When Stress Becomes Trauma: Healing the Nervous System | Dr. Aimie Apigian, MD

Dr. Aimie Apigian joins the show to explain how unresolved trauma can become embedded in the body's biology, shaping energy, digestion, sleep, pain, mood, and the ability to respond to stress. Drawing from her experience as a physician, adoptive mother, and trauma specialist, she breaks down the difference between healthy activation and nervous system overwhelm, including the shutdown state that can leave people feeling exhausted, disconnected, or stuck.

We dive into:

• How Dr. Apigian's personal health crisis changed the direction of her medical career
• The difference between stress, trauma, and nervous system overwhelm
• The three nervous system states: safety, activation, and shutdown
• Why high cortisol can coexist with fatigue, collapse, and low capacity
• How the body trauma loop keeps people moving between activation and overwhelm
• Why complex patients need precise, stage-appropriate nervous system support
• How somatic exercises can create a felt sense of safety in the moment
• The role of parts work in reducing inner conflict and supporting regulation
• Why healing must address the mind, the body, and biology
• What clinicians should understand before recommending trauma-focused therapies

🕒Chapters

00:00 Meet Dr. Aimie Apigian, MD

00:34 From Surgery Residency to a Personal Health Crisis

02:34 Finding Functional Medicine and Trauma Healing

04:41 When Talk Therapy Did Not Create Forward Movement

07:26 The Three States of the Nervous System

09:23 Stress vs. Overwhelm, Freeze, and Shutdown

13:07 The Critical Line of Overwhelm

15:43 Understanding the Dorsal Vagal State

18:07 The Body Trauma Loop

18:31 A Precision Approach to Nervous System Healing

21:45 Why Dr. Apigian Entered Addiction Medicine

23:45 The Power of Simple Somatic Exercises

25:21 What Changed in the First 21 Days

27:17 A Stomach Support Exercise for Felt Safety

30:13 Why Pressure and Weight Can Feel Regulating

33:13 Building Capacity Before Deeper Trauma Work

34:57 What Clinicians Need to Know

36:42 Somatic Work and Parts Work

39:23 Healing the Mind, Body, and Biology

42:33 Somatic Coupling and Complex Symptoms

44:39 Resources for Individuals and Practitioners

🔗 Dr. Alex Carrasco, MD

https://nourishmedicine.com/

https://www.instagram.com/dralexcarrasco/

🔗 Dr. Aimie Apigian, MD

https://www.biologyoftrauma.com/book 

https://www.instagram.com/draimie 

https://www.biologyoftrauma.com/ 

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Transcript

Meet Dr. Aimie Apigian, MD

Dr. Alex Carrasco 0:10

Well, thank you so much for joining us today, Dr. Amy. I am so excited to talk with you. Um, your book is amazing and I recommend it to a lot of my patients.

Dr. Aimie Apigian 0:18

So um I Well then I'm I'm excited to talk to you and hear your thoughts.

Dr. Alex Carrasco 0:22

But what I want to do is maybe start with kind of your story because you have an amazing story, and um you're, you know, a conventionally trained doctor that then kind of changed

From Surgery Residency to a Personal Health Crisis

Dr. Alex Carrasco 0:34

gears, and I'd like to hear, you know, that whole genesis.

Dr. Aimie Apigian 0:37

Yeah, I actually came from surgery. So it's amazing. From medical school. I went into surgery residency, general surgery residency. And during that time, I was an adoptive mother. So I had foster parented during medical school and then adopted one of my foster children. And he was really struggling, which was why I had adopted him. Not because I had the answers, but because I knew that I really wanted to get him out of the foster care system. Yeah, but didn't have any answers. And so that was this other life of mine outside of my medical training, is I need answers as a mother for my child who is headed towards a path that is awful if I don't find answers to help him shift gears. Yeah. And what happened during the middle of surgery residency was that that adoption failed. And the grief of that was actually the final straw that broke my body. And one month later, I woke up, was on transplant surgery rotation, and found I couldn't actually get out of bed.

Dr. Alex Carrasco 1:51

Wow.

Dr. Aimie Apigian 1:52

And that had never happened to me before. I'd always been very strong. My definition of strong back then was shove it all down, don't feel your surgery resonates. So, I mean, there is a type. There is a stigma, and we hold true to the stigma. Yeah, we're proud of the stigma. And that was when I first realized I need to learn a different way of living life because that grief opened up something that was so much bigger than what I could process, or I had the skills to move through. And it is actually what then triggered the chronic fatigue syndrome that I got diagnosed with and then autoimmunity.

Finding Functional Medicine and Trauma Healing

Dr. Alex Carrasco 2:34

Wow.

Dr. Aimie Apigian 2:35

And it was so bad that I had to take a medical leave from residency for several months. And it was a process to figure out how do I get my life back, how do I get my health back? And that is really when I landed on the fact that I need to do my own trauma work.

Dr. Alex Carrasco 2:54

Yeah.

Dr. Aimie Apigian 2:55

That was how I found functional medicine. And so at the same time, I'm learning functional medicine and I'm also embarking on this thing called trauma healing and having no idea what I'm doing. And were you still a resident? Yes. How? Well, on a medical leave at that point, because my symptoms were so severe I couldn't even get a few hours through work. And it was one of those classic presentations that I had been trained in, starting in medical school, of that patient that comes in and they have all of these vague symptoms.

