Most people experience stress regularly. Stress, when managed adequately, can help people feel motivated, achieve goals, and adapt to changing conditions. However, in contrast to moderate, short-term stress that most people experience regularly, some people are subject to a type of stress called toxic stress, which can result from traumatic events in childhood.
Toxic stress causes profound changes in the body and the brain, and it can result in a greater risk of developing a range of chronic and acute mental and physical illnesses.
This article gives coaches an overview of the connection between childhood adversity, the body, and health in the short- and long-term. We also summarize up-to-date research on how events or experiences in childhood may be affecting your client’s health and wellness, and we provide you with guidance for how to implement a trauma-informed approach in your coaching practice.
What Is Childhood Adversity?
Childhood adversity is a broad term that refers to circumstances or events that pose a serious threat to a child’s wellbeing.
Trauma is one possible outcome of childhood adversity. While there is no universal definition of trauma, the most commonly used definition is that which was developed by the Substance Abuse and Mental Health Services Administration (SAMHSA):
Individual trauma results from an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life-threatening and that has lasting adverse effects on the individual’s functioning and mental, physical, social, emotional, or spiritual wellbeing.
Events may include a threat of physical or psychological harm, such as violence in your community or natural disasters, or a severe or life-threatening event that impairs healthy development in childhood.
An individual’s experience of these events may or may not determine if the experience was traumatic. A child and her family evacuated to a family member’s home before a volcanic eruption may be traumatic for one individual but not for another. The way an individual understands the event, the feelings that arise, and how they felt it impacted their life may influence whether an experience is traumatic or not.
A critical component of trauma is whether the event had adverse or long-lasting effects on the individual experiencing them. The effects may be immediate or have a delayed onset, and they may not necessarily connect the effects with the traumatic event. A person who experiences chronic anxiety, for example, may not immediately connect the adverse childhood events that led to difficulty coping with daily activities.
While childhood adverse events occur before the age of 18, other traumatic adverse events can occur at any time in our lives.
The main difference between trauma experienced in childhood and trauma experienced in adulthood is that, in childhood, our bodies are still growing and developing. On a biochemical level, trauma alters the excretion, uptake, and response of bodily chemicals, which have a direct impact on our physical, emotional, and cognitive development.
Some examples of childhood adversities include:
- Parental divorce
- Parental imprisonment
- Not feeling loved or not feeling accepted
- Being emotionally, verbally, or physically punished for making mistakes
- Seeing or being subject to emotional, physical, sexual, or economic abuse
- Not having enough to eat; clean clothes; clothes that fit; or a safe, private space in your home
- Childhood abandonment
- Childhood homelessness
- Experiencing or witnessing violence in the community
- Systemic discrimination due to race, sex, skin color, sexual orientation, gender identity, ethnicity, or spiritual beliefs
While it may be easy to see how these events could have a lasting detrimental effect on a person’s emotional or psychological wellbeing, the physical impact on the human body and how trauma increases the risk of disease is often overlooked.
Why Understanding Childhood Adversity Is Important for Health and Wellness Professionals
Wellness, by definition, encompasses seven interconnected dimensions of wellbeing. These are:
- Emotional health
- Intellectual health
- Physical health
- Cultural health
- Interpersonal and social health
- Occupational health
- Spiritual health
As health and wellness professionals, or professionals who aim to have a positive impact on any dimension of a person’s wellness, it is important to fully understand the holistic nature of a person’s health. It is vital to be sensitive to the complex and multi-causal nature of physical health issues that your clients may have. For example, toxic stress and childhood adversity can immediately impact emotional wellness, while also having a negative impact on physical wellness in the long term, meaning that coaches should not assume that lifestyle choices or behaviors could have prevented the development of a health condition.
Understanding childhood adversity can help health and wellness professionals be more sensitive to the complex nature of behaviors that affect a person’s health and help to create a trauma-informed environment for your clients.
What the Research Says About How Childhood Adversity Affects Our Bodies
Childhood Adversity Can Cause Chronic Stress
Adversity in childhood impacts mental and physical health throughout life. We can understand the primary mechanism of how childhood adversity affects our health by understanding that adversity of any kind causes stress, and the trauma that can result from the adversity can lead to chronic stress.
Acute, Chronic, and Toxic Stress
It is normal, and even healthy, for our bodies to be subject to acute moderate stress in the short-term. Our brains react to light to moderate stress levels by adapting our behavior and metabolism to help us have a positive outcome when we are no longer in a stressful environment.
