Autonomic Self Assessment

Answer the following statements with the selection that is most often

true for you. Note that this self assessment is not a substitute for

qualified medical diagnosis, nor should it be considered as such. This

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assessment is intended only to give you personal insight into what

**may** be happening with your nervous system and should not take

the place of appropriate medical treatment by a licensed therapist. For

our complete medical disclaimer, please visit our website at

www.wholebodyrevolution.com.

When I am hanging out with friends, I most often feel:

A Like I belong and am included in the group.

B Anxious and nervous that I’m going to say or do the wrong

thing.

C Like I’m on the outside looking in, apart from the group and

not quite belonging.

When facing challenges in work or in life, I usually:

A Struggle at times, but overall I know I can handle whatever

comes at me. I’m capable and resourceful.

B Think constantly about what might go wrong and make

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contingency plans so I’m prepared for the worst case

scenario.

C Feel like things are happening to me one right after another

and I just want to crawl in bed and pull the covers over my

head.

When it comes to sleep:

A I sleep like a baby. I fall asleep quickly and easily and tend

not to wake up much during the night. I wake up feeling

refreshed and energized.

B My mind whirs and it’s hard for me to fall asleep. It seems

like when I lie down at night is the time that my brain tries to

solve all the world’s problems.

C I feel like I’m in a fog, like I never get enough sleep. And

even when I do rest, I don’t feel refreshed in the morning. I

rely on coffee or other stimulants to get me through my day.

© 2020 Functional Balance, Inc.

 Autonomic Self Assessment
My digestion is:

A Healthy and robust. As long as I eat a relatively nutritious

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diet, I seem to do just fine.

B Compromised. I struggle with a lot of gut issues such as IBS,

diverticulitis, SIBO, and food sensitivities. I have to be very

careful what I eat or my stomach gets upset.

A mess. I deal with intermittent gut pain, upset stomach,

C
episodes of vomiting and either diarrhea or constipation,

seemingly without cause.

When it comes to my body, I typically feel:

A Pretty good. I do not experience chronic pain or muscle

tightness, although I may have the occasional aches and

pains that come with overexertion, long flights or short

periods of increased stress.

B Stiff and achy. I have some chronic muscle aches and

tension that often cause me discomfort or pain and at

times interrupt my sleep. I feel like my body is getting older

and falling apart.

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Pain. I have been told either that my joints are hypermobile

C
or that I am very stiff and locked up. No matter how much I

stretch, my body doesn’t seem to let go.

I tend to:
I set goals and enjoy the process of working toward them,
A
even though sometimes it’s not easy and I may face

daunting challenges along the way.

B Be a go getter. I love crushing my goals and am always

looking for the next mountain to climb, so to speak. I’m

always pushing myself to reach higher and accomplish

more.

C Feel like there’s no use. No matter what I do, I can’t seem

to shape the course of my life. I often feel defeated and

discouraged, like there’s no point in even trying.

© 2020 Functional Balance, Inc.

 Autonomic Self Assessment
I like to:

A Have a general idea of where I’m headed but I’ll go with

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the flow and see what unfolds. Who knows where I’ll end

up?

B Know exactly what’s going to happen and have at least

one backup plan in case of emergency. Maybe two. Okay,

three.

C Just keep doing what I’ve been doing. Making big changes

feels like pushing a boulder up a hill and I’m just too tired.

When I think about the years that have gone by, I feel like:

A I have many good memories, along with periods of stress. I

can recall the course of my life fairly clearly, but some

memories are stronger than others.

B Time has been frenzied and I have no idea where the

years have gone. I feel like I’m always busy, running from

one thing to the next. Life has been a blur.

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C I have trouble recalling long periods of my life. I have few

memories, as though I didn’t really live those years. The

ones I do have are foggy and fuzzy.

The world is:

A Safe.

B Dangerous.

C Neutral.

© 2020 Functional Balance, Inc.

 Autonomic Self Assessment
In the course of my life...
While I am busy taking care of my responsibilities, I make
A
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time for the things I love. I know that I’m capable of doing

whatever I set my mind to.

