THE ACCRESCENT™ PODCAST EPISODE 247

Leigh Ann Lindsey (00:00.574)
Well, Dr. Apigian, welcome to The Accrescent Podcast.

Dr. Aimie Apigian (00:04.61)
Thank you. I’m really excited to have this conversation with you given your life experiences, but then also your work.

Leigh Ann Lindsey (00:11.29)
We were just talking off air that I don’t think your book could be more aligned for my podcast audience, but also the clients I’m working with every day, which is this idea that trauma has biological effects that then create this cascade that can lead to things like autoimmunity, like chronic illness, like cancer, etc.

And so it’s so exciting for me because I do feel like I’ve been trying to map this slowly for clients. And not that I’m the only person in the world doing this, but to be able to have someone who’s put this all into a book with so much detail and specificity is absolutely amazing and just so needed at this time. But I think the place to start, because it helps ground all of us in, is

What even got you interested in the biology of trauma? What made you start to see that there might be a biology of trauma? Give us a little bit of that origin story.

Dr. Aimie Apigian (01:06.04)
Biology of trauma actually originated in 2014 when I woke up one morning as a third year general surgery resident and could not get out of bed. And then on a medical leave, finally got diagnosed with chronic fatigue syndrome and autoimmunity. And I was very clear on what had been the trigger for me. And it was my wake up call that.

I had spent years pouring into other people, and it was time to do my own trauma work. Not just inner work, trauma work. And why I knew that is because it came just on the tail end of the largest loss and grief that I have ever experienced in my life. And not knowing how to feel feelings.

process overwhelming unbearable sensations like that kind of a loss, I threw myself back into work, which is what you’re also expected to do as a general surgery resident. And so when I then had this health crash one month later, there was no

Confusion on my part as to what had been the trigger. And I also knew by then, given my experience as a foster parent and then adopting, that there were layers deep and that this had just been the final straw, but it was not the only thing. I knew at that point that I had.

Leigh Ann Lindsey (02:39.594)
Mm-hmm.

Dr. Aimie Apigian (02:45.983)
Stored trauma that I didn’t always understand why, because I didn’t see that my childhood was traumatic in any way. But I was starting to recognize patterns. And these are the patterns that you’ve already alluded to, that the fifth pattern is the development of health issues and disease, because that is the only outcome that can come from this type of dysregulation in the nervous system for that long.

And what I discovered was that as I started my trauma work, I was experiencing flare-ups in my health issues, not always improvements. I was having a flare-up with the fatigue, with the autoimmune symptoms. And I realized this can’t be right, this can’t be health, because as a physician, I know what the healing process looks like.

And my patients are getting better after a surgery when given the right tools at the right time. So I wonder if I wonder, I start to be curious, and that really was how I discovered then the biology of trauma was my own biology was so far imbalanced by this point that it was creating a ceiling effect.

And was holding me back in my trauma patterns and in my trauma therapy. And so I couldn’t just.

Go to a practitioner and work on the trauma aspect of it. I also needed to bring in this biology aspect in order to help my process with metabolizing and processing and resolving these layers of trauma that I had buried. So that was the first time that I really bridged it, was seeing.

Leigh Ann Lindsey (04:36.298)
Completely.

Dr. Aimie Apigian (04:40.615)
What can a person do? What can I do in order to get my life back, get my health back, get my career back once trauma has driven my biology to such a degree that I now have a chronic health issue and I don’t just want to manage it.

Leigh Ann Lindsey (04:58.79)
Yeah, completely. there’s so many facets to this. Something I think a good place to start is this is sometimes what I’ll describe to my clients that in my room and in my work specifically, we’re focusing a little bit more on the I call it hardware versus software. And so I’m I’m working a lot on the software. What’s going on deeper in the psyche, the conscious, but also deeper in the unconscious mind.

Dr. Aimie Apigian (05:16.085)
Yes, exactly.

Leigh Ann Lindsey (05:26.59)
But sometimes, but we absolutely need to be supporting the hardware as well, the brain, the nervous system. And there’s even times where I feel like my work can’t happen until the hardware is settled, and also vice versa, that if we’re focusing too much on the hardware and there’s no progress happening, that’s when it’s time to focus on the software. So they absolutely go so hand in hand.

Dr. Aimie Apigian (05:51.894)
And this is what I was seeing over in my my medical work and my medical training and doing surgery is these principles of this is what the body needs for healing. When a person came in in an acute trauma, like a car accident kind of trauma, and here I am with my surgical team in the emergency room to meet them, the first step was always to stabilize them.

Leigh Ann Lindsey (06:19.21)
Right.

