← Therapy for Black Girls
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- [00:11]
Dr. Joy Hardin Bradford
Welcome to the Therapy for Black Girls Podcast, a weekly conversation about mental health, personal development, and all the small decisions we can make to become the best possible versions of ourselves. I'm your host, Dr. Joy Hardin Bradford, a licensed psychologist in Atlanta, Georgia. For for more information or to find a therapist in your area, visit our website@therapyforblackgirls.com while I hope you love listening to and learning from the podcast, it is not meant to be a substitute for a relationship with a licensed mental health professional. Hey y', all, thanks so much for joining Me for session 432 of the therapy for Black Girls Podcast. We'll get right into our conversation after a word from our sponsors. This is an I Heart Podcast Living with a rare autoimmune condition comes with challenges but also incredible strength. Especially for those living with conditions like myasthenia gravis or MG, and chronic inflammatory demyelinating polyneuropathy, otherwise known as cidp, finding empowerment in the community is critical. Untold Stories Life with a Severe Autoimmune Condition, a Ruby Studio production in partnership with Argenics, explores people discovering strength in the most unexpected places. Listen to untold Stories on the iHeartRadio app, Apple Podcasts or wherever you get your podcasts. This episode of Therapy for Black Girls is brought to you by Chase Sapphire Reserve. Whether you are booking your next trip or a weekend escape, Chase Sapphire Reserve is your gateway to the world's most captivating destinations. When you use your Chase Sapphire Reserve card, you get eight times points on all purchases made through Chase Travel and even access to one of a kind experiences like music festivals and sports events. And that's not even mentioning how the card gets you into the Sapphire Lounge, by the club and at select airports nationwide. Travel is more rewarding with Chase Sapphire Reserve. Trust me. Discover more@chase.com SapphireReserve cards issued by JP Morgan Chase Bank NA member FDIC subject to credit approval terms apply Today we're diving into a topic that's transforming how we understand public health education in this country. Childhood Trauma and its Lifelong Impact on the Brain and body for decades, adverse childhood experiences, or ACEs like abuse, neglect or exposure to violence were often seen as just social or emotional issues. But research has revealed the science of something much deeper. These experiences can rewire a child's developing stress response system, leading to increased risk of chronic disease, mental health disorders, substance dependence and even incarceration later in life. Joining us today is someone who's pioneered the charge in translating that science into statewide action as California's very first Surgeon General, Dr. Nadine Burke Harris helped put childhood trauma at the center of Public Health Policy. She not only trained tens of thousands of providers to screen for aces, but pushed for major changes like linking juvenile justice reform to health equity. Dr. Burke Harris brings a clinician's insight and an advocate's persistence to a conversation that challenges us to think bigger about prevention, healing, and what it really means to create environments that build holistically healthy and stable children. If something resonates with you while enjoying our conversation, please share it with us on social media using the hashtag tbginsession or join us over on our Patreon to talk more about the episode. You can join us at community.therapy for black girls.com. here's our conversation. Thank you so much for Joining us today, Dr. Burke Harris.
- [04:17]
Dr. Nadine Burke Harris
Oh, it's my pleasure.
- [04:19]
Co-host or Interviewer
I'm so excited to chat with you. I feel like I remember seeing you years ago, I believe, on the OPRAH show, and I was like, oh, my gosh, this is such good work. I'm so glad that she has discovered this and is talking more about aces. So I'm so honored to chat with you.
- [04:34]
Dr. Nadine Burke Harris
Yeah, thank you. That was fun. That was like a pinch me moment talking to Oprah. I know it's a little crazy.
- [04:43]
Co-host or Interviewer
So you were, you made history as California's first surgeon general and immediately got to work talking about childhood trauma and made that a statewide priority. Can you talk about what it was like stepping into that role and why it felt important to address childhood trauma.
