The Biology of Trauma with Dr. Aimie Apigian | Wellness Sherpa with Jenn Payeur

Welcome to the Wellness Sherpa Podcast where we engage with passionate leaders, holistic thinkers and disruptors who courageously share their personal journey, mission and wisdom with you. Together we create a safe space to empower you to live your best, most vital life. Thanks for being here. Well, I am thrilled to have a guest here that I actually really just met. I'll get to meet in person next week, which is exciting for me. Dr. Amy Ayan, who has focused on trauma and I will just say, and I know you have a book, and we'll talk about all that. I am convinced without a shadow of a doubt that trauma is the driver of everything, of everything. So I'm excited to dig in here and welcome for being here today and thank you so much for your time and energy.

I am so excited to be here. I really am impressed with the work that you do and how you show up in the world. So really excited to have a conversation about this with you.

Thank you. So why don't you give us a little bit of background. How did you start focusing on trauma? What's the backstory here? And then tell me what you have learned about trauma over the years.

I never saw myself going into trauma. I am a medical physician and actually I started on a very conventional medical path. I'm a very science based person. I love biochemistry and so I actually started with a master's in biochemistry. And at that point I was going back into my medical school training and I had a few months free and I thought, how can I make the most out of this time that I have? And I decided to become a foster parent. And for those who have ever done foster parenting or probably thought of foster parenting, I think that you'll know or you'll imagine that you know that it's a very meaningful activity and you get invested more than what you thought you might perhaps. And I remember the phone call, they had a four year old, he needed a home. He'd been in the foster care system since age 9 months. And it was an immediate yes for me. Did not plan to adopt, had just planned to foster parent. But then as things were unfolding and I knew his story more, I saw that he was so impacted by the early life trauma that he had had that he was not going to be able to be successful in being placed in other homes. So it was, I was his last chance or it was going to be a group home for the rest of his childhood. And that ate at me. It just, I, I couldn't sleep knowing that that's what would happen. To him. So even though I was single in medical school, I was clearly not the best choice of a mother for him. I, I could see that I was his best chance at getting out of the foster care system that had only continued to cause trauma. And that's my story. That's where my world changed, my life changed. And I had to dig deep and find answers and solutions because I didn't. The, the evidence based therapies were not working and I had a son now and he needed help and he was relying on me to find those pieces. So that's how I got into trauma. And then it opened my eyes to where I started to see the same kinds of patterns, the same kinds of patterns of guarding our heart, pushing people away, not wanting to be seen, having a fear, like at the level of I think I will die if people actually saw the real me. And all of this then led me into what I do now of how can I help people have the resources, information and tools that they need in order to create the change in their life that will give them a better life and better health. Because as you've mentioned, trauma is behind everything, including every chronic health, symptom, condition and diagnosis that we have. It's not just the mental health that's easier to see, it's also the physical health.

So are there different types of traumas? And can you share a little bit more about that? For me, I went to a four year healing school and we talked about these things called characterologies and they were very much tied to trauma and it was more age based in utero. There is trauma at birth, there can be trauma at different ages and the traumas show up differently. So can you talk a little bit about that? And if you, Is that true in your world?

I love this because there's been so much misunderstanding and I would say confusion around trauma. What is trauma? Was that a trauma? Was that just stress? What about the big T, the little T's? And so as I went into my study, deep dive into studying the nervous system, what I have seen is that there's one trauma response that the body has, okay, that simplifies things because it's one trauma response. And by trauma response, I mean the actual physiology involvement of the sympathetic nervous system, adrenaline, the noradrenaline, the cortisol, the shutdown, the dorsal vagal communication, the mitochondria, the metabolism. That is what I see as the body's trauma response on a physiological level. And it only has one trauma response. It doesn't have multiple. It has one trauma response. So in essence it doesn't matter what the specifics are it, if it causes a trauma response, this is what it causes, this specific physiological response in the body. So then we can look at, well, what if I had this kind of experience in utero, Would that have been different if I had experienced that same kind of situation as an adult or even as a 13 year old? And this is where the answer is. Well, well, yes, because we need to look at every individual and what capacity do they have at that time in that moment? Because that's going to determine if their body goes into a trauma response or stays in a stress response. Their capacity. And when we are in utero, we don't have much capacity at all, I would say zero capacity. We don't have any capacity for self regulation. We are trapped inside of this belly, we can't escape. So our capacity is going to be zero. Which means that as we are looking at, well, what would have caused trauma, what would be in utero trauma? It would have been anything that caused this type of physiological response in the body at that time. As a two year old, if we were neglected or just didn't have enough co regulation, that would have caused a trauma response. And so being able to simplify it. Yeah, yeah, yeah, please.

