How Trauma Reprograms the Vagus Nerve & Orienting Reflex | Healing from Trauma

Hey there everybody, and welcome to this video on the vagus nerve, orienting reflex and traumatic injury. I'm your host, Dr. Donnelly Snipes. Now, up till now in this series, we've been talking about the brain and the limbic system. Now we're going to start talking about how all those things may interact in order to respond to trauma, but they also may inadvertently cause traumatic injury. In this video, you're going to learn about the vagus nerve, describe the orienting response, explore the relationship between the vagus nerve, the orienting response, the HP axes, what you learned about last week, and how those things work together to respond to trauma, but also potentially in causing traumatic brain injury. And then we'll identify two main strategies to help people recover from trauma. So let's just recap from the last video. In the analogy that I'm using, the brain is your main office of this big company. The frontal cortex is your CEO. He's sitting there in the main office and he thinks about all the decisions. Well, or she, the hypothalamus is the cheap chief operating officer. And this is the person who wants to make sure everything is running smoothly and works with the CEO. The amygdala also is part of that C suite because this is the risk manager. This is the person who makes sure that the company is protected against any threats. They are protect, protected from harm. And the vagus nerve is the vice president of operations that carries signals between the brain and the body. They go to all of those executive management meetings and they find out what is going on, what the expectations are, and they also report from the, the workers work floor to the C suite executives, what's going on down there in order to make sure that there's communication. So the vagus nerve carries information both to and from the, the brain. It's connected to most bodily systems, either directly or indirectly through other nerves or sensory organs. These are the things that I refer to as the floor managers. The trigeminal nerve, for example, is a floor manager. And it takes in information from the face, like when you frown and it tells the vagus nerve, hey, we're kind of squinty right now, there might be a problem. The, the nose, the sensory organs also reports to the brain and via the vagus nerve, it transmits that information to the brain and takes messages from the brain to the rest of the body. So once it takes that information up there and triggers the HP axes to try to decide what to do, then messages get transmitted back throughout the body. Now, yes, I am grossly Oversimplifying this, but what we need to know as far as being counselors is, is right here. And if you're a medical doctor, you're going to go way more in depth. Triggers the, the vagus nerve, among other things, triggers the orienting reflex. Now the orienting reflex is really cool, but it's also what's responsible for, for hyper vigilance. So let's just take a little look at this vagus nerve. And I know it's hard to read all of the different labels that are on here because there's so much stuff. And you can go to survive personalabuse.org and see a copy of this on your own desktop so you can zoom in on it. But basically you see the green lines that are going through. That's the vagus nerve. That sucker's got its little fingers in everything from the, the larynx, where you swallow and also where you make noise when you the, your voice box. The cardiac nerve, the pulmonary plexus, the posterior gastric nerve. So your stomach, then it starts talking. The renal plexus, that's your kidneys. So it goes into the splenic branch, the pancreatic branch, the colon. It's everywhere. So it's important to recognize this because the vagus nerve can either say, hey, there's a threat, speed things up, or hey, we can relax, let's calm things down. Now, a lot of people do vagus nerve work by massaging. For example, the trigeminal nerve. And the trigeminal nerve is this yellow nerve that you see here. And it goes up above our eye in the ophthalmolog zone. And that is, you know, where we have what plastic surgeons often call the 11. That's where you have your frown creases. It also goes down in your cheeks and down in your mandibular zone. So it knows when you're clenching your teeth. It also knows when you're eating and it goes down into the rest of your face. And a lot of our expressions are in response to perceptions of pleasure or threat. And the vagus nerve takes in information from that and says, okay, let's figure out what to do here. Another place that people work on improving vagal tone is the auricular branch, and that's the ear. And you have multiple places on the ear that correspond to the vagus nerve. Now that's, you know, really kind of interesting. But the take home for this is there's a lot of videos online on stimulating the auricular branch of the vagus nerve. In order to promote activation of the relaxation response. Now that that's a little bit oversimplified because the wavelengths that you use and the rate of stimulation should be adjusted based on. On different disorders, different conditions that may be promoting vagus nerve dysfunction. But you can talk to your doctor about that. So it is out there. There are a lot of videos on it. And one of the things that people are able to do, obviously under doctor supervision, is to use what they call a TENS unit or a transcutaneous electronic nerve stimulation unit, which they sell over the counter. And there's a little clip that you use instead of the patches like you use on your back or on your arm or your leg when you have pain, there's a little clip that you attach to these points on your ear that correspond to the auricular branch of the vagus nerve. So let's talk about the