How might the trauma of adverse childhood experiences impact the health of older adults?

As I am now in my 60s, I am even more eager to do what I can to maintain my health, physically, mentally and emotionally. My personal goal is to live to 120 years of age and to be teaching yoga beyond the age of 100! Perhaps I will shoot for breaking the Guiness World Record as the oldest yoga teacher, currently held by Tao Porchon-Lynch, who died at the age of 101 in 2020. Who knows, right? Well, new research into the impact of adverse childhood experiences (ACEs) in older adults might level set my expectations a bit.

 In 1995, Kaiser Permanente began the original study collecting data on (ACEs). Since the publication of that data, the Centers for Disease Control and Prevention (CDC) has expanded the scope of such data collection through the Behavioral Risk Factor Surveillance System (BRFSS). Since 2009, every state has begun to collect such data in its efforts for prevent violence, recognizing the long-term health impacts of ACEs. Most of the research to this point has focused on the negative mpact of such ACEs on the health and well-being of children and early to mid-life adults. New research took a look on the potential impact on older adults, specifically ages 50 years and older.

This new research study out of UCSF investigated the connection between ACEs and physical mobility, cognitive impairment, and functional disability in 3,387 participants between the ages of 50 and 97 years of age. Raising the collective awareness of ACEs, along with their traumatic impacts on our children, is important to implement preventive measures moving forward. As the results of this study highlight, it is also vital for implementing trauma-informed geriatric care approaches, since older adults who have had adverse childhood experiences are more likely to experience physical and cognitive functional impairments.

How might compassion factor into suicide prevention?

I think most, if not all, adolescents experience some level of dissatisfaction with their bodies, especially now with the advent of social media. I remember when I went through puberty (yes, before social media), I was constantly comparing myself to my friends and the images I saw in magazines and on TV. I was born shortly before Twiggy became the “Face of 1966” in the fashion modeling world. My mother was obsessed with the latest fashion trends, so this unrealistic ideal was something that took a stong and lasting hold of our entire household. I didn’t measure up then and I don’t measure up now. It’s not hard to imagine how never being able to measure up to some impossible ideal within our families can lead us into the dark recesses of our minds, inviting that self-judgmental part to begin to lead us through life.

As our self-judgmental part grows, it tries to convince us that it motivates us to try and do/be better, that without it’s help we would become unmotivated and lazy. However, this is not true. In fact, research has shown that self-judgment puts us at risk for suicidal thoughts, especially during adolescence. Body dissatisfaction has also been shown to be a risk factor for suicidal ideation and this dissatisfaction peaks during adolescence. So you can quickly see how dissatisfaction with our bodies in adolescence, when our bodies are in such a state of growth and change, invites self-judgment, leading to body shame and, without some support to balance the negative spiral of judgment and shame, can contribute to the risk of suicide.

So where might compassion play a part? Well, research is beginning to demonstrate how self-compassion can be a protective factor against suicidal thoughts. Unfortunately, teaching – or even modeling – self-compassion is not widespread in our cultures. Instead we have been taught messages such as “Suck it up, buttercup.” Such messaging has told us that to offer ourselves loving kindness or compassion is self indulgent. Again, another falsehood. Self-compassion is actually the motivating force for growth and change. So, if everyone committed to practicing more self-compassion towards themselves – thus modeling it to others – we would be contributing to the reduction in suicide risk, especially in adolescents.

If you would like to read more about this research showing how self-compassion can mitigate suicide risk associated with body dissatisfaction in adolescence , click the link below.

Can cultivating compassion improve the process of psychotherapy?

Prior to becoming a therapist myself, I spent a significant amount of time on the couch as a client.  I am forever grateful for the encouragement and compassion I received on those couches as the therapists supported my journey of growth.  However, for all of the compassion they may have offered me, none of them taught me about compassion.  I learned about compassion through the Eastern philosophies I studied as part of my yoga training.  As I began to practice compassion consciously, I came to personally discover its deep healing power.  So, when I began to practice as a licensed psychotherapist, I integrated Eastern and Western approaches, and teaching compassion to my clients is a tool I rely upon to facilitate healing and transformation.

