Recovery Pathway

People living with complex PTSD often have symptoms that hinder therapy, like emotional dysregulation, dissociation, or sleep disturbances. One of the worst of these is the loss of a sense of "home," often caused by extreme trauma that happened there, such as domestic violence, familial sexual abuse, or sex trafficking.

Without any place they feel safe, people feel lost and exposed. Out of control and belonging nowhere. Worthless. Helpless. Hopeless. Worse still, they exist in a constant state fight-or-flight, a stress response which causes serious harm to both mental and physical health and makes it next to impossible to genuinely participate in therapy, let alone make any meaningful progress.

In the most ambitious experiment in this project, the Recovery Pathway, we have set out to tackle one of the most stubbornly therapy-resistant obstacles to healing for survivors of extreme trauma, and moreover to do so using environmental design. We posit that some of these survivors can have their sense of home and security restored by doing nothing more than walking home regularly along the path that leads to Cloud Nine Studios.

The Steps to Recovery

While on this path, residents are in a liminal space. During the time it takes to traverse it, we have the opportunity to change the way they feel about the experience of making this transition between the outside world and their residence.

To that end, this path and the entire entry process have been carefully constructed to cause a sequence of psychological effects, each of which are mostly mild and insignificant on their own, but when combined and repeated over time, can create a significant therapeutic effect.

Furthermore, each step of the path is designed to create experiences that are unique throughout each residents' day, if not their entire lives, as this serves to aid memory formation and isolate the experiences, preventing them from being grouped with or compared to previous experiences, which could have negative feelings associated with them.

Step 1: Gated Airlock

An airlock is a chamber with multiple doors designed to control the transfer of air or other substances between areas of differing pressure or cleanliness. It acts as a buffer zone, preventing contamination from disrupting the environment on either side of the airlock. Similarly, a security airlock is a chamber designed to control the movement of people between areas, and prevents unauthorized access to sensitive areas through multiple checkpoints. Here, an airlock is created between two security gates.

Key Moment: Approaching the First Gate

From the very beginning, the experience of coming home to Cloud Nine is notably different. These security gates are the opposite of ostentatious; rather they are designed to be hidden in plain sight by being camouflaged as a normal section of a fence.

Residents looking at the gate will immediately recognize it as familiar waypoint that marks the entry to the path home, which will calm the amygdala and lower cortisol levels. However, they will also recognize it as a secret they are in on, which produces a mild sense of self-satisfaction and belonging, which in turn, boosts self-esteem, making them feel more worthy and valuable.

Key Moment: Operating the First Gate

These gates not only look different, but operating them also feels different from using almost any other door. Residents unlock them by holding a proximity key in the proper location, after which the huge, 5-foot-wide steel door opens automatically, swiftly and silently.

Residents will receive a small dose of dopamine when the gate opens as expected. Furthermore, those with generalized anxiety disorder will feel relief as their worry that their key will not work proves to be unfounded in this moment (as well as at the next gate and the front door). After the gate closes automatically behind them, residents' amygdala activity and cortisol levels should drop significantly, as a powerful barrier now exists between them and the outside world.

Key Moment: Walking Through the Airlock

An empty space between two secure gates, the airlock is an overtly liminal space within an already liminal path.

Crossing it involves a short walk toward a clear, unchallenging objective, which occupies the entire body but not the mind. These conditions result in the release of dopamine and the activation of the parasympathetic nervous system, which counteracts the effects of the sympathetic nervous system—which governs the "fight-or-flight" response—returning the body to a state of calm and giving the brain a brief moment to relax and wander.

Key Moment: Operating the Second Gate

Unlocking the second gate has a similar effect to the first, but severely muted because it is now a recently repeated action. When the gate opens to reveal the expansive courtyard, seeing the grass, trees, and flowers will reduce amygdala activity and lower stress hormones somewhat, but that impact pales in comparison to the calming effect of what happens next.

After the gate closes and looks like it has become part of the fence again, the gated airlock the residents just walked through becomes an formidable barrier and buffer between them and the outside world. Combined with the unique visual aesthetic of the courtyard, the Cloud Nine Studios grounds can feel like a place in quiet stasis, out of step in space and time with the rest of the universe. This level of insulation and security may seem cartoonishly unnecessary to the average person, but for those whose sense of home has been shattered, or those who want to get away from the source of their trauma, the feeling of safety it provides is both welcomed and needed.

Step 2: Winding Path

The first step was all about making residents feel safe, deactivating their amygdalae and lowering their cortisol. While walking along the winding path continues to activate the parasympathetic nervous system to extend these calming effects, the second step is largely focused on releasing significant amounts of the neurotransmitter dopamine.

