Powerful Strategies to Undo PTSD: Rewiring the Traumatized Brain

Hey there, everybody, and welcome to today's video on how to rewire the brain to undo the effects of trauma. I'm your host, Dr. Donnelly Snipes. In this video, we're going to review the impact of trauma on the brain and the person and identify strategies for healing and rewiring the brain and the nervous system. So let's start out with a brief review on the impact of trauma, and I have a bunch of links in the video notes if you want to take a deeper dive into the. Into the impact of trauma on the body, on the nervous system, on the person. But that's just way too much to get into and still get to how to fix it. So you cannot separate the brain from the body, nor can you separate the body from the mind. The. The brain helps us interpret what we're seeing. The brain is responsible through the HPA axis of activating or deactivating our stress response system. So we can't separate the two of them. When you have thoughts, those thoughts are processed in the brain, and then the brain responds accordingly, whether it's to ramp up the nervous system or to ramp up the relaxation. So we need to recognize that we can't just say, oh, we're going to do this over here. We're not that simple. So physically, trauma impacts the HPA axis, your stress response system. When somebody experiences trauma and doesn't integrate it, when somebody has unprocessed or unhealed trauma, that HPA axis, or threat response system stays activated. It's not something that turns on and off like it does for most people. When it stays activated for too long, it naturally starts to become dysregulated. Think about a machine at a factory that runs 24 hours a day, seven days a week. At a certain point in time, it needs to go down for maintenance. It needs to be recalibrated. It needs stuff to happen. But if it's not turning off, then it just gets progressively less efficient and less effective. We also see what's called excitotoxic shrinking of the hippocampus. Now, the HPA axis is the hypothalamus, pituitary, adrenal axis. But the hippocampus is another part of our brain that's involved in emotion processing and behavior. When we are regularly exposed to stress, those stress hormones like cortisol and glutamate and even norepinephrine are secreted into the body, into the brain. And those stress hormones, I want you to think of them as your hot hormones, and they actually create a Situation where your neurons die. We have excito, which means excitement. So you're excitatory neurotransmitters, they're too hot, too high and we start seeing a loss of neurons. We see a strengthening between the dmn, the default mode network, which is your autopilot, and the amygdala, which is where we process fear. So the fear aspect of your brain is regularly saying, hey buddy, check, make sure there's not a problem. So you end up paying more attention and operating from a fear based standpoint. We also see strengthening of the amygdala and the connection between the amygdala and the prefrontal cortex. We see hypervigilance. And this is not new. I didn't bother to even hyperlink it because we know that people who have not effectively processed trauma, often more hypervigilant. When we experience trauma, whether it is a natural disaster or victimization, doesn't really matter. When we experience trauma, at least briefly, we lose our sense of safety and personal empowerment. Now when you integrate trauma, you reclaim that sense of safety and empowerment. But if you haven't, then you're constantly going to be on edge, you're constantly going to be nervous when you're waiting for the next bad thing to happen. We also see weakening, if you will, of vagal tone. Now your vagus nerve is the nerve that a lot of people refer to as the primary driver, if you will, of your relaxation response. And we see that the vagus nerve becomes less able to turn off the HPA axis. So the HPA axis is your stress or your threat response, the vagus nerve, among and other things are your relaxation response. Well, when the autopilot, when the default mode network and the amygdala are working together and they are just full bore ahead looking for those dangers in the world and expecting to see dangers in the world. Then when the vagus nerve comes knocking and says, hey, why don't we just take a break for a little bit, it cannot interrupt that autopilot. So the executive control network where we do all of our fact based reasoning has a hard time breaking in. Sleep disruption is another side effect of unresolved trauma. When you don't feel safe, you cannot completely relax to get good quality deep sleep. Sleep. Sleep and circadian rhythm disruptions contribute to cognitive decline by activating neuroinflammation, which suppresses neurogenesis. So not only are you not getting good sleep and you're feeling groggy and it's increasing stress, but this sleep deprivation also creates A stressor on the body, which leads to neuroinflammation. We start to see systemic inflammation and inflammation in the neuronal areas and a suppression of neurogenesis. So we're losing neurons, but we're not creating anymore. So we start to see hippocampal shrinkage. We also see changes in other areas of the brain. We also see systemic inflammation when one system goes offline and starts experiencing stress, especially that HPA axis, under extended periods of stress, cortisol loses its ability to act as an anti inflammatory. So we start seeing systemic inflammatory responses. Now, inflammation in and of itself, just like anger, anxiety, just about anything else is not a bad thing. Inflammation is your body's response to an injury. If the brain thinks that there are injuries, then it's going to send out the paramedics, if you will think of the inflammatory cytokines as the paramedics to check and see and triage and try to fix things. So it makes sense that this might be happening. Normally there's an on, off switch, but when the fight or flight is constantly on, then you've got the inflammatory cytokines, the paramedics constantly operating in this battlefield sort of triage scenario, which means we start getting systemic inflammation. They're just always on rotation. We also see changes in the gut microbiome, and I know you've heard me talk about this before, and I'm going to continue to talk about it