Dr. Aimie Apigian (06:20.287)
And so that’s what you’re talking about with the difference between the software and the hardware. Like, are there lifestyle things that they need to change so that maybe next time they don’t even get in a car accident? Yes. But is that the time to address them? No. We’ve got to stabilize them first to even then be able to work on some of these other things. So there is so much of this layered approach, but the idea that there is a sequence is so critical for people to understand as they’re navigating their healing journey.

and sometimes can be frustrating and confusing and very discouraging to work so hard and get so little progress.

Leigh Ann Lindsey (07:00.52)
Completely right. And I think what we’re seeing a lot of now, especially in integrative medicine, is the hypersensitivity, hyper-reactivity, where patients aren’t even able to tolerate treatments, tolerate supplements. And so it’s a level of sensitivity. And that usually is the time where I’m like, we gotta focus on the software first, because the hardware is too sensitive. How can we start to settle things so that they’re able to tolerate a little bit more?

But the at the end of the day, they cannot be separated from each other. And that is I really I mean, that’s what integrative and I think holistic medicine is all about, is we can’t look at these things in isolation from each other. So go ahead.

Dr. Aimie Apigian (07:45.258)
Yeah, and when when we see it that way, when we see like that it’s not actually mind body, like it’s just a system. It’s a s it’s a being. Then we see that simultaneously, let’s do something to stabilize the hardware while we work on the software. It’s it’s it’s both. It’s and it’s not neither or this, it’s yes and.

Leigh Ann Lindsey (07:53.15)
Being

Leigh Ann Lindsey (08:11.658)
Mm-hmm. Exactly. So I think a good place to start is, and this might sound rudimentary, but let’s define trauma. Because it is a word that we are hearing so much, it’s thrown around a lot. And you alluded to this point earlier, which is I also will have clients come in going, my I I don’t think I’ve had trauma.

So my, you know, integrative oncologist said I probably should come see you, but I really don’t think I have any trauma, so I don’t think there’s any emotional component to this. And then we start talking and things start surfacing. But how would you, Dr. Apigian, define trauma?

Dr. Aimie Apigian (08:52.169)
Hmm, this is actually where I decided that I had to start my book. And I actually rewrote the entire thing, 18 chapters, from start to finish, seven different times, because I would write it and then I would read it as if I knew nothing. And I was just coming to this work, and I’d be like, nope, I’m already lost. I’m already.

Leigh Ann Lindsey (09:03.303)
Stop. no.

Dr. Aimie Apigian (09:18.655)
Trying to get into the weeds before I’ve really defined, like, what are we even talking about here? And so in chapter one, I lay out the exact five steps that our physiology goes through to go into a trauma response. If those five steps don’t happen, it was not a trauma response.

And so then in chapter two, I then hone in on: so what is the difference between a stress and a trauma? Like you, I think that this concept is critical for people to understand because if they have stored trauma and not just stress, but they’re not calling it by that name, they’re minimizing the impact that it has had on them.

And by downplaying the impact, they don’t understand the priority that it is to address this because of what impact it will continue to have.

The impact of trauma on our biology is so much bigger than the impact of stress on our biology. But at the same time, if I’m just going through something stressful and I’m thinking that it’s a trauma, well then I’m also mismatched in what I know to do to support my body during a stress response so that it does not become a trauma. So I think that these skills, even though we’re not taught them yet.

Are some of the most critical skills that a person can have, not just a practitioner, but a person can have to understand even their present moment, not just their past and what they’ve been through, but their present moment, what is my body doing right now? So the difference is really down to our capacity to respond.

Dr. Aimie Apigian (11:08.417)
There are layers to understand what would determine my capacity to respond. There is a psychological layer, meaning, well, what do I believe about myself? Do I believe that I’m capable of hard things? And we know from studies back in the 1950s and 60s with psychologist Seligman. He worked with dogs.

Always makes me sad, but that was an incredible study showing the power of learned helplessness. Where we have come to believe I’m not capable of something that hard. So I should not even try.

And it was shocking to me to see that I had that pattern of learned helplessness. Because here I am, I’m a physician, I’m a high-functioning person, I’m an athlete. What do you mean, me having this programming of my nervous system of learned helplessness? So it can be very insidious, and we don’t recognize it until we see that study and recognize ourselves and the dogs. And then that’s part of the psychological perception.

Of our capacity that can hold us back and make a stress become a trauma. But then there are these biological factors that can affect our ability to respond. So at the end of the day, how we define trauma is anything that, for any reason, at that moment in our life prevented us from being able to respond in self-defense.

Leigh Ann Lindsey (12:45.611)
And it’s respond, is it respond at all or respond in a way that made me feel safe again in the moment?

Dr. Aimie Apigian (12:54.732)
Yeah, we’re not actually talking about safety in the moment. If this is a real threat to our life, a stress response is designed to give us the energy to overcome that.

