The Biology of Trauma with Aimie Apigian MD, MS, MPH

[00:00:00] Dr. Aimie Apigian: So, that's what I do now, is I look at a person and I say, we've gotta address everything, mind, body, and biology. Because with neglecting one of those pieces, we're still going to stay stuck. 

[00:00:14] Dr, Melinda Ring: This is Next Level Health. I'm your host, Dr. Melinda Ring, Director of the Osher Center for Integrative Health at Northwestern University. On this show, we explore ways to take actionable steps towards optimizing our health with leaders in the integrative, functional, and lifestyle medicine fields who believe in science backed and time tested approaches to well being. Let's take your health to the next level. Today we're exploring one of the most powerful and often misunderstood drivers of chronic illness, emotional suffering, and stalled healing, trauma. Trauma isn't something that just happens in the mind. Increasingly, research is showing that trauma reshapes our biology and understanding that biology may be the missing link in why so many people struggle to heal despite doing all the right things. My guest today is Dr. Amy Apigian, a double board certified physician in preventive and addiction medicine with master's degrees in biochemistry and public health. She's also a certified functional medicine physician with extensive training in trauma and somatic therapies. We're going to today explore some of the key messages from her bestselling book, the Biology of Trauma, how the Body Holds Fear, Pain, and Overwhelm and how to heal it and talk about what it really takes to move towards healing after deep pain, and overwhelm, fear, and trauma.Welcome, Amy.

[00:01:49] Dr. Aimie Apigian: Thank you so much. It's really good to see you again, first of all, and it's good to be able to have this conversation.

[00:01:54] Dr. Melinda RIng: Yes. So important. So before we dive in. I just wanna briefly explain for, or define what we're talking about when we mean trauma,Trauma doesn't necessarily have to be a dramatic event. It could be ongoing stress or emotional neglect or medical experience, or simply like too much, too fast, too long. And so I say that to say that whether you've experienced what some people call big T trauma or something less obvious that today's conversation is really for everyone. Amy, you, you, you echo that.

[00:02:27] Dr. Aimie Apigian: I do, and I think that we as physicians, we see a different side of the body than what most people might know to look at. And so I think that as physicians we can see that I. Everyone is carrying some degree of trauma and it's just part of being human and it's part of what our body does to generally hold onto things. 'cause we, we haven't known what to give our body to heal. So there's no shame in it, there's no embarrassment. Doesn't need to be this big, bad word. It's just part of being human. And the more that we can normalize it, the more we can have these kinds of conversations and be like, okay, so then what do we do about it?

[00:03:04] Dr. Melinda RIng: Yeah. I so love the way that you remove the shame from it and are like normalizing it. I feel like it's kind of where. Depression and anxiety were, you know, from a few decades ago where it was a shameful thing and then it became acceptable to talk about it. Now we're seeing that happen to menopause, and I feel like now you're doing that with trauma, so thank you for that.

[00:03:27] Dr. Aimie Apigian: yes, and I am loving watching people start to be able to have this conversation with me. Own trauma and the body, and it's like their eyes light up. They feel understood, they feel heard. They are finally able to talk about some of the things that they may have considered weird before, and now they're realizing no, nothing that my body does is weird. Nothing that my body does is anything other than what it does to help me survive life. Sometimes a life that has been hard and we can move into befriending our body and actually becoming a partner with our health rather than hating our body or feeling like our body has betrayed us, or that it's broken in some way.

[00:04:11] Dr. Melinda RIng: Yeah. Yes. I love that. Loving our body again. Now Amy, your journey into this whole trauma research world is, you've shared deeply personal and I think began, or at least the way I read it, when you adopted your son Miguel, during medical training. Can you tell a little bit about that story and how it really fundamentally changed your understanding of trauma and healing?

[00:04:37] Dr. Aimie Apigian: Yeah, I did not choose this path. I feel that this path chose me. I did not set out in my childhood or even when I went into medical school saying I want to study trauma and the body. It was the farthest thing from my mind, actually. And what changed everything for me was when I decided to become a foster parent. And what happened was that I was also doing a master's in biochemistry at the time. Finished that and had several months. Of free space before jumping back into medical school. And I said, what if I became a foster parent? What if I could use my time in a meaningful way? And I went through all of the tasks and changes to your home that you need to make and all of the security aspects that they have, you do. And so by the time the social worker actually called me. I was already back in medical school. I was in internal medicine rotation, for example, as a third year. I know you're, you're

[00:05:38] Dr. Melinda RIng: I'm like, oh my God, how did you do that? Wow.