Henceforth, the microbes in the gut break down what you eat into its component parts in order to use those amino acids, those vitamins, those minerals, in order to reassemble them in a format that they need, whether it's the format of glutamate and norepinephrine and adrenaline in order to promote the fight or flee response, or the format of GABA and serotonin and endorphins in order to promote the relaxation response. So when we're under stress, a different group of microbes populates and is actually activated. So our brain is focusing, or our gut is focusing on making everything that's needed to support, fight or flee, not rest and digest. And there are also alterations in your thyroid and gonadal hormone levels, your estrogen, testosterone, progesterone, DHEA and even oxytocin under stress. So stress. And I know we're supposed to be talking about trauma, but remember, when a person experiences trauma, they lose their sense of safety and empowerment. That leaves the person feeling stressed, vulnerable. And that ongoing sense of stress, even if it's not directly related to that trauma, that Ongoing sense of unsafeness and disempowerment, a source of chronic stress. And that chronic stress leads to all kinds of biochemical activations. We know that alterations in thyroid, especially hypothyroid, mimic symptoms of depression. We know that alterations in gonadal hormones, estrogen, testosterone, progesterone, the whole list, affects the availability of serotonin and affects the reactivity of certain receptors for certain neurotransmitters. So we know that as other hormones change in the body is going to alter the availability and activity of the neurotransmitters that are necessary, if you will, for a feeling of safety and empowerment and happiness and all those things that people really crave affectively. If a trauma is not integrated. Now, remember I said not everybody experiences trauma and it results in traumatic injury. Some people experience trauma and they're able to process it and integrate it and regain their sense of safety and empowerment. But for those who can't, they have difficulty feeling positive feelings because, number one, the neurotransmitter imbalances is out of whack. Number two, they've got that fight or flight system going. They've got that threat response system going. And when you are under a. When that system is going, when you perceive a sense of threat, then you are going to be more likely to be scanning and looking for threats and being aware of threats in the environment. So you start perceiving the world as much less safe and yourself as much less empowered. So it's this negative spiral that starts. We also see emotional dysregulation. And this is another thing I've talked about in other videos. But when that HPA axis starts to become get out of whack, then it turns down the sensitivity. Basically, the master Control center is saying, we can't run this hot this long, so we need to turn down our sensitivity. So we don't respond to everything that comes our way. Well, that sounds like a great system. But when it does turn down that sensitivity. Yeah, you may not be responding to things that used to cause you stress, you just don't have the energy. But you're also not able to respond with excitement. You're not responding with as much anxiety or anger maybe, but you're also not responding with excitement. You're feeling more flat. Now, when that system does get triggered, you have a tsunami of neurochemicals. So you go from flat to furious or flat to really, really anxious. I don't know what the F is that I'm looking for there. So emotional dysregulation Makes sense. When you look at it from a biochemical, neurological perspective, emotional dysregulation in people who experienced adverse childhood experiences or early childhood trauma makes sense because it's a symptom. That indicates partly that their HPA axis is kind of out of whack and we're going to talk about how to reset that. But it's important to kind of get everything into perspective cognitively. After a trauma, at least in the early period, people feel a sense of pessimism, disempowerment, inflexible thinking, and have difficulty with memory and learning. Now, if they integrate that trauma and they get their sense of safety and empowerment back, then the system recalibrates, and a lot of these things greatly weaken, if not go away. But if they don't integrate it, then, like I said, with that HPA axis on, it's kind of like you're being in a battleship and having that in the movies. It's always a red light that flashes that indicates that you are manning your battle stations and you're constantly looking for threats, and you're constantly on guard. Well, when you're constantly looking for threats, you're going to find them. Normally, you may not even notice them because they're really not, you know, gonna make that big of a difference in your world. But when you're constantly scanning, you're gonna notice the minute threats. You're gonna notice when people look at you wrong and probably interpret it from a pessimistic or disempowered cognitive standpoint. Well, when you do that, the world starts to feel, and I know I said it earlier, starts to feel much, much less safe, and you start to feel much, much smaller and much, much less powerful and much, much less capable of keeping yourself safe. Well, when all that happens, you stay in fight or flee, and that fight or flight system amps up even more. It says, ooh, we're getting getting into dangerous waters. We need to be on even higher alert. When all those excitatory neurochemicals are just flooding your brain, you are in fight or flight mode. Your brain is saying, we need to defend ourselves or get the heck out. This is not the time to start reading War and Peace. This is not the time that we can focus on learning something over here. We need to protect ourselves. Environmentally. The exponential increase in trauma triggers can become devastating for a lot of people. And I'm going to try to keep this kind of short. But when somebody experiences a trauma, say it's a car accident and, well, I'm talking about a store Here. So let's say it's a victimization, and the person who victimizes them is wearing a particular cologne, or maybe even it's not the perpetrator, but the person that they're with is wearing a particular