So many times, I’ve heard the sentiment in therapy from my clients “oh Sula, can I really change? I’m in my [insert decade]es now”.
Good news! There is no age cut off for making change. In other words, old dogs can learn new tricks and have them stick [1,2].
What do we mean by rewire our nervous system?
Excellent question. Let’s start there. If, by nervous system, we mean the network between brain, spinal cord and the nerves throughout our whole body, when we talk about the wiring of the nervous system, what we mean is the precise way our brain and nerve networks are established.
And in understanding this, we can already identify that it’s a bit of a misrepresenting term, because our nervous system is not “wired” in one particular stable and non-changing state. It comprises a network of nerves that communicate with each other connecting different regions of the body using multiple and many pathways depending on multiple and many factors. There will be some habitual pathways in the sense that some are prioritised over other alternative routes. This can happen as a result of environment, context, psychological experience and existing biology. Let’s consider it in action:
Whenever I go to hospital (environment) it is because I am really unwell (context) and I always have a horrible experience waiting and trying to advocate for myself (context). This leads me to feel scared and stressed (psychological experience and physiological experience). My sympathetic nervous system, the fight or flight biology, will be activated automatically to protect me from threat (biology).
If this happens over and over again, we can see how this pathway would automatically light up even if I was just visiting hospital to see a friend or for a routine appointment. Our body likes to automate for us.
How does our nervous system “wire” in chronic illness?
Well hopefully I’ve clarified that there is not a single way that a nervous system wires. That it is highly personalised depending on a range of different factors. So, I’m going to focus in on one particular “type of wiring” * that commonly comes into play when someone has a chronic illness. And that is the wiring around threat. Afterall the experience of physical suffering of any kind is a very threatening experience. This can, again, be made more or less threatening by environment, context, psychology and biology.
The threat detection process can start in our brain as we perceive a threat. However, it can also be a preconscious process whereby our peripheral organs or tissue more generally, send messages to the brain to say “something is going on here” (a process called neuroception) and the brain responds by amplifying the message and consequent threat response. This is what happens in pain [3] but it is a process that could apply to other physical bodily experiences (e.g. heart palpitation, gut movements, etc).
Once that threat level is elevated the brain will be in close communication with the peripheral area in question, plus the sympathetic nervous system (the fight, flight or freeze) will be activated to protect us from threat. This activation over time may change due to the fact that it has been activated for so long or so repeatedly. This can all lend itself to brain changes (structural and functional – i.e. volume of grey matter and how brain areas are activated or not), how our hormone systems function and how our immune system functions [4,5].
We can see similar changes in people with post-traumatic stress disorder (PTSD). Those who have experienced distress so overwhelming that it changes how the brain processes the information, and consequently how the nervous system responds [6].
The impact of nervous system changes
When we have a nervous system that is in threat detection mode it has an impact on our emotional landscape. Again, there is no one particular way this can play out. Different ways we may experience this include having more intense and out of the blue emotions, a persisting sense of stress/ overwhelm or feeling lower or less present. When our nervous system is always “on” it is also common to feel hypervigilant and/or irritability. It stands to reason when we feel like this our minds are on the lookout for things that could go wrong too.
Consistent patterns establish pathways
When our emotional landscape is changed, we may develop ways to cope with this, which themselves become choiceless habits. Brain shortcuts if you will. For example, if we always feel overwhelmed by small stressors, we may develop a coping mechanism of trying to dull this with distraction (be it alcohol consumption, phone use or trying to stay busy with things that feel manageable). Once these strategies become habitual, they can create more issues that solutions. It’s easy to see how this might happen with the preceding examples. What’s happening biologically is that we are creating more “nervous system wiring”. A more complex version of algorithmic programming “if x then y”; “if I feel overwhelmed, seek something to numb that feeling”.
This comes back to a simple principle: “We are what we repeatedly do.” - Aristotle.
The neuroscience of habits evidence this [7].
Too late to change?
At the point at which we realise that we feel we no longer have control over our responses, it can feel like there is no going back. Surely there is not. After all, we didn’t seem to have control over the habits and circumstances that got us there in the first place, how could we retrospectively gain control. Although this evaluation is intuitive, it is inaccurate. There are lots of ways sequences of events beyond our control get us into a position we, upon closer inspection, don’t want to be in and find it tricky to leave. Think of someone who has been in a loveless, familiar relationship for decades and then one day, decides to leave the relationship.
What’s changed? Well likely many things, albeit subtly over a long while. At the point at which the person is ready to make that big and potentially very disruptive change, we can be sure one specific thing has happened. The person has gained an awareness that they lacked clarity on beforehand. It is this awareness that allows them the choice to make change. In this example, it is a simple awareness: This relationship is not working for me. It makes my life worse in some way. The consequent action is relatively clear, if not simple. End the relationship and try and rebuild independence. This change in context is going to create substantial changes in the way a nervous system functions just by the very nature of the change, which involves different environments potentially, different experiences, different psychological and relational experiences and much more.
What about if the change is our own internal landscape and not an external change? Are you bound by the old habitual pathways that you have had trodden consciously and unconsciously over and over?