Dr. Alex Carrasco 3:38

It's that patient that no one wants 4 p.m., especially at the end of a clinic day.

Dr. Aimie Apigian 3:43

And we talk about them behind the closed doors, saying things about them that would be very rude if an everyday person were to hear those conversations and not understand the context of the physician side of things. Right.

Dr. Alex Carrasco 3:58

Because it's overwhelming. How can you help someone?

Dr. Aimie Apigian 4:02

Exactly. Yeah. I am here to help you to I have no idea what's wrong with you. And so I'm gonna say that it's all in your head. Yeah.

Dr. Alex Carrasco 4:09

And so all of a sudden you're like just stressed.

Dr. Aimie Apigian 4:12

Right. So here all of a sudden, I am that patient that I've always viewed a certain way. Yeah. And wow, what a wake-up call. And that was my big internal shift towards that is why I knew that I needed to do my own trauma work and had no idea what to do, other than what I'd always told my patients to do, which was, you know, you should probably go talk to someone about that.

When Talk Therapy Did Not Create Forward Movement

Dr. Aimie Apigian 4:41

And so here I go in to talk to someone about that. And what I find happens is I have this great therapy session. And I am so proud of myself. I opened up, I talked about all the stuff, I probably cried a lot. And that was my definition of great session. And yet I'd come home and I would head straight for the kitchen for comfort food, take it to the couch, where I then proceeded to lay on the couch for the rest of the evening, unable to focus, unable to do anything, unable to have any productive activity or thought. It was like I was even more exhausted and numbed out and zoned out and checked out. Yeah. And I'm like, this can't be right. Like this, this does not look like the healing journey that I take my patients through when I've done surgery on them. Right. It's like you have a cathartic experience, but it doesn't result in any forward movement. Yeah. And it's the contrast that really helped me because here I am. I'm a physician. I'm trained to take someone who comes in sick, fever, high white count, abdominal pain, take them to the OR, do the surgery, take out the appendix or the gallbladder or whatever it is. Yeah. And then still support them on the healing journey so that their wound heals. And not just the skin surface wound, but inside. Yeah. And being able to see that healing process and then being able to look at my healing process. And I'm like, this is nothing like what I know the body is designed to do. I'm not sure that other people can have that contrast because if they haven't been on that physician side of things, how would they even know? Right.

Dr. Alex Carrasco 6:37

And so that was, I'd say, deeper if they haven't been on the surgical side of things. This is also true. Because not everyone sees how the body can heal. This is also true.

Dr. Aimie Apigian 6:48

You know, and how the body fights fights, it fights for you, it fights for life. Yeah. And I really got to see that in the ICU. Yeah. Patients on the edge for having to revive them and see how much the body actually fights to be alive. Right. And so then to apply that to observing my own energy levels and being able to see these three states of the nervous system and the different energy levels that are associated with each one.

Dr. Alex Carrasco 7:23

Well, let's talk about that. What three states?

The Three States of the Nervous System

Dr. Aimie Apigian 7:26

So in medical school, we are taught about two. Right. We are taught about parasympathetic and sympathetic, which is true. And there's this other layer now. So what people will probably understand is the term parasympathetic has been labeled as rest and digest. And it's the idea that you are feeling calm and safe. And so your body is in this rest and digest state. It's not exactly the whole picture.

Dr. Alex Carrasco 7:58

Okay.

Dr. Aimie Apigian 7:58

But then the other state that we are very clear on is the sympathetic state. This is what people will recognize as fight or flight. Yeah. This is the high adrenaline state that you need when you need to survive in the moment from an active danger. Right. And those two states are where we want to be spending the most amount of our time. Even in an everyday activity, we want some stress because stress is how we grow. In fact, this is how we grow our muscles. I've got to go to the gym and actually stress these muscles out.

Dr. Alex Carrasco 8:39

So true.

Dr. Aimie Apigian 8:40

Sad in order. We wish that there were a different way. Isn't that just thinking of manifest strength through peace? The stress plus rest is that rhythm that we want in every day of our life. And is that like a one stress?

Dr. Alex Carrasco 8:57

Or is that what's the ratio?

Dr. Aimie Apigian 8:59

What's the it's gonna be different for every person because it also depends on the degree of stress that you are experiencing. If the more intense the stress, the more rest. The more rest you need.

Dr. Alex Carrasco 9:15

So you as a surgeon and a foster mom had a lot of stress and no rest.

Dr. Aimie Apigian 9:21

A lot of stress with no

Stress vs. Overwhelm, Freeze, and Shutdown

Dr. Aimie Apigian 9:23

rest, which means that I was going into the third state so often that this is now where I was living most of the time. And that third state is really a state of overwhelm.

Dr. Alex Carrasco 9:35

Yeah.

Dr. Aimie Apigian 9:36

It's not calm because I feel safe. Yeah. It's collapsed. It's no longer fight or flight in the face of a threat. It's I'm so overwhelmed by the size of the pressures, the demands, the responsibilities in my life that I'm just gonna curl up into a ball and want to hide from the world.

Dr. Alex Carrasco 10:02

Yeah.

Dr. Aimie Apigian 10:02

Rather than taking action, I'm an inaction.

Dr. Alex Carrasco 10:07

Yeah.

