Jorina Elbers, MD


September 20, 2023

Jorina Elbers, MD

Pediatric Neurologist

By Jorina Elbers, MD

Pediatric Neurologist

Dr. Jorina Elbers is a pediatric neurologist and researcher with expertise in chronic stress and trauma. She was recently an assistant professor at Stanford University and is currently the director for the Trauma Recovery Project at the HeartMath Institute, a 501(c)3 nonprofit. She is also the co-creator of the HeartMath for Parents Program.

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Image by DANNY OWENS / Death to the stock photo

September 20, 2023

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The definition of trauma is antiquated. It’s long been considered a psychological condition related to a life-threatening event like war, giving the illusion that it’s rare and only affects the mind.

Trauma also hasn’t been given the attention it deserves in the medical community. As a pediatric neurologist, I didn’t learn anything about trauma during my nine years of medical training. It was only when I started seeing my own patients and taking the time to hear their stories that I learned about the decades of research describing how trauma affects the body and our health.

My experience has taught me that trauma casts a wide net—across all ages, genders, ethnicities, social backgrounds, and centuries.

What is trauma?

It would take many articles to list every possible source of trauma, but the most important thing to realize is that trauma is entirely personal.

One person who experiences war and displacement may not develop symptoms of trauma, while another person who swallows a piece of food the wrong way can develop an extreme fear of eating. Trauma is not necessarily about the event but how we respond to it and what social supports we have to fall back on. Genetics, age/developmental stage, attachment style, and social support all play a role in whether or not a particular event is stored as a traumatic experience in the brain and body.

Trauma is not necessarily about the event but how we respond to it and what social supports we have to fall back on.

It’s a common misconception that when a traumatic event happens, we should just be able to forget it or “shake it off” as if it were a scraped knee. 

Traumatic memories vs. non-traumatic memories

The subconscious mental filing of experiences is something we all do, all the time: what you had for dinner last night, the movie you saw last month, and the birthday party you threw last year are all neatly tucked deep inside the brain through a process called “integration.”

Integration involves linking new memories with existing memory networks for flexible extraction, much like a filing system. Because of this efficient filing system, most memories are effortlessly forgotten in the subconscious. Some memories can be recalled and retold, but mentally, emotionally, and physically, the experience is clearly in the past. 

But traumatic experiences are not like most memories. When an event is experienced as emotionally or physically harmful or life-threatening, it activates an extreme level of arousal. This level of arousal creates changes in the brain and body that store the experience in a special way to become unforgettable. This is an important aspect of our survival—we need to remember those things that threaten us.

Instead of being neatly filed and integrated, the experience “dis-integrates,” and is not properly stored. As Bessel van der Kolk, MD, writes in The Body Keeps the Score, “The imprints of traumatic experiences are organized not as coherent, logical narratives but in fragmented sensory and emotional traces: images, sounds, and physical sensations.”

These memory traces are linked in a way that makes them instantly accessible through similar emotions, thoughts, or sensations. When triggered, subconscious pieces of trauma from the past may be experienced as though they are occurring in the present moment.

Mental & physical symptoms of unresolved trauma

Trauma happens when an adaptive mechanism of survival actually becomes a liability, causing traumatic memory fragments to be unwittingly and subconsciously triggered over and over again. Then, covert experiences of trauma masquerade as overt emotional issues, including:

  • Extreme avoidance
  • Depression
  • Anxiety
  • Panic attacks
  • Uncontrollable emotions
  • Relationship difficulties

The body is also affected. When the stress response is repeatedly activated over time, it causes various systems to become dysregulated and leads to health problems including:

  • Poor sleep
  • Chronic pain
  • Asthma
  • Heart disease
  • Digestive issues
  • Frequent infections
  • Inflammation
  • Chronic fatigue

Many of us have tried strategies of avoidance and distraction to bury trauma. We lean on excitement, pleasure, work, substance use, or pharmaceutical numbing, but we can never seem to shake the invisible threat we feel. Our body bears the burden. Anxiety, depression, and illness become the default, and a real solution appears out of reach. 

