How Does Botox Impact the Nervous System & Emotional Regulation?

Today, we're talking about something that might surprise you—we’re going to talk about Botox.  If you're asking, “Why are we discussing Botox on a podcast focused on mental health?” Another centerpiece to this podcast is talking about ways to support, heal and regulation your nervous systems, in that it's important to consider how everything we do—including something as common as a Botox—could play a role. Today we'll talk about both the cosmetic & medical uses of Botox as we talk through it's benefits and it’s potential impact on your nervous system, brain, and emotional regulation (potentially of you and your kids). Hit play to learn more!

Here's the 3 takeaways:

1. Botox is a neurotoxin. It is used both medically & cosmetically. Most of the research show’s it’s more safe than not but that doesn’t mean there aren’t risks and side effects. Do you feel aligned with how or why you choose Botox? Does it improve that quality of your life in a way that outweighs potential costs?
2. Potential costs of botox include muscle atrophy, changes in brain activity, and emotional regulation - with potential implication for both you and your children’s emotional literacy.
3. Long-term effects of Botox are not fully understood.

Sources mentioned:

• Stark, S., Stark, C., Wong, B. et al. Modulation of amygdala activity for emotional faces due to botulinum toxin type A injections that prevent frowning. Sci Rep 13, 3333 (2023). 
• Davis JI, Senghas A, Brandt F, Ochsner KN. The effects of BOTOX injections on emotional experience. Emotion. 2010 Jun;10(3):433-40. doi: 10.1037/a0018690. PMID: 20515231; PMCID: PMC2880828.
• Weise D, Weise CM, Naumann M. Central Effects of Botulinum Neurotoxin-Evidence from Human Studies. Toxins (Basel). 2019 Jan 6;11(1):21. doi: 10.3390/toxins11010021. PMID: 30621330; PMCID: PMC6356587.
• BBC Article: Are there long-term health risks to using Botox?

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Transcript

0:00  
Welcome to regulate and rewire an anxiety and depression podcast where we discuss the things I wish someone would have taught me earlier in my healing journey. I'm your host, Amanda Armstrong, and I'll be sharing my steps, my missteps, client experiences and tangible research based tools to help you regulate your nervous system, rewire your mind and reclaim your life. Thanks for being here now, let's dive in. 

Hey, welcome back today. We are talking about something that might surprise you, especially on a podcast focused around mental health. We today are talking about Botox, because another centerpiece to this podcast is talking about a variety of ways to support your healing, your regulation and your nervous system, and it's important to consider how everything we do, including something as common as a cosmetic procedure, could play a role in that now We're all likely most familiar with Botox as the wrinkle smoothing injection, but what you might be less familiar with are its potential impacts on your nervous system, your brain, your emotional regulation, and those are things we're going to talk through today. And what actually sparked this episode was that a trauma therapist friend of mine texted me a couple weeks ago, and I'll just read you that text she wrote: 

"Hey, Amanda, wondering if you might be able to direct me to any articles or research on the impact of Botox on the nervous system. I have a complex trauma, slash chronic pain client that gets Botox for migraines and is wondering about the impact on the nervous system. Thanks." 

Now before the fire and the pitchforks come out, because I know people have really strong feelings on both ends of the Botox spectrum. I just want to make it clear that this is not a pro and this is not an anti or Botox shaming conversation at all. There are very, very real and valid reasons that people choose Botox for both medical and cosmetic reasons, and what I am going to do is share what I have found in the research, and in my opinion, also the limitations of that research, because I believe that in order to have true and informed consent about the decisions that we make, we need To be truly informed. And I hope this conversation helps you better understand Botox. What it is understand Botox from a nervous system lens, and it just gives you more information to decide if the benefits of Botox outweigh the potential costs. And we'll talk about that in a variety of different ways as this conversation goes on. 