[00:05:41] Dr. Aimie Apigian: And, and I, again, looking back, I have so much compassion for myself and how unhealed I was that I would've made these decisions and taken on way more than what was realistic, but that tho, those were my trauma patterns and they were unhealed and I would say unrecognized trauma patterns for me at that time. So when they told me about Miguel, he was four years old, had been in the foster care system since age nine months, and just as they talked to me more about his story, his life, it was an immediate yes for me. I didn't know how I was gonna do it. I had no idea how I was going to do it. And as I bring him into my home, it took me to the lowest place that I have ever been because what I expected was that he wanted to be loved, and love was actually what terrified him. And so the more I loved him, the more he wanted to push me away to guard his heart, to hurt me. If that meant keeping himself safe, which again, safe for him, meant safe away from being loved. Because love had only meant pain for him, and that is how I started studying trauma. I needed to find answers for him because everything that I was doing was not working.

[00:07:09] Dr. Melinda RIng: First of all, like an amazing story and yes, having gone through medical training, and internal medicine training too, it is, it's intense. Like it, it's emotionally and physically draining in and of itself. And then. To go through this whole journey with another person, a little person who's fully dependent on you. I mean, I, I just, wow. I can't even imagine what that was like at that point. And, but look, you know, look, it, it really created something beautiful. So, now you also share that in like around 2014, you had your own health challenges. How did that further maybe frame your relationship and understanding with trauma and, and how you work with people?

[00:08:02] Dr. Aimie Apigian: I threw myself into finding answers for Miguel and. That was one more way in which my own trauma pattern of people fixing was playing out. And this is also what I did in medical school and in residency. I had no sense of myself or my worth, and so I would pour myself out for everyone else and neglect myself. I lost myself, and that was why I pushed and pushed and pushed, pushed through exhaustion, pushed through whatever obstacles seemed to come up. The answer was always, keep going. You can't stop. You've got one more thing to do. You've got another day of patients to go see you've got, for me, I was in surgery residency then, and so it was always, there's no time to rest and you don't deserve to rest. And my body just. Cave out, it could not keep up anymore, and I would've continued doing the same thing if my body had not said no more. And that's what happened in 2014. I went through the biggest grief and loss, and one month later I woke up and the fatigue had gotten so bad that I literally could not get out of bed. And I had to take a three, four month medical leave from residency because that's how far gone my body had been pushed, and I just wasn't even paying attention to it. I just kept asking more of it and more of it, and that was when we discovered the autoimmunity. I was on medications for anxiety, for depression, being told that this was burnout, and really feeling like I had. No sense of answers for myself at this time. And then that was how I found functional medicine. I started my own trauma therapy, and that's really where the concept of the biology of trauma came out of that experience of realizing that my body was so broken down that it didn't have the capacity for trauma therapy, and as much as I wanted to heal all of these wounds from my past, now my body, my body needed to be available for the process. It needed energy for the process, and it didn't, it didn't have that. And so just seeing how everything is connected, that I can't do emotional work without. The body works without the biology work. And so that's what I do now, is I look at a person and I say, we've gotta address everything, mind, body, and biology, because with neglecting one of those pieces, we're still going to stay stuck.

[00:10:53] Dr. Melinda RIng: How do you explain that trauma isn't just a psychological weakness, that it's biological and a biological survival response. 'cause I think people think of trauma as emotional, psychological. Can you talk about from your research, how you've found that trauma actually shows up in the body, even at like a cellular level?

