The Sequence of Trauma—And the Art of Resolution

December 9, 2025

BY AIMIE APIGIAN, MD

That’s when she heard the skidding. Her head snapped up from her phone, eyes scanning. A car had lost control on the wet roads and was sliding right toward her. Her whole body activated. Her heart started pounding, her posture straightened, and she gripped the steering wheel and started turning as she rapidly pumped the breaks to avoid losing control herself. She did everything right, but despite her best efforts, she couldn’t get out of the way. She froze and stared at the oncoming car.

The memory of what happened next became fragmented for Elena. Time seemed to slow down, and the impact remained blank in her mind. The rest was like a dream. She remembers lying on the ground, feeling strangely disconnected from her body that felt heavy and chilled. The voices and movements of people around her seemed distant and dreamlike.

When the paramedics arrived, their calm, clear directions became an anchor—something she could follow without having to think. It wasn’t until the ambulance ride that the fog began to lift. The world gradually came back into focus: Voices became distinct again, her thoughts cleared enough to answer questions, and with this return to reality came the first waves of physical pain spreading through her body. She noticed her body wanted to tremble, but, embarrassed, she blocked it.

Over the next few months, Elena recovered from her physical injuries—yet not psychologically or emotionally. She couldn’t do those morning drives without a surge of anxiety; she was more emotionally sensitive overall, not just tearing up, snapping at her daughters when they bickered. She had never been this way before.

One year later, after several ER visits for fatigue and swelling, she was diagnosed with lupus, an autoimmune condition. It came out of the blue for her.

Though her doctors offered medications to manage the symptoms, she couldn’t shake the sense that something deeper had changed in her body since the accident—something no lab test could explain. That lingering discomfort led her to start looking beyond conventional care. She heard me speak on a podcast on the trauma-autoimmunity connection. The idea had never occurred to her, and she was motivated to start trauma work if it would help. But before joining my program, she wanted to know if it would really help given that her type of trauma had been a car accident.

She voiced one of the most common questions I hear: “Will your program help me with my specific type of trauma?”

As it does for many people, the answer might surprise you: The body doesn’t differentiate between types of events. Our nervous system engages one universal trauma response.

The Universal Instinctual Trauma Response of the Body

So what exactly happens inside the body when trauma hits? How does something that leaves no external mark create such long-lasting internal disruption?

The answer lies in our biology. The body has perfected one instinctual response to help us survive anything, even danger that seems inescapable. Through my own training and observation, I began to recognize how this same internal sequence appeared across very different scientific and therapeutic fields.

I first encountered this instinctual trauma response through the clinical work of psychiatrist Louis Tinnin and his wife, Linda Gantt, PhD, an art therapist. What intrigued me was how to recognize the same progression, though described in physiological terms, in my study of the polyvagal theory originated by Dr. Stephen Porges. To my surprise, I saw this same progressive sequence described in my somatic therapy training when describing the response to our body’s self-defense movements being blocked. (Somatic means “of the body,” and in the context of trauma therapy, it refers to body-based modalities or “bottom-up” approaches.)

As Peter Levine, PhD and founder of Somatic Experiencing, explains this instinctual response in his book Waking the Tiger: “In response to threat and injury, animals, including humans, execute biologically based, non-conscious action patterns that prepare them to meet the threat and defend themselves. The very structure of trauma, including activation, disassociation and freezing are based on the evolution of survival behaviors.” In other words, these responses are not psychological weaknesses, but evidence of deeply wired biological wisdom designed to keep us alive.

With this knowledge, I now had eyes to see these steps unfold. Everything made sense, even my own body’s responses to shutting down in therapy had seemed unpredictable. In my nonprofit work with hundreds of adopted children from around the world, I started seeing this progressive sequence get triggered when their attachment pains—specific emotional wounds resulting from unmet early needs—got poked. Whether they were my patient undergoing physical trauma of a surgery, experiencing emotional overwhelm from a diagnosis, or they were a family member overcome with grief at the bedside of their dying loved one, the same progression emerged.

This instinctual trauma response of our body is a survival programming consisting of five simple but purposeful steps that can unfold over seconds, as it did for Elena, or over minutes or hours—sometimes so quickly we barely register the different stages. Recognizing this helps us move from self-blame to self-understanding—our body is simply following its design. Since this programming operates completely outside our conscious control, our responses don’t always follow logic, sometimes making us question our sanity. Yet, just as we don’t consciously choose to pull our hand back from a hot surface, our body engages this survival programming automatically, as natural as keeping our heart beating and our lungs breathing.

