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1.) What are Adverse Childhood Experiences (ACEs)? And how do they relate to toxic stress?

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1.) What are Adverse Childhood Experiences (ACEs)? And how do they relate to toxic stress?

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This post offers a definition of what Adverse Childhood Experiences (ACEs) are. The post also introduces how ACEs impact overall wellness.

What are aces? and how do they relate to toxic stress? Center on the Developing Child at Harvard University. (2020, October 30). Retrieved June 19, 2022, from https://developingchild.harvard.edu/resources/aces-and-toxic-stress-frequently-asked-questions/

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Center on the Developing Child at Harvard University

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What are ACEs?

The term "ACEs" is an acronym for Adverse Childhood Experiences. It originated in a groundbreaking study conducted in 1995 by the Centers for Disease Control and the Kaiser Permanente health care organization in California. In that study, "ACEs" referred to three specific kinds of adversity children faced in the home environment-various forms of physical and emotional abuse, neglect, and household dysfunction. The key findings of dozens of studies using the original ACEs data are: (1) ACEs are quite common, even among a middle-class population: more than two-thirds of the population report experiencing one ACE, and nearly a quarter have experienced three or more. (2) There is a powerful, persistent correlation between the more ACEs experienced and the greater the chance of poor outcomes later in life, including dramatically increased risk of heart disease, diabetes, obesity, depression, substance abuse, smoking, poor academic achievement, time out of work, and early death.

How do ACEs relate to toxic stress?

ACEs research shows the correlation between early adversity and poor outcomes later in life. Toxic stress explains how ACEs "get under the skin" and trigger biological reactions that lead to those outcomes. In the early 2000s, the National Scientific Council on the Developing Child coined the term " toxic stress " to describe extensive, scientific knowledge about the effects of excessive activation of stress response systems on a child's developing brain, as well as the immune system, metabolic regulatory systems, and cardiovascular system. Experiencing ACEs triggers all of these interacting stress response systems. When a child experiences multiple ACEs over time-especially without supportive relationships with adults to provide buffering protection-the experiences will trigger an excessive and long-lasting stress response, which can have a wear-and-tear effect on the body, like revving a car engine for days or weeks at a time.

Importantly, the Council also expanded its definition of adversity beyond the categories that were the focus of the initial ACE study to include community and systemic causes-such as violence in the child's community and experiences with racism and chronic poverty-because the body's stress response does not distinguish between overt threats from inside or outside the home environment, it just recognizes when there is a threat, and goes on high alert.

What is trauma, and how does it connect to ACEs and toxic stress?

While trauma has many definitions, typically in psychology it refers to an experience of serious adversity or terror-or the emotional or psychological response to that experience. Trauma-informed care or services are characterized by an understanding that problematic behaviors may need to be treated as a result of the ACEs or other traumatic experiences someone has had, as opposed to addressing them as simply willful and/or punishable actions.

What can we do to help mitigate the effects of ACEs?

People who have experienced significant adversity (or many ACEs) are not irreparably damaged. There is a spectrum of potential responses to ACEs and their possible chain of developmental harm that can help a person recover from trauma caused by toxic stress.

At the most intensive end of the spectrum are therapeutic interventions, ranging from in-patient treatment to regular sessions with a mental health professional, which are designed specifically to deal with serious trauma.

Trauma-informed care or practice is less intensive, but affects how practitioners in a range of fields, such as social work, medicine, and education, work with people who have experienced toxic stress, and reflects an awareness of the harm that has occurred and takes that into account. There are also many less-intensive practices that can help individuals reduce the effects of stress-from meditation and breathing exercises, to physical exercise and social supports.

ACEs-based screening and referral is an increasingly common approach, in which individuals are given an ACE score based on a brief survey of their own personal history of ACEs. This can indicate a general, non-specific sense of increased risk based on population-level probabilities, but it cannot predict accurately how any one individual will fare. In other words, a high ACE score can serve as a rough first screener to identify people who may benefit from services, but it cannot tell you what specifically you are at risk for, nor what to do about it.

The ideal approach to ACEs is one that prevents the need for all levels of services: by reducing the sources of stress in people's lives, whether basic needs like food, housing, and diapers, or more entrenched sources of stress, like substance abuse, mental illness, violent relationships, community crime, discrimination, or poverty. Supporting responsive relationships with a parent or caregiver can also help to buffer a child from the effects of stress, and helping children and adults build their core life skills-such as planning, focus, and self-control-can strengthen the building blocks of resilience. These three principles-reducing stress, building responsive relationships, and strengthening life skills-are the best way to prevent the long-term effects of ACEs.

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What Are ACEs? And How Do They Relate to Toxic Stress?

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What are Adverse Childhood Experiences (ACEs)? In this infographic and FAQ, learn about ACEs and toxic stress, and how to prevent or reduce lasting harm.

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1.) How does wellness impact resiliency?

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1.) How does wellness impact resiliency?

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Wellness and resilience go hand-in-hand. Resiliency is a person's ability to cope and adapt to new situations. Implications of a developmental systems approach to resilience include: Resilience is dynamic and changes over time dependent on the experience of the individual. Resilence also depends on internal and external systems relative to the individual. Interventions to nurture or bolster resilience can target different processes within levels or linking system levels (Masten et al, 2021).

Without personal wellness such as positive self-image, high confidence, and the individual ability to embrace growth and adapt, one's resilience can be directly impacted. Lack of wellness chips away at one developing the ability to build resilience, but it is never too late to build resiliency back up! (Reach Out, 2022).

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2.) Take the ACEs Quiz and learn about what it does and does not mean

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2.) Take the ACEs Quiz and learn about what it does and does not mean

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This post allows the reader to take an ACEs quiz to learn his/her/their ACEs score. The article introduces the three categories of ACEs and the health risks associated with ACEs.

Starecheski, L. (2015, March 2). Take the ace quiz - and learn what it does and doesn't mean. NPR. Retrieved June 19, 2022, from https://www.npr.org/sections/health-shots/2015/03/02/387007941/take-the-ace-quiz-and-learn-what-it-does-and-doesnt-mean

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An ACE score is a tally of different types of abuse, neglect, and other hallmarks of a rough childhood. According to the Adverse Childhood Experiences study, the rougher your childhood, the higher your score is likely to be and the higher your risk for later health problems. You can take the test below:

So, you've got your score. Now what?

First, remember that the ACE score isn't a crystal ball; it's just meant as guidance. It tells you about one type of risk factor among many. It doesn't directly take into account your diet or genes, or whether you smoke or drink excessively - to name just a few of the other major influences on health.

To learn more, check the CDC's ACE Study website. You'll find, among other things, a list of studies that explore the ways adverse childhood experiences have been linked to a variety of adult conditions, ranging from increased headaches to depression to heart disease.

Remember this, too: ACE scores don't tally the positive experiences in early life that can help build resilience and protect a child from the effects of trauma. Having a grandparent who loves you, a teacher who understands and believes in you, or a trusted friend you can confide in may mitigate the long-term effects of early trauma, psychologists say.

"There are people with high ACE scores who do remarkably well," says Jack Shonkoff, a pediatrician and director of the Center on the Developing Child at Harvard University.

Resilience, he says, builds throughout life, and close relationships are key. Recent research also suggests that for adults, "trauma informed" therapy - which can center on art, yoga or mindfulness training - can help.

How best to find and help kids who are experiencing abuse and neglect right now?

Child psychologist Hilit Kletter, of Stanford University's School of Medicine, says that to spot these children, she looks for visible signs of stress to understand what might have happened to them and how best to intervene. Some kids have nightmares or recurring thoughts of a stressful event, she says, or may re-enact the trauma through play. Or the child may seem distracted or withdrawn.

"This will come out at school," Kletter says. "Teachers will tell parents [their child] seems to be in a daze in the classroom, not paying attention."

Kletter says reactions to trauma are sometimes misdiagnosed as symptoms of attention deficit hyperactivity disorder, because kids dealing with adverse experiences may be impulsive - acting out with anger or other strong emotions.

"It's something that's very common in trauma: difficulty in regulating emotions and behavior," she explains. "That's why a lot of these kids get in trouble with the classroom."

Shonkoff's research center at Harvard tests interventions that can build resilience in kids who are growing up with adverse experiences - not just problems in the family, such as those the ACE study investigated, but also trauma stemming from poverty, for example, or from the chronic stress of racial or gender discrimination.

To bolster parents, the Harvard team is testing interventions right now that use video coaching to show moms and dads how to engage their babbling infants, using sounds and facial expressions in a style Shonkoff calls serve and return.

Shonkoff says these early interactions - a kind of conversation - have been shown to help children with later learning and literacy. Even more important, they boost kids' resilience, by helping them build secure attachments with caring adults. Research suggests that just one caring, safe relationship early in life gives any child a much better shot at growing up healthy.

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Take The ACE Quiz - And Learn What It Does And Doesn't Mean

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First developed in the 1990s, the 10 questions of the Adverse Childhood Experiences test are designed to take a rough measure of a difficult childhood. Finding out your score is easy. Now what?

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3.) CDC On: Preventing Adverse Childhood Experiences

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3.) CDC On: Preventing Adverse Childhood Experiences

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This CDC PDF is a helpful resource. Readers learn about how ACEs influence health and opportunity (p. 8), prevention strategies (p. 8-17), and interventions to lessen immediate and long-term harm (p. 21ff)

Leveraging the best available evidence - centers for disease control ... (n.d.). Retrieved June 19, 2022, from https://www.cdc.gov/violenceprevention/pdf/preventingACES.pdf

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Through practice and self-awareness, resiliency can be built and fine-tuned to the individual harnessing the power. Incremental wins are the path to building a strong foundation. Cognitive Behavioral approaches are correlated with success and can be integrated into client homework. Some exercises that can build resilience and mental toughness include:

Storytelling activities
Purpose reflection
Positive psychology
Perform acts of kindness
Gratitude activities
Three good things activities
Find something funny
Find the silver lining
Body scan

...and so much more! https://positivepsychology.com/resilience-activities-exercises/#what

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There is a buzz about resilience lately.

Resilience is the ability to recover from setbacks and adapt to challenging circumstances and is required to thrive and flourish.

