When I first met Aadya she was in her early thirties and her most pressing symptom was intense migraines, which, according to her doctors, had no known cause. These were more than just bad headaches – they could last for three or four days and were so debilitating she had to lie in a darkened room until they passed.
At the point Aadya approached me, her migraines were being triggered almost weekly. Apart from the fact she was spending almost half her time trying to avoid any form of stimulation to survive this living hell, she was also starting to feel increasingly hopeless and depressed that things would never change.
I knew from Aadya’s intake questionnaire that she’d experienced sustained physical abuse as a child, and it seemed plausible that there was a link between this and her migraines. As we explored her childhood together, she described some of the horrific events she’d endured, and I noticed that as she did so, there was a flatness and resignation to her expression and voice, and I had a strong sense that something inside of her had shut down in order to survive.
It was also obvious to me that Aadya was someone who lived in a state of high stress, and she was clearly experiencing anxiety, too. As I asked her about how she experienced her nervous system in her life now, she said that she certainly felt she was more easily triggered on a day-to-day basis than her friends were.
She often felt highly anxious about small things, and after a shock, it took her much longer than it should do for her system to recalibrate and settle back down into a state of calmness. In fact, even when she felt less wired, she noticed that there was an ongoing feeling of trepidation and a sense that the world was an unsafe place to be.
As Aadya continued to talk to me, what had happened in her body over the years became increasingly apparent. The abuse she’d suffered had been utterly overwhelming and would have been too much for anyone, let alone a child, to process. Unable to leave the unsafe environment physically, Aadya did the next best thing – she left it emotionally and retreated to her mind.
Part of the genius of the human organism is that when we face the threat of danger, our nervous system switches gears to protect us. In Aadya’s case, this meant her system had become hyper-activated and sensitized to any kind of threat. This speeding up of the nervous system serves a dual purpose – it prepares us for immediate danger and it also allows us to disconnect from the resultant difficult feelings that we don’t feel safe to process.1
Aadya’s body’s response hadn’t just been the best option available to her, it’d been the reason she’d survived. However, her survival had come at a price. Her nervous system had become normalized to living in a constant state of stress, and she was so familiar with being this way that she barely noticed it. That was, until the migraines became so intense that she’d no choice but to look for help.
I explained to Aadya that her migraines were not in themselves the issue – they were a symptom of an underlying issue, which was that her nervous system was dysregulated (impaired and not functioning in the way it should be). Aadya was living in what I’d many years earlier come to call a maladaptive stress response. As is so often the case, the impact of her trauma wasn’t ultimately in the original event, but in the changes in her stress response and the outcomes in her life. To understand Aadya’s experience further, let’s look at the mechanics of what happens in the body when the stress response is triggered.
Imagine that you and I are walking down the street when we suddenly spot a huge electric bus heading straight for us. In that moment of frantic realization that our time on Earth might be coming to a swift and messy end, we can choose to respond in one of three ways:
When it comes to meeting threat in our lives, each of these responses has been painstakingly tested through millions of years of evolution. Sometimes, fighting is the best way to survive; other times freezing and hoping that we haven’t been seen is our saving grace; and other times still, we need to flee as fast as our legs will carry us.
Now, whichever response we choose, it’s going to be labor-intensive, so we need the resources to do so. When our nervous system is triggered into a stress response, almost immediately our heart rate increases and blood starts flowing away from non-survival-based functions, such as digestion, to our arms and legs, allowing us to leap into action. Alongside this, our adrenal glands release more of the hormones adrenaline and cortisol to fuel our body.
At the same time, our emotional center shuts down because exploring the nuanced and complex emotions we have about the situation – for example, how it reminds us of being dominated by an overbearing parent – holds no value for our immediate survival.
Freezing our emotions is a sensible way to survive that moment, but it has a huge price in the long term. For a compelling exploration of the health consequences of long-term emotional shut down or disconnection, I recommend Dr. Gabor Maté’s excellent book When the Body Says No.2
The American writer Mark Twain famously said: ‘I’ve seen many troubles in my time, only half of which ever came true.’ The truth, though, is even more tragic. You see, as I mentioned earlier, research shows that our unconscious mind can’t tell the difference between something that’s real and something that’s vividly imagined.
Here’s an example of this. I’d like you to close your eyes and imagine that in your left hand you’re holding a ripe, juicy lemon. Move the lemon close to your nose and smell its fresh aroma. Now imagine that you’re holding a knife in your right hand and are carefully cutting the lemon in half. Hold one half of the lemon close to your nose and once again smell it, noticing how much stronger the aroma has become. Next, I’d like you to move the lemon toward your mouth and take a large bite out of it.
What happened as you imagined doing this? Did you start to produce saliva, and perhaps have a strong, visceral response to biting the lemon? Here’s the thing – you were simply imagining something, but your body responded as if it were real.
Now let’s look at how this works with our stress response. Just as we can imagine eating a lemon and our body responds as though it’s real, our stress response doesn’t need actual, real physical danger to be triggered. Indeed, for the majority of us, for most of the time, what’s triggering our stress response is imagined danger.
To add to the problem, research demonstrates that when we’re activated in a stress response, we’re more likely to perceive a non-threatening situation as dangerous.3,4 In a sense, we have a confirmation bias in that we look for danger and threat and we find it, even when it isn’t there. So, once we get used to being in a stress response, in a way, it becomes self-generating.
Furthermore, our body’s stress response is designed to be used to respond to acute and short-term stressors. What it isn’t designed for is the kind of ongoing, chronic stress that many of us experience in our daily lives these days.