Leigh Ann Lindsey (12:57.512)
Uh-huh.

Dr. Aimie Apigian (13:07.874)
This is actually a very critical aspect of our nervous system. That again, I didn’t learn in medical school. This was my study of my nervous system as I realized the design and purpose of a stress response. And that the skills that I need to learn then are how to generate a stress response that will be effective, how to make sure that I can sustain it for however long this threat is going to remain in my life. And then at the end of it,

Then be able to complete it and return to a sense of safety. But I can’t return to a sense of safety unless I first generate the amount of energy and action to overcome that danger. Whereas a trauma response, a trauma response is going to be: I am not able to overcome. I’m not strong enough.

Leigh Ann Lindsey (13:53.067)
Okay. And that’s so often not able. Okay.

Dr. Aimie Apigian (14:04.46)
I’m not smart enough. I the list can go on for all the reasons why I can’t. And so the trauma response is this moment in time when our nervous system perceives that we have hit a wall. And hit a wall in terms of: I’m trapped, I’m powerless, and I’m all alone, facing what feels like.

a life threat. I don’t know if I’m going to be okay, but there’s nothing I can do about it. A stress response is still when we can do something about it.

Leigh Ann Lindsey (14:46.347)
Okay, yes. And this, I mean, I want to look at this from a couple different layers of this is why a car accident could be traumatic because there was nothing I could do to stop it. Or but abuse can be traumatic because there’s nothing I can do to stop it. I’m trapped. I can’t overcome this. But also potentially, and I don’t mean that, you know, it feels it’s so easy to want to start to compare.

Dr. Aimie Apigian (14:57.89)
Yeah. Exactly.

Leigh Ann Lindsey (15:15.817)
Well, that is not severe as that, and that wasn’t actually traumatic, but you know, something like I’m getting bullied at school. a teacher, there was a moment in class, I can’t I I mean this has happened multiple times where I’m with a client and we’ll go back organically, what surfaces from the unconscious is a moment that as adults looking in on seems very benign.

Or, like, that’s, you know, yeah, that probably was a bit embarrassing, but you wouldn’t think it would have this really traumatic impact. But to your point, it’s, you know, the teacher embarrasses me in front of the class. And for whatever reason, I did not have the capacity to overcome and respond to what that did inside of me, and it became a trauma for me.

Dr. Aimie Apigian (16:06.776)
This is how so many trauma responses happen in childhood. And as adults, we look back and we see that was not trauma. But let’s just take that example. A child, they’re in the classroom, here’s their teacher who’s selected them in front of the whole class, and they’re embarrassing them or in some way causing shame.

The normal human response would be to act in self-defense, fight or run away. Does that child really have any choice to do either of those? If this is your teacher, you can’t. Psychologically, you feel trapped.

It’s the same thing with a parent. What if the parent ha is angry with you? And maybe as a parent who hasn’t done their own work, and so as they are disciplining you, they have these angry eyes. And yet they make you, the child, look into their eyes as they tell you how awful you are, how stupid you are, how they wish they’d never had you.

That is a moment where did they ever hit you? No. Did they ever abuse you? No. But yet in that moment, you are experiencing an existential life crisis as a child who’s being told that you are bad and stupid and shouldn’t even exist. And you can’t run away. You can’t fight back because they’re your parent.

And you need them for survival because they’re the ones giving you your supper that night and your bed at night. So there’s all of these everyday experiences now that when we look at it, we realize: my goodness, this is that moment of there’s a threat, and I can’t.

Dr. Aimie Apigian (18:15.23)
do anything about it, whether I choose to because of my psychological beliefs or because of my physical health, that I don’t feel like I have the energy to respond. At the end of the day, it does not matter what the reason is. It matters that we couldn’t and didn’t respond.

Leigh Ann Lindsey (18:32.797)
Yeah. So i i the question we’re asking really beneath is there trauma? Do you have trauma is have you ever had an experience where you were overcome and unable to respond?

Dr. Aimie Apigian (18:45.218)
Yes, yes. Now that by itself is huge for people to look back and say, yes, like there’s been many experiences. But then we as practitioners get to ask the next question because the next question is really what matters for them today. Did you ever know how to complete and resolve that trauma response?

Because as a practitioner, I’m not worried about the trauma that you’ve healed. I’m not worried about the resolved trauma. It’s no longer impacting your life, your relationships, or your health. I am concerned about the unresolved trauma. And so from that experience, did you have anyone in your life?

That you were able to share that experience with to that degree and detail that you then felt a complete and whole return to a sense of safety. Most times the answer is no, I didn’t have anyone. And that’s when it gets stored and it becomes our disease decades later.