[00:11:15] Dr. Aimie Apigian: Yeah, this was fascinating to me, and especially as a physician, right, because I had never seen trauma as something that's biological. I had always seen it as purely psychology and something that will mess with your mind. And the first inkling that I had that this is so much deeper than what I've been taught was the final piece that Miguel needed for his healing journey. And what we did was we went through an art narrative process where we took a story from the past and we literally took snapshots in time of what would your body have been doing in that moment? What would your body have felt like at that moment? And we walked through these moments in time of every story, and I saw that every story that is a trauma to the body has the exact same effect inside of us. And it got me curious as I then started to study my own nervous system, when I realized that I could start to sense those interchanges, those inner states, and that my energy levels dramatically changed, my brain clarity dramatically changed my gut and the bloating and the inflammation would change almost instantaneously, and I became fascinated by this .So that I was kinda watching myself as a third party observer, now watching myself go into a trauma response and noticing, being able to notice for the first time these changes that are happening, that are creating very clear, distinct changes in my biology. That was when I was like, Hmm, this is an, this is really truly what Gober Mate says is trauma is what happens inside of you in response to what's happening. It's not what's happening to you. That's not the trauma. The trauma is the actual physiology that's happening inside of your body to respond to this. And what is this? That allows us to gain clarity on what is it that happens, that our body will respond in this way. And it really is the response to powerlessness. It's the response to being completely powerless. You've lost your whole sense of safety, and you feel all alone. When that is our experience, the body has this same predictable response every single time. So it does not matter whether that experience happens for you in a car accident or whether it happens for you over in combat, or whether that happens for you over the Thanksgiving dinner with your family. It doesn't matter because when you feel that way, that is always the body's response to survive feeling powerless. It does change even our biology at the cellular level because that's how it changes our immune system. It changes that brain fog that comes up. It changes our metabolism and so our energy, it even changes our DNA, and this is how epigenetic changes start to happen in the moment, but then also become chronic over time. So. Trauma really is a cellular response, a system and cellular response of the body to feeling completely powerless.

[00:14:53] Dr. Melinda RIng: You mentioned, Amy, that you know for different people, different triggers that we, we all have our individual triggers depending on many things like our own constitution, our history, our experiences, just how we were brought up in our environment. Do people also have individuals? Biological physical responses or do you think there that everybody has kind of like this common, you know, like you mentioned, affects the immune system, affects the brain, affects the gut, you know, does, does everybody react in the same way or do people need to kind of figure out what their own individual cue, physical cue is that they've crossed that critical line of overwhelm.

[00:15:46] Dr. Aimie Apigian: This is what's fascinating is that. When we look at the human body, the human body has very distinct ways of surviving, and it's the same for everyone. What is different are your specific triggers, like you mentioned, that will be unique to you. But once you perceive powerlessness in not a good way, this is the response of the human body. We can even see this in animals like this. This is how life is wired to survive different degrees of danger. And we see this in the fact that there are two survival responses of the body. One survival response is more sympathetic, which is that high energy, and you're going to be running, you're going to be fighting, you're going to be taking action in order to survive. But once there is a point where, again, there's nothing else you can do, and you are now powerless in the face of this danger and threat that looks and feels so much bigger than you fighting it or trying to run away from it is no longer going to work. You need a different survival strategy now. And we see this in humans. We see this in animals because this is how the nervous system is designed, which is wonderful to take the shame out of it because this is just how we're wired. It's not a choice that we are making consciously. What is really fascinating is that when babies are born, they don't need to be taught this. They are born already with these instinctual responses built into their nervous system, and they are already having these exact same responses as they will have for the rest of their life, which is how we know it just comes wired into our hardware. It's not something that we learn or that we choose.

[00:18:00] Dr. Melinda RIng: So to be a little more, I guess, specific or scientific, you know, what's. What actually happens in the nervous system in the body when someone crosses that line from, you know, again, that sympathetic nervous system. This is what is classically called the saber tooth tiger coming after you where you're activated, but coping into maybe that point where you realize you have three saber tooth tigers coming after you, or you know, what, where suddenly you're, you're not. Activator and coping, but you, you tip into trauma physiology. Like what, what shift happens in the nervous system at that point?