Key Moment: Rounding the First Curve

As one of the building blocks of learning, the brain finds the recognition of patterns rewarding.

When we see multiple still objects lined up in an orderly fashion, we get some dopamine.

When we see multiple objects moving linearly toward organization, we get exponentially more dopamine, with a large amount released in anticipation of the eventual pattern recognition and a substantial spike when it happens.

However, the human brain struggles to effectively track multiple objects moving non-linearly, so when we see multiple objects moving in a coordinated, yet non-linear fashion toward organization, the dopamine release is greater still from the visual stimulation, attention-switching, and intense anticipation of an even larger payoff when the pattern is finally recognized.

This is the effect engineered by this environment, which features a large number of captivating visual elements that are aligned in straight lines, but the path running through them is curved, causing their relative positions to shift non-linearly as residents walk by them.

Key Moment: Looking at the Lunar Beacon

As residents walk along the path, they pass by the Lunar Beacon, a 12-foot steel sculpture that frames a giant mosaic of highly reflective dichroic art glass and is suspended 20-feet from the ground. Between its size, position, and several captivating aspects, it practically forces passersby to look at it.

Looking at such a visually stimulating object also releases dopamine, which is added to the copious amounts released by the aforementioned ballet of non-linear motion being performed by all the other visual elements in the courtyard.

Looking at such a unique object—as it is truly one-of-a-kind—aids in the formation and organization of memories, which is important in the long-term, as it is the cumulative impact of many trips along this path that can lead to a profound therapeutic effect.

Finally, the scale and elevated position of the Lunar Beacon all but force onlookers to look up. This is significant because simply raising our head and adopting an upright posture can have a surprisingly powerful impact on our psychological well-being as it raises mood, self-esteem, and confidence while reducing fear, anxiety, and stress. It also has a positive impact on the vagus nerve and the flow of cerebrospinal fluid, both of which play a role in regulating mood and stress response, plus it increases oxygen flow to the brain, which can improve focus, alertness, concentration, and persistence in problem-solving.

Key Moment: Crossing the Circle

The anticipation, stimulation, and dopamine all continue to rise until residents cross the center of the circle, which itself is at the center of the courtyard. When residents reach this point, all the non-linear motion resolves at once and order seems to spring from chaos.

The western Beacon-shaped tree well is seen to be aligned with the connecting curb, which is aligned with the center circle platform as well as the bench and Beacon-shaped pattern on it, which are aligned with the other curb and the eastern Beacon-shaped tree well, and all of these elements point toward the Beacon. From here, the five planters below the Beacon and the holes within them all come into alignment to form a symmetrical shape with angles that also point up at the Beacon. Finally, from here the crown of the closest tree aligns with the hole in the middle of the Beacon, and the four control joints and nine resulting sections they create in the wall behind the Beacon are all visible through and aligned with that same hole.

This many elements in a complex environment coming into alignment at once caps the anticipatory buildup with an even larger and more satisfying spike of dopamine. For sure. dopamine feels good and reinforces behavior, so this rush of it causes a pleasant sensation. However, this feeling quickly fades when the pattern has been resolved, which causes a psychological effect that is equally, if not more important. To see why, it is useful to compare it to more commonly understood neurotransmitter that operates in a similar fashion: epinephrine.

When we perceive a threat, our adrenal glands release epinephrine to prepare our bodies for action, and most or all conscious thoughts are pushed aside to focus on the threat. After the threat has passed, the epinephrine is quickly removed. When this happens, we may not even remember what we were thinking about before the threat appeared, and instead focus on the next thought that comes to mind.

Dopamine can work similarly, and the goal in the step is to make it do so, and more specifically to trigger a mental reset through visual stimuli that capture attention and cause a dopamine spike to reward the brain and then quickly fade, leaving the mind a relatively blank slate, which prepares residents for the next step.

Step 3: Waterfall

Beside the next section of the path there is a water feature made from natural stone that includes an artificial waterfall that flows into a small pond.

Key Moment: Recognizing the Sound

While the sound of the waterfall can be heard as soon as residents enter the courtyard, it can fade into the background as white noise, especially when their attention is captivated by the visual elements of the previous step. However, after the mental reset at the end of it, recognizing the sound of rushing water may be the first stimuli to recapture their sensory attention.

The gentle, rhythmic sounds of flowing water can trigger a relaxation response, activating the parasympathetic nervous system and reducing physiological stress measures heart rate and blood pressure. Also, by masking distracting noises and inducing a sense of peace, water sounds can help improve focus, concentration, clarity, and creativity.