Leigh Ann Lindsey (19:58.902)
So let’s now move into. I’m so fascinated in this stress response versus trauma response because I think you’re adding a different layer of nuance to this conversation. Correct me if I’m wrong, but I feel like what I understand is, or what is often kind of the rhetoric in the world of nervous system, stress, trauma is a trauma happens, it creates a stress response, which you then stay stuck in.

Which then can maybe lead to disease, chronic inflammation, et cetera. But it sounds like we’re adding a different layer to this. So let’s let’s break this down and just so you know, the my I think my audience and I, we love specificity and all the sciencey details. So feel free to go into more details than you might normally.

Dr. Aimie Apigian (20:47.086)
100%. That’s why I was really looking forward to this conversation because I knew that I could. The stress response physiology is driven by adrenaline. So as we look at those five steps that the body takes, it starts with an activation that we will call the startle response. Starting with the startle, we are already in that sympathetic tone now.

The sympathetic tone is to upregulate our energy, and it does that through things like adrenaline. The startle response is specifically noradrenaline that’s prepackaged, which is why we can jump without even thinking about it first. Whereas with adrenaline, there’s a few seconds of delay before that adrenaline hits, which is why the startle response is necessary because it gives us that running start if we really do need to move into the full stress.

Response. So the startle has about 15 seconds for us to decide is this a real problem and danger or is not?

Most of the time, if it is a real danger, we don’t need all 15 seconds to move into the stress response. Within a split second, we can see, yes, a car is coming right towards me. I need to get out of here. But if we don’t know, and this is so much of the examples in our modern life, where it’s an email that arrives in our inbox and we’re looking at it, being like, do I open that email? What could it say? You’ve got 15 seconds.

Leigh Ann Lindsey (22:23.391)
Yeah.

Dr. Aimie Apigian (22:26.7)
You’ve got 15 seconds to look at the problem and then to say, phew, it wasn’t what I thought it might be. I don’t see a problem here. There’s no danger. But if you still have not opened that email in 15 seconds, you are moving into the stress physiology.

So let’s talk about the stress physiology now. The stress physiology is designed for one single purpose. Overcome. That’s it. Overcome. However you need to, whatever you need to do, overcome. And that is why our physiology changes to something that is so hyper-focused that it is only able to focus on what do I need to do to overcome?

And for people with focus problems, like ADHD, they intentionally find things to put themselves into a stress physiology because it helps them focus. This is why caffeine or stimulants help them, is because it takes a brain that is otherwise paying attention to everything and says, nope, here is the one thing to pay attention to. So str yeah, stress physiology is not bad at all.

Leigh Ann Lindsey (23:44.523)
Yeah. that’s fascinating.

Dr. Aimie Apigian (23:51.371)
We leverage it all the time without knowing that that’s what we’re doing to help us get things done. What we need to know about it is that it is driven by adrenaline, and the amount of adrenaline that is secreted into our blood is in direct proportion to the size of the danger that we see. So if this is a small danger, like shoot, I’m about ready to be late for this meeting, well.

Your body will generate the amount of adrenaline that’s needed just to help you get to that meeting on time. It’s not going to generate the amount of adrenaline that you would need to outrun a tiger. And so our nervous system is so precise, it actually is able to see this is the size of the danger, which means this is the amount of energy I need.

And it creates the amount of adrenaline that’s needed for the size of the problem that we see. Now, already I know that your mind is starting to think like, well, we see problems everywhere when they don’t even exist. We create problems in our mind. That is true. And for our nervous system, it doesn’t make a difference.

Whether it is stuff that we are creating in our mind because of the experiences and stories we have from the past, it’s still an adrenaline stress response. It doesn’t have to be real, it’s perceived. And we are going to stay in that place for as long as we need to to overcome. And that’s where the challenge starts to happen for people.

Leigh Ann Lindsey (25:38.283)
Well right, ’cause it’s also when a perception of overcoming has been registered.

Dr. Aimie Apigian (25:44.929)
Yes, that is also true. And so, what do I need to do to overcome? There’s two factors. Well, how much activation do I need to overcome? And for how long? The stress response is like a sprint. And there’s two factors in every sprint that determines whether you win or not. How fast can you sprint?

But for how long can you sprint that fast? Either one of those two factors of the equation can easily reach the point where we can’t do that anymore, and yet we still have not overcome. The problem is still there.

And at that moment is when we hit the wall. That’s the third step. We hit the wall and we realize I can’t. I don’t have enough. I’m not able to sprint fast enough or sprint long enough that is needed to overcome this problem. And if I can’t overcome it, I’ve got to switch my survival strategy. Overcoming is one survival strategy until it no longer is an option.

