In This Issue:
CHAD MORRIS, Ph.D., Director
I, along with many of my friends, turned 50 this year. Birthdays have never held much significance for me and usually when I’m asked, I need to stop and calculate how old I am. This year has been surprisingly different. Being alive for half a century has led to a different level of reflection, sometimes bittersweet.
I have thought a great deal about my friends and family no longer on this physical journey with me, and the uncertain world that younger generations face. I have a greater awareness of the unknown number of years I have left to enjoy travel or see my beloved gardens bloom again. This may all sound maudlin, but that would inaccurate. While at times I do have a sense of despair, I also have a renewed attention to the wonder of being alive and compassion for the contrasting emotions we all face each day. Ultimately, I realize I have the ability to create my own meaning with the guidance of my emotions and that this work is, perhaps, my most important work. In the following passages, my colleagues present how they too are creating their own experience as well as working to assist others to overcome adversity and flourish.
Registration is open for several of our 2019 trainings!
Rocky Mountain Tobacco Treatment Specialist Training Program: October 14 – 17, 2019
Motivational Interviewing for Behavior Change – Level I: November 6 – 7, 2019
A Study in Wellness
Developmental Origins of Health & Disease
CHRISTINE GARVER-APGAR, Ph.D., Research & Evaluation Director
It has been over 20 years since a landmark study called “Adverse Childhood Experiences” was published in the American Journal of Preventative Medicine.1 Prior to 1998, researchers had demonstrated impacts of child abuse on adolescent and adult mental health, but no one knew whether these early experiences might impact physical health outcomes or whether other types of adverse childhood experiences might have similar negative consequences. The ACE study set out to answer these questions by collecting data on early childhood experiences from over 17,000 adults and expanding the definition of what ‘early adversity’ might include. The researchers examined long-term health impacts of child abuse and neglect, and they also looked at a variety of household dysfunctions including parental drug abuse, incarceration, mental illness, and domestic violence.
Findings from the study revealed that the more categories of adversity a person experienced as a child, the greater the likelihood that they would experience a diverse array of health problems as adults including chronic disease, mental illness, addiction, cognitive challenges, and socio-emotional difficulties. Furthermore, the study showed that even among this population of relatively educated and financially secure individuals (study participants were medically insured by Kaiser Permanente and living in San Diego), experiences of early stress and trauma were considerably more common than anyone realized. This study has since spurred over two decades of investigations to figure out how and why early childhood stress and trauma have such pervasive impacts on lifelong health. The resulting body of research has profoundly changed how the medical community approaches health, disease, and the injurious effects of early stress and trauma.2,3
So, what have we learned? We now know that early life adversity alters the way brains develop. We know, for example, that when people have experienced early chronic stress and trauma, they process and regulate emotions differently,4,5 they make decisions and assess risks differently,6-8 they think differently about the future,9 and they have different responses to stressful situations.9-10 We know that these changes in brain development almost certainly increase the likelihood people will engage in poor health behaviors like substance use or making poor nutritional choices.9,11,12 It is also likely that these brain alterations make it harder for people to change their behaviors, even when they know the long-term consequences. We know that poor health behaviors and chronic disease tend to cluster together,13-14 especially within marginalized and underserved populations. People living in poverty, those experiencing discrimination, and those struggling with behavioral health conditions are especially vulnerable when it comes to experiencing the burdens of tobacco use, managing stress, and maintaining healthy sleep, nutrition, and physical activity. And we know that health risks are passed down within families,15 creating an intergenerational cycle of poor health and disease.
But here is what we also know. We know that when people are supported, they can change behaviors in ways that improve their health and the health of their families. We know that when it comes to health risk clusters, interventions that target multiple health risk behaviors can be effective across multiple domains.16-17 And we know that interventions that focus on family systems, rather than on single individuals, can be particularly powerful.18
In response to these pressing challenges and opportunities, BHWP is excited to introduce our RAISE Families for Health Program. The program is designed to provide administrators, healthcare providers, and peer specialists the necessary knowledge and skills to help parents and caregivers envision a healthy lifestyle for their families and achieve their personal wellness goals through participation in our RAISE Families for Health group curriculum. This innovative program provides training on strategies for coping with stress, maintaining tobacco-free families, healthy sleep, healthy eating, and physical activity as well as ways to promote positive behavior change through motivational engagement and behavior change strategies. We invite you to learn more about our RAISE Families for Health Program.
