Recently I interviewed Dr. Aimie Apigian, and we chatted about stored trauma and thyroid autoimmunity. If you would prefer to listen the interview you can access it by Clicking Here [1].
Recently, I did an interview with Josie Warren, who personally dealt with multiple autoimmune conditions. She mentioned that chronic stress was the single most important factor in regaining her health. In this interview, Dr. Aimie will differentiate between stress and trauma. Even though I did the interviews about a month apart, I relistened to the episodes on my own back-to-back. While I always bring up stress to my patients, Dr. Amie made me realize that it’s not just about dealing with the fight or flight response and blocking out time for meditation, as it goes well beyond this.
I am very excited because I am going to chat with Dr. Aimie Apigian about stored trauma and thyroid health. Dr. Aimie is the leading medical expert on how life experiences get stored in the body and restore the body to its best state of health through her signature model and methodology, The Biology of Trauma. She is a double Board-certified medical physician in preventative medicine and addiction medicine. She has a Master’s in biochemistry and a Master’s in public health. In addition to her medical training, she is also a functional medicine physician. Dr. Aimie has trainings and certifications specifically in neuroautoimmunity; nutrition; genetics for addictions, mental health, and mood; and behavioral disorders. She has several certifications in various trauma therapies, including the instinctual trauma response model; somatic experiencing, which was developed by Dr. Peter Levine; and NeuroAffective Touch by Dr. Aline LaPierre. Thank you so much for joining us, Dr. Aimie.
Dr. Aimie Apigian:
Absolutely. I am really excited for this conversation. Such an important conversation. Thank you for the invitation.
Dr. Eric:
You’re welcome. I agree. Definitely a very important conversation we’re about to have. Can you start out by giving your background? How did you start helping people with trauma? Getting into how you developed your signature model and methodology, The Biology of Trauma.
Dr. Aimie:
When you were reading my introduction, it takes me down memory lane of all the different trainings I’ve had, yet at the end of the day, this was actually just for me to save my own life and to try to help my son Miguel, who I had adopted. It was while I was in medical school at Loma Linda University. 2008 was when Miguel came into my life. He was a foster child at the time, four years old, landed in my home. I thought I knew what to do. I thought that my love was strong enough to heal him of all of his prior wounds that he had had up until that point. I had so much to learn. He was really the one that opened that door up for me. I made a commitment to him to figure out what he needed in order to help him be happy. I wanted him to have some happy years in his childhood.
What I saw happening was that he was bringing his past with him as if it were still happening. My love continued to actually be a trigger for him, and he would be very reactive and not want to connect with me because that did not feel safe to him. When I saw that not changing with time, I got very worried about his future. I started diving into trauma at that time. It was specifically around attachment because that’s what I recognized was his core issue.
Then I went on to general surgery residency after medical school. I was finishing up my third year of general surgery residency. I am on transplant surgery rotation of all things. My body broke. I got so sick that I could not even get out of bed for a period of time. I saw my conventional medicine doctor and found from my lab results that I had high autoimmune markers, that my thyroid levels were off, but not yet to the point where they would diagnose me with anything. They did diagnose me with chronic fatigue because they couldn’t figure out why I was so fatigued that I could not get out of bed. I actually ended up having to take a medical leave; that’s how sick I got.
In the process, what I realized through my studies on trauma was that all of the health symptoms and conditions that I was having, or at least that I was on the pathway to having, all of them were related to adverse childhood experiences. I had no idea why because that was not me, or at least I thought. That was my son. My son had had a lot of childhood trauma. I had not. Why was I having the same health issues as one of them?
It started me on this pathway of asking questions around, well, what exactly is trauma? What exactly are those things that happen in childhood that create these adult-onset diseases? Through that process, I started learning and tracking my own system, experimenting with my own system, then started all of my trauma therapy trainings, all to help me better understand what was happening in my own body and how to get my life back. What I was experiencing was not what I wanted my future to be.
That is how I developed all this. That is how this started. This was never intended initially to go out and help other people, and certainly not to start a professional training program, where I am training professionals around the world in my methodology. This started with me having to figure it out for myself, not knowing if it could be done, not knowing if as an adult, we could actually rewire these trauma and stress patterns that have been in our system since childhood. I was willing to figure it out and do everything that I could in order to see if it could be done, just to get my life back.