cologne. And, you know, the trauma happens. They, you know, emerge from it. They heal physically on the outside, but there's still a lot of anxiety, a lot of stress because it came from out of the blue and, and they weren't able to protect themselves. So they still feel a sense of disempowerment. Well, so sometime later, they're in a store and they smell that same smell, they smell that same cologne, and it triggers the memory of that incident and maybe even a flashback. It doesn't necessarily have to trigger a huge flashback, but it can trigger that memory and that anxiety reaction. Like, oh, crap, something bad's really fixing to happen. That's traumatizing because the person's now standing in the middle of Walmart going, I don't feel safe, or Target or Home Depot or wherever they're at. I'm not just picking on anyone's store. But this is, is normally a very benign situation. But now they had that anxiety attack and they're like, oh, maybe I'm not safe here. So they've been re traumatized. Now they're in a benign situation and they've lost a sense of safety and empowerment. Oh, that's not good. So then now not only are they afraid of encountering somebody who's going to victimize them, but now they also may start becoming afraid of being out somewhere in public, being in a store, and having that feeling triggered. So they start to want to avoid places because they don't want to experience that anxiety feeling and they don't want to experience memories of the trauma. So you see that each situation kind of re traumatizes the person and adds to the number of things that trigger that stress reaction. This can lead to isolation or agoraphobia if it goes on for too long. But it's important to recognize that sometimes seemingly benign people, places, things, events, triggers can trigger that stress response for somebody. And they may not exactly realize where it came from. So we need to do what's called backward chaining to say, okay, well this is what's going on, what's that related to? And see if we can figure out why that became a trauma trigger or a stress trigger for them. And relationally or interpersonally after a trauma, the impact varies. Part of it depends on what kind of a trauma the person experienced. If it was victimization. The person may have difficulty trusting others, especially people that are similar in some way to the offender. And it could be their gender, it could be their race, their ethnicity, their height, the way they dress, the way they talk. It doesn't have to be somebody who looks exactly like the offender. It can be any sensory trigger, for lack of a better word, anything that reminds the person of someone, the person who victimized them, can end up triggering a sense of distrust and a sense of fear. If the trauma was caused by a disaster, like a fire or a hurricane or tornado, the ability to trust others and organizations depends on the aftermath of the event. If the community bonded together and everybody helped one another and it was this empowering situation, then guess what, their ability to trust may be actually enhanced. However, their ability to trust, if there was looting, if there was blaming, if there was discontent or violence in some way, then their ability to trust others may have been diminished. And that can even mean a lack of a sense of caring. If your entire neighborhood gets wiped out by a tornado and everybody else in the county is like, sucks to be you, that sense of being safe in that community is probably going to dissipate and it's going to be replaced by a sense of anger and fear. And regardless of whether it's a victimization or a disaster of some sort, separation and safety anxiety for self and significant others going to likely increase. In some people, if you've been victimized, then when you're not with your significant others, the people you care about, the people you trust, the people you love, you may be worried that they're going to be victimized. So you start feeling very anxious when they're not in your presence. Same thing for yourself. I mean, you obviously may have some safety anxiety, but a lot of times the. What's described sometimes as clinginess or neediness, we can see a separation anxiety because the survivor is so worried that somebody that they love is going to experience something bad, whether it's the same exact thing or something else, they feel powerless, they feel unsafe. So they are assuming everyone else is disempowered and unsafe. So let's talk about the goals. Okay? As I mentioned, I have several videos that are noted in the video notes that talk about in depth the impact of trauma on the brain and on the person. So if you want to get more in depth on that, you can go to those videos, but let's talk about what we can do. And it has to be a holistic approach. You can't just say, okay, do this one thing here, and you're going to rewire your brain or do this one thing over here, and you'll make it. You'll fix it and make it all better. Because everything is interconnected. It's like if your car is breaking down and this metaphor may not go very far, but. And you change the oil. Well, yeah, the oil needs to be changed to keep things going well. But you also have to pay attention to other fluids and rotate the tires and tune up the engine in order to keep the car running smoothly. So after a trauma, it's kind of like a car that has been run into the ground for 10 years, never been to the mechanic, and maybe even been in an accident. There's just. There's not one thing that we can do to make it brand new again. There's. There's a rebuilding process. So one of the first things that we can help people start doing, and probably one of the easiest things, is to start strengthening their vagal tone. Getting that vagus nerve, that relaxation response to be able to kick in when they start feeling anxiety, being able to trigger that vagus nerve so they can get into their wise mind and say, okay, I'm feeling anxious right now. It's what I'm feeling now. Is there a threat and what can I do about it? Recognizing that just because you feel anxiety doesn't necessarily mean that there's a threat at this time and this context. So strengthening vagal tone is a. I consider it a distress tolerance skill because it helps people feel like they won't be completely overwhelmed by their emotions. They