Compassion guides us into spaces of acceptance of our limitations as human beings, to embrace our imperfections, and to comfort ourselves when experiencing suffering.  It soothes the inner critic and perfectionist, it reduces the amount of pressure on our overly developed responsible part, and creates space in our lives for more connection, peace and joy.  Until perhaps more recently, compassion – and specifically self-compassion – was not something that was taught to us as children, or even as adults.  So, by the time we are adults, we have been led to believe that the inner critic is our internal motivator to do more and better.  Instead the inner critic partners with the perfectionist to wear us down, telling us we will be enough and worthy once we, and everything around us, is perfect.  That is simply an impossible dream that we are chasing, inviting in exhaustion, anxiety, depression, shame, and isolation.

Through the years of not only offering compassion to my clients, but teaching them to offer compassion to themselves, I have noticed how it has enhanced the process of psychotherapy and made the effects more enduring.  A mantra I offer my clients is that self-compassion is the antidote to what ails them.  Easily said, but perhaps not so easily implemented.  Yet, when clients begin to loosen the grip of the inner critic and perfectionist and begin to challenge the myth that self-care is selfish, they begin to experience relief from their symptoms.  I don’t need any more evidence than that to know that compassion works!

However, for those that might want to read more about the effects of compassion, including how it creates structural changes in the brain, click on the link below for the most recent research in this area.

Can focusing on emotions when talking with your therapist improve symptoms of Binge-Eating Disorder (BED)?

Binge-eating disorder, although not formally recognized until added to the most recent version of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), is the most common eating disorder in the United States.   Having experienced the suffering from this diagnosis myself in the past, I used to refer to it as an emotional eating disorder.  Simply put, I used food to soothe and comfort myself.  I had not learned any healthy coping strategies when I experienced emotions, so I did my best to stuff them down with food.  It wasn’t until I took the journey of befriending my emotions and honoring their intelligence that I even became aware of my unhealthy relationship with food and eating behaviors.

Once I was able to accept my emotional beingness as a human, so many more things began to make more sense to me.  With the support of a good therapist, I came to learn that what I had experienced as a child was traumatizing and I disconnected from my emotions to survive.  However, living life from only the logical intelligence perspective was so limited.  And, even though I disconnected – or dissociated – from my emotions, it didn’t mean they went away.  They wanted to come out and be heard, so they knocked on the door loudly, sometimes bursting in when I least expected or wanted them.  So I used food to try to quiet them down, like you feed a baby when they are crying.

When I learned how to recognize my emotions and allowed them to have some air time, I was able to engage in a dialogue with them so they could inform me what I needed in the moment.  I then needed to learn how to give myself what I needed.  My personal journey towards valuing my superpower – my emotional intelligence – is the reason that my psychotherapy services include emotion-focused therapy (EFT).  Prior to EFT being researched to the point of becoming an evidenced-based practice, most research and treatment for BED aligned with cognitive behavioral therapies (CBTs).  Unfortunately, these approaches could not address efficacy, failure to abstain from such unhealthy eating, and high drop-out rates from treatment, because powerful emotions are among the most accurate predictors of BED.

This realization led researchers to consider exploring other psychological treatments with a focus on emotions.  A recent research study looked at EFT as an alternative treatment approach for BED other than CBT.  The results validate my own personal journey.  The findings provided additional evidence that individual EFT might be beneficial in the treatment of BED, as it supports clients in processing uncomfortable emotions instead of relying on food as an emotional coping mechanism.

To read the full article, click the link below:

Can practicing self-compassion reduce shame?