Dr. Eric:
That is some story. Thanks for sharing. When working with any chronic health condition, most listeners have a thyroid or autoimmune thyroid condition, be it hypothyroidism or hyperthyroidism. A decent number of people will respond just to diet and lifestyle, stress management, getting proper sleep, taking supplementation. There will be people who just don’t respond, not to say that with all of these people, it’s adverse childhood experiences. Is it still safe to say that at least in some of these people, that is playing a role in them not getting the results they or I are expecting to get?
Dr. Aimie:
I may say something really controversial here. Many people might not want to hear me say this. This is what I have found: When it comes to these chronic diseases, especially autoimmune, all autoimmune conditions fall under the category of being trauma-related, not stress-related. That opens up this whole can of worms to be like, well, then when would you have experienced trauma? We need to redefine trauma because just like me, you may look back on your life and be like, “Me? I haven’t had trauma. I relate to being stressed, but not traumatized.” I had to relook at what is trauma? That’s why I call it the Biology of Trauma. There is a whole biology of trauma. Autoimmune conditions are squarely in the freeze response or trauma response category.
Dr. Eric:
That brings us to the question: What is the difference between stress and trauma? Why don’t we dive into that right now?
Dr. Aimie:
Let’s do it. This is a really important distinction. Most people aren’t aware of this distinction. Most professionals, even practitioners, you will still hear them say, “fight, flight, or freeze,” as if all three of those are the same. They’re not. Many people are being diagnosed with stress or even chronic stress when they should be diagnosed with trauma. You are in a trauma response. Your body is chronically in a trauma response, not a stress response. Here is the difference.
There are three ways you can tell the difference between stress response and a trauma response. One is your body’s sensations. One is the thoughts you’re having. The other one is the physical health conditions or symptoms you are experiencing.
Let’s go with body sensations first. When you are in a stress response, it is that state when you are actively running or facing and fighting the danger in your life, whatever that danger is, whatever that problem is. It is when you are running from that dog who is going to bite you. It is when you are racing towards your meeting in order to get there on time. It is a very high energy state. Your senses are very alert and tuned into the problem. What are all the different factors contributing to that problem? What do I need to do to face that problem? Stress response is when you don’t want to go to bed because you actively have a problem, and you want to solve it. You’re taking action to solve it.
The trauma response is when it feels like things have been too much, and all you want to do is go to bed. In fact, you don’t want to get out of bed. You want to pull the covers over your head. There is a problem in your life, but it feels like you don’t have the energy to face the problem. There is this sensation of a collapse of energy, a low energy. In fact, when you feel into your body, it’s when you want to curl up into a ball.
A fight response is, “No, I am going to fight you.” The trauma response is, “I’m done fighting. I don’t have the energy to fight anymore. I may still go through the motions because I still have responsibilities. I still have a job, I still have kids, I still have a partner, I still have life.” That is what it feels like. “I’m just going through the motions” rather than experiencing the aliveness and energy and joy and feeling like you’re actually present and engaged.
The trauma response will have you feeling like you’re distanced, like things are a little foggy. Things are a little numb. You don’t feel like you belong. You feel like you’re on the outside looking in, sometimes at your own life, let alone at a group of people. You can be surrounded by a group of people yet still feel very alone. That is the trauma response. That is the difference between trauma and stress.
Dr. Eric:
If someone is dealing with chronic stress, oftentimes, you will hear practitioners, and that includes myself, talk about blocking out time for stress management and incorporating mind/body medicine, whether it’s meditation or yoga or biofeedback or tai chi, or anything else. Is it safe to say then that with trauma, that is not the solution? Let me ask this differently; Does mind-body medicine play any role when it comes to trauma? Is it for those who are chronically stressed?
Dr. Aimie:
Like you say, there is a lot of different modalities. Rather than focusing on which modality, I teach the principles of what the trauma response needs in order to come out of the trauma response. What does the stress response need? Those are two very different things. When we think that it’s stress, and we apply tools for stress, but it’s actually trauma response, those tools aren’t going to work.