orienting reflex. Now, the vagus nerve takes in sensory information and communicates it to the brain and then takes messages back down to the body. Well, that's all well and good. One of the things it does is trigger the orienting reflex. When it there's a threat perceived, the orienting reflex is triggered. Ivan Pavlov defined the or orienting reflex as the what is it? Reflex. It's an interruption of ongoing activity by presentation of an unexpected stimulus that triggers increased awareness and learning. So that unexpected stimulus could be something that surprises because it was a quiet room and somebody dropped a tray. Or it could be you expected something to go one way and it goes another way. Think about caregivers and babies. Babies have this orienting reflex, and I love triggering it when I'm in the store, because to a baby, every face is different and they haven't generalized to say, okay, that's a smile. So the way I smile may look a little bit different than the way their mom smiles or their dad smiles or their sister smiles. So they are attracted to or attuned to the faces of different people. Newborns in the presence of a caregiver often orient to that person. We are kind of hardwired to orient to faces. Since babies have very little in the way of schema, their orienting reflex stays activated if the caregiver's face is more expressive. So if you make faces at a baby, it'll stare at you for longer because it's like, oh, what is that? I haven't seen that before. What is that? And every little slight change in your facial expression, it's trying to figure out kind of what's going on. What does it mean? And it's forming schema. It says, okay, when I see this particular expression, I, you know, can laugh or it. Everything's okay. When I see this particular expression, yeah, it's no bueno. So the child is trying to figure those things out. And we see in infants that are stressed, they will actually avert their gaze in response to stressful facial expressions or from the caregiver. With each experience, the child forms schema, or memories, if you will, that associate a feeling of safety, fear, or pain with that experience. If the child's caregivers are insensitive, inattentive, or rejecting, the child doesn't learn to interpret these stimuli. And the world seems chaotic and unsafe, painful or overwhelming. So when there isn't a secure attachment, when the caregivers are what we call insensitive to the child, they. They don't respond to meet the child's needs. They're just like, you know, whatever. The child is kind of left going, I don't know what to do with this. So they start feeling more anxious, they start feeling more stressed out. In adults, anything unexpected or that or that happens results in an activation of the orienting reflex. I'll get there in a minute. The orienting reflex enhances sensitivity and the defensive reflex to reduce it. So when there is a negative stimuli or a threatening stimuli that triggers the orienting reflex, the reaction is going to be for the person to try to figure out what is it and how can I get safe? Now, there are other times that the orienting reflex is triggered, and it can be in response to positive things. You're sitting there having lunch with your best friend, and all of a sudden you hear a baby laugh. Okay, that's mine. And I hear that. And all of a sudden I'm turning and I'm trying, looking around, trying to figure out, where is this happy little child at? That's my orienting reflex kicking in, going, ooh, there's a baby. But in terms of trauma, the orienting reflex enhances sensitivity. And when somebody senses that there might be a threat, it says, hey, we need to be more hypervigilant right now. There might be a threat. So keep your eyes open. Everybody on high alert. In the presence of unexpected stimuli, the vagus nerve triggers the orienting reflex, increasing awareness and learning. You smell smoke. Now, if you are out at a campsite and at a campfire and you smell smoke, you're not going to think anything about it. If you're sitting in your living room watching television and you smell smoke, that's going to trigger your orienting reflex. You're going to be like, where's that coming from? So when that orienting reflex is triggered, it inhibits ongoing activity. You're going to stop watching the television and try to figure out where that is coming from. Increase sensory sensitivity so your senses become heightened so you can try to hone in on or target where that stimulus is coming from, where that threat might be coming from, and any other threats around eye and head targeting movements are going to happen. You're going to actually turn and look. You're going to move toward whatever's going on. You're going to try to turn and take a look. And if it's bad, you're going to turn the other way and run. Vasoconstriction of peripheral vessels, vasodilation of vessels in the brain and heart rate deceleration. Now that sounds really weird. You're like, excuse me, Fight or flight, right? We got to get the heck out of here. Well, that's true, but that's the next step. During this orienting reflex, they think that it was programmed into us. Just think about rabbits or other prey animals. When they get startled, what do they do? The first thing they do is freeze and perk up their ears and try to figure out where that threat is coming from. They suspect that that wiring has carried on in humans as well. And no, we are not descended from rabbits. But similar wiring helps perpetuate species, living species. So there's a brief deceleration of the heart rate so you can figure out what's going on. Then there's the release of endorphins, which are your natural painkillers, and acetylcholine. Now, why would you want to release painkillers in the presence of a potential threat? Well, if you're in pain, it's going to be