpected stimuli, with or without a startle, the vagus nerve triggers the orienting response, increasing awareness and learning. Now, one of the interesting things about the orienting response and how it differs from the startle response, the startle response is a stress response. It's going to kick off that HPA axis and you may feel your heart pounding. The orienting response actually makes you freeze, if you will. You know, a lot of times when we talk about stress, we talk about fight, flee, fawn, freeze or forget about it. Well, this is more the freeze. When the orienting response is triggered, it very briefly inhibits ongoing activity, lowers your sensory threshold and increases perceptual awareness. It encourages eye and head targeting movements. You will look and listen towards the stimulus. You have vasoconstriction of peripheral blood vessels, so your blood pressure goes up and vasodilation of blood vessels in the brain. All of a sudden it's getting bathed in all kinds of oxygen and stuff and the heart rate decelerates. This is called a vasovagal response. About 80% of the role of the vagus nerve. I know we've been talking about it as a Messenger, but about 80% of the nerves are thought to be rest and digest or relaxation response nerves. So the vasovagal response is what happens to your vasculature, your veins and your arteries in response to activation of the vagus nerve. When the vagus nerve is activated, it says, okay, calm down for a second. And there's a release of endorphins and acetylcholine within brain tissues. But let's think about that for a second. Let's just think about very primitive brain structures and animals, okay? Not saying we're, you know, rabbits or what have you? But a lot of times when an animal hears a stimulus or sees something that triggers its orienting response, what does it do? It freezes and it listens. So the vagus nerve is basically triggering that. In us humans, it says, okay, be still for a second. Freeze. Figure out what's going on, and then you can figure out what the frig to do next. PTSD is associated with a single traumatic event. However, stimuli that prompt flashbacks to that trauma can be ubiquitous, causing the person to feel as if they're reliving the trauma. So if you have a traumatic experience that causes ptsd, then a week, a month, whatever, later, you're at your friend's house or you're at the store and something triggers a flashback, well, then all of a sudden, remember, go back here. Your ongoing activity is inhibited. Your sensory thresholds are lowered, so you're more aware of what's going on. You start taking in all those stimuli and, and encoding it with that flashback, that memory, that feeling of panic or terror. So now that reaction, that schema, a bunch of stimuli have been added to it. Cptsd, or complex ptsd, is associated with chronic threat or frequent traumatic exposures. Again, whether it is a flashback or actual exposure to additional traumas, each time the person is exposed and thrust into that trauma reaction, stimuli in their environment become associated with that threat. So you can see how very quickly, lots and lots of different stimulants, stimuli can start becoming associated with the threat and in the future will trigger the threat response. Novelty and stimuli that are associated with strong reactions, either positive or negative, are received by the vagus nerve and trigger the associated schema. And it can be positive. You can see, have a positive experience that is just amazing. And when you experience it in the future, it can trigger the associated response. Sometimes you have to experience something that's more mild a few times before the brain figures out, okay, what do I do with this? Not only can the orienting reflex be triggered by presentation of an unexpected stimulus, and here's the kicker, it's also triggered in anticipation of pain or threat. So if you're going to the doctor and you anticipate getting a shot, you know, I think we've all been there. Your orienting reflex is heightened during that period because you're anticipating pain or threat. So let's think about the person who's had trauma, who, especially complex trauma, who has for a long time not felt safe or empowered. That means they're constantly anticipating pain or threat. They don't feel safe. So their orienting Reflex is regularly triggered. They're regularly more sensory aware that sensory threshold is turned down. Why does this happen? Well, in an effort to stay safe, the person becomes hyper vigilant. They're like, okay, I know this could be really bad, so I need to kind of of be on guard. Stimuli present in anticipation of a threat now becoming coded in the threat schema. When I used to work in substance abuse treatment, it was a residential treatment facility, and the presence of law enforcement would trigger a reaction by the clients. Even if law enforcement wasn't there for any to pick up anybody or to cause any problem. The people who were in treatment had become so accustomed to negative interactions with law enforcement that when law enforcement showed up, it would trigger their orienting response and they would be anticipating and be more hyper aware of what was going on. So everybody started kind of feeling like they were walking on pins and needles. When these stimuli are encountered in other neutral situations, it triggers the threat schema or heightens the