Dr. Aimie Apigian 10:08

And so people will often hear the term freeze response. That's the first step of this other state. Yeah. Which it starts with hey, there's a threat which we will experience either as an actual danger, like a car coming towards me, or a threat is also looking at my to-do list and seeing like there is no way I can get through this to-do list. And this to-do list feels like it's survival. Exactly. So the moment that you're dissociating when you look at your to-do list, that is your trauma response, actually. And we haven't known to call it that. Yeah. But it's actually very different physiology than the stress response. Okay. The stress response is the equivalent of your foot being on the gas pedal. Yeah. And what does that look like?

Dr. Alex Carrasco 10:58

Is that like adrenaline?

Dr. Aimie Apigian 11:00

And it is always adrenaline. Yeah. The sympathetic system, the gas, is always adrenaline. And that adrenaline does what we need in that stress state. Yeah. I also call this the activation state because stress has such a bad wrap, and it's really not bad at all. Yeah. So let's just call it activation so that we don't label it as bad. Yeah. And just see like if I am running a marathon, I need to be activated. If I'm getting up to speak in front of a crowd, I need some activation. Is that a life threat? No. I mean, you might think that public speaking is a life threat, in which case you might freeze, but for a lot of people, it's that state of just upregulation of my energy, of my alertness in a way that this is who I need to be. This is how I need to show up right now in my life. But at some point, our body has a critical line. And that critical line refers to my capacity to respond. Right. And so just taking public speaking as one example, based on your past experiences and what that means to you to stand in front of a crowd of people and be judged, be criticized, ridiculed, whatever it is that is the meaning associated with that, you are now perceiving that as a life threat. Right. And that might cross the critical.

Dr. Alex Carrasco 12:30

And it might not even be a real a reality.

Dr. Aimie Apigian 12:32

No, this is perception. This is your meaning. Yeah. The meaning that your past experiences have created for this thing, person, place, or thing. Yeah. And based on the meaning or the perception of the size of danger, will then push that adrenaline to different levels. So just think of driving a car. You can have your foot on the gas a little bit, or you can have it all the way down to the floor. And that's exactly what happens in our body. And when we are pushing that gas pedal all the way down to the floor, that is okay for a

The Critical Line of Overwhelm

Dr. Aimie Apigian 13:07

moment in time, but that is unsustainable. And so when we reach the point where our body says, okay, that is so much fear that I can no longer respond, then that's when it almost like trips the emergency break. Yeah. And this is where labs can start to look very confusing because we can have high cortisol, which is actually just being driven by adrenaline. Right. So we can have the high cortisol, but be in this tired, collapsed exhaustion state, and we think that the cortisol is the problem. Right. No, the cortisol even isn't even able to do its job, which its job is to protect us from the adrenaline because the emergency brake is on.

Dr. Alex Carrasco 13:53

Right.

Dr. Aimie Apigian 13:54

And so this is where understanding the operating state of the body, which is driven by the nervous system. It's like the orchestra, the conductor is the nervous system, tells the whole orchestra what song we're playing, in what key, what tempo. And the whole body shifts to what the conductor is saying. And so the digestive system cannot be in parasympathetic, ventral, vagal, rest, and digest mode, but yet my kidneys are in sympathetic mode, or my heart is in overwhelm mode. They're all in one of those states because it's the whole system, it's the operating system. It's the switch. And so that's then becoming the most important piece for people's health, their mental health, their emotional health, but also their physical health is what state are you living in most of the time? Yeah. Because where I got to the point where I was mostly in overwhelm. Yeah. I was, I was not even able to generate the adrenaline function anymore. And I could for maybe a brief moment in time if I drank enough caffeine, or if I fasted, or if I did these things that we know creates adrenaline, but it wasn't even, there was so little gas in the tank that it wouldn't take long for it to reach that line, that critical line again, and whoop, we're back and feeling the depletion that a person will feel when they're in this third state of the nervous system.

Dr. Alex Carrasco 15:34

And what is the that third state called? Like, is there a clinical name for it now? In the polyvagal lens.

Dr. Aimie Apigian 15:41

Yes, let's talk about polyvagal

Understanding the Dorsal Vagal State

Dr. Aimie Apigian 15:43

theory, please. Yeah. It is called the dorsal vagal state.

Dr. Alex Carrasco 15:47

Okay.

Dr. Aimie Apigian 15:48

And that refers to the signal to shut down in order to survive, comes from the vagus nerve, which just a side note then all vagus nerve activation is not good. You have to be very careful.

Dr. Alex Carrasco 16:04

Okay.

Dr. Aimie Apigian 16:05

Because you are working with vagus nerve activity. And sometimes that can tap into stored trauma and not just the ventral vagal. Rest and digest activity that you're trying to promote with these vagus nerve stimulation activities or devices. Right. And so the dorsal vagal state refers to the fact that the vagus nerve is just the train tracks.

Dr. Alex Carrasco 16:32

Okay.

Dr. Aimie Apigian 16:32

It's just the nerve. It's more important. Well, which train is running down the train tracks? Interesting. Is it the train that gives the message to the whole body of we're safe? Yeah. We're feeling supported. Yeah. We're feeling secure. So let's connect. Let's open up. Let's be creative. Yeah. Or is it the other train? And is it the train that gets triggered when the panic and adrenaline reach such a high level that the body says, I can't respond to this. This is much bigger than me. And then the other train leaves that train station. And now the message coming down to the whole body through the vagus nerve is let's hibernate to get through this.