It is a foundational psychological tool that empowers us to feel effective and capable of handling uncertainty.

Despite this definition, there has been discussion about what the essence of resilience really is. Is it a quality, skill, or personality trait? Is it genetically determined or taught?

Regardless of the exact nature of resilience, current thinking is clear. We can develop and improve our resilience. Experts confirm that resilience is a quality and a skill that can be enhanced, yet requires effort and consistency.

Before you read on, we thought you might like to download our 3 Resilience Exercises for free. These engaging, science-based exercises will help you to effectively deal with difficult circumstances and give you the tools to improve the resilience of your clients, students or employees.

This Article Contains:

What are Resilience Tools?

17 Science-Based Resilience Building Activities (+PDF)

Assessing the Status Quo With a Mental Toughness Questionnaire

8 More Exercises and Techniques for Increasing Mental Strength

Resilience Activities for Groups

Teaching Resilience Activities With Youth & Adults

Worksheets for Developing Mental Toughness

Resilience Training Activities and Exercising for the Community

More Free Resilience Training Materials & Resources

Master Resilience Training (MRT) Exercises Used in the Army

Useful YouTube Videos

PowerPoint Presentations (PPT) on Resilience

A Take-Home Message

References

What are Resilience Tools?

Developing resilience is a personal journey. The key is to identify ways that will work well for you as part of your own strategy for fostering resilience. Deliberate practice combined with self-awareness is critical to enhancing resilience. Resilience activities are ways we can develop it like a muscle, as it needs to be worked in order to get stronger.

Through activity, these skills can be developed through small, incremental wins. It is the habits that form the foundation of our mental beliefs that matter when the going gets tough.

The resilience tools suggested in this article are intended to be a starting phase for your journey of building resilience and mental toughness.

17 Science-Based Resilience Building Activities

Storytelling Activity

We can adjust our paradigms by re-creating narratives we tell ourselves. We can get stuck in re-playing the same stories, which may not be helpful or productive. By creating a healthier storyline, we foster our sense of control and how we interpret events.

A study conducted by Pennebaker, et. al (1988) indicated that individuals who engaged in therapeutic writing experienced more wellbeing and happiness (i.e. resilience) months later.

Consider an example in your life where you continue to repeat a story that produces worry or anxiety. Try writing out a new version with a more positive interpretation. Recognize how you feel in the process.

The Upside of Stress Activity

In her book, The Upside of Stress, Kelly McGonigal (2011) recognizes that seeing the upside of stress is not all about differentiating if it is all good or all bad. Rather, it is about how choosing to see the good in stress how you can use strengths to deal with challenges. She identifies tending and befriend is one of the best ways to do this and describes how helping others helps us develop resilience.

“Tend and befriend,” was named by UCLA psychologist Shelley Taylor, PhD. Taylor et al. (2000) discovered that they were more pro-social rather than aggressive in stressful times. Transformation can come from tragedy, as people can turn personal crises into ways to help others. McGonigal reports,

“Helping others increases the chemistry of hope and courage and dampens fear and despair.”

Think of one of the most difficult events of your life. How you can use this story to help others. How can you leverage it to impact someone in a positive way?

Purpose Exercises

Finding meaning in one’s environment is an important aspect of resilience. In “Man’s Search for Meaning,” Psychiatrist and Holocaust survivor, Viktor Frankl stated,

“Everything can be taken from a man but one thing: the last of his human freedoms – to choose one’s attitude in any given set of circumstances. To choose one’s way.”

(Frankl, 1959)

Psychologists have found repeatedly that people with a strong sense of purpose experience more resilience, a stronger sense of wellbeing and even better cognitive functioning. Purpose in life fosters resilience in part by protecting the brain against the negative effects of stress. According to Patricia Doyle, Ph.D., a Neuropsychologist with the Alzheimer Disease Center,

“purpose somehow gives your brain resilience. It makes your brain stronger and more resistant to the effects of diseases like Alzheimers.”

(Boyle et. al, 2012)

Other scientific studies support that having a strong purpose predicts health and longevity. Recent research suggests that finding meaning in life’s experiences, especially when facing challenges, is a key mechanism of resilience (Schaefer, et. al, 2013).

Robert Butler with the National Institute of Health researched health and longevity and reported findings in his book “Why Survive? Being Old in America.” People who had a strong sense of purpose lived longer than those who didn’t have a clear purpose.

Dan Buettner, who founded Blue Zones, also has done worldwide research. In studying women of Okinawa, Japan, it was discovered that one of key reasons for their longevity is their strong sense of purpose.

Okinawans are known for pursuing their ikigai which is a concept meaning “reason for being”, or “reason for waking up in the morning.” (Buettner, 2005).

Use these activities to help you discover, foster, and exercise your unique purpose:

Find your Ikigai Activity

The graphic and exercise in the worksheet can help you clarify your meaning, purpose, and mission in life while considering practical concerns of maintaining lifestyle, earning a living, etc.

Here is the Ikigai worksheet and template to walk you through this reflective exercise.

Richard Leider is a subject matter expert and offers compelling and practical resources to tap into our power of purpose (Leider, 2015). Learn more about Leider’s content here.

Try one of his suggested activities to clarify your purpose:

Purpose Reflection Activity

1. Why are you?

2. Why do you get up in the morning?

3. What keeps you awake at night?

4. When are you most alive?

5. What does being successful mean to you?

6. How might you apply your gifts to a pursuit that is of deep interest to you and helps others?

7. What can you do to make a difference in one person’s life, today?

8. What is your sentence (meaning, if you summarized your purpose in one 140 character sentence, what would it be)?

9. If you say yes to living purposefully, what do you say no to?

10. If you met an older version of yourself, what sage advice would they give you?

The Purpose Check-Up Activity

If you have already tapped into purpose, consider doing a short check-up exercise that allows for you to reflect, take inventory, and recharge.

The purpose checkup activity is available here.

Here is his Manifesto for Purpose and 10 Questions for Unlocking the Power of your Purpose.

Here is a helpful blog and activity form on how to unlock the power of purpose.

Positive Psychology Activities

The framework for the foundation of positive psychology was established by Martin Seligman and Mikhalyi Csikszentmihalyi (2000). The Positive Psychology movement has been focused on what processes and models can contribute to human beings flourishing and thriving.

Since the development of Positive Psychology, much research has supported the effectiveness of such interventions and the positive impact on wellbeing and resilience (Seligman et. al, 20015). Seligman (2011) developed the PERMA (Positive emotions, Engagement, Relationships, Meaning and Accomplishment) model for psychological wellbeing. The following activities are around the key PERMA themes.

Strengths and Gifts Activities

Research proves that identifying and leveraging strengths enhances resilience. A study led by Sherry Hamby of the Life Paths Appalachian Research Center in Monteagle, Tennessee highlights the importance of a strengths-based approach in helping people recover from trauma (Hamby et. al, 2018).

A great place to start is to reflect on your individual talents and strengths and consider how you can make a difference using them.

The Values in Action signature strengths survey measures 24 positive character traits, among them curiosity, creativity, bravery, persistence, integrity, fairness, leadership, and self-regulation. You can take the test here.

Take this free survey to capture your key character strengths.

Ask 5 people close to you to send in writing what they see are your top strengths.

Perform Acts of Kindness Activities

Sonya Lyubomirsky research shows that one of the best ways to boost happiness and resilience is to perform acts of kindness, volunteering, mentoring, or even expressing gratitude toward others (Lyubomirsky, et. al, 2005).

Consider a formal volunteering program in an area you are passionate about.

Pick one person a day to show extra kindness to

Display random acts of kindness, i.e., paying for a stranger’s coffee

Gratitude Activities

The practice of gratitude is one of the most time-tested and proven methods for enhancing resilience. One study published in the Clinical Psychology Review confirmed the benefits of habitually focusing on and appreciating the positive aspects of life on resilience and wellbeing. (Wood, et. al, 2010). Researchers Robert Emmons and Mike McCullough found that people who kept gratitude journals experienced improved wellbeing (2003).

Select from the following:

Every day for the next week, write down 3-5 things each day that you are grateful for.

Start a gratitude blog/group text with friends

Write a letter of gratitude to people who are special to you.

Tell people you see everyday what you appreciate about them.

Three Good Things Activity

According to Fredrickson’s broaden-and-build theory (2001), positive emotions can help broaden your momentary thoughts, actions, and attention to your surroundings. One example of this is to foster positive thoughts and emotions. Says Barbara Fredrickson, PhD, the author of Positivity (2009):

“In our research program, we found that the daily repertoire of emotions of people who are highly resilient is remarkably different from those who are not.”

Consider ending your day by reflecting on and writing down 3 good things that happened today.

Be intentional about reflecting on the experiences, noting how you felt, and what was the best thing about the experience.

Design a Flow Activity

“Flow” is the term used by researchers for optimal states of consciousness, those peak moments of total absorption in an activity (Csikszentmihalyi, 1997).

Research across various domains has shown the positive impact of experiencing a flow state on resilience.

Seek out a new flow experience that optimally engages your attention and leaves you with a sense of accomplishing a goal. As you explore new flow activities, consider the following criteria:

A task requiring skill and concentration

Involves intense focus

Is goal-directed

Provides ongoing feedback

Can feel both challenging yet effortless

You feel in control

You lose track of time

Find Something Funny Activity

Laughter has been found to boost resilience. A study evaluating humor induced positive psychology interventions identified the benefits of incorporating daily humor activities to induce laughter reduced depression and increased joy for participants, even months later (Wellenzohn, et. al., 2016).

Spend 10 minutes each day for 7 days on the following exercise:

1. Write down the three of the funniest things you have experienced, seen, or heard that day. Provide detail and note how they made you feel. If you can’t think of anything, do an online search for funny stories or anecdotes. Social media can be a good source for funny material.

2. Write down why you found it funny. The more specific you are, the more effective the exercise will be.

3. Write these three funny things at the end of your day. Doing so will foster a new habit and may help you absorb the emotion more as you are going to sleep.