Whether we faced an oncoming car like Elena, felt powerless in our childhood family of origin, or have confronted unbearable pain in a divorce or death, our body moves through this same sequence. The triggers may differ, some being emotional and others physical, but the internal experience remains identical. Understanding this universality helps demystify trauma and unites all healing paths under one biological truth: the body’s drive toward balance.

This is why these five steps provide us with a map to our inner world, not only showing us how our body enters a trauma response but also revealing the often-overlooked path back to balance. In fact, even if our body has been holding past unresolved trauma for decades, these steps will be the map we will use to find the way back to health, wholeness, and authenticity.

Let’s walk through these five steps and see how each one is programmed to serve a crucial purpose for our survival.

Step 1—The Startle

What will become a trauma response always starts with an initial startle. It’s a moment when we first sense that something is off, and it’s our body’s reflex reaction to a potential threat. The purpose is to quickly assess whether a perceived threat is real, its magnitude, and to give us a jolt of energy that serves as a running start if we need to respond.

Our physiology adapts in a number of ways to accomplish this purpose. Our senses become hyper attuned and quickly gather all the information about this potential threat—primarily what we see, hear, and feel, though smell or taste are also part of the quick assessment. Our attention is focused only on gathering information to determine if the danger is real and if so, how big it is.

This instant alertness comes from noradrenaline, a sister hormone to adrenaline that’s pre-stored in our tissues, waiting for its signal. When released, it creates that characteristic startle jolt and puts us in hyper-alert mode, providing a brief window of heightened energy and awareness for assessment and decision-making.

When she heard the skidding tires, Elena’s body went into her startle response faster than she could consciously process the sound. Her eyes and ears took in everything quickly, and her startle response served its purpose. A potential threat (a sound) was confirmed as a real danger—a car was coming toward her. Her startle response escalated to the next step—the active stress response. Thankfully, her startle response had given her body a running start, and she immediately took action to avoid a collision.

It’s important to know that when we block our innate threat assessment, this will be a reason for our body to assume a real danger and progress to the next step, for example, intentionally not looking at something that startles or scares us because we are scared of what we will see.

Stephanie Gorka, PhD, a researcher out of Ohio State University, has studied the role of uncertainty as a reason for why we will escalate to stress, even creating what is called “anticipatory anxiety.” It is also possible that our nervous system was wired to perceive everything as a real threat—or to be unable to stop our survival response once the train has left the station with the startle. This programing we would have had in the first year of our childhood.

We will startle with anything sudden, loud, or unexpected, even when kids jump out from their hiding place to scare you. The startle is just a reflex reaction. It is then the job of our nervous system to quickly assess and determine if there is a real danger or if it can relax back to a sense of safety.

As you think about times when you have been startled, maybe in response to a loud noise, or a smell that alerted you to burning food, or an unexpected ring of the doorbell, this is your body’s reflexive response doing its job to alert you to possible danger and give you a running start into the next step, the stress, if the danger is confirmed.

Step 2—The Stress

The purpose of this step is to overcome through action, which requires an immediate upsurge of energy. While the startle serves as our initial alert to assess if action is needed, the stress response serves as our only chance to overcome.

While often simplified as “fight or flight,” the invisible activity in our body is truly impressive. Our body generates an energy surge—adrenaline floods the system, much like pressing the accelerator in your car all the way down. Our whole body coordinates its efforts toward one single goal: overcoming the danger.

Her entire body immediately mobilized to help overcome the threat—all of this happening faster than she could logically analyze and think through what to do.

This is exactly what happened in Elena’s body. The instant her startle response confirmed danger, her system flooded with adrenaline-fueled energy. Her heart pounded to deliver more oxygen and nutrients to key cells to make energy fast. Her hands gripped the steering wheel with new-found strength. She took quick action by pumping the brakes and turning the wheel. Her entire body immediately mobilized to help overcome the threat—all of this happening faster than she could logically analyze and think through what to do.

We’ve all experienced this energy surge in both dramatic and ordinary moments—catching a child before they fall, rushing to meet an urgent deadline, or jumping out of the way of an oncoming car. In each case, our body provides exactly what we need: immediate energy for action. When successful, we feel relief and can relax, like a firefighter after extinguishing a blaze and the sprinter crossing the finish line.

But sometimes, like Elena, our best efforts aren’t enough. Just as the startle response escalated when danger was conf irmed, the stress response escalates when our energy surge does not match up against the size of the danger and ongoing efforts are useless.

Step 3—The Wall

Unlike the other steps, the wall isn’t a survival strategy—it’s the pivotal moment that triggers our body’s shift to a different kind of protection. From the high-energy state of stress, we hit a wall that renders us powerless. For Elena, this was the moment that, despite her stress response working perfectly, she realized she couldn’t outmaneuver the oncoming car. A collision was inevitable.