harder to fight or flee. So that release of endorphins, which happens partly as a result of cortisol when the HPA axis is triggered, can actually help prepare you to fight or flee. The response, not surprisingly, is stronger in people with underlying anxiety or ptsd. People who already feel unsafe in their environment have a stronger response. They are already, you know, up here, and that kind of pushes them, you know, to the brink. I gave the example a minute ago of the smell of smoke at a campfire versus in your home. It's going to trigger a different response. Seeing a co worker at work, you're not going to think much about it. If you see that same co worker in the airport, you're probably going to turn and look and go, oh, hey John, I didn't expect to see you here. It's not surprising to see a roommate at home in the evening. But if that roommate shows up in the middle of the day when they're supposed to be in school, that may, you know, startle you. You know, when may be home sleeping or cooking or whatever you're doing. You don't have to be anywhere they show up, it's likely going to be startling a little bit because you're going to be like, I, I didn't expect you. Or sounds in the house during the day. You expect certain h sounds in the house during the day versus at night. There are other sounds, certain sounds you don't expect to hear in the house at night. So they are going to be more likely to trigger the orienting reflex. During a traumatic event, the HPA axis is activated and a person's orienting reflex is supercharged. So there's a trauma or a potential threat. So you're like, something tells me that there might be a problem, there's something going on. So now I'm hypersensitive. I'm hyper aware of what's going on and I'm trying to figure it out. I've got my radar on. All of the associated stimuli at this point start to become coded in that memory. You know, I remember this time when I got scared and I can tell you, you know, what I saw, what I smelled, what I did. So all of those things become part of that narrative, part of that person's story. The brain forms a schema or a memory related to that event and all the stimuli associated with that event. So not just the fact that they heard somebody knock at the door at 2 in the morning, but the dog that was barking, the, the smell in the air. Even though they may not really realize they're coding the smell, they may code the smell in the air and that can serve as a trigger later. Let's talk about trauma related stimuli for a second. Stimuli in general, but in this particular case we're talking about trauma. And what I want you to recognize is there are so many different stimuli that can be associated with trauma and then generalized into the environment. It's not surprising that people with anxiety, ptsd, cptsd can report like they never feel safe, can report that they can't ever feel like they can relax. They're always hyper vigilant, they're always on edge, they're always on guard because everywhere they look, they see, smell, hear, feel something that reminds Them of being unsafe. So let's think about a particular trauma and I will let you choose what kind of trauma you're going to use for this example. But if it was a trauma that was committed by a person, or even a trauma like a tornado, where you and your family were in the basement together when it happened, those people are present for that trauma. So those people may serve as a reminder of that trauma. If it's due to a victimization, then obviously that person is going to remind you of that trauma. But that person's name, you know, if you know their name, then in the future, when you hear their name, even if it's just their, a first name, you know, somebody else with the same first name, it may trigger that memory. Or if you see somebody who looks a little bit like them, it can trigger that memory. Or smells or sounds or moves like them, it can trigger that memory. Places where that trauma occurred or similar places. If you were in a car accident on the interstate, well, that was one interstate in one state at one time. Yes, but being on the interstate or being even on a highway can be triggering sights, smells, sounds, the time of day, you know, like if something happened at night, then nighttime can be more triggering the date. So anniversaries, the activity that you were doing when the trauma happened can also be a trauma related stimuli. I remember when my grandmother passed away, I was out jogging and I felt very guilty for not being by her side when it happened. She had been on hospice care for a long, long time. And that was traumatic. And for a while after that, when I would go jogging, I would feel kind of guilty for not being there with my loved ones, for fear that I might finish my jog and come back and another one would be gone. So an activity that seems so disconnected from a trauma can actually serve as a trigger if it's associated in some way. And I'm sure there are other stimuli that I'm missing, But the whole point was thinking about the multiplicity of different stimuli. PTSD is associated generally with a single traumatic event. However, stimuli that prompt flashbacks to that trauma can be ubiquitous, can be everywhere, causing that person to feel as if they're reliving that trauma. When they go to the grocery store, when they go to the airport, when they go to work, work, you know, there may be something that reminds them of that traumatic event. And every time they're reminded, it creates a little mini trauma. CPTSD is associated with chronic threat or frequent traumatic exposures. Again, stimuli in each situation start becoming associated with that threat. So let's think about domestic violence. There may be an initial DV episode, and then all the stimuli associated with that are encoded. And the person says, okay, as