orienting response. So again, anytime we experience pain or threat or even significantly anticipate pain or threat, we become more aware of stimuli and it can trigger the threat response. The HPA axis, the vagus nerve. In the future, think about and smells are one of our greatest triggers. And I can tell you, for me, when I go into an environment, especially like a doctor's office or something, and I smell a particular smell, there's just an, I think they all use the same cleaner. It triggers a particular sensory reaction in me, or it did that I had to work hard to reprogram, if you will. People with ptsd, complex ptsd, generalized anxiety and borderline personality disorder often have problems with their vagus nerve functioning. It's just not able to trigger that rest and digest. Why is this? Well, people with ptsd, cptsd, anxiety, and borderline Personality disorder often have experienced trauma and may not feel safe in their environment, in their skin. So there's this ongoing feeling of threat. Because of that, there's a strengthened connection between the default mode network, their autopilot, and the amygdala, which is where your brain processes threat and fear. Now let's talk about the default mode network really quick. Default mode network operates every day in us. When you get up in the morning and you get out of bed and you go to make your coffee or whatever it is that you do, or you drive to work, a lot of times you don't think, think about every move you're making because that's the default mode. It's saying, okay, I know how to do this, you know, I can wake up in the morning and get up and make my coffee without even thinking about it. And that can be wonderful because it saves precious mental resources for when I do need it. But when that default mode network starts to become too intertwined with the amygdala, which is where we have that fear and threat processing, then the default mode network is for all intents and purposes, operating in a threat based state. This keeps the HPA axis, our threat response system and the orienting response more activated. Because we're regularly anticipating threat or harm, it causes the hippocampus, which is responsible for emotion regulation, to shrink. Yes, there are brain changes and the connectivity of the amygdala and the default mode network continue to increase. The more they sense fear in the environment, the more triggers they associate with fear, the closer they become as best buds, the more intertwined they become, the stronger they become and the harder it is for the vagus nerve to go, hey guys. Yet really no need for that right now. Let's think about this. Because of its strong connection with the default mode network autopilot, when the amygdala is hyperactive, it prompts autopilot fear based reactive responses. So you're regularly operating on the. No time to think about it. I just need to react. I need to fight or flee that impulsive behavior. People may start constantly feeling like they're helpless and in danger. They react in the only ways they know how, which doesn't alter the schema or fix the problem. It actually adds additional stimulus and reinforces that connection between the dmn, the autopilot and the amygdala. This reinforces the person's feeling of being powerless and unsafe. Further strengthens the amygdala connections in persistent pain states, depression, anxiety and ptsd. It's been found that the rate of communication between the amygdala and the dmn, the autopilot is doubled. So not only are there more connections, but they're talking with each other a lot more. Increases in connectivity between the DMN and the amygdala lead to reduced task induced deactivation, which as I mentioned earlier, the stronger the connections, the more the connections between the amygdala and the default mode network. They're kind of off in their own little world. And the vagus nerve may want to say, hey, we can rest and digest. Is having difficulty breaking that communication. And yes, this is grossly oversimplified for those of you who are neurologists, but you know, we're really getting to the basics here, task induced deactivation is when you're able to turn off your default mode and say, hey, I need to do something different. This can be as simple as making your coffee in the morning. I know, I use coffee as a reference a lot. In the winter, we keep it cooler in our house and I need to warm up my coffee water for 2 minutes and 30 seconds. Now that it's summer and we have the air conditioning on, we keep it warmer. And 2 minutes and 30 seconds is actually too hot. It burns my tongue. So I need to set the microwave for two minutes. But that means I have to remember I have to turn off autopilot and go, oh yeah, I'm not doing 2:30 anymore. I'm doing two minutes. Okay. Now obviously that has nothing to do with trauma, but that's an example of how we manually override our default mode network. Or if you're pulling out of your neighborhood, and normally you pull out of your neighborhood and you turn left to go to work, but you need to, for whatever reason turn right today to go somewhere else. How many times have you just mindlessly or on autopilot turned left and then they're like, oh crap, I gotta make a U turn. Okay, so again, that is where you're noticing and stopping your autopilot and manually overriding to turn the other way. Task induced deactivation is also when