Wellness in Practice
CINDY MORRIS, Psy.D., Clinical Director
The movement of the fire burning in the chiminea behind me creates a complex dance of shadows on the side of the house. The warmth and energy of the fire matches my excitement as I engage in an animated conversation with a new friend. We stand close so we can hear each other talk over the other conversations going on around us. We share painful and wonderful life experiences alike and explore the way in which these experiences have informed our personal change and growth. We express delight about the magic we invite into our daily lives. We talk about our intention to be authentic by freely speaking our truth. I feel nourished by our sharing. It is as if I’d eaten a delicious and satisfying meal.
To others, we may simply look like two people chatting at a friend’s birthday celebration. However, I know it to be different. I know that we each approached our conversation with an open heart, which allowed a deep and meaningful connection. We spoke without censor and in this, I feel great pleasure and pride. As you likely know, to move through the world with an open heart can be a challenge. But it is a risk with great reward.
There was a time in my life when I often felt lonely and alone. I’m happy to say that these feelings are long past. As I uncover and discover myself, I have more to share with others and these contributions are more often profound. Whether the bond we form is for the moment or for a lifetime, I am transformed and humbled by the majesty of the human spirit. This is the best gift we can give to ourselves and to each other. Let’s pass it on.
In the Flow
KATHIE GARRETT, M.A., Clinical Associate
I am stretched out on the grass before a lake in a park near my house. It is late afternoon and this brief interlude provides a needed pause for wonder and reflection. I love the light at day’s end at the close of summer. Its tender elasticity is almost unbearably soft. It’s as if the sun is tapping into its energy stores to stretch out the summer light as far as it can possibly go before it dissolves into dusk. Interestingly, as I think about the sun in this way, it’s ability to effectively stretch the borders of light and to essentially make do with less, it reminds me of human resiliency and my own ability to cope at times when emotional rations are lean.
For the most part, I am resilient and that is not necessarily a testament to my well-seasoned coping skills as much as it’s a consequence of a calm and optimistic disposition that, I’ve been told, has been with me since birth. I tend to move comfortably in the world, guided by a sense of curiosity and interest. I can laugh or cry at the drop of a hat and often do both at the very same time. I have pleasant work relationships and deep friendships. Still, I know I can be even more emotionally resilient with mindful practice.
Take this breather, for example. I can certainly do more of this on a daily basis—choose to stop and smell the roses or expand my view of the world in the moment. Also, I can pause more often in my conversations with friends, family, and co-workers to provide space for others’ words so that I might better hear and understand. Similarly, I can attend more regularly to my own thought processes to bring awareness to the messages I am giving myself. Am I being fair and kind to myself? And I can pause more often before I agree to take on any additional tasks to consider my external and internal reserves. How often do I say, “Yes,” before checking in on my energy level or ability to get things done without over sacrificing? Finally, I can pause more often in my human grief and my desire to remember that loss comes in waves that last for seconds and not forever.
In this moment, I commit completely to honoring the wisdom of the pause and enjoying this heavenly light.
Made to Move
DEREK NOLAND, M.A., Community Liaison
For those of us who greatly value the outdoor opportunities that are unique to summer—such as warm temperatures for water activities, easier alpine exploration, or simply the long daylight hours—this time of the year can present a difficult transition. That’s not to say that we’re relegated to the couch once fall begins, but some limitations are inherent upon the changing of the seasons. My aim is not to sound alarm bells or pull anyone away from the pleasant, if fading, glow of the final days of summer. Yet, even so, while many people strive to pack in whatever remaining goals or activities that have eluded them over the past few months, this time of year also presents an opportunity to conscientiously prepare for the generally slower winter season.
To think about this process another way, once we’re truly embedded in the chill of winter, my mind inevitably starts to orient itself to the next summer season, dreaming of mountain tops, seasonal vacation possibilities, and just being more comfortable outdoors. Overall, I think there is emotional value in identifying such things to look ahead to with excitement, so long as it does not take away from our present situation. And with that concept in mind, I posit that now is the time to take a similar approach to welcoming the uniqueness of the colder seasons with equivalent optimism.
What opportunities will the colder months present to you this year? Now is the time to give this notion some thought. Personally, I’m mentally starting to line up some activities and goals for the winter months, such as identifying books I want to read, online courses to take, physical fitness goals to pursue, and so forth. Perhaps this winter you’ll want to learn a new hobby, take some sort of instructional class, spend more time with friends and family, or yes, even take advantage of outdoor winter activities. Whatever the case may be, I encourage you to frame the winter season in a light of positive anticipation.
