How Safety Helps the Nervous System Heal

That key feature of overwhelm is that we often see ourselves as the problem. We’re not strong enough. I should be able to do this. And we see our selves as a problem and that is what autoimmunity is.

It’s our immune cells saying, you’re the problems, I’m going to attack you. Welcome to the Integrative Medicine Roundtable, where practitioners lead, brought to you by the North Carolina Integrated Medical Society, join integrative health care leaders, clinicians and innovators as they share practical insights, emerging research, and the conversations shaping the future of patient care.

Welcome to the Integrative Medicine Roundtable, where practitioners lead. I’m Dr. Lisa Broyles with NCIMS at our Synergy 2026 conference. And I have the fantastic privilege of interviewing Dr Amy Apigian.

i have just read her book. It’s amazing. Everyone should read it. She will change your practice forever as far as understanding the link between your patient’s autoimmune disease and their past trauma.

So I will let Dr Apigeon just introduce herself and then we’ll get started. I am a medical physician by background. I actually started in general surgery and then switched.

Once I knew that I wanted to study trauma in the body, I switched and I’m now a double board certified physician in preventive medicine and addiction medicine, but now have my online programs.

and education to help people learn the skills to actually work with and shift their nervous system state. Physician educator, we need more like you. Thank you!

Well, I was wondering when I reading your book, you talked about your five-step trauma response or how people end up in overwhelm. Can you just briefly describe that for us?

Yes. And where I learned this was in trauma therapy trainings. Coming out of being a foster and adoptive parent, I searched for anything that was working and helping these kids who had been adopted.

And this was one of the things that I found. It was an art narrative process, but what they were mapping out were these five steps. Yes. I was like, why didn’t I learn this in medical school?

Right. So then I’ve taken those five sets and I looked at, well, what’s the physiology of these steps? Does it match what we understand? as the biology and physiology in the sympathetic state with the vagus nerve, and it matches up perfectly.

And so the five steps are, first we startle. That’s the first time that our sympathetic nervous system turns on, secretes noradrenaline from the tissues, makes us jump.

That is to get us ready for, really, the fight-or-flight of the stress response. So the response is the second step. We are going to stay in that stress-response as long as we can and as well as need to.

Okay. As long the stresses there, we’re going stay that response until we no longer can. And at that point, third step is we hit a wall. And that wall is where we become powerless, trapped, and all alone.

That then triggers the next step, the fourth step which is the freeze response. Okay. that’s unsustainable physiologically. And so the body shifts into that last and fifth step the shutdown.

And I think so many of us as clinicians have had patients in that shutdown. And i think you’ve been invaluable in teaching me how to recognize what stage my patient is at.

Are they in the still able to handle its stress response? Or have they moved into overwhelm and I can’t function anymore? And, I love how you described as a physician, it’s important for me to know the difference so that I could offer them help according to what state they’re in.

So, I really appreciate that. You talk a lot about the dangers of just pushing through, and I have some… I mean, we’re doctors, right? We are absolute professionals at pushing though, that’s what we are trained to do.

But what happens to your body when you ignore its signals and you push and push? So every body has a critical line. Up into that critical, we are in stress mode and we can get things done.

We can hold a lot and successfully do that. The challenge is, is that when we don’t know that we’re right up to that line or that, that’s when that stress physiology that energizes us.

Right. trauma physiology that drains us, and without recognizing that, that’s when we push through. So we’re trying to push though a state that is already in shutdown.

It doesn’t need us to pushed through, what it needs is a sense of safety so that it can come out by itself and then we won’t have to need to Yeah, that makes sense.

You talked about overwhelm being something at a cellular level. So that’s like, can you connect those dots for me? So how do I go from feeling emotionally shut down to having autoimmune disease?

Right. This is the idea that this overwhelmed and shut-down state is happening at the cellular-level and the system- level? Yes. At the cellular level, we see this as the Cell Danger Response.

Okay. And what happens is that the mitochondria have stopped being able to be efficient about energy and ATP production. Right. There are other factors that it creates.

Yes, toxins, gut, those bios. Exactly. And oxidative stress is actually one of the main, both precipitants and results of that cell danger response. So it’s actually, one way that we can measure what is trauma burden in terms of trauma having become our biology.

Looking at the amount of oxidative damage at DNA level. Fascinating that we actually can measure these things. So if you have the mitochondria unable to make energy efficiently, which means that your metabolism is shutting down.

Which means it affects every cell in your body that needs energy to do what it does. You’re going to have the imbalances in you immune system from the metabolic changes, but also from nervous system changes.

Because the nervous and the immune systems are in so much conversation that you’re nervous systems will communicate to your immune. We’re in danger and your system will be like, I got you.

Let me attack everything. And that’s really that key feature of overwhelm is that we often see ourselves as the problem. We’re not strong enough. I should be able to do this.

And we see our selves as a problem and that is what autoimmunity is. It’s our immune cells saying, you’re the problem, I’m going to attack you. Yeah, that makes a lot of sense.

I’ve seen so many people that there’s so much emotional trauma that’s come along with that autoimmune disease. And I think that your book helps people unwind where it started, going back way back to see where did this first begin?

And sometimes that is a painful process. to look under the hood and see what’s causing the dysfunction. And I think it’s even harder when you get more and more, the older you are, or the more professional you, you don’t want to admit that these things are affecting you until you can’t get out of bed one day.

The idea that it is overwhelming and because we as professionals even, we need to function and so we bury that for as long as possible. because it would be overwhelming.