And if you can’t overcome a life threat, and you’re now trapped, powerless, and feel all alone, your nervous system is going to switch survival strategies. Most people don’t know that there are these two different survival strategies. They think of it as just one. No, there are two.

Leigh Ann Lindsey (27:22.431)
Right. Well, exactly. I think we would have, yeah, we would have looked at it as, well, there is the stress response of hyperactivity anxiety, fight, flight, and then there is the stress response of hypoactivity freeze fawn.

Dr. Aimie Apigian (27:37.56)
Yeah, right. That freeze fawn, the hypoarousal, hypoactivity, is not the same physiology as the stress physiology. The stress physiology is an upregulation of your energy production and utilization in your mitochondria.

Leigh Ann Lindsey (27:47.238)
Mm.

Dr. Aimie Apigian (27:58.505)
Once we reach this other survival strategy, it’s a down regulation of your energy production and utilization. They are complete opposite survival strategies. One survival strategy is fight or run away. The other one is shut down. Stop moving. Stop trying.

Leigh Ann Lindsey (28:20.106)
Yeah.

Dr. Aimie Apigian (28:24.492)
Which is why, when that’s the survival strategy that our physiology moves into, we can feel it if we know what it feels like. All of a sudden we went from this like, hi, energy, panic, anxiety, what do I need to do? To feeling hopeless, to feeling defeated, to feeling crushed.

our muscles start to feel very heavy. Why? Because literally our energy production has been downregulated in our mitochondria.

And so the physiology is creating the emotions and the sensations of this trauma response survival strategy. And there’s three mechanisms of this survival strategy. I cover this in chapter six. And they are fascinating because they are what create then the patterns that we can see in ourselves or those that we help today. The three survival strategies are: if I can’t overcome this, then I am going to dissociate.

Meaning I’m not going to be fully present. I need to disconnect from the reality that is unbearable for me at this moment. So I’m going to dissociate to some degree. I’m going to enter into a energy conservation state.

And I’m going to immobilize. And that’s why we call it the freeze response. Even though it’s freeze first and then the fuller shutdown, it’s these three survival strategies that help us survive those experiences in our life where we can’t do anything.

Leigh Ann Lindsey (30:13.067)
I mean what I’m hearing and so much of what I work on with clients is what are the narratives? What what happened, but what narratives got created in my psyche that are still playing out? And so much of what I’m hearing you say is

Sometimes there’s a very real case of I can’t overcome this. And oftentimes that is what is true in childhood. But what I see so often happening for my adult clients is the narrative of I don’t have autonomy, I can’t do anything about this persists.

Even when in adulthood they actually do have more autonomy. So, for example, my co-worker is an absolute nightmare, there’s nothing I can do, I’m totally trapped in this, and it is putting them in a trauma response because that narrative is flaring, the perception of I can’t overcome.

And sometimes our work is to go, is that an accurate perception? And sometimes it is. And then we gotta go, okay, let’s see how else we can workshop this. But sometimes it’s very often not. It’s an old perception from the past of actually maybe I can overcome. But I think this is interesting, and I’d love for you to talk a little bit more about

Dr. Aimie Apigian (31:28.131)
Mm.

Leigh Ann Lindsey (31:33.158)
the adrenaline component of the stress response, and also this is different. It we always think of stress as cortisol, which I know you’ve talked about before. So let’s talk about that. But then I want to start to now understand when we’re in I guess I’m gonna ask, I’m gonna hit you with a bunch of questions. Can we be in a stress response chronically without going into a trauma response?

And also I wanna understand a little bit better if we’re in a stress response chronically, how does that affect our physiology versus if we’re in a trauma response chronically, how does that affect our physiology? And are they different?

Dr. Aimie Apigian (32:13.888)
Yeah, great questions. So let’s go back to that adrenaline. I love it. I love it. This is where we get to geek out on the science and the biochemistry. The adrenaline, I want you to think of it as adrenaline surrounding a cell and it being a messenger, being a message for the cell of what do I need from you right now?

Leigh Ann Lindsey (32:16.351)
Sorry, I’m a master of like hitting you with a bunch at once.

Leigh Ann Lindsey (32:24.797)
Yeah, exactly.

Dr. Aimie Apigian (32:42.934)
And so the amount of adrenaline that surrounds that cell is going to tell it how high do you need to go, and also for how long do you need to go. When we discharge that metabol, sorry, discharge or metabolize the adrenaline, then that signals to the cell: okay, we’re done. We’re back in safety. You don’t need to stay in this upregulated fight or flight state.

How do we discharge and metabolize adrenaline? Through movement. Adrenaline is what moves us to take action. It literally forces our muscles to do something. That’s why if you have a lot of adrenaline and you’re sitting down, you find yourself fidgeting, like you can’t stop moving, because that’s what adrenaline does for us. And it’s that movement that metabolizes the adrenaline.

