How childhood trauma affects worksite wellness
Tough picture, I know. Hang in there with me. I have two questions for you. What does childhood trauma and worksite wellness have in common? And why should a worksite wellness professional get familiar with the concept of being “trauma-informed?” It all starts with a story.
In 1985, Dr. Vincent Felitti, a physician and chief of Kaiser Permanente’s Department of Preventive Medicine in San Diego, California was running a weight loss program for patients who were 100 to 600 pounds overweight. But every year, half of the participants kept dropping out, even though they were losing weight successfully.
Not understanding the reason, he decided to meet and interview them personally, and he found out a reason by accident. He was starting his interviews with some standard medical questions, and with one woman he misspoke a question. Instead of asking, “What age did you become sexually active,” he asked, “What weight were you when you first became sexually active.” And she answered, “40 pounds … it was when I was 4 years old, with my father.” He and his colleagues then interviewed 285 more participants who had dropped out of the program, and most of them had also been sexually abused as children. The clinical team was astonished.
Through their discussions with the patients, they also learned that their eating was a tool that they used to manage difficult emotions like fear, anxiety, anger, or depression, and that when they couldn’t eat, their feelings became overwhelming. Further, being overweight served as a means of protection for some, making them less noticeable to possible perpetrators.
After sharing this information with a doctor at the Centers for Disease Control (CDC), they developed the Adverse Childhood Experiences (ACE) Study. They studied over 17,000 people and followed them over 15 years. They, and other studies that followed, found that there is a direct relationship between childhood trauma and the adult onset of chronic diseases, health issues, mental illnesses, social issues, and professional problems; and the more ACEs someone has, the more severe the issues.
Trauma lives in the body and in behavior
Furthermore, others have found that trauma does not just live in the memories of the person. Trauma lives in the body. It affects us at a cellular and genetic level. And it can be passed down genetically through generations. The more trauma you’ve had (or your parents or grandparents have had), the higher the physical effects and health conditions.
Trauma also is associated with habits of self-harm and poor self-care, the behaviors that we usually label in wellness as “unhealthy lifestyle behaviors” or “risk” behaviors.
As Darius Cikanavicius explains: “Self-harmful behavior is often a survival strategy, meaning that that’s the best way the person adapted to survive in their unhealthy childhood environment … If a child is routinely punished, actively or passively, they internalize it and later in life do it to themselves. If a child is not allowed to feel certain emotions, like anger, they learn to deal with it in destructive and self-destructive ways, which often involved self-harm and poor self-care. These are “more acceptable” ways of releasing it.” (Cikanavicius, D., 2018)
Does this mean that the person is doomed? No! The brain has neuroplasticity, which means it can change over time through conscious attention, nurturing, positive relations, and repetition. Changes in the brain will then create changes in the body, but it’s important to know that we don’t just do this alone on our own. We do this with each other. We heal in relationships.
Trauma informed care
Because of the research on ACEs, the health care, mental health, and social services industries are now using a “trauma informed care” (TIC) approach to working with all individuals.
“Trauma informed care understands and considers the pervasive nature of trauma and promotes environments of healing and recovery rather than practices and services that may inadvertently re-traumatize.” (University of Buffalo, 2015)
Trauma informed worksite wellness
So, what does this have to do with worksite wellness? Everything.
Since we started with a story about an obesity clinic, let’s start there. Consider the weight-management focus for most worksite wellness programs. We measure obesity. We talk about the risks. We then provide educational information on nutrition and physical activity to help.
While measuring and education is helpful for some, especially if they seek it out for themselves, for many the experience of being weighed at work is traumatic. It “adds insult to injury.” Let’s break down what I mean by that idiom:
- Injury: Childhood trauma(s).
- Effects: Altered brain, biology, and behavior yielding the onset of conditions.
- Insult: Insinuating that the person’s conditions are their fault.
The TIC approach is switching the question from “What’s wrong with you?” to “What happened to you?” It’s changing our whole way of thinking away from judgment and toward empathy.
Now, you may be thinking, “But it’s not appropriate for me to know what happened to them as a child.” This is true, and if we are worksite wellness professionals, we shouldn’t ask. It’s not our place. We are not mental health clinicians. If it ever does come up, and the person does want to get help, we should always refer them to a properly trained clinician. So, what can we do?
How to help
First and foremost, we can drop the judgment and blame. We can stop treating people like they are failing. We can stop treating people like they don’t know enough or are not doing enough. We can start understanding that what they are doing is serving to protect them in some way (even if we don’t understand how or why). We can work with people wherever they are, in a way that doesn’t re-traumatize them.
The TIC field has been developing ways we can all help each other heal from trauma. Here are the main principles and values that we all can abide by:
- Safety — Make the person feel safe and secure;
- Transparency and Trustworthiness — Be transparent and be someone they can trust;
- Choice — Give the person the autonomy and freedom to choose their path;
- Collaboration and Mutuality — Work with the person as an equal; and
- Empowerment — Encourage and empower the person using their strengths.
To be, or not to be, the health educator
The last question you may have is, “What about all the information I know? What about all the credentials I have in health or wellness? Doesn’t that mean I know more than them, and that I should share it with them?” The answer is, it depends.
The reality is that a person will only accept, receive, and retain educational information if they have a reason to seek it out, and a desire to know it themselves. Force feeding them information isn’t going to help them. If they didn’t ask for it, it’s likely going in the trash. So, a good rule of thumb is don’t provide educational information unless they ask for it.
Here is what you can do instead: Be with people, get to know them, talk to them, listen to them, support them, and encourage them. Be someone who makes them feel seen, heard, valued, appreciated, and safe. Be someone who trusts them to follow their own path, on their own time, in their own way, however that is for them. And if you are this person to them, you can be sure that if they ever want information about something you know, they will come to you to ask you for it. Until then, and even if that never happens, love them anyway!
How to help yourself with your own ACEs
Lastly, I must bring up the fact that we, as worksite wellness professionals, also likely have our own share of ACEs. So, how can we help ourselves while also helping others? We do the same thing that we would do to help others.
We must sit with ourselves with empathy. We must drop the judgment and blame. We must see ourselves through the lens of love and forgiveness. We must make ourselves feel seen, heard, valued, appreciated, and safe within our own minds. We must observe our own thoughts, feelings, and behaviors, and know that we can change if we choose to. We can reach out to others to help us. We can heal! And as a dear friend told me: We deserve it!
For more information on trauma informed care (TIC), go to the State of Wisconsin Department of Health Service’s TIC website page. For more information on adverse childhood experiences (ACEs), and to calculate your own ACE Score, go here. Both sites have email lists you can sign up for to keep up with news.
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