- [04:57]
Dr. Nadine Burke Harris
As your first priority? That's so funny. It's actually a funny story because when the governor's office reached out to me about creating the role of California surgeon general, I was like, seriously? And also because I'm fundamentally an advocate, I came into to my work really, to help vulnerable communities and help vulnerable children. Help. And I remember when I sat down with Governor Newsom before I took the role, and I said, hey, listen, this is a big priority for me. And he said one thing that actually just hooked me when I said I really wanted to have adverse childhood experiences and toxic stress be an area of focus and not just the impact on health, but how it affects our society in a larger way. He said to me, I'll do you one better. We are moving the Department of Juvenile justice under the Department of Health. And that really was the thing that kind of hooked me. It was really exciting. And it showed the way that when we think about how we address really big public health challenges like childhood adversity, we recognize that it has to be a public health approach. I had been doing this work as a pediatrician and a clinician working in the community for a really long time, and people can be doing really good work. But if our systems are set up to make that more difficult, then what we will see is that we won't get to those transformative outcomes that our communities really need. So that's why I kind of hit the ground running in my role as California Surgeon General. And I'm really pleased that since 2020, when we launched the initiative to train clinicians to do early identification and evidence based intervention for adverse childhood experiences and toxic stress, We've trained almost 50,000 providers and more than 4 million ACE screens have happened in California. So it's. We're doing the work at a big scale. Yeah.
- [07:19]
Co-host or Interviewer
So I don't think I knew that about the Department of Juvenile justice being moved under the Department of Health, but it makes perfect sense when I hear you say it.
- [07:26]
Dr. Joy Hardin Bradford
Right.
- [07:26]
Co-host or Interviewer
But sadly, I do not think it is something that, like more states have adopted, or at least not enough of them. Can you talk more about the connection that you think is important to really highlight between Juvenile justice and the Department of Health?
- [07:40]
Dr. Nadine Burke Harris
Yeah. So, you know, I'll start by just backing up a second and just giving listeners a little bit of background on adverse childhood experiences. And for me as a clinician, when I was taking care of patients in a very vulnerable neighborhood of San Francisco, a lot of patients were being referred to me for ADHD or attention Deficit Hyperactivity disorder. And I also observed that so many of my patients were experiencing just really difficult things at home and in the community. So they were being cared for by parents who were struggling with mental health disorders or substance dependence or they were witnessing violence at home or in the community. And when I started reading the research about how this affects kids developing brains and bodies, what I found in this. There was this big landmark study from the CDC and Kaiser Permanente called the Adverse Childhood Experiences Study. And what they found was that, number one, when they looked at 10 categories of adverse childhood experiences, and those include physical, emotional, or sexual abuse, physical or emotional neglect, or growing up in a household where a parent experienced mental health disorder, substance dependence, incarceration, parental separation or divorce, or intimate partner violence, that those things were actually incredibly common. Right. So two thirds of folks had experienced at least one. One in eight folks had experienced four or more of those categories of ACEs. And not only were they common, what they found was that there was a dose response relationship between these adverse childhood experiences and health outcomes. So things like, when I say dose response, I mean, the more categories of ACEs someone had experienced, the higher their risk for things like heart disease, stroke, cancer, but also depression, anxiety, substance dependence. And then we see this really powerful association between these aces and incarceration. And we now understand that when we're in childhood and we experience something stressful or traumatic, that activates our stress response. Right. Though everybody's got their biological stress response, some people call it fight or flight. Right. And that when kids are exposed to stressful or traumatic experiences too frequently or too intensely, it can actually change the way our biological stress response is wired. And so we see prolonged activation of the stress response, and that, we now understand, is what leads to these increased risk of physical, mental, and behavioral health disorders. So at the time when Governor Newsom asked me to serve as California's first Surgeon General, part of the reason why it was so important for me to look at this in a really holistic way and the impact on our society is because a research study coming out of Florida showed that when they studied kids who were in the Florida juvenile justice system, they found that more than 90% had experienced at least one ACE and 50% had experienced four or more. Right. So when we look at the impact of adverse childhood experiences and really the impact of what happens when someone has a dysregulated stress response and may have impaired impulse control or other difficulties, or increased risk of substance dependence or other things like that, it's making sure that we address the root cause so that we can prevent these later life negative outcomes. And just seeing that the governor was willing to make that change for me, it reflected that he really understood that we have to target the root causes.