Imagine encountering a big dog in a dark alleyway at night. He growls, then barks, then quickly starts toward you. Your stress response activates perfectly—adrenaline floods your system, and your legs carry you faster than you thought possible. There’s a chance you’ll escape. But when you turn left and face an unscalable wall, you’re trapped. There is nothing more you can do.

While the wall is what triggers the first step of the trauma response, it is not the wall itself nor the threat that creates the trauma. Rather, it is the internal experience of being trapped and powerless in the face of an inescapable life threat.

Trauma expert Dr. Bessel van der Kolk explains, “Preventing people from moving when something terrible happens is what makes trauma a trauma.” Many experts refer to this as “thwarted movement,” defined as self-defense movements made ineffective. There is nothing that we can do that might make a difference.

The walls we hit aren’t always visible. Most often, they’re invisible barriers that trap us and create just as much powerlessness. Negative self-beliefs we hold as truth from past experiences can be just as immovable as physical barriers; they are just as real and render us feeling powerless and trapped.

Common invisible walls we hit can include:

Childhood conditioning that anger isn’t safe, blocking us from speaking up in self-defense.

Deeply held beliefs about not being good enough so it’s best to not even try.

The helplessness of watching a loved one suffer when we can do nothing to help.

Can you remember moments in your life when it felt like you were powerless? When your best efforts weren’t enough?

This moment of hitting the wall is helpful to recognize because it changes everything. It is what makes our body change survival strategies as it crosses a line of overwhelm that we cannot uncross in the moment. Unlike the previous steps that had two possible outcomes—resolution or escalation—the wall leads to only one outcome: escalation into the freeze, the f irst step of the actual trauma response.

Step 4—The Freeze

With the wall marking our powerlessness, our body now engages its most powerful survival strategy: the freeze.

While the previous steps involved energy, movement, and action, the freeze marks our entry into the trauma response—a fundamentally different way to survive when action becomes impossible. Many mistake its stillness for passive weakness, but the freeze is actually our body’s strongest survival mechanism, overpowering both our adrenaline-fueled energy surge and logical thinking.

The wisdom of the freeze as a survival strategy is in its purpose to stop movement and action that now endangers rather than helps us. Like a circuit breaker that cuts power to prevent system damage, the freeze is how our body shifts its survival strategy from heroic action to a strategic paralysis.

What happens in our body during this freeze is remarkable. In this moment, the body isn’t malfunctioning—it’s protecting. Dr. Levine describes how our muscles lock tightly, trapping all the energy from our previous stress response inside our body.

We’re quite literally “scared stiff,” our body frozen in a state of shock as we face the unthinkable.

Elena’s body went into a freeze response. For a split second after realizing impact was unavoidable, she froze, staring at the oncoming car. Time seemed to slow down; her body locked in place, no longer trying to escape the inevitable. Her breath would have caught in a full inhale as the shock of the powerlessness of the moment took hold.

She froze, not because she chose to nor because she was weak or some kind of failure, but because her body decided that inaction and shutting down was her best chance of surviving. The freeze is the transition step between the wall and the shutdown.

You may recognize times in your life when you have felt frozen inside. Maybe as a child, watching conflict between your parents that you couldn’t stop. Maybe now you find yourself paralyzed during a conflict at work or home. Perhaps you have had unwelcome sexual experiences in the past and now freeze in intimate moments with a loving partner.

Or perhaps a moment of being in the spotlight makes you freeze inside, feeling like you are holding your breath. While the experiences vary widely, they share a common internal experience: the shock to the body when we realize we are trapped, powerless, and alone.

But our body can’t remain in this state of high shock indefinitely. The intense internal pressure of the freeze—all that trapped energy and shock—leads our body to progress to its final protective step: the shutdown.

Step 5—The Shutdown

The survival strategy of the shutdown is clear: “Don’t die but stay barely alive.” The shutdown is our body’s response to what Dr. Bessel van der Kolk defines as trauma: an experience that feels “overwhelming, unbelievable, and unbearable.” It is natural that a body would shut down when something feels overwhelming and unbearable. Like other mammals who freeze and shut down when trapped and powerless, our body operates on an ancient wisdom: Maybe if we play dead, the threat will go away.

The shutdown helps us survive these overwhelming experiences by engaging three trauma survival mechanisms: disassociation, immobilization, and energy conservation. These create mental and emotional distance from sensations that feel unbearable and have us conserve energy rather than use it.

These survival mechanisms explain why Elena felt disconnected from her body and the people around her after the collision—why she felt heavy and cold—and why even basic tasks like talking felt difficult.

