Rebalancing the Nervous System to Improve Health and Healing

I'd like to welcome everybody to today's presentation on rebalancing the nervous system for mind body health. I'm your host Dr. Donnisee Snipes. Exhaustion, overwhelm, and dysregulation often keep clients from succeeding in therapy. If they are constantly stressed, then a lot of their energy is being shunted from their thinking mind to their reacting mind or their fight orflight, if you will. Uh the resources, the bandwidth they have to learn and implement new skills is therefore significantly reduced. If we can help them rebalance their nervous system so they're more able to get into and stay in um or spend more time in their parasympathetic or um system and their wise mind, they're going to be a lot more effective. We're briefly going to define the autonomic system, the sympathetic nervous system, the parasympathetic nervous system, and the trigeminal nerve. We'll explore the causes and symptoms of sympathetic dominance and identify strategies to begin to strengthen and rebalance the nervous system. As I mentioned before class, about eight months ago, I did a video that would be a good part one for this video. Um, it covers some of the issues that co-occur when people's nervous system is imbalanced. And I have that linked in the PDF of the PowerPoint. So, let's start diving in. The first thing we want to talk about, we're going to work from the top down, is the autonomic nervous system. The autonomic nervous system controls automatic functions in our body to help maintain balance. And I always remember autonomic with automatic. You know, that kind of sounds similar. So, autonomic controls automatic functions. It has two parts. the sympathetic nervous system, which is the stress response or the gas pedal. So, think your brain is having sympathy for what's going on with you right now, and it's going to help you fight or flee. And the parasympathetic nervous system, that's the other one. The parasympathetic nervous system is responsible for rest and digest as well as rebalancing. It's the brakes. It helps down reggulate so your body can divert energy to regaining homeostasis after a stressful event. The sympathetic nervous system obviously is there to help you fight flee or respond quickly. It's your survival brain. When it's activated, your heart beats faster. Your breathing speeds up. Your pupils get bigger so you can improve vision. When people are excited or when they're stressed out, their pupils will get bigger. Digestion slows down because now's not the time to send energy to the gut. Now's time to send energy to the muscles and extra energy, blood sugar is released. Well, that can be good in the short term. In the long term, we can see insulin resistance and other metabolic disorders developing and adrenaline floods your system. And when we talk about people who are experiencing a strong stress reaction, sometimes we talk about being in in an adrenaline haze. When we're in that adrenaline haze, we tend to get tunnel vision. We tend to be focusing on whatever we're fighting or fleeing from. We have difficulty with flexible thinking because energy is not going to our wise mind, our thinking mind. energy is going to our reactions. The parasympathetic nervous system is the balancer. It's the rest, digest, and rebalance branch. The main part of the parasympathetic nervous system is the vagus nerve. And we've heard a lot about the vagus nerve over the past few years. Uh it works opposite the sympathetic nervous system to help keep the body in balance. Now what's interesting is about 80% of vagus nerve fibers carry information from the body to the brain from the gut from you know the liver the spleen everything to the brain to tell the brain whether things are safe or whether things are stressful. But there are 20% of the fibers in the vagus nerve that take information once the brain makes a decision takes the information from the brain and sends it down to the body. When the vagus nerve is sending information to the body, it is sending information about down reggulation. So we've only got 20% of those vag nerve fibers that are actually involved in down reggulation. The other part that we want to talk about and it's not really part of the uh um parasympathetic nervous system but it is important is the trigeminal nerve and the trigeminal nerve senses movement in the face and it connects you know to your eyebrows. It connects down here kind of to your nose and your upper jaw and then it comes down here to your lower jaw. It senses tension. It senses when you're clenching your teeth, when you're furrowing your brow, or when you're laughing. The trigeminal nerve actually meets with the vagus nerve in the brain stem and says, "Hey, vag nerve, this is what I'm picking up from this person's facial muscles and expressions." When the sympathetic nervous system is activated too often due to chronic stress, people can develop sympathetic dominance. Essentially, the gas pedal stays pressed for so long that the body treats high alert as the new normal. And we all know people, we may be people who experienced chaotic home environments at some point. And maybe we started to believe that chaos was normal. And we started to believe that we were unsafe and powerless. Therefore, high alert is the new normal. If I'm unsafe and powerless all the time, then I'm going to be on high alert all the time. When that happens, it gets easier to overwhelm the system and the shutdown is much slower. it's harder for the parasympathetic nerve to get in there and tell the brain or tell the body, hey, you know, it it's all good. Threat's passed. We got this metaphor for sympathetic dominance. And I've used this in a lot of classes, but I think it's important to repeat. Think of stress tolerance as a bucket. We start the day with a bucket. And if you are in a good mood, if things are going well, you may start the day and your bucket is empty score. So you can add in a lot of