can sit with it, they can acknowledge it, but they don't have to take a deep dive down into it. Strengthening vagal tone means being able to reliably get from your emotional mind into your wise mind. One of the easiest ways to do this is through respiratory vagus nerve stimulation, which is a fancy way of saying deep breathing. Your vagus nerve has little projections that go into your gut, your diaphragm. So when you're breathing shallowly and quickly, it registers stress. When you're breathing deeply and slowly, it registers relaxation. So you are manually overriding the stress response. You are manually, if you will, turning on the vagus nerve. A lot of people benefit from just kind of wrapping their head around that. That's why we deep breathe. How many times when you were growing up, did your parents or your doctor or teacher or somebody say, take a few deep breaths, honey. Maybe that's just me, but. And I never knew why. I was like, well, what's the point? Of that it doesn't make any sense. There's a reason for it. When you breathe slowly and deeply, you start triggering that relaxation response. So you can get the adrenaline flood to subside and you can see more clearly what needs to be done. Respiration, you've got. Wherever you are, whether you're in the car or you're at your kid's ball game, or you're in the middle of the store, or you're in bed, you're breathing. So you don't need anything special, which is great because people know they always have a tool with them that they can use. Transcutaneous vagus nerve stimulation has gotten a lot of publicity lately, and that is using a TENS unit and attaching it through an ear clip to your tragus, which is the little flap on your ear, and stimulating your vagus nerve here. That can work for people, but you've got to have the TENS unit with you. There's some research that's indicated that the wave amplitude and frequency needs to be fine tuned in order to have it work most effectively. So you can look at the video on vagus nerve stimulation that I've got. You can do some research on it. There's lots of videos on that. You can also massage the vagus nerve. And I encourage people put their middle finger on their tragus, their index finger behind their ear, and gently, you know, just hard enough to make the skin move. You're not trying to push down the little ear flap just hard enough to make the skin move. Rub there and your vagus nerve comes up and connects to other nerves on your face. So when you start rubbing here, you're actually triggering that vagus nerve. Biofeedback is another way of monitoring the vagus nerve. You're not actually really triggering the vagus nerve with biofeedback. You're monitoring how effective you are. So as you start to breathe slowly, you can monitor your heart rate, for example, and. Or you can monitor just your breathing. And you can notice as you start to breathe more slowly when you what it does to your body. So the next tool is or thing that needs to happen is to reduce inflammation. Remember we talked about how persistent stress and persistently feeling unsafe and disempowered keeps that HPA axis active, which ultimately ends up leading to systemic inflammation. All right, so we got to reduce inflammation. The good news is that by strengthening vagal tone, you're going to start reducing inflammation. Why is that? Because when you turn on the vagus nerve, when you strengthen that vagus, vagal tone, then you're actually turning off that HPA axis. You're giving it a chance to rest, you're giving it a chance to rebalance. So vagal tone is a tool that can be used to not only help the person tolerate the stress reaction and feel empowered to endure the emotional state, but it's also helpful at reducing systemic inflammation. Nutrition is another tool that is very helpful at reducing systemic inflammation. Remember I said when people are experiencing trauma, their gut microbiome changes and a lot of times they eat high fat, high sugar foods because those are immediate sources of energy. And when you're stressed, your body's in fight or flee. What do we need to fight or flee? We need energy, and fat and sugar give us really fast energy and long enduring energy. So it makes sense why people, when they're stressed, crave those things. However, both of those things are inflammatory. And focusing on a anti inflammatory, low fat, moderate fat diet has been shown to be helpful with reducing inflammation. And you know, you can look at the anti inflammatory diet, the Mediterranean diet, and there's a lot of research that has shown that when we cut out those highly processed carbs, or at least significantly cut down on them, and we switch our fats to high omega 3s and reduce our omega 6s, we see an improvement systemically in inflammation. We see a reduction in the amount of inflammatory cytokines that are detectable in the blood. We also want to preserve neurons and increase neurogenesis. Remember again, under stress, HPA axis active excitatory neurotransmitters just coursing through the brain to make sure that we stay on high alert. But things start to become uninhabitable after a while or, you know, all the workers start to get tired and drop off, however you want to envision it. So we start to see neurons dying. Well, we want to keep those neurons, which means we've got to turn down the intensity and ideally the frequency of the HPA axis make it less excitotoxic up there. But not only do we want to preserve neurons, keep them from dying or dying as quickly, but we also want to increase neurogenesis. And yes, your brain can create new neurons. It's possible. We see it after stroke, we see it after traumatic brain injury. We see it after a lot of things. We know our brain can heal itself to a certain extent. So how do we do this? Aerobic exercise. And I don't mean you've got to go out and run five miles. Aerobic means with oxygen, walking, dancing, vigorously cleaning house. That's one of my favorites. So I always throw that one in there. Things that you enjoy at least 30 to 45 minutes a day. And again, it doesn't have to be super intense. It has to be something that's going to increase the rate at which you're breathing. So instead of breathing six times a minute, you're breathing ten times a minute. Nutrition. I know this one came up again. Low fat, low glycemic index foods