So what's the difference between a stress response and a trauma response?

Yes. So as I was looking at the nervous system, trying to understand first like how to help my son and then my own nervous system and then patients and course members, I started seeing that there is this very distinct pathway that the body goes through and in order to get all the way into that trauma response. And it goes through a stress response, but it crosses a line.

Okay.

And I was fascinated by this because I had never been taught this distinction. I had been taught in fact, that when it comes to survival responses, there's fight, flight or freeze, as if that's the only. And they're all the same thing. And so coming through that lens, it was very much a very different paradigm to see. Actually no, there are distinct steps, there are five steps in fact that the body takes to go all the way into the trauma response and it goes through the stress response. So the stress response is where we realize that there is a danger or a threat. Now, a stress is not bad, it's not good, it just is a stress response. And so even if someone is going to exercise because of their normal exercise routine or they're going to run a marathon, that would still be a stress on their body because it is a threat to their physiology per se, to do that level of activity. And their body has to adjust in order to rise to the occasion to let them do that physical exercise, marathon or whatever it is. And so the stress is there to give us the energy in order to do something, in order to meet a challenge. It adapts. And in our cells, there's so much adaptation that our mitochondria even change shape in order to be able to make more energy for us. Wow. So that is the stress response. But then there is a line in my book, I call this the critical line of overwhelm. Because as long as we think that we have a chance to overcome this again, assuming right now that we're talking about a true life threat and we need to overcome it, then we're going to give it our best go. But the moment that we see, sense, feel, think, believe that we're not going to be able to overcome, we actually don't have the capacity to overcome this. Our body changes survival strategies. Okay, no longer is the strategy, let's do our best. No, because it's going to be useless. If doing anything is useless, it's going to not make any difference at all. Then my best survival strategy is to not care, is to shut down, is to give up my power, give up my sense of ability, because I, I should rather conserve my energy than to use up my energy in what would be useless. So that's the line that it crosses. And now we're no longer in stress response.

And so is that a conscious. Is that a conscious thing that's happening? It's unconscious. Correct.

It is so unconscious that our logical brain will make up stories afterwards of why we went into overwhelm. But it is a nervous system decision in the polyvagal theory. For those in your audience will be familiar with the polyvagal theory work coming out of Dr. Steve Port, gorgeous. There's this idea that our nervous system has a perception of our capacity. And that is what decides whether we will be in stress mode, in shutdown mode, or in parasympathetic calm and alive mode. We have three different modes, and they're each different operating modes, if you want to call it that way. We're. Everything is in that mode. And when that nervous system has its perception, that's why it's called neuroception, nervous system perception. That is what is making this decision. So it's a hidden assessment. It's an equation between what are the demands against me, what is my felt sense of capacity, and that's what decides on what line of that overwhelm will I be, will I still be in stress mode and I think that I can overcome or am I in that place where I, I don't see any chance for me to actually be able to overcome and I should change my survival strategy to somebody like your son.

Who had trauma from a very young age, it sounds like from living in the system. Right. Does that weaken over time? So does that mean. So let's say he's now 16. You, you've helped him get out of this trauma and taught him, I'm sure, about the trauma response and all of this. But if that hadn't happened as a 16 year old who's had trauma their whole life or as a 50 year old who's had trauma their whole life, does it compound as they go? Do you go into that trauma response faster? Tell me a little bit about that.