the body recognizes that, hey, I'm in an environment. It's similar to environments that may have been threatening in the past, but I'm in an environment right now that is safe, in which I'm empowered. I'm different now. I'm safer now than I was when I was five. Now that I'm 25. The parasympathetic vagal response or the rest and digest can then be activated when people are unable to deactivate that default mode and engage the executive control network and engage their reasoning, their higher order thinking, their fact based logic, whatever you want to call, causes a lot more problems. People have higher levels of anxiety and rumination because they're stuck in, in that out of date thought loop. And they have an inability to effectively interpret the current context, causing prior learning to be applied, reinforcing fear. So they're still reacting as if they were in that situation. They're still reacting now at 25 like they did when they were 15 because that threat response is so strong that they are unable to override it. And think about, all right, what's actually going on here right now? So what do we do? Vagal Tone or the ability of the vagus nerve to deactivate the autopilot and activate the relaxation response must be improved. Cognitive processing and cognitive behavioral techniques will be much more effective with when somebody is not in fight or flee. We've talked in other videos about how when you're in the fight or flee state, your brain is bathed in glutamate and cortisol and adrenaline and all those stress hormones and it's not able to effectively form memories, override the autopilot, et cetera. So the first step for people is to start learning how to trigger, manually trigger if you will, the rest and digest heart rate variability. Biofeedback can be one technique and that one is really easy. Either with one of those little finger pulse ox monitors with your activity tracker, or even better yet with a chest strap like, like. Well, you can monitor your heart rate and you can see how your heart rate is responding based on your breathing. And you can learn by seeing how when you start breathing more slowly and more deeply, it actually lowers your heart rate so you're triggering that rest and digest. Deep breathing can be very helpful because again, it reduces your heart rate. When you're stressed, you breathe more shallowly, more rapidly, and your heart beats faster. Heart rate variability I guess let's go back up to that. When someone is not in an anxiety state, when they're resting, their heart rate is at one level, we'll say 60 beats a minute. We'll just pick a number. When they encounter stress or go upstairs or whatever they're doing physical or emotional stress, their heart rate goes up. But then when that stressor is over, their heart rate goes back down to their baseline or their relaxation rate. That is good. You want to see changes in heart rate variability. When somebody's heart rate doesn't have much variability, that means they're never getting back down to a relaxation state. So by actively practicing deep breathing, by taking care of yourself, if you've over trained or if you're overstressed, you will see a reduction in heart rate variability that tells you that your body is just consistently under stress. So using techniques to help your body get to a place where it has a relaxation state that it can spring up from is helpful. Deep breathing is a technique that people can use to help themselves get into that relaxation state. Yoga has been found to be very, very helpful for improving the vagal tone or vagus response. Well, let's think about it. In yoga you are engaging in a posture, whatever the posture happens to be, and that involves activating muscles. But you are also at the same time overriding your body's stress response. That says, okay, wow, this is a lot of effort, you're breathing slowly and deeply. So you're telling your body, hey, there's no threat, you got this, just chill out. And so yoga can really help you gain more control over your breathing and your heart rate. Exercise itself can also help people get into a non fight or flee state because basically, and again, this is grossly oversimplified. When you're stressed, you're sitting still, your heart rate's pain pounding, your blood circulating, you've got all kinds of stress stuff going on, but you're sitting still, you start to exercise, your body goes, oh yeah, you're exercising, your heart rate supposed to be beating fast and you're supposed to be breathing heavy. So then when you stop exercising, everything decelerates. It's almost like it recalibrate. Helps you recalibrate between your neural response and your bodily response. Smiling and laughter have been shown to affect heart rate variability and also to trigger the vagus nerve. Why is that? Well, again, you've got the trigeminal nerve here and when you smile a lot of times you're also like raising your eyebrows just a little bit. You're activating all of those muscles that sit that are associated with positivity, if you will, or non threat. So that can help reduce your heart rate. Now if you're given a really forced, cheesy smile, it's not going to trigger the vagus nerve in the same way. It has to be a somewhat genuine smile, if you will, which is a lot of times. In dialectical behavior therapy, Linehan talks about having open hands and a half smile because it's easier to do that