tend to be most helpful for the preservation of neurons and increasing neurogenesis in the brain. Alcohol. Sorry guys. Alcohol has been shown to be neurotoxic. When alcohol comes into the body, well, number one, the ethanol is a poison. So that's kind of no good. And that promotes inflammation in and of itself. But when the alcohol leaves the body, it leaves the body faster than the body can compensate. So you go from feeling relaxed to feeling anxious, you go from feeling somewhat relaxed to triggering that HPA axis in high gear. Which is why when people detox from alcohol, they're at high risk of stroke. Their blood pressure goes way up. That is that HPA axis kicking into overdrive. So you do want to try to eliminate alcohol. If you've been drinking heavily, it's strongly, adamantly, I can't stress it strong enough that you detox from alcohol under medical supervision because alcohol detox can be life threatening. However, getting alcohol out of the system can be another tool. And eating antioxidant rich foods that are high in omega 3s. Antioxidants are colors. So you want to eat colorful foods and ideally some that are high in omega 3s, like flax seeds or chia seeds, olive oil. You have walnuts. Walnuts are another great one that you can easily get your omega 3s in your body. Now if you are an omnivore, fatty fish are excellent sources of omega 3s. But not everybody is down with eating animals. So whatever you feel like. But antioxidant rich, you eat those colorful foods. Orange, green, purple. See how many colors you can get on your plate at any one meal. I always aim for three colors on my plate at every meal. But all of those things are going to promote a reduction in inflammation, no matter what it's caused by. And neurogenesis, which is super awesome. So now just to kind of summarize, we're not really adding all that many things. We are strengthening vagal tone, we are improving nutrition and adding a little bit of movement, aerobic exercise. The next thing we're going to talk about is sleep. We all need sleep. This is not anything new that we're really asking somebody to add. We may be asking them to change their sleep hygiene some. And it's really important to evaluate a person's sleep quality. Most of the time. Yeah, I'm pretty comfortable saying that. Most of the time, people who have unresolved trauma do not sleep well. And so they need to figure out how they can feel safe when they're sleeping so they can get good quality sleep without medicating ideally, and set their circadian rhythms. So the video I have on sleep hygiene can walk you through the steps of doing that. That's a process. If this person hasn't been sleeping well for months or years, they're not gonna suddenly read a handout you give them and be like, oh, thanks, Doc, and sleep through the night. It's going to be a process. But what you wanna look for is improved sleep quality when we do that. Remember, sleep deprivation contributes to neuroinflammation and neuronal death. So good quality sleep promotes neurogenesis and helps reduce inflammation. So that's wonderful. So vagal tone, nutrition, aerobic exercise, sleep hormone balance. Now, this is, as they go, kind of an easier one. Go to their doctors. If their estrogen or testosterone or progesterone are out of balance, then the doctor can advise them on steps to take to get those back into balance. And I'm not necessarily saying hormone therapy. Sometimes there are natural approaches that the person can do, but making sure that your gonadal hormones and your thyroid hormones are in optimal range for you is really important to making sure that HPA axis can function effectively. It's really important to have good hormone balance to promote neurogenesis. And there were some fascinating studies about how imbalances in gonadal hormones impacted the body's ability, the brain's ability to form new neurons. Now, one of my favorites is hobbies and interests. And you may be scratching your head going, preserve neurons. Yes, Hobbies and interests encourage neurogenesis. When you're learning new things, your brain forms new connections and it actually promotes neurogenesis. And those things, those neurons that are developed, according to at least one study I read, neurons that are developed as a result of learning tend to be more resistant to dying off later on. So hobbies and interests, one of the reasons that they are excellent for preventing late life dementia is because they help form these really strong, really resistant neurons in your brain. We learn more, we learn more effectively, and we have better neurogenesis when we're doing things that make us happy. So whatever your hobby Is, if it's woodworking, if it's singing, if it's gardening, engaging in those things actually promotes brain recovery. So who doesn't want to have a prescription for engaging in their hobby for an hour a day? Socialization is another way to actually preserve neurons, because when we interact with other people, it promotes oxytocin, our bonding hormone. And oxytocin actually acts as a neuroprotectant, so it helps preserve neurons. And when we are more relaxed, when we're engaging with others, we're often having more fun. And theoretically, we are increasing neurons, we're learning things, we're laughing. So there are a lot of benefits to socialization. Not everybody is going to want to get on the socialization bandwagon right away, so that's cool. However, remembering that oxytocin is really important to preserving neurons, what else can you do to promote oxytocin? Doing things that are kind for others. Snuggling with an animal, that's another one that I'll never turn down. Even. Well, those are some of the big things that people can do in order to promote oxytocin. So, just to summarize, because I know it looks like a lot, but we're talking about strengthening vagal tone, mainly through regular deep breathing and aerobic exercise, decent nutrition, sleep, and doing things that are fun and hanging out with friends or snuggling with an animal. All of those things are tools that can help preserve neurons and increase neurogenesis, which helps start repairing the brain. Remember, we already had hippocampal shrinkage. We already had shrinkage in our brain as a result of ongoing trauma. So. So we need to build it back. We also want to reduce unnecessary HPA