- [12:15]
Dr. Joy Hardin Bradford
Dr. Burke Harris, can you talk about the impact of, like, racism and discrimination on ACEs?
- [12:20]
Co-host or Interviewer
Like, is there a category for that in the scale?
- [12:25]
Dr. Nadine Burke Harris
So that's a great question. And in the original ACE study, it was done in a population that was 70% Caucasian, 70% college educated. Right. And so they did not include exposure to discrimination as one of the ACE criteria. And in part because that was not what they were seeing in their patient population, so they didn't think to include it. But this is why the science is so important. And I'm going to confess that science is my love language. One of the things that's really important. And so people often ask me, like, isn't exposure to discrimination an ace? And I want to like, this is where the super science nerd in me is going to, like, pull things apart a little bit, which is that because it wasn't included in the original ACE criteria. I wouldn't call it an ace. Right. But what we do know, and this is very clear, the science shows, is that it is a risk factor for the development of a dysregulated stress response. Right. Which many doctors and clinicians now refer to as the toxic stress response. And why that's an important distinction is because right now we have data from more than 20 countries that shows that, for example, an individual with four more ACEs, their relative risk of ischemic heart disease is 2.2. Right. So they're 2.2 times as likely to experience ischemic heart disease. And we're able to do those calculations and those analysis when we're looking at the traditional ACE criteria and we're looking at this health outcome. And so we can use that to say, okay, well, what's the cost of heart disease and how much of the heart disease that's out there is due just to aces, right? So the CDC has done this analysis. When you use different factors, the ability to do those types of analysis rigorously is. Right. Like you have to compare apples to apples and oranges to oranges to be able to, to make those analyses. But what's important is that ACEs are a risk factor for developing the toxic stress response. There are other risk factors for developing the toxic stress response, including exposure to discrimination, including, for example, experiencing war. Right. Including things like being separated from your parent or caregiver through deportation or migration. Right. And what's important is that when we understand who is at risk for having a dysregulated stress response, then we can address that with evidence based interventions to help to regulate the stress response. So it's really important that we are very rigorous with the science. Right? Because you know, the folks who, there's always folks who say, oh well, that's real bogus. That's this, that's that. And for those people I love to be able to come with very hardcore analysis that really stands up to people trying to punch holes in it. But what we understand is that we understand that the treatment, the treatment is the same. And that's the piece that we have to work on identifying who's at risk and someone is at increased risk if they've experienced discrimination and then understanding what are the interventions that make a difference.
- [16:16]
Co-host or Interviewer
So let's dig into your love language of science a little more. You've mentioned the term dysregulated stress response and it sounds like you talk, talked about impulse control is something that is a byproduct of having a dysregulated stress response. Can you talk about what a regulated stress response is? And, like, what does this look like in the brain when children and even adults are having a dysregulated stress response?
- [16:37]
Dr. Nadine Burke Harris
Yes. So, oh, my gosh, this is so much fun. So let's keep in mind that our stress response was designed to save our lives from a mortal threat, right? And the animals that didn't evolve a stress response, right, like they didn't live to reproduce. So when we think about. When we talk about the stress response, one of the things I talk about a lot is like, imagine that you're walking in the forest and you see a bear, right? Like what happens in our brain and body. Immediately, our brain's fear response center, which is the amygdala, it gets activated and it sounds the alarm, and it tells our brains and our bodies to release stress hormones. And so we release adrenaline and cortisol and a whole bunch of other stress hormones. And what happens in our bodies, right, our hearts start to pound, right? Our blood pressure and our blood sugar increases, and we shunt blood to our big muscles for running and jumping and away from that itty bitty muscle that holds your bladder close. So you may pee your pants, but there's no judgment, right? So you can be ready to either fight that bear or run from the bear. And that's why we often call it fight or flight. Now, if you were to think about it, fighting