[00:18:39] Dr. Aimie Apigian: This is what I would want everyone to know about their body, so I'm. So glad that you're asking this, and in fact, it's so important to me that this is how I start my book. This is chapter one. Chapter one is let me lay out the five steps that your body goes through when it goes into a trauma response, and the steps are built on these degrees of danger. So the first step is always going to be a startle, which is just that first sense that something might be off. And whether that's because you hear a loud noise or you smell something or you see something, all of the information is coming in and you just get that sense that something's not right. At that point, your body starts to change and goes into survival mode. If something's not right, I may not be safe, but I need to check it out first. So I talk about the startle response, how much time we have in that start of response, but. If the startle response confirms that, yes, we have danger, well then the next step is really an escalation of our response because it's a new level of danger. No longer just a sense, it's confirmed. There is a danger, and when there is a danger, our body will always first choose to do something about it. And so that's where we have adrenaline that moves us into action, moves our muscles. It actually makes our brain more clear because we need to think very fast to know where to go? What should I do? How do I overcome this danger? But as you say, there comes a point, and if we are not able to overcome the danger. Now our body has to do something different. In my book, I call this hitting the wall, and it's like if you are driving a car and you're trying to get away and you realize that you're up against a wall, what's the point of keeping your foot on the gas pedal? If you're not moving, if you're not able to actually escape from the danger. And so that's this sense of powerlessness. Here I am, I'm exposed, I'm vulnerable. I can't protect myself, and this danger is still coming at me. Now if running away or fighting, it is not going to work, it's, it's, not helpful. It actually is more dangerous to keep my foot on the gas pedal 'cause then I'm gonna burn through all my gas and still have not been able to accomplish anything. And so our body now puts on the emergency break. The emergency break in terms of the trauma response is called the freeze. Many people have felt this way where it's that moment of shock and disbelief and it literally stuns your body. It stuns your heart. It stuns your diaphragm. Your breath catches in this full inhalation of, oh. I can't believe this is happening, but at this point, again, this is unsustainable and so the body says I if, if I can't overcome this, the best thing for me to do is just to kind of give in, give up, surrender, play dead. And maybe the danger will lose interest in me. Maybe I won't be seen. Maybe I won't be heard. I'll even drop my core temperature so that I won't be felt, my warmth won't be felt. There's all these physiological changes that happen at that moment when the body switches from the high energy survival response of, I'm gonna try to get away, or I'm gonna try to fight this too, there's nothing else I can do. The best thing for me to do is just to stop trying.

[00:22:42] Dr. Melinda RIng: Yeah, and what struck me in the book too, when you're going through this universal five step trauma response is that this freezing dissociating collapsing now going numb isn't weakness. It's not failure, but it's, as you say, what the body is. The body's just doing exactly what it's designed to do to survive. So it is not a 'cause. I do think, you know, again, with that idea of removing the shame, the sense of failure, you've really reframed that in such a needed way.

[00:23:20] Dr. Aimie Apigian: Well, it's, but it's still what it feels like right? Like it feels like I am giving up. It feels like I'm a failure. It feels that way. So that is why, yes, like you're saying, it's so helpful to know what's happening inside the body because it's almost like we have to check our emotions at the door and be like, I know that I feel this way. But this is actually what's happening and it's just creating those feelings. But I am not those feelings. Mm-hmm.

[00:23:52] Dr. Melinda RIng: So then when people have this trauma response, they've reached the fifth stage and they're in this shutdown phase. Is that where the biological issues start to manifest? You know, again, you've linked this trauma response to autoimmune disease, chronic fatigue, digestive issues, chronic pain. Is it in that place that this terrain, biological terrain is created?

[00:24:24] Dr. Aimie Apigian: Yes, and what's fascinating is that you and I as physicians, we're taught that stress is really the cause of all of these illnesses and especially chronic illnesses, and people need to. Do better stress management and better self-care. And actually the science suggests that it's not, it's not the stress physiology that makes us sick. It's when our body is done fighting and it enters into that shutdown and that collapse, that is where the real damage starts to happen. In stress physiology, our body is definitely shunting energy over into movement and taking action. And so it is true, it's going to decrease our digestive system. It's going to decrease our detoxification system. 'cause those aren't priorities when you are trying to overcome a problem. But now that we know that there's this trauma physiology, we can see that the trauma phase. Has a much greater impact on our biology, and this is where it just gets stagnant, it gets stuck. The stress response is not going to get stuck because it's a very active phase. We're taking action and it's temporary. And so when we go into stress, we will either come out of stress, either return to a full sense of safety, and our body recovers or. Coming out of stress, we didn't accomplish that overcoming, and we go into overwhelm or that trauma physiology, and that's where things just linger. And our detoxification system is shut down even more. Our metabolism is shut down. Our digestive system is shut down. Everything is just shut down. It's like dimming the lights down. We're gonna dim the lights down as much as possible to not die. But it's also not safe to be fully alive right now. And so if I'm not fully alive and it's not safe to be fully alive and open and vibrant, then in this place of. Cowering and collapsing, and I'm going to do the bare minimum. It's one of the ways in which people can recognize that they're in this state by just looking at their breath. Their breath will go slow and shallow. Why? Because they're just breathing the bare minimum that their body needs to. Do. It's staying alive, but we're not gonna be doing repair and digestion and cleaning things up and taking toxins out. That's not what the body can even do. And part of that is also because of its impact on the mitochondria and our metabolism, and it shuts down energy production. And so we literally, we, our body, our body is having to make those decisions around. If I only have limited energy, where should my energy go? And it's never going to be about recovery and healing. It's going to just survive.