axis activation, and I emphasize unnecessary. Our threat response system, our HPA axis is there for a reason, and we need it. We just don't want to have it on all the time. Practicing mindfulness or learning mindfulness can be very helpful at reducing unnecessary HPA axis activation. Because as we begin more mindful of self, we become more aware of our early stress warning signs. If we start feeling, yeah, we become more aware of our vulnerabilities. We know if we didn't sleep well the night before that, we may tend to be crankier today. We may tend to restructure, respond more strongly to stress today. So we can take steps to kind of head that off at the pass. So self awareness, self mindfulness is super important to reducing unnecessary HPA axis activation. It also helps us identify triggers in our environment if we're Mindful. And we notice, oh, I'm starting to feel kind of anxious, wonder why, you know, I'm in the middle of this store, I'm in the middle of this situation. What about this is triggering my anxiety? And at that point we can address those triggers and either identify them as irrelevant or recognize that they remind us of something in the past and figure out how to deal with them. And mindfulness of the moment is also important to reduce HPA axis activation. And what I mean by that is when people do start to feel triggered. Mindfulness in the moment, recognizing, okay, non judgmentally accepting, I feel anxious right now. It is how I feel, it is what it is now. Mindfulness of the moment says at this time and in this context, is there anything to be anxious about? Is there a threat? Or said a different way, Am I safe? And if not, what can I do to get safe? Mindfulness at the moment helps people start recognizing the false alarms. And as they start becoming more aware of the false alarms, then they have the ability to trigger that vagus nerve and turn off the false alarm and say, nope, in this context at this time I'm safe. Yes, I recognize why my anxiety was triggered and that sucked, but, but at this time I'm safe, so let's move on. So they haven't created another situation that's going to trigger their anxiety. Grounding is another great tool and this goes along with mindfulness. But sometimes people start to feel anxious and part of what they can do when they're breathing. You know, sometimes you want to have something to focus on when you're breathing. Practice doing that. Slow breathing. Four in, hold for four, four out, hold for four. But also noticing five things they see, four things they hear, three things they smell, two things they can feel. And that can really help people get refocused in the moment and regrounded. So they're like, okay, this is where I'm where I am right now. I'm not back there. That unsafe place and time. I'm right here right now. I'm not an 8 year old child that's lost in the mall. I am a 28 year old person who is sitting at her desk at work physically. We already mentioned these. Sleep and nutrition, super important. When you are sleep deprived, your body very helpfully turns on the HPA axis in order to give you sort of a internal or a natural hit of excitatory neurotransmitters. When you drink caffeine, it triggers the HPA axis to release adrenaline and cortisol. So when your body Recognizes that you're sleep deprived without you even having to drink caffeine. It says, oh, hey, I know what I need to do here, let me give you a hit of all these excitatory neurochemicals. Well, again, sounds great in theory, but it stresses the HPA axis. So if you're getting enough sleep, then the HPA axis doesn't need to turn on for that. It can say, okay, we've had plenty of sleep, you've got plenty of energy, no worries. When you are nutrient deprived, the HPA axis registers that as a threat, especially if you are like your blood sugar's low or something else. The HPA axis recognizes when the body doesn't have all of the tools and ingredients it needs, if you will, to make the hormones neurotransmitters to keep functioning optimally. And when that happens, it goes into stress mode. Pain management is one we haven't talked about yet, but it is important. Inflammation causes pain. So as we start to reduce inflammation with vagus nerve activities, nutrition, sleep, you know, that's wonderful and that should help some. However, it's unreasonable to expect to go your entire life without having pain. You're gonna wake up with a kink in your neck, you're gonna have pain here and there. So pain management tools are really important. We, when we feel pain, that's our body's cue that something's wrong. It may not be completely broken, it may just be a little out of kilter, but something's wrong and that triggers the HPA axis. For some people, that really ramps up the HPA axis because they have health related anxiety. So every time they feel pain, they start expecting the catastrophic end. And so, so pain management is really important to be able to recognize pain for what it is, to develop strategies to cope with the pain in a healthy way. Recognizing that sometimes you're going to have pain and you can still have a rich and meaningful life. Sometimes you're going to have a headache or even a migraine and as soon as it passes, you can get back to your rich and meaningful life. Relaxation is another tool and relaxation is triggering that vagus nerve, but it's also triggering the release of what we'll call cool hormones and neurochemicals like GABA and your endorphins that help you feel relaxed and calm and happy and blissful. Relaxation exercises. You can do progressive muscular relaxation, you can do yoga, you can do painting. Whatever it is that helps you feel relaxed, that helps you feel de stressed. Sometimes a lot of us will carry our stress like in our chest and in our muscles and stuff and in our neck. When you've relaxed, you don't feel that tension anymore. So making a list of the things for each person that helps them feel relaxed. What can you do when you come home after a hard day of work that helps you feel relaxed? Is it a hot bath? Is it playing with your dog? Is it painting what works for you affectively? We want to help people improve their emotional intelligence by doing this. What we're doing is helping them first increase their emotional awareness. What is the purpose of this emotion? Too often we just have these