But let's start with the beginning of just what. What is Botox? So it was originally developed for medical purposes to treat things like muscle spasms, chronic migraines, and then over time, it's become most well known for its cosmetic use. Botox is short for botulinum type A toxin. So Botox is a neurotoxin, and it works by temporarily paralyzing muscles. Let's get a little nerdy for a second. It temporarily paralyzes muscles because it interferes with something called acetylcholine, and this is a chemical messenger or a neurotransmitter that helps transmit signals in our nervous system. This brain chemical neurotransmitter, acetylcholine, plays a key role in sending messages from our nerve cells to our muscles, telling them to contract, but it's also involved in various brain functions like memory and attention, and there is some research going to look at, can injecting Botox in a localized region have impacts? Can it and does it travel beyond the injection site into different parts of the nervous system? Can it have impact on the other functions in which this neurotransmitter plays a role? And some of those questions are still left unanswered by research. So in short, when you inject botox into, say, your forehead, it smooths out wrinkles by preventing those muscles from moving so much. And while the effects and the impact of Botox is primarily localized, meaning it works only in the area of injection, but there is some interesting recent research also finding how it can impact the brain, specifically in areas involved in emotional regulation. 

So what this insinuates is that Botox might not just change your appearance or your level of intensity around chronic pain, but it could potentially influence how you feel and process emotions. A small study by UCI researchers found that Botox injections to a person's forehead may alter the way that their brain interprets and processes other people's emotions. Yes. So when you see somebody else who is happy or angry, we unconsciously mimic that expression. So think about a conversation with your friend and their eyebrows furrow and they're angry and they're frustrated. You as a human being, hardwired for connection, are likely gonna furrow your brows to some extent as well. This also breeds kind of empathy and compassion and and that connection when we mirror these emotions. But because Botox prevents that muscle reaction, it can scramble the brain's ability to interpret other people's facial expressions, so we may not appropriately interpret their emotions, and then, because our face doesn't move as much with our emotions, they may misread ours. So it has potential to dampen human connection, because the face isn't as expressive. 

Now, on the flip side, another research is looking at how Botox may help patients suffering with depression, because it gives them an inability to frown. I have a lot of feelings come up about this, because just forcing somebody's face not to frown so that their brain doesn't get signals that they are shut down or unhappy doesn't actually get to the root cause. So interesting research, nonetheless. There was also another study that found Botox participants exhibited an overall significant decrease in the strength of their emotional experience. When discussing Botox potential impacts on emotional regulation, what we are looking at is the facial feedback hypothesis. So this theory suggests that our facial expressions can actually influence our emotions. 

So again, different parts of this conversation are going to apply to you differently, whether you are somebody who is using Botox medically or using Botox cosmetically. So if you are getting a botox injection into your jaw for something like TMJ, one could argue that we should also look at chronic stress or a history of trauma for TMJ as a more long term holistic approach. But if you need pain management, if you need relief right now, that is something that a botox injection is used pretty regularly for an injection into your jaw for TMJ is not really going to dampen your facial expressions in other places. 

So know that I'm going to talk about considerations of Botox for both these categories, medical users and cosmetic users. But a lot of this research right now is more the cosmetic use of Botox, where facial features are dampened because of the kind of muscle freezing effect that it has, which is what we're looking at with this facial feedback hypothesis. So this theory suggests that our facial expressions can actually influence our emotions. So if Botox limits your ability to make certain facial expressions, it might also impact how you experience emotions. And many people have reported feeling emotionally blunted after Botox. 

So you get to pause and say, Oh, interesting. Have I noticed that for myself? Maybe yes, maybe no. Maybe it's not something you ever thought to pay attention to before. And so this could be because they aren't physically able to express emotions as fully as they did before that procedure. So while this might sound like a good thing if you're struggling with anxiety, it also means reduced ability to experience the positive emotions like joy, excitement, enthusiasm and interestingly, Botox is also being studied and interestingly, under the same kind of facial feedback hypothesis, Botox is being studied as a treatment for depression, with this theory that by reducing the ability to frown, it might help break negative feedback loops that reinforce depressive thoughts. 