Dr. Alex Carrasco 17:18

Yeah.

Dr. Aimie Apigian 17:19

And that is why it feels like in order to get through this, I have to push my body. Right. There's not this natural vitality that I wake up with. I wake up and I'm like, shit. I don't want to, yeah. I don't want to be awake. Yeah. It's not that I don't want to get up. I don't even want to be awake. Wow. And what do I need to do? Because I can't lay here in bed all day. I have this and this and this and this. I am this and this and this and this. And so we reach for those things that help us push through and create enough adrenaline that it gets us back into that stress state long enough to get something done, in which case our body's like, and I'm going back into the collapse.

The Body Trauma Loop

Dr. Aimie Apigian 18:07

And we get in the loop. Yeah. And that is what I call the body trauma loop, where we're just looping between the two survival states, stress and the trauma response. Wow.

Dr. Alex Carrasco 18:17

And so I think at one point in time you told me that the way that you approach trauma was basically with surgical precision. And that you wanted outcomes like just like you said earlier,

A Precision Approach to Nervous System Healing

Dr. Alex Carrasco 18:31

like a surgeon. So walk me through that. What does that look like?

Dr. Aimie Apigian 18:37

You know, two people can show up and they're both complaining of anxiety, sleep problems. Let's throw in some digestive issues since everyone seems to have those. Yes. Why not include some mast cell activation symptoms? Very invoke right now. Some long haul syndromes. Whatever we want to throw in the mix. Right. Two people, very similar symptoms, and yet they can have different patterns in their nervous system. That we want to be precise about what they need at this point of their healing journey. Okay. Maybe someone has still enough of that oomph gas in their tank that they are generating a stress response and they are mostly in stress. That is very different than a person who has waited so long that they can't even generate a stress response.

Dr. Alex Carrasco 19:28

Yeah, like what about the patients that have like PEM?

Dr. Aimie Apigian 19:31

Exactly.

Dr. Alex Carrasco 19:32

Like what do you do there?

Dr. Aimie Apigian 19:33

So the idea is being able to see this is where your nervous system is at right now, knowing that there's this progression of the longer we wait, the longer the burden is created and accumulated, the more that there will be this pattern of stored trauma in the body. And that that just means that any new stress, and we already know what your body's going to do. Your body is either going to, if it's earlier in the process, be stressed by it.

Dr. Alex Carrasco 20:03

Yeah.

Dr. Aimie Apigian 20:04

Or if it's later in the process, just fall into the collapse and overwhelm. But knowing which one you are at right now helps us then be able to know, well, if you're this at this stage, this is what your body needs. We need to focus on repair, we need to focus on support so that your body actually has the nutrients to sustain that stress response and be able to complete it as we then work on decreasing the triggers for that stress response. Yeah. But if you're not even able to generate a stress response, that is not the right place to start. And so these general protocols, especially the ones that say, like, well, you should reduce your stress, you should manage your stress better. Yeah. That's not even gonna touch someone who's no longer even in stress, even though they won't have the words to explain that to their provider, because they're still saying, I'm anxious and stressed, but it's actually so much more than that. It's actually overwhelm, yeah, not stress. Yeah. So the more precise we can be about knowing where your nervous system is at right now, the degree of burden helps us know where to insert that intervention at this point that will be exactly what your nervous system needs to start to move back towards healthy rhythms and resilience.

Dr. Alex Carrasco 21:25

Yeah, I think at one point you had also shared that, you know, in some of the courses that you teach, people have these really amazing transformations, you know, unexpected, kind of like medical miracles, right? So what do you say to that patient that say does have PEM crashes or can't get up and they had long COVID? You know, how do you how does your

Why Dr. Apigian Entered Addiction Medicine

Dr. Alex Carrasco 21:45

approach help? Because it's a totally different lens.

Dr. Aimie Apigian 21:48

I know. But you know, when I I came into this work through grief. Yeah. And as I piece together my path back to health. I then decided to study trauma and the body. And that's when I became an addiction medicine physician. That's so cool. Because at that point it was just me. I'm in of one.

Dr. Alex Carrasco 22:11

Yeah.

Dr. Aimie Apigian 22:12

Doesn't mean much in science, in of one.

Dr. Alex Carrasco 22:14

So you decided, okay, I'm not going to be a surgeon.

Dr. Aimie Apigian 22:16

Right.

Dr. Alex Carrasco 22:17

I'm going to pivot.

Dr. Aimie Apigian 22:18

Yep. And then you went into addiction. Yes. Yeah. So that I could study trauma in the body from my patients. Because of all the people in the world. Yeah. Of all the fields in medicine, that is the population that is most sensitive, raw, and most avoidant of feeling. Right. And so if I could help them figure out how to shift their state, how to actually create a change in their health and their life by the nervous system work, I knew that I could teach anybody that.

Dr. Alex Carrasco 23:03

Okay.

Dr. Aimie Apigian 23:04

And so what I started to do with them was try different things that had helped me and see what is it that makes the biggest difference for your symptoms and for them. It's not relapsing.

Dr. Alex Carrasco 23:17

Right.