emotions. Anger, anxiety, guilt, grief. All these labels. But what's the purpose? Why do we have them? Emotions are designed to motivate us or to inform us. So anxiety, that is your body's smoke alarm. That is your body saying, hey, pay attention. There might be a threat. Just like a smoke alarm says there might be a fire. It doesn't mean there is. Means there might be. Anxiety is your body's smoke alarm. Once people recognize that that anxiety does. Does not mean there is a threat. It means there might be. Okay, well, that's. That's a good piece of information to have. Anger is the same way some people respond with anger. They start getting angry because they feel like there might be a threat, and they've got to look and see, is there something I need to fight off right now? And if not, okay, cool. But once people recognize the purpose of the emotion, what's it there to do? How is it designed to help me stay safe, to help me procreate and keep the species going on? That can be helpful, then helping them identify their indicators. How do you know when you feel anxious? What's your first early warning sign that you're starting to get anxious? What's your next warning sign? That way they can intervene early before they are completely overwhelmed with terror. They've already intervened and becoming aware of their triggers. Now that I know the purpose of anxiety, you know, it's there to keep me safe, to let me know if I need to fight or flee. And I know what it feels like when I start to get anxious. Well, that's great. As soon as I start to get anxious, I can look around and I can say, okay, what's causing this? What is triggering this feeling for me now and why? And then I can address it. Distress tolerance is another skill we need to have people develop because we will have emotions. Our body is designed to feel emotions to motivate us to do things. It's not designed to give us emotions. That we just sit with, that we become overwhelmed or drown in. And they're designed to the, the emotions are designed to help us understand. It's communication, it's the way our body communicates without words. So distress tolerance skills, thoughts, distress tolerant ones. I can do this. This too shall pass. I can experience this pain and still have a rich and meaningful life. Activities like breathing that can help the person get into their wise mind, sit through, tolerate the flood of the excitatory neurochemicals until they dissipate and they can get out of that adrenaline haze and they can see clearly and assess the situation. Guided imagery or even sensations like splashing cold water on their face. Problem solving so you've identified the emotion, you know what it is, you're aware of it, you sit with it, you tolerate it until the emotion subsides and you can get into your wise mind and then you move on to problem solving. All right, I feel anxious in this situation. What can I do to improve the next moment? Grief and trauma processing is something else. If people have experienced trauma, then they need to process that trauma. They need to feel safe and empowered. One of the keys is that feeling safe and empowered in the present. You know, I can look and objectively say as a 50 year old person in this situation, I am safe and I am empowered and this trauma is not happening again. But there is a part of me that experience that trauma, that needs to process it so that that nine year old girl needs to feel safe again. And so grief and trauma processing involves helping the person process that experience from the perspective of when they had that experience. For a lot of people, not everybody needs to do that, but, but for a lot of people it's helpful. Some people say helping the inner child process that grief, however you want to phrase it, it's important. And grief, we're going to lose things, we're going to experience losses and that will trigger the HPA axis. That is likely a necessary triggering of the HPA axis. When you experience a loss and then you integrate it, holding on to that grief, prolonged grief, extended intense grief that is unnecessary HPA axis activation. Now, how long is appropriate to grieve depends on the situation and the person. It's not for me to say, but it's important for the person to be able to look at it and say, okay, is continuing to grieve. What I need to be doing right now. Vulnerability, awareness and management. I mentioned triggers and I already mentioned vulnerabilities a little bit. Vulnerabilities are things that make you more likely to be triggered. So for me, being in pain or being tired are my two biggest vulnerabilities. I know that I tend to be much more irritable, and I respond much more strongly to things that irritate me when I am either in pain or when I'm tired, therefore, so I'm aware of my vulnerabilities. Therefore, when I am in pain or I'm tired, I take steps to protect myself from extra steps to protect myself from stressors. I asked myself, you know, well, do I really have to do this today or do I really have to go to this meeting? And it's important to recognize what those vulnerabilities are for you. And it's not just physical states. It can also be places. My daughter, for example, is an introvert, and she gets overwhelmed when she is in huge crowds. You know, she doesn't have. It's not agoraphobia. She just. The energy is just overwhelming to her. So she knows that when she's in large crowds, it's easier for her to have her anxiety triggered. Know what your vulnerabilities are and positive affect activities. This can kind of go back to those hobbies and interests. Those can all help promote the release of some of those cooling neurotransmitters to balance out the heat of the stress hormones. Cognitively, we want to promote efficacy and empowerment, Help people identify and address their cognitive distortions. What do they have control over in the current context, based on the available facts? What are some alternate explanations for what might be going on besides this catastrophic one or this personal one, that it's all about them, and what are some exceptions to the rule? Instead of saying, every place I go is dangerous, what are some safe places that you've gone? Tragic optimism and radical acceptance are forms of cognitive restructuring that can be very helpful, too. Recognizing, yes, this happened, and