It is important, so important for me to note that this is still an emerging area of research, and I'll share, in my opinion, one that I am not really on board with, because I feel like it's just another band aid trying to mute the symptoms of depression without actually getting to the root of what's causing a brain and a body to be overwhelmed to the point of shutdown. I don't think turning your muscle you're frowning muscles off so that you don't frown is much more than a band aid to figuring out why maybe you're frowning, why you're sad, why you're having so much shut down in your life to begin with, but interesting research nonetheless. 

Now, really quickly, before we go on, as a lot of this conversation is spent, you know this research study found this, or this? Found this, something I want to know about research in general. This goes for today's research on Botox, but research for. A lot of the other conversations we've had on this podcast, and will something to note is that these peer reviewed research studies, especially the big studies, they are really expensive to do, so in order for a research project to be done, there needs to be funding. And we would love to think that where the funding comes from doesn't impact the outcomes of that research, but it can, and it often does. This is, for example, why research around nutrition can be so contradictory. Because not only can where the funding comes from shift the outcome of what we learn in research, but so can the way that you're asking the questions you can change outcomes of these scientific studies based on specific aspects that you're looking at, adjusting variables like sample size control or settings. This is why one nutrition study might find that eggs are killing you and another one might show it as a superfood. Why one study might label a plant based diet as life saving, and another one might show it to be extremely depleting. 

The main contributor to a hormone imbalance when it comes specifically to Botox. Some context here is that the global Botox market was valued at $4.5 billion in 2022 and it is projected to grow to $11 billion by 2032 the primary driver of that is the esthetic market. Instagram filters. We're all we're all in it. We're living in this world. But another driver is that it is becoming more common practice as a medical treatment or intervention for chronic pain, migraines, TMJ, muscle spasm disorders. And what we need to know about studies even looking at the medical benefits of Botox. In these studies, they are specifically looking at Botox is effectiveness at reducing symptoms? Does it reduce intensity or frequency of migraines, of TMJ, of muscle spasms? And it's not often looking at other potential side effects or other mechanisms. All of this is to say Botox is big business, and so research that focuses on the possible negative impacts of it are studies that likely don't have access to as much potential funding. They're going to happen less frequently. They are going to happen in smaller sample sizes and just at a slower rate. And one of the more neutral articles that I found about it, that I sent to my therapist friend, I will also link the studies I reference in the show notes. This is a 2019 study titled central effects of botulium, neurotoxin, evidence from a human study. 

So in short, the study explored how Botox might impact the central nervous system, and it reiterated that while Botox is known for causing muscle paralysis at the injection site, there is new evidence to suggest that it may have additional effects on the brain or the spinal cord, and that can change how the brain processes sensory input and echoing what we've already talked about, about potentially impacting the way that our brain maps facial movement specifically for processing emotions and emotional regulation. 

Another really interesting aspect to this that people are discussing right now that might be worth considering, especially if you're a parent or a grandparent or a teacher to young children, is the impact of parental or adult Botox use on children's emotional literacy. So one aspect of Botox use that often goes overlooked is this potential impact on those people around us, particularly children. We talked a little bit about how our facial expressions are mirrored in more an adult to adult context. But as parents, our facial expressions play a crucial role in how our children learn to understand and regulate their own emotions, how those regions of their brain and therefore their nervous system kind of learn and regulate and calibrate from a very young age, children rely on their parents' facial cues to make sense of the world around them. These expressions help our kids to learn about emotions, to learn how to express emotions themselves, how to respond to the emotions of others. And there's a hypothesis that when a parent uses Botox, and because of what Botox does, what it's designed to do, it can reduce the ability to fully express emotions through facial movements, and this might inadvertently affect a child's emotional literacy. And when I use this term emotional literacy, I'm referring to the ability. Recognize, understand and express emotions effectively. If a child frequently encounters a parent whose facial expressions are somewhat muted due to Botox, they might miss out on important nonverbal cues that are essential for developing these skills, and one might argue that they will get enough of those skills and cues from other adults in their life, but with remember how much, how many billions of dollars that Botox industry is supposed to grow, they are predicting that more and more and more of the adults around your children facial expressions are going to be muted. 