That’s when people can get stuck, or they experience resolution of those physical health symptoms, but then other physical health symptoms appear. I have seen this quite often in people who do some of these different modalities that maybe their gut issues resolve, their thyroid issues resolve, but then it shows up as something else, like chronic pain or inflammation somewhere else. It always shows up somewhere until we actually work with and resolve the true underlying and root cause.
What the trauma response needs is three things. The trauma response has to have a felt sense of safety. I’ll come back to that because it can be tricky for some people. The other things are time and energy. The trauma response is an energy problem, so that’s where the biology factors come in. We need to look at all of the things that are draining our energy that are contributing to us continuing to go into the trauma response. It’s become this conditioned pattern. Now we just go automatically into it without really even needing a trigger because that’s what we’re conditioned to do. It needs time.
There are two triggers for the trauma response. One would be when things happen too much too fast. The body hasn’t had time to process what’s happened. it hasn’t had time to integrate what’s happened. It overwhelms it. it goes into the trauma response. The trauma response is in a sense our protective adaptation to buy us some time.
Then it needs a felt sense of safety. If you were a turtle, and you had danger approaching, you’d pull your head back into your shell. That’s like a trauma response. We close up. We retreat within ourselves. We’re not sticking our head out until it’s safe outside. We don’t want to get our head bitten off. That’s the same thing with the trauma response. We’re not going to come out of that trauma response until we have a felt sense of safety.
Here’s the problem: So many people live in their heads. They are used to thinking about things and talking about things and analyzing things. They have no idea that they actually don’t feel safe in their own body. They tell themselves that they should feel safe. They maybe even say affirmations and mantras and do mind/body medicine that tells them. Is it a felt sense? Do they actually feel safe in their body? Until that is in place, the body itself will stay in its trauma patterns. Doesn’t matter what the mind does.
When we look at the different modalities that are out there that can help us, that is the question we want to ask: Does this help me create a felt sense of safety, time, and energy? If so, then it’s the right tool for the trauma response. If it doesn’t, it still maybe the right tool, but it’s not the right time to use this tool.
The stress response needs different tools. Those may be better tools for the stress response. We are not in the stress response yet; we are still dealing with the trauma response. Anybody with active thyroid issues, especially autoimmune, is in the trauma response. Unless you have a thyroid storm, and then you are clearly in the sympathetic stress response, but otherwise, if you have any version of hypothyroidism, the fatigue, the heaviness, the low metabolism, those are all symptoms of the trauma response. It doesn’t need to be emotional. It can be our biology that pulls us into that trauma response.
Dr. Eric:
You’re explaining that connection between the physical trauma and emotional trauma. That’s one of the things I wanted to ask you about.
Dr. Aimie:
It can be both. When we look at adverse childhood experience studies, for those who may not be familiar with those studies yet, I encourage you to look at those. They came out of the work of Dr. Vincent Felitti in San Diego at Kaiser, working with obese women and noticing that a high percentage of them had had sexual trauma in their childhood. It opened up this question for him: Is there a connection here? He was willing to ask the questions that no one else wanted to ask, let alone talk about.
Since then, it’s opened up all these other questions of if that’s the association with obesity, what about with autoimmune thyroiditis? What about Hashimoto’s? Yes, there are clear connections between adverse childhood experiences and autoimmune thyroid conditions. There is a great paper that came out in 2009 by SR Dube. If you search “adverse childhood experiences, thyroid, 2009, Dube,” you will find the article. There is a very clear association. What they also found in that is it’s not only the association with the thyroid issues, but it’s also the severity of symptoms that you are likely to experience. The more stress or the more adverse childhood experiences you had as a child, the more that predicts you will even be hospitalized for the severity of your thyroid symptoms.
There is another article that was published in 2018. This was looking at subclinical hypothyroidism in pregnancy. What they found is that the childhood stressor or abuse is associated with increased risk of mothers experiencing subclinical hypothyroidism when they are pregnant. This was published in the journal Psychoneuroendocrinology in 2017.