How to heal

In my work, I’ve found that getting past our past involves integrating traumatic memories in the present.

Traditional therapies can offer some relief but aren’t successful for every person. For example, traditional talk therapy focuses mainly on reconstructing a verbal or written narrative to integrate an experience. This can be difficult for several reasons, especially when the trauma story is not consciously accessible.

Dissociation within the trauma response can create memory loss or confusion surrounding the event. The event also may have occurred during infancy or childhood, during pre-verbal periods of development. Alternatively, repeated traumatic experiences may have occurred so often that talking about “an event or events” does little to integrate the experience in its entirety.

In addition, part of the trauma now lives in the body’s unremitting arousal response, so talking about “the event” can actually perpetuate and further embed the trauma response in the body through reactivation rather than resolve it.

Instead, integration starts when trauma is brought up in a way that allows the body to access a state of safety and regulation instead of overwhelm. The concept of “That was then, but I am safe now” needs to be a lived experience by the body, not simply a cognitive endeavor.

Therapies that incorporate regulation into their model of trauma processing include Eye Movement Desensitization and Reprocessing (EMDR), Brainspotting, Somatic Experiencing, Hakomi, Sensorimotor Psychotherapy, Neurofeedback and Psychedelic-Assisted Psychotherapy.

Finding a therapist who is trained in one of these trauma-focused therapies can help to unstick trauma memory fragments, even ones that do not have an accompanying “story” or narrative that can be succinctly told.

The concept of ‘That was then, but I am safe now’ needs to be a lived experience by the body, not simply a cognitive endeavor.

Even after the integration process, the traumatized body may still experience symptoms related to chronic dysregulation. When there have been months, years, or even decades of repeated trauma activation, the body’s baseline nervous system function becomes wired toward activating the stress response. In these cases, practicing frequent, daily self-regulation strategies (ie. sleep, meditation, dance/ movement, nature exposure) are an essential step in trauma healing.

Breathing exercises can also help rewire the nervous system

When reprograming the nervous system, it’s also important to “catch” the default responses of anxiety, fear, or upset in the moment and train a new response right away. Otherwise, we continue to reinforce old patterns.

Slow, deep breathing automatically sends a message of safety from the body up to the brain that shifts the biological response away from stress activation and towards regulation. In a recent study from Stanford, controlled breathwork practices were more effective than mindfulness meditation for improving mood and reducing physiological arousal1. Breathing exercises are free, portable, universally accessible, and only take a few minutes to be effective.

And research from the HeartMath Institute and others has shown that adding a rejuvenating emotion, like care or appreciation, for something or someone in your life while you breathe provides additional benefits.

The Heart-Focused BreathingTM technique developed by the HeartMath Institute is a great example of an emotionally charged breathing practice. Here’s how to do it:

  1. Focus your attention on the area of the heart.
  2. Imagine your breath is moving in and out of the heart or chest area, breathing a little slower and deeper than usual. Find a rhythm that’s comfortable.
  3. Take 5-10 slow deep but comfortable breaths through the heart area. You can place your hand over your heart to help with the point of focus.
  4. Afterwards, take a moment to notice how this makes you feel.

The more you can practice this technique throughout the day (in meetings, in traffic, in line at the grocery store, while doing the dishes etc.), and in the moment whenever you feel anxious or upset, the more easily you can reprogram the nervous system towards balance and regulation.

On a final note, trauma is an experience that can disconnect us from the heart. This is one of the reasons we might “lose our way” after a traumatic event. Reconnecting with the heart using practices like these can also help us rekindle that lost connection to our wisdom, our inner guidance, and our truer self.

The takeaway

As a neurologist who now specializes in treating chronic stress and trauma, I believe that finding the right trauma therapist and practicing Heart-Focused Breathing to regulate your body are two simple ways to relieve the emotional and physical symptoms left behind by trauma. With these tools, the disempowering experience of trauma can be transformed into a greater capacity for awareness, agency, growth, and connection to the deepest parts of yourself.