Dr. Victor Carrión has spent three decades working with children who've experienced trauma, and the most important thing he's done may be the simplest: he renamed the condition. Post-traumatic stress disorder becomes post-traumatic stress injury. That single word shift carries enormous clinical weight. Injuries heal. Disorders are managed. The framing tells you something about what's possible.
The core claim here is that PTSD isn't a malfunction of the brain — it's an adaptation that outlived its usefulness. The stress response did its job. It protected you. But it got stuck. The nervous system kept the alarm running long after the threat was gone, and now the alarm itself has become the problem.
What strikes me about Carrión's framework is how cleanly it maps onto everything we know about the HPA axis — the hypothalamic-pituitary-adrenal system that governs your cortisol response. In trauma survivors, this system loses its regulatory feedback. Cortisol, which should spike and then drop after a stressor, stays elevated. The system can't find its baseline. We see this same dysregulation in chronic stress, in burnout, in the overtraining athletes who push past recovery into breakdown.
The avoidance piece is where Carrión gets clinically precise. "PTSD feeds on avoidance" isn't a metaphor — it's a description of how neural pathways get reinforced. Every time you sidestep the trigger, you confirm to your nervous system that the threat is still real. The pathway between stimulus and fear response grows stronger. The only way to rewire it is to move through the discomfort in a controlled, supported environment. That's the premise behind Q-centered therapy: structured exposure that teaches the nervous system a different ending to the story.
Here's what most people miss: cold exposure and contrast therapy work on the very same norepinephrine pathways that are dysregulated in PTSD. When you enter cold water, your sympathetic nervous system floods with norepinephrine. In trauma survivors, this system is already chronically activated — and that's precisely why cold exposure, when introduced carefully and with appropriate support, has shown early promise as an adjunct to trauma treatment. You're not bypassing the stress response. You're practicing it. Controlled, voluntary, finite. The cold ends. You get warm. The nervous system learns: stress is survivable. It has a beginning and an end.
If you're working with someone navigating trauma — or navigating it yourself — the practical takeaway from Carrión's work is this: structure matters more than intensity. Consistent, supported exposure to manageable stressors — whether that's therapy, breathwork, cold, or simply naming what happened — is more effective than heroic efforts to push through alone. Recovery isn't about toughness. It's about teaching your nervous system, incrementally, that the present moment is safe. That takes time. That takes support. And it is absolutely possible.