Dr. Aimie Apigian 23:17

I can get you through a detox, but it's when I send you home.

Dr. Alex Carrasco 23:21

Right.

Dr. Aimie Apigian 23:21

That's when we are really stress testing. Are you ready for this? Are you ready for living life a different way? And what I found surprised me because here I am, again, coming from the lens of a physician, where I have been taught that the most powerful thing I can do is to get out my prescription pad and to write the right medication for you.

The Power of Simple Somatic Exercises

Dr. Alex Carrasco 23:45

Yeah.

Dr. Aimie Apigian 23:46

And here I'm seeing that the best intervention I can provide them at this point is teaching them simple somatic exercises, somatic referring to body-based exercises that gives them the power, the agency in the moment to choose something different because they can create a feeling of safe enough right here, right now. Okay. And I realized that's it. People are so afraid to feel their feelings because the more high functioning they are, the more they are afraid of falling apart. Yeah. The more they feel the need to shove that down, keep that buried, because if it were to come to the surface, I would fall apart and I can't fall apart. And for them, if they were to feel their feelings, they knew that they would use their substance of choice. Right. And so for me to be able to see that those exercises, more than any supplement, more than any diet, more than any prescription medication, was helping them the most not relapse. Wow. I realized there's something here. But then, as you're saying, other things started to happen. And enough people said the same thing that I'm like, wait, what did you say happened? Because I wasn't expecting that. And then when I made this into my course and I'm teaching people these same exact exercises, I started measuring and asking about these things specifically because I wanted to

What Changed in the First 21 Days

Dr. Aimie Apigian 25:21

see, is this really something? Yeah. Or was that just a random occurrence in the addiction medicine population? And no, it's statistically held true. So as people come through and learn these exercises, in the first 21 days, they experience all kinds of changes in their health that they haven't even been trying to do. We haven't even talked about gut health yet. We haven't even gone into the deeper work and the biology of trauma work. This is just, I need you to learn how to create a feeling of safe enough right here, right now, in the next 30 seconds. Here's how to do it. I'm going to teach you a different exercise every day for 21 days. 30% decrease in sleep problems. Whatever they are, 30% decrease in those sleep problems, 27% decrease in GI issues. Whatever the issue is, constipation, diarrhea, pain, bloating, doesn't matter. All of them are experiencing on average a 27% decrease. 28% decrease in anxiety, 28% decrease in depression. Wow. And 26% decrease in daily physical pain. All at the same time. So it's not like one person only experiences this one in, I don't know which one. In three weeks. In three weeks, in 21 days. Yeah. And that was when I realized that there is magic to this. I hate to use that word because it it seems to exclude science. Right. But the science, when applied in the right way, is healing. It is healing. Yeah. And things will start to shift that you weren't even expecting to shift, just as a byproduct of the work that we're doing.

Dr. Alex Carrasco 27:11

That's so fascinating. Can you give us like a taste of what one of

A Stomach Support Exercise for Felt Safety

Dr. Alex Carrasco 27:17

your exercises is? Yeah. Yeah. Absolutely. Okay.

Dr. Aimie Apigian 27:20

Uh, so what I will do is I will give you this and I'm going to ask you to put this over your belly. Okay. Yep. Keep the one behind your back because I want you to have some back support. That's another one of the exercises. So I don't want to take away your back support. I want you to bring in what I call stomach support. Okay. This is one of the exercises that I teach everyone, especially those with any habits of emotional eating. And see, this is exactly what I teach people to do. I want you to just feel it and see how can I make this better? Okay. I want the pillow this way. Okay. Okay. And so many of us are used to analyzing. And as soon as they make it change or they feel that they want it differently, they always ask me, well, why? And I'm like, doesn't matter. Right. Doesn't matter. Right. Let's just get into the actual feeling connected with our body. And if our body is saying, hey, I'm kind of like the pillow this way, or a little to the right, a little to the left, more pressure, less pressure. Can we just say, okay, I'd love to do that for you? Why do we live so much in our head? Right. And so just this is an exercise that I will bring in for people, especially with digestive issues, and ask them to put something over their belly when they go to eat.

Dr. Alex Carrasco 28:37

Oh, interesting.

Dr. Aimie Apigian 28:38

There's something about having protection over our belly that lets those muscles relax, soften.

Dr. Alex Carrasco 28:45

Yeah.

Dr. Aimie Apigian 28:46

It's almost like our abdominal wall muscles brace in order to help protect us from, well, who who knows what? But the danger that we think might be around the corner.

Dr. Alex Carrasco 28:57

Right.

Dr. Aimie Apigian 28:57

That's just it. We we live our life expecting bad things to happen. And so we're always braced and bringing in that sense of I've got you right now. Yeah.

Dr. Alex Carrasco 29:06

Being held.

Dr. Aimie Apigian 29:07

Being held. You can relax because I'm going to protect you for right now. And then I ask people to take the pillow away. I'm so sorry, take the pillow away. And what do you notice? Um, what do you notice when you take it away?

Dr. Alex Carrasco 29:22

I guess I feel like it's um kind of empty. Empty.

Dr. Aimie Apigian 29:27

Yeah.

Dr. Alex Carrasco 29:28

Yeah. It's not as warm. Not as warm.

Dr. Aimie Apigian 29:30

Yeah. People use the word I feel more vulnerable.