Otherwise, the adrenaline is toxic. Adrenaline is like a drug. It is so powerful, it is so toxic in high doses that if we don’t move, it will create a ton of tissue damage. That’s why it creates conditions like fibromyalgia.

It literally is the adrenaline from previous trauma responses that didn’t get metabolized because we moved into immobilization, the freeze, the paralysis. We’re not moving, and that’s what’s then leaving the adrenaline.

To do damage because we’re not moving to discharge the adrenaline. So the adrenaline is critical for understanding then how a cell responds to that signal. And so the amount of adrenaline comes around a cell, and a cell then says, well.

Dr. Aimie Apigian (34:46.866)
Do I have everything I need to make the amount of energy that this amount of adrenaline is telling me to make? If there’s a little adrenaline, the cell is a lot more likely to say, Yeah, I can turn up the heat for you. I gotcha. I’ll be right there. Whereas if it’s a ton of adrenaline, a cell is more likely to say,

I don’t have what I need to make the amount of energy that you’re asking me to make. Maybe I’m running deficient in a key nutrient that I need to make energy. What about B6, B12, magnesium? These are all things that are needed to make the ATP.

Leigh Ann Lindsey (35:19.595)
Mm-hmm.

Dr. Aimie Apigian (35:34.521)
Well, what about the oxidative stress that is created in the process of making ATP? If that has not been cleared out yet, then that might be another reason for a cell saying, I can’t help you with this one. This is more than what I can safely do. And that is at the cellular level what will trigger a trauma response.

Where biologically I’m already depleted to the degree that I can’t respond and even generate a stress response.

Leigh Ann Lindsey (36:16.757)
Yeah, this is so fascinating.

Dr. Aimie Apigian (36:19.072)
Right? Cause here’s where most people get labeled with adrenal fatigue.

In those circumstances, and their practitioners are trying to measure cortisol, has nothing to do with cortisol, has nothing to do with the adrenal gland itself. It’s not that the adrenal gland woke up one morning and be like, I think we’re done making cortisol. We’ve made it long enough. It really is at the cellular level, and it saying to the adrenaline, I can’t do what you’re asking me to do. I need more support.

And that’s why when we look at the sequence for healing, we realize that when we are helping our body

Back to its ability to generate a good stress response, we have to provide it the support that it needs to generate it. As long as we give our body what it needs, it will take it and do the rest. So if it’s not doing what it needs to do, like generating a good stress response to overcome the problems in my life, it’s because I’m not supporting it in the way that it needs.

Leigh Ann Lindsey (37:23.883)
Hm. Okay. Let me mirror look

Dr. Aimie Apigian (37:26.018)
But once it goes into that freeze response, it doesn’t matter how much cortisol you have because your body has thrown on the emergency brake and it’s like insulin resistance. It’s not responding because it’s in a completely different state now where it doesn’t respond to those things.

Leigh Ann Lindsey (37:37.62)
Yeah.

Leigh Ann Lindsey (37:44.96)
Yeah. So let me mirror back what I’m hearing because this is very fascinating to me and I think gonna you know change and support how I work with clients is the if we are in a stress response that for any reason the body decides we cannot overcome, and this can be psychologically because of truly I can’t overcome this, I’m about to crash in a car, or a misperception.

We’re gonna go into a trauma response. But also, if there is just genuinely not enough biological energy to respond to that stress response, it will categorize it as cannot overcome, move into trauma.

Dr. Aimie Apigian (38:30.102)
And that is why we go back to the definition of a trauma. Anything, anything, psychological, emotional, biological, doesn’t matter, anything that for any reason at that moment in our life made us unable to respond.

Leigh Ann Lindsey (38:46.837)
This feels very important for complex chronic illness cancer because a part of the work is to go, what do we need to shift psychologically and physically so that first of all we’re just perceiving way less stress responses in general? Maybe we’re going into that much less.

Dr. Aimie Apigian (38:51.234)
Yes. Yes.

Leigh Ann Lindsey (39:07.327)
But also I think it sounds like that that takes a little bit more work. It sounds like the starting point is going, we need to make sure your body has resources to even respond to the stress response that your body keeps creating. That might be a part of where we’re getting stuck and also where patients are having these really intense flares.

Dr. Aimie Apigian (39:27.756)
Yes. So the intense flares are always because we exceeded our capacity and it felt unsafe. Flare-ups are an expression of danger, of fear. And so establishing safety, that is for me what stabilization is.

Stabilization is coming in and saying, I need to make your nervous system feel safe.