There is another article on post-traumatic stress disorder and the incidence of thyroid dysfunction in women, which was published in 2018 by Cambridge University Press. They found there is this association between the diagnosis of PTSD having a higher risk of hypothyroidism. Of course, it does. Hypothyroidism by itself puts us into a trauma response. We see these connections that the earlier in life, and the more times in life that you have experienced overwhelm, that is what actually promotes the nervous system changes that cause the immune system changes that cause autoimmune. Stress does not cause autoimmune. The trauma response is what causes autoimmune. The autoimmune causes the trauma response. It goes both ways.
Dr. Eric:
Obviously, you brought up these examples because you know my audience consists of people with thyroid and autoimmune thyroid conditions. If you did the same studies on multiple sclerosis or lupus or rheumatoid arthritis-
Dr. Aimie:
All autoimmune. You can’t ignore the facts. That’s why when my autoimmune markers came back high, and my doctors wanted to make it insignificant, “Well, you haven’t had any of the clear symptoms yet. Once you have those symptoms, come back, and we will diagnose you with lupus.” How do I get off of this path? I don’t want an autoimmune condition for the rest of my life, but I am clearly on this path. That’s what my studies led me to, “Aimie, you can’t ignore the facts.” This is related to what I thought at the time was stress, and I have since learned it’s trauma response. That became my focus of how do I work with my trauma response so that it is no longer driving my health?
Dr. Eric:
Can you talk about some of the things you do? Some of the therapy modalities or methods you use to regulate the nervous system.
Dr. Aimie:
In the approach I have created, which is The Biology of Trauma, there are three arms to this approach. One arm is what I call somatic work or body work. This is where I use my mind to put attention on different sensations on my body so that I can be aware of what’s happening and provide it a felt sense of safety, which is what the trauma response needs; provide it a felt sense of support, which is what the stress response needs; and provide it with a safe experience of growth and expansion and joy and healthy anger and boundaries and all of these other things that autoimmune people need to work on as well. The somatic work, which is working with the body and body’s sensations, using the mind to put attention on the body.
The second arm is our thoughts and belief systems. I classify this as parts work. Anyone who is familiar with internal family systems, this is how I frame this. There are different parts of us. There is the part that experienced a situation in life. What were the belief systems that we made coming out of that? What were the stories we told ourselves about ourselves coming out of that experience? Those now have continued to drive our belief systems about ourselves, our views of ourselves. I actually incorporate parts work in our belief systems with the body work so that they are actually done together.
Then I bring in the biology piece. As we can see, whether we’re talking about stress or trauma, but especially trauma, it has chronic effects on our biology. Now it’s no longer enough to go back and process the trauma, which I will mention that we can’t process trauma until we have some tools in place. We can’t process that trauma and expect everything to be resolved because now we have had this downstream effect. It’s our biology that will keep us stuck.
We also do need to address how our biology has been affected by the trauma. The tools that we have to use include what we call regulation. Regulation, you can think of as stabilizing the body. I did 3.5 years of general surgery residency. When a person goes into surgery, surgery can be thought of as processing trauma. We are going to fix the problem. We are going to rewire the nervous system. We are going to do this big release, or whatever it is that we’re processing. That is what happens in surgery. You just don’t take anybody to surgery at any time. You have to do a pre-surgery assessment. Are you ready for surgery? Are you ready for processing that level of trauma, that depth of trauma? Are we actually going to retraumatize you by trying to help you?
That is what a lot of therapies do. They try to help people process when they are not yet ready to process. We haven’t stabilized the system yet. The body has to be stabilized to go into surgery. You wouldn’t go into surgery without anesthesia. You would create more harm than good. That’s what we do with therapy. We are trying to do good, but actually putting them in a place where we are asking the body to do more than what it’s prepared to do at that time. It’s not yet stabilized. Doesn’t have the tools yet.
Those tools are called regulation skills. The short of it is, the regulation skills are the body work. Our being able to shift my own states of my nervous system to be able to recognize when my system has gone into the stress response, the trauma response, and have the tools in the moment to create a felt sense of safety or a felt sense of support or to bring my system back into parasympathetic.