Dr. Alex Carrasco 29:35

Yeah.

Dr. Aimie Apigian 29:35

I feel exposed. I feel open, exposed. Yeah. Well then put the pillow back on, please.

Dr. Alex Carrasco 29:41

Me in the microphone. Pillow.

Dr. Aimie Apigian 29:45

This is the simple exercise. Just that awareness, right? Yes. And being able to realize I can create a feeling of being held. Yeah. I can create the feeling of this warm protection at any time that I want to. Yeah. I don't have to wait for someone else. I don't have to uh wait until my therapy appointment. Yeah. I have tools. Yeah. I love

Why Pressure and Weight Can Feel Regulating

Dr. Aimie Apigian 30:13

it. I can create this wherever I am. I do it now while I'm driving, while I'm working, while I'm eating. Do you have a special pillow? No.

Dr. Alex Carrasco 30:20

I have a weighted blanket. Oh, I was gonna ask about that actually.

Dr. Aimie Apigian 30:24

Weight.

Dr. Alex Carrasco 30:24

My body loves weight. Mine does too. So I have to tell you, there's this really funny, like, I sent this to my husband because there's this ad um of this, of this weighted blanket. I think it's called Burby.

Dr. Aimie Apigian 30:37

Yeah.

Dr. Alex Carrasco 30:38

And it shows how, like, if you you get like 10% of your body weight on top of you, that tends to be like the sweet spot for people when they sleep. And then they said, but if you don't get this blanket, you end up having like seven blankets on top of you to try and get that weight. And I sent it to my husband because it's true. I literally my whole life have slept with like at least 10 layers. And it's not because I'm cold, it's because I need the pressure.

Dr. Aimie Apigian 31:02

Yeah.

Dr. Alex Carrasco 31:02

So tell me about that.

Dr. Aimie Apigian 31:04

Yeah. You know, and what's fascinating is then to experiment where does my body like that pressure the most? Not on my feet. Not on my feet either. My body loves that pressure on my stomach. Interesting. And so now I lay down. I do have scoliosis. And so I have my feet up on pillows so that my back is flat.

Dr. Alex Carrasco 31:22

Yeah.

Dr. Aimie Apigian 31:22

And then I put all 21 pounds on my belly. It's not spread out over my whole body. Yeah. And I have found like that will drop me into sleep faster than anything else. So interesting. So interesting.

Dr. Alex Carrasco 31:35

What is that? Is that like being restricted in the womb? And that reminds us of that safety. Or do you have, or tell me, like what's the why behind that?

Dr. Aimie Apigian 31:45

There's there's so much that who knows the real answer.

Dr. Alex Carrasco 31:51

Or specific answer. Right.

Dr. Aimie Apigian 31:53

And at the end of the day, again, like does it matter? Right. No, it's just fun to think about. Fun to think about, fun to analyze ourselves. Yeah. And there's so much around what is held in our gut. So many emotions are held in our gut. That's why we call it a gut feeling. Yeah. And even being able to have that connection with our nervous system and our gut, then that is communicated up our vagus nerve to our brainstem, communicating safety.

Dr. Alex Carrasco 32:22

Yeah.

Dr. Aimie Apigian 32:22

And so, especially with those with IBS or digestive issues, some sometimes, not everyone, but sometimes having the weight there m decreases those pain signals. That's a signal of safety to the brain. Pain is a signal of danger to the brain.

Dr. Alex Carrasco 32:38

Right.

Dr. Aimie Apigian 32:39

And so it can be a way to quiet that noise, which again, if I can do that for my body a few times a day and just have it feel safer.

Dr. Alex Carrasco 32:48

Yeah.

Dr. Aimie Apigian 32:49

Why would I not? I want my body to feel safe so that it can show up for me the way I want to show up in the world. Yeah. That's really cool.

Dr. Alex Carrasco 32:58

Yeah.

Dr. Aimie Apigian 32:59

So then in the book and in the course, you kind of guide people through that. I do. I've got the course, the foundational journey. And it's the skills that a person needs to safely then go and do the deeper work. Okay.

Building Capacity Before Deeper Trauma Work

Dr. Aimie Apigian 33:13

Whether they do the deeper work with me, and I have the whole biology of trauma program, or they go and do the deeper work with someone else, you still need to know how to swim before you jump into the deep end of the pool. Ideally. Otherwise, we risk only reinforcing the overwhelm. Right. Even something good can still be too much too fast.

Dr. Alex Carrasco 33:34

Yeah.

Dr. Aimie Apigian 33:35

And it overwhelms us. And every single time we allow that overwhelm, we are literally reinforcing trauma biology into ourselves.

Dr. Alex Carrasco 33:45

And like, does that create a plastic?

Dr. Aimie Apigian 33:48

Exactly. Like and then we have negative neuroplastics. Yeah. Negative simply because it's taking you in a direction that you don't want to go. And then it's becoming this well-worn road. And that becomes your path in your neural neurons that say any stress is now a reason for an overwhelm response. Yeah. Versus being able to reprogram that through neuroplasticity and build your capacity, build new neural pathways that say, I can do this. Right. And I can pace and I can build my capacity to be able to respond to stress, complete those stress responses, and stay out of that overwhelm where there's no growth. There's no growth and overwhelming.

