I had my first panic attack the morning I dropped my 10-month-old son off at day care for the first time. I wasn’t worried about him starting school; in fact, I was excited to finally have a quiet house and the space I needed to run my business. But my body had a different idea.
Huddled against the steering wheel of my gray Honda CRV, I shook and hyperventilated. I sobbed in a way I never had before, like I was breaking into a million pieces. Images flashed across my vision: The ultrasound picture showing a baby without a heartbeat. The neonatal intensive care unit (NICU) team huddled around my newborn son. Me, alone in a hospital room without my baby.
At the time, four years ago, I had no idea what was happening to me. But over the next few months, I would come to understand that after an extremely challenging pregnancy and birth, I’d developed a condition known as postpartum post-traumatic stress disorder (PTSD).
About 9% of birthing parents experience postpartum post-traumatic stress disorder following childbirth, according to Postpartum Support International, an organization that raises awareness about various childbearing-related mental health issues. (Some studies place that number closer to 30%.) There are various risk factors, including feeling powerless during labor, experiencing poor communication or a lack of support from your medical team, a baby going to the NICU, an unplanned C-section and beyond. When I look at the description of postpartum PTSD now, I wish someone had told me I had nearly all the risk factors. But as I sat in the day care parking lot that day, gasping for breath, I was unaware I was experiencing trauma symptoms.
That moment marked the start of a healing journey that would lead me through many different types of therapies, but perhaps the most important was strapping my son on my back and hiking long miles through rainy Pacific Northwest landscapes.
In 2019, I was immersed in life as a gear reviewer, traveling all over Washington and Oregon with hiking boots, tents and jackets stuffed into the trunk of my car. I was in the best shape of my life following a year of yoga teacher training. My writing business was bringing in six figures. It was an idyllic season, which is partially why I felt so knocked off course when I found out that I was pregnant with twins. The pregnancy was planned. The hyperemesis gravidarum (a condition that involves throwing up over and over again, every day, for the entire nine months of pregnancy) and twin pregnancy were not.
When my pregnancy was 12 weeks along, an ultrasound tech whispered in a shaky voice: “See that one? It’s smaller and it doesn’t have a heartbeat.” For the next few months, I struggled to believe that my remaining baby would make it. At the 20-week ultrasound, the tech confirmed that our baby boy looked healthy. I felt numb, still—and nauseated. At 34 weeks, I caught norovirus and threw up so hard my water broke.
My son was born prematurely that same day and immediately transported to the NICU, where he was hooked up to every imaginable machine to help him breathe for the next two days. Because I still had norovirus, I wasn’t allowed to see him for almost 36 hours. After two exhausting weeks in the hospital, my husband, son and I finally went home.
It’s difficult to pinpoint where my trauma began. Did it originate in the depths of my despair during a pregnancy so difficult I felt like it stole everything from me? Did it grow in that hospital room where I sat, alone, unable to see my baby and unsure if he would be alive the next day? Or did it start when we went home two weeks after he was born and tried to “get back to normal?”
After years of therapy, I’ve learned that trauma is not linear. I expected that if I had trauma, I’d experience symptoms right away. So when they arrived nearly 10 months after my son’s birth—seven months after the global pandemic shut down our lives and nearly shut down my business—I didn’t understand what was happening. (According to the National Institute of Mental Health and the Mayo Clinic, trauma symptoms can begin anywhere from three months to several years after the inciting event.)
I can remember a night in 2020 when I was so panicked I felt like I might die. I begged my husband to take my son out of day care but couldn’t give him a good reason. Unable to get him on board, I stormed out of our house and spent an hour walking around our neighborhood in the dark, trying to convince myself that I could breathe.
Eventually, a friend helped me realize that I might be experiencing PTSD symptoms. She recommended a therapist who had Eye Movement Desensitization and Reprocessing (EMDR) training. According to the EMDR International Association, this therapy helps reduce the vividness and emotion associated with a traumatic memory. While I’d spent years doing cognitive behavioral therapy (CBT), I found that only talking about my traumatic experiences was actually making them worse; they came up more often in my dreams and I felt less able to drop out of hypervigilance. I was willing to try something new.