[00:27:38] Dr. Melinda RIng: I mean, I, I think this is something that perhaps has not been and will become now part of functional medicine, integrative medicine that. You know, trauma as a root cause of chronic disease, you know, that hasn't been there as a root. You know, functional medicine talks about root cause, root cause, and you know, trauma as you've. Talked about in your book and are sharing now because, and not just because of the emotional, because of what it's doing to our bodies, important healing systems, the inflammation, the immune mitochondria, the autonomic system, you know, for all of those reasons, that becomes then one of those things that we need to heal, not just leaky gut, you know, people are just like, oh, it's my gut. I need to heal my leaky gut. But we've gotta put trauma in that category now too.

[00:28:31] Dr. Aimie Apigian: Yeah, And, this is where it gets really interesting. I'll use that word. Interesting. It gets really interesting because once a person has a leaky gut. came first? Did the trauma come first and it caused the leaky gut, or did the leaky gut come first and create this overwhelm because of the biology? And so many people ask me this hoping that it will guide them for the next steps. Like where do I even start? And so when my responses. It doesn't matter because right now you have both, which means that they both need to be done and they need to be done somewhat. In an integrative, holistic simultaneous way because you can't, you can't heal your leaky gut completely without also addressing the underlying trauma, and you can't heal that underlying trauma without addressing the leaky gut. They are so interconnected. Trying to separate them is just an illusion.

[00:29:30] Dr. Melinda RIng: Let's say have a new diagnosis of an autoimmune disease or fibromyalgia or chronic fatigue or you know, and brain fog, any of these things, if they know they have a history of trauma, maybe it's more obvious, but, you know, where do you think both providers, we have providers who listen to the podcast too, you know, when at what point should trauma be part of that the workup, I would say, you know, when should an exploration into trauma happen?

[00:30:00] Dr. Aimie Apigian: As we sort of started the conversation, since everyone has some degree of trauma, it should always be a. A piece to the larger puzzle. Now, what I really want people to be educated on is where do you start? What does that mean? Because what I thought that meant was, all right, I need to go in and do my trauma work, and I signed up for this therapy and these intensive. 'cause I was like, let's get this done. If I need to do this, let's just get it done. Exactly. And I got sicker in the process. And my sugar cravings and emotional eating got so out of control and I'm realizing, oh, this approach is not working. And this is where I also need to attune to my body and my biology to see what is my current capacity and stay within my capacity, especially as it relates to trauma work. Let's not get in over our heads. Let's do the work. But it's how we do the work. It's how we do the work. And so what would be so important for people to know is that we don't want to wait, but we also want to make sure that we are building that foundation of doing it safely and opening up Pandora's Box.

[00:31:23] Dr. Melinda RIng: You emphasize this idea of safety as the not willpower, as a foundation of healing. And, and I think you mean that in multiple ways, right? Like, kind of like you were saying, you have to be bi, you have to have biologic safety, not just like. Emotional safety. I think usually we think about emotional safety when we're starting to go into trauma work, but what you are talking about is your biology has to be ready to take that on, right? So Yes, people begin creating more safety