Find the Silver Lining Activity

Looking at the bright side is scientifically proven to enhance our resilience. In a 2014 study, participants who went through such an exercise increased their resilience, were more engaged and experienced decreased negative thinking (Sergant & Mongrain, 2014). Other studies have also supported the positive impact this cognitive re-appraisal exercise can have on resilience (Troy et. al., 2010).

Think about an upsetting experience you have had recently. It could be a small example (i.e., my kids missed the bus this morning). Rather than focusing on the frustration of the experience, reflect on three positive things about it. Maybe it offered you time to have a special talk with your child on the way to school, or allowed you to see the sunrise from a different place, etc.

Engage in New Mindfulness Practice Activity

Mindfulness is defined as “paying attention in a particular way: on purpose, in the present moment and nonjudgmentally” (Kabat-Zinn, 1994). Scientific research has supported the benefits of mindfulness for many years. Recent studies indicate that psychological resilience is enhanced in mindful individuals (Bajaj & Pande, 2015). In other words, mindfulness can foster resilience.

Body Scan Activity

Body scan is one form of mindfulness meditation, focused on the physical experience of mindfulness. It is a technique that hones your attention on different areas of your body to gain awareness and optimize your sensation. Scientific research indicates that practicing body scan techniques is linked to greater wellbeing and increased resilience (Camody & Bear, 2008).

In this video, Dr. Elisha Goldstein will walk you through a brief 3-minute body scan.

Mindful Breath Activity

Dr. Andrew Weil developed what he calls the 4-7-8 breathing technique. Try this exercise:

Exhale completely through your mouth, making a whoosh sound.

Close your mouth and inhale quietly through your nose to a mental count of four.

Hold your breath for a count of seven.

Exhale completely through your mouth, making a whoosh sound to a count of eight.

This is one breath. Now inhale again and repeat the cycle three more times for a total of four breaths.

Dr. Andrew Weil explains the 4-7-8 exercise here.

Self-Compassion Activity

We are often most critical of ourselves and quicker to show compassion to those hurting around us. How we respond to our own stress and challenges is important. Research findings indicate that self-compassion skills promotes resilience and serves as a protective emotional mechanism (Trompetter, et. al., 2017).

Think of a difficult circumstance in your life that has been concerning you. Write down some details about the event. What would you tell a friend in that situation? What tone would you use? What actions would you take?

Assessing the Status Quo with a Mental Toughness Questionnaire

Mental toughness can be defined as how effectively individuals deal with stress, pressure, and challenge. The Mental Toughness Questionnaire assessments are online psychometric measures developed used to assess Mental Toughness. They have been developed in collaboration between Professor Peter Clough of Huddersfield University and formerly of Manchester Metropolitan University, and Doug Strycharczyk, Managing Director of AQR.

Many psychometric tests measure behaviors and personality traits. The MTQ test developers propose that how we think is a key driver for the development of behaviors and attributes. Professor Peter Clough’s research identifies four components of mental toughness: Control, Commitment, Challenge, and Confidence.

There are two tests designed here to measure Mental Toughness: the MTQ48 and MTQPlus. Both psychometric tests are normative, which allows users to compare their scores before and after a training or development program.

The differences between the MTQ48 and MTQPlus are noted here:

MTQ48

• 48 Questions
• Assessor, Development and Coaching Reports
• Provides scores for:
• Overall MT
• The Four C’s
• Subscale Scores for Control and Confidence

MTQPlus

• 74 Questions
• Assessor, Development and Coaching Reports
• Provides scores for:
• Overall MT
• The Four C’s
• Subscale Scores for Control and Confidence
• Additional Subscale Scores for Commitment and Challenge

8 More Exercises and Techniques for Increasing Mental Strength

Take your Resiliency Inventory

The late Al Siebert, PhD founded The Resiliency Center in Portland, Oregon. He developed a quick resilience test. Take this quiz, adapted from The Resilience Advantage (2015).

Rate yourself from 1 to 5 (1 = strongly disagree; 5 = strongly agree):

I’m usually optimistic. I see difficulties as temporary and expect to overcome them.

Feelings of anger, loss and discouragement don’t last long.

I can tolerate high levels of ambiguity and uncertainty about situations.

I adapt quickly to new developments. I’m curious. I ask questions.

I’m playful. I find the humor in rough situations, and can laugh at myself.

I learn valuable lessons from my experiences and from the experiences of others.

I’m good at solving problems. I’m good at making things work well.

I’m strong and durable. I hold up well during tough times.

I’ve converted misfortune into good luck and found benefits in bad experiences.

Convert your scores with the following key:

Less than 20: Low Resilience — You may have trouble handling pressure or setbacks, and may feel deeply hurt by any criticism. When things don’t go well, you may feel helpless and without hope. Consider seeking some professional counsel or support in developing your resiliency skills. Connect with others who share your developmental goals.

10-30: Some Resilience — You have some valuable pro-resiliency skills, but also plenty of room for improvement. Strive to strengthen the characteristics you already have and to cultivate the characteristics you lack. You may also wish to seek some outside coaching or support.

30-35: Adequate Resilience — You are a self-motivated learner who recovers well from most challenges. Learning more about resilience, and consciously building your resiliency skills, will empower you to find more joy in life, even in the face of adversity.

35-45: Highly Resilient — You bounce back well from life’s setbacks and can thrive even under pressure. You could be of service to others who are trying to cope better with adversity.

Mental Toughness 2 Minute Hack Activity

This activity is a life hack to develop mental toughness in less than two minutes. Tempting, but is it too good to be true?

Jason Selk, a performance coach who has trained a range of Olympic and professional athletes, uses this exercise:

Try this 2-minute centering hack:

Start with a centering breath. Breathe in for six seconds. Hold it for two seconds. Breathe out for seven seconds.

Recite a personalized identity statement that emphasizes a positive quality and specifies something you want to become in five seconds, such as “I am confident and passionate,” or “I’m consistently excellent every day as a leader, executive, and mother.”

Visualize your personal highlight reel for 60 seconds—thinking of three things you’ve done well in the past day. Mentally rehearse three important things you need to do today. Repeat your identity statement for five seconds. Finish with another centering breath cycle—breathing in for six seconds, holding for two and then exhaling for seven.

You can find more mental health exercises and interventions here.

Navy Seal Activities

“Much of mental toughness is simply attitude and self-esteem,” writes Stewart Smith, a former Navy SEAL and author of The Complete Guide to Navy SEAL Fitness. Several of his suggested activities are noted here.

– “It’s My Job” Reframe Activity

Smith proposes that often the simplest form of mental toughness is to simply tell yourself, “It’s my job.” Write down job descriptions for the roles you play and hats you wear (husband, mentor, daughter, brother, coach, etc.).

Review these descriptions weekly and consider treating them like duties, meaning non-negotiable. Consider the commitments you’ve made by taking on these roles, so that even when you are tired or unmotivated, you will keep your word. Knowing others are counting on you can foster your own sense of commitment.

– Foster Your Team Activity

Smith identifies the importance of having a strong team and support network around you in determining mental toughness. When faced with challenges, this becomes even more critical. Write down the names of important supports in your life. Under each name, write down two things you can do to strengthen your connection with that person in the next week.

Perform Under Pressure Activity

The Mental Toughness Trainer website offers some activities or “drills” to enhance mental toughness.

– Imagination practice

Take time away from the daily grind of training to visualize what you want. Find an imagination/visualization practice that works for you. Get specific and detailed about envisioning yourself achieving success.

Watch this clip of a very famous athlete to help gain insight: From :19 to :47 seconds.

Think of your best performances, and tap into as many senses as you can. Consider, pictures, your inner voice, sounds, smells, thoughts or feelings in your mind to make it real.

Stoicism Activities

The philosophy of Stoicism endorses being resilient: strong, steadfast, and in control of ourselves. Ryan Holiday, author of The Obstacle is the Way, provides this helpful summary of stoicism and highlights key practices.

Here are a few activities featured:

– Practice a State of Misfortune Regularly Activity

According to a well known stoic, Seneca, we should prepare ourselves for difficult times even while we are enjoying the good ones. He identifies the importance of build ing resilience to prepare for obstacles. This exercise involves taking a few days every month to practice a state of poverty or greater need than what we are used to.

By doing so, we may experience less worry about what we fear. It is important to note that this is an actual exercise rather than a reflection. It is not suggested to “think about” misfortune, but to actually live it. Try removing some of your regular comforts and conveniences for 2 days.

This practice of what you fear can allow you to come to terms with “is this what I used to dread?”

– Turning the Obstacle Upside Down Activity

Choose not to be harmed and you won’t feel harmed. Don’t feel harmed and you haven’t been.

Marcus Aurelius

The Stoics had an exercise called Turning the Obstacle Upside Down in order to train their perception. It involves turning a problem upside down, so that every “bad” can become a new source of good. If we have a difficult person in our life, the practice would tell us that they are a good learning partner who is teaching us patience, understanding, and tolerance, rather than focusing on the frustration.

Consider a challenge in your life. Reframe the obstacle so that you see it as an opportunity for growth.

Celebrate your Differences Exercise

This is an exercise to worry less about what others think of you. Consider this – what others think of you is actually none of your business. We all spend more time than necessary caring what others think. To address this concern, the Stoics endorse loving and appreciating yourself, fully embracing how unique and different you are.

Take time to reflect on your unique qualities. What sets you apart from others? What special value do you bring? How are you different? How can you celebrate other’s uniqueness?

If we compare, we despair. So, separating our individuality and not being threatened by the strengths of others is freeing and in turn, builds our resilience.

Resilience Activities for Groups

What is Resilience Activity (25 minutes)

Discuss with the group what resiliency is (the ability to bounce back, bounce forward from tough times). Have each participant write down their own definition and provide an example of when they or someone they know has been resilient.

Form two large concentric circles. The participants in the inner ring circle share their definitions. Those in the outer circle share their example. Then, rotate back to the inner circle for them to share, and outer circle then shares their definition.

Rotate turns until everyone has shared. At the end of the exercise, draw a Y chart on a whiteboard or large paper for everyone to see. As a group, brainstorm the essence of what it looks like, feels like and sounds like to be resilient.

Buzz Idea Activity (20 minutes)

The Reachout.com website provides practical tools and lessons for enhancing resilience:

Here is a group activity designed to introduce, educate, and spark discussion on resilience.