From the moment we wake up to the moment we go to bed, we experience micro triggers everywhere – from social media and the 24-hour news cycle to the frantic pace of modern life and the stressful commute to and from work. In time, our nervous system becomes overloaded by the constant demands placed on it, which is why there’s so much research demonstrating the relationship between chronic stress and everything from chronic pain to sleep issues, anxiety, depression, and chronic fatigue.5–10
Now, as interesting as all this is, there’s a crucially important piece in how this helps us understand the four stages, or ECHOs, of trauma. You see, when we consistently trigger our stress response, our body starts to learn that this is normal, and so it adapts to it becoming our baseline, or our new homeostatic balance.11,12
The body has all kinds of homeostatic balances, from blood pressure and temperature to the circadian rhythms that manage our hormone levels based on our regular sleep and awake times. The term homeostasis is derived from two Greek words meaning ‘same’ and ‘stable,’ and in a sense, our homeostatic balances are the body’s way of keeping things the same and stable, to support consistent and reliable ongoing functioning.
Our homeostatic balance allows us to feel safe and steady and is heavily influenced by whatever state we live in as our normal. The problem, though, is that repeated exposure to trauma triggers, and our inability to regulate our nervous system, leads our homeostatic balance to shift.
Over time, our body adapts and normalizes to a state of high stress, and it works to maintain and sustain this level as normal. This is a maladaptive stress response – a stress response that’s normalized to an abnormal level of high alert and so has become maladaptive.
The result is that our body is now working to maintain a level of stress. Indeed, in the short term if we try to calm our system, as soon as we stop, it’ll return to the higher level of arousal that it’s learned is normal. When we experience ongoing stress as a child, ultimately, we’re training a shift in our homeostatic balance that can define our life as an adult.13–16
It’s also worth noting that the danger of living in this way is that it becomes a self-fulfilling prophecy. We learn that safety is a product of being in this maladaptive stress response, because despite the price we pay to do so, we notice that we do survive the bumps and scrapes of our life, and our system learns that this must be the result of the state we’re living in, regardless of whether this is true or not. It might be deeply uncomfortable, but our unconscious believes that it works.
And so, the more anxiety we have, the more justified and intense our stress response becomes. Like a self-generating power source, the more anxious we become, the more entrenched we become in this response.
The impact of sustained stress on our physical body – from our immune system to our digestive system, and from our hormones to our nervous system – is very well documented in modern science. For example, the field of psychoneuroimmunology (PNI) has established that psychological stress disrupts the interaction between the nervous and immune systems.
Stress-induced immune dysregulation has been shown to be significant enough to result in health consequences, including reducing the immune response to vaccines, slowing wound healing, reactivating latent herpes viruses, such as Epstein–Barr virus (EBV), and increasing the risk for more severe infectious disease.17–20
When our emotional body is functioning naturally and healthily, we’re able to process our emotions in a way that’s similar to how our digestive system processes food. There are four stages to this:
A problem occurs when this process is unable to work properly. Just as stress will cause digestive issues in our physical body, when we go into a maladaptive stress response, we become unable to process our emotions and they get stuck in our emotional body.
In my work with chronic illnesses, one of the phrases I use most often is, ‘For our body to heal, it has to be in a healing state.’ In this context, I’m referring to our physical body, but the same is true of our emotional body. When we’re in a maladaptive stress response, we’re blocked to the very healing that we need. To open to, digest, and metabolize our emotions, we must first learn to calm and reset our nervous system.
Furthermore, the feeling of safety we’re so deeply seeking simply cannot be found when our body’s pumped full of stress hormones, our mind is running at twice the speed it needs to, and we’re locked in a state of constant tension. Ultimately, safety is a feeling that exists in our body, not as a state in our nervous system and mind. And because safety is a feeling, you can’t think your way to a feeling of safety. Please read that again: You can’t THINK your way to a FEELING of safety.
Let’s return to Aadya’s story for a moment. The reason why she felt so painfully stuck was because all the known ways out of her anxiety involved thinking harder and faster, and the more she did so, the more likely she was to have a migraine.
As everyone does when in this state, Aadya had tried thinking through every possible outcome and scenario, and as a bright young woman, she’d come up with many. This dilemma is what I call the safety loop. The more we feel unsafe, the more our mind and nervous system speed up to try and protect us; the more we disconnect from our body and get lost in the realms of our mind, the more unsafe we end up feeling. And the further away we become from the very feeling of safety that we need.
To build the feeling of safety in our body, we must learn to switch off our maladaptive stress response, reset our homeostatic balances, and train our nervous system into a healing state. With a calmer nervous system, we’ll then find the feeling of safety that we seek in our body.
To help lay the foundations for resetting your nervous system, I’d like to spend a little time exploring its current state. Remember, the point of this is to start to create healing and change, and knowledge can help us do so. Think about the following questions and then respond to them using the worksheet at www.alexhoward.com/trauma.
If you’ve answered yes to any of these questions, then there’s a good chance your nervous system needs some help to calm and reset. You may also notice that at different points in the day it’s more agitated than others, and that around particular people and situations you’re much more easily triggered.
As Aadya worked with me using the RESET model we’ll explore later, she was able to reset her homeostatic balance, and almost immediately she noticed a reduction in the frequency and intensity of her migraines. As we then worked to bring into balance the ‘perfectionist’ and ‘achiever’ patterns that had become her strategies to try and win love (you’ll learn about these personality patterns in Chapter 8), her migraines stopped happening almost completely.
And this is our next focus: understanding the strategies that you’ve developed in your life to attempt to manage the outcomes of your trauma.