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As a therapist who specializes in treating complex posttraumatic stress, I am often asked whether my practice is “depressing,” or whether it brings me down. It’s an obvious question: Along with the victories and the moments of fulfilling interpersonal connection, I am in vicarious contact with intensely difficult situations and stories. Also, practicing somatic psychotherapy develops one’s sense of empathy: the ability to sense what another person is feeling and to also feel it. So I often literally feel, in my own body, the sensations and emotions of the distress experienced by the people I work with in therapy. This is a good thing, as it is a fairly reliable indicator of what a person in therapy may be experiencing. Fortunately, my training affords me the capacity to feel others’ distress without getting stuck in it.

But no, my practice does not bring me down. I am deeply grateful for my training and my entry into this field. I can’t imagine doing anything else, because I believe increasing humans’ capacity for self-regulation is the most important thing in the world.

That’s a big statement. I don’t make it lightly.

You might be wondering: why self-regulation, of all things? After all, most people don’t even think about self-regulation or how it relates to our individual or collective lives. The topic doesn’t even cross most people’s minds.

As I noted in a previous article, “The term self-regulation means ‘control [of oneself] by oneself.’ It refers to a system taking the needed steps to keep itself in balance.” Specifically, somatic therapy helps people learn to self-regulate the balance of the fight/flight response in their nervous system. This balance can (and should) change moment by moment, depending on the current situation and environmental demands upon the person. In other words, it’s a dynamic balance—and it has to be accurate or there will be problems!

According to Stephen Porges, we have four basic states (like “gears”) in our autonomic nervous systems. Our thoughts and behaviors at any moment are hugely influenced by the relative proportions of each. These are physiological states in the autonomic nervous system. They are:

  1. Social engagement. This state is controlled by the ventral vagal (10th cranial) nerve. In social engagement, a person remains calm. They are truly available to be present with others. They can experience empathy. They are able to hold good boundaries, cooperate with others, and maintain a sense of humor. The key concepts here are calm, flexibility, and empathy. This state is vitally important; it forms the foundation of good self-regulation and, generally speaking, should be the most predominant “gear” in daily life. However, it’s often overlooked, as the public doesn’t tend to have much education about it.
  2. Fight. Usually experienced as angerirritability, or rage, this state is controlled by the sympathetic nervous system (SNS). It comes online when the person’s midbrain structures perceive a threat. The more predominantly the person is in a fight response, the more the prefrontal cortex goes offline and the less the person is able to experience calm or empathy.
  3. Flight is usually experienced as fearanxiety, or restlessness. Also controlled by the SNS, the flight state includes the same loss of cortical function as with fight.
  4. And then there is freeze, which is usually experienced as passivity, low energy, amotivation, dullness, foggy-headedness, and reduced capacity for cognition and emotion (other than fear). This state is also mediated by the vagus nerve—but an older, more primitive portion of it, the dorsal vagal system. Basically, freeze is a death preparation state, and it shows up when the body “thinks” social engagement, fight, and flight would be ineffective.

As Peter Levine writes, previous traumatically stressful events that have not been fully resolved in the nervous system will disrupt a person’s self-regulation, biasing their response to present-day events. Specifically, unresolved trauma causes the person to respond with excessive fight, flight, and/or freeze response relative to the current situation.

Self-regulation supports cooperation and healthy group norms. I wish we could wipe out 25% of our fast-food restaurants and liquor stores, replacing each of them with a free somatic therapy clinic.

Here is a thought exercise to illustrate the vital importance of self-regulation and how it impacts just about every situation across our human lives—on small and large scales. Imagine each of the following common scenarios. Then, imagine how each scenario could be different if at least one person involved was able to maintain calm social engagement.

  • Bobby is growing up in an impoverished neighborhood. One of his parents is absent and the other is stressed, working two low-wage jobs in order to pay the rent. In his family and in his immediate community, there is no one consistently available who creates a sense of calm and safety. Bobby’s nervous system never learns how to drop out of threat response and into relaxed social engagement. As he grows up, this lack of internal safety and stability has an impact on every interaction and decision he makes.
  • On the freeway, one driver doesn’t see another in time and nearly causes a collision—not at all on purpose. The other driver is angry and begins to escalate. The at-fault driver becomes upset by this.
  • Two next-door neighbors don’t get along well. One decides to start barbecuing his dinner. The other is allergic to smoke; she yells at him to stop, or else she’s going to get her cousin to beat him up. The first neighbor pulls out a knife and waves it at her.
  • A country is faced with a major decision: whether to stop manufacturing a product that has a large negative impact on the environment (including animals and people). Some lobbyists profit majorly from the manufacture and sale of this product. They are competing for economic rankings for their shareholders, so they are focused on increasing financial profit and do not show empathy to those severely affected.
  • Two cultures (or one culture and one subculture) have hated each other for generations. The insults and the fighting have gone on for so long that no one remembers the original transgressions. The topic is charged with emotion and exaggeration. Children in each culture are raised to hate (or at least dislike and avoid) the other culture. Eight-year-old Amanda secretly feels curious about the other people and would like to get to know some of them. She doesn’t talk with anyone else about this, because doing so could get her labeled a traitor and ejected from the very family and community she needs in order to survive and grow up. This collectively stuck survival charge isn’t usually in the foreground, but it permeates the background of her daily life.