stressors before it starts to overflow. But if you start the day and you're already stressed out, you're already feeling unsafe and powerless, you didn't get good sleep, what have you, that bucket is already at least partially full. So it doesn't take much to cause an overload in a healthy system. Once the stressors passed, the body recognizes safety and the parasympathetic nervous system jumps in and drains the bucket and says, "All right, stressor's gone. You know, we can empty that out." Now, with chronic stress, the bucket may not fully drain between stressors. The parasympathetic nervous system is trying to support recovery. So, it's trying to empty the bucket, but the sympathetic nervous system keeps on going and keeps adding stress to that uh stress to that bucket. Think about, you know, cartoons or whatever that you've seen where people are in a little boat and it springs a leak and one person's trying to um use buckets to get the water out, but the water's coming in too fast and it keeps filling up and they keep it's just an ongoing process. And a lot of times in those cartoons, they lose and the boat fills up. The more chronic stress, the more water and the less room in the bucket before overflow. Sympathetic dominance leads to multiple neurossychiatric, autonomic, metabolic, immune, inflammatory, and gastrointestinal symptoms. And I don't know about you, but if I've got any of these going on, it impacts my mood. It impacts my stress tolerance. It impacts my patience. Therefore, we need to recognize that mindbody connection. The autonomic nervous system plays a role in the wide range of physical and mental issues including executive functioning, social affective or emotional, attentional and motivational behavior. When the sympathetic nervous system is active, it affects all of those things. When the parasympathetic nervous system is active, it affects all of those things in a different way. During periods of stress, energy and resources are shunted from the prefrontal cortex where we do all of our executive functioning, thinking, concentrating, planning, organizing, problem solving, all that higher order stuff. the energy is taken away from that and shunted over to our system to help us fight or flee or avoid the threat. When the prefrontal cortex is offline, and I think this is a really interesting point, when the prefrontal cortex is offline, the amygdala is basically running the show and the parasympathetic nervous system is unable to inhibit or turn down the stress response. Why is that? The amygdala is our fear response. That is going to be sort of our emotional reacting stress response. The parasympathetic nervous system requires the brain to say, "Hey, it's all clear." But if the brain, the executive functioning part of the brain is not engaged, then the parasympathetic nervous system doesn't really kick on. When this happens, people experience disinhibited defensive reactions. They start reacting out of stress. They are stuck in fight, flee, fawn, um, or flop. Long-term stress keeps the sympathetic system on most of the time. Now, it may turn down a little bit and it turns up a little bit or a lot of bit, but it stays on all the time. So, there's a constant energy drain from the prefrontal cortex to everything else. What causes that? Well, recovery debt, if you will. If you are getting poor sleep, poor nutrition, no downtime, or constant stimulation from caffeine, lots of screen time, overwork, your body is not being afforded the opportunity to rest, recover, and rebalance. A lot of that takes place during quality deep sleep, but some of it also takes place when people actively relax, when people actively downregulate and say, "Okay, let's get things back in balance." Learned threat is another long-term stressor. If people experienced trauma, chronic anxiety or other unresolved stressors, then the person continues to feel unsafe and disempowered. Now, these are unresolved issues, but you know, a lot of the people that we work with, their trauma, whatever's causing their chronic anxiety or their stress is an unresolved issue. When these issues are unresolved, people continue to feel unsafe and powerless. So the brain continues to scan for danger even when they are objectively safe. Even when they can look around and go, "Yeah, I mean objectively I'm safe, but I still feel like I'm in danger. I still feel nervous. I'm still hypervigilant." Additionally, long-term stress promotes low veagal tone. The vagus nerve is not a muscle. I'm not saying that, but I'm making the metaphor. If the vagus nerve were a muscle, it's a muscle that hasn't been used very much or in a long, long time. The sympathetic nervous system, oh, that's being exercised a lot. The parasympathetic nervous system, the vagus nerve, hasn't been exercised. So, it's weak. It has low veagal tone. It has difficulty kicking in and responding. Essentially, the brakes have gotten weaker. So, the same stressor produces a bigger, longer reaction. For those of you who used to play on at the park on teeter totters or seesaws, whatever they call them where you are, think about it this way. If you are sitting on one end and you weighed 60 lbs and the person who gets on the other end weighs 60 pounds, then it goes back and forth pretty easily. But if you're sitting on one end and you weigh 60 pounds and the person on the other end weighs 140 pounds, you know, they can flip you off really easy by sitting down too fast and you take off airborne. Um, did that have the stitches to show it? But anyhow, um, but we I used to encounter this when I was on the seessaw with my son because he was a little guy and I was a grown-up. Um, and it obviously he couldn't counterbalance me. He was too weak. Um, body feedback is another source of long-term stress. Pain, inflammation. Now, in general, when we have pain, with the exception of fibromyalgia, in general, when we have pain, there is some inflammation in the system. Um, however, you know, they