[00:31:57] Dr. Aimie Apigian: yes. This is such a great conversation because when we talk about safety, most people assume, oh, you're talking about psychological safety and emotional safety and Yes. And we are also talking about having a biology of safety. So most people. Are starting with some degree of a biology of trauma. The first step is creating a biology of safety. And that's still only the first step because after that we wanna create a biology of healing, and then we wanna create a biology of and expansion where we're living our true purpose. So there are these phases of the healing journey that involve our biology, along with our psychology and our emotions. So when I talk about safety, yes, like I'm also saying, we've got to get your body and your cells resourced at such a level that they feel safe because we have this thing called neuroception. And neuroception is what is driving our behaviors and our health unconsciously. In fact, you could call it your subconscious. And what it is, is the perception of your nervous system for how much in threat versus how much in safety you are. And it makes those decisions based on a dashboard of information. So think of it like your car. When you drive, you've got your dashboard of information so that you know is it even safe to drive your car right now? Or is your gas tank empty? Are your tire pressures low? It has this dashboard of information. To help us know is it safe right now or do I need to move into one of the survival responses? And on the dashboard yes. Is your, who am I with? Do they love me? Do I feel safe emotionally and psychologically? Those are aspects on the dashboard, but also on our dashboard is what is your nutrient level? What's your magnesium level? What's your zinc and B six level? What's the status of your mitochondria? How much toxins is your body carrying? This is also on your dashboard, and so our nervous system has the ability to step back, look at this whole dashboard and say, I'd love to be able to do this for you, but we just don't have the capacity. You should see all the toxins that I'm trying to carry right now. This, you know, phosphate and this idea and all, you know, you should see all of that because you can't just trust me, trust me, we don't have the capacity for that or trust me, we're not safe. And realizing that that is a subconscious decision that's being made and it's pulling in information from outside of us, but also from within us.

[00:34:53] Dr. Melinda RIng: This is very helpful for even me as a, you know, somebody who's been in the integrated functional world for several decades. Now because I've absolutely seen that when people start to go into. This work, psych, you know, any, any kind of therapy really psychotherapy, emotional explorations that they can come in and they're like, I'm exhausted. You know, and they feel it physically. I'm like, yeah, you know this, it's work. You know? And so we have to think about doing this, healing work as. It's real work, just like you would think about lifting weights. Like what do you need to fuel your body to manage that kind of work too, not just when you go to the gym. Now you emphasize in the book, and this goes back to what you mentioned at the beginning, That sometimes the diet supplements, exercise mindset work just won't move the needle in people in survival mode because it, it doesn't have that capacity to absorb or benefit from the healthy inputs when it's stuck in this trauma physiology. And so what I'm hearing you say is. Yes. And like we, yes, you need those things to do to move out of survival mode and, you're also impaired in using them, so you need to be doing the work to move everything around together. Is that sort of accurate in terms of how you think about these things?

[00:36:28] Dr. Aimie Apigian: Is a great summary of this concept of the biology of trauma. Yes, trauma affects our biology. No doubt about it. And our own biology becomes the reason why we get stuck in our trauma patterns because it now is this ongoing queue of danger of inflammation, low nutrients, toxins, and our own biology becomes sources of danger that keep our bodies stuck in trauma responses.

[00:36:57] Dr. Melinda RIng: one of the powerful insights in your book is about how trauma can be passed down through generations. And you share the hopeful and perhaps motivating fact that if we heal our own nervous system patterns, it's actually one of those most powerful gifts and things that we can do for our children. So can you talk a little bit about that and maybe some ideas about what parents and caregivers can do to heal their own patterns so they don't unintentionally pass them on?