Ah, this is fascinating. You're asking great questions, Jen, that not everybody asks. I love this. It accumulates over time. And when we don't know how to reset our body to safety after we've crossed that line, our body doesn't return to safety. It stays on guard. It stays with that sense of. But the danger could be there. The monster could still be there. The we're waiting for the next shoe to drop. We can't relax because we know that the next bad thing is happening. So with that, we look at how do we reset our body to safety? Because the reality is, is that when we're not able to do that, then these accumulated effects happen. And this is where we start to get autoimmunity. This is where we start to get chronic pain or metabolic syndrome, overweight, the insulin resistance. There's all of these chronic health conditions and each of them are a result of the accumulation of these trauma responses.

And so what does one do? Because, you know, as we talked, I mean, I believe that this is underneath everything not, you know, physical, emotional, mental, all of it. And yet we live in a world where we go to what we see, which is the physical, right? So for me, I had stage four cancer 10 years ago. I had lots of trauma in my childhood. But in the modern world, other than therapy and some of those things, I was never taught about my nervous system. I was never taught how to reset my nervous system and even acknowledge what was going on. Right. I was taught no pain, no gain. Drive through it, right? Don't cry or I'll give you something to cry about. All of those things, right, that happen in our family patterns. So can you share more about that, Jen?

This is where so many people have experienced trauma, and they don't see it as trauma.

Right.

These were just the messages that we grew up with. How can that be trauma? They didn't hit me, they didn't abuse me, they didn't neglect me. And when I compare my childhood to someone else's childhood, who am I to complain? But yet our body has this story of, no, I felt all alone, I felt trapped, I felt powerless. Those are the qualities that create the trauma response in us, and that's what we carry. And as a physician, seeing all of my patients who had all kinds of conditions and recognizing that they had had these kinds of messages in their childhood and they were still living them out, Jen, as an adult, they're still pushing through. They're still telling themselves those same thoughts of don't cry or I'll give you something to cry about. Right. So even though those messages were instilled in their childhood, again, they got embedded into the body.

Yes.

It's not just the past. They've brought the past into their present because they didn't know how. And no one showed them how to reset their whole system to safety, which would have made those messages go away. Those messages are not ones of safety. They are ones of fear. Fear.

Right. And so you carry those through your lineage. Right. So typically those messages get passed down from generation to generation. So tell me about that. How does that show up in. In dysregulation and imbalance?

Dis.

Ease all of that.