Within days, my new EMDR-trained therapist had diagnosed me with PTSD. According to the National Institute of Mental Health, PTSD involves a variety of symptoms, including insomnia (check), terrible dreams (yep), memory flashbacks (check), distressing thoughts (check), dissociation such as a sense of being separate from your body or emotions or feeling that things and people in your environment are distorted (check), avoiding situations related to the traumatic event (another yes) and bursts of strong anger (definitely yes). To qualify as having PTSD, a person must be experiencing symptoms from four symptom clusters (re-experiencing, avoidance, arousal and reactivity, and cognition and mood), and those symptoms must be severe enough to interfere with aspects of daily life, and they must last for more than a month.
My new therapist noted that NICU stays have been associated with PTSD, as are challenging miscarriages. (One study found that 15% of NICU parents tested positive for moderate to high-severity PTSD symptoms. Another recommended that every parent in a NICU setting should be educated about trauma). Twenty percent of people who are diagnosed with hyperemesis experience PTSD, and a history of anxiety is another PTSD risk factor. In short, I had all of the danger signs, lined up in a row.
Together, my therapist and I made the decision to take my son out of day care. It turned out that my trauma was triggered by a situation that felt all too familiar: I couldn’t enter the building where my son was due to COVID-19. The day care didn’t update me on how he was doing during the day. My brain experienced the current situation as if it was a duplicate of my labor and NICU story.
This is how trauma works, says my therapist: Your brain is a library full of memories. Most memories get put back on their appropriate shelf, but trauma memories don’t get stored correctly. Instead, they sit at the front of the library, coming up over and over again. Because those memories are miscategorized, your body experiences any new, similar situation (also known as a trigger) as being exactly as dangerous as the original traumatic event. In fact, your body experiences any similar situation as if it were the old one—hence the feelings of panic and anger that accompany any trigger.
According to Allen Kanerva, a trauma coach and NLP (neuro-linguistic programming) trainer, 98% of your memories are malleable, and stored in the hippocampus, “which is all pastel colors, soft music and a cappuccino machine.” But traumatic memories, Kanerva says, live in the area of the brain controlled by the amygdala, which is on high alert for fear and anxiety responses as well as dangerous situations.
Kanerva explains that the goal of trauma healing is to take the memory out of the amygdala and reform it, so it gets put back in the hippocampus when you “return” the library book.
Most therapists I’ve spoken with note that this approach doesn’t mean you won’t ever feel sad about the traumatic event. But EMDR—which involves recounting the events in a narrative fashion while either tapping bilaterally or watching a moving dot or light—and other somatic therapies can help lower the overall emotional charge of the traumatic memory.
Kanerva says it’s important to remember that you can’t just tell yourself that you’re safe after you’ve been traumatized. “Our emotional states are totally unconscious, so change will also happen unconsciously,” he says.
Because I could only work during my son’s afternoon naps, I was left with long hours each morning to care for him. So, I taught myself how to strap him to my back in a soft hiking carrier. We hiked in a new place nearly every day. I talked to him as we walked through the woods, spying birds and trees. He learned his first words on the trails and now, at age 4, he’s an adorably enthusiastic bird-and-tree-identifier. During that first month after taking him out of day care, spawning salmon were running in Piper Creek Seattle’s Carkeek Park. We sat on a nearby bench for hours, watching them leap into the air.
While we hiked, I told my son stories about my pregnancy and his birth. I cried and reached back to hold onto his small foot. Often, he placed his tiny hands on my shoulders. It was the only place where I felt safe during the entire year following that first panic attack, planting one foot in front of the other in the lush green vista.
A combination of EMDR therapy and hiking with my baby helped me heal. Four years later, those traumatic flashbacks are thankfully a distant memory. In 2022, I was able to get pregnant again and—despite another round of severe vomiting with hyperemesis—my daughter was born at term, healthy as can be. The experience felt like closure. But I always wondered why hiking with my firstborn was so impactful for me.
The answer turns out to be a complex cocktail of bilateral stimulation (alternately stimulating the left and right sides of your brain) and taxing the short-term working memory, plus experiencing joy.
Hiking and Walking as Therapy
To start: bilateral stimulation is used in EMDR (via rotating lights or objects, tappers or buzzers) to help you stay in the present moment while speaking about the past. When we began our work together, my therapist explained that this physical back-and-forth helps your brain understand that you’re here, right now. The traumatic event isn’t currently happening, even though you’re talking about it—which is what helps you put the memory back onto the right “shelf.”
How does this connect to hiking? It turns out that bilateral stimulation occurs when you’re walking.
