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Apr 19, 2021

We are often witness to, or sometimes in the middle of, traumatic events. Whether it’s a mass casualty or cumulative stress over time, our nervous system can get stuck in an upregulated state. In this episode, we break down: training to handle stressful events, protective strategies to employ during and after traumatic events, the physiology of PTSD, specific techniques to downregulate your nervous system and getting to a place of equanimity.

Guest Bio:  Ryan Cheney is a mental health therapist, breath work, and performance coach based in Bend Oregon. Our guest on Stimulus Episode 5: The Art of Breathing, Ryan is a thought leader in the field of wellness for health care professions. You can contact him here for further questions and consultations.

This episode is in support of World Bicycle Relief -- delivering specially designed, locally assembled, rugged bicycles for people in need. They’ve developed an efficient, innovative, and scalable model to empower students, health workers, and entrepreneurs in rural developing regions with life-changing mobility. Donate here. We will match donations up to $1,000.

We discuss:
The Las Vegas mass casualty and the wide range of emotional responses of those who were involved [03:50];
  • While everyone agrees this mass casualty was tragic, some trauma surgeons and emergency personnel described the experience of caring for the victims as deeply fulfilling. These specialists had dedicated their careers training to run a disaster, and when it finally happened, it was game on.
  • For others, the experience brought shock and distress.
The fact that trauma is different for every single nervous system [05:50];
  • What’s traumatic for one person may not be for another.
  • When people have a reaction to trauma (with recurring thoughts, difficulty functioning, etc), that’s their system trying to integrate the event and make sense of it all. It’s important that we normalize some of the response patterns.
  • Factors that might increase the likelihood of having difficulty with trauma include a history of adverse childhood experiences or developmental trauma.
  • Protective factors: taking action (vs. freezing) after a traumatic event and having a strong sense of meaning/purpose.
“Life is never made unbearable by circumstances, but only by lack of meaning and purpose.”
― Victor Frankl
Training to handle stressful events in a better way [08:15];
  • You can work on building resilience and learning how to modulate your nervous system.
  • Having the right mindset, understanding your purpose, and incorporating a healthy lifestyle (breathwork, mindfulness, relationships, playtime) can all make a difference.
What’s happening physiologically when you have PTSD after a traumatic event [10:40];
  • Trauma is experienced through sight, taste, touch, sound, smell. It travels through your body into your brainstem and then into the limbic system.
  • When you are exposed to the sensations associated with the initial traumatic event, your limbic system is flooded with the emotions of that event. This deep limbic system holds onto negative things more strongly than positive ones.
  • Over time, for many people, the trauma starts to ‘integrate’ and one's memory of the event changes. Positive thoughts will emerge, like “I made a difference that day”.
  • For others, their nervous system gets stuck. They stay in that trauma response.
Strategies that are protective of your nervous system DURING a traumatic event [14:20];
  • Taking action (vs. the mindset of helplessness) is a protective factor when your nervous system spikes into the sympathetic zone.
  • Giving yourself compassion is important if you’re feeling overwhelmed. You can recite the mantra, “We are doing the best we can, and that’s good enough.”
  • Sending compassion to the people you’re taking care of and wishing them well is another “in the moment” strategy.
The importance of PRE-TRAINING so that you have tools to down-regulate your nervous system in the moment [19:20];
  • Opening vision has an immediate calming effect. Looking up and opening your peripheral vision stimulates the vagus nerve.
  • Breathing is the second best thing for managing the nervous system. Elongating the exhale for a few moments will instantly bring the nervous system down in a chaotic environment. Many people like cycles of breathing: in for a count of 3, hold for a count of 1, and exhale for 6.
  • These tools can be used to modulate your daily activities and response to stress. They can help keep you in the sweet spot of your performance zone where you’re ramped up, but not overwhelmed or frozen.
“Practice equanimity and awareness mindset so that it becomes automatic.”
Protective, positive strategies that can be used AFTER a traumatic event to reduce the risk of PTSD [25:50];
  • Connecting with your team or friends who can relate to the trauma you’ve been through is a far better option than isolating yourself and stewing. In medicine, critical stress debriefing is a big part of connection.
  • While isolation generally puts you in a negative place, intentional solitude (especially if in nature) can be healing. Similarly, journaling helps quiet down the amygdala and integrate events.
  • The Body Keeps the Score is a book that discusses how you can work with your body to move it towards integrating a trauma response.
The role movement plays in down-regulation and why dosage matters [31:40];
  • Intense exercise can impart an extra-sympathetic dose on your nervous system which might help release your thoughts, but it adds stress to your system.
  • Walking, hiking in nature, yoga, Tai Chi, and Qi Gong are down regulatory movement processes that quiet the amygdala and ramp up the parasympathetic nervous system, so that things can recover, repair, and integrate.
The benefit of EMDR (Eye Movement Desensitization and Reprocessing) and other body-based therapies for processing acute trauma [35:10];
  • While talk therapy has a role, it engages a ‘higher level thinking brain’ which is not where the stuck trauma is stored.
  • EMDR research shows that trauma reprocessing therapy should happen as soon as possible after a traumatic event, before it’s solidified in the limbic system.
“Sometimes our system gets stuck in certain states, and we need help getting back to a nervous system that can modulate freely, like it's supposed to.”
The process of intentionally letting go, or “cutting strings”, when something is weighing heavily on you (such as a client, patient, etc.) [37:30];
  • Notice what state you’re in from a place of equanimity. Are you overwhelmed, amped up, stressed, anxious?
  • Ask yourself if there’s something you need to learn from this.
  • Take deep breaths, open your vision, or go for a walk to put yourself into neutral.
  • Now, it's time to go into the place of emotional control, to let go, and to move on. Bring to mind something that makes you feel joy or gratitude, and then think about that client or patient that's weighing on you in this new state of compassion. Wish them well. Ryan recommends envisioning a pair of scissors or a sword cutting the tie with that person, wishing them the best and watching them drift away. The brain loves storytelling and imagining, so creating a visualization of letting go can be powerful.
  • The more you do this, the quicker you get at it.
“I like to be proactive in this way so that we're not waiting until someone's got full blown PTSD. How do we get in front of that? How do we become more resilient? How do we build these practices to modulate the day?”
And more.
Shownotes by Melissa Orman, MD