Yeah. That makes sense. So can you describe a little bit what your recovery program looks like? So, the body needs very specific things and in a specific order in order to heal.

I think of it almost like in the shutdown, we are the turtle that pulls into its shell. We’re not in fight or flight anymore. we’re trying to run away.

Right. So the first step is making it safe for me to poke my head out again. making it safe for me to put my feet out so that I then could do something.

But until I feel safe to even do that, I’m going to stay retreated, hiding from the world that seems very scary. And I think you made a good point that that safety has to be a multi-level safety and it goes beyond our conscience feeling of safety.

There’s also the subconscious, the somatic. You talked about the mind, body, biology. I would add the spirit too that you have to feel comfortable at every level of deep safety, and then you said that often when you come out of that, some negative emotions often come up, right?

And that’s what we’ve labeled them. We’ve labelled them as, those are negative emotions. There you go. Right. Things I’m not supposed to feel. I am not allowed to, I not okay to.

Exactly. Anger, shame. Yeah. Anxiety. They’re uncomfortable emotions. I would say, especially for many women, we were trained. We were raised, whether it was spoken or not.

It was something that was in the air that you as a woman were not supposed to be angry. You were supposed to be nice, kind, southern charm. And so the idea of we do feel angry and we’re supposed feel anger when someone puts our life at risk.

And so here we have these intense, uncomfortable emotions coming up. And unless we’ve learned the skills to actually feel those and to know what our body needs to do with those, we end up being overwhelmed by our own feelings.

Yeah, that makes a lot of sense. So learning how to, once I do start coming into a feeling of safety and I feel an emotion that I even just called negative, then I would be able to feel that, be in touch with it and be okay with that to start to enlarge my capacity.

Exactly. Yeah. You talked about support being so important. Support is huge. support is the feeling that someone is in it with you. That’s what support feels like.

You’ve got that in your marriage. Many people do not have, have not had that since childhood. Like they don’t even understand the concept of what would that feel like?

And so for each of these, whether we’re talking about it starts with safety or then we need to bring in support, it’s more important to learn how to create that feeling for yourself.

I don’t want people thinking, well, I didn’t have someone in my life, so I can’t. Exactly. No, no, we learn to create this feeling for ourselves. One of the most helpful somatic exercises for me was neck support.

where it’s a very intentional support on the neck. The brain stem is back here, so there’s all kinds of scientific reasons. But when I first learned how to do that for myself and find just the right spot, just right pressure, it actually gave me a feeling of being loved.

And I thought, how interesting. You mean I don’t have to wait for someone else to make me feel alive? Like, I can give myself that feeling. What a gift that I give to myself.

And now I navigate these uncomfortable feelings because when they come up, what do I need right now? What does my body need? I’m able to ride the waves of emotion and not get drowned in the wave of emotions.

I see so many women that are in this situation where they feel like they can’t express emotion or they cant fall apart, right? Because they’ve got the kids, they got their husband, their parents they’re taking care of.

So all these people that they are caring for and they aren’t caring themselves. and that lack of self-care causes them to eventually break down, and then that ripples out to the rest of the family.

And these women, then you compound they’re not eating right, their hormones are off, they nutrients are of, there gut’s a mess, you’ve got a disaster on your hands, right?

You’re in trauma response. I think for me as a clinician to learn the skills to recognize what state my patient is in and then give them the right resources to help them start to listen to their own body and learn how to find support and safety to grow their capacity, right?

This is what we all need to learning as clinicians. You know, one of the most helpful questions that I’ve learned to ask those who come through my courses is, what is the very first thoughts that you have when you wake up in the morning.

That tells me so much of where they’re at right now. Yes. And most women are waking up with the thought of, I wish it were not morning, I don’t like my life.

I’m overwhelmed by my live. Yes. And if that’s where they’re starting out most days of their life, then that gives me this insight into, so then tell me what you do next.

I grab a cup of coffee. It gives them the adrenaline that helps pull them out of that shut down. And I see that for the rest of their day, they’re using coffee, sugar, food, exercise.

sometimes drama, pressure, and deadlines in order to create the stress for themselves to get through and have the energy to give. Interesting. Right. That makes so much sense.

I think you really truly understand, I had never known just all the things that the vagus nerve truly did. And I remember reading in your book that nerve roots even went down into my gut.

Well, that makes sense with the gut being the second brain. So I’ve learned so much about the role of cortisol versus adrenaline and that what we learned in med school was only a piece and not the whole picture, right?

And that’s what integrative medicine is all about is finding the hole picture so that we can truly heal the who person and just individually treating this nervous system or this gut system like they’re two completely separate people when they are in the same person, Right?

They are the person driven by the nervous Absolutely. Well, is there anything else you want our listeners to know today? I think I just want to reinforce the sense of agency and empowerment that comes with understanding your own triggers, your responses, and your reactions.

They no longer confuse you and you find that they become information for what next layer do I want to heal? Yeah, when you give people knowledge, then they have hope.

They have a hope that their hope is the best medicine sometimes. Right, that makes total sense. When you gave them hope, they don’t feel powerless anymore.

That’s it. And then, there comes that capacity that stretches, and then you can manage stress better and come out of the trauma response. How amazing that we get to facilitate that as the providers.

It’s incredible. It, it’s an absolute joy. Thank you so much. Thanks for joining us on the integrative medicine round table where practitioners lead. If you found value in today’s conversation, follow our podcast, share it with a colleague, or visit us at ncintegrative.org and join our community today.

We’ll see you at the next roundtable.