A picture tells a thousand words… A great way to introduce a topic.

Spread miscellaneous pictures or magazine cut-outs on the floor. Ask participants to choose a picture card they think best relates to the word resiliency.

Participants then share what their card means in relation to resiliency and what resilience means to them.

You can learn more about Reachout.com activities here.

Horoscope Activity with Youth

Open the session by reading horoscopes from a newspaper or magazine and facilitate a short group discussion. Why do we think people read them? Are they true?

Explain that they are now age 25 and they are going to write their own horoscope for their lives at age 25. Areas to cover within their horoscope are: family, career, relationships, money and housing. Encourage them to include hopes, dreams and ambitions, how they feel about themselves and how others will see them.

Once everyone has completed their horoscope invite them back as a group to share or discuss with the person next to them.

Make Time To Do The Things You Enjoy Activity

Discuss with the group what is important about making time to do things they enjoy. Highlight the replenishing benefits of engaging in activities we are passionate about. Have individuals write on a notecard what they love doing and why. Come together as a group to share what they love doing and what the benefits are of these activities.

You can learn more about this resource and additional activities here.

Teaching Resilience Activities with Youth and Adults

Create a Personal Resilience Plan Activity

Utilize the following outline:

Identify the resilience skills and strategy you currently use. What works well?

Identify 2 resilience skills you would like to develop.

Write 1 goal for each of the skills you identified.

Identify potential obstacles in developing these skills.

Increase Confidence Activity

It can be helpful to recall past memories of times you have succeeded and felt effective. Remembering our positive performance and achievement can foster a sense of self-efficacy and in turn, build our confidence and resilience.

Write down 3 experiences when you overcame a tough situation, and were still able to perform at your best and be optimally effective. How were you able to do it? What worked well for you? What is important to keep in mind for next time?

Thought Stopping Activity

Cognitive reframing can be a helpful technique to adjust maladaptive thinking and improve resilience. Recognize when you have a negative or unhelpful thought when you are interpreting an event. When you have the unhelpful, re-direct quickly. STOP and interrupt the thought pattern by following literal techniques:

1. Picture or draw a big red stop sign or red flashing light

2. Immediately say “STOP” to yourself

3. Re-direct to a healthier thought immediately

Realizing Resilience Masterclass

Besides these activities, if it is your passion to teach resilience, then the very best way to do that would be to enrol in our Realizing Resilience Masterclass©. This exemplary online course provides you with all the tools, videos, tutorials, and presentations you can use to teach others how to be resilient. Highly recommended by teachers and coaches, this course is invaluable.

Worksheets for Developing Mental Toughness

9 Steps to Forgiveness Activity

Forgiveness fosters resilience. According to Harris et al (2006), after completing a six-week forgiveness training (90 minutes/session), individuals reported lower stress, anger, and hurt than people who didn’t undergo the training.

Participants felt more optimistic and capable of forgiving immediately post-training as well as four months later.

Forgiveness involves letting go of resentment or anger toward an offender and finding some peace with a concerning situation in order to move forward in a healthy manner. The process of forgiveness can feel overwhelming or abstract, so Dr. Fred Luskin of Stanford University has developed nine steps to walk people through the process of forgiving someone who hurt them.

The Greater Good in Action website provides an activity/worksheet walking through these 9 steps. You can access the steps here.

Gaining Perspective on an Argument

Conflicts with others can foster and fuel negative emotions.

Learning to address conflict more effectively will enhance our resilience overall. We naturally interpret situations from a first person perspective, being concerned with our own thoughts and reactions.

By becoming a detached observer and considering a third person perspective, studies indicate that we can reduce our level of distress and anger. Finkel et al (2013) had couples practice such exercises regularly for one year. Subsequently, participants reported feeling reduced distressed around conflict.

This activity allows to practice taking a third person point of view by taking a step back and observing the situation from another perspective. The suggested steps are outlined here on the Greater Good Science website.

Resilience Toolkit

This Emotional Resilience Toolkit was developed by Glasgow CHP South Sector Youth Health Improvement team in partnership with The South Strategic Youth Health and Wellbeing Group. It provides various worksheets and resources in quick guide format. It was designed to be utilized by people working with youth aged 10 and older.

You can find the toolkit here.

Resilience Building Plan Worksheet

Sydney Ey, Ph.D. an Associate Professor in the Department of Psychiatry at Oregon Health & Science University has developed a worksheet to create a resilience building plan. Here is an outline of the resilience building plan template:

1. Recognize Your Signs of Stress.

1. Where do you feel stress in your body?

2. What are some of the bad habits you engage in when feeling stressed?

2. Focus on Building Physical Hardiness.

1. What kind of small changes can you invest in to improve your health? (Better sleep, better nutrition, hydration, exercise, etc.)

2. List one small change you can make now

3. Strengthen the Relaxation Response – Calm Body and Calm Mind.

1. List some activities at home that could help you relax.

2. List some activities at work that could help you relax.

3. Try out some new relaxation skills such as mindfulness or meditation apps such as Calm or Headspace.

4. Try some self-soothing activities such as:

Tactile (Holding something comforting or soothing)

Smell (Smell of lavender, fresh air)

Visual (Puppy or kitten photos, looking out the window, etc.)

Auditory (Listen to music, listen to sounds of nature)

Taste (Drinking some tea, eating chocolate)

4. Identify and Use Your Strengths.

1. Describe a time when you were able to overcome or handle a major challenge in life.

2. What did you learn about yourself?

3. What personal strengths did you draw upon?

4. Draw upon an image of when you were the most resilient.

5. How might you apply this strength now?

5. Increase Positive Emotions on a Daily Basis.

1. Identify sources of humor or joy.

2. Express gratitude, visit someone or write a letter.

3. List your accomplishments.

6. Engage in Meaningful Activities.

1. Notice what happened in your day that was meaningful on a regular basis.

2. What kinds of activities did you find meaningful?

3. Identify activities that put you in the flow. (Enjoyable things you do that cause you to lose track of time.)

7. Counter Unhelpful Thinking.

1. Write down what you are thinking about when you get stressed and then ask: What is the worst that can happen and could I survive it? What is the best that could happen? What would I tell a friend in a similar situation?

2. If you can’t stop thinking about something, write about it a couple of times over a 4-week period for about 15 minutes each time. Notice how your story changes or your perspective becomes clearer each time.

3. If you are being hard on yourself, practice self-compassion and learn to be kind to yourself. Give yourself a mental break or a pat on the back.

4. Remember a hero, a coach or a mentor that encouraged you when you doubted yourself.

8. Create a Caring Community.

1. Connect with friends and family on a regular basis.

2. Identify your sources of support, at work, at home, and in the community.

3. Practice good communication and conflict resolution skills.

Mental Toughness for Enhancing Performance

Jason Selk offers worksheets on developing mental toughness to enhance performance:

Mental Workout Worksheet following his 5 Step Process.

Goal setting for greatness worksheet, link here.

Success Log Worksheet, here.

Reach Out Resources on Building Resilience in Young People – here, you can find miscellaneous webinars, activity sheets, and resources on building resiliency in young people.

Resilience Training Activities and Exercises for the Community

Boosting Resilience Through Creativity

Creativity is a resource for coping with stress and increasing resilience. It can be picking up a new creative habit, or seeing things in a different way.

Get outside your comfort zone to explore with a new craft activity. Consider taking a class or buying tools at a craft store to try something new: drawing, painting, sketching, clay, sewing. YouTube provides many DIY craft ideas and project ranging in skill level, cost, and commitment investment.

Collage: Collect scraps of ideas, magazine pictures, words, symbols, images, nature items, leaves, petals, etc. Don’t look for immediate connections, yet be open to allowing these scraps to overlap in new ways. Combining ideas and creating new patterns are key practices of creativity. Use the items to make a collage and let the theme emerge.

Mirror Strengths Activity

Adults have the opportunity to help children boost their sense of resilience. Resilience researchers Steven and Sybil Wolin (1993) report that how a child’s self-concept develops over time depends on the environmental mirrors in that child’s life. They discovered that the most meaningful situational protective factor for developing resilience is one or more caring, believing alternate mirrors.

A powerful activity is to recognize and reflect back to a child his or her strengths. Make it a priority to be intentional and explicit to mirror the strengths of children in your life, by communicating:

“I see what is right with you, despite your struggles. And I believe what is right with you is more powerful than anything that is wrong.”

Find a time to take this action today by mirroring someone’s strengths back to them.

Classroom Activities

The following classroom activities are suggested by Laura Namey in Unleashing the Power of Resilience.

1. Promote self-reflection through literary essays or small-group discussions.

After children have read a book or heard a story that features a heroic character, encourage them to reflect by answering the following questions.

Who was the hero in this story? Why?

What challenge or dilemma did the hero overcome?

What personal strengths did the hero possess? What choices did he or she have to make?

How did other people support the hero?

What did the hero learn?

How do we use the same personal strengths when we overcome obstacles in our own lives? Can you share some examples?

2. Encourage reflection through personal essays.

Writing stories about personal strength can help reinforce resilience building activities for youth. By exploring answers to the following questions, they can foster insight of their strengths and what need in healthy relationships with others.

Write about a person who supported you during a particularly stressful or traumatic time. How did they help you overcome this challenge? What did you learn about yourself?

Write about a friend that you supported as he or she went through a stressful event. What did you do that most helped your friend? What did you learn about yourself?

Write about a time in your life when you had to cope with a difficult situation. What helped and hindered you as you overcame this challenge? What learning did you take away that will help you in the future?

3. Schedule discussions about human resilience into the classroom.

In order to raise awareness, schedule class time to discuss how resilience is connected to personal success and positive social change. Share examples of figures they are familiar with and how they overcame obstacles to reach their goals.

Ten Minutes/day Gaming Activity

SuperBetter is a gaming app designed to increase resilience. Jane McGonigal, stress researcher, designed the game to help people become more capable of getting through any tough situation and more likely to achieve the goals that matter most. Her research supports the positive impact of such gaming on resilience, even in only 10 minutes/day.