Then I can work on building its capacity and even stress testing it a little bit to see are we ready for that amount of stress? Okay, let’s give it some more of this. Let’s do another detox. Let’s help help it, support it as we then build our capacity for stress. But before we can do that, I’ve got to start at the very, very beginning, which is stabilize the system.

Stabilize, stabilize, stabilize. Otherwise the rest isn’t going to stick. It’s it’s not able to land because there’s not the foundation of safety that I need to build that support on.

Leigh Ann Lindsey (40:41.739)
So would you say, because I I’m thinking of kind of different client profiles where sometimes there’s a client who comes in and seems to be in a perpetual state of anxiety or is just all day long going into that state of anxiety, but they’re not, at least at this point, having the crash, the collapse, the paralysis, the shutdown.

And that maybe to me sounds more like, okay, maybe you’re not actually going into a trauma response. You are stuck in a loop of stress response. And maybe in some ways that’s good, because it sounds like the trauma response is like a deeper layer. At the very least, it sounds like their psyche is perceiving threat, I overcame it. Next threat, I overcame it. Threat, I overcame it, and they’re just in that cycle all day long.

But at least they’re perceiving that they’re overcoming things. Versus maybe I have another subset of clients who come in and maybe they’re totally in a shutdown, paralysis, collapse place, or they’re alternating between the two. Hyperactive anxiety, I can go for a bit, and then there’s a crash.

Dr. Aimie Apigian (41:55.887)
These are all the profiles that we see as the accumulation builds over time. Initially, when we have stored trauma, we will be chronically in that sympathetic tone.

And the reason why we’re there is because there is still that background overwhelm that we never resolved, but it’s so uncomfortable to go to that place that we’re trying to stay out of it. And the way to stay out of the heaviness is to create the stress.

And so creating constant stress for ourselves, living constantly in that sympathetic tone is a sign that underneath all that is still stored trauma that we’re trying to stay out of and keep buried.

Leigh Ann Lindsey (42:47.561)
And we have just enough fuel to keep all of that going.

Dr. Aimie Apigian (42:50.376)
Exactly. But then to your point, that’s not going to last forever because you are burning through your fuel. You are going to reach the point where you’re starting to run into deficiencies and imbalances that your body says, Whoa, we can’t do this. We need to rest. You’re not a person who seems to be able to rest, so we’re going to force rest by going into shutdown, the trauma response.

And the more time that this accumulates, the more time that a person will be spending in that shutdown state. But first, they go from I’m always activated to now I’m going to loop between activation and crash, activation and crash. I call it the climb and the crash. The climb and the collapse. But even as they continue that cycle, those crashes and the periods of collapse are going to last longer and happen more frequently.

Because their body just is not able to generate that climb as much anymore. Until eventually, maybe one day like me, they wake up and they’re only in collapse. They’re not even able to generate the stress anymore.

Leigh Ann Lindsey (43:56.661)
Yeah.

Leigh Ann Lindsey (44:02.026)
Right.

Leigh Ann Lindsey (44:05.983)
You know, it’s interesting because just as I think back over my life, I think I’ve been in every phase of that at different points where you know, I’ve been in times where it’s just like high anxiety, go, go, go, just so intense. I’ve been in phases of, you know, hyperactivity collapse, hyperactivity collapse. And then I’ve definitely been in the collapse of

Dr. Aimie Apigian (44:10.538)
Of course we have. Of course.

Dr. Aimie Apigian (44:25.335)
Of course.

Leigh Ann Lindsey (44:26.175)
There’s just no coming. Yeah, I just can’t regenerate. But what it’s also making me think of is when I have cancer or chronic illness patients come in, I’m always asking, what’s happened within the last 10 years? Because there almost always has been a significant trauma of some sort from the onset of the disease. But what I’m also seeing is there’s almost always a

Dr. Aimie Apigian (44:43.371)
Exactly.

Leigh Ann Lindsey (44:50.645)
Combination of an emotional trauma and a physical trauma. Whether the physical trauma, and right, and I think to your point, it’s maybe they had a physical trauma first, where they were in a car accident a while ago and they’ve been okay, and then the emotional trauma hit, and that’s what tipped them over the edge, or vice versa. There was emotional trauma. I feel like this might have a little bit been more the case for me of I was sexually abused chronically by my father.

Dr. Aimie Apigian (44:54.06)
Yes.

Leigh Ann Lindsey (45:17.245)
And then as I came and was playing professional soccer, I had six concussions, and then I got exposed to mold, and that tipped me over the edge and completely threw me into this place.

Dr. Aimie Apigian (45:28.598)
And that is, I mean, perhaps the details are different, but that’s the story of so many people. It wasn’t just one thing that we’re looking at. It was this and then that and then this and then that. And so it brings me to kind of clarify the two reasons why we will then go into a trauma response. It’s either because what has happened to us has been too much too fast, or

For stories like ours, it’s just been too little for just too long. That’s the chronicity of it.

