Why Trauma Work May Not Be Your First Step, with Dr. Aimie Apigian
Episode 194. A solo episode of The Biology of Trauma® podcast with Dr. Aimie Apigian.
Trauma work may not be your first step because the body needs enough capacity to hold the work before the work can land. If sleep, brain inflammation, or a depleted biology is what is limiting that capacity, then supporting the biology first is what makes the trauma work possible later.
That is the argument Dr. Aimie makes in this episode, and it starts somewhere unexpected. She does not ask about your past. She does not hand you the adverse childhood experiences checklist. She does not calculate your ACE score.
What she looks at instead is the impact of your past on your present. Three domains: your life, your relationships, your physical health. She is watching for one pattern that repeats across all three, because a pattern showing up in every domain at once is coming from the nervous system rather than from any single circumstance.
This is the assessment she teaches practitioners, given here for you to run on yourself.
Dr. Aimie Apigian, MD, MS, MPH is a double board-certified physician in preventive and addiction medicine with master's degrees in biochemistry and public health. She is the author of The Biology of Trauma, founder of Trauma Healing Accelerated, and the creator of the Biology of Trauma® framework.
Dr. Aimie assesses stored trauma by looking at the present rather than the past, watching for one pattern that repeats across your life, your relationships and your physical health. Whether a stressor becomes overwhelm depends on your capacity, and capacity is read from a three-part dashboard: your thoughts and beliefs, your somatic implicit memories, and your biology. Because trauma work runs on energy, the highest-leverage starting point is sometimes sleep or brain inflammation rather than the trauma itself. Sequence matters, and sequence can change.
Why doesn't Dr. Aimie ask about your past?
Because the word gets in the way, and because a resolved past is not the thing that needs working on.
Three moves sit underneath that. The first is language. When she says trauma, the person in front of her hears whatever they believe trauma means, which is usually something larger and more obvious than what she is looking for. She points at her own history as the reason she stopped relying on the word.
"I never would have used the word trauma to describe my childhood. And yet, clearly, my body had the footprint, had the patterns of stored trauma in my body."
The second is the difference between resolved and unresolved. Plenty of people have done real work on wounds that are now closed. Returning to dig those up serves nobody.
The third is where she goes instead, which is the whole assessment.
What are the three domains she actually looks at?
Your life, your relationships, and your physical health. She asks about all three because stored trauma reveals itself as one pattern running through every one of them.
"And what we see is that the same pattern runs through all three of those. Our relationship patterns turn out to be the same patterns that are showing up in our physical health. And this is how we know we are looking at stored trauma. One pattern showing up everywhere."
The image she uses is a tree. The roots determine the fruit, so any fruit points you back to the root. A pattern appearing in one domain could be a circumstance. A pattern appearing in all three is being directed by the nervous system.
For practitioners: she names this explicitly as your intake. Ask across all three domains, then look for what repeats. The repetition is the finding.
Unresolved stored trauma, as used in this episode: whatever from the past is still affecting your life, your relationships or your physical health today. The test is present-tense effect rather than the severity of the original event.
What does this look like in a real life?
Dr. Aimie tells her own, and it is the clearest illustration in the episode of why a past-focused checklist misses what a present-focused assessment catches.
Since she was a little girl, change and goodbyes were challenging. Closures undid her. She would become so emotional that she was embarrassed by it, while everyone around her saw someone who looked composed.
"And while everyone else might think I looked fine, inside I was holding everything together. It's like building up the dam of the flood of tears that were going to come when everyone else had left."
She describes what she did as what many sensitive people do. Stay calm on the surface, fall apart alone. She assumed the pattern was personality. She never connected it to trauma.
It changed as she did her inner work and nervous system repair, and it did not change by learning to stuff it better.
"It changed by me no longer needing to avoid numb or distract because my body could now feel those emotions and ride those waves and stay present."
The same pattern had been showing up in her relationships and in her physical health. Repairing the nervous system moved it in all three places at once.