Key Moment: Walking by the Waterfall

Walking by the waterfall compounds the aforementioned relaxing effects of the waterfall sounds by adding more sensory stimuli to the experience, which may also produce an additional neurochemical response.

The primary source of serotonin release during the entry process is exposure to sunlight; nevertheless we aimed to maximize additional release through other stimuli, especially for those who walk the path at night. Research supports that exposure to many aspects of nature can raise serotonin levels (although nature exposure does not nearly rival the efficacy of SSRIs as some claim), and running water is one of the most impactful elements of nature exposure. Furthermore, some researchers have described how small, artificial waterfalls can be constructed to provide the same health benefits as large, naturally occurring falls, most notably, to make them affect the air surrounding them in a way that triggers serotonin release. (The support for this is admittedly limited and needs to be more widely reproduced, but the principles are sound and we followed them in hopes they are effective.)

Key Moment: Viewing the Sculpture

While walking by the waterfall, residents will also see a sculpture that is nestled among the river rocks. As with all objects of visual interest and beauty, looking at this work of art can stimulate the release of dopamine. However, its true purpose is to attempt to elicit the most elusive of the feel-good hormones: oxytocin.

Oxytocin, the "love hormone," is primarily released through physical touch and social interactions. Considering that Cloud Nine Studios is a collection of women living by themselves, and that some, due to past traumatic experiences, may not like to be touched or even be around other people, some residents may suffer from chronic oxytocin deficiency.

However, under the right circumstances, oxytocin can be released by emotionally evocative visual stimuli or even just thoughts, such as the photograph or memory of a loved one. The challenge here was to find a visual stimulus that evokes an emotional response with each member of a group of unrelated women who might have little in common other than that they have all experienced serious trauma.

To that end, the sculpture shows an abstract figure of a small woman sitting with her arms wrapped around her bent knees, with her head in a position that suggests quiet reflection. Beyond its inherent beauty, this sculpture was chosen because it models healthy emotional regulation, as people often use this body position to comfort and reassure themselves when feeling anxious, stressed, or uncertain—emotions common during recovery from trauma with which many residents will identify.

As opposed to the Lunar Beacon, whose deeper meanings rely on understanding its purpose beyond its inherent appearance, this piece requires no such explanation, as its form is intuitively understood. As a piece of Healing High Art, it should come as no surprise that thousands of sculptures were evaluated before one was found that seemed like it had a chance of reliably eliciting oxytocin release for the residents of Cloud Nine Studios.

We were unable to find quality research to either solidly support or contradict this assessment, so this portion of the experiment is based on little more than one person's reasoned belief that this particular sculpture will be able to achieve this specific goal for this very specific audience.

Step 5: Fragrant Flowers

While the primary source of endorphins will be the physical activity of walking along the path, and for some residents, ascending the staircase.

This is also an opportunity to have one final boost of endorphins stimulated by smell.

Lavender would be used, but it is toxic to cats. Theoretically out of their reach, but some could bring their cats out, or drag it in on their shoes.

Step 5: Front Door

Lion knockers

Oxytocin from cats at front window.

Haven House

At Haven House, this starts with ascending an extra-wide, textured staircase Oversized elements (staircase, front door) and front door, castle elements (block walls, lion knocker) make it feel like a fortress automatic deadbolt, which helps those with anxiety know that the door is always locked as soon as it's closed.

At Haven House, since all the practical considerations have been well taken care of, the focus moved to harmony

Great care has been put into the entry experience.

At the very top of all priorities was safety: both actual safety and the perception of safety. (A close second was promoting sleep quality.) Each of these priorities are executed wildly differently at each facility. For example, a big challenge at Cloud Nine was to design a process by which women who are recovering from serious trauma can come home alone and feel safe, even at night. At Haven House, much of the travel is done in groups, a staff member is always here, if not a full house of people—the experience is very different. Since all the practical safety concerns are well taken care of, in a group living situation like this, how the women feel about their housemates is going to be the top variable affecting their sense of safety at home.

Coming home to a house full of people you get along with is an incredibly therapeutic experience in and of itself; however, living in an environment with people with whom you have constant conflict triggers the stress response, consuming precious mental energy and interfering with sleep, potentially exhausting a patient before they even arrive at Monima for therapy. For this reason, I concluded that the largest variable source of positive or negative effects of living at Haven House is the other residents, and the most effective measure to improve the perceived safety of the home would be to improve the interpersonal relationships of the residents, so I made dozens of design changes specifically to promote harmony.