So many times, we have relied on other people to do that for us, whether it’s a therapist, our partner, our friends. We have relied on other people to help manage our emotions, to help stabilize us, to help bring us back down to a place of settling and feeling okay. We go to therapy in order to help us feel safe in an area of life that we don’t feel safe. That is why the therapy doesn’t work, no matter what modality you use, because a person needs to go into therapy feeling safe for their body to be ready and open and able to process what happens in that therapy session. Otherwise, we can retraumatize people by even a good thing causing too much too fast.
There was one other trigger for the trauma response other than too much, too fast, which is too little for too long. Too little of something that you need for too long, be it too little of support, love, touch, whatever it is. Too little for too long is the other trigger for the trauma response in our life.
Dr. Eric:
Wow, this is quite a process. You said the reason why therapy doesn’t work, or if someone goes to a psychologist, is they need to feel safe prior to seeing a therapist or psychologist. On top of that, they are not dealing with the biology. They are just dealing with the psychology. That’s why someone might be seeing a therapist or psychologist for months or years. Maybe they are getting a little bit of progress, but not where they could be by seeing someone like you, who focuses on the whole picture.
Dr. Aimie:
Yeah. One thing I discovered that I’d love to share is how to know when the therapy that you are doing is actually retraumatizing you. Sometimes, we are not aware enough of our own bodies yet to be able to recognize that. It shows up in our health. If you are experiencing a flare-up of your physical health conditions, of your chronic health conditions, for me, I would experience a flare-up of my autoimmune stuff. I would wake up and feel inflamed, and my gut issues would flare up. Those are signs that what you are doing is too much for your body. You are actually retraumatizing yourself. That is how it’s manifesting. That’s how it’s expressing. That’s how it’s trying to talk to you and get your attention of, “This is not the right thing at this time. This is too much too fast for us.”
We can use our physical health as a measure, as a monitor for how we are doing any therapy process, and whether it’s helpful, and maybe it’s a good thing, but not just the right thing at the right time.
Dr. Eric:
After or while someone is working with you, a lot of people don’t know this, but my bachelor’s degree is in psychology. If someone works with you, is it completely unnecessary to see a therapist or psychologist? In some cases, is it still beneficial to see someone in addition?
Dr. Aimie:
Great question. I’m not going to say that no other process is going to be helpful. I don’t call what I do therapy because what I’m doing is teaching you how to give your body what it needs to heal itself. That’s very different than going to somebody else and saying, “Will you please fix me?” This is a natural part of the trauma response. We lose our own sense of power. We feel powerless. We feel like it’s too big for us. It’s a very important principle in my methodology to empower people and teach them so much of what they can do for themselves.
It is my belief in my experience and certainly with the thousands of people who have come through my courses that when they have the skills to do a lot of this themselves, the rest becomes clear. For some of them, they’re good. Their health conditions are better. We have had some come through with their thyroid levels off. Then they regulate their nervous system and provide a felt sense of safety and support, and their thyroid levels come back to normal. It’s been phenomenal the health changes that happen.
For some people, it becomes clear to them that “This over here is another piece I’m missing. This is a piece that is the next best piece for me.” It changes the feeling of being lost. “I don’t know what to do, so I’m going to randomly pick something and hope that they know what they’re doing.” This process changes that, where now they are making decisions that are coming from a place of clarity. “I can tell what my body needs. I know what my body needs. Let me go find someone who will fit that piece and be able to do that for me.”
It’s a very different place than feeling like you’re spiraling out of control and grappling for something, someone, somewhere that can help you versus “I know my body, I’m an expert on my system, I’m an expert on my trauma, and I know that this is the next piece for me. Let me go find that specific person.” It’s completely different. It’s such meaningful work to see people go from a place of feeling very lost, feeling very broken and being able to see that through this process, they come to their clear path forward.
Dr. Eric:
This is important not just in regaining someone’s health, but in maintaining their health, too. Flare-ups will happen. Obviously, you can’t undo the past, the trauma(s) that people have experienced in the past. If someone is dealing with Hashimoto’s or hyperthyroidism/Graves’, and maybe they just haven’t gotten the results that they expected by changing their diet and doing other things that I teach on the podcast and other functional medicine practitioners teach, what are some next steps that you would recommend they take?
Dr. Aimie:
I would recommend they start to look into the trauma. I know this is scary, and it can be daunting to look at trauma work. Or maybe I have been doing trauma work, but I have been doing it wrong.
