Do You Know Your ACE Score?

What are Adverse Childhood Experiences and how do they impact your physical and emotional well-being?

The CDC (Center for Disease Control)/Kaiser Permanente ACE Study was conducted between 1995-1997 and collected confidential data from over 17,000 Kaiser HMO members during physical exams. This was one of the largest investigations into child abuse, neglect, and household challenges that looked at later physical health and well-being. For both waves of this study, two-thirds of the people who completed the ACE questionnaire reported at least one adverse experience, and more than 1 in 5 experienced three or more ACEs. The greater number of adverse childhood experiences reported was associated with both physical and mental health challenges in later life.

Adverse Childhood Experiences are potentially traumatic events that occur in a person between the ages of 0-17. They include experiencing violence, physical and/or sexual abuse, neglect, witnessing violence at home, losing a family member, or having a family member attempt or die by suicide. The CDC estimated that up to 1.9 million cases of heart disease and 21 million cases of depression could have been potentially avoided by preventing ACEs. Women and several racial/ethnicity groups were at higher risk of having experienced 4 or more types of ACEs. It is believed that having 4 or more ACEs is associated with a higher risk of injury, sexually transmitted infections, maternal and child health problems, eating disorders, teen pregnancy, involvement in sex trafficking, and a wide range of health issues including diabetes, heart disease, and cancer to name a few. Additionally, when there are significant trauma experiences as children, it can impact you as an adult when you experience a new trauma.

Prevention of adverse experiences is one way to help protect children. This may include treatment for substance abuse for their parents, mental health care for parents (and sometimes children), and additional help from community resources for children and families. Common mental health challenges for those who have experienced adverse childhood experiences as children include anxiety, depression, and post traumatic stress disorder. The good news is you can seek help from both medical and mental health professionals to treat the medical issues associated with ACEs and alleviate mental health symptoms that occurred from childhood trauma.

Please feel free to ask your therapist to assist you in screening for adverse childhood experiences during your initial consultation. For more information about ACEs, feel free to listen to the attached: TED Talk about this very important topic.

For additional reading about ACEs, feel free to search www.cdc.gov

Lets Focus on the Children

Our world is going through something many of us have not seen in our lifetime. For that reason, we need to focus a bit on our children.  You will notice some of your children are anxious, confused, perhaps having nightmares or not wanting to go to sleep. 

When very young children, 5 and under hear the news over and over again, throughout the day, they believe all this chaos is going on over and over again; they become very anxious and afraid. If you have that young of children, please have them in another room if you going to binge-watch the news.
  
For children 6 through 10, they also may have some of the same reactions. They might stop doing schoolwork, and not wanting to do their chores at home. They may feel guilty and helpless especially if they know someone who has gotten ill or even died. Children also understand the risk their parents are taking if they are essential workers, this can cause them to be extra stressed or worry, understandable of course. 
  
Youth and adolescents 11-19 go through a lot of physical and emotional changes because of their developmental stage. So it may be even harder for them to cope with the anxiety associated with hearing and reading news of the outbreak. Don't forget they have lost a lot too, no promotions/graduations, no prom, no first/last season on the varsity team they worked so hard for. They are grieving those lost memories. 

They may say, "I'm ok" or go into silence when they are upset. They may complain about physical aches and pains. All this, because they cannot identify what is really bothering them emotionally. They may also experience anxiety/depression - start arguments at home with siblings or parents and resist any structure or authority. And, they may try to engage in risky behaviors like drugs and alcohol.

As parents, caretakers, and guardians we want to help, 

With the right support around them, children and teens can manage their stress in response to COVID-19. We want them emotionally and physically healthy.  Perhaps a family "making dinner together" will help, or playing a game of scrabble might just be the right thing. Be a good listener, turn the TV off at times, and bring out the old games that might be familiar to them. They can use hugs, and non-judgemental coaxing.
Often parents on the front line need some "space, time and debriefing" as well and some ways to relax. This is normal and a healthy way to process the stress of the day. Try to maintain consistent routines, let your children know you care and love them, and address your own anxiety and stress, during this debrief.

Sheltering in place means everyone needs some personal space and time.  Find a way to make that happen. Keep things in perspective to relieve your stress. Eat healthy foods, and drink lots of water. Avoid excessive amounts of caffeine and alcohol. Don't use tobacco or illegal drugs. To the best of your ability, get adequate sleep, take breaks throughout the day and add in physical exercise.

We will get through this, eventually, we will come out on the other side stronger. Kids need your help as parents to get them through the other side of this. You can do it.