This idea of generational trauma was something that confused me for a while because I could see it happening. The studies show that it happened. But exactly how? Like, are we just talking about genetics? Right. Because if we look at it from a medical standpoint, we can say, well, diabetes must run in the family and cancer must run in the family, must be genetic. But when I'm looking at them and being like, no, these are trauma driven conditions, well, then it's the trauma that must be being passed from one generation to the next. How exactly is that happening? And there's really two ways, Jen. One way would be through the actual nervous system regulation. And when a baby and a young child is dependent on their parent for that nervous system regulation, whatever the parents have not resolved will be passed on. Yep, it will. It will not be conscious, probably will not be conscious, because these are things that include how long we maintain eye contact or how we smile. Do our muscles around our eyes move when we smile or is it just our mouth that's smiling? We don't think about those Things because they're not in our conscious control. But yet a baby is picking up on all of that because that is either a sign of safety for them or a sign of my parent is not fully present. My parent is stressed, my parent might be overwhelmed. And so I don't want to add to their list of responsibilities and needs. Let me cut myself off and not feel that I'm hungry. Let me not feel that I need something, because I might overwhelm them. And if I overwhelm them, I'm dead because I depend on them for my survival. So, so often we can look at children and see that this generational trauma pattern resulted in them abandoning themselves in order to try to preserve that attachment relationship. There's one other aspect, though, for how generational trauma gets passed on. And this is really important for anything that appears like a genetic disease that's being passed down, and that is this idea of oxidative stress and epigenetic changes. As I've done my studies on the. The impact and the mechanism of how even early childhood experiences becomes adult diseases, a central player in all of this is oxidative stress. Now, at first I was like, oxidative stress? What's the big deal? Well, I'll tell you what the big deal is. It's a big deal. Big deal. That oxidative stress is something that we normally produce. So it's not like it's exogenous or outside of us, it's something that we produce in the process of making energy. And if you think of the mitochondria being the factory houses to make that energy, if you think of factory houses in the city, whatever they're producing, they're also producing some smog. They're also producing our cars, right? They're combusting that gasoline and they're producing smog, so. Or the exhaust. So there's always this idea that when you make something, there is this byproduct that is trash. And the important thing, whether you're talking about the city, the air quality, or your body, is are you cleaning up the trash? As long as you're cleaning up the trash, it's not a problem. It doesn't accumulate and cause damage. It's when you're not cleaning up the trash and it accumulates for decades. That's what happens with the oxidative stress. It accumulates and it turns into damage. What is it damaging? It's damaging our DNA. It's damaging our cells and their membranes, making them leaky and not work as well. It's even damaging our mitochondria, which makes them not be able to make as much energy for you, which means that you will have a less capacity and you will cross that critical line of overwhelm sooner than other people who don't have as much oxidative stress. So it's not fair that those who've had early trauma or other trauma in their lifetime, that they have this internal damage that's happening that makes them more susceptible to trauma. But this is how generational trauma happens. That oxidative stress, it actually starts to cause damage to the DNA. It exceeds our body's ability to repair our DNA. And then changes start to happen, and these changes become epigenetic changes. And this is how generational trauma is passed down in our DNA by these tags that get added to our DNA as a result of this damage. We can look even in one person's lifetime. PTSD now has been shown to be an epigenetic condition. It is not random. It's not just everyone who will get have a traumatic experience. It is specifically those who have so much oxidative stress that it is crossed that line. And now it's triggering an epigenetic crisis in their body.

So how do people find their way back to their wholeness, to nervous system regulation? I know you have all kinds of means and suggestions and all of that. Tell me that. And then if we can talk about where somebody starts.

Exactly. Because we can talk about all this. But as long as it's just theory and ideas, what good have we done? And I would not be sharing this if I had not found solutions. And as I worked with my son, we got to that point. I then worked with over 100 children who had been adopted from other places in the world and started seeing that there is a predictable pattern of what the body needs. The big picture is that it needs a reset to safety. How we do that is through a word that I will just call repair. We need to repair. Damage has been done. We need to repair the damage. We can't just brush it under the rug. It doesn't go away with time. We need to actually repair. Because trauma impacts three levels. All three levels will need repair. Let me walk through those three levels. Yes, I was just going to ask those three levels. I'll just start from top. Top to bottom. How's that? The top level is our mind. So trauma does impact our mind. We've already talked about the beliefs that we can have coming out of our childhood. That's damage from trauma. We need to do the repair so that those are not our natural default thoughts, which then turn into behaviors, which then turn into habits. Yes. We can have trauma driven habits and coping mechanisms, of course. So that is one level. The mind is one level. But that is just one level. And that's where I see a lot of people focusing their attention and neglecting the other two levels. And they will never experience the degree of healing that they could if they address all three levels. The you say.

Just quick question when you say they're addressing the mind. So that would be tools like therapy. Right. Things like that where they're, you know, after having affirmations.

Right.

So you're trying to basically rewire your thoughts.

Exactly. Okay. We're working at the thought or behavior level.

Okay, perfect. I just wanted to clarify.

Yes, yeah, you're talking about it, right. So there's cognitive behavioral therapy where it's focused on the behavior and what can we do to change the behavior and the triggers for the behavior. But all of that is talking, analyzing, and it's at the thought and behavior level that you're trying to change things, which again is necessary but not sufficient.

Okay, perfect.