long as I make sure that all of these things are right and this doesn't happen, then I'm safe. Then there's another incident about something else. So there's even more stimuli to add to that that have to be all perfect. And all of those stimuli start getting encoded to the point where the person feels like there's no way they can ever create an environment in which they can feel safe. Novelty and stimuli that are associated with strong reactions, both positive or negative, are received by the vagus nerve and trigger the associated schema. So for some people, they love novelty. That's not a big deal. That's exciting. For other people, novelty is associated with the schema of the unknown and not being in control and triggers anxiety. And then stimuli that are associated with strong positive reactions are received by the vagus nerve and can trigger the associated response. So if you're thinking about going and doing your favorite thing or you're sitting down to eat and you're eating your favorite meal, that those stimuli, that meal is associated with a strong positive reaction. So what's the vagus nerve going to do? The vagus nerve is going to say, hey, this is cool. We're safe. We can relax, we can enjoy this meal. If you are getting ready to go to something that's stressful, I usually use the example of a doctor, but I won't pick on them today. If that's a negative association for you, then your brain may say, hey, we're getting ready to go do this. So it triggers that schema and you may start anticipating distress. So I. I guess I got a little ahead of myself. Not only can the orienting reflex be triggered by the presentation of a stimulus, you know, something pleasant happens. Like I said, I hear a baby laughing. I'm going to be triggered by that. And I'm going to turn and I'm going to look. It's not unpleasant, it's not scary. I'm not worried, I'm thrilled. And I know if I turn and look, it's going to make me even happier because there's virtually nothing better than a laughing baby. But I. It can also be triggered by distressful sounds. So that can happen, but it can also be triggered in anticipation of pain or threatening. If somebody's afraid to fly, for example, they're anticipating that this is going to be terrifying, that this is going to be dangerous, so they Start encoding all of these schema or all of these triggers that are associated with flying, and they become hyper vigilant. So every time there's a bump or there's a weird smell or there's a this or that, they, their HPA axis, their stress response system is kicked into even higher overdrive. In an effort to stay safe, the person becomes hypervigilant. They're in that higher overdrive. Stimuli present in anticipation of a threat become encoded in the threat schema. So let's stay with the airport. For example, going to get on a, a plane. Well, that flying can be scary. Well, that also means that the plane can be scary. That also means that going to the airport means that you're getting ready to get on the plane. So that can be scary. That also means that anxiety can be triggered in anticipation of getting there, and all of those things can start to be encoded. If you always take a Uber to the airport, then Uber may start to become a trigger for anxiety. Because when you see one, you think, oh, that reminds me of going to the airport, and I really hate that. When these stimuli are encountered in neutral situations, it triggers the threat schema, heightens the orienting reaction response, and triggers the HPA axis or the stress response. Each time the stress response is activated in response to a trigger, in response to an associated stimulus, it strengthens the connection to the schema of unsafeness. So you have this memory of flying, and it's really, really scary and you don't like it. You're terrified of flying, and you have all of these different things that remind you of going to the airport and flying. Every time you encounter one of those things, it strengthens the connection between that goes to that memory. It strengthen, strengthens the presence of that memory in your brain, so it makes the brain feel even more unsafe. Trigger review triggers can be associated with the trauma, associated with reliving the trauma, or associated with anticipation of feeling unsafe. So another example, if somebody is robbed, then they go to the store, they're shopping, they're minding their own business, and they pass somebody in the store that looks like the offender. Oh, crap. Then they have a stress response. Okay, all right. Maybe they're able to downregulate it at that point, but their brain now starts thinking, oh, maybe I'm not safe in the store. So now you anticipate feeling unsafe in the store, and the orienting response and HPA axis become more hyper aware of threats or reminders of threats in the store. So now the rest of the time that you're walking around, you're feeling unsafe and you're hypervigilant and, and you're hyperaware of potential threats. So that's an exhausting experience. You get home, you calm down, then the next time you're getting ready to go to the store, your brain goes, oh, that was unpleasant the last time. Let me just replay that for you for a second. And then you start having that anticipatory anxiety. And this memory, this belief about not being safe can be generalized then maybe to all stores. So maybe this happened at the grocery store, and then you go to the home improvement store and something about being in the store reminds you of being in that other store, which reminds you of the trauma, which reminds you of being unsafe. This is exhausting, just downright exhausting. And it's not something somebody does intentionally. Most people I've talked to, I can't think of a single person who said, oh yeah, I do this intentionally. Most people I've talked to have said, I don't