"So nothing on a checklist of my past would have caught that."
What is the equation underneath all of this?
Your capacity, weighed against the amount of stress your body is carrying. That ratio, rather than the size of the event, decides whether something registers as stress or tips into overwhelm.
"Yet if we are well resourced, we're going into a situation with feeling resourced, with feeling supported, with feeling safe enough, then that same stressor is only a stress. And we move through it, we overcome the challenge."
When capacity is low, a small stressor sends the system into overwhelm. Overwhelm is a whole-body event mediated by the vagus nerve, which signals that continuing to operate at this level of stress is not worth the cost because the problem cannot be overcome. Dr. Aimie points readers to chapters four and five of The Biology of Trauma for the physiology.
Because the nervous system conducts every system at once, the change is never confined to one place.
"The whole physiology changes, which is why the labs can show a lot of imbalances everywhere without one clear place that says this is a diagnosis. And that can precede the diagnosis by years."
This is the mechanism behind an experience many listeners will recognize, of being told nothing is wrong enough to account for how they feel.
"So when someone has been living in survival mode and going into overwhelm for years, like me, maybe since your childhood, yes, their labs are going to come back with a lot of imbalances. It's never just one thing."
Where is the line between stress and overwhelm?
At the moment the body concludes there is nothing left it can do.
Dr. Aimie walks it through a car accident. While you are still pumping the brakes, turning the wheel, scanning for a gap, your physiology is in response mode.
"As long as we are in response mode, we are in stress mode. The moment where we recognize that nothing that we've done or tried or can try will save us from this impending hit. That is when our body shifts to a different survival mode."
Grief follows the same arc. It can sit in stress mode for as long as some part of you still believes the person can be kept, or the relationship repaired. Loss, surgery, a health crisis, all of them run this way.
She also names one that rarely gets counted. Perimenopause is a change in the body's hormones, and change itself is a stress on the nervous system.
"How our nervous system responds to that change is what reveals the unresolved stored trauma."
The same holds for changes you chose. A move, a new job. The nervous system reads change as change.
Stress versus overwhelm, as used here: stress is what the body meets while it still has a response available. Overwhelm begins when the body registers that no available response will work, and it produces a different physiology, which is the body's trauma response.
What is the nervous system dashboard?
It is the check your nervous system runs, below your awareness, to decide whether it is safe to spend energy right now.
Dr. Aimie borrows the dashboard of a car. Before you drive you glance at tire pressure, fuel, engine temperature, oil, and what you are reading for is whether it is safe to go.
"Our nervous system is running the same check. Is it safe to be fully alive right now? Is it safe to be connecting right now? Is it safe to be responding right now?"
And the alternative reading is the one that matters.
"So if our dashboard says you should pull over because it's not safe for you to be driving right now, that is the equivalent of a trauma response of the body."
What are the three things that feed the dashboard?
Thoughts, somatic implicit memories, and biology. This is the part of the episode that changes what you do next, because each of the three is a different place to intervene.
One. Thoughts and beliefs. Your self-talk is data going into the system.
"So your self-talk, your beliefs, standing at the mirror, telling yourself you are a failure, your body is listening, and taking that in as a threat, decreasing your capacity even as you have that thought."
Two. Somatic implicit memories. She uses the piano. You practise a piece until your fingers know it without you tracking a single note.
"It became a felt sense. My fingers just knew where to go. I didn't have to tell them where to go. They just knew where to go. That's what your body does with the memories that it has stored."
A smell that once meant danger, a car coming through a red light: the body responds before you have identified what you responded to, because a meaning is already coupled to the cue. Which is also why environment counts. Cues of danger in the room around you keep the dashboard reading danger, and cues of safety raise capacity.
"And so this is a way in which to say that this is your body playing the song that it has memorized. And we can teach it to play a different song."