And so just taking a moment to pause again. I'm not for or against either decision for you in your life, but true and informed consent means that we understand all of the possible implications of a choice for or against something. So the summary of this part of the conversation is that children learn not just by what we say, but by what we show them. So if a parent's ability to express emotions like happiness, sadness or concern is limited, it could potentially lead to challenges for the child in interpreting and understanding those emotions, and over time, this might, and again, I say might, because research is really limited in this area, might impact how the child learns to process and express their own feelings, as well as how they perceive and react to the emotions of others. So what I'm not saying is that parents who use Botox are doing their children's emotional development. Many, many, many, many factors contribute to a child's emotional literacy. Facial expressions are just one piece of the puzzle. However, like I said, I think it's just important to think about it, to take it into consideration, and then choose what feels right and best for you. 

Now, another thing that I want to touch on is the long term risks of Botox, and I'm going to share a little snippet from a I believe it's a 2024, BBC article, again, I'll link it in the show notes. It reads very little is known about the long term health effects of taking Botox, as most clinical trials only follow up on patients for six months or so. However, some studies have found that long, lasting cosmetic use of the botulinum toxin can trigger permanent changes to facial expressions with persons no longer able to flex their facial muscles. A 2022 review study found that people who regularly receive Botox injections showed changes in their muscle composition, function and appearance up to four years after their last injection. And a side note from this article for a minute, this is just due to muscle atrophy. If you don't use your abdominal muscles for 10 years, they are going to atrophy. If you don't use your arm muscles, they are going to atrophy. They are not going to work in the way that they should. They are going to decrease in form and function.

The article continues by reading. So in a similar way, if the muscle that causes the creasing of your face doesn't get used or is paralyzed with Botox, after a while, it's not as strong as before, so you have less of an expression. End Quote, so my thought here, especially for those of you who are using Botox for cosmetic reasons, if you do not plan on doing it forever, then you may want to consider the extent to which you do it. Now I personally had friends who started doing Botox in their 20s. That means by 45 they could already be 20 years into Botox. And again, depending on the frequency, the intensity of it, I'm sure it's gonna have varying effects on their muscles and the atrophy when it comes to the Botox juice, you do you and I say that in the most supportive way possible, and know that you may be permanently altering some form and function. 

Okay, we have talked a lot about the risks of Botox. It's been a little doom and gloom up to this point, but I do want to discuss how it can be beneficial. So while it is widely known for its cosmetic use, it also has gained recognition for treating chronic pain conditions, migraines, TMJ and even certain types of neuropathic pain. Its effectiveness and pain management comes from its ability to block that acetylcholine, that neurotransmitter, by reducing muscle tension and spasms, Botox can alleviate pain and may even impact the pain signaling pathways in the nervous system, offering relief where other treatments may fall short. So for those of you who are suffering from chronic pain, Botox can be life changing, reducing pain severity, improving overall quality of life. The. The catch here is that Botox is effects for chronic pain are temporary. They typically last no more than a few months, which require regular treatment to maintain relief. And again, this repeated use could have a cumulative effect on the nervous system over time, especially for individuals also managing anxiety or depression. So while Botox can be a really powerful tool in managing chronic pain, which can be really important because chronic pain is often linked to increased symptoms of anxiety and depression, it should also be considered as part of a more complete and comprehensive approach to that chronic pain, addressing physiological, emotional and different psychological aspects that may be at the root of that pain. 