Where this started, but then later this came, but then later this came. And by the time we’re here, we were in such a state of depletion because of the chronicity of it, as opposed to something that just was in a shorter amount of time but was just stacked too much too fast. But those are your two reasons for why we will exceed our capacity to respond and find ourselves in a trauma response. Too much too fast or too little.

And it’s just been too long.

Leigh Ann Lindsey (46:40.085)
Yes. my gosh. I know we have to land this plane because you’ve got a hard stop, but there’s so many places I want.

Dr. Aimie Apigian (46:46.644)
I feel like we’re just we’re just you know warming up and we’ve got so much more to cover. And that’s why I write the book. Yes.

Leigh Ann Lindsey (46:50.911)
Well, and that’s why you write the book, right? Because th you just can’t possibly cover it all in an hour. And to be able to also like really sink into these details so much more. So I do I mean, I have to take us here.

Which is so what does it look like? You’re also saying we need to be able to complete these responses. What does it look like to c help ourselves actually complete a trauma response? I’m sure you’ve had clients say this, right? I I have clients come in all the time who are like, I’ve done

10 years of talk therapy and I am still stuck. And I do think getting into the unconscious is a completely different way of metabolizing trauma. But it’s the point we’ve already made, which is I’m not working in isolation. I’m making sure my clients are doing something to support the body as well. But we’ve mapped all this out, we didn’t get too much into it, but I also think it goes without saying, and my audience will understand.

Then when we’re in these responses chronically, it is creating this cascade and a ripple effect of there’s chronic inflammation, we’re almost hoarding energy, so energy isn’t being used appropriately, hormones are starting to shift, neurotransmitters are getting downregulated, all these things. Yeah. And then that’s how disease starts to progress and get created. So how do we work with this, Dr. Apigian?

Dr. Aimie Apigian (48:08.022)
It’s all the things.

Exactly.

Dr. Aimie Apigian (48:17.358)
Yeah, what what I want to do for your listeners is be able to say there’s the big picture. And for the big picture of the whole healing journey, I’m going to send you to section three of my book. I want to focus in on where do you start?

Dr. Aimie Apigian (48:40.512)
What’s the first step that we take? And I was shocked that as a physician, that the most important first step that I saw making a difference for my patients was for me to teach them somatic skills that within 60 seconds could create a feeling of safe enough right here, right now.

So often, what we are doing is we’re living in the reactions of the past. And that’s what’s creating the ongoing stress and trauma responses in my life today is my perception and the meaning that I have from these things that happened in my past. And the only way to break that is to.

Say right now, I’m not even gonna talk about the past. I’m not gonna focus on the past, I’m not gonna think about the past. I am going to create the feeling of safe enough right here, right now. And every single time that I feel myself losing it, I’m going to come back to this. I’m not gonna let those thoughts derail me. I call it like chasing sticks that are floating down the river. I used to be one that’d be like, let me jump into the river and let me chase this stick, and it would take me

Somewhere that I’m like, how did I get here again? I’m back in all of my old stories, back in the overwhelm, the heaviness of those stories. And so the first step is actually not doing any processing at all. No stories, no processing. Learn to create a feeling within 60 seconds so that you can use it in the moment when you need it and start to live more of your day in this state of safe enough.

Palm alive.

Leigh Ann Lindsey (50:32.863)
Mm-hmm. Can you give us one really quick example of a somatic practice that does that? Are we talking like vagus nerve exercises, breath work?

Dr. Aimie Apigian (50:40.654)
I’m gonna say no, it’s not breath work, and it’s probably not the Vegas nerve exercises that you’re seeing all on social media right now. These are and in fact, what I can do is I can share my five-day nervous system reset with your audience. And that will be five of the, I wanna call them my favorite, five of my favorite somatic skills. And they’re all video guided exercises, they’re about five minutes each, and I’ll just share that with your audience with the link.

Leigh Ann Lindsey (50:55.37)
Yeah, that’d be.

Leigh Ann Lindsey (51:08.789)
Yeah, that’d be perfect. That’d be amazing. I know there’s so many little details that we could get into, that’ll be fantastic. But we’ve gotta run and get you to your next engagement. So Dr. Apigian, thank you so, so much. I can’t wait. I’m just gonna be referring this book left and right to clients. I think it’s gonna be such a phenomenal resource.

Dr. Aimie Apigian (51:28.291)
Well, thank you for the work that you do. It makes a big difference and and the world needs this more than ever.

Leigh Ann Lindsey (51:35.339)
Absolutely.