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

Highlights from the Mindfulness in America Summit

Last year, I fortuitously stumbled across the Mindfulness in America Summit held in New York City in October. I could not attend in person due to the distance, but they had a wonderfully inexpensive option to join via live broadcast. It was a wonderful day-and-a-half program with a number of leading experts in the field of mindfulness. I had hoped to attend in person this year, but alas, had to opt for the virtual ticket again. Nevertheless, it was another amazing experience with more excellent speakers. I thought I would share some of the highlights and the incredible ways that mindfulness is being applied in so many different arenas.

Day 1

The conference opened with the father of modern-day mindfulness himself, Jon Kabat-Zinn. He led participants in a sitting meditation but made the point that every moment is the meditation. The message: yes, our daily mindfulness practice is important to build the skill, but we shouldn’t lose sight of the fact that living our lives with awareness from moment to moment is what mindfulness is really about.

  • Mindfulness and Politics: I was so excited to hear from Congressman Tim Ryan (D-OH), author of “A Mindful Nation: How a Simple Practice Can Help Us Reduce Stress, Improve Performance, and Recapture the American Spirit.” He was asked how mindfulness can help individuals deal with the current divisiveness present in our country these days. He emphasized the need for all of us to return to civility and understand that those with differing opinions are not stupid. He also shared an update on three key pieces of legislation related to mindfulness:
    • Federal education funds designated for use on social and emotional learning in schools, including programs to teach students mindfulness.
    • The creation of grants to help modify VFW facilities to include rooms for mind-body practices such as meditation.
    • The creation of a wellness program on Capitol Hill, to include mental health counselors trained in Mindfulness Based Stress Reduction techniques as well as designated rooms in congressional buildings for meditation and similar practices.

 

  • The New Face of Mindfulness: There was a panel at the end of the day with three leaders representing the “new faces of mindfulness”: Jesse Israel (of The Big Quiet), Gabrielle Prisco (Executive Director of the Lineage Project) and Diego Perez (a writer known as Yung Pueblo). All three of them spoke openly about challenging circumstances in their own lives that led to their personal mindfulness practices as well as the work they are currently doing in that arena. I was most inspired by Ms. Prisco, who had previously worked as a lawyer in the family court system. She spoke of the toxic culture inherent in that system, for all parties involved (clients and staff) and the absence of the word “love” throughout the system and process. Her organization brings mindfulness programs to vulnerable youth to help them manage stress, build inner strength, and cultivate compassion. They also train youth-serving organizations in the development of mindful practices. She envisions a youth justice system built on love with workers pledging a Hippocratic-like oath to “first do no harm.”

 

Day 2

The second day was jam-packed with top-notch speakers representing areas as diverse as law, healthcare, the military and professional sports. For the sake of space and time, I have selected just a few of the sessions I found most meaningful:

  • Mindfulness in the Military: Anderson Cooper interviewed neuroscientist Amishi Jha, PhD and Major General Walter Piatt about mindfulness training for active duty soldiers. There has been quite a bit of research done using mindfulness in the post-deployment arena, particularly for soldiers diagnosed with PTSD. However, Dr. Jha recognized the need for such training both pre-deployment and in the field. She found a willing participant in Major General Piatt and has received grant funding to study the impact of Mindfulness Based Attention Training for soldiers, which is an adaptation of the Mindfulness Based Stress Reduction program. Major General Piatt argued that all military personnel need “mental toughness” training much like the physical training (PT) that is required every day.

 

  • Mindfulness in Healing and Healthcare: Dan Harris (ABC Nightline co-anchor and author of “10% Happier: How I Tamed the Voice in My Head, Reduced Stress without Losing My Edge and Found Self-Help That Actually Works”) interviewed Mark Bertolini, the CEO of Aetna. Mr. Bertolini was in a very serious skiing accident in 2004 and turned to yoga and mindfulness to help manage his pain after finding little relief from multiple pain medications. His personal experience and recovery were so remarkable that he suggested offering yoga and mindfulness to Aetna employees to help deal with stress. They did a pilot study in order to convince the skeptical Chief Medical Officer at Aetna and had incredible results: they reduced stress by 33%, increased productivity by 62 minutes/month and saved the lives of two employees who admitted that they had been on the brink of suicide due to the pressures at work. The program has since been rolled out to all employees and expanded to include other practices such as pet therapy and PTO banks (where employees can give their paid time off to other employees in need).

I was even more excited to hear Mr. Bertolini’s rationale behind Aetna’s decision to merge with CVS, which is grounded in the desire to address social determinants of health. In the United States, your zip code often plays a larger role in determining your longevity than your genetic code. The leaders at Aetna realized that an organization like CVS, with pharmacies/clinics in almost every community, would be better equipped to help reduce local barriers to health and wellbeing. Mr. Bertolini sounded like a health coach when he said, “We need to ask, ‘What is it about your health that gets in the way of the life you want to lead?’” He used the analogy of “TripTiks®” for health – similar to those highlighted road maps that AAA used to provide to members when they traveled, we need to help individuals map out the road to better health.

  • A Mindful Approach to Race and Social Justice in the US: I am not sure my summary can accurately reflect just how powerful this session was. Once again, I was awestruck by Rhonda Magee, a Professor of Law at the University of San Francisco, who also teaches mindfulness-based stress reduction interventions for lawyers, law students, and for minimizing social-identity-based bias. She, Jon Kabat-Zinn and Anderson Cooper had a moving discussion about the current “woundedness” in society and how the next two to three generations need to address it to help us all heal. They talked about using mindfulness and compassion to explore who we are in relation to each other and to help recognize our own biases. Professor Magee challenged us to begin conversations with people who we don’t think we have anything in common with and be willing to sustain that dialogue. That is not an easy ask in today’s world where it seems we become more divided every day, but as she noted, we need to turn the lens of awareness to where the pain is in order to begin the process of healing.

 

If you missed the summit but want to attend next year, click here to visit Wisdom 2.0, the organization that presents the summit. You can sign up for their e-mail list to stay abreast of this and other mindfulness events.