B I wish I could spend more time doing what I love but I have

to go to work, pay my bills and support my family. Someday

I’ll have more time.

C I’m just getting through the days. I don’t really have the

bandwidth for hobbies, and honestly I don’t really know

what those things are anymore. I feel a little like I’ve lost

myself and don’t know who I am anymore.

When it comes to creativity:

I enjoy expressing myself in various ways, whether I have

A
“talent” in that area or not.

B Often when I have creative thoughts or inspiration, it

disappears as soon as I sit down to write it out or start the

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project.

I’m not creative at all. When I do feel inspired to create

C
something, I feel overwhelmed by all the steps it takes to

do it.

Relaxing is...

A Easy for me. I love reading, meditating or just hanging out

with myself, letting my thoughts wander..

B Kind of hard. I’m always on the go and have trouble sitting

still. I always feel like I should be doing something.

C Okay, but I prefer to have something to distract me, like

Netflix or a video game.

© 2020 Functional Balance, Inc.

 Autonomic Self Assessment
People are:

A Good.
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B Irritating.

C Cold and uncaring.

I would describe myself as:

A Usually calm and centered, although I have my stress like

everyone else.

B Often anxious or worried, although I can be great in a

crisis when everyone else is freaking out.

C Low energy with bouts of what could be called depression

or despondency.
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I would say that:

A I am proud of my accomplishments in life. I’ve had my ups

and downs but overall I think I’m doing pretty well.

No matter what I achieve, I never feel like it’s good enough.

B
Sometimes I forget to stop and celebrate how far I’ve

come.

C I’m ashamed of where I’m at in life. I thought I’d be further

ahead than this. I don’t feel like I’ve accomplished much at

all.

© 2020 Functional Balance, Inc.

 Autonomic Self Assessment

Mostly A
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“Everything is fine and the world is a friendly place.”Answers that

are mostly in the A category favor the ventral vagal social

engagement state of neural activation. Ventral vagal is defined

by the statement, “I can…”If you are in the ventral vagal state,

you’ll typically feel capable of handling whatever the world

throws at you. You are resilient and while you may undergo

periods of intense stress, you know that you’ll bounce back.This

state is defined by general feelings of happiness and playfulness.

A person in a ventral vagal state is typically relaxed and calm,

sleeps easily and wakes up refreshed. Your digestive and immune

systems are functioning optimally, and you generally enjoy good

health.Ventral vagal is also the state that allows us to connect

with and feel empathy for the people around us. Whether you’re

more of an introvert or extrovert, if you’re in the ventral vagal

state, you likely have fulfilling relationships with friends, family and

romantic partners. You are able to be present and engaged with

the people in your life, and to have empathy and compassion for

their feelings or experiences.Of course, no one exists in a ventral

vagal state all the time, nor should you. It’s normal to have periods

of stress and strife, but when ventral vagal is your dominant

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autonomic state, you will easily return to a relaxed, centered

feeling once intense circumstances have resolved. Living from a

ventral vagal state also allows you to feel more capable and

handle challenges that may arise in life with more grace and

ease.What to do about it: to keep yourself in a ventral vagal state,

spend time doing things that you love and connecting with friends

or family. Focus on being present in the moment and don’t let

yourself get distracted by worried thoughts, social media or tv.

The more time you spend in a ventral vagal state, the stronger this

neural pathway will be for you, keeping you calm and centered

even in the most stressful of times.

© 2020 Functional Balance, Inc.

 Autonomic Self Assessment

Mostly B
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“I’m not safe and I have to watch out for danger.”Answers that fall

into the mostly B category indicate a predisposition for sympathetic

nervous system activation. This state is correlated with feelings of

unease and overwhelm. It’s often defined by the statement, “I have

to…”If you live predominantly in the sympathetic nervous system state,

you will likely feel like there is always another mountain to climb. Your

to-do list is never-ending and there’s no rest for the wicked, so to

speak.You have to go, go go! And even though you’ve accomplished

a lot in life, there is still so much to do. You may often feel irritable,

impatient and frustrated with the world and those around you for not

understanding your need to get things done. You may get angry at

those who try to slow you down, or at employees and co-workers who

don’t move at the speed you do.Laziness is a sin in your eyes, and

those who drift around at a slow pace are holding you back.