I describe shame as that toxic, black mold that grows in dark, damp places that can make you sick when you don’t even know it is there.  In order to get healthy, first we must become aware of the mold’s existence and then we need to invite air and light into the space, because mold can’t survive in the light.  It is the same with shame.  Shame on the surface functions as an internal regulator to discourage us from violating moral and social norms.  However, when small seeds of shame are planted, especially when we are children, it grows just like toxic mold, creating a very unhealthy internal state of being.  From these toxic seeds of shame grow weeds, such as feelings of ‘less than’ and thoughts of ‘not being good enough’.   What if there was a simple internal cleaning solution that could eliminate that toxic shame?  Well, research on self-compassion is becoming the light that is needed to kill off those weeds at their very roots!

When I was little I had a lot of things happening to me that brought shame, including my parents getting divorced and being poor due to being raised by a single mother.  With no money to spare, we found ourselves pulling things out of the Good Will bins, instead of putting things into them, so often our clothes did not fit right (I remember high-water pants before they were a fashion item).  In such a vulnerable place, my mom was taken advantage of by men and I witnessed domestic violence.  These types of circumstances were out of my control, but that didn’t stop the seeds of mold from taking hold and sprouting nasty weeks.  And those weeds, always present, drove my behaviors for many years.

Finally, when my body began to show signs of disease, I realized I needed to change something.  With the help of a good therapist, I was able to gain insight into how traumatizing those events were to a child and how the shame guided my behavioral responses, such as trying to be perfect all of the time and taking responsibility for ‘out-of-scope’ tasks and events.  Add my people-pleasing part and I had the trifecta for anxiety, exhaustion, depression and many other symptoms of trauma.

When I was able to offer myself the same compassion I would offer others that were experiencing some sort of suffering, I began to feel a sense of relief.  My thoughts changed from ‘What is wrong with you’ to ‘What happened to you’.  And I was finally able to move into a space of understanding, opening the door to choice when it came to how I wanted to act in this world.  Offering myself compassion by shining light on the toxic mold of shame opened the door to true peace of mind.  Cultivating compassion has been shown to reduce the negative chemicals (e.g., cortisol, etc.) and increase the positive ones (e.g., oxytocin, etc.) in the brain.  And with this data, new models of therapy are emerging within the field of trauma-informed care.  One of the most recent and promising ones, Somatic Self-Compassion® training is a trauma-informed self-compassion training that was designed to combine interoception (how we feel on the inside) and sensory modulation (adaptive responses to external changes) in order to teach individuals more effective coping with current and past stress.

One of the most recent feasibility research studies utilizing Somatic Self-Compassion® included shame as a variable to better understand how stress, shame and self-compassion might be related.  What this study showed was that combining trauma-informed care with the increased focus on somatic/body intelligence (i.e., interoception and sensory modulation) reduces shame, including body shame and that such training would be a good fit for trauma survivors.

To read the full study, click on the link below:

Can welcoming and accepting our unpleasant emotions change an unhealthy relationship to food?

Growing up, my parents had two different approaches to emotions.  One, my mother, expressed them all the time and the other, my father, never expressed them at all, believing that showing emotion was a sign of weakness.  As I write this, I now know that my household was not all that uncommon.  What I have learned over my life time is that many people struggle to balance their emotional experiences because we were never taught that emotions are natural, universal, and intelligent.  Instead, we were taught that unpleasant emotions were not welcome and somehow had to be controlled!

Being a more “right-brained” human, I tried my best to control my emotions over the years, having internalized the cultural myth that emotions can be controlled.  What tools are available to use in a war to try and control unpleasant emotions?  Exercise? Shopping? Work? Food?  Yes, Yes, Yes and Yes!  Over the years, work and food took center stage for me as my weapons of choice.

I didn’t understand then that those weapons were pointed at me, trying to harm or shut up a significant source of my innate human intelligence, the part of my intelligence that was trying to tell me that my needs were not being met in that moment.  I used those weapons to attempt to distract myself from a sense of overwhelm and loss of control.  Work became a source of comfort for the part of me that wanted to have a voice and food became a source of comfort for the part of me that believed it had just survived a life-challenging event, where it had navigated through the overwhelm and came out on the other side.  Food became almost a reward for making it through each day, with my thoughts saying “You did a good job, so you deserve to treat yourself to a big meal” and my body initially responding to the food intake with a release of tension, almost as if it was thanking me for finally giving it fuel to continue to live.  Now I recognize the need that was not getting met in the moment was comfort!