don't always go together. When there's pain, you know it. When there's inflammation, you may not know it. You may have some lowgrade systemic inflammation and not be aware of it. People with depression have a significant correlation with lowgrade or moderate neuroinflammation. They don't know that. They don't have pain in their brain. But we do know that there is often neuroinflammation. Dispiosis when the gut microbiome gets out of whack. The vagus nerve conduct connects to the gut microbiome and it notices changes in there. And when our gut is out of balance, it's stressful because a lot of our hormones are made there. our nutrients, our food is broken down there and the nutrients are repackaged into things our body needs. And if the gut is out of whack, if the right microbes aren't there, they can't do their job. So then we end up without the stuff we need to heal, repair, rest, digest, all that stuff. we can develop insulin resistance or even diabetes because of chronic uh release of blood sugar. Your body's constantly dumping blood sugar and fatty acids into the system to help you fight or flee. Well, eventually the receptors um start to become resistant to them. So, we start to see insulin resistance. Hormone drift is another long-term stressor. People who are chronically stressed often have what we see is a flat level of high cortisol. Cortisol is not in and of itself bad. It's actually good when it works right because it is a steroid. It's an anti-inflammatory. Cortisol is supposed to peak in the morning to give you that get up and go and then decline throughout the day. However, people who are stressed, what happens? It may peak in the morning, but then it just stays flatline throughout the day. Unfortunately, melatonin, the hormone that helps you get to sleep, um is not compatible with cortisol. When cortisol is high, melatonin is going to be low. Helping people downregulate enough so their normal circadian cycle of cortisol can work is important and again part of it is circadian cycle gonatal hormone changes whether it's due to taking birth control or hormones for something or aging where you're losing a lot of hormones uh it is a stressor on the body yes I know especially hormones hormone changes due to aging are natural, if you will. However, it doesn't mean they're not stressful. And thyroid hormone changes, including reverse T3. When people are stressed for too long, the body tries to put on the brakes another way. And what what it does is release this enzyme called reverse T3 that actually breaks down T3, our thyroid hormone, to keep us from being so revved up. People with high levels of RT3 tend to have symptoms of hypothyroid even though their thyroid tests may be may be coming back just fine. Thank you very much. This is called uh nonthyroidal illness syndrome and I've talked about that in other videos. But if people are experiencing a lot of stress and fatigue, hypothyroid, depressive symptoms, it's always helpful in my opinion just to look at that RT3 level once, see if it's elevated. Um because RT elevated RT3 is often a sign of chronic stress and chronic activation of the autonomic nervous system. In terms of symptoms, uh physical and environmental symptoms, and I'm putting these together, we're not doing the pneummonic in order because they kind of go together. Persistent threat scanning, startle, and hyperarousal. I'm on edge. constantly. Um, if you want to put it a positive spin on it, it's kind of like being um playing tennis and being on your toes at the baseline. You have to be ready for that ball to come wherever it's going to go. Um, so you're persistently scanning, you startle more easily, and there's a lot of hyperarousal pain ampl amplification. When we're stressed constantly, hormones get out of whack, the system gets out of whack. um you know, we're not going to go into all the nitty-gritty, but we actually become more sensitive to pain. We experience increased inflammation and possible autoimmunity. Sometimes the immune system just completely goes haywire. It's like I don't even know what to fix and what's broken anymore and ah so it starts attacking itself. Uh the increased inflammation is the result of multiple factors but recognize that chronic stress leads to impaired stress feedback. Gluccocorticoid resistance so cortisol is not anti-inflammatory anymore. Cortisol dysregulation so cortisol stays high. All of these foster a pro-inflammatory state. When there's inflammation, our body wants to fix it. Inflammation says there's a problem and our immune system wants to get rid of the inflammation. We see sleep fragmentation, not sleeping well, not getting deep sleep, increased heart rate and blood pressure, decreased veagal tone, and increased arterial stiffness. Well, that's a bummer. Interpersonally and intrapersonally, we see low self-efficacy. When our stress response is high, when we tend to disregulate, a lot of times we feel less capable of dealing with life on life's terms or handling things. When that happens, we start to often feel bad about ourselves. And sometimes we start to feel bad about ourselves as a result of dysregulation. It's like, "Oh, I feel really bad that I was so mean to them," or what have you. We see irritability and impatience and importantly a perception of neutral social cues as more negative. So there's the interpretation bias. This is our body saying seeing something neutral and saying well I don't know if it's good or bad. So, just to air on the safe side, we're going to say it's a threat because when we're stressed, our body notices the threats and doesn't notice the positives, the good, the strengths, the safety. Emotionally and cognitively, we have attentional bias to threat and exaggerated physiological responses to threat cues. When there's a threat, instead of getting a little bit stressed, tense, the person tends to get very stressed or tense, it's like ah we see more irritability and brain fog or executive dysfunction that