Sympathetic activation can also be correlated with aggression and

posturing. You may feel the need to “put on airs” and prove your

worthiness. You may also get defensive when your authority is

challenged.If you are in sympathetic nervous system activation, you’ll

experience tension through the midline of your body, characterized by

fixed or darting eyes. You will have a tendency to lose awareness of

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your peripheral vision. You will likely experience muscle tension in your

back and hips as well as digestive issues and possibly autoimmune

conditions. Sympathetic nervous system activation is essentially your

body being always on the defensive, which can cause an overactive

immune system resulting in autoimmune conditions such as

fibromyalgia.People who live in sympathetic nervous system activation

are also prone to symptoms of obsessive-compulsive disorder and

may feel the need to control everything in their lives. A perceived lack

of control or sense of chaos can trigger anxiety or panic.Sympathetic

nervous system people thrive on certainty and may turn to addictive

behavior in uncertain situations or circumstances.What to do about it:

When the world seems unsafe, whether literally or metaphorically, you

need to calm your biology by giving it a felt sense of safety. Do this by

focusing on pleasant sensations in your body. This can be something

as simple as warm sun on your skin, a cool breeze, the feeling of your

clothing, petting a soft cat or any other sensory input that is calming

and pleasant. Do this for ten to twenty seconds multiple times a day.

The more often you bring your awareness to what feels good, the

more quickly you will pull yourself out of sympathetic lockdown.

© 2020 Functional Balance, Inc.

 Autonomic Self Assessment

Mostly C
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“I have no idea who I am or what I want in life.”Answers that fall into

the mostly C category align with a dorsal vagal shutdown state. This

state correlates with feelings of dissociation, numbness and

disconnection from the world and those around you. Dorsal vagal is

defined by the statement, “I can’t.”If you live predominantly in a dorsal

vagal state, you likely feel like you’re moving through life in a fog.

Events are happening to you and you have very little control over the

course of your life. You may be prone to depression, lethargy and

despondency. And while you feel sleepy or foggy often, it’s difficult to

fully rest. You never feel refreshed after you sleep. Dorsal vagal

shutdown is also correlated with either joint hyperlaxity (joints that are

too loose) or tonic immobility (joints that are locked tight). Dorsal

vagal is a state of “playing possum,” or essentially feigning death to

either escape a predator or self-anesthetize against death. It often

occurs when a person has insufficient resources to fend off a threat in

their life, or as a result of prolonged stress or trauma. People who live

in a dorsal vagal state may feel defeated and ashamed that they

have not or can not accomplish more in their lives. They may know

what they should do everyday and set out with the best of intentions

but somehow fall short of accomplishing even the most basic tasks.
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Every day that a to do list goes unfinished only seems to deepen the

self shame. Dorsal vagal is also associated with feelings of numbness

and disconnection, as though you were apart from the world, on the

outside looking in. Physically you may feel completely numb, or you

may experience intense pain. Stretching seems to have no effect on

muscle tension. Massages and chiropractic adjustments yield

temporary relief at best. You may feel like you have never been truly

happy, even though you do remember times of laughter with friends.

But those memories seem removed from you, almost like a movie you

watched one time and can barely recall. What to do about it: Dorsal

Vagal: Focus on feeling your body. Dorsal vagal shutdown is a

numbing state and to start to dissolve the frozen part of your nervous

system, put your attention on sensations in your physical self. Notice

what you notice -- the texture of the floor under your feet, the weight

of your pelvis on your chair, even the sensation of breath expanding

your chest. You may also find it helpful to practice orienting -- that is,

let your eyes wander around the room slowly, landing on any colors,

shapes or textures that draw your attention.

© 2020 Functional Balance, Inc.