like this. I don't like feeling afraid. Everywhere I go, people with ptsd, cptsd, anxiety and borderline personality, these things all have really, really close overlapping symptoms. They often all have strengthened connection between their default mode network or their autopilot and the amygdala. So their autopilot is constantly talking to the risk manager who's saying all these bad things could happen. And if you've worked in a big organization, you know that risk managers tend to be somewhat hyper vigilant when this happens. It keeps the HPA axis, the stress response system activated and the orienting response hyperactivated. So you're, you're stressed and you're scanning and you're hyper aware and you're more sensitive, you're more aware, your, your senses are more acute. It causes the hippocampus, which is part of the emotion processing area of the brain. It actually causes the hippocampus to shrink over time because all of that stress is neurotoxic. It starts killing neurons, triggers the HPA axis and ultimately glucocorticoid resistance. When that HPA axis is triggered too much, we start seeing neuronal death in, you know, in the hippocampus. But we also see that the receptors, the cortisol receptors, start becoming tolerant to cortisol. They start not responding to, to the same level of cortisol. If, if you give it the average level of cortisol, there's no response from the system. The only time the HPA axis is triggered is when there's A tsunami. And the analogy I usually make is alcohol. People who drink alcohol, you know, initially it has a certain effect. Eventually they become tolerant and they need more to get the same response. Same thing with cortisol. The receptors are not all that much different. In persistent pain states, depression, anxiety, PTSD and cptsd, the rate of communication between the amygdala and the default mode network is doubled. Okay, so interestingly enough, not only is the rate of communication doubled, so the DMN is asking the amygdala, and the amygdala is calling on the DMN twice as often. Signals are going back and forth twice as often. But there's also more projections of the amygdala into the dmn, so there's more watchers, if you will. The increased connectivity between the DMN and, and the amygdala, so between the autopilot and the fear response, or the risk manager, leads to a reduced task induced deactivation, which is, you know, a fancy way of saying an inability to turn off the stress response, an inability to turn off autopilot and intentionally engage in the moment and, and intentionally trigger the relaxation response. So vagal tone is your vagus nerve's ability to jump in and go, we got this, we can calm down now. You know, we can trigger that relaxation response. But when the DMN and the amygdala are so tightly intertwined and communicating so frequently, the vagus nerve can't get a word in edgewise. This is associated with higher levels of anxiety and rumination and an inability to effectively interpret the current context using prior learning and which reinforces fear. So the person is not able to get out of emotion based reasoning into their wise mind. It's just no time to think, just fight or flee. No time to get into that wise mind. When we're constantly in this fight orf flight state, we start experiencing emotional disregulation or that emotional response of feeling flat. Nothing's really triggering that stress response to being enraged or terrified. And there's just no, no middle ground. It's important to recognize when the vagal tone becomes poor, you know, we have the flat to furious. There's no middle ground in there. And it takes the person longer to return to baseline because the vagus nerve is just having difficulty getting the attention of everybody else and going, hey, hey, we, we can down regulate now. So the two things that we really need to do right now are strengthen vagal tone. We need to help the vagus nerve be a little bit more assertive and Heal the HPA axis because as long as the HPA axis is dysfunctional, as long as the cortisol receptors are not responding like they should to cortisol, the vagus nerve is going to have a hard time regulating the system. So we need to heal the body, but also help that vagus nerve so we can strengthen vagal tone through conscious practice. It's one of the few aspects of our nervous system that we actually do have a certain amount of conscious control over. One of the things or one type of thing that you can do is heart rate and, and, or breath monitoring during distress tolerance activities. Now, what does that look like? Well, you can do this during emotional distress if you are feeling anxious or angry, practicing square breathing exercises or grounding exercises or meditation, and noticing how whatever distress tolerance activity you've chosen is helping your heart rate decelerate, helping your breathing slow down and become deeper. Okay, that's the vagus nerve kicking in. And, or, and, or you can do it during physical activity like yoga or strenuous exercise. When you do yoga, you strike a pose and you hold it, and a lot of times that requires a fair amount of physical strength and at a certain point it's going to start feeling a little uncomfortable. And one of the things to that a lot of people do during yoga is try to control their breathing so they don't start hyperventilating in response to that slight discomfort. By doing that, you're overriding the default mode and saying, hey, there's no threat here. We can tolerate this pain. There's no need to get all fired up about it. And training yourself to override some of those signals. Same thing is true in exercise. And this is one of my favorite ones. After I have a good hard workout, it's almost a game for me to see how quickly I can get my heart rate back down to baseline. You know, how quickly