[00:37:30] Dr. Aimie Apigian: Yeah, patterns. So you know, you and I are trained to see patterns as physicians and being able to see that there are patterns of trauma that have become chronic. Let me just say that again because as we go into this conversation, I wanna be clear for people that there is an acute trauma response, something that happens right now in the moment, and then there's this trauma that becomes chronic. And for most people, we're now working with the trauma that has become chronic, which is why I choose to not go into long histories with people. Tell me all the bad things that happened to you. Oh no. In fact, those stories only bring us down. What I'm gonna be looking for are, are there patterns of chronic trauma that I can see happening in your life, in your relationships, or in your health today? That's how I know if there's trauma work to be done, I am less concerned about trauma that you've already resolved. I'm concerned about the trauma that has been unresolved. That's what's still having an impact on your body, on your life, on your relationships. So I'm going to be looking for these patterns as they show up today, and especially for practitioners. It's sometimes easy to notice those patterns because like me, they can be the chronic people pleasers, the chronic perfectionists, the ones who people fix, the ones who push through. These are trauma patterns. Being able to recognize that, yeah, I've got these. Okay. That's all we need to know then to say that we know that we've got some trauma work to do, then. What does that mean in terms of passing on to our children or even to those around us, and there's so much of our unconscious communication with people, nonverbal communication with people that allows them to feel safe with us. That allows them to feel like they can connect with us, that they can share openly with us. These are things that we walk around not knowing that we're giving out all of these signals to other people, especially those that we are close to, those that we live with. And yet, our nervous system, our trauma then has this unconscious impact on them that we may not even be recognizing. But this is where the hope comes in, right? Because wait a second. If my nervous system is going to be affecting them at an unconscious level, that means that all the work that I do to create a better inner state within myself, a more healed state within myself, it's going to naturally benefit them. Amazing. Yes, find me up for that. And that's where there's so much hope that comes in for parents and not passing on generational trauma. It is possible to not pass that stuff on. And both like it. The patterns, right? Because if your children see you, people pleasing or being a perfectionist, well that is having an impact on them, and that is one way in which generational trauma gets passed on, not just through our biology, though it definitely is through our biology, especially epigenetics, but also through our own default ways of living life and connecting with others that they're seeing and modeling as well.

[00:41:14] Dr. Melinda RIng: For somebody who's listening right now who, who may recognize themselves in this conversation, what would you share as a few foundational practices they can begin implementing to support their nervous system in biology and just help them move towards their own next level of health and healing.

[00:41:36] Dr. Aimie Apigian: Yeah. You know, out of all the things that I've done and all of the patients that I've worked with now, it's been a goal of mine to find what makes the biggest difference the fastest. If I'm just starting out with someone. Everything is a mess. Where do I start? What has the biggest leverage, the fastest win? That will then start to shift things, and then we can have the space to work on other things. We can have the energy to work on other things. And as a physician, I was shocked to see how fast people can learn how to shift their own interstate out of that survival mode and into a calm and alive mode. But that is where the healing happens. That is where our body has that space to do all of these healing strategies that it already has. It just hasn't been able to engage those because it's been in survival mode. And I call these somatic referring to the body. Soma is the Latin word for body. And so these are body-based exercises. We're gonna stay out of our heads. We're gonna stay outta story. We're not gonna analyze because that's not where the shift happens. The shift happens. In our body. And so that's how we create that shift. So I'm going to teach them a very simple exercise. Something like pretending to push a heavy rock away, or doing some vibration with your vocal cords, or giving yourself just the right hug, self hug. That allows your body to say, right here, right now, I'm safe enough and that's all we need is just safe enough. And people can learn how to do that for themselves, and that's what changes things the fastest. Not to say that the other things don't need to be done, we do, but it, it, it also tends to create the space for the other things to be done. So that's why

[00:43:30] Dr. Melinda RIng: Right, right. I think that's a great tip. Thanks so much for sharing that. I, I uh, I'm gonna be adding this into my repertoire, so for my future patients, um.

[00:43:41] Dr. Aimie Apigian: got the five day reset on my website, on my book webpage, so that is where you can go to get my top five exercises for free.

[00:43:50] Dr. Melinda RIng: Absolutely. Well, Amy, uh, thank you for this powerful and deeply clarifying conversation. I've learned a lot personally. And if this episode resonated with you or you can think of somebody who it might benefit, I highly recommend Amy's book, the Biology of Trauma. It is a best seller. This is Next Level Health. I'm Dr. Melinda Ring. If you found today's conversation meaningful, please follow the podcast and share the episode with someone who might need it. Until next time, be gentle with yourself. Say, stay curious about your body's wisdom and keep moving toward your next level of health.Thank you for joining me on this episode of Next Level Health. I hope you found some inspiration and practical insights to enhance your wellness journey. Don't forget to leave a comment on YouTube or review on Apple Podcasts. I'd love to hear your thoughts and suggestions for future topics or speakers. Be sure to follow Next Level Health with me, Dr. Melinda Ring as we continue exploring the path to healthier, happier lives together.