ACEs and Resilience

This spring, I had the opportunity to attend a screening of the documentary “Resilience: The Biology of Stress and the Science of Hope” at my daughter’s high school. It was co-sponsored by Public Schools First NC, a statewide nonpartisan, nonprofit organization focused solely on pre-K – 12 public education issues. The documentary addresses the link between toxic stress caused by Adverse Childhood Experiences (ACEs) and the increased risk it puts children at for chronic disease, homelessness, prison time, and even early death.

I was somewhat familiar with the topic of ACEs before I watched the film, but I have to admit the data and information shared was eye-opening and thought-provoking. For those not familiar, Adverse Childhood Experiences can include:

  • Physical abuse
  • Emotional abuse
  • Sexual abuse
  • Physical neglect
  • Emotional neglect
  • Mother treated violently
  • Substance abuse
  • Mental illness
  • Parental separation/divorce
  • Incarcerated relative

The more ACEs a child experiences, the more likely he or she is to suffer from things like heart disease, diabetes, poor academic achievement and substance abuse later in life. Children who experience four or more ACEs are at greatest risk for these negative health outcomes. Experiencing multiple ACEs can cause what is known as toxic stress, or excessive activation of the body’s stress-response system. This can lead to long-term wear and tear on the body and brain. One way to think about it is as if you were to rev a car engine for days or weeks at a time. Imagine what that would do to your engine.

When children experience this toxic stress, they are essentially in survival mode. Self-protection becomes the priority, thereby affecting their social skills and their ability to learn. This can lead to difficulties in school. In addition, the increase in stress hormones can suppress the immune system, leaving children susceptible to illness and poor health in general.

Although exposure to ACEs is harmful, the good news is that the damage is not irreparable – and there are ways to reduce the effects of ACEs and toxic stress. Obviously, the primary approach should be to reduce the sources of stress in children’s lives, by meeting their basic needs or providing services in the community to help avoid exposure to these adverse experiences. However, for children who have already been exposed, strategies such as professional counseling, meditation, physical exercise, and spending time in nature have been shown to counteract the effects of ACEs. In addition, studies have shown that building resilience helps reduce the effects as well. Resilience is the ability to adjust or bounce back when bad things happen, and it is a skill that can be learned – by children and adults.

I have to admit that my interest in this topic and the documentary is really two-fold: understanding how ACEs can affect youth in my community but also how they may play a role in the lives of the adult clients whom I coach. Many of the clients I work with are often overweight or obese and may also have chronic conditions such as high blood pressure, high cholesterol or diabetes. Oftentimes, these adults are struggling with anxiety and/or depression as well. It is highly possible that these physical and mental health conditions are a result of ACEs that these individuals endured in their youth.

My experience watching this documentary and learning more about ACEs has prompted me to think about how I can possibly address this topic in my work as a coach. To be honest, helping individuals heal from the trauma of ACEs and toxic stress is really more appropriate for therapy or counseling, which is outside my scope of practice. In addition, coaching differs from counseling in that it is more focused on exploring the present and the future (e.g., through goals and action steps) rather than investigating and healing the past. However, as a coach, I think it would be helpful to know if a client did experience one or more ACEs in the past. It could open the door to introducing evidence-based practices such as mindfulness and meditation, which are helpful tools for behavior change as well as building resilience. It could be a win-win for the client – helping them heal from trauma in their past while also moving them forward in the direction of their vision and goals for optimal health and wellbeing.

I plan to explore ways that I can broach this topic if a client shares information that leads me to believe they may have experienced toxic stress due to ACEs. Sometimes clients offer this information outright. Others may drop more subtle hints about their past, allowing me to test the waters for further exploration with a gentle inquiry to share more if they are willing and able. Clients may or may not wish to elaborate, but if they do, I now feel more prepared to explore the connection between ACES and current health concerns – as well as strategies to counteract the damage that may have already been done.

If you are interested in learning more about ACEs, below are some resources that may be helpful:

CDC website about ACEs

Infographic: The Truth about ACEs

Finding Your ACE Score

The Gift of Patience

Patience. It’s something I have been thinking about a great deal, especially this time of year when there are extra things that need to get done for the holidays on top of my usual responsibilities. A quick internet search produced the following definition:

Patience: the capacity to accept or tolerate delay, trouble, or suffering without getting angry or upset.

I like that definition as I have come to learn that patience really is about acceptance and tolerance of things that are not quite the way you want them to be.

There are several things that have been testing my patience lately. I have a morning ritual that includes reading the newspaper – and I am an old-fashioned girl who likes to read the actual paper version, not the e-edition I can access online. For some reason, the carrier has been delivering the paper almost an hour later than usual…which is too late for me to read before I head to work. This has forced me to choose between reading the e-edition or skipping it altogether, neither of which I prefer. I’ve opted for the e-edition for now. I do plan to reach out to the carrier after the holidays, to see if this is just a short-term change or if this will be the new norm, but for the time being, I have had to accept that this is just the way it is.