Dr. Alex Carrasco 34:36

Yeah, I think that it's just amazing. So for our clinician audience, we have a large clinician audience. So for clinicians that are listening, you know, what would you tell them? Like, you know, we all, a lot of us take care of chronic complex patients. Um, there's also probably people that are just starting to kind of step into the world of um precision medicine,

What Clinicians Need to Know

Dr. Alex Carrasco 34:57

integrated medicine, functional medicine. And we talk about trauma as a, you know, we talk about trauma as a factor, but we don't always have tools for it. So we're like, go to therapy, go to see a trauma therapist, go to EMDR, go to ETT. Um, but you know, what would you do, like like what do you wish all doctors or clinicians knew?

Dr. Aimie Apigian 35:17

I'm gonna specifically speak to the more complex patients that walk in. Yeah. And what I would want the clinicians to know is that not all therapies are the same. Not all programs are the same. Once a person has reached that level of complexity and their metabolism and their immune system and their digestive system, then it really needs to start with the skills of a person learning to shift their state. So sending them to a program that works on retraining your brain is not actually what they need. They don't need retraining of their brain. They need, they need skills to shift their state in the moment. Then once they gain those skills, now we can layer in, okay, now maybe let's look at more of this other, all of these other modalities that can be helpful. But this is where we can be more precise about the nervous system regulation piece that we all know is needed. It's that not all programs, not all therapies are the right thing at the right time. And where patients experience the most help when they're coming in with a complex syndrome is the somatic work and the parts work. Those together create an internal sense of safety along with an internal sense of peace that they can

Somatic Work and Parts Work

Dr. Aimie Apigian 36:42

create for themselves in the moment. So the somatic work is like kind of the example that you just showed me. What's the parts work? Parts work. So parts work refers to this idea that there's a different part of me. I have one part of me that loves to eat chocolate cake. And then there's this other part of me that says chocolate cake is bad for you and you should only eat salad. Yeah. And when I go to eat dinner, I hear those two parts in my head fighting. Right. And that's what creates the inner tension and the inner conflict.

Dr. Alex Carrasco 37:14

Yeah.

Dr. Aimie Apigian 37:14

And that's why when we start to bring in parts work and we can actually work with, communicate with, negotiate with these different parts of us, then we have more skills to create the inner peace and not just live with that conflict of, well, I can only give one part of me what it wants. One part is gonna get the chocolate cake and the other part's not gonna get anything.

Dr. Alex Carrasco 37:36

So is this part of the work that you figured out with your addiction patients? Because this is very different from anything I've heard before.

Dr. Aimie Apigian 37:43

Yes. Yeah. This was necessary. This was a necessary layer to bring in on top of that body piece. Right. And then even being able to see in the moment they have a trigger and all of a sudden their heart is racing and they're ready to use right now. If we've done the somatic work and they can pause and be like, okay, I can shift my state, it's so helpful to then be like, what part of you just got triggered? What was it that happened? Did someone say something? Did someone not say something? Did and what part of, oh, it's that child part of you that lived with a parent who was emotionally absent. And so what that situation just did was trigger that part of you that has never had the healing. Right. And now we can work with that part and we can learn how to show up for that part from our adult self and give it the nurture, the presence, yeah, the attention that it didn't get back then and it has still stayed stuck as a little child because it's never had the healing. Wow.

Dr. Alex Carrasco 38:49

Yeah, it's interesting that you talk also about the like the salad and chocolate cake, especially in the current um, I guess, environment of you know, GLP1s and you know, these are wonderful tools that that can help a lot too. But I also think that a lot of disordered eating is you know surging on probably.

Dr. Aimie Apigian 39:12

I mean, I see all disordered eating as a manifestation, an expression of a nervous system that's just dysregulated and can't calm down on its own.

Healing the Mind, Body, and Biology

Dr. Aimie Apigian 39:23

Yeah. Yeah.

Dr. Alex Carrasco 39:25

So in your book, do you talk about the parts work or is that you do? Okay.

Dr. Aimie Apigian 39:30

And then in the course as well. I do because the way that I see it now is we need to address all three layers. What's the third layer? We haven't gotten there yet. We we have, we just haven't labeled it as the third layer. Okay. Because all three layers are going to influence whether my nervous system, my autonomic nervous system, is getting the signals of safety or getting signals of danger. Right. And if one layer even gets missed, it will continue to give signals of danger to my nervous system. And all this other work that I've done over here will not be enough to outweigh the ongoing signals of danger. So the layers are mind layer. So this is where I do the parts work for the thoughts that appear in your head, the beliefs that you hold about yourself, the beliefs that you hold about others, the perceptions that you have about the world, the body layer, which is the somatic layer. Right. And then the biology layer. Okay. I separate body and biology because the somatic layer is a crucial one. Most people in medicine are not really aware of the somatic layer. Right. And this is the layer that doesn't respond to logic. Right. It responds to sensory input that then has a meaning associated with it. I call it being coupled. Okay. And so a smell can be coupled with a memory. Right. A sight, a sound. These are all sensory inputs and they have couples. And so maybe that is coupled with oh, when I smell lavender, I think of my grandmother dying. Right. And she would right. Then there's the meaning. There's the whole story.

Dr. Alex Carrasco 41:21

When I smell pine salt, I am so happy because all of like the Cuban old ladies in Miami wash their houses with that pine.

