Once upon a time, I wrote a piece called Neuroception and the Hierarchy of Needs. In it I discussed how the brain determines threats from the environment, altering the way the world is perceived and directly influencing the nervous system. A hypervigilance to threat must be addressed in order to help people better engage with the environment. When one is in this constant state of threat, they begin to exhibit consistent patterns of which they become less and less aware. Why worry about the nuances of thought or movement patterns when there are more pressing matters to attend to – an important presentation at work, going for a PR in the weight room, dealing with trauma… The window of tolerance to new and different neurological states has narrowed in an effort to maintain protection. But along the way, we actually seem to lose our awareness of our behaviors and even our sense of self.

Loss of Agency

A stressor that is significant enough to demand hypervigilance can signal a change in neural processing (thru the dopamine pathways in the brain) and facilitate patterns of thought and movement that may not be optimal for someone to adapt to the environment. With repeated stressors, these patterns become ingrained and we begin to lose awareness of how or why we are doing something. I often think of the aging bachelor who becomes a rigid caricature of himself as he continues to do things only his way and thinks that’s the only possible way to do it. It appears that maladaptive patterned behavior comes with a reduction in self-awareness and the ability to regulate oneself. 

According to Bessel van der Kolk, author of the tremendous The Body Keeps the Score, we have two distinct forms of self-awareness: our autobiographical self that assembles our experiences into a coherent narrative thru language and our moment-to-moment self (primarily in the medial prefrontal cortex – MPFC) that is based in the physical realm and is more difficult to describe. It is the MPFC that has robust connections to the emotional limbic brain (amygdala, insula) and gives us the feeling of agency — that we are in charge of our own life

With trauma or any sufficient stress to an individual [though not necessarily something that would be traumatic or stressful to someone else because n=1 baby], the medial prefrontal cortex (MPFC) begins to show reduced activity while the limbic brain is amplified. An imbalance between the rational brain and the emotional brain drives rigid, reflexive behaviors and a loss of self-awareness. The emotional brain is running the show, seemingly without our control. This is often why people under chronic duress/pain are unable to even accurately describe their symptoms because they don’t have access to them. Many of my chronic pain clients feel as if they are not in control of their lives, bouncing from symptom to symptom and physician to physician. It’s my opinion, and research is backing this, that so many people are hypervigilant, rigid, and unaware of how they’re moving thru and perceiving the world. 

If you aren’t aware of something, can you really change it?


Because the MPFC is inhibited, much of this occurs without conscious control. That’s hand-drawn, by the way, in case it wasn’t obvious 🙂

Awareness and Change

“Knowing what we feel is the first step to knowing why we feel that way”
Bessel van der Kolk

Awareness is the first step to changing patterns. By simply noticing what is happening with our internal state, why we are behaving and moving a certain way, it seems to destabilize the subconscious and facilitated patterns that have formed in response to the environment. How can you learn and create new neural frameworks without the ability to know what something feels like and the capacity to explore that feeling?

The ability to know what you know and feel what you feel without collapsing into a reactive, rigid caricature is the essence of self-regulation and, ultimately it’s what the great movement and behavioral therapists teach their clients. Helping a client to understand why they feel that way (and I do NOT mean pathoanatomic labeling) is a crucial step in establishing a recognition of behavior that is otherwise inaccessible. Opening the window of tolerance to threats and stressors from a place of consistency and security starts with awareness which accesses the MPFC and allows us to monitor our internal state. The MPFC helps to control and balance the limbic brain as if a rider on a horse – the horse is still very much alive but you’re in control of it. 

Now just because we understand the “why” doesn’t automatically change the “how” . But it’s the first step. Triplanar movement and training capacity (especially aerobic), rhythms and breathing, making better predictions, and integrating perceptions all help change the “how”.  And that’s what we’re doing in treatment and training – restoring and reinforcing a robust sense of self thru awareness and behavior modification.

​- Seth

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