Well Being and Trauma

A national guide to addressing trauma, and an assessment of how we are doing.

Posted Feb 13, 2018

Two news items:

Vermont Addresses Trauma: Lawmakers tackle childhood trauma effects

After hearing sometimes-emotional stories from more than 60 witnesses, a group of state legislators studying the effects of childhood trauma couldn’t come up with just one bill to address the problem.

Instead, they drew up four.

The package of bills—three in the House and one in the Senate— aims to improve trauma support and treatment within state government, health care and education via new positions, training and strategies.

The idea is that the long-lingering impacts of childhood trauma are the “root cause” of social problems including imprisonment, poverty, homelessness, addiction and chronic illness.

“So many people feel like this is the nexus of so much of the work that we need to do in Vermont,” said Sen. Becca Balint, D-Windham.

At issue are adverse childhood experiences, defined as traumatic events that “can have negative, lasting effects on health and well-being.”

The concept is not new. A landmark 1998 study from the Centers for Disease Control and Kaiser Permanente found that nearly two-thirds of more than 17,000 participants reported at least one adverse childhood experience such as abuse or neglect. More than 20 percent reported three or more such experiences.

I have addressed the Kaiser trauma study in PT (nothing I have written has garnered more attacks than this piece).

For our current purposes, here are three questions to help Vermont along:

  1. What are the best ways to overcome trauma for people with mental disorders and addiction? 
  2. How have we done with this task so far—for example, in helping prison populations?
  3. Are we creating or reducing the amount of trauma that people experience?

Our National Well-Being

Gallup-Sharecare has developed a national Well-Being Index, comprising the following five measures:

  • Purpose: liking what you do each day and being motivated to achieve your goals
  • Social: having supportive relationships and love in your life
  • Financial: managing your economic life to reduce stress and increase security
  • Community: liking where you live, feeling safe, and having pride in your community
  • Physical: having good health and enough energy to get things done daily

The 2017 results from the Gallup-Sharecare Well-Being Index painted a bleak picture of the well-being of Americans. For the first time in the nearly 10-year history of the Gallup-Sharecare Well-Being Index, zero states improved well-being by a statistically significant measure.

Out of a possible score of 100, the national Well-Being Index score dropped from 62.1 in 2016 to 61.5 in 2017, marking the largest year-over-year decline since the index began in 2008.

The good news for Vermont is that it tops (along with South Dakota—West Virginia is last) the states in well-being. The bad news: its well-being rating didn't increase so that it's hard to imagine its trauma experiences will decline.

Now let's address the questions I raised.

What are the best ways to overcome trauma for people with mental disorders and addiction?

I described in PT how the Substance Abuse and Mental Health Services Administration (SAMHSA), the government agency charged with formulating drug and alcohol treatment policy, convened a panel of mental health and addiction experts to create a unified model of recovery.

The result was based on four pillars:

  • Health: overcoming or managing one’s disease(s) as well as living in a physically and emotionally healthy way;
  • Home: a stable and safe place to live that supports recovery;
  • Purpose: meaningful daily activities, such as a job, school, volunteerism, family caretaking, or creative endeavors, and the independence, income and resources to participate in society; and
  • Community: relationships and social networks that provide support, friendship, love, and hope.

Very similar to the Well-Being Index—indeed, in many points (purpose, community, physical-health) identical. Not surprising, after all, since these elements of well being are both fundamental and commonsensical. These are the things that enable a person to experience life positively.

How have we done at overcoming trauma so far—for example, in helping prison populations?

The Vermont legislature has passed laws to address trauma after it is created by community and social conditions like those measured in the Well-Being Index.  How will they do so?  As the prison example indicates, along with the growth in drug-related deaths in Vermont as elsewhere, such actions, therapy included, have not been particularly effective—or effective at all. 

Are we creating or reducing the amount of trauma that people experience?

Indeed, if we accept the Well-Being Index results as meaningful, Vermont, along with the rest of the country, despite all of its good intentions, is seemingly in the process of increasing trauma.

Trauma grasshopper wrote:

I give group sessions in addiction rehab.
Although I am not a trauma specialist there seems to be a focus on people's negative past.
It does not mean they have PTSD. For example I had a quiet group comprised of a few people on early release from prison.A few working class people , one from the "not criminally responsible" serious crimes hospital.And a few non working early 20's.
The woman who was say 50 was trying to understand the technique I was teaching.So she felt it was good for her so she asked me."Why, just before I exploded at my sponsor, did I see myself run into my bedroom closet to hide from my father as if I was little again,where I could see myself banging the back of my head on the wall".
So previously she felt that perhaps she was damaged from this and saw this in her mind and would explode and so here she is in her 50's still impacted.So I told her when she found herself in the past with negative emotion to immediately assess what has just happened in the present.In this case her sponsor was picking at her and criticizing too much while she was getting a big meal ready and so the stress built until her brain went to a way to take her to safety.when she did not run she was given a burst of anger to protect her.It was a brain response She was not being assertive.This level of stress saved her before with this action and some parts of the brain don't think it just operates on a program.
She agreed that assertiveness was an issue.So now we were n my specialty.I taught her how to practice relax breathing so that when she was in a situation where someone was berating her she would be able to belly breathe so as to remain calm and then have her voice heard. She was not shy actually outspoken but didn't like hurting people's feelings.There are people who will attach themself and carry on like this if they can take advantage and she needed help with relationship skills.If the other person becomes more controlling then she can always opt to cut that person out and develop other friendships.Without feeling guilty.As far as I could see there was no reason to get her to go to "walk a day in my shoes" events to tell her story about her father's psychological abuse and relive that to help bring awareness.
She did marvelously especially when the focus changed from seeing herself as someone who could not change and was forever defined as traumatized.
I taught her to belly breathe and suggested she do it often throughout the day with different methods.Then I brought her on a treadmill and walk till her HR was about 105.I instructed her to belly breathe while walking and she saw her HR drop to 95 then to 90 and even below.She needed to counter the "tiger jumping at her" with the para sympathetic nervous system so they do not breathe shallow and trigger adrenaline that makes them want to fight / flight.
So the method I use trains a person that they Recognize when they are in the negative past to Rewind (backtrack) to what started this and see what can be Resolved.
When we say that trauma causes addiction we could be overlooking methods to empower people.Too much focus on people living in their narrative.As well it seems a lot of this "walk a day in my shoes" is getting people to overshare . While they may be compassionate and listen , they more likely will avoid eye contact the next time because when we over share we step across other people's relationship boundaries .
In effect making it worse because the client will not understand why people they met seem to want to avoid them.
Yes interpersonal relationship skills.
Yes to volunteer
Yes to home and purpose.