Three. Biology. Mitochondria, energy, hormones, blood flow, oxidative stress, inflammation, nutrient status, how well the gut is absorbing. All of it reports in. Her question is whether the raw materials for a response are even present, and separately, how much stress the biology is generating on its own through toxins, mold, Lyme, or inflammation.
"Past a certain point, our own biology can push us over the line from stress into overwhelm when nothing actually has happened outside of us."
That loop is the Biology of Trauma® in one sentence. Stored trauma changes the biology, and the changed biology generates more overwhelm and more trauma responses.
Why is trauma work often not the first step?
Because trauma work runs on energy, and integration is what requires the energy. If the dashboard is reading low, the work cannot land no matter how willing the person is.
"Sometimes we don't have the capacity to do the trauma work. It wouldn't be able to stick, it wouldn't be able to integrate because integration takes energy."
So the highest-leverage move is sometimes on a layer nobody came in thinking about. Brain inflammation, driven by mold or another trigger, pushing the system toward freeze, which is what brings the old story back to the surface. Or sleep, where the assumption runs one direction and the causation may run the other.
"And so what if we started with sleep, got you better sleep, how would that change your capacity for doing the trauma work?"
Dr. Aimie describes patients who have been in trauma therapy for years, some for decades, who are not moving.
"They have more insights, perhaps, but it hasn't actually changed how they live their life differently."
She is explicit that starting with biology is still trauma work rather than a detour around it.
"And remembering that even if I realize I'm not ready to start the trauma work yet, I need to support the biology piece first, that still is so much a part of the trauma work. Don't think that you're not doing trauma work."
How does she decide what to start with?
She looks for the biggest block, one thing rather than the whole list.
The reasons behind a block are specific to the person. Low energy sends her to imbalances, mitochondria, toxins, brain inflammation. Biology is a factor for everyone, and which part of the biology is not the same for anyone. The same is true of somatic implicit memories, which are a reason nearly everyone is stuck and are different in every body.
She writes the list, then prioritizes it, and the reason is the one thing that would undo the work.
"And yet, if I try to do the whole list at the same time, I get overwhelmed. If I am working with someone and I give them the whole list, they get overwhelmed."
She calls this being more precise about nervous system repair. Three layers to look across: the mind, or parts work; the somatic layer; and the biology. Then one question. What could I do right now that feels doable.
Key Takeaways
The assessment is present-tense. What matters is what is still affecting your life today rather than what happened and has already been worked through.
One pattern showing up in your life, your relationships and your physical health at the same time is the signature of stored trauma, because a single nervous system is directing all three.
Most people carrying stored trauma would not use the word trauma about themselves, which is why Dr. Aimie stopped relying on it as an assessment tool.
Whether something becomes overwhelm depends on capacity rather than on the size of the event.
Overwhelm is a whole-body event, which is why labs come back with many small imbalances and no single diagnosis, sometimes for years before one appears.
The line between stress and overwhelm falls at the moment the body concludes no available response will work.
Change is a stress to the nervous system, including change you chose, which is why perimenopause, a move, or a new job can cost more capacity than expected.
Three inputs feed the dashboard your nervous system reads: thoughts and beliefs, somatic implicit memories, and biology. Biology alone can push a system into overwhelm with nothing happening in the outside world.
Supporting sleep or brain inflammation first is part of the trauma work rather than a delay of it, because capacity is what the trauma work runs on.
Find the biggest block and start there. Handing yourself the whole list produces the overwhelm you are working to come out of.
Notable Quotes
"I do not ask about your past. I do not get out the checklist of adverse childhood experiences. I am not calculating your ACE score."
"What I look at is more the impact of your past on your today. Because that is where it is still leaving its footprint."
"Plenty of people have done real work and healed real wounds, and going back to dig those up serves nobody. What matters is what is still having an effect on our life today."
"And this is how we know we are looking at stored trauma. One pattern showing up everywhere."
"So nothing on a checklist of my past would have caught that."