I have created a starting place for people, so that can be a helpful place. It’s a starting place for doing this type of body work, trauma work through the lens of what were the overwhelming experiences that I’ve had in my life? Let me start with the superficial layer. Let me do things gently. Let me learn how to build in these felt senses of safety and support rather than what I call jumping off the cliff of the emotions where I hope you have your parachute because that can be a hard landing if you are trying to go process something.
I have starting place retreats, and I do them over a weekend, Friday-Sunday. Very low time commitment. 30 minutes for Friday, an hour and a half on Saturday, and an hour on Sunday. It is a starting place to show people this is what this type of trauma work means, so you don’t have to be afraid of it. You know what it’s like. They can make a decision to continue on with me, or they now have a better sense of what it is that they need. They sometimes go and find that in their local area, someone they can meet with in person. They don’t do an online course with me.
I do a 21-day journey for those people who want to do that journey with me and have me guide them into their own body, their own nervous system, and start to become the experts of their system. There are options, but they need a starting place.
My strong recommendation is get to know what it is that you actually need, what your body needs. From there, things start to become clear. If that is coming to my Starting Place Retreat, come. Experience it. Be able to make a better informed decision of what do you want your next step to be? Do you want it to be one of my longer courses? Do you want it to be something in person, but now you have a better idea and sense of what it is that you’re looking for? How gentle or fast is your body ready to go? That is something that each person needs to know in order to keep it safe and not have it be an experience that retraumatizes them.
Dr. Eric:
The three-day retreats are in person, not virtual? Is that correct?
Dr. Aimie:
Those are all virtual.
Dr. Eric:
Okay. Anywhere, people can do them. You mentioned the 21-day program. Obviously, that’s online. Anybody can do that as well.
Dr. Aimie:
Yes. The 21-day Journey is what I designed. I was taking all of my patients through. At that time, I was still having my own clinical practice. I noticed that if I could teach them these skills first, their health/baseline was at a very different place. We could do so much more and faster with their actual medical care. I started having all of them do just 21 days of some very simple, basic somatic work. These are short exercises. I teach these exercises. They are 10 minutes every day.
The whole first week in that 21-day journey is me teaching them the seven different exercises to create a felt sense of safety. This is where most of them tell me, “I didn’t even know that I didn’t know what it felt like to be safe. I didn’t know.”
The whole second week is me teaching them seven different exercises to create the felt sense of support. When you feel like someone has your back, my goodness, you can do anything. We are able to stay in that stress response and not have our stress turn into trauma because we felt all alone, and no one understood what we were going through.
The third week of that 21-day journey, I teach them different exercises on how to safely step into growth and expansion and joy and healthy anger and boundaries, all of these things that we need to bring into the trauma work, but we also need to bring it in at the right time. That is never at the very beginning. We need to create a felt sense of safety and support first. Then we can move into these more expansive things.
Dr. Eric:
Would you say this is something that everyone can benefit from?
Dr. Aimie:
Every single person.
Dr. Eric:
I’m asking because especially those with an autoimmune thyroid condition, but you said every autoimmune condition, trauma is a factor.
Dr. Aimie:
Who in our life today does not experience stress and overwhelm? Everyone, to some degree. I really do consider this as the manual for our human bodies and knowing what our bodies need to get through life in the most healthy way possible.
Dr. Eric:
I probably need to go through that too, then.
Dr. Aimie:
I would love to have you in it.
Dr. Eric:
I know we covered a lot. Is there anything I didn’t ask you that I should have asked you? Anything else you’d like to share?
Dr. Aimie:
We did cover a lot. I imagine there are some people who already feel overwhelmed with all that I shared. I just want to share hope. There is so much hope, no matter how old you are, no matter how far you are in your disease process. No matter what, no matter how your life experiences have been up until now, there is so much hope. It’s just using the right tools in the right way in the right order. That is what we have not been doing. That is what will give us so much more freedom and change for our future.
Dr. Eric:
Well said. Thank you so much, Dr. Aimie for sharing your knowledge on trauma and relating it to thyroid health and autoimmunity. I am sure the listeners learned a lot. I did as well.
Dr. Aimie:
Thank you so much.