Gaming activities provide a way to bring the strengths you already demonstrate in life: optimism, creativity, courage, and determination. It provides a safe space to practice these skills, then transfer them into real life. Play SuperBetter Games 10 Minutes a Day.

Learn more here, and download the free app on iTunes here.

Watch Kelly McGonigal’s Ted Talk on creating the gaming app here:

More Free Resilience Training Materials & Resources

Stress Conversion Activity

Take a break to foster resilience. Psychobiology expert Ernest Rossi, Ph.D. studies ultradian rhythms and how they impact our ability to focus and be effective.

In his book The 20 Minute Break (Tarcher, 1991), Rossi reports how people have a biological need to take a 20-minute break after 90 minutes of activity in order to operate at peak efficiency and effectiveness. He identifies the process of rest as a “stress conversion” exercise. Not only does it feel good to take a break, it is a scientifically replenishing experience to build resilience.

For one week, schedule breaks every 90 minutes into your calendar. Experiment with these stress conversion time blocks on your calendar and observe how it impacts your performance.

Energy Management Activity

In “The Power of Full Engagement, Managing Energy, Not Time, is the Key to High Performance and Personal Renewal,” Tony Schwartz and Jim Loehr argue that energy, not time, is the fundamental currency of high performance (Schwartz & Loehr, 2005). They propose that by effectively managing our energy in different areas of life, we prevent burnout and subsequently become more resilient.

Four sources of energy are identified:

Physical;

Emotional;

Mental; and

Spiritual.

Energy capacity diminishes both with overuse and with underuse, so we must balance energy expenditure with intermittent energy renewal. In order to expand capacity, we need to push past our comfort zone, training as athletes do to enhance performance. In order to build muscle strength, we must incrementally stress it, expending energy beyond normal levels.

The same applies to increasing emotional, mental and spiritual capacity. Schwartz & Loehr maintain that positive energy rituals, such as highly specific routines and activities are critical for managing energy and building resilience.

Consider these principles and take inventory on your energy management habits. Answer the following questions to identify areas for incremental change:

What do you do to optimize energy in all 4 areas of your life daily? What could you do?

What rest/recovery rituals are incorporated into your day?

What do you do to disengage?

What activities do you find replenishing?

Where are you stretching yourself and growing in each of the 4 areas?

Resiliency Log Activity

Keep a resiliency journal to reference periodically. Write down a list of accomplishments, goals, and special achievements. Make note of particular challenges and how things worked out, from any time of your life. For example, learning a new game, completing a difficult project, having a tough conversation, finishing a race, acing a hard test, etc.

Refer to it to energize you and promote confidence as you face new challenges. Keep your journal handy so you can add accomplishments to it throughout your life and career.

Tiny Exercises Activity – Build Resilience by Wasting Time

According to Kelly McGonigal, tackling a pointless but mildly challenging task is a scientifically-backed way to improve willpower and resilience. Engaging in practices we find nonproductive can make us more resilient.

Find one tiny activity to incorporate several times into your workday, even if it is four minutes per hour.

Master Resilience Training (MRT) Exercises Used in the Army

The Army has incorporated the basic principles of Positive Psychology to develop the Comprehensive Soldier Fitness program. Positive Psychology’s areas of focus include building mental toughness as well as identifying signature strengths, meaning, purpose and positive relationships.

The program was developed in partnership with Martin Seligman and the University of Pennsylvania’s Positive Psychology Center (Seligman, 2011). The center serves as the training hub of the program’s Master Resilience Training program for noncommissioned officers.

Learn more about the program here.

Soldiers learn a series of skills to enhance their resilience through some exercises noted here:

ABC Activity

The ABC cognitive reframing technique involves recognizing thoughts triggered by events and understanding the reactions that are driven by those thoughts. Soldiers learn to recognize an activating event (A), their beliefs (B) about the event, and the emotional and behavioral consequences (C) of those thoughts.

Examples provided teach how to separate the events from self talk in the heat of the moment and how these thoughts impact emotions and behaviors. They learn to identify thought patterns that are driving adaptive as well as counterproductive outcomes.

Explanatory styles and thinking traps

Participants learn how explanatory and other thinking patterns can enhance leadership, performance, and mental health or undermine them. Thinking traps such as jumping to conclusions are identified as examples and they can detract from resilience.

Participants consider examples of thinking traps and the impact it has on others. In doing so, they can identify their deeply held beliefs, referenced as icebergs (e.g., “I can handle whatever comes my way” or “Asking for help is a sign of weakness”) and core values (e.g., “People should be treated with dignity and respect” or “We should strive for forgiveness and mercy”).

They learn to recognize when these icebergs are contributing to out-of-proportion emotion. Once the iceberg is identiﬁed, they assess:

if the iceberg continues to be meaningful to them

if the iceberg is accurate in the given situation

if the iceberg is overly rigid, and

if the iceberg is useful.

Participants reflect on how these beliefs contribute to or undermine their effectiveness.

Energy management

Participants learn the importance of rejuvenation to maintain energy and resilience. They learn strategies to recover and replenish one’s resources (prayer, exercise, meditation, progressive muscle relaxation, etc).

Problem-solving

This activity involves a six-step model of problem-solving used to recognize the contributing causes of a problem and to identify solution strategies. Participants learn about conﬁrmation bias (the tendency to search for or interpret information in a way that conﬁrms what one already believes) and how it detracts from objectivity.

Minimizing catastrophic thinking

Participants also learn about catastrophic thinking, or ruminating about worst-case scenarios. They watch videos and discuss examples of catastrophic thinking, evaluating the impact this thinking on has on energy, focus, problem-solving, and emotions.

A three-step model is taught:

1. Capturing catastrophic thinking

2. Generating a best-case possibility, and

3. Fighting back against counterproductive thoughts in real-time.

They learn to challenge negative thoughts in a systematic way.

Cultivating gratitude

Participants complete a gratitude or “three blessings” journal. This activity is referred to as “hunt the good stuff.” The purpose of the exercise is to enhance positive emotions, particularly gratitude.

Identifying Character Strengths

Participants identify their top character strengths, identify strengths in others, and practice using individual strengths and team strengths to overcome a challenge and reach a goal.

Strengthening Relationships

Soldiers are provided with practical tools that help in building relationships. They learn the process of challenge beliefs that interfere with positive communication. Through role-plays, they review communication patterns and their impact.

They complete an exercise identifying their typical ways of responding and also use worksheets to help clarify how they can use their strengths to respond more constructively.

Useful YouTube Videos

Courtney Clark hands-on Resilience Exercise

Dr. Dan Siegel: The Opportunity to Build the Circuits of Kindness and Resilience

Best TED TALK on Super- Resilience-How to FALL UP, Dr. Gregg Steinberg – Learn how to use adversity as your superpower in this entertaining and informative TED Talk

Edutopia: Teaching Grit Cultivates Resilience and Perseverance

Cultivating Resilience | Greg Eells | TEDxCortland

Sean Richardson Mental Toughness: TEDxVictoria – Dr. Sean Richardson – Mental Toughness: Think Differently about your World

Jocko Podcast #1 – With Echo Charles | Leadership, Ownership, Mental Toughness

PowerPoint Presentations

Resiliency Ohio has put together a Powerpoint information with detailed statistics, information, resources, and paradigms, visit this link for more information.

University of Pennsylvania/Army Master Resilience Training Presentation.

The MindMatters organization assembled this learning tool designed to educate on basic concepts of resilience, especially as it relates to students in schools.

A Take-Home Message

We hope you have found value in this outline blending resilience-building research and tactical activities. Ideally, the information has sparked new ideas, fostered empowerment, or helped developing resilience feel more manageable.

We would all likely agree that cultivating our resilience is appealing and appreciate the benefits of doing so. However, it can feel overwhelming to know where to start…or where to pick up. Finding which techniques work best may require some experimenting; yet research shows us it will be worth the effort.

Scientific data confirms that by engaging in some of the outlined activities, you will experience enhanced resilience and mental toughness.

Thank you for your time invested and best of luck on your resiliency journey!

We hope you enjoyed reading this article. Don’t forget to download our 3 Resilience Exercises for free

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23 Resilience Building Tools and Exercises (+ Mental Toughness Test)

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We blend resilience research with tactical activities and exercises to spark new ideas, foster empowerment, & help you build resilience.

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Story telling activities can be a great way to build your resiliency!

Think of a narrative you have told yourself over and over. A narrative that may not be productive to your self image or self esteem, for example. Now, replace some negative pieces of that story with positive pieces.

Example: I lost my luggage at the airport and didn't have internet to find my way places when I got to a new country. This city must hate me. I never prepare well enough.
Change to: My luggage got to me a little later than I arrived in the country, but I was able to find my way to the hotel and have some spontaneous adventures without having to Google everything! I always think so well on my feet.
What changed? You took control of the narrative in a positive way! You found your way and had fun despite some minor setbacks.

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what words come to mind when you hear "wellness"?

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When you hear the word "wellness" several things might come to mind. You might naturally gravitate to think about physical or mental health. Maybe you think of success? But how is wellness defined in the counseling field?

One working definition of wellness is "an active process through which people become aware of, and make choices toward a more successful existence",  Sweeny and Witmer (2000).

Wellness is more than physical strength or overall strong mental health. Scroll below to get a glimpse into a more holistic view of wellness in the counseling field.

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The Indivisible Self is an evidence based model of wellness, whose roots can be found in the The Wheel of Wellness theoretical model. The concept fostered in the Indivisible Self Model is that humans exist in a holistic way, where individual parts of the self interact but are indivisible.

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1.) American Counseling Association (ACA)

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1.) American Counseling Association (ACA)

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All information is listed under "Knowledge Center" on the ACA website.
**Self-Care Resources for Counselors**
The American Counseling Association recognizes that the work counselors do, while very important and rewarding, can also be stressful. Self-care is an essential tool that can help in dealing with stress. The following ACA resources focus on self-care for counselors.