Each of the above scenarios illustrates the ripple effect of dysregulation and how it lies at the core of most human problems. There are many, many other examples. Imagined the other way—that is, with the influence of a self-regulated person or people—these scenarios can also illustrate the powerful positive impact of self-regulation: it has a strong tendency to stop conflict and exploitation (due to the presence of empathy). Self-regulation supports cooperation and healthy group norms. I wish we could wipe out 25% of our fast-food restaurants and liquor stores, replacing each of them with a free somatic therapy clinic.

And the thing is, we could—if only there were enough aware, self-regulated people to make it happen.

Until then, I’ll hold off on my occasional daydreams of being a barista, or a nature guide in a sustainability program. Instead, my colleagues and I continue to support self-regulation, one nervous system at a time.


  1. Porges, S. W. (2001). The polyvagal theory: Phylogenetic substrates of a social nervous system. International Journal of Psychophysiology, 42:123–146.
  2. Porges, S. W. (2003). Social engagement and attachment: A phylogenetic perspective. Roots of Mental Illness in Children, Annals of the New York Academy of Sciences 1008:31–47.



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When Nicole Lepke’s son was born, she listened to her pediatrician and kept peanuts away until the age of 2, but the toddler still developed a severe peanut allergy when he finally tried them.

Now, 12 years later, health experts have reversed their advice on peanuts, urging parents to begin feeding foods containing peanut powder or extract during infancy in hopes of reducing a child’s risk for allergy.

The about-face on peanuts has stunned parents around the country who are coping with the challenges of severe peanut allergies. Like many parents, Ms. Lepke is now plagued with guilt. By restricting peanuts early, did she inadvertently cause the very allergy she was trying to prevent?

“There is this constant guilt that you have as a parent,” said Ms. Lepke, a mother of three who lives outside Milwaukee. “And then if the recommendation changes the next year, you feel it even more.”

Since the new guidelines were announced last week, many parents, alarmed by the recommendation that peanut-containing foods be deliberately fed to infants, have lashed out at the medical community in social media posts.

A new parent who gives peanuts to a baby “could be sentencing them to death,” said Peggy Cottle, of Dayton, Ohio, who has a child with a peanut allergy.

Ms. Cottle said that it often seems like every year a new study comes out that negates an earlier study. “There is no definitive proof on what causes food allergies,” she said.

Jennifer Urso Doggart, a mother of four from Jefferson, Ohio, said she feared babies would be used as “guinea pigs” to test the new allergy prevention guideline.

“You follow advice and then find out years later that it was the wrong advice,” Ms. Doggart posted on the Facebook page of“‘Oh no. Wait. We were mistaken. It’s actually the opposite thing you should be doing!’”

But others reacted with sadness, wondering whether better information earlier on might have prevented their children’s allergies. “It is a bit disheartening and frustrating,” Heather Eslinger, a physical therapist in Colorado Springs whose children have nut allergies, said in an interview. “It is hard to accept that things may have been different had we known then what we know now.”

While national health officials have a track record of reversing medical advice from time to time — menopause hormones and trans fats are two examples — few topics are as fraught as food allergies. For starters, food allergies disproportionately affect children, and the risk of making the wrong decision about a food is immediate and potentially deadly. As a result, parents are particularly fearful about following the advice.

“I gave my 5-month-old a bit of my toast and peanut butter and we ended up in the emergency room,” said Lori Dombek, 58, a web developer in Gorham, Me., whose son is now 22. “Peanut allergies are nothing to fool with.”

But scientists say the new guidelines are based on the latest science. A large clinical trial studied hundreds of British children at risk for peanut allergies, giving them either peanut-containing food regularly from infancy or withholding all foods with peanuts.

By the age of 5, the trial found, those who had been given peanut-containing food early in life had an 80 percent reduced risk of developing a peanut allergy.

“The trial’s results were very very unambiguous,” said Dr. Matthew Greenhawt, chairman of the American College of Allergy, Asthma and Immunology’s food allergy committee and one of the authors of the new guidelines. The fact that the guidelines changed over time makes them more credible, not less, he said.

“You want them to change over time if there is better data available that can make a more informed statement — that’s progress,” Dr. Greenhawt said. “That’s why taxpayer dollars fund N.I.H. research – to push the envelope, to build a better mousetrap, to find a better answer to a question.”

The shift in recommendations was not as abrupt as some may think, experts said. As recently as 2000, the American Academy of Pediatrics told parents to withhold peanuts from children at high risk for allergies until the age of 3. But in 2008, the academy backed away from the recommendation, said Dr. Scott H. Sicherer, a spokesman for the academy and one of the authors of the new guidelines. Although the recommendation against withholding nuts from children under 3 was rescinded, that message didn’t catch on.