prefrontal cortex is offline which is and brain fog is sort of the common term for saying I can't think, I can't concentrate, I can't problem solve, I can't organize, I just can't right now. So, rebalancing the system means reducing the frequency and or duration of unnecessary stress. Going back to that analogy of muscles, you want to quit working out the sympathetic nervous system as much and you want to start working out the parasympathetic nervous system more. And again, nervous system is not a muscle. It doesn't exactly work that way, but it's the best analogy I can make. Rebalancing means intentionally activating the parasympathetic nervous system to empty the bucket and increase a sense of safety and capability. Making your uh parasympathetic nervous system and veagal tone an important part of the overall daily wellness strategy is essential. is not just one of those things that when I get stressed then I'll do these activities. No, we need to try to actively engage that vagus nerve, that parasympathetic nervous system throughout the day. Start really strengthening that. Remember the behaviors, thoughts, and feelings all tend to be nervous system responses and are interconnected. When we sense danger, we may think, "Oh, hey, there's danger." And then feel afraid and then react accordingly. First thing, improve veagal tone and the parasympathetic nervous system. Down reggulation breathing, this is a core feature. Um, you can try with square breathing. Breathe in for four, hold for four, exhale for four, hold for four, and repeat. Not everybody likes doing that. Vader breathing. One of you actually suggested this, and I thought it was fabulous, so I stole it. Um, but my my husband used to do this all the time to kind of mess with my son. He would walk down the hall and breathe like Darth Vader with the Darth Vader helmet on and my son would like get all frustrated and what have you. But I digress. Vader breathing. You breathe in really strongly through your nose and you make a whooshing sound as you exhale. Slow breathing. Or you can smell the roses and blow out the candles. Again, you're not counting there. You're using guided imagery to imitate something which has a double focus. You're slowing your breathing and you're focusing on something beside the stressor. You're saying, "Smell the roses. Blow out the candles." I encourage people to train using BOF feedback. Get a pulse ox monitor. They're really cheap. Periodically, a couple times a day or once a day even, go on a walk around the outside of your house or up and down the stairs a few times. Get your heart rate up a little bit. Pop that pulseox monitor on, sit down, and practice your down regulation breathing. Notice how the heart rate drops. Now, it's important to recognize that especially when your heart rate variability increases, when your heart gets healthier, when your nervous system gets healthier, it's not going to be a straight downward motion. When I inhale, my heart rate goes up a couple beats. When I exhale, my heart rate goes down a few beats. So, it's, you know, kind of like this going going down. It's a a stairwise, if you will. But that's okay. We want the general trend to be down. Why do it this way? Because starting out trying to downregulate when you're experiencing distress can be overwhelming when you are doing it this other way. It can be helpful for those of you who like yoga. doing a yoga pose, putting that o uh pulse ox monitor on, you'll see your heart rate go up as it becomes more difficult to hold that pose. Breathing through it as to notice your heart rate going down. Um, you can do that as well. Taking many breaks throughout the day. This is super helpful for people who have, you know, chronic tension and stress throughout the day. If you're at work, whenever you take your coffee breaks, whenever you're adding caffeine, um, well, try not to drink caffeinated, but whenever you take your breaks, take one minute, two minutes, whatever you can afford, and practice that down reggulation breathing. It can be helpful to have your pulseox monitor so you can just see the effect. But research has shown that these little breaks throughout the day help empty the stress bucket just a little bit. Just a little bit. And that can keep it from overflowing. Um it also means that your sympathetic nervous system is spending less time exercising which means you know it's not getting stronger and more overpowering. And then finally, in response to stressors with or without BOF feedback, when people feel stressed, a lot of times they can notice when they're feeling stressed and when they're feeling better. But I like data, so I always like to have my pulseox monitor. But when people start to experience distress, pop that pulseox monitor on your finger, start practicing that down reggulation breathing and noticing that you do have the ability to downregulate. You don't have to stay spun up forever for hours. You do have the ability to downregulate. Now it may take some time uh but as people become more skilled they start to feel more efficacious. They start to feel more empowered to manage their stress response. Vegas nerve stimulation can also be helpful. Your vagus nerve the one place that actually comes out is on your tragus and your cona you know right in your ear. You can put your middle finger on your tragus, which is your little ear flap. Put your index finger behind your ears, and then rub in circular motions. You only want to press hard enough to move the skin. You don't want to be pressing that thing down into your ear, but rub hard enough, just hard enough to move the skin, which stimulates that vagus nerve. What I do is I do four circles as I inhale. and then four circles in the opposite direction as I exhale slowing the breathing stimulating the vagus nerve at the same time what you're doing is what I call a manual override you are actively telling the brain no problem here everything is okay we've got this there are