"So when someone has been living in survival mode and going into overwhelm for years, like me, maybe since your childhood, yes, their labs are going to come back with a lot of imbalances. It's never just one thing."
"And survival responses will always supersede our logic and willpower. So the pattern is the information."
"How our nervous system responds to that change is what reveals the unresolved stored trauma."
"So if our dashboard says you should pull over because it's not safe for you to be driving right now, that is the equivalent of a trauma response of the body."
"Past a certain point, our own biology can push us over the line from stress into overwhelm when nothing actually has happened outside of us."
"Our body has adapted to what it has carried and it can adapt to the repair and the support that we provide it now."
Episode Takeaway
I want to say something about the pattern I told you about in this episode, the one where goodbyes undid me.
I carried that for thirty years and I did not know how deep it went. I had never once thought of it as trauma, because nothing in my childhood looked like what I thought trauma was supposed to look like. I thought it was personality. I thought it was sensitivity. I thought it was who I was, and I had made my peace with it in the way you make peace with something you have decided cannot move.
Then it moved. And what I want you to notice is how it moved, because that is the whole episode.
I was not doing goodbye work. I had not gone looking for the reason. I was not sitting with a therapist trying to locate the origin of it. I was building capacity. I was supporting my biology, changing what I was telling myself, and letting my body learn a different song than the one it had memorized. And one day I was present at a closure, feeling all of it, not managing it and not falling apart later.
The pattern changed without me ever aiming at the pattern.
This is why I start where I do. Your present is the leverage point, because your present is where the pattern is still running and still visible. What determines whether you can change it is capacity, which sits on three layers that all report into the same dashboard: what you believe and say to yourself, what your body has stored as a felt sense, and what your biology is able to do today.
If you have been doing the work and your body has not moved, I do not want you to read that as a failure of effort. Effort is almost never what is missing in the people who ask me this. What is missing is capacity, and capacity is buildable. Sometimes the fastest way in is sleep. Sometimes it is the inflammation in your brain. Sometimes it is the mold in your house. All of it feeds the same dashboard that decides whether your body can afford to go there yet, which makes it part of the trauma work rather than a detour around it.
So find the biggest block. One. Not the list. If all three layers are loaded, take one thing from each, and let those three hold you while your body makes the change it has been waiting for permission to make.
Your body adapted to what it had to carry. It can adapt again to what you give it now. The sequence matters, and the sequence can change.
If you want to see which pattern is running in you, start with the free 2-Minute Assessment for Stored Trauma. Find your primary pattern of responding when life becomes too much. You cannot change a pattern you cannot see.
Frequently Asked Questions
If Dr. Aimie does not use an ACE score, how does she assess stored trauma?
By looking at the present rather than the past. She asks about three domains, your life, your relationships and your physical health, and watches for one pattern that repeats across all three. A pattern present in every domain at once is being directed by the nervous system, which is what makes it a signature of stored trauma rather than of circumstance.
Is it a mistake to start with trauma therapy?
It is a question of sequence rather than of value. Trauma work requires energy to integrate, and integration is what makes it stick. If capacity is low, the same work that would land later does not land now. Supporting the layer that is limiting capacity first is what makes the trauma work possible.
How do I know whether my capacity is low right now?
Watch how your system responds to change. Dr. Aimie describes two failure modes, over-reacting or under-reacting, with neither one matching what the moment actually called for. Trouble sleeping, gut symptoms, and mood swinging widely in response to an ordinary change all point toward a nervous system operating with less capacity than the situation is asking for.
Why do my labs come back with lots of small abnormalities and no diagnosis?
Because the nervous system conducts every system at once. When someone has been living in overwhelm for years, the whole physiology reorganizes around surviving it, so the imbalances appear everywhere rather than in one place. Dr. Aimie notes that this pattern can precede a diagnosis by years.
Can biology alone cause a trauma response?