a bear would not seem like a good idea because he's way bigger, he's got teeth and claws, right? All that stuff. And so what actually happens in our brains is that the amygdala, the fear response center, sends projections. It sends nerve cells to this part of the brain up front. It's called the prefrontal cortex. And it's responsible for impulse control, judgment, executive functioning, and it turns it way down. Because the last thing you want if you are face to face with a bear, is some impulse control getting in the way of survival, right? And what it does is it turns up a part of the brain called the noradrenergic nucleus of the locus coeruleus, or as I like to call it, the part of the brain responsible for. I don't know karate, but I do know karaza. This is our within the brain stress response center, and it gets us amped up. Now, the last thing that happens when we activate our stress response is that it also activates our immune response. Because if that bear gets his claws into you, you want your immune system to be Primed to bring inflammation to stabilize that wound so you can live long enough to beat the bear or get away. So this is genius. It was designed to save our lives from a mortal threat. And then when that threat is resolved, it turns itself off. It does something called feedback inhibition, which is a little bit like, I would call it, like, the body's stress thermostat. You know, how you set the thermostat to whatever, let's say it's 70 degrees, and your system will pump out heat until it gets to 70 degrees, and then it'll turn itself off. That's how our stress response is designed, is that it gets activated and we release lots of stress hormones. And when they get to a certain level, it turns itself off. So children, because they typically aren't in control of their environments, they require a safe and caring adult to help them turn off their stress response system. So safe, stable, and nurturing relationships are a fundamental prerequisite for children's healthy development. And when children don't have that nurturing, buffering relationship to help turn off their stress response, what we see is something called loss of feedback inhibition. So just imagine that the stress thermostat is broken and the stress response system gets activated. And instead of turning off, when you reach certain levels of cortisol and adrenaline, it just keeps going and higher and higher and higher. So I don't know if you know anyone in your life. I can think of a couple folks that I'm thinking about who, number one, they can go from like, zero to 60 really quickly, right? Like, it's just huge levels of stress hormones just flood their system. Number two, you can see that the upset, like, kind of overshoots the mark, right? And it's, wow, the response is really intense. And then, number three, it can take them a really long time to calm down. And those are signs of a dysregulated stress response. And for some folks, you can see it in, like, behavior and upset. For some folks, you won't see any behavioral symptoms. What you'll see is, for example, they get sick really easily when they're overwhelmed. Like, the issue is with their. The responses, with their immune system, right? For some folks, it's like they experience something traumatic. And this is one of the things that I saw in my patient population. A child experiences something traumatic, and where you see the difference is in their hormonal response, right? So, for example, someone experiences a trauma, and then they gain 50 pounds, right? Or they stop eating, right? And they. And they either kids are not growing or adolescents may develop an eating disorder or. Right, that's where we start seeing these changes. So for some it's in their behavior. For some it's in their metabolism. For some it's in their immune system.
- [22:47]
Dr. Joy Hardin Bradford
More from our conversation after the break. This episode of Therapy for Black Girls is brought to you by Chase Sapphire Reserve. Whether you're booking your next trip or a weekend escape, Chase Sapphire Reserve is your gateway to the world's most captivating destinations. When I travel somewhere, I'm typically determined to try the best local pizza and find the best spa experience. With Chase Sapphire Reserve you have access to everything from private dinners hosted by award winning chefs to VIP treatment at the most sought after events. Chase Sapphire Reserve allows you to take advantage of one of a kind experiences while earning three times points on dining worldwide. No matter your destination, travel is more rewarding with Chase Sapphire Reserve. Discover more with Chase sapphire reserve@chase.com Sapphire Reserve cards issued by JP Morgan Chase Bank NA member FDIC subject to credit approval terms apply.
- [23:53]
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- [24:57]
Co-host or Interviewer
Dr. Burke Harris like how is toxic stress different from like the everyday stress that we might experience?