"The Martial Therapist"

I got home that night full of bruises, tired as hell, and I noticed a growing pain in my wrist…

Have you ever just woken up in the morning and decided, “No, not today”. Well if you’re like me, then that happens more often than you’d like. I think at some point that happens to all of us. We just wake up and for whatever reason (you could be tired, stressed, lonely, overwhelmed, hungry, etc.) you decide that today is just not going to be your day and there’s nothing anyone or anything can do to turn it around. The funny thing about those days is that they tend to come out of nowhere (Ugh, so frustrating!) and the feelings that come along with those days tend to grow out of control quickly. I want to tell you about one of my bad days so that I can (hopefully) show you how I was able to turn it around.

I’m a therapist that practices Cognitive Behavioral Therapy or CBT for short. So I’m basically equipped to handle any situation…good, I’m glad you caught the sarcasm there! But in all seriousness, I make my living showing people that they have the ability to help themselves feel better by teaching them simple tools and strategies. So it’s obvious that I should be perfect at doing those things, too…right? Well I won’t keep you in suspense any longer. I’m not as good as I would like to be. The cool thing about being a therapist is that I am trained how to use all of these wonderful self-help tools, so when I end up not using those tools myself, I get to add an extra serving of guilt to my day. Remember, no matter how hard your therapist works for you, they are working just as hard making sure they have their personal life in order as well. In essence, they have to put on their oxygen mask on before assisting you with yours!

Well that morning, I did not feel like getting up and going to work. I thought to myself, “How the hell am I supposed to help anyone when I feel like this?”. I was slow in every step of my morning routine. I slept in until I absolutely had to get up. I took too long on the toilet. I lingered in the shower…you get where I’m going with this. I did NOT want to do anything and my behavior was telling me as much. Often, when we are feeling off, our behavior will change in subtle (or sometimes not-so-subtle) ways. I we can clue ourselves into these changes, we have the chance to head off the storm! My response was “Screw that”. I was feeling crappy and I wanted to! I knew in my mind that I was doing things to keep myself low, but I just wanted to feel low for a bit and forget all of my training as a therapist. The problem is that little voice in the back of my head nagging me to stop being such a hypocrite. I wondered to myself as I was taking way too long to pack my lunch, “If I was my own client what would I do to help solve this problem?”

The answer is frustratingly simple. Two words…Behavioral Activation. This terribly simple concept can solve so many issues. But when we need it most, it’s the last thing we want to use. Ridiculous, I know. What is Behavioral Activation? Translated into human speech, Behavioral Activation boils down to this…

 If you’re feeling crappy, do more stuff and you won’t feel as crappy.

                                                                OR

When you engage your body and mind in pleasurable activities, you tend to feel better.

So I did what any begrudging therapist who is aware of their own self-sabotage would do, I made a plan to go beat up my friends that night after work.

I know what you’re thinking (Okay, maybe I don’t really know). But you might be thinking that I’m nuts for saying that and that maybe I should be reevaluating my profession for having these thoughts. I swear, things will make sense soon. You see, every week I go to a self-defense martial arts class that teaches me to use my body as a lethal weapon in case I ever find myself surrounded by some seriously menacing dudes who want to beat me up. I go to the gym and spend two hours every session using my body in ways that I would never dream of using toward another person in my outside life. But for those two hours when I’m in class with the rest of my group, I am free from everything that weighs me down. Let me give you a taste of what a normal session looks like.

We start out by partnering up and hardening our bodies by striking each other on our arms, legs, and stomachs. This is so we can get used to the pain of getting hit by another person. Then we do some light warm up exercises, you know practicing how to apply a choke for maximum effect or which body parts provide the least resistance to breaking. You know, normal, typical, everyday kinda stuff. After that, we usually train some new way to apply pain as a defensive strategy. After that we do some intensive aerobic and strength exercises to make sure that we’re good and tired for the night and so that our bodies will feel something if the hitting somehow didn’t do it.

Now you might be thinking, is that what all therapists do to relieve tension? Do they all just want to hurt other people? No…at least not me. Here’s the thing, when I go to these classes, I am completely free from everything that bothers me. It’s hard to worry about your day when you’re dodging a punch. I can’t be thinking about my stressors and be effective in my fight at the same time, so the stress just has to go. When I go to class, I train with other people who are there to get better and have similar interests to me. I have built a network of friends that are motivated to work hard and are glad for me when I improve. I consider myself lucky to have these people in my life. Each time I go I am working toward something bigger than me and using my body to the point of exhaustion so that when I’m done, I have nothing left but the satisfaction of a job well done (and a few extra bruises and scrapes).

That morning I noticed my behavior had changed, I was mindful of how my thinking was keeping me down, and felt the sting of knowing that I could do something about it. I decided that I would go train that night even harder than normal because I needed to get out of my funk. I messaged my group ( so they could hold me accountable if I didn’t go) and exercised my body and mind.

I got home that night full of bruises, tired as hell, and I noticed a growing pain in my wrist…

…but the only thing I had the energy to do was smile to myself and say “You did it”.