I can live a rich and meaningful life, Recognizing that, yes, this happened, and I can move forward into feeling safe and empowered again. Tragic optimism means recognizing the problem. That's the tragic part. And having hope that you can improve the next moment. Radical acceptance means accepting what is and not trying to convince yourself that it doesn't exist. So you're saying, all right, it is what it is, and there's hope. Hardiness and a rich and meaningful life is also important. Encouraging people to recognize what is important to them in their rich and meaningful life and how many of those things do they actually have going for them right now? And then deciding when stuff comes up, you know, am I going to use my energy? Am I Going to let my energy, my anxiety overwhelm me right now? Or am I going to take that anxiety, put it over here, and use that energy on something I can control and get curious. And I mean this literally. Behavior is communication and our bodies communicate through us, through sensations when we feel a certain way. Get curious, why is it that I'm feeling this way right now? That will help you understand yourself, understand your triggers and be able to respond more effectively environmentally. Have people identify their triggers and figure out how to manage them. This means not only distress triggers, you know, what things in your environment trigger physical distress, like pain or discomfort and emotional distress, but also what triggers can you add or keep in your environment that help you feel safe, empowered and content? You want to walk into a room and feel safe, empowered and content? So what can you do to make that happen? Make sure they have access to shelter and basic needs. 211. Org is a great place to go to get started. To find out about community resources. Patient assistance programs are available through most pharmaceutical companies. If your patient is having difficulty affording their medication and it's like a one page sheet, just go to the pharmaceutical company website and look for the patient assistance programs. If they are in jeopardy of homelessness, go to the local housing authority. There may be grants to prevent homelessness or to help people stay in their homes if they are in jeopardy of eviction. And relationally, inner child work is important in my opinion. Having the person become aware of their inner child. We all have one, so some are really happy, some are traumatized, some are somewhere in between. Becoming aware of your inner child and reparenting that child. And what I mean by that is developing a secure attachment, being consistently aware of that child, being responsive to that inner child. If they want to go out for ice cream, then maybe figure out if you can go out for ice cream. So being consistently available, being responsive, being encouraging, being validated and being attentive, paying attention to that inner child and when it wants to come out, not always pushing it down, going, no, there's no time for fun. Once you've developed secure attachment with your inner child, once that inner child feels safe, a lot of times you'll start to feel more integrated and less stress because you don't have that thing in the back of your head always telling you, oh, are you sure we're safe? Are you sure we can do this? Secure attachment with others is the next step. And this helps people address their abandonment fears and recognize that not everybody's going to be around all the time. But developing Secure relationships with a few people can can help people feel safer and more empowered. Learning how to set and maintain boundaries is also really important. So people feel safe and empowered. They don't feel like their physical boundaries are being invaded. They feel like they can have their own thoughts and feelings with that thoughts and feelings without having those invalidated or stomped over by somebody else. And so they start to feel safer in their body. Becoming aware and manage interpersonal triggers and what I mean by those. I know we've talked a lot about a lot of triggers, but interpersonal triggers are like micro expressions that people make that just make them want to climb the wall. Becoming aware of those and if somebody does them, recognizing them for what they are, my so and so used to do that and it drives me up the wall and separating it. So they recognize that in this context, at this time, that micro expression may mean something completely different. Developing assertiveness and addressing their fear of being assertive. Because a lot of people may know how to be assertive, but they're afraid to do it. So working through that. Because if we can't communicate our thoughts, wants and needs, we can't get them met. If we can't get them met, then we don't feel safe or empowered. And learning how to listen without defensiveness. Learning how to listen without assuming that disagreement is a rejection of us. Recognizing that disagreement is a rejection of an idea, not of us as a person. Activity Get a thousand dollars of monopoly money in $10 bills. These are your energy credits and a stack of blank index cards. These are your IOUs and an envelope. Each time something increases stress or activates your HPA axis, place one of the $10 monopoly bills in an envelope. If you run out of those bills before the end of the week, use the blank index cards. Include things like poor sleep, poor nutrition, alcohol use and over caffeination. They that trigger your HPA axis. That way you can get an idea about how often that thing is being turned on. The goal is to spend less than $1,000 of your energy credits each week. This is just one of those awareness activities that's a little more fun than just keeping a journal. Trauma impacts people physically, affectively, cognitively, environmentally and relationally. Rewiring the traumatized brain is like recovering from a sprint. The more you reduce stress or slow down, the faster it'll happen. If you're recovering from a sprint by jogging, it's going to take a little while longer. Recovery requires reducing the stress and allowing the brain and body to heal and rebalance, creating new schema that promote empowerment and safety. So you start seeing the world as safer and more controllable and becoming more mindful to reduce autopilot based responding.