- [25:04]
Dr. Nadine Burke Harris
Yeah, so everyday stress is a normal, normal and regular part of life and it's actually kind of important for learning and it helps us be able to figure out what to pay attention to and all of that good stuff. The kind of the medical way that we assess toxic stress, right is that it's associated with changes in brain architecture. So changes in the structure and function of children's developing brains and then on into adulthood or changes in the immune system. The hormonal system, even the way our DNA is read and transcribed. And so, for example, what we see is that, like homework. Let's just give homework as an example, because people have asked me about that. So homework for a lot of kids is stressful, right? But when we look at the data around kids who received homework and kids who didn't receive homework, we don't see increased risk of cardiovascular disease in kids who received homework. Right? And so that's the place where we look at, is there a stressor? Does it biologically meet the criteria? Right. Where you have this stressor that kind of overwhelms the physiologic stress response and actually leads to a dysregulation of the biological stress response, and then does it also lead to increased risk of disease? And so that's how we're able to assess whether it's kind of an everyday stressor or whether it's like a really severe stressor that leads to increased risk of toxic stress. One thing that I want to say that's really important is that when doctors talk about the stress response, we talk about three different types of. So you've heard me talk about the toxic stress response. And that is when you have actually a change to the way that your stress response is wired, that increases the risk for lifelong health challenges. And then on the other side of that, when it's functioning normally, we call that the positive stress response. Right? It's a good thing. It's protecting you from danger. And in between, when the stress is more. More intense.
- [27:21]
Dr. Joy Hardin Bradford
Right.
- [27:22]
Dr. Nadine Burke Harris
Or more severe. But and this is key, that kids receive adequate buffering, caregiving structures. And I would advocate that, that the same is true for adults as well, that the body's biological balance, what we call homeostasis, can actually recover. And so that is what is called the tolerable stress response. When we start to see increases in stress hormones, maybe the beginning of symptomatology, but then the individual is wrapped with the right supports, the right care, and that helps the body to be able to regulate itself again. And so that is the tolerable stress response. And one of the things that's really important about that is that that's what we're trying to leverage, because experiencing something stressful or potentially traumatic, we're not going to be able to prevent all of that. Right? But we do know that with the right supports, the right scaffolding in place, that we can prevent the development of the toxic stress response through early detection, early intervention, and nurturing, buffering care.
- [28:46]
Co-host or Interviewer
So let's Stay with the early detection and kind of early intervention part. Dr. Burke Harris. So what are your recommendations for like how often pediatricians and other people involved with kids are assessing for ACEs?
- [28:59]
Dr. Nadine Burke Harris
Yeah, so I can tell you this is something that I feel so proud of. Like it feels really. So in California during my tenure as Surgeon General, we launched the ACEs Aware initiative. And essentially what we did was we took the research and I was on a committee for the National Academies of Sciences, Engineering and Medicine. And one of the key findings looking at the impact of stress on health and like the number one finding was early intervention improves outcomes. That is like been proven in the science. Right. Early intervention and nurturing care can actually allow the brain to, can actually change brain architecture. Right. Like if even in kids, for example, who were in group homes in a, like a foster care setting when they got high doses of nurturing caregiving, we were able to see on MRI normalization of the white matter structure of kids brain. So we're talking about it really makes a difference. And so. But the challenge is our system doesn't enable early detection. Right. So most kids don't come to any attention unless they develop mental health symptomatology. And similarly, even if a child comes to attention, if you're a mental health provider or you're trying to provide the wraparound care, the supports for the family, oftentimes like in my clinical practice, we were doing this, but we couldn't bill for mental health or support services if the child didn't have a mental health diagnosis. Right. So here we have a systemic structure that requires someone to be harmed before they can get access to care. Right. And that seems a little backwards, especially considering that the data is so strong about the risk of harm. So what we did as part of the ACEs Aware initiative was in addition to training providers and how to screen for ACEs and training them on evidence based interventions to respond to risk of toxic stress. Right. We also in California made it so that a child could get access to services based on the result of their ACE screen and they didn't require a mental health diagnosis, a child with four or more ACEs could get access to wraparound services paid for by Medicaid. Because rather than wait for them to develop physical health symptoms or mental health symptoms or as we started this conversation, Right. Rather than waiting for them to go into our juvenile justice system. Right. Which again is going to cost us way more money, we said children can get access on the basis of the result of their ACE screen if they're identified at being at high risk of having A toxic stress response. And so we recommend, and the way that we rolled it out in California was that that providers could get paid for doing screening for kids once a year. So just typically at their regular physical. And one of the things I think is really important about that is that when we launched it initially, folks thought like, oh, wait, why isn't the screening happening, for example, at a mental health. People thought, oh, yeah, no, we should be. The screening should happen as part of a mental health visit. But as we know, right, if we're trying to do prevention, then if we're doing it at the mental health visit, that's going to be after someone's already symptomatic from a mental health standpoint. So we really want to do it as part of their regular, well, child exam, whether that's by a pediatrician or family physician, so that we can actually do prevention, which is the data shows that when we actually do early identification and early intervention, we can improve health outcomes.