By 2008, the message was “You don’t need to avoid peanuts till age 3, feed the baby as you wish, there’s no evidence that delaying is going to be helpful,” Dr. Sicherer said. But by then, “It was stuck in people’s minds and wasn’t easily forgotten — it had become the gospel.”

Dr. Sicherer said he understands the resistance to the new message, and the fear that the advice might change again. In addition, he noted that giving your children peanut foods at a young age doesn’t guarantee they will be allergy-free. “It’s not foolproof. Even in the study, some still developed an allergy or had it when they started,” he said.

The new policy also leaves a lot of unanswered questions about allergies and other foods. When should other allergenic foods like eggs, dairy, fish and shellfish be introduced to young children? And what about eating peanuts during pregnancy and lactation? Experts said research about introducing other allergenic foods is ongoing, and that studies on eating peanuts during pregnancy and while breast-feeding are weaker observational studies, and the results are mixed.

There are social implications as well. Parents of children with allergies often feel that they are subtly accused of causing allergies by being overprotective or of being neurotic and exaggerating the risks. They worry that the new guidelines will encourage those stigmas. Doctors say no one should be blamed for peanut allergies or feel guilty about them. “There is no peanut-allergic child right now who is peanut allergic because of something their mother or father did,” Dr. Greenhawt said. “It’s not their fault. This is something that was there.”


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We used to think of hormone imbalance as a “women’s issue,” one that was only really relevant in the days before a woman’s period (hello, PMS) and during pregnancy. But these days, we know that hormones rule our entire lives and are greatly responsible for how we—both men and women—feel on a daily basis.

Hormones influence our mood, appearance, energy levels, libido, and even our digestion. Knowing this, we’ll all want to do what we can to prevent a hormone imbalance before we have one. This involves reducing stress, moving our bodies, and most importantly, making sure we’re getting adequate amounts of hormone-supporting nutrients.

But what nutrients are those, exactly? It’s a little hard to pin down. As Jon Mitchell, PA-C, certified physician assistant and functional medicine health consultant, explained: “Hormones are complicated because there are so many biochemical systems and lifestyle factors that influence their levels, which is why addressing them requires a comprehensive approach.”

That said, there are a few nutrients that come up over and over again when it comes to hormone health. Here are some of the most important ones and why we should be getting enough of them:

1. Methylated B vitamins

According to Bindiya Gandhi, M.D., integrative medicine doctor and mindbodygreen Collective member, if we want to prevent hormones imbalances, methylated B vitamins are a great addition to our wellness routines. “Methylated B complex helps replenish the body of essential B vitamins that are important for detoxification as well as during a female’s menstrual cycle,” she said.

A B-complex will include the full gamut of B vitamins, which is important since specific B vitamins are important for specific hormone functions. For example, “When vitamin B1 and B6 are low, it can cause menstrual cramping,” explained Gandhi.

But wait, what’s the difference between a methylated B vitamin and a normal B vitamin? It’s pretty simple: Methylated B vitamins are in a form that is more readily absorbed and used by the body.

2. Omega-3 fatty acids

Fending off chronic inflammation and balancing hormones are almost synonymous, and that’s because inflammation is almost always involved when something in the body is out of whack. Enter: omega-3 fatty acids. According to Gandhi, these anti-inflammatory superstars, “decrease overall inflammation and pain, especially during menstrual cycles.”

Fats are also the building blocks of many of our hormones, so it makes sense that we need to consume plenty of them for optimal hormone function. You can get omega-3s through foods like salmon, flaxseeds, chia seeds, and sardines or take an omega-3 supplement. David Perlmutter, M.D., mbg Collective member and functional medicine doctor, suggests 800 to 1,200 mg of DHA daily.Article continues below

3. Probiotics

Did you know that there’s a strong connection between gut health and hormone health? Studies have shown that estrogen actually delays gastric emptying, which can lead to constipation. For women with estrogen dominance, this is crucial information to know.

That said, understanding the gut health-hormone connection is just as important for men as it is for women. As Collective member and integrative medicine doctor Vincent Pedre, M.D., wrote in an articlefor mindbodygreen: “The standard American diet (SAD) leads to obesity through inflammation by affecting your gut flora…and allowing bacterial endotoxin (a bacterial cell wall component and potent activator of the immune system) to leak into your body. The trans-mucosal migration of endotoxin directly leads to lower testosterone levels by affecting its production in the testes.”

If you want to safeguard your gut health (and thus, your hormone health!) a good place to start is a high-quality probiotic. Studies show that a daily dose of these beneficial bacteria can improve constipation by improving consistency, transit time, and stool caliber.

We all want to keep our hormones in tiptop shape. And as Gandhi explained, “It’s always better to get to the root cause of the specific hormonal imbalance and prevent it—rather than waiting and treating it with prescription medication.” By upping our intake of these important nutrients, we have a better chance of nipping hormone imbalance straight in the bud.


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