In a word, no. Relatively short term and acute behaviour change adopted at a later age, can have a transformative effect on our nervous system activity. This was shown in a study exploring the effects of forest bathing on the nervous system activity and depression reporting in the elderly, whereby parasympathetic activity (rest and digest arm of the nervous system) was enhanced after participants aged 65+ engaged in a forest therapy programme [8]. Other studies demonstrate how it is possible to reorganise brain processing pathways and nervous system activity in elderly adults using habit change, mindfulness practices and body movement [9-11]. Encouragingly, a lot of these interventions were relatively short-term programmes, meaning that they did not require lengthy periods to result in psychophysiological changes.
So how do I change?
I feel like I’ve led you up the garden path, if you felt this was all a compelling avenue towards the inevitable crescendo of “do x and y to change”. Of course, that would be silly as I don’t know what you want to change, where would make most sense to start, how you just start, etc. That requires more than a newsletter. However, what I will say is this. Making the change is simpler than you think. And that’s not to say it is easier than you think. Change is hard but it need not be complex.
In chronic illness, burnout and trauma, there are often automatic unpleasant psychophysiological responses to internal and external events. For example, panic when feeling sensations or total shutdown when feeling threatened. These then cause a cycle that further maintain the nervous system dysregulation. Breaking that cycle starts with spotting the pattern. Spotting the pattern may start with being on the lookout retrospectively and then trying to live spot it. When we are more able to spot it live, we can subtly change our relationship to the experience over time. This creates space for us to start developing a choice about what alternative would better suit us. If you’d like to explore this more, use the question prompts below to get started. If you haven’t yet, you might like to download the managing chronic stress and burnout download to compliment this work.
Takeaway activity
Use pen and paper (or digital device if you prefer, but I think paper always helps) and answer the questions below:
1. What reactive nervous system or habitual cycle do you think resembles some of the examples above? Is there one that you would like to focus on changing?
2. What seems to kick off the cycle (situation, internal feeling, external circumstance or trigger?)
3. What do you feel when this happens? What scary or unpleasant thoughts come up?
4. How do you stop feeling bad or try to stop feeling bad?
5. How in control do you feel when this happens? Do you currently feel able to intervene?
6. What part of the cycle do you think you’d have the best chance of noticing first when it starts to happen live?
7. Your challenge for the upcoming weeks is to look out for whatever you have written in response to number 6. Not necessarily to interrupt, but just to notice what is happening here. Try and come at it as though you are an alien that has been dropped into your body and you’re trying to understand what the experience of this is like so you can disseminate with your alien friends to better understand humans (you’re a nice alien).
References
[1] de Gobbi Porto, F. H., Fox, A. M., Tusch, E. S., Sorond, F., Mohammed, A. H., & Daffner, K. R. (2015). In vivo evidence for neuroplasticity in older adults. Brain research bulletin, 114, 56-61.
[2] Park, D. C., & Bischof, G. N. (2022). The aging mind: neuroplasticity in response to cognitive training. Dialogues in clinical neuroscience.
[3] Martinez-Calderon, J., Ho, E. K. Y., Ferreira, P. H., Garcia-Muñoz, C., Villar-Alises, O., & Matias-Soto, J. (2023). A Call for Improving Research on Pain Neuroscience Education and Chronic Pain: An Overview of Systematic Reviews. Journal of Orthopaedic & Sports Physical Therapy, 56(6), 353-368.
[4] Elbers, J., Jaradeh, S., Yeh, A. M., & Golianu, B. (2018). Wired for threat: clinical features of nervous system dysregulation in 80 children. Pediatric neurology, 89, 39-48.
[5] Kendall-Tackett, K. E. (2010). The psychoneuroimmunology of chronic disease: Exploring the links between inflammation, stress, and illness. American Psychological Association.
[6] Pace, T. W., & Heim, C. M. (2011). A short review on the psychoneuroimmunology of posttraumatic stress disorder: from risk factors to medical comorbidities. Brain, behavior, and immunity, 25(1), 6-13
[7] Ruiz-Tejada, A., Neisewander, J., & Katsanos, C. S. (2022). Regulation of voluntary physical activity behavior: a review of evidence involving dopaminergic pathways in the brain. Brain Sciences, 12(3), 333.
[8] Lim, Y. S., Kim, J., Khil, T., Yi, J., & Kim, D. J. (2021). Effects of the forest healing program on depression, cognition, and the autonomic nervous system in the elderly with cognitive decline. Journal of People, Plants, and Environment, 24(1), 107-117.
[9] Zheng, Z., Zhu, X., Yin, S., Wang, B., Niu, Y., Huang, X., ... & Li, J. (2015). Combined cognitive-psychological-physical intervention induces reorganization of intrinsic functional brain architecture in older adults. Neural plasticity, 2015.
[10] Malinowski, P., Moore, A. W., Mead, B. R., & Gruber, T. (2017). Mindful aging: the effects of regular brief mindfulness practice on electrophysiological markers of cognitive and affective processing in older adults. Mindfulness, 8, 78-94
[11] van Os, Y., de Vugt, M. E., & van Boxtel, M. (2015). Cognitive interventions in older persons: do they change the functioning of the brain? BioMed Research International, 2015.