also handheld and transcutaneous uricular vagus nerve stimulation machines um handheld. There's a little device that's put out by Hoolist that you can place right here or um what is much more researched is the transcutaneous uricular vagus nerve stimulation. Have people check this out with their doctor before they do it. But what it involves is getting a relatively inexpensive TENS unit. You can get them offline. Um, but you want to get one, um, I think it's like the 107000 or something. Um, but you want to get one that you can alter the wavelength and the frequency of the wave. Um, get an ear clip. You clip the ear clip to that tragus to that ear flap and the stimulation can help activate or innervate trigger whatever you want to say the vagus nerve and they've shown a lot of effectiveness with this. Again, you have two things going on here. You're actively stimulating that vagus nerve. And for most of us, we notice, we focus on that sensation. It feels a little weird. It feels like somebody's kind of tapping constantly on our on our ear. That's okay. Um, both of those, again, turn your attention away from the stressor and toward what you're doing in the present moment and your objective safety. These things help strengthen the parasympathetic nervous system or veagal tone, improve empowerment and reduce the amount of time spent with an active sympathetic nervous system. The trigeminal nerve like I mentioned before there it's in your face and it your face communicates by to the vagus nerve. Hey. Uh, through the trigeminal nerve, uh, what's going on in DBT, Lahan talks about the half smile. Why does that work? Well, because you're activating that trigeminal nerve, and the trigeminal nerve is going, well, they're kind of smiling, so must not be too dangerous out there. Trigeminal nerve tells the vag nerve, vagus nerve tells the brain. You know, we start activating that parasympathetic nervous system. Humming also helps activate that trigeminal nerve because when you hum your entire face cavity sort of vibrates. My grandmother used to constantly hum um while she was doing housework and I she was always in the best mood. But humming for some people can be very can be very calming and it's not loud humming. It's just gentle passive humming. Humming. Um, she used to hum zippity dudah constantly. Um, but that can stimulate that vagus nerve. Facial progressive muscular relaxation. And this is progressive muscular relaxation but just in the face where that trigeminal nerve is. Tensing, furrowing the brow and then relaxing it. Noticing the difference. raising the eyebrows and then relaxing and noticing the difference. Um, smiling and holding that smile, noticing how that feels when all those smile muscles are engaged and then relaxing those muscles. Um, I tend to avoid when I'm doing facial progressive muscular relaxation, I tend to avoid focusing too much on the stress um, tension and I focus more on noticing what it feels like when the happy muscles, if you will, are activated. Facial massage can also help relax some of those muscles and activate the trigeminal nerve to send that same signal. The benefits of trigeminal nerve stimulation include communicating to the vagus nerve that hey, there's no threat right now. It's all good. It's important to stabilize those circadian rhythms because every cell and every system in our body has a circadian rhythm. And when those get out of balance, out of whack, then the factory kind of runs a muck. You've got certain departments that are online, certain departments that are offline, and nobody's communicating. The acronym or pneummonic for this is least light. Make sure it's bright during the day and daylight. You want to look for bulbs that are 45 to 6,500 Kelvin and have it dark and yellow at night. Look for bulbs that are 2500 to 3500 Kelvin. Eating at about the same time every day can help anchor your circadian rhythms. It's a huge thing for anchoring the circadian rhythms because when you eat, so many systems are activated. That's why a lot of us get hungry about the same time every day because our circadian rhythms or rhythm has released the hormones that tell us, hey, it's time to eat. You know, I know this is when we generally eat and we're prepared. Engaging in activities about the same time every day. Now, this doesn't have to be boring. just in general getting up, putting on your clothes, doing something productive. Um whether that is cleaning the house or going to work or going with your family out to the lake or something, but you're not sitting around in your PJs in your bed. So, getting up, taking a shower, if you will, getting getting dressed, the um doing something productive, and then winding down and going to bed about the same time every day, sleeping, going to bed, and getting up about the same time every day. Your awakening response is strongly set by or regulated by your circadian rhythms. If you are getting up and going to bed at all different times, your body doesn't know when to spike that cortisol and when to let it decrease. And temperature. Now, this doesn't anchor your circadian rhythms as much, but it kind of clues it in. Keep it warmer during the day and cooler at night. This benefits people by helping regulating cortisol release as well as serotonin and melatonin release in addition to a whole bunch of other stuff. Enhance sleep. Sleep quality is important. Not just when you go to sleep, but actually getting good quality sleep where you're getting enough deep sleep. Different things happen in different phases of sleep. During light sleep, we have some um consolidation of what's going on. During uh REM sleep, our body is trying to make sense of, you know, what went on during the day. During deep sleep, there is more deep learning, but that's also when our body rests and rebalances and a lot of toxins are cleared out of our brain. If we don't get enough deep sleep, we tend to wake up in the morning and we still feel groggy. Things to help