do I recover after that stressor is passed? And when I'm exercising, exercising, especially if I'm doing intervals, how quickly can I get my heart rate to down, regulate or decelerate when I'm not exerting as much energy? And you know, that's one of those games I play. But it is an activity in strengthening vagal tone as I start to become more aware of, okay, if I do this, it helps me reduce my activation, I become more aware, I become more empowered to help control and strengthen that vagal tone. And then similar, but not quite the same, is progressive muscular relaxation where you lie somewhere, sit somewhere where you're relatively comfortable, and then you practice intentionally tensing muscles and then intentionally relaxing muscles. So you start to notice the difference between what it feels like when they're tense and what it feels like when they're relaxed. Then when you're going through the day, you can do a body scan and you can notice, hey, I've got tension in my muscles here. And you can intentionally relax those muscles. And that sends the message, because remember, that vagus nerve has its little grimy mitts everywhere, sends the message to the vagus nerve that, hey, the thinking part of the brain says, I can relax now. And finally, systematic desensitization. Repeated presentation of a stimulus results in gradual reduction of the oriented reflex, otherwise known as habituation and recruitment of the default schema. So, you know, I know that is like super technical. What it basically means is when you're exposed to something over and over and over again and that nothing bad happens, then you start to become used to experiencing it. If you do something enough, it's not as scary anymore. And this reduces the vagus nerve, triggering the stress response, triggering the orienting response, the vagus nerves. Like, oh, yeah, I recognize all the stimuli. I recognize this, been here before, not a big deal. We don't need to trigger anything. That's good. It helps reprogram the default schema via activation of the vagus nerve and cognitive processing. So in systematic desensitization, the person encounters the feared stimulus or event or trigger or whatever you want to call it, and they are assisted by the therapist, generally in practicing distress tolerance skills. They're assisted in triggering that vagus nerve until they can. Until they feel calm. They feel like a one on a scale of one to five. So they learn how to take conscious control of that stress response, which helps them feel more empowered in the face of that particular stimulus. When they're calm, they're able to activate the wise mind and explore their beliefs with regard to that trigger. So if they see a spider, for example, initially, they may be terrified of spiders. But once they learn how to override that, they learn how to communicate to their brain that, hey, I'm safe. I'm safe right now. In this situation, they can get into their wise mind, and then they can start saying, all right, not all spiders are things you want to play with. Am I safe right now? Is this spider a threat to me? So they can start reprogramming their beliefs about spiders, just like people can reprogram their beliefs about planes or other things that are terrifying to them. Habituation or getting used to something is often stimulus selective with respect to basic and contextual factors. So getting used to something, you can be used to seeing a doctor in a surgical mask walking down the hall of the hospital, that's not going to surprise you at all. You see somebody on the street, well, that's not a good example anymore. You may be used to seeing somebody with a ski mask on when it is negative 3 degrees outside and you're outside. If you see somebody with a ski mask on in the middle of the mall, that's probably going to trigger the orienting response. You're not going to habituate to that because that indicates something is, is kind of a mission. And we need to heal the HPA axis or the stress response system. And last week we talked about how you can't heal one without healing all three. The hpa. Hypothalamic pituitary, adrenal, hypothalamic pituitary, thyroid, and hypothalamic pituitary gonadal. But right now I'm just going to kind of generally refer to it as the HPA axis because that's the one that's leading the charge here. We need to reduce what I call PACER stress to heal the HPA axis and that glucocorticoid responsiveness. We need to get the receptors to start responding to cortisol at normative levels for that individual, not have to have a supercharged dose in order to get any sort of response. In order to do that, we need to calm the system down. We need to give it a break so it can heal itself. Now, PACER stands for physical, affective or emotional, cognitive, environmental, and relational. So real quick, I'm just going to go through some of these now. I have other videos on rewiring the traumatized brain and how to release trauma from your body that go into more detail on these. But and on just about every one of these topics. But just in summary, physically, we need to reduce unnecessary HPA axis activation. And the HPA axis or the stress response activates not only in response to emotional stress or pain, but in response to anything that disrupts the balance in the body. So starting out with mindfulness, being mindful of yourself. How do I feel right now? You can prevent a lot of unnecessary distress by handling things before they get out of hand. You know, if you start noticing that you're getting hungry, eat. Instead of waiting until your blood sugar is way, way low and your HPA axis has triggered a, a, a, the release of more blood sugar and you're all shaky. So mindfulness of self can Be very, very helpful. And mindfulness of self also means being mindful of your emotions and your thoughts and all