“It’s thought to activate our parasympathetic nervous system, which is like stepping on the brake of a car,” says licensed therapist Meredith Siller. By rhythmically moving your feet, you’re able to be grounded right here, in the present. This makes hiking an ideal environment for memory reprocessing.
Second, putting the visual-spatial cortex to work also seems to have a major impact on recategorizing traumatic memories because it makes memories more malleable.
“When you’re hiking, you’re on a mountain trail with wind, trees and sounds,” Kanerva says. “You’re tasking your short-term working memory by navigating, assessing and thinking about how far up you’re going to go. Your brain is actually relaxed because it’s being tasked in the present moment.”
In a 2009 study, researchers found that playing puzzle games reduced unwanted flashbacks in traumatized people. Why? Because when their short-term working memory was taxed by the game, their traumatic memories became malleable, allowing the player to put the memories into the calm hippocampus instead of the reactive amygdala.
It’s also long been known that spending time outside, in nature, can help reduce anxiety and promote creativity. Some research suggests that walking outside, even for less than 20 minutes per day, can help you drop out of fight-or-flight mode. In other words, being outside may allow you to finally rest if, like me, you’ve spent years in a state of hypervigilance, waiting for worst possible thing to happen.
“Being in nature, or being outdoors in general, has huge benefits for those who have experienced trauma,” says Siller. “Taking in a new environment can help us practice being present, which is a really useful tool to cultivate when trauma tends to send us to the past.”
She also highlights that trauma healing isn’t just about processing traumatic events; it’s also about experiencing joy and aliveness, which often occurs when we’re outside, soaking up the wonder and beauty of nature.
Even four years ago, when I Googled “nature and PTSD,” I found virtually no research. But during that time, researchers at the University of Washington (whose Nature and Health research unit has received grants from the REI Cooperative Action Fund) have been studying nature therapies for veterans who have PTSD. Their research is still in its beginning stages, but they have found that hiking is a potential treatment for veterans with PTSD. In a very early feasibility study, median PTSD scores improved more for those who spent time in nature, versus those in an urban setting. Lead author Alyson J. Littman says the results of the early study were promising, and she draws lines to attention restoration theory (which suggests that mental fatigue is improved when you spend time looking at nature) and stress recovery theory (which says that human beings have a preference for natural environments). Still, she needs more funding to continue learning about why hiking and nature help with post-traumatic stress.
“All of this is a layered approach,” Kanerva says. “When you’re walking, and you laser focus on dominant trauma while the visual spatial load is high, it’s successful for healing.”
But he notes that just spending time outside without talking about the traumatic narrative may not be as helpful for removing trauma triggers, even if it does help you feel less anxious. This could be why several veteran-focused studies have found that walking with a group and telling stories is more healing than hiking alone in silence.
I spent many years over the course of the coronavirus pandemic dealing with trauma and caring for a new baby. I grieved all I’d lost. I missed my former self, the one who could take off at any moment for an adventure, the one who didn’t live in fear of the next panic attack.
But there’s something researchers call post-traumatic growth, which is defined as “positive psychological changes experienced as a result of the struggle with trauma or highly challenging situations.” It’s a parallel process: While you experience post-traumatic stress, you may also experience growth. It’s an image that matches the complexity I’ve often felt as I dig into my own psyche: This life can be beautiful, brutal, challenging and joy-filled, all in the same breath.
Four years out, I’m able to see that I’m not who I was before I became a parent. I’m braver. I care less about what others think. I dance more, and I play with my kids. My identity is about far more than my work. Now, I notice the changing seasons in central Oregon, where we moved when my son turned one, with deep delight. I feel the contours of my days subtly changing as the leaves fall, as the first buds of spring emerge. I live in my body now, in a way I never did before.
And when I hike down the trails in my neighborhood, two sets of tiny, sticky hands holding mine, I point in awe at the trees and pine cones. I remember that human beings are built to endure. As much as we fall apart, we also fall back together.
If you think you might be experiencing symptoms of PTSD, or you underwent a challenging event during which you were not believed or supported, reach out to a doctor or therapist, especially someone who specializes in trauma, PTSD or perinatal mental health.
The Substance Abuse and Mental Health Services Administration (SAMHSA) offers a free 24-hour hotline for families and individuals facing mental health or substance use crises. Call 800-662-4357 (400-662-HELP) for referrals to community-based organizations for support as well as local treatment facilities and other resources. You can also text your five-digit zip code to 435748 (HELP4U) to find assistance near you.