The next level that I'll talk about is the somatic level or the body level. Now when I talk about the body level, I am talking about repairing those memories that your body has of, of powerlessness. We have not always realized that our body is holding those memories. We think that once we're done with the experience, we've moved on. Your body has not. Your body has the memory of being or feeling trapped, powerless, alone. And until we actually do the movements to change those memories, it will always be there to tell you, oh no, we can't do that. That's too hard. We should just shut down because it has the memory of. That's how we survive life. So we actually need to work with our movements at the tissue level, the muscle level, the nervous system level, to create new memories of ability, capability, empowerment, so that it can be a programmed response in our body at that level that is beneath the thought and behavior level.

And so what are some ways to do that?

Yeah, so what I teach is I start people. And now we're getting into like where would people start? And then I'll go into the next level where people just give me some examples.

And then.

Oh yeah, exactly. The somatic. Somatic practices are where this is at. And there's different levels and layers of the somatic practices. Where I start people is helping them learn how to create different sensations in their body. So I actually need them to know how to create the feeling of being held, for example. I need them to be able to create the feeling of being safe enough right here, right now. So many people actually don't know how to do this. They depend either on other people or they never feel that way. And they go to numbing and distracting and avoiding that so that they can get some relief from always feeling unsafe. So that's where I start them. But eventually we do need to move into this aspect of. Let's work on a story of your past where this experience was felt by your body. And we imagine ourselves in that story and we think, okay, that moment happened for some. Maybe it's a car accident. In fact, chapter one of my book opens with my patient Elena in a car accident. And she was not able to outmaneuver the car that was coming towards her. So at the last second, her body goes into a trauma response, realizing that there's nothing that she can do that can make this stop, and she freezes. And there's the impact. She never knew how to reset her body to safety. And so one of the things that we eventually needed to do was to imagine her back in that car accident. And when she sees that car coming, what could she. Would she have wanted to do in order to avoid that car?

And then recreating. They're recreating a new experience.

Recreating a new experience. A new ending to the story.

Okay, perfect.

With movement, not just with talking about it, like actually doing the movement that you would have done.

Okay, so that's the piece that starts to bring empowerment.

Yes. At the muscle level, in the tissue. In the tissues, yes. But the tissues are not the deepest layer. Right. This layer is the biology. The mitochondria, the DNA, the oxidative stress that we've just talked about. If we don't intentionally repair that, we're still living under the effect of trauma. We're still going to get the autoimmunity, the chronic pain, the chronic fatigue. We're still going to get all of this stuff. So that is one piece that needs to be brought in. So the way that I approach it now is I'm looking at how can we address all three pieces for someone at the same time in a. In a way that's not overwhelming, but we focus on one thing at a time. We do one step at a time, and we're going to address it at the mind level, at the body level, and at the biology level. And when we do that, Jen, it is like all the pieces come together because this is what the body needs. It needs the repair on all three levels. And when it can get it at the same time, it's able to move through these healing stages much faster than if it only does one thing at a time or tries to do everything all at once. There's, there's a process, there's a system, there is a structure there. And this is what brings me a lot of hope in helping people, teach them and guide them through then what their body needs for that healing that they want in their life.

And so you have programs where you do this. So let's talk a little bit about the programs that you offer. And then I want to talk about your book because I am so excited to read it.

Oh, thank you. So I have left my traditional medical school or medical training practice and this is something that was very hard for me to do. It was because I'd always seen that this is what I was going to do. But when I realized that I was not able to make the impact on my patients that I wanted to because I wasn't able to bring in this kind of trauma work, health insurance won't always cover it. And so my hands were tied behind my back and I realized that for me to have the greatest impact, I needed to be able to take this directly to the people who need it. And so I have started my programs, they're online and they help self help individuals learn how to work with their nervous system to release this trauma on all three levels to reset to safety. And then I've developed a practitioner training program to teach them how to do the same for their clients or patients.

And how long are each programs?

Great question. So I have it broken into six weeks at a time, but I do if they want the whole thing, then I've got the whole thing. And they can enroll in the one year program or they can take it in bite sized pieces. Whatever feels safer.

I was just gonna say.