where you feel you're welcoming the world, whatever it is. Your open hands and a half smile is like, okay, I don't know if I'm thrilled, but it is triggering or activating all of those nerves in there. And interestingly enough, humming can also be helpful. Well, let's think about it. A lot of the vagus nerve receptors are kind of in your head and in your face and in your voice box. What happens when you hum? You are stimulating all of those nerves. Theoretically, you're not going to hum when there's a threat. So I think somewhere back in our brain, our brain kind of associates that. But by humming, it's almost like stimulating those nerves so they can't send threat responses to the brain. But all of these heart rate variability, biofeedback, deep breathing, yoga, exercise Smiling and laughter and humming have all been associated with improving what they call vagal tone or your ability that the ability of your vagus nerve to actually trigger the relaxation response. Once you get to the point where you can manually override the distress, then you can move into working with somebody on developing a program of systematic desensitization. And I've talked about that in other videos, but since about systematic desensitization is when a stimulus is repeatedly presented and the person starts out in a very safe place, like in their home, where they feel safe and they think about exposure to the stimulus. And then they practice their skills for manually overriding the threat response and reducing heart rate and triggering the rest and digest. So they practice that until they get to the point that they can think about being in that situation and not getting stressed. It actually doesn't even trigger that threat response anymore. And then they move to the next level, if you will. Maybe they go from imagining it to viewing a video of it or something and they do the same thing until they can view the video and it doesn't trigger their threat response. They're reprogramming the schema associated with that stimuli. They're realizing, hey, I can think about this and it doesn't mean I'm unsafe. I can see a video of this and it doesn't mean I'm unsafe. It's important to work with a professional to identify the steps so you don't go too fast, too quickly or too far too quickly. It is important to note that habituation or your ability to reprogram that schema is often stimulus selective with respect to basic contextual features. What does that mean? That means a person in a mask in the hospital may not trigger the stress response in you. You know, if a mask used to trigger the stress response, seeing a person in a mask in a hospital may not trigger that stress response. But seeing a person in a mask on the street, because that is an unexpected situation, may trigger the stress response. So it may be important if there's a particular stimulus or smell, sight, thing. It may be important to rewrite the schema in multiple different situations so your brain, when it, wherever it encounters that particular stimulus, can say, oh yeah, no biggie, got this. We are constantly making decisions about what to pay attention to information about the things we see, hear, smell and feel are carried by the vagus nerve to the brain. The brain consults our memories, our schema, to identify the appropriate response. If the situation is new, extremely intense, or unexpected, it may trigger the orienting response. If the situation is known, then the brain tells the vagus nerve and the rest of the body how to respond based on prior experiences. The vagus nerve, among other nerves, carry that information to the rest of the body. But remember, the vagus nerve is really your powerhouse. Once the fear response is triggered, the default mode network or autopilot takes over and the ability to effectively process new information decreases significantly. Once you're in autopilot and you're in Fight or Flee, it's really hard to process sights, sounds, smells, etc. Associated with the experience. Whether it's a flashback or another traumatic experience, all of the stimuli associated may become associated with the feeling of threat or danger, causing the person to more often perceive threats wherever they are, strengthening the parasympathetic vagal response. The relaxation response starts with creating safe places and a recognition of faulty expectations. So creating safe places, being able to override that autopilot, and reprogramming our outdated state schema so we can be more specific about what conditions are threatening versus what conditions certain stimuli are not threatening. Gradual reprogramming or reconditioning of stimuli through exposure and intentional responding, which means again, being in a situation, being exposed to a triggering stimuli, and then being able to choose how to respond to that instead of reacting impulsively, can reduce the strength of the connection between the default mode network and the amygdala and increase the situations in which the relaxation response is triggered. Helping to reprogram the threat response system and reduce emotional dysregulation. Going from flat to furious, having that extreme emotional response and may also help reduce inflammation because we know when the HPA axis is regularly triggered that people start experiencing more systemic inflammation due to the buildup of oxidative stress and the release of inflammatory cytokines.