that other stuff. We're going to get to those. And mindfulness of the moment, being aware of what's going on right around you right now. You know, is there something that's potentially triggering or could potentially trigger a stress response? And what do you do about it? Sleep. Inadequate sleep triggers the HPA axis. The HPA axis says, oh, you didn't get enough sleep, that means you're vulnerable. So let me help you stay awake. Let me help you be a little bit more alert by releasing all these stimulating or stress hormones. Nutrition. When we eat certain foods, it increases inflammation, which triggers the HPA axis. When we don't have adequate nutrition, our body can't make the neurotransmitters and hormones it needs. So the system gets out of balance, which triggers the HPA axis. When we get dehydrated, it triggers the HPA axis. So we need to make sure that people are paying attention to basic activities of daily living like sleep and nutrition in order to help calm the system, in order to help the body be a safe place to be. Pain and inflammation management is also important. Pain triggers the HPA axis. Inflammation triggers the pain sensations. So you generally don't have one without the other. Not all inflammation is caused by poor nutrition. It can be caused by injury. It can be caused by autoimmune disease. It can be caused by stress that triggers autoimmune flare ups, which triggers pain. So we need to address those. You may not be able to completely get rid of pain, but reducing pain to the extent possible and then adjusting your relationship with pain, instead of being angry that you have it, or just desperately trying to get rid of something that you can't get rid of, that's going to trigger that HPA axis. At a certain point, some people with chronic pain start to learn to live with it. It's like, okay, today's a good day. My pain is a two instead of a six. So I'm happy with that, I'm good with that. And relaxation skills can also be helpful because those are going to directly trigger the vagus nerve. Aerobic exercise, nutrition, sleep, making sure your hormones are in balance, engaging in hobbies and things you're interested in, and socialization, all of these things reduce the neurotoxic environment and actually promote neurogenesis. It promotes healing of the brain. It promotes healing of that hippocampus where we process those emotions affectively. Developing emotional intelligence can be super helpful. If people don't know how they feel or are not aware of their early warning signs of distress, then stress is probably going to sneak up and bite them in the butt, as my dad used to say. Okay, so developing an emotional intelligence, being aware of the fact that anxiety doesn't mean there is a threat, it means there might be a threat. The purpose of anxiety is to make you aware so you can check it out to see if there's a problem. The indicators of anxiety differ for different people and the triggers for anxiety differ for different people. But knowing what those are for you is really important because then you start to feel more empowered to identify it, to recognize it. And instead of being this scary thing that, oh my gosh, I feel anxious, therefore something bad must be happening. You start thinking, okay, I feel anxious. Let me see if something bad's getting ready to happen. Kind of like your smoke alarm in your house. If it goes off, it doesn't necessarily mean there is a fire. Distress tolerance. Well, once you're aware of your emotions, that's great. But in order to effectively process them, you got to get out of that emotional mind and into your wise mind. You've got to turn off the default mode, silence the amygdala, amygdala a little bit, and activate the executive control network, activate the vagus nerve so you can get into your wise mind and think, okay, what do I do next? And then problem solving. This is improving the next moment. I may not be able to get exactly what I want, but what can I do in this situation at this time to improve the next moment? And sometimes that just means tolerating distress. Let's just be honest. Grief and trauma processing. And I have two asterisks by that because that's something that is a long term process that people often benefit from doing with a therapist. Vulnerability awareness and management. Being aware of physical, environmental, interpersonal conditions that make you more likely to have stressful emotions triggered. You can become aware of those if you know that when you are hungry, you tend to get hangry, which means you're more easily triggered into being irritable and angry when you're hungry. Great. Well, then you know that not only do you need to be aware of your hunger levels to prevent low blood sugar and HPA axis activation, but also to prevent being irritable and getting excessively angry and engage in positive affect activities. Do things that actually help you feel, oh my gosh, hold on, happy. Cognitively promote a sense of efficacy that can do attitude and empowerment. I can do this and I will do this. Address distortions, cognitive distortions, by looking at every situation and evaluating them based on the facts in this context at this time. And what is it about the situation that you can and cannot control? Look for alternate explanations for things that are going on besides it having to do with you. You know, what's another explanation for why this might have happened? Look at the big picture. Yes, this thing here sucks, but does that mean your entire life sucks, or does that mean this aspect of your life right now sucks, but the other stuff is going okay and finding exceptions instead of saying something always or never happens, looking for exceptions. And that goes back to evaluating the facts. Tragic optimism is kind of part of this, that we're talking about. Optimism or toxic