- [33:25]
Co-host or Interviewer
So we've talked a lot about that hallmark study, right? Like the very first study. But I would imagine there's been lots and lots of research done on ACEs since then. Can you talk about, like, any of the research that talks about specifically, like, what aces look like in the black community and how either intervention or detection might look different?
- [33:46]
Dr. Nadine Burke Harris
Yes. So one of the most interesting studies, it was really eye opening for me was a study called the Strong African American Family Study. And they looked at ACEs and experiences of early adversity. And what they found was that for some folks, their exposure to early adversity was associated with increased risk of mental or behavioral health disorders. But what they found in looking at this community of African Americans was that for the folks who didn't have any mental or behavioral health symptomatology, that when they measured what we call something that researchers call allostatic load, it's essentially the effect of stress on your cells. Right. Increased allostatic load is associated with increased cardiovascular disease. It's literally the physical changes to your body. Those who didn't have mental health symptomatology had a higher allostatic load, meaning that, like, their physiology and their cells were more affected and that they were had increased risk of chronic disease. Part of the reason why that's so important is again, because some folks say, like, well, you know, we should just be. We should just be screening for mental health disorders, and if someone has a mental health disorder, that's who should get care. When we look at health disparities, particularly in the African American community, right. And we look at rates of diabetes, okay. A person with four more ACEs, it has a 70% increased risk of diabetes. Okay. When we look at cardiovascular disease, you know, all of these different things, what we see is that. Are you familiar with the term John Henry ism? Right. Where it's like, John Henry, like, working on the railroad line. So I may not remember it perfectly, but essentially it was the story of a laborer by the name of John Henry who was working on the railroad line. And essentially he performed this, like, absolutely heroic feat of physical strength in. In what he did, and then he dropped dead. Right. And so when people refer to John Henryism, often they talk about the ability to perform or the ability to seem like we're okay and doing well, but really there's a profound internal toll that's not being measured. And this is why the Strong African American Families study was so important. Because for many of the folks who don't have mental health or behavioral health symptomatology, they get no care. They don't. I'm just going to say this because I was just speaking at a conference last week. I was at the Prevent Child Abuse America conference in. In Portland, and I was giving the keynote address. And I'm going to say that no fewer than 15 people came up to me during that conference, either before or after I gave my talk. And they say, Dr. Burke Harris, thank you so much for your work. What you described, that was me. I experienced and they told me however many aces they had experienced. And I didn't have mental health symptomatology, I had really bad headaches. I had really bad stomach pain. I developed an autoimmune disease at this age, but I never had behavioral problems. And this is. I just, like, I'm so. I hear it now so often that the notion that for me, it just. Our systems need to. Our systems need to get better. Right. We can't wait until someone has mental health symptomatology before we provide them services.
- [38:36]
Co-host or Interviewer
Well, can you talk a little bit about that, Dr. Burke Harris? I mean, because of course you are. Your training is as a pediatrician. So that's your ideal population. But because a lot of people who will be listening to this and will who have heard your work recognize it themselves as a child. Right. Like, oh, my gosh, like, if I took this test, this is where I would score. And so can you talk about what it looks like to kind of recognize that you maybe have high experiences of aces as an adult and what that looks like and how it might present?