improve sleep, naps. Keep them under 40 minutes and try to do them earlier than 5 hours before bed. If you go to bed at 8:00, don't take a nap after 300 p.m. You know, that's really not hard to do. Ergonomics. Make sure you can get comfortable to sleep and stay asleep. Urinating, do it before you go to bed. Try not to overload on the fluids so you have to get up and pee three times a night. Temperature, we already covered that, but making sure you are comfortable throughout the night. Um, keeping a sleep routine, a windown routine can help clue your body in that, hey, it's time to go to bed in addition to going to sleep about the same time. Making sure that there is no light. You want it as dark as possible. And that includes the charging, you know, the charger lights and other lights in your room. And even the moon, if the moon is streaming through your window, sometimes it can feel like daylight. And finally, sanctuary. I don't know what else to call it. Um, making sure that this is a place where you can actually relax. You would actually feel safe putting in earplugs and putting on a a sleep mask and not be worried that someone was going to startle you or something was going to happen. Create sanctuary. It should be quiet. It should be feel safe to you. And ideally, keep the stress out of the bedroom. This is not the place to argue with your significant other or pay your bills or do those sorts of things. When you walk into your bedroom, it should be associated with relaxation and sleep. Deep sleep allows rebalancing and repair, which helps reduce neuro as well as systemic inflammation. In terms of triggers, add positive triggers and reduce negative ones. Triggers can be sights, sounds, temperature, light, whatever. When you look around your environment, and this isn't just for sleep, at at the office, in your car, um at home, take one room at a time and look around and say, "What sights, sounds, or light issues in this room are causing me stress?" If you've got a flickering light or certain lights are out, it's too dim, it's too the there's too much glare, whatever. Anything in the environment that triggers stress, you want to make a note of it so you can address it. Additionally, you don't want to just get rid of the stressful triggers. You want to add positive triggers. add sights, sounds, and potentially lights that help you feel um content, that help you feel safe, that you know may make you smile when you see them. Colors are a huge thing under sights. Um, whenever every house we've moved into, I've always painted all of the walls like a light butter yellow because that feels warm and inviting to me. When I walk into a house that has walls that are gray or blue, it feels cold and um institutional to me. So, I don't I personally don't like those colors. Some people love them. More power to you. Uh and that's why I say it's important for every person to figure out what triggers their positive mood. When our environment is promoting positive and reducing you can't eliminate all negative but reducing the negative it helps us create a sense of safety and it reduces sensory overload. Now I have hyperacusis and tenitis in here. People with hyperaccus are notice sounds as being a lot louder than they really are or they may react to certain sounds as completely intolerable. Um the clicking on a keyboard or somebody chewing or writing with a um especially writing with a pencil on paper. Those are three of mine that and dogs licking drives me absolutely bonkers. Tenitis is ringing in the ears. Both of these are worse when people are more stressed. And when these are worse, it increases stress. So, it's a stress spiral, if you will. Encouraging people who have these issues to address them because that will help reduce their ambient stress, if you will. Pain management again with the ergonomics. is not just when we sleep. The chair you sit in, you should be able to put your feet comfortably on the ground. You should have sufficient lumbar support so you're not hunched over. Um, at work, in your car, wherever you sit to watch TV all day long, and your bed, those are the places that you spend the most time often. Make sure that they are ergonomically sound. If you're somebody who does woodworking or painting or something, again, make sure that you're not having to hunch over all the time, that whatever you're working on is sufficiently elevated that you're not having to bend over. Guided imagery for pain management. You can use the volume knob imagining the pain, you know, noticing it, being aware of it, and imagining turning down a knob that actually turns down the intensity of the pain, the colors. Imagine the pain as redot. And again, each time you exhale, breathe in. And each time you exhale, imagine it the red turning slightly lighter, slightly lighter, slightly purple, and then eventually it'll turn to blue. Or if you prefer, you can go to orange and then yellow. Some people like yellow because it's more cheerful, whatever. But you're imagining that red going away. Alternate focus, just what it sounds like, having people turn their attention either to another body part or something else in the room. Uh my son used to love to watch his fish, his goldfish, swim back and forth. He would right before bed, he would sit there and he would spend five or 10 minutes just watching his fish. And they didn't do anything. They just swam back and forth. It was kind of like his own little fishy EMDR. But okay, that's fine. uh he was focused on it. When I was a kid, lava lamps, my grandmother had a lava lamp that I loved to watch. Um and I would be focused in on it and that would turn my attention away from whatever else. Massage as medically approved can help with pain whether it's re releasing muscles because a lot of times if you have pain in one place you tense other muscles to guard and you can end up with as a knotted achy mess. Massage can be very helpful. Massage also increases oxytocin which is an