Dr. Aimie Apigian 41:29

That's funny. Yeah.

Dr. Alex Carrasco 41:30

Yeah.

Dr. Aimie Apigian 41:30

We smell cinnamon and we have a body reaction. Yeah. That's that body reaction will happen regardless of what you decide you want your reaction to be. Right. Because the olfactory nervous the somatic layer. Yeah. And so that I feel like most clinicians are much more familiar with the mental layer and biology. And they and the biology. And they approach the mental layer with mindset rather than parts work, which is going to fail. Yeah. But then they they're just not aware of the somatic layer. And so when I started training with Peter Levine and somatic experiencing, it opened my eyes to how the body stores these implicit memories. And even a certain movement, a certain posture will trigger this implicit memory of what danger I was in in previous years and experience. And I won't even know what I'm reacting to.

Somatic Coupling and Complex Symptoms

Dr. Aimie Apigian 42:33

I will just know that all of a sudden I feel anxious. All of a sudden, I feel like I'm panicking. I've got to get out of here. I've got to, whatever it is. And it's because it's stored at the somatic layer as well. So that's why the somatic layer is one of the most important ones for the complex patients because they have so much that has been coupled. Right. Now we have mast cells that have been coupled with a chemical. We have mast cells that have been coupled with a food. And we're trying to just quiet that with Cursitan and bromolane, but not actually addressing the somatic coupling of it. Right. Until we can bring in that somatic piece. And that's why all therapies are not the same. You cannot send them to a brain retraining program and expect the somatic coupling to change with mental work.

Dr. Alex Carrasco 43:23

And so then would that would that be like do you do somatic training within your programs as well?

Dr. Aimie Apigian 43:29

100%. All right. We do all three layers. That's amazing. Mind, parts work, somatic, and biology.

Dr. Alex Carrasco 43:36

Yeah. Yeah. But I feel like it's really comprehensive.

Dr. Aimie Apigian 43:41

It needs to be.

Dr. Alex Carrasco 43:42

Yeah. Yeah.

Dr. Aimie Apigian 43:43

It has to be.

Dr. Alex Carrasco 43:44

I don't know if any many other people are talking about medicine in the way that you're talking about. It's really it's very refreshing and eye-opening.

Dr. Aimie Apigian 43:52

Yeah. I feel like this is the truly integrative approach that we all have aspired to and haven't really known what to do and how to do it. Yeah.

Dr. Alex Carrasco 44:02

Yeah, because the trauma piece is so huge. It's so big. Yeah. And it's so deep. And it's so hard to understand. And it's it's not logical. Right? I mean, maybe there is a logic to it that you figure out piece together. But as a human being, you can't logic your way out of it necessarily.

Dr. Aimie Apigian 44:20

And that's the important thing to know.

Dr. Alex Carrasco 44:22

Because you can be a logical person and say, like, I understand that this behavior is detrimental to me. Right. And still not be able to change it. Yeah. Yeah. And I think that's that's I see that a lot in my practice. Yeah. And I I think probably our audience does too.

Resources for Individuals and Practitioners

Dr. Alex Carrasco 44:39

And that's where we've got to go to these other layers. Yeah. Okay. So if you're listening, you know, how can people learn more about you? How can they learn your work? Are you training people? Like, how does everyone in the world learn how to do this kind of medicine?

Dr. Aimie Apigian 44:53

Sure. So they can find me at biology of trauma.com. And my courses and programs are both for self-help individuals and practitioners. And I say that like in sense of self-help practitioners, because while I do train practitioners, I also expect them to do to experience this and to build their own capacity of their nervous system.

Dr. Alex Carrasco 45:16

Yeah.

Dr. Aimie Apigian 45:17

Because I experienced so much of my own overwhelm in working with people who had trauma, who had stories and were coming to me in pain. And I was just trying to hold it all, not knowing how to unburden my own nervous system.

Dr. Alex Carrasco 45:33

Yeah.

Dr. Aimie Apigian 45:34

And so this learning is very experiential. And so I'm taking them through the process of precision nervous system healing in order for them to learn how do I create this same experience for those that I help? It's even though the knowledge is important, it has to be embodied knowledge, meaning you know what it feels like to feel safe. Because if you don't know what it feels like, how can you create that feeling for someone else? Yeah. And that's what we have to have. Yeah, and be authentic about it. The nervous system requires a felt sense, yeah, a gut feeling. And that's what we need to learn to create for those that we help.

Dr. Alex Carrasco 46:14

I love that. Well, and how can people find you on Instagram, your website?

Dr. Aimie Apigian 46:19

They can find me on LinkedIn, on Instagram, my website. I do have a page on my website for my book where I have some resources. For the clinicians, especially, they will want to grab the nervous system journal.

Dr. Alex Carrasco 46:31

Okay.

Dr. Aimie Apigian 46:32

It's where I start someone to better understand where exactly is your nervous system, how often is it in overwhelm, how often is it in stress, so that I can know what's my intervention at this point. So they can grab that for free on my website, biology trauma.com.

Dr. Alex Carrasco 46:47

If you're a practitioner interested in exploring advanced biomarkers from Vibrant, you can learn more about testing options at vibrant wellness.com. And remember to follow us on Instagram at VibrantWellness. See you next time.