Pulling into the parking lot, you find no accessible parking. Suddenly a spot opens up, but someone pulls in before you. They do not have a placard and, ignoring their surroundings, they proceed to jump out of their car and walk towards the front door. Your stomach drops, your face gets hot, and you feel angry, anxious, and sad all at the same time.
Triggered, your sympathetic nervous system has activated a response process and your simple errand now hinges on the prospect of a difficult confrontation: either confronting the oblivious driver yourself or trying to find someone to help you. First, you still have to find an accessible spot to park.
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This example is just one of many ordinary daily experiences becoming extraordinary for someone using a wheelchair to exist in the world. The physical damage of a spinal cord injury leads directly to mental health challenges through the frequent reactions in brain and body to trauma, anxiety, and stress.
We can ask illuminating questions about the nervous system response: why is it so primed to be reactive, what is it doing in these reactions, and what can one do to regain control after being triggered?
Meet Maggie: LCSW & wheelchair user
I have used a wheelchair for 21 years. I have spent a lot of time feeling stressed, anxious, sometimes traumatized, and in some degree of discomfort. All of these things consistently increase my likelihood of being in an elevated nervous system state. I have severe chronic nerve pain, and like many of you, live with constant back and neck pain.
Frequently, I struggle with access to parking, bathroom stalls, and buildings. I have to deal with people who stare, ignore me completely, or truly want to be helpful but instead awkwardly worsen my struggles. These examples of triggering events might push us out of the window of tolerance. I can’t change the world enough to eliminate my triggers.
I can, however, work on tools and skills to return myself to baseline as quickly as possible.
The science behind triggers and anxiety
In order to understand what to do about an activated nervous system, we must first look at what is happening in the body when triggered. Think of your brain as a house with two floors. The “downstairs brain” (aka reptile brain), includes the brain stem and the limbic system, and is in charge of vital life support systems like breathing and cardiac function.
The fight/flight response is coordinated there by the sympathetic nervous system (SNS), while the parasympathetic nervous system (PNS) controls the “rest and digest” response. The “upstairs brain” (aka the wise brain) of our mental model includes the prefrontal cortex, and is responsible for impulse control, rational thinking/complex thought, and self awareness.
As we perceive our experiences throughout the day, sensory input is initially sorted by the thalamus and sent first through the amygdala, then milliseconds later to the frontal cortex. Along with the neighboring hippocampus, the amygdala determines immediate reactions to danger – “survival instincts” which are computed without much, if any, conscious thought.
Reacting to a jump scare in a movie is an example of this survival mechanism at work, and while it has helped keep us (as a species) alive for millions of years, it is also a system that can sometimes become maladaptive.
The stress response: fight, flight, freeze and fawn
The stress response causes significant physiological changes in the body. Fight or flight is referred to as hyperarousal and symptoms include anxiety, overwhelm, stress, anger, irritability, and/or a loss of control. Freeze and fawn are referred to as hypoarousal and include feelings of lethargy, emotional numbness, exhaustion, depression, and sometimes shutting down completely.
When we are neither hyper- or hypo- aroused, it is referred to as being within the window of tolerance, the optimal arousal zone. Research shows that those with trauma are more likely to get triggered and pushed out of the window of tolerance. It is not only easier for them to be triggered, it takes longer to return to baseline.
When the stress response recurs chronically, people experience mental health issues such as attention deficits, memory issues, sleep disorders, irritability, and chronic anxiety.
Finding control through our breath
We have control of these systems through our breath. The inhale is linked to the sympathetic nervous system and the exhale is linked to the parasympathetic nervous system. In other words, we inhale “fight or flight” and we exhale “rest and digest”. When we feel anxious or have been triggered by something, we can first work to actively bring awareness to our own breathing pattern.
Begin with paced breathing, and practice doubling the length of each exhalation. If I inhale for 4 seconds, I am going to exhale for 8. This way, I can actively choose to spend more time emphasizing the “rest and digest” function of my nervous system response, decreasing anxiety and slowly bringing myself back to the window of tolerance.
If, while practicing a paced breath, one feels dizzy or lightheaded, add a pause of 2-4 seconds in between the inhale and exhale, allowing the body to use up extra oxygen in the bloodstream.
I know firsthand that taking a breath doesn’t fix everything. It is a start, though. When the pain is so bad I don’t know what to do or the environment I’m surrounded by is reminding me of what I can’t do, I do my best to return to something I have control over, that I have power of, and that is my breath.
Leaning into the exhale, I say something kind, compassionate, and loving to myself like, “You got this Maggs. Take another breath. You got this.”
This is where we begin. I challenge you, if you dare, to begin noticing your breath and practicing staying in the exhale more than the inhale. Notice how the exhale feels in the body, and how it begins to decrease anxiety and calm the system overall.