For example, if we are preparing a proposal at work on which a promotion is dependent, we will likely feel stressed. The stress we perceive through the increased cortisol (the stress hormone) circulating in our blood will lead our brain to signal our body to produce more adrenaline. The adrenaline will help give us the focus, energy, and drive we need to finish the presentation, pay attention to detail, and deliver it effectively.
After we deliver the presentation and get awesome feedback, our brain will release “happy” and “relaxing” chemicals, like dopamine, serotonin, and endorphins, and will once again establish a balance.
However, chronic stress, like that which develops when a person lives in a neighborhood or home where they don’t feel safe or when a person has had a traumatic childhood experience and usually feels stressed or anxious, causes an overload on the stress response. Stress response overload sparks a cascade of changes in the body on the mental and physical levels.
In general, chronic stress can be managed and reduced using techniques like meditation, exercise, and behavioral therapy.
Toxic stress is the most extreme type of stress and, as you might imagine from the name, the one with the most deeply harmful impact on the body and the mind. The term toxic stress was developed to describe the type of stress that people who have lived through a subset of childhood adversity called the Adverse Childhood Experience (ACE).
Toxic stress alters the developing brain, even shutting down entire areas of the brain as a way of protecting the mind from experiencing similar trauma. The changes increase a person’s risk of developing both physical and mental diseases. Not only is toxic stress persistent, but it is also systemic, and unlike chronic stress, the effects of toxic stress usually cannot be reversed.
Changes in the Body as a Result of Toxic Stress
A recent systematic review of studies published in the British Medical Journal examined studies on the childhood and adult impacts of adversity in childhood on the mind and body.
The study categorized the effects of childhood adversity into behavioral consequences, neurobiological consequences, and physical consequences in the short- and long-term. We summarize the findings below.
- Increased risk-taking
- Aggressive behavior
- Involvement in violence
- Difficulties in relationships with others
- Increased risk of psychiatric disorders, such as depression, post-traumatic stress disorder (PTSD), conduct problems, substance abuse, self-harm, and suicidal thoughts
- Exposure to our mother’s stress in infancy can result in reduced brain activity.
- Psychosocial deprivation (isolation, neglect) is associated with reduced overall brain volume and white and gray matter in several brain areas and reduced brain activity.
- Decreased cognitive function, especially executive functions, which can negatively impact educational and professional achievement
- Not reaching full growth potential and loss of muscle mass, which is also associated with a reduced brain volume and altered brain functionality
- Higher cortisol levels and greater risk of ear infections, viral infections, asthma, skin infections, chronic hives and rashes, intestinal infections, and urinary tract infections
- Greater risk of chronic disease in adulthood, including cardiovascular disease, stroke, most types of cancer, asthma, chronic obstructive pulmonary disease, kidney disease, diabetes, and metabolic diseases
- Greater engagement in health risk behaviors, such as smoking, drinking, drugs, and risky consensual sexual behaviors
Toxic stress can be the primary cause of all of the most common chronic diseases health and wellness coaching clients are living with. These include:
- Cardiovascular disease
- Most types of cancer
- Chronic obstructive pulmonary disease (COPD)
- Kidney disease
- Metabolic diseases
…and many others
How to Include a Trauma-Informed Approach in Coaching
A trauma-informed approach is a framework that can be applied to any practice. The key assumptions in a trauma-informed approach are summarized by the four “Rs”:
- Realizes that trauma is ever-present in individuals, communities, organizations, and institutions and that trauma causes a range of long-term effects, including effects on physical health and chronic disease risk.
- Recognizes the signs of trauma in clients and families.
- Responds to the recognition of their role in preventing or reproducing trauma by fully integrating knowledge into practices and organizational processes. This includes regularly revising and integrating new knowledge as you become aware of it.
- Resists re-traumatization by avoiding creating or recreating situations that will cause people to relive a traumatic event or experience a new traumatic event.
The key ingredients to creating a trauma-informed approach as it may apply to your coaching business include:
- Involving clients in the coaching process and your coaching strategies.
- Leading and communicating about the transformation process.
- Creating a safe environment.
- Getting trained in trauma-specific approaches in the health profession.
- Engaging referral sources and partnering with organizations or clinicians who specialize in trauma and adverse childhood events.
- Preventing secondary traumatic stress.
The Six Principles of Trauma as Applied to Health and Wellness Coaching
SAMHSA has identified six key principles of a trauma-informed approach. Here, we have briefly described how you can apply them to your coaching practices. Keep in mind that these concepts may be challenging to grasp and apply. While we provide some examples for how to do this, we encourage coaches to seek additional information and training in how to integrate a trauma-informed approach into their business.
Your clients should feel safe when they are in coaching sessions with you, when they recall the experience of your coaching sessions, and when carrying out actions they committed to during their coaching sessions.