Another situation that has tested my patience for the past several months is related to health insurance coverage. After several years of having to purchase health insurance on our own, I feel fortunate that my family and I have access to more affordable health insurance through my part-time position as a wellness coach. However, I have been wrangling with the insurance company since the spring regarding payment for the anesthesiology services provided during my colonoscopy. Turns out, the facility where I had my procedure is in-network, but the anesthesiology practice is not. (Yes, head-scratcher, isn’t it, considering you can’t bring your own in-network anesthesiologist to your colonoscopy – and I can’t choose where my gastro performs the procedure!) The insurance company initially denied the claim from the anesthesiologist, who in turn appealed the decision on my behalf.

I was excited to get the initial letter saying that the appeals committee agreed to process the claim as in-network, only to be followed by a more detailed letter explaining that they would only cover the “maximum allowable amount” and the anesthesiologist could balance bill me for the difference. From reading the EOB, it appears that the maximum allowable amount is only about 10% of what the anesthesiologist actually billed (incredulous and I will be calling the insurance company about this but not today). Fortunately for me, the anesthesiologist is only charging me a small portion of the remainder of the bill. I have decided to go ahead and pay it as the poor provider deserves to be compensated for her time especially given that the colonoscopy was back in May…but this is just one example of our broken healthcare system. I just don’t have the time or energy to fight the insurance company any longer. I’ve come to accept that this is just the way it is, right or wrong.

As I mentioned earlier, the holidays are another time when my patience often gets tested. This happened last night, as I was trying to finish up shopping for gifts before we travel to visit family. I didn’t really have a hard time with the shopping itself but rather the frustration that the responsibility was all falling on me while my husband and daughter were home watching a movie. I could feel the resentment building by the time I finished up at the last store. When I got home, I calmly informed them that I didn’t appreciate the fact that I was the one doing all the work while they were having all the fun. I could tell they felt a little guilty, and I will be sure that the holiday tasks get divided up more evenly next year. However, I also realized that I took on a lot of the responsibility myself and did not ask for help when I started to feel a little overwhelmed with everything on my plate. Lesson learned.

One thing that I am grateful for is that I am much more patient than I used to be – and I credit that change to my mindfulness meditation practice. I used to have a very short fuse and blow up over the “small stuff” as they say. I didn’t like that about myself and I knew it was really only hurting me and my wellbeing. I still consider myself a work in progress and that is why my wish for the new year is to cultivate even more patience – with myself and with others. We are all human and we all make mistakes now and then. Treating myself and others with compassion is the greatest gift I can give myself.

I wish you and your loved ones a wonderful holiday season and a happy, healthy New Year!

 

ralphwaldoemerson1-2x

Being Present is A Gift

It is hard to believe we are coming to the end of the year already.  It seems like once we hit Halloween, the rest of the year just flies by…which is why I chose the topic of being present for my final post of 2017.

I am taking time off to be with family over the holidays. I don’t get to see my extended family as often as I’d like due to distance, so visiting them is a source of joy. However, it can also be stressful: lots of people crammed into a relatively small house, many (usually too many) tempting, high-calorie treats, and difficulty keeping up with my usual exercise routine and sleep habits. It’s only for six days so I usually give myself a little leeway, knowing I will get back on track once we return home. However, there is one practice that I won’t sacrifice even when I travel and that is my daily morning meditation.

Sure, I may have to make some adjustments when I travel – finding a quiet place to practice, and choosing a time when I can do so uninterrupted. Fortunately, I am an early riser whereas many of my family members like to sleep in, so I am usually able to finish meditating before anyone else is awake. I love the peace and stillness in a house when everyone else is still deep in their dreams.

The reason I maintain my practice even when I am out of my normal routine is the benefits I reap from taking time to sit and be still. I have noticed a profound change in how I engage with the world since I started meditating regularly. I am calmer and less reactive. I don’t sweat the small stuff nearly as much as I used to (and believe me, I used to worry about it ALL). I have created space – literally and figuratively – that allows me to experience life in a different way. I am more aware of what’s happening to me and around me – and the coolest part is that I notice this awareness. Some people describe it as living more consciously. I prefer to describe it as living more mindfully versus mindlessly going about my day, missing out on most of what transpires from dawn to dusk.

My wish for all of you in 2018 is to find ways to be present in your life. One of the best ways to do this is to do one thing at a time. Study after study has shown that multitasking is a myth – the brain cannot focus on more than one task at a time. It merely switches back and forth quickly from task to task, giving us the illusion of productivity. In reality, it actually takes more time to complete the tasks we’re switching between and we make more errors than when we focus on doing one task at a time in order.

So, during this holiday season, as well as throughout the new year, consider the following advice as you go about your day and see if you notice a difference:

When sitting, just sit.

When eating, just eat.

When walking, just walk.

When talking, just talk.

When listening, just listen.

When looking, just look.

When touching, just touch.

When thinking, just think.

When playing, just play,

And enjoy the feeling of each moment and each day.

From “When Singing, Just Sing – Life as Meditation” by Narayan Liebenson Grady