anti-inflammatory and and can help reduce anxiety. and TENS units. Some are now wireless. TENS units stands for TENS transcutaneous through the skin electronic nerve stimulation. When you put them on, it kind of feels you're sending little electrical currents. It kind of feels again like somebody's just tapping you. It doesn't hurt. It doesn't You don't want to turn it up so strong that it's making your muscles tense or anything. Um but that um percussive nature, if you will, actually causes the cells in that area to the nerve endings in that area to release natural endorphins. And they've shown that that natural endorphin increase can last for up to like an hour and a half after treatment. Anyhow, TENS units are easily available. You don't need a prescription. It's always good to get clearance with your doctor. Up until recently, you've had to have a little unit and wires coming up and you attached them with little electrodes and it was kind of cumbersome, but they now make some that are wireless and everything is included. You can attach it to your arm, to your back, what have you. Um, and I think that's absolutely fabulous. Safety is also important for rebalancing. Being mindfully aware that you are safe in the present moment whether you know wherever you're at. If you are in La La Land, you may not recognize in this moment at this time I am perfectly safe. And by reminding your brain that, turning your brain to that attention to that, it allows your brain to say, "Oh, okay. I'm safe right now." We can activate the parasympathetic nervous system. Open and focused mindfulness, being aware of the present moment. Open mindfulness is being aware of everything going on. You go out to the park and you are you just notice what you notice. You don't hang on to anything. You notice the dog walking by. You notice the little bird that flies by. You know, you just notice. Um, for some people that can be very relaxing. Other people prefer focused mindfulness, which is like focusing on the fish or the lava lamp or a candle flame because they're turning their attention to one thing and they're clearing their mind of everything else. Doing that clears your mind of those stressors. And when we turn our attention away from stressors, it tells the brain, "Hey, that's not something we really need to actually pay attention to right now. That's actually not an imminent threat." Progressive muscular relaxation super helpful. Starting at the top, starting at the scalp and working your way down to the toes, tensing each muscle group and relaxing it. noticing the difference between tense and relaxed. And I encourage people when they tense, hold it for a count of four or something. And then when they relax, feel the blood coming back into those muscles and pushing out the stress. And then what we're basically envisioning is pushing all that stress down and out of our toes eventually. When I used to do this at UF with my students, about half of them fell asleep before we actually got down to the toes. But that's okay. Benefits of these things include turning the attention from the stressor, manually overriding the stress response and relaxing the muscles, and allowing the body to downregulate. You're not in in these, you're not actively focusing on your breath. You're focusing on something else, but you're activating the parasympathetic nervous system which says, "Hey, I guess we can relax." Sends the message to the brain. The brain says, "Okay, no problem." And then those 20% of the fibers in the vagus nerve tell the body while we're relaxing, slow down, slow the heart rate, slow the breathing. Nutrition encourage people to manage their blood sugar. High blood sugar, low blood sugar is stressful on the body and it causes the stress response to activate. So manage that blood sugar. Eat an anti-inflammatory diet. This is not super difficult. Encourage people to try to include three colors of foods on their plate at every meal. Generally comes from fruits and vegetables. um those things tend to be more anti-inflammatory and less processed and stay hydrated. Dehydration is a huge stressor on the body because our body is made of so much water. When there's not enough, the body registers that as a stressor. Carry a water bottle with you. In general, have people talk with their doctor to address hormone balances and any hormone imbalances and any underlying physical issues that are contributing to distress. If you've got undiagnosed insulin resistance or you're pre-diabetic or, you know, whatever else, there are a lot of things that people may not recognize as going on under the hood, if you will, that may be contributing to some of their lowgrade chronic stress. Get in nature 30 to 45 minutes a day. The health benefits of nature include reduced cortisol, heart rate, blood pressure, and blood sugar. They've shown that green walking, walking in places where there's trees and plants as opposed to through downtown, improves heart rate variability, which is a sign of cardiovascular health. Um, there's a positive effect of park versus urban environments on cardiovascular health. Again, spending time out of the city or even in a park in the city can be beneficial. There's a reason why a lot of people feed the pigeons. It's relaxing. Interaction even with indoor plants may reduce psychological and physiological stress. Not everybody wants to go outside but having plants indoors whether they are um well indoor plants can help people a lot. The effect of nature exposure on perceived physiological stress was significant in this particular highlighted study. People felt more balanced when they came back in from nature, especially if they didn't take their phone with them and text the entire time. And nature has shown beneficial effects on acute and chronic cardiovascular and inflammatory and immune issues interpersonal and intrapersonally. encourage people to use to address that inner critic and engage in positive selft talk that's believable not