Prior to meeting with clients, inform yourself about neutral terms to use in a session that might discuss a person’s body, history, health condition, or other.
While you are in session with your client, before engaging in any specific topic, start by asking them, “Do you feel safe talking about…”
Here are some examples:
- Do you feel safe speaking about your experience with your previous fitness coach?
- Do you feel comfortable telling me why you came to our coaching session today?
- Do you feel safe talking about your relationship with food?
Other components that can help a client feel safe include:
- A private space without interruptions
- A nondisclosure or confidentiality agreement
- Open body language
- Being open to changing the direction of a session
Trustworthiness and transparency
Strive to build a trusting relationship with your client. Transparency is an important component of building trust. Some ways to build trust through transparency include:
- Involving clients in the discussion about session goals and your coaching strategies.
- Tell and show what tools you hope to use and be open to changing them based on your client’s needs.
- Check in with them often and be open to answering any questions they may have.
- Telling and showing them how you will keep their information safe.
- Using informed consent forms that are easy to understand and reminding them they can decide to take away consent at any time.
Building trust takes time, and building a trusting relationship with your client is often the result of multiple, consistent actions on your behalf to demonstrate to your client that you can be trusted. Keep in mind that people who have experienced any sort of trauma may have a harder time trusting others, especially when it comes to something as personal as their health. Be prepared to roll with the resistance.
Peer support groups have been used in many environments to create a sense of community among people in a similar situation and working toward similar goals or who have had similar experiences of trauma. Support groups, formal or informal, digital or in-person, offer an opportunity for your clients to build relationships with people who are on a similar path to improve their health.
You may think that peer support groups, in the traditional sense, may not work well with your coaching methodology, especially if you are focused on offering personalized, one-on-one services. However, you can apply many of the principles of peer support to untraditional contexts in your coaching business.
Some ideas for how you can create opportunities for peer support for your clients include:
- Creating a member’s only Facebook page or chat group
- Having client mixers
- Including optional group activities, in addition to the one-on-one coaching as part of the service
- Offering group coaching services for people with something in common (including a health condition, a need or desire, or a common goal)
- Inviting your clients to bring along a trusted friend or family member to the session with them
Keep in mind that, if you feel your services don’t fulfill the type of peer support your clients may need or want, you can have resources on hand for your clients for how and where your clients can find them. Have brochures ready or links on your website for where your clients may find additional emotional or psychological support.
Collaboration and mutuality
Collaboration is essential to effective coaching. As a coach, you are essentially a guide, a support, and a source of information for your clients. Work with them to understand their needs, wants, goals, and limitations. Talk to them about the tools you have access to. Use effective interview and communication techniques to create a space of collaboration to build a plan or a guide that responds to those needs.
Even when your client feels satisfied with processes and next steps, be open to change and flexibility. Your client should feel that they are an equal partner in the coaching process and not being lectured or told what to do.
Empowerment, voice, and choice
As a coach who has built a safe environment of trust and collaboration, you have the opportunity to identify and appreciate your client’s strengths and use them to help empower them. When you empower your client, you:
- Respect their voice
- Allow them to speak and actively listen to them
- Take criticism well
- Are open to changing
- Recognize your flaws and mistakes
- Respect your client as the choice-maker
Essentially, you should provide a space where, after talking through their situation, goals, desires, and barriers that may be out of their control, your client has the power to choose when, how, and whether or not to make a change.
It is important for you not only to elevate that choice but also to respect that choice.
Cultural, historical, and gender issues
People and communities experience different forms of trauma based on their culture; their individual, family, and ethnic history; and their gender. It is important for coaches to educate themselves about these issues constantly so that they are prepared as possible for building meaningful relationships with different people.
This principle may seem very nuanced, but it is intimately connected with the previous principles. If your client feels that you are challenging their experience with race or gender, or they feel like you don’t feel that it is important, not only will you be creating a space where they don’t feel safe, you may also be re-traumatizing them.
It is not necessary for you to be a scholar in gender studies and the history of racism for you to be a good coach that can build relationships with people who are different from you. But, it is important for you to have an open mind, listen actively and with empathy, value and respect other’s experiences and feelings, and be willing to learn constantly.
Trauma-informed health and wellness professionals are few and far between. Being trauma-informed can help you to better support your clients, and it can help you identify if and how your current coaching practices and communications may be triggering to clients with traumatic experiences.
While this article is meant to provide you with an overview of the importance of a trauma-informed approach and with preliminary information for how to apply it in your coaching practice and wellness business, we encourage you to seek out training in trauma-informed approaches to your business.