So besides chronic pain management to determine if your use of Botox, cosmetic or otherwise has benefits that outweigh the costs, is to simply ask yourself the degree to which it improves your life quality. So choose Botox or don't, but choose it through a lens of informed consent, considering both the benefits and potential costs, especially if you are somebody who's managing anxiety and depression, especially if you're somebody who's trying to regulate your nervous system, this is, like so many of our conversations, highly nuanced. I don't have a lot of personal experience with Botox. In fact, I don't have any personal experience with Botox. I haven't had chronic pain that warranted it, and I haven't chosen to partake for cosmetic reasons, and I likely won't, but that doesn't mean that I'm not immune to the social pressures to look forever young. I spend a lot of time in front of a camera. I had friends suggesting it to me before my wedding, I present regularly in corporate settings, and I've definitely, definitely occasionally thought it might be nice to soften the lines across my forehead or the crease forming between my eyebrows or the amassing lines around my eyes. But for me, it's not worth it. It's not worth it, financially, physiologically or psychologically. It's not worth it for me as a parent to young children, and it's absolutely okay if you decide it's worth it for you, I think for me, it's also personal protests me flipping the bird to a society that tells us that we shouldn't look our age. It's me taking a personal stance for a little bit more of the society that I wished I lived in that embraced and celebrated aging more, and I am trying to do my part to embrace that in myself, and I've done a lot of the internal work to get to a point where I no longer look in the mirror and want less from my face. I'm aging when too many people that I have loved dearly have been denied that I am a very emotive human. My eyebrows are up 70% of my life, and I now can look at my reflection and know that each line on my face is part of a story, and I don't want to mute that, and I want you to do what feels true and right and awesome for you that helps you show up in the world in a way that is most reflective of you and what you want. 

So coming back, what does all of this mean if you are on a journey to regulating your nervous system, healing from anxiety and depression, and it essentially comes down to being informed and weighing your pros and cons. If you are somebody who is using Botox for chronic pain, and you are like Amanda, the level of pain that I experience all the time, it makes me a really emotionally dysregulated human, and getting Botox to minimize that pain, pros outweigh the cons. Love it. If you are somebody who shows up in the world in a considerably more confident way because of cosmetic Botox that you get, the pros may outweigh the cons. But if you are somebody who is sitting here, I don't know, I'm kind of on the fence. I don't feel like I'm a super emotionally regulated person. I probably wouldn't be listening to a podcast like this if I was a really emotionally regulated person. And I have some mixed feelings. I maybe feel the social pressure to get cosmetic Botox, or I have been using strictly Botox to manage migraines or chronic pain, and I haven't taken a more comprehensive approach to it, and maybe I want to then you are somebody who I hope this podcast gave some helpful information for you to move forward in navigating those situations, maybe with yourself, maybe with somebody that you. Know, loves you and trusts you, maybe with a provider that you know and trust, and that's really what I wanted to do with this conversation, was just to give you more information to make a truly informed decision that feels aligned for you. That's it. Okay. 

Three takeaways from today. 

Number one, Botox is a neurotoxin. It can be used both medically and cosmetically, and most of the research shows it is more safe than not, but that doesn't mean that there aren't risks and side effects. So the question here is, do you feel aligned with how or why you choose Botox? Does it improve the quality of your life in a way that outweighs potential costs? 

Number two, potential costs of Botox include muscle atrophy, changes in brain activity, specifically in areas of emotional regulation, with potential implications for both you or your children's emotional literacy and intensity, both of the happy and of the hard. 

And number three is an understanding that long term effects of Botox are just not fully understood. It hasn't been around long enough. Those long term studies haven't been done enough. And I will say with the caveat here of I want you to remember to research your research, consume research from people you trust. 

And the final tangent I'll go on is that, especially in a day and age of social media and you know, gotcha headlines, I have watched over and over and over and over and over again as people take one specific study, one specific aspect of one specific study, turn it into a headline and blow it completely out of proportion and out of context to maybe what was actually being researched. So just because someone says it's research based even me make sure that you ask, Do I trust the source that it's coming from if I am going to make a decision based on this fact, have I also done my own research around that research? 

And that's it, friends, okay, that's enough for today. Thanks for being here as always, and I'll see you next week. 

Thanks for listening to another episode of The regulate and rewire podcast. If you enjoyed what you heard today, please subscribe and leave a five star review to help us get these powerful tools out to even more people who need them. And if you yourself are looking for more personalized support and applying what you've learned today, consider joining me inside rise my monthly mental health membership and nervous system healing space, or apply for our one on one anxiety and depression coaching program, restore. I've shared a link for more information to both in the show notes, again, thanks so much for being here, and I'll see you next time you

Transcribed by https://otter.ai