Article recommendations by the ACA:

1.  Self-care for the activist counselor
https://ct.counseling.org/2018/06/self-care-for-the-activist-counselor/

2. Behind the book: Counselor self-care
https://ct.counseling.org/2018/04/behind-the-book-counselor-self-care/

3. Stumbling blocks to counselor self-care
https://ct.counseling.org/2015/02/stumbling-blocks-to-counselor-self-care/

4. Cultivating a practice of mindfulness
https://ct.counseling.org/2016/12/cultivating-practice-mindfulness/

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As a counselor, which of the following elements are absolutely essential for you to do your job well?

a) Thorough grounding in counseling methods and techniques

b) A strong sense of empathy and compassion

c) Adequate sleep

d) Regular vacations or breaks

e) All of the above

The correct answer is e) All of the above. You probably knew that already. But do you also think that answers A and B far outweigh the importance of C and D? If so, you may not be tending to your own wellness the way that you should. All counselors need to regularly engage in a healthy self-care routine to help mitigate the very real risk of burnout.

Many people struggle to attain a healthy work-life balance. Counselors often work with clients toward achieving that balance by helping them understand the concept of self-care and how to nourish wellness. But sometimes counselors get so busy and focused on helping others that they neglect to monitor their own wellness. Counselors may also operate under the assumption that their training and emotional insight somehow inoculate them against burnout - or at least help to prevent it. That is a fallacy. Counseling, like other helping professions such as medicine, nursing, psychology, social work and teaching, has a high burnout rate. Individuals in each of these professions are at greater risk for burnout because of the empathic and close relationships they must form to do their jobs.

"It's important for people - for counselors in particular - to realize that this is hard work," says Gerard Lawson, an American Counseling Association member and associate professor of education at Virginia Tech. Though counseling work is not typically physically demanding, emotionally it can take a toll, he says.

Research has shown that the strength of the therapeutic relationship between the counselor and the client is the most important predictor of successful outcomes. But forming, maintaining and operating within that bond are not easy tasks, notes Lawson, a licensed professional counselor (LPC) who studies counselor wellness and burnout. Due to the nature of counseling work, this bond is often forged with people who are struggling or in pain. Confronting those emotions day in and day out can take a toll over time, sometimes leading to vicarious trauma, Lawson explains.

"We are seeing some of the hardest things," says ACA member Elizabeth Venart, an LPC and director of The Resiliency Center of Greater Philadelphia, where she practices and also provides trauma and resilience training to other mental health professionals. "We often meet people at the worst times in their lives." In addition, the essential professional component of empathy is the "conduit" through which other people's experiences can profoundly affect counselors, she says.

On top of that, it's hard not to want to "fix" every client, says Charles Crews, an ACA member and associate professor in the Texas Tech University College of Education. Although it sounds cliché, many times counselors really do care too much, he notes. "They want to help every single person who comes in," he says.

Although counselors should want to help every client, when a client isn't progressing, it can be easy to become disenchanted or hardened, says Crews, whose doctoral dissertation focused on counselor burnout. Less experienced counselors may also start to battle discouragement, doubting themselves and their skills, he adds.

Jennifer Sharp, an ACA member and assistant professor at Northern Kentucky University, says that many of her students come in wanting to change the world. "They don't understand the barriers," she says. "We come in [to the profession], and we don't have realistic expectations."

ACA member Jonathan Ohrt, an assistant professor in the counselor education program at the University of South Carolina, agrees. He says that counselors-in-training need to give serious consideration to what their professional lives might look like, taking into account their individual work styles, interests and values. Understanding the potential challenges of the work environment for counselors is also particularly important because factors such as inappropriately heavy caseloads, inadequate supervision and poor peer support have a significant influence on burnout rates, say Ohrt and Sharp.

"We don't necessarily think about what specializations we might be best at," Ohrt says. He adds that students should ask themselves, "What is my job satisfaction if I work in this setting? Will I be happy? Will I be able to work with addiction? Am I going to be comfortable working in school settings where teachers, the principal and parents are all pulling me in different directions?"

Ohrt says graduate students should also ask themselves the ultimate question: "Do I want to be a counselor?"
Signs of burnout
Having realistic career expectations might help newer counselors to prepare for some of the job's stresses, but even established counselors need to understand the signs of impending burnout and the steps they can take to avoid it.

According to Lawson, who served as chair of the ACA Task Force on Counselor Wellness and Impairment several years ago, research shows that burnout has three stages.

Emotional exhaustion: Every counselor experiences a bit of exhaustion at one time or another. But when practitioners feel drained as soon as they step through the office door, even with plenty of sleep and after time away to get recharged, that's generally a sign of emotional exhaustion, Lawson says.

"Sometimes in session, you can see counselors might steer away from a topic that they know is going to be difficult to talk about because they just can't do it," he says. "They don't have anything left there to give to this client, and that's not good for the client."

Depersonalization: At this stage of burnout, counselors start viewing clients not as people but as cases. "Sometimes it slips into our language," Lawson notes. "You'll hear counselors talk about 'I have another borderline this afternoon.'"

Lawson acknowledges that this may occasionally be nothing more than a kind of shorthand in the counselor's language. But usually, he says, it's more serious, indicating that the counselor is no longer connecting with clients as people and instead reducing them to their problems.

Reduced feelings of accomplishment: At this stage of burnout, a counselor feels that whatever he or she does won't make a difference. The counselor has, in effect, "checked out," Lawson says.

Other signs that a counselor is burning out can include a decreased level of involvement with family and friends, a failure to engage in normal social activities and increased instances of tardiness or absenteeism. Sharp says that counselors in a downward burnout "spiral" may also display the inability to handle crises and a noticeable increase in negativism, cynicism and defensiveness.
Burning bright, not out
"I don't know that there's a specific antidote to how I keep [burnout] from happening to me, which is why we focus so much on wellness when things are going OK," Lawson says.

An emphasis on wellness helps counselors to build up their emotional resources so they will be better able to handle bumps in the road when they occur, Lawson emphasizes. Counselors can do a number of things to engage in self-care. Maintaining professional boundaries, seeking supervision and support from colleagues, drawing a clear line between home and office, participating consistently in activities and hobbies, and taking regular vacations are all important parts of the wellness picture.

Perhaps nothing is more important to maintaining counselor wellness than refusing to navigate professional issues in isolation. That is why it is so critical that practitioners actively seek out peer support and ongoing supervision, Lawson says.

"Burnout is a long-term process, a long-term degradation," he says. "But compassion fatigue, vicarious trauma, those things can happen very quickly. Good clinical supervision is top of the list [of preventive measures] - having someone you can debrief with, someone to help you shoulder the burden. And for people who aren't in supervision, [having] a colleague or a peer [whom] you can turn to and consult with or debrief with, even if it's not a formal supervision-type relationship."

Lawson emphasizes that the supervision should be clinical in nature. "I think in our world, supervision has become a product of being sure that all the boxes are checked and all the t's are crossed and all the i's are dotted," he says. "And that's important to get reimbursed for the work we do and to be sure that we're complying with all the expectations. But good clinical supervision is different from that, and that's where a supervisor is able to ask, 'What's happening in the work you're doing for this client?' and 'How are you doing working with this client?'"

If a direct supervisory relationship isn't possible, counselors should look at the alternative resources available to them, Sharp says. "For example, in school counseling there are not a lot of opportunities for supervision. But one of the things I would do is talk to a more senior school counselor and set up a time twice a month to talk," she explains. Sharp adds that if a counselor doesn't have any colleagues within the same school, he or she could look to other schools within the district to find a senior-level counselor.

If counselors don't have supervisory resources, they should turn to a colleague or peer, Lawson says. Ultimately, what matters is that counselors have someone they can check in with to gain perspective or just to talk to about how certain clients are affecting them.

Venart leads a regular supervision group for counselors who are working to obtain their licensure. Through the years, several group participants have decided to continue meeting together for peer supervision even after completing their licensure hours. Venart stresses the importance of educating new counselors to view supervision as an ongoing, careerlong necessity. She suggests that counselors look for colleagues to connect with in their current workplaces, from former jobs or past professional trainings, or perhaps among the people they met in their graduate programs.

While working on his dissertation, Crews found that if counselors felt they were part of team - even one of their own making - it seemed to have a beneficial effect on their job satisfaction and degree of wellness.

Lawson concurs. His research has concluded that participating in professional organizations plays an important role in peer support, and counselors who are part of such organizations are generally more "well."
Accepting limits
In addition to offering encouragement, supportive peer groups can help counselors to recognize and accept their boundaries and limitations. This is important because one of the difficult realizations about being a counselor is that it's not possible to help everybody, Lawson says.

"I think part of the struggle for counselors is when they meet somebody and they want desperately to help them solve their problem," he says. "Sometimes we counsel people who have problems that are not really solvable."

He explains further: "I am thinking specifically about things like domestic violence or intimate partner violence. I may meet with someone who is experiencing intimate partner violence ... and they're going to go home to the same violent situation because it's unsafe for them to leave. [When under no legal mandate to report] I have to sit with that week in and week out knowing that I can't solve that problem. So I need to have good boundaries about what I can do and what I can't do. ... For me to become more and more invested in them doesn't help them more. It just means that it takes a greater toll on me."

When the need is so great, it is easy for counselors to convince themselves that just a little more time or effort, either in the office or outside of it, will solve all the client's problems, observes Crews. "I work with traumatized kids, and it is really hard not to want to get more involved in their lives," he says.

However, in his practice and in his role coordinating the school counselor program at Texas Tech, Crews has learned that no counselor can control what happens in a child's life outside of the counseling office. "Often, school counselors are dealing with parents who do not understand what is going on with their child. You do all this work with [the child] from 8 to 4," he says, "but then they go home."

Addiction counseling is another area that requires counselors to have a firm grasp of what they can and cannot do, Crews notes. "Counselors get tired out. They [feel like they] keep banging their heads against the wall because their clients relapse, but that is the nature of addiction," he says. That doesn't mean that clients struggling with addiction can't be helped, but relapse is often part of the process, and counselors need to be able to make peace with that, Crews says.

Counselors also need to recognize when they have reached their limits. "I think one of the things that is really difficult for counselors is to say that 'I can't take on another individual who is experiencing such trauma or immediate risk, and there are a lot of good folks out there who can do that work,'" Lawson says. He emphasizes that it is crucial for counselors to realize these limitations before a potential client becomes an ongoing client, however. Disrupting the therapeutic alliance after it has developed can be damaging for the client.