Surely, I would be remiss not to note that some of you are undoubtedly dreaming about winter this time of year with the same type of passion I described in anticipating summer—and that’s equally wonderful. Regardless of what time of year you prefer or what events you look forward to from year to year, the key premise I’m aiming to impart via this example is achieving and maintaining a healthy balance. I believe there’s great value in looking ahead with excitement to upcoming events or seasons, so long as we remain grounded and even exhilarated by our current environment as well. Realizing this emotional balance and appreciating the special opportunities that every part of a calendar year presents can be a useful tool in maintaining a state of relative equilibrium and satisfaction regardless of the month.
Alongside those thoughts, I wish you emotional balance and wellness, not to mention a productive, engaging winter season. It’s hard to believe, but we’ll be bundling up to stay warm in very little time. But until then, while keeping the positive aspects of the upcoming winter in mind, I think there’s still a little time to squeeze in one last warm-weather excursion.
- Felitti, V.J., Anda, R.F., Nordenberg, D., et al. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: the Adverse Childhood Experiences (ACE) study. Am J Prev Med, 14:245-258.
- Garner, A.S., Shonkoff, J.P., Siegel, B.S., et al. (2012). Early childhood adversity, toxic stress, and the role of the pediatrician: translating developmental science into lifelong health. Pediatrics, 129:e224-e231.
- Shonkoff, J.P., Garner, A.S., Siegel, B.S., et al. (2012). The lifelong effects of early childhood adversity and toxic stress. Pediatrics, 129:e232-e246.
- Heleniak, C., Jenness, J.L., Vander Stoep, A., et al. (2016). Childhood maltreatment exposure and disruptions in emotion regulation: a transdiagnostic pathway to adolescent internalizing and externalizing psychopathology. Cognit Ther Res, 40:394-415.
- Mclaughlin, K.A., Lambert, H.K. (2017). Child trauma exposure and psychopathology: mechanisms of risk and resilience. Curr Opin Psychol, 14:29-34.
- Arnsten, A.F.T. (2015). Stress weakens prefrontal networks: molecular insults to higher cognition. Nat Neurosci, 18:1376-1385.
- Ross, L.T., Hill, E.M. (2002). Childhood unpredictability, schemas for unpredictability, and risk taking. Soc Behav Pers, 30:43.
- Bechara, A., Damasio, H. (2002). Decision-making and addiction (part I): impaired activation of somatic states in substance dependent individuals when pondering decisions with negative future consequences. Neuropsychologia, 40:1675-1689.
- Lovallo, W.R. (2013). Early life adversity reduces stress reactivity and enhances impulsive behavior: implications for health behaviors. Int J Psychophysiol, 90:8-16.
- Ellis, B.J., Del Giudice, M. (2019). Developmental adaptation to stress: an evolutionary perspective. Annu Rev Psychol, 70:111-139.
- Richardson, G.B. (2012). Immediate survival focus: synthesizing life history theory and dual process models to explain substance use. Evol Psychol, 10:731-749.
- Duffy, K.A., McLaughlin, K.A., Green, P.A. (2018). Early life adversity and health-risk behaviors: proposed psychological and neural mechanisms. Ann NY Acad Sci, 1428:151-169.
- Chiolero, A., Wietlisbach, V., Ruffieux, C. et al. (2006). Clustering of risk behaviors with cigarette consumption: a population-based survey. Prev Med, 4:348-353.
- Leventhal, A.M., Huh, J., Dunton, G.F. (2014). Clustering of modifiable biobehavioral risk factors for chronic disease in US adults: a latent class analysis. Perspect Public Health, 134:331-338.
- Ware, J. J., Munafo, M.R. (2015). Genetics of smoking behaviour. Curr Top Behav Neurosci, 23:19-36.
- Albarracin, D., Wilson, K., Chan, M.S., et al. (2017). Action and inaction in multi-behavior recommendations: a meta-analysis of lifestyle interventions. Health Psychol Rev, 12:1-24.
- An, L.C., Demers, M.R., Kirch, M.A., et al. (2013). A randomized trial of an avatar-hosted multiple behavior change intervention for young adult smokers. J Natl Cancer Inst Monogr, 47:209-215.
- Prado, G., Cordova, D., Huang, S., et al. (2012). The efficacy of Familias Unidas on drug and alcohol outcomes for Hispanic delinquent youth: main effects and interaction effects by parental stress and social support. Drug Alcohol Depend, 125:S18-S25.