Before the diagnosis of binge-eating disorder (BED) officially made it into the DSM-V in 2013, I would (and still do) describe my past, unhealthy relationship with food as an emotional eating disorder.  I had bought into the “comfort food” phenomenon, where people seek out certain foods that create a temporary elevation of mood and a sense of relaxation.  It was only after spending time with a compassionate therapist and discovering yoga as a replacement tool was I able to befriend my emotions and my body enough to listen to what they were trying to tell me.  When I gave them “on air” time, I was able to become more aware of how I used food to soothe and distract from facing the fear and feeling the sting of powerful emotions, such as shame and rejection.

It was my own personal journey of learning to sit with my powerful emotions and honor that they serve me that brought my emotions into balance, so they don’t feel so overwhelming and scary anymore (and no longer show up in the most inappropriate places!).  In fact, when I start to feel overwhelmed, it is a red flag to “STOP” and reevaluate what I need to bring back balance.  By welcoming and accepting all of my emotions, I was able to establish a healthy relationship to food, recognizing food as simply fuel for my vehicle, so I could begin to make food choices that might be considered “premium gas” for my body.

It is also my own personal healing journey that has informed my work as a psychotherapist, embracing emotion-focused therapy as my “go to” approach.  What I learned – and share with my clients – is that as humans, we all have emotions and would not want to control them because they inform us, as they are a powerful source of intelligence.  So how excited was I when I read new research that validated my personal experience!  This research confirmed that the experience of unpleasant emotions is among the most accurate predictors for binge eating episodes in BED and individuals with BED often experience difficulties with deficits in emotion regulation.  It looked at the effectiveness of emotion-focused therapy to reduce the reliance on an eating disorder as an emotional coping mechanism and the evidence is emerging for the benefits of EFT for BED!

If you would like to read the full research article, click the link below:

Is expanding our capacity for compassion – for self and other – the key ingredient in healing through psychotherapy?

Growing up in chaos challenges our equilibrium to seek control, wherever and whenever we can find it.  This is a recipe for our perfectionist part to step forward and take control, driving us mercilessly to do more and better, striving for an ideal that does not exist.  Ultimately, this is a recipe for failure, disappointment, anxiety, depression or worse.  It wasn’t until I learned that as a spiritual being having a human experience that I am limited and flawed that acceptance began to flow in.  This realization did not mean that I stopped striving to grow, do better and be a less judgmental human.  It did mean that I had to reign in my perfectionist part and redefine my goals and ideals.

When acceptance began to flow for my limitations and mistakes, along with it came relief.  I could stop setting myself up for failure and begin to release my grip on unrealistic expectations, not only for myself but of others.  It opened the door to see and accept the limitations of others as a natural and universal aspect of being human.  It also loosened the grip of the need to control, which calmed my overly developed responsible part, creating space for the capacity to simply be.

Part of my journey towards acceptance included work through psychotherapy that encouraged me to confront the chaos of my childhood and the traumatizing effects it had on all parts of me.  I learned that perfectionism is a self-destructive and addictive belief system that fuels a primary thought that if I look perfect, and do everything perfectly, I can avoid or minimize the painful feelings of shame, judgment, and blame.  Shame is the intensely painful feeling or experience of believing that we are flawed and therefore unworthy of love and belonging.  Shame says ‘I am bad’ versus the feeling of guilt, which says ‘I did something bad’.

Having a compassionate witness, my psychotherapist, guide me along the sometimes slow and painful path back to wholeness, was mission critical for my healing.  I came to learn that as children living through adverse experiences we adapt by turning against ourselves, which distorts our sense of self.  We develop self-hatred as an adaptive response to protect our parents, which plants the seed that will grow the perfectionist part and set us on the path to work to improve our ‘bad’ self.