Other times the solution might involve some creative scheduling rather than putting a moratorium on certain types of clients. "I had a period of time when I had many depressed adolescents on my roster in my practice," recounts ACA member Stacey Chadwick Brown, a licensed mental health counselor with a private practice in Fort Myers, Florida. "Then I noticed that when I had six depressed teenagers in a row on one day, I got depressed."

Brown didn't want to turn any of the adolescents away, but she knew she needed to make some adjustments to safeguard her own mental health. After giving the situation some thought, she realized she just needed to spread the clients' sessions throughout the week rather than scheduling them all on one day.

Sometimes, tweaking schedules can help counselors who are feeling overwhelmed. But other times, caseloads are simply too heavy, and that can be detrimental to both practitioners and their clients, Lawson says. "You have to have pretty good judgment and be able to say, 'I'm already working 60 hours a week. I'm probably not the best person to take on this next client.'"

In certain environments such as large practices, clinics or agencies, counselors may not have total control over the number of cases they are handling, notes Sharp, a national certified counselor and former school counselor. However, with some planning, counselors may still be able to set some boundaries, she says.

"Counselors need to be careful about what boundaries they can set without putting their jobs at risk," she cautions. "[But] there are small adjustments you can do to make things more manageable, such as not scheduling things after 6 p.m. or not working 10-hour days."
Work and life in harmony
Another boundary proves exceedingly difficult for many counselors: leaving work at work and embracing some true downtime.

It took Brown a while to learn how to separate her work from her personal life. "When I was younger, my worldview was different. I thought I could do anything," she recounts ruefully. "Once I had my first baby, I guess I was just exhausted - and still working. I think that's when things changed for me. That's when I realized I had to compartmentalize more."

Whereas Brown had previously responded to clients in the middle of the night, she decided to stop putting herself "on call." Instead, she made sure her clients had resources for off-hours crises and informed them she would check in with them the next morning. Brown also stepped up her self-care by making sure she got enough sleep, eating well, getting exercise and taking extra walks in between counseling sessions with clients.

But there was another instance when Brown felt the need to step away from her work for a week to regroup. It occurred when the mother of one of her clients died in an accident that was both extremely traumatic and very public. Brown didn't know the woman's mother directly, but the combination of her tangential connection to the woman and the tragic circumstances behind her death made Brown feel that she was experiencing secondary trauma.

Part of that had to do with the shocking and public nature of the story. "It was in the news everywhere, and everyone was talking about it, but I couldn't say anything," Brown recounts. She realized that she needed to take a step back and reground herself professionally, which included increasing her focus on self-care. Among other steps, she met and talked things through with colleagues whom she regularly turns to for support.

"Usually what we do as counselors is say, 'I'll take on this client, this committee or this task, and I know I have to give something up to have time to do it,'" says Lawson. "And the stuff that we give up is the stuff that's good for us - like sleeping and time with friends and vacations and all of those things that we know are good for us."

"I think counselors are notorious for not taking time off, and we have convinced ourselves that we are indispensable in the lives of our clients," he continues. "As a result of that, we don't take a week or two weeks off to go recharge our own batteries, and the results can be pretty dire."

Lawson acknowledges that leaving work behind can be difficult but says counselors can take some intentional small steps to do just that. "I think it's really important for folks to have rituals for how they take care of themselves," he says. "Part of that is how do they leave work at work and not take it home with them? So, even with my students, I recommend that when they get home from their internships or when they get home from their work, the first thing you do when you come through the door is change clothes so that you can literally shed the day. I hate to say it this way, but [it's] so you don't take the 'residue' of work home with you. You put on comfortable clothes - clothes that you're going to want to spend time with your family in."

Lawson also knows many counselors who maintain rituals for "closing time" at the office as part of their self-care routines. "Some people have plants in their office, and the last thing they do in the evening is water the plants and tend to them," he says. "It is sort of a very grounding thing for them. It's a nurturing thing, but it's also a closing sort of ceremony for them at the end of their day."

Other counselors like to leave a clean desk, clearing papers and charts and putting away files. "Then, when you lock that file cabinet, it's sort of a symbolic 'I'm putting that stuff aside so that I can move on and go home without it,'" Lawson says.

Lawson asserts that when counselors incorporate a deliberate process of leaving the day behind, they're less likely to take work home with them too often.

Lawson has a personal story that he keeps in mind: "My grandfather was a police officer back in the days when they didn't have radios, so they had call boxes around town," he recounts. "The police officers would carry around these call box keys, and when [my grandfather] got home, he would hang up that key and would be done for the day."

Crews' wife teaches theater, where a common directive is, "Leave your issues offstage." Crews has altered that advice and adopted it as his mantra: Leave it at the door.

"I had an actual floor mat that said, 'Leave it at the door,'" Crews recounts. "It was a very physical thing. If I wiped my feet, I could leave it there and go on."

Venart suggests that counselors try "writing and ripping" to help them close the day and leave their work at work. She thinks that the practice of writing about whatever was stressful that day and then ripping up the pages and throwing them away offers a symbolic ritual to help release whatever stress has accumulated. Venart also recommends visualization. For example, counselors might imagine a strong container in which they can transfer the stressful events and emotions from the day. Counselors can then "seal" the container, lock it and put it away somewhere safe.
Leaving room for play
The ability to leave work behind, both physically and mentally, is essential to counselor wellness, and one element that goes hand in hand with that goal is making time to engage in activities that are personally enjoyable, Lawson says.

Some counselors find physical activities to be most helpful, while others enjoy tackling pursuits that sharpen the mind without being related to work.

Lawson likes to take a break from textbooks and other professional publications and read purely for pleasure, while Crews prefers playing video games and going out and being social.

Brown embraces her creativity. "I'm a crafter and a painter. That is really my therapy, my Zen," she says. "When I am doing artwork, I am fully present."

Venart is a proponent of grounding work, such as connecting with the body through deep breathing, posture and movement. She's also a certified "laughter yoga" instructor. ("It's an actual thing!" she exclaims.) The practice incorporates playful group exercises, laughter and deep yoga breathing. "Research has found that whether you are actually laughing or faking laughter, the [physiological] result is the same," Venart explains.

Sharp advises counselors to embrace whatever brings them joy, community and a sense of belonging because those elements go a long way toward achieving wellness. "Develop a life outside work that is fulfilling," she says, "because that can be a buffer and carry you through when work is not a source of fulfillment."
Small town, big fishbowl
Practicing in a rural or small community poses a particular set of challenges to a counselor's wellness, say Deborah Drew and Mikal Crawford, both of whom practice in, live in and have studied small rural communities. In these communities, counselors are isolated, yet never alone - and that's not always a good thing.

"You're living in a fishbowl," says Crawford, who has previously presented with Drew on the ethics of self-care in small or rural communities at the ACA Conference. "When you're living in the same community where you work, your personal life is exposed on a regular basis."

It is difficult for counselors in rural or small communities to completely set aside work. Seeing clients at the gym, in the grocery store, on community committees, in clubs or at church is a regular occurrence, Crawford notes.

"It's like, where do I go to let my hair down?" Drew exclaims, voicing a common lament.

Some practitioners cope with this fishbowl effect by finding social outlets in another community or by doing small things such as going to the grocery store or the doctor's office somewhere else.

But the reality is that it is hard for counselors to truly relax when they're constantly navigating such tricky boundaries, Drew and Crawford say.

"There is no such thing as avoiding dual relationships in rural areas," Drew says, adding that they can pop up when a counselor least expects them. For example, Crawford says, imagine bringing on a new client, beginning to work with that client, then taking your car to the repair shop and finding out that the client is your mechanic.

The dual relationship could happen even closer to home. For example, the sole school counselor might have a child or relative who is also a student at the school, Drew says.

Sometimes, counselors in small or rural communities even discover that they are counseling two clients who are related to each other, Drew says. This circumstance is especially tricky because if the counselor discloses the link to the clients, the counselor could be breaking confidentiality. On the other hand, client A may disclose information in session about client B that client B hasn't chosen to share with the counselor. At some point, the counselor will need to decide how - or whether - to manage seeing both clients. In some cases, it might be best to refer one or both clients, Drew says.

In these communities, seemingly everyone is connected by fewer than six degrees of separation, yet counselors often lack professional connections of their own, Drew and Crawford say. Counselors may have few colleagues to consult with and even fewer specialists to refer to. Practitioners in these communities have to learn to be generalists so they can handle a variety of needs, Drew explains. Counselors who are practicing or wish to practice in a rural area or small community need to ask themselves if they can learn to be OK with such challenges, Drew advises.

But for their own wellness, counselors in these environments still need to have people they can talk to about living and working in rural areas and who can help them work through the challenges, Drew says. She and Crawford recommend that these counselors seek out other mental health professionals, even if it involves driving a substantial distance. For example, Crawford cites a group of women practitioners that she talked to while doing research. They all lived and practiced in rural Vermont and New Hampshire and formed a support group that met monthly in a centralized location.

Professional organizations are also an important source of support, Drew and Crawford say, noting that in Maine, the rural practitioners are often the most active members in the state counseling association.

But they stress that counselors practicing in these comparatively isolated areas need additional support from colleagues and support networks to properly care for themselves and their clients. These counselors also need to be particularly intentional about practicing self-care by regularly engaging in activities that they enjoy.

At the same time, Drew and Crawford think that most counselors-in-training don't truly understand how different it can be to practice in a small or rural area. Thus, they aren't adequately prepared for the challenges - both personal and professional - that they will face.

"I think there is not enough training in the counseling profession that is specifically for rural areas," Crawford says. "I think we need to focus on that. How can I not just survive in a rural area but thrive?"

****

To contact the individuals interviewed for this article, email:

****

Laurie Meyers is the senior writer for Counseling Today. Contact her at lmeyers@counseling.org.

Letters to the editor: ct@counseling.org

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Stumbling blocks to counselor self-care - Counseling Today

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As a counselor, which of the following elements are absolutely essential for you to do your job well? a) Thorough grounding in counseling methods and techniques b) A strong sense of empathy and compassion c) Adequate sleep d) Regular vacations or breaks e) All of the above The correct answer is e) All of the above.