While the survival strategy itself is simple, managing our physiology to not die but stay barely alive is complex. Our breath returns from the stuck inhalation of the freeze and is now slow and shallow, even irregular at times, but has to be just enough to give us the amount of oxygen to stay alive. People around us may remind us to breathe. We may feel like we want to curl into a ball. Anything that takes energy, even just talking, feels hard to do. We may feel disoriented, as we have completely lost our sense of safety and don’t know if we are going to be OK.

We feel alone and helpless inside.

You might recognize times your body has gone all the way into the shutdown trauma response. Maybe you’ve described this feeling as “checking out,” “going numb,” or “going through the motions.” Understanding that this is your body’s sophisticated survival strategy can help shift how you view these experiences.

The shutdown is the final step in our body’s universal and instinctual trauma sequence. It shows that our bodies have an incredible innate resilience to survive, even when they have to shut down to do so. Your body knows exactly what it’s doing, even if your conscious mind can struggle to make sense of the experience and the body’s response.

Which is why I come back to Elena’s question and an exercise that can be so useful in the process to help our mind and body resolve a past trauma response. And sometimes, the body needs more than understanding—it needs to experience resolution. That’s where story work becomes a powerful tool.

A Brain-Body Journey—Completing your Trauma-Response Story

One of the most powerful ways to help your body know that a past experience is over and you are now safe is to draw a story of the experience with an ending that has you out of danger.

To make the story make sense to our brain and feel true to our body, we draw each step, tracing the inner experience of the body through startle, stress, the wall, freeze, and shutdown. We bring in all the sensory elements of what we saw, smelled, and felt. We draw the inner sensations of our body at each of the steps. Most importantly, we draw out the story in third person, labeling each character on the page, especially ourselves, with their names.

This allows us to stay in the present moment as “me” and not be in the story. We then draw a moment after this experience, even if it is years later or right now in the present moment, in which we are safe enough. I call this exercise the Art Narrative Process. It’s success is based upon engaging both your right and left brain as you walk through what would have been the progression of the inner experience in your body. It’s a way to work with both the linear memories and the fragmented sensory ones, helping to bridge what your brain still holds as an unfinished story.

Using these five steps in a structured art narrative to bring an end to a specific story of the past is so powerful to our brain. For some, it has been the final piece needed to shift out of survival mode and be able to open up and bond with others.

Which is why I come back to Elena’s question and an exercise that has helped so many people complete the story their body still holds as unfinished. When we can give our body a sense of resolution—when we can help it see and feel that the danger has passed—something shifts. We begin to move from survival into healing.

I want to make an important note about how we want to do any inner work. It is so easy to retraumatize ourselves in the process of personal development or trauma therapy. I would not want you to do the art narrative process, or any trauma therapy, in a way that overwhelms you. Every time we experience overwhelm, our body is reinforcing its freeze and shutdown survival strategies. This inner work will be stressful, and we choose to do only as much as we can tolerate.

I say this because as Elena began to recognize stored trauma in her body, she would want to throw herself into therapy and “get it all done.” She still needed to learn the difference between stress and overwhelm to stay in her growth zone during therapy and not get retraumatized despite her good intentions. Our body clearly distinguishes between stress and trauma, responding differently to each depending on our level of safety and capacity.

The specific trigger—whether a car accident, loss of a loved one, or chaotic childhood family dynamics—matters less than the universal internal experience our body goes through with these five sequential steps, each with its specific purpose, from the startle to the shutdown.

Every trauma story is different, but the internal sequence is the same—biologically wired to protect us. When we understand it, we reclaim connection to ourselves, to others, and to the safety of the present moment.

By understanding these steps and learning how to move through them, we can begin to reclaim what trauma once stole: our connection to ourselves, to others, and to the safety of the present moment.

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Aimie Apigian, MD, MS, MPH, is a pioneering force bridging biology and healing as a double board-certified physician in preventive and addiction medicine. With masters degrees in biochemistry and public health, Dr. Aimie’s expertise extends beyond her foundational medical and surgical training into areas like psychosomatics, functional medicine, neuro-autoimmunity, nutritional biochemistry, and epigenetics.

Her extensive training in somatic, art, and psychodrama trauma therapies, combined with her firsthand experience with trauma as a foster-adoptive mother and her own chronic health issues, led her to discover a missing piece to interventions. As founder of The Mind-Body-Biology Institute and creator of The Biology of Trauma® framework, she has developed a revolutionary integrative approach that addresses the full impact of fear and powerlessness.

Through her courses, speaking, and practitioner training programs, Dr. Aimie provides a holistic, structured, and science-based process for repair of the impact from stored fear, pain, and overwhelm so you can live your best and most authentic life.

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The Sequence of Trauma—And the Art of Resolution

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