I love that. Yeah. And we get to focus on different aspects because there are different aspects that will need attention. We need to put attention on that shutdown response. When, when, when I have shut down, what does that look like? Does that look like me pushing people away or does that look like me holding on to other people? What, what do I do? Does that look like isolation? Does that look like emotional eating? Does that look like binge watching movies? What, what do I do in order to find my escape and my shutdown? We need to work with that if we're going to see any change. But then I guarantee you that as we work on that and Our body's like, oh, I can be more alive, I can be more present. What naturally will start to surface is grief. Grief is what comes up first. It's not joy, happiness, bliss, bliss. It's the grief. And there's all kinds of grief. There's both the grief of things that have happened in our life that we never fully grieved, but there's also the grief realizing how much time we've lost being ourselves. And so we've got to work through that, because if we don't work through that, that will put us back into that shutdown and wanting an escape from those feelings of grief. There's one more aspect that will keep us stuck in this pattern though, of shutting down and giving in and giving up. And that would be our attachment. In our early life, as we've talked about, those messages are so deeply programmed into our mind, into our tissues, into our biology, that we will need to address that. So that is one of my six week deep dives is going into attachment neurodevelopment and learning how to rewire that programming on all three levels. And then we'll need to work with the stress response, because if we can't generate a good stress response, we're going to be crossing that line of overwhelm and having more trauma responses. So we need to learn what really am I supposed to do with this stress response, that I can keep it as a stress response and not have it turn into a trauma response that overwhelms me. And then we'll need to work on letting go of those things that keep us in resentment, that keep us in anger, that keep us in stress. Things like toxins. Whether we're talking about parasite toxins or whether we're talking about those toxic people in our life, they both need to go. They both need to go. So this is, this is how I walk people through all the different aspects of their trauma response stored in their body that they'll need for that healing process.

And so once somebody goes through this, then you've addressed all these levels and it's not like, you know, because a lot of therapies, people kind of fall back, right? You know, you, you even look at things like AA, it's like, okay, I've been in it for 15 years, I'm good. And then something happens a, a trauma response, and then it's easy to go back. So what I'm hearing from you is this really allows people to move forward and to release in the, in the body, the physiology, in the mind, all these places where we've been holding this trauma. And I would imagine it would clean up the epigenetics as well.

Exactly.

So I going to healing school. One of the sayings was when you heal your traumas, your healing seven generations back and seven generations forward. And that, you know, that's what the indigenous say. And I truly have seen that in my own life.

Right. And what a beautiful thought. Yeah, what a beautiful thought that I. I can do that. Yes, there's something that I can do. Healing starts with me, but it doesn't end with me.

Right.

It just starts with me. Yes. Full effect spark generations. Yes, I love that.

And so tell me about your book, the Biology of Trauma and when it comes out and how people. I'm assuming there's a pre order.

There is a pre order. It's actually already available to order on Amazon. So people want to go to Amazon. They will find it. The Biology of Trauma. And Gabor Mate wrote the forward. For those of you who are also in love with Gabor Mate, as I am, and this is the work of my heart and my soul. And to the degree, Jen, that I actually rewrote the entire book eight times, it was like, no, this isn't it. No, that's not it. And I had a very specific purpose for this book where I have sat with now so many patients, so many course members, so many practitioners, but also so many families and adopted parents like me who just needed to know what to do and they weren't getting that answer. And so I've broken it into three different sections that explains how the body experiences trauma. But the second section is on why does the body hold on to that? How does that happen? And then the third section is here's what we do about it. Here's the repair, here's the releasing. Here's. Here's that healing process. And so it's intended to be a book of hope, of it doesn't matter what's happened. It does not matter what's happened. As long as you are still alive and breathing, even if you're already in bed on your back and can't get out of bed like I was at one point in my life, it doesn't matter. There is still hope and there is still things that you can do as long as you are alive. It is a book of hope.

I love that message. And at a time in the world where we need it now more than ever. Thank you so much for your wisdom. This was one of my best episodes. I love your messaging. I love your mission and the world needs you and needs your wisdom now more than ever. So thank you so much for being here, and I can't wait to meet you in person next week.

I'm looking forward to it, Jen.

All right. Thank you.

Thank you.