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2.) ACA - Recommended Books for Self-Care

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2.) ACA - Recommended Books for Self-Care

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https://imis.counseling.org/store/detail.aspx?id=78143

Additional recommended books by the ACA on Self-Care/Wellness are listed below:

1.  The Secrets of Exceptional Counselors
Jeffrey A. Kottler
https://imis.counseling.org/store/detail.aspx?id=78141

2. Relationships in Counseling and the Counselors Life
Jeffrey A. Kottler and Richard S. Balkin
https://imis.counseling.org/store/detail.aspx?id=78132

3. Disaster Mental Health Counseling: A Guide to Preparing and Responding, Fourth Edition Edited by Jane M. Webber and J. Barry Mascari
https://imis.counseling.org/store/detail.aspx?id=78126

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Wellness is not a one size fits all. Our age, context and lifestyle all effect wellness. These areas of life also change over the lifespan, meaning wellness look different at different times for different people.

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Reclaiming Wellness | Jessica Matthews | TEDxPLNU

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3.) Smart Phone App options for additional Wellness support.  

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3.) Smart Phone App options for additional Wellness support.  

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All apps listed are available in the App Store and Google Play.

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Being human is hard. That's why we created the Breethe app: your all-day (and night!) partner for anxiety, stress, sleep, and more. People call us "the friendliest wellness app" - and there's a reason why.

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Meditation for Sleep & Anxiety

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American Counseling Association Code of Ethics 

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Limited information is identified in the Code of Ethics related to counselor self-care.
"In addition, counselors engage in self-care activities to maintain and promote their own emotional, physical, mental, and spiritual well-being to best meet their professional responsibilities."   (American Counseling Association, 2014, p. 8)

https://www.counseling.org/resources/aca-code-of-ethics.pdf

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American Counseling Association Code of Ethics

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You are Worth it!

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"Why Self Care isn't Selfish" | Jessica Brubaker | TEDxGrandCanyonUniversity

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1.) How childhood trauma affects health across a lifetime.

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1.) How childhood trauma affects health across a lifetime.

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"Childhood trauma isn’t something you just get over as you grow up. Pediatrician Nadine Burke Harris explains that the repeated stress of abuse, neglect and parents struggling with mental health or substance abuse issues has real, tangible effects on the development of the brain. This unfolds across a lifetime, to the point where those who’ve experienced high levels of trauma are at triple the risk for heart disease and lung cancer. An impassioned plea for pediatric medicine to confront the prevention and treatment of trauma, head-on."

Harris, N. B. (n.d.). How childhood trauma affects health across a lifetime. Nadine Burke Harris: How childhood trauma affects health across a lifetime | TED Talk. Retrieved June 19, 2022, from https://www.ted.com/talks/nadine_burke_harris_how_childhood_trauma_affects_health_across_a_lifetime?language=en

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童年創傷如何影響一生健康

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童年創傷不是一件長大就能解決的事。兒科醫生娜汀‧哈里斯 (Nadine Burke Harris) 解釋虐待、忽視、和父母精神健康不良或有藥物或飲酒問題，都會影響兒童的大腦發展。童年經歷影響終身，在高壓環境下長大的兒童比他人得到心肺疾病的比例高三倍。這是一位慷慨激昂的兒科醫生祈求眾人面對、預防和治療心理創傷的演講。

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4.) How ACEs impact the developing brain and future experiences of mental illness.

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4.) How ACEs impact the developing brain and future experiences of mental illness.

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This talk describes the lasting impact of adverse childhood experiences (ACEs) and resultant mental illness before explaining the effect on the brain.

Symmons, R. (2020, April 3). Adverse childhood experiences: What's it got to do with me? YouTube. Retrieved June 19, 2022, from https://www.youtube.com/watch?v=Yxmzjpp9AC0

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Adverse Childhood Experiences: What’s it got to do with me? | Rachel Symmons | TEDxUoChester

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2.) The Lifelong Effects of Childhood Adversity and Toxic Stress

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2.) The Lifelong Effects of Childhood Adversity and Toxic Stress

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"This report presents an ecobiodevelopmental framework that illustrates how early experiences and environmental influences can leave a lasting signature on the genetic predispositions that affect emerging brain architecture and long-term health. The report also examines extensive evidence of the disruptive impacts of toxic stress, offering insights into causal mechanisms that link early adversity to later impairments in learning, behavior, and both physical and mental well-being. Research suggests that many adult diseases should be viewed as developmental disorders that begin early in life and that persistent health disparities associated with poverty, discrimination, or maltreatment could be reduced by the alleviation of toxic stress in childhood."

Shonkoff, J. P., Garner, A. S., Committee on Psychosocial Aspects of Child and Family Health, Committee on Early Childhood, Adoption, and Dependent Care, and Section on Developmental and Behavioral Pediatrics, Siegel, B. S., Dobbins, M. I., Earls, M. F., ... & Wood, D. L. (2012). The lifelong effects of early childhood adversity and toxic stress. Pediatrics, 129(1), e232-e246

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The Lifelong Effects of Early Childhood Adversity and Toxic Stress

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3.) How ACEs impact the leading causes of death in adults.

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3.) How ACEs impact the leading causes of death in adults.

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This article illustrates the relationship between health risk behavior and disease in adulthood to the breadth of exposure to childhood emotional, physical, or sexual abuse and household dysfunction during childhood. Persons who had experienced four or more categories of childhood exposure, compared to those who had experienced none, had 4- to 12-fold increased health risks for alcoholism, drug abuse, depression, and suicide attempt; a 2- to 4-fold increase in smoking, poor self-rated health, more sexual intercourse partners, and more sexually transmitted disease; and a 1.4- to 1.6-fold increase in physical inactivity and severe obesity. The number of adverse childhood exposure categories showed a graded relationship to the presence of adult diseases, including ischemic heart disease, cancer, chronic lung disease, skeletal fractures, and liver disease. The seven categories of adverse childhood experiences were strongly interrelated, and persons with multiple categories of childhood exposure were likely to have multiple health risk factors later in life. The study found a strong graded relationship between the breadth of exposure to abuse or household dysfunction during childhood and multiple risk factors for several leading causes of death in adults.

Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., & Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American journal of preventive medicine, 14(4), 245-258.

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Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults

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4.) Adverse Childhood Environment and Late-Life Cognitive Functioning

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4.) Adverse Childhood Environment and Late-Life Cognitive Functioning

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Clinical studies suggest childhood maltreatment may cause nervous system changes and consequent cognitive disorders. The persistence of this association in late life is examined in this study. The study found that some adverse childhood events continue to have a negative effect on later-life cognitive performance. In contrast, some more severe acute events may have the opposite effect, underlying the necessity to consider events individually and not as global test scores. For example, sharing parental problems and, for women, losing a parent was associated with poorer verbal retrieval, whereas being sent to a foster home or mistreated by schoolmates was associated with poor visuospatial memory. Severe abuse was associated with a lower risk of cognitive impairment on some tests suggesting a resilience factor.

Ritchie, K., Jaussent, I., Stewart, R., Dupuy, A.-M., Courtet, P., Malafosse, A., & Ancelin, M.-L. (2010). Adverse childhood environment and late-life cognitive functioning. International Journal of Geriatric Psychiatry, 26(5), 503–510. https://doi.org/10.1002/gps.2553

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Int J Geriat Psychiatry - 2010 - Ritchie - Adverse childhood environment and late‐life cognitive functioning

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5.) Resilience: The Biology of Stress and the Science of Hope (documentary)

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5.) Resilience: The Biology of Stress and the Science of Hope (documentary)

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“The child may not remember, but the body remembers.” The documentary Resilience reveals toxic stress can trigger hormones that wreak havoc on the brains and bodies of children, putting them at a greater risk for disease, homelessness, prison time, and early death. While the broader impacts of poverty worsen the risk, no segment of society is immune. Resilience also chronicles the movement to fight back. Trailblazers in pediatrics, education, and social welfare are using cutting-edge science and field-tested therapies to protect children from the effects of toxic stress—and the dark legacy of a childhood that no child would choose.

This documentary is available for purchase or rental through YouTube. For more information on "Resilience" visit the film's website at: https://kpjrfilms.co/resilience/

Redford, J. (Director). (2016). Resilience: the biology of stress and the science of hope [Film]. KPJR Films.

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1.) What Trauma Taught Me About Resilience | Charles Hunt | TEDxCharlotte

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1.) What Trauma Taught Me About Resilience | Charles Hunt | TEDxCharlotte

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What Trauma Taught Me About Resilience | Charles Hunt | TEDxCharlotte

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2.) Building Resilience: 5 Ways to a Better Life

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2.) Building Resilience: 5 Ways to a Better Life

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Building Resilience: 5 Ways to a Better Life

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3.) Therapeutic Art Activity to Build Your Resilience

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3.) Therapeutic Art Activity to Build Your Resilience

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Therapeutic Art Activity to Build Your Resilience

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5.) Paper Tigers: One High School's Unlikely Success Story

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5.) Paper Tigers: One High School's Unlikely Success Story

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At the crossroads of at-risk teens and trauma-informed care, that Paper Tigers takes root. Set within and around the campus of Lincoln Alternative High School in the rural community of Walla Walla, Washington, Paper Tigers asks the following questions: What does it mean to be a trauma-informed school? And how do you educate teens whose childhood experiences have left them with a brain and body ill-suited to learn? In search of clear and honest answers, Paper Tigers hinges on a remarkable collaboration between subject and filmmaker. Armed with their cameras and voices, the teens of Paper Tigers offer raw but valuable insight into the hearts and minds of teens pushing back against the specter of a hard childhood. Against the harsh reality of truancy, poor grades, emotional pain, and physical violence, answers begin to emerge. The answers do not come easily. Nor can one deduce a one-size-fits-all solution to a trauma-informed education. But there is no denying something subtle and powerful at work between teacher and student alike: the quiet persistence of love.

This documentary is available for rental or purchase on YouTube. For more information, visit the movie's website at: https://kpjrfilms.co/paper-tigers/

Redford, J. (Director). (2015). Paper tigers: one high school's unlikely success story [Film]. KPJR Films.