- [39:06]
Dr. Nadine Burke Harris
Yeah, and so I can talk about that, and I will. Honestly, I feel like it would be. I don't know, it would be amiss for me to talk about it without talking about my own experiences. I think part of the reason that I am so passionate about this work is because I myself really experienced a lot of aces, like, significant number of aces. And it was really funny to me because. Not funny as in humorous, but, like, when I came into this work, I came into this work for my patients. I think that my own experience of aces, what that did for me was it made it intolerable that to just be leaving folks to kind of fend for themselves. That wasn't okay with me, I think, because I know what it feels like to have these experiences and to really struggle. I think it was important to. Like, when I started taking care of my patients, I was like, okay, let me understand this better. What is the biology behind it? And then how do we intervene? And it turns out that the good news, and this is why this work is so important to me, and I feel like it is so hopeful for anyone who has experienced ACEs. Like, the ACE data is based on what happens when you experience aces and you get nothing. Right. And now there's been 30 years worth of research to say, what can we do? So, number one, knowing that a dysregulated stress response is the. What we're trying to treat is key. Okay? So it's like, how do we regulate the stress response? And one is things like. So number one is safe, stable, and nurturing relationships and environments. Right? That is absolutely key. And I think that one of the things that's tricky. It's easy to say, but I will say it's another thing to do. Because one of the things that gets really tricky is that if you grow up in an environment where there was a lot of chaos or where you really loved your parent or caregiver, but your parent or caregiver was also the source of a lot of drama and harm. Verbal abuse or physical abuse. Right? Then we get in, like, our. Our nervous system can really become wired to kind of intermingle intimacy with chaos and violence. Regulation, right?
- [42:06]
Co-host or Interviewer
Yeah.
- [42:08]
Dr. Nadine Burke Harris
Yeah. And so we have to unlearn that. So that's one of the reasons why therapy is so important. Therapy is really key, and it helps us learn how to keep ourselves safe. I think one of the things that's really tricky is that when you're a kid and you don't have you. You don't have the capacity to keep yourself safe, we sometimes learn some coping mechanisms that are intended to try to keep us safe that we bring into our adult lives. Right. And so there are times when we have to, when we look at how we're reacting and how we're responding to a situation. And it's really helpful to have someone like a professional to check in with and say like, whoa, I had this experience. Because this is what's key. We know that when we experience, you know, stressful or traumatic experiences in childhood, when we're exposed to something that reminds of us of those experiences, that can be a trigger. And then you get the full activation of your biological stress response with those triggers. And so every time our biological stress response gets activated, that also increases our risk for health, mental health and behavioral health challenges. Right. And so even though whatever it was happened when we were kids, our biology is still responding as though that's what's going on today. Right. And so we see things like safe, stable and nurturing relationships and environments. Mindfulness, like meditation, that helps to strengthen the parasympathetic nervous system, which is like the resting and digesting and it counteracts the fight or flight response. So really strengthening our ability to counteract our fight or flight response is really important. Exercise is really important. So daily exercise to be able to burn up those stress hormones and also to strengthen the release of endorphins and other feel good hormones that counteract our stress hormones. Time in nature, I don't know if you've ever experienced this, but getting out into nature, going for a hike is like a combination between exercise and. But one of the things that I learn from my mental health colleagues is something called co regulation. You probably know this a lot better than I do, which is actually part of what happens when kids are supported by safe, stable and nurturing folks. Is that you, if you're regulated, then the child will calibrate their nervous system to how you are. Right. And we can, we can co regulate with nature. Right. Like just being in experiencing nature actually helps to reduce the activation of the fight or flight response and increase the activation of the parasympathetic, the resting and digesting. So sleep, exercise, nutrition, mindfulness, mental health, healthy relationships and time in nature are some of the key interventions. And I should say I talk a bit more about this for folks who are looking for resource in my book the Deepest well, which can kind of for folks who want to do more of a deep dive and understanding a little bit about how toxic stress works and what things help to counteract it.
- [45:42]
Dr. Joy Hardin Bradford
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- [47:53]
Co-host or Interviewer
So I am curious, Dr. Burke Harris, are you aware, and it may be too soon for this, are you aware of any research that's been done related to ACES in the pandemic? Because when I think about, you know like that period of time where it felt very much like a bear is chasing us, right? Like oh my gosh