optimism is being optimistic about, you know, everything. And that's just not real. And it creates. It's just as toxic as being pessimistic. Tragic optimism recognizes the unpleasant and the pleasant. It says, this isn't going great and it can improve maybe. And there are these other things that are going well in my life and tragic optimism and radical acceptance kind of go hand in hand. Radical acceptance means looking at a situation and going, it is what it is. I may not like it right now, but it is what it is. Hardiness and your rich and meaningful life is also important. Recognizing keeping a list of all the things that are important in your rich and meaningful life. And when you start feeling like everything is going to crap, looking back at that and saying, all right, of all the things that are important to me, which things are going okay to maybe even great. And yeah, there's things that aren't going well. That's just part of life. And then purposeful action. How can I use my energy to affect positive change instead of using my energy to sink deeper into the quicksand of distress and ramp up that HPA axis fighting against it, which means you got to get curious environmentally. Create safety. If you don't feel safe in your environment and in your own skin, then that HPA axis is going to be triggered. So explore your triggers for stress and distress and your triggers for safety, empowerment and contentment. What can you add to the environment that can help you feel safer and more empowered? If you need help with shelter and basic needs, 211.org or the United Way website has a whole bunch of lists of and connections that can help people. Patient assistance programs in the US can help you connect with pharmaceutical companies to more afford affordably access medication and housing and urban development again in the US Is a resource to help you find affordable Housing if you don't have food, shelter, and medical care. Those are your base baseline needs if you look at Maslow's hierarchy. So in order to feel safe, we need to make sure that you're getting those needs met and relational. Inner child awareness and reparenting is so important. A lot of people, if not the majority of people with CPTSD and borderline personality, particularly have attachment trauma. So they are going to need to reparent that inner child in order to start feeling safe in their own skin. In order to start feeling safe around other people. Developing secure attachment with others means also addressing abandonment fears. Learning how to set, maintain and respect boundaries so you're not afraid that people are going to trample all over your boundaries, so you're not afraid that you're going to be taken advantage of or taken for granted. Awareness and management of interpersonal triggers. You know what things trigger your stress response? I know my mother used to have certain looks that she would give me that just irritated me to no end. And, you know, that was her job, being my mother. But when other people make those particular facial expressions, it kind of triggers that response in me. And I've got to remind myself, different person, different place, different time. Learning how to be assertiveness and addressing your fear of assertiveness and associated abandonment is also important. In order to get your boundaries respected, you've got to be able to communicate them. To communicate them, you need to have assertiveness and learning how to listen without defensiveness because none of us is perfect. And constructive feedback is. Can be very, very helpful. Recognizing that when people disagree with you or provide constructive feedback, it is a rejection of an idea or a comment on a behavior, not on you as a person. We are constantly making decisions about what to pay attention to. Information about things we see, hear, smell, and feel feel are carried by the vagus nerve to the brain. The brain consults our memories, which a lot of times I call schema to identify the response. It says, okay, what do I do here? If it's new, intense, or unexpected, it triggers the orienting response. So the orienting response starts saying, all right, need to be more aware of what's going on. High alert. If it's known. The brain tells the vagus nerve how to respond based on prior experiences. So the brain's not considering the facts in context at this time, saying, well, in the past, when this has happened, this is what we've needed to do. The vagus nerve carries that information to the rest of the body. Once the fear response is triggered, the default mode network or autopilot takes over and the ability to effectively process new information decreases. You get into that fight or flee, not time to think, fight or flee. Sights, sounds, smells, etc associated with the experience then become associated with danger, causing the person more often to perceive threats wherever they are. Because people are going to wear the same cologne as, you know, somebody that betrayed you, potentially, you know, somebody else is probably wearing that same cologne and you may run into them. Gradual reprogramming or reconditioning of stimuli through exposure and intentional responding, systematic desensitization can reduce the strength of the connection between the default mode network and the amygdala and increase situations in which the vagus nerve is triggered, helping to reprogram the HPA axis and reduce dysregulation and inflammation. So basically, you develop a new relationship with that stimuli. So the vagus nerve can just say, hey, no big deal. All clear here. This is not the same person, place, thing, time. We're safe now. I know that was a lot of material, but I'm hoping that through this series of videos, the way our body impacts our feelings, our thoughts, and even our health is going to start becoming more clear.