you know I'm good enough and I'm smart enough if they don't believe that that's going to feel fake and it's not going to be productive encourage them to engage in positive selft talk I can get this done today or you I did a good job on that small things. Help them address the inner critic. Help them connect with and help the inner child feel safe. If the inner child feels unsafe, then the person is chronically going to feel unsafe because there's a part of their brain that's constantly saying, "Nobody's ever been there for us. We've never been safe. Why should we expect now to be any different?" Help them connect with that inner child. Help them develop secure attachment with themselves. They're not going to risk rejection as much when they start practicing secure attachment behaviors with self. It's the safest place to start. The behaviors that we want them to engage in include consistency, attentiveness, responsiveness, encouragement, and safety. And I've got a ton of videos on these topics. Help them identify and learn how to maintain boundaries in each piece of life, physical, interpersonal, emotional, cognitive, and environmental. When they feel like they can be safe in relationships with others, it's going to help them feel safer uh nurturing, potentially supportive relationships. improve assertive communication and listening skills. When we are in fight or flight, we tend to react either passively or aggressively. So, in order to be assertive, we need to get into our wise mind. But a lot of people don't know what assertive communication is or even how to do it because interacting with others has always felt so unsafe that as soon as they start to do it, they get into that stress response. Help them identify characteristic behaviors of safe people and identify safe people in their life and how those safe people can help them reduce their own stress. What can these people do to help you? And for some people, emotional support animals are extremely helpful. We know the benefits of petting an animal, playing with an animal. Just having an animal sit with you reduces the stress response, reduces blood pressure, heart rate, etc. These behaviors or these activities empower people to identify and nurture safe, supportive relationships, and as a bonus, they get the release of oxytocin. Emotionally, encourage people to engage in positive focus 20 minutes a day. What did I do right? What can I learn? You know, what did I do right? What's going well? What am I grateful for today? 20 minutes a day. The other 23 hours and 40 minutes, focus on whatever you want. A lot of people do this during a meal or maybe even a meal with family so people can share their positive focus. Behavioral activation, laughter, awe, love, joy and contentment, and gratitude. engaging in behaviors that stimulate these feelings. These feelings are parasympathetic feelings. So, if we're feeling these feelings, then we're turning down the intensity at least of the stress response. Mindful reflection times three. Encourage people to reflect on their day. What did they do well? What can they learn from their experiences today? and what did they and did they not have control over? This helps them get a more balanced perspective. Cognitive restructuring help clients address distortions, unhelpful and inaccurate core beliefs about self and others as well as identifying beliefs about themselves, the past or the present that cause them to feel unsafe or powerless. These are not always core beliefs, but they're beliefs nonetheless. This helps people increase awareness and helps address thoughts that keep the person from feeling empowered. And hardiness, commitment, control, and challenge. We've talked about this so many times. Start by having people define their rich and meaningful life and identifying which aspects are going well and not so well. that helps them develop balance because rarely is everything going to hell in a hand basket. Control. Help them identify what aspects of situations that they can control, which are out of their control, and ways to address what's in their control and how to deal with things that are just out of their control. And finally, view problems as challenges and seek support for addressing them. Just like you do on a ropes course, there's an obstacle. You work with your team to figure out how to get over, around, through, under, etc. This increases focus on the big picture to help people add balance. Encourage your clients to focus on progress, not perfection. Notice improvements in their ability to downregulate either the intensity of their reaction or the duration of their reaction. Notice improvements in energy, sleep, muscle tension, pain, tooth grinding, their mood, their patience, or their attitude. Improvements in any of those are improvements and our progress. And they also need to realize that some days just suck. And that's the way it's going to be. They may be disregulated that day. They may feel like they've taken six steps back. That's a moment. That's a day. And sometimes when we look at what was going on, there was a lot of stress that was triggering that. This ensures people notice and build on small improvements and do not embrace bad days as complete failures. And finally, small steps. Instead of trying to change the world or change their nervous system in one day, what can they do right now? What's one thing that they can do today to help themselves downregulate, to help themselves rebalance? This helps reduce senses of overwhelm and provides immediate results which can be additive. Stress occurs in every piece of life. Unnecessary stress keeps the sympathetic nervous system active and contributes to imbalance and stress overflow. The goal is to balance stress and restoration, not eliminate stress entirely. Pro tip, make sure that when people are trying to do this, they're not making stress management stressful, judging themselves, putting too much pressure on themselves for rapid results.