As I write this, my intention is not to blame, pass judgment on or shame parents.  I am in a space of understanding and acceptance that humans do the best they can with what they know in the moment.  However, the child goes through an unconscious development process that suggests:  which is safer, for the child to believe that their parents are bad and they don’t love you or that they are incompetent and the world is not safe OR for the child to believe that there is something wrong with them, that they are not good enough or have something to be ashamed of?  When we can understand that the fear of the loss of the attachment to our parents creates unendurable pain, then we can understand it is safer to turn on ourselves, because it leaves room for hope.  Hope that if we work hard enough, we can change that bad part of ourselves and become lovable.  This process creates the belief that if I can be good enough, I’ll be loved and belong.

What current research is offering is an approach to undoing the damage of this natural adaptive developmental process that is effective and embraced by people who suffer from shame.  It is compassion-focused therapy.  What is being demonstrated is that compassion is an essential capacity for growth, both inside and out.  It is why I integrate a self-compassion assessment and meditation into my healing offering through talk therapy and offer a recording (here) for download for ongoing support.  Having and truly offering compassion in therapy honors the experience of universal human suffering and now research is creating the evidence needed for compassion focused therapy to be embraced by the psychotherapy community.

To read more about where the research on compassion focused therapy currently stands, click the button below:

Can primary care physicians jump start the complex PTSD healing journey of the underserved?

As efforts to shine light on the underlying causes of health risk continue, especially as the disparities have become even clearer during this pandemic, the focus remains on the connection between adverse childhood experiences (ACEs) and the burden created on the human body individually and the healthcare system as a whole.  I am so grateful for Dr. Nadine Burke Harris, California’s Surgeon General who established early childhood, health equity and ACEs and toxic stress as key priorities, with a goal to reduce ACEs and toxic stress by half in one generation.

It still amazes me that so many people are not aware of the ACEs data that show the trauma our children endure, especially within low-income communities of color.  It has been out for years and continues to be collected every year, with expanding definitions of what constitutes adverse childhood experiences.  And it becomes frustrating when our healthcare systems continue to simply look at the symptoms of trauma, such as addiction, depression, and anxiety, without addressing the root cause.

I’m encouraged, and I hope you too find it encouraging, to learn that Dr. Burke Harris is starting with a campaign to provide Medi-Cal providers training, clinical protocols, and payment for screening children and adults for ACEs.  For more information on this campaign, you can click here.

It is also encouraging to hear about the research looking at other approaches to the chronic effects of trauma that are showing positive outcomes, especially within underserved primary care patient populations.  One particular pilot study tested the feasibility of a two-session motivational treatment intervention, implemented with Black primary care patients.  The intervention addressed adverse childhood experiences, post-traumatic stress symptoms, health risk behaviors and behavioral health referral acceptance.  The results were encouraging, suggesting that it is feasible to implement a brief motivational treatment with underserved primary care patients, that was received well and connected almost one-third of the participants to behavioral health services to continue the healing journey.

To read more on this pilot study, click the link below:

What is it about mindfulness that reduces stress – ACCEPTANCE!

In my own personal journey of healing, as well as being a compassionate witness to the healing of others, I have come to realize that suffering comes from rejecting parts of ourselves that we either think or believe are unacceptable to others.  When I first found myself in psychotherapy, I discovered that I was rejecting my emotional parts, because expressing emotions in my family of origin was either not acceptable or was overwhelming.  However, the effort it took to try to reject these emotions from my life was exhausting, created a great deal of anxiety and was completely unsuccessful.  In fact, the more I rejected them, the more my emotions would come out when I least expected!

It wasn’t until my therapist had me befriend my emotions that I was able to regulate them, honoring that they were a core source of my intelligence and would not want to reject them.  Wow, what a concept, ACCEPT my emotions as part of this experience of being human.  When I learned, which was a process, to allow those parts of me to express themselves, they no longer raged (read overwhelmed me).  It was as if giving them air actually dissipated the energy, versus the thought that ignoring or avoiding them, not giving them air (AKA suffocating or stuffing them) would extinguish the flame/energy.  And one of the main emotions I was trying to avoid feeling was fear.  My family did not acknowledge fear and instead taught us to wear many different masks to not reveal such vulnerability.  So the perfectionist and people-pleasing parts of me became overactive, to compensate for the scared little girl part that simply wanted to feel safe and accepted.