Dr. Aimie says yes. Past a certain point, inflammation, toxic load, nutrient depletion and mitochondrial compromise can push a system over the line into overwhelm with nothing happening in the outside world at all.
I have been in therapy for years and nothing has changed. What now?
Dr. Aimie describes exactly this pattern in the episode, including people with decades of therapy who have gained insight without the shape of their life changing. Her reading is that this comes back to capacity, and that the next move is finding which of the three layers is limiting it rather than working harder on the layer already being worked.
What is the single fastest thing I can look at in myself?
How you handle change. Change is a stress to the nervous system whether or not you wanted it, so the way your system meets a change is a direct read on the capacity available to you.
If everything on my list feels like a block, where do I start?
Dr. Aimie's answer is one thing from each layer rather than the whole list. One from mind, one from body, one from biology. She warns that handing yourself the full list produces the overwhelm you are trying to come out of.
In This Episode
00:00 — What unresolved trauma remains from your past?
01:17 — Where does stored trauma always show up? (the three places)
02:14 — Why did goodbyes undo Dr. Aimie for 30 years?
05:09 — What is the capacity equation?
05:44 — What makes overwhelm a whole-body event?
08:42 — What does dysregulation look like in real life?
10:27 — How do you tell stress from trauma? (the car accident test)
13:27 — Why does perimenopause lower capacity for stress?
15:37 — What is the nervous system dashboard?
16:41 — How do thoughts feed the dashboard?
17:14 — What are somatic implicit memories? (the piano)
20:16 — How does biology report into the nervous system?
21:55 — Why is trauma work often the wrong starting point?
25:32 — How do you choose the right sequence?
28:08 — What changed a 30-year pattern without targeting it?
29:10 — What one assessment reveals your primary pattern?
Resources and Guides
Take the free 2-Minute Assessment for Stored Trauma, referenced at the close of this episode. Find your primary pattern of responding when life becomes too much.
The Biology of Trauma, the national bestselling book: biologyoftrauma.com/book
The Foundational Journey, the entry point into the Biology of Trauma® work.
Related Podcast Episodes
Episode 138: The Biology of Trauma: Why Your Body Holds On When Your Mind Has Healed with Steven Wright For the listener in this episode who has understood the story and whose body has not caught up.
Episode 169: Your Body Is Still Running a Trauma Response, Here Is Why If the phrase "I have done the therapy, the supplements and the breathwork and my body has not moved" is the reason you are here, start with this one next.
Episode 135: The Hidden Difference Between Stress and Trauma In How The Body Keeps Score The mechanism underneath the equation taught in this episode, at more depth than a solo episode has room for.
Your Host
Dr. Aimie Apigian, MD MS MPH, is a double board-certified physician in preventive medicine and addiction medicine with master's degrees in biochemistry and public health. She is the author of the national bestseller The Biology of Trauma and the founder of Trauma Healing Accelerated, where she teaches the Biology of Trauma® framework to individuals and to practitioners.
Research
Thurston RC, Bromberger J, Chang Y, Goldbacher E, Brown C, Cyranowski JM, Matthews KA. (2008). Childhood abuse or neglect is associated with increased vasomotor symptom reporting among midlife women. Menopause, 15(1), 16–22.
Carson MY, Thurston RC. (2019). Childhood abuse and vasomotor symptoms among midlife women. Menopause, 26(10), 1093–1099.
Gibson CJ, Huang AJ, McCaw B, Subak LL, Thom DH, Van Den Eeden SK. (2019). Associations of intimate partner violence, sexual assault, and posttraumatic stress disorder with menopause symptoms among midlife and older women. JAMA Internal Medicine, 179(1), 80–87.
Epperson CN, Sammel MD, Bale TL, Kim DR, Conlin S, Scalice S, Freeman K, Freeman EW. (2017). Adverse childhood experiences and risk for first-episode major depression during the menopause transition. Journal of Clinical Psychiatry, 78(3), e298–e307.
Disclaimer
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