Along the way, I gathered some tools to deploy during the process of accepting all parts of myself, such as but not limited to deep breathing, yoga, journaling and guided meditation, as these tools helped me to welcome those parts of myself that I had been trying to avoid.  These tools might be referred to as contemplative science, cognitive practices, or simply mindfulness.  Now, I didn’t really know what it was about these practices that made them so effective for me, yet what I did know was after practicing them consistently for a period of time my anxiety went away.  What I came to realize was that the power of rejection creates long-lasting wounds to the hearts of many and that acceptance is healing.  Acceptance is a basic human need, as we are wired for connection and want to belong.  When we believe parts of ourselves are unacceptable and try to reject or mask those parts, we create our own chronic stress and suffering that manifests in symptoms such as anxiety.

Now the research is helping us to understand the power of acceptance and how contemplative science practices support us in monitoring our present-moment experiences through the lens of acceptance, reducing biological stress in the body through emotion regulation and evidenced by a reduction in cortisol levels and systolic blood pressure reactivity.  In addition, research is showing how Acceptance and Commitment Therapy (ACT) is becoming an empirically-supported treatment option for anxious youth.  I think this is critical information to share at this time, as no one knows the lasting effects of the fear coming from the uncertainty the COVID-19 pandemic is creating.  What we do know is that social isolation is not a healthy state of being for humans (think solitary confinement in prison) and we will all need tools to heal the traumas of this time.

If you would like to read more of the research on the healing effects of acceptance, click the boxes below:

Compassion for Survivors of Trauma – a New View of Substance Use Disorder/Addiction!

I remember being assigned to read the book by Dr. Gabor Maté, In the Realm of Hungry Ghosts, while in graduate school and simply feeling gratitude, compassion and validation afterwards.  I never believed in the medical model of addiction that describes the symptom of addiction as a chronic disease of the brain, even suggesting a genetic component to the disease, implying that if my parent(s) had addictions, most likely I would too.  Now, don’t get me wrong, the brains of people who struggle with addiction are different, yet those changes are created as a response to the adverse childhood experiences (AKA TRAUMA) these people survived.  And if your parents suffered from addictions when you were growing up, that experience is traumatic to a child!

I’ve written before about the impact of adverse childhood experiences, especially on physical health later in life as well as addiction; however, I felt compelled to revisit it again when I learned of research that found over 96% of the study participants suffering from substance use disorders, including prescription opioids, nicotine, and cocaine, had trauma histories.  When comparing the groups based upon their drug of choice, the prescription opiate group reported more traumatic childhood experiences than the other groups and a younger age of their first adverse childhood event.  So, when you learn about the underlying dynamics associated with substance use, the thought of “Just Say No” to drugs seems crazy!

Trauma comes in many packages and I’m grateful that the new California Surgeon General (Dr. Nadine Burke Harris) is focusing on early childhood, health equity and Adverse Childhood Experiences and toxic stress as her key priorities. (For more information on the ACEs Aware initiative, visit www.ACEsAware.org.)  It is time to stop blaming the victims and participate in bringing this information forward in order to educate.  What we don’t know, we don’t know.  However, once we know better, we can do better.  With this knowledge, we can bring more empathy and compassion in our interactions with people that struggle with substances.  We can take extra steps to explain this new research to them, validating their experiences and bringing them hope that they can heal from these past traumatic experiences and release their attachment to something that is harmful to them.  We can empower them to explore various healing modalities, such as psychotherapy, neurofeedback, meditation, hypnosis, guided imagery, and expressive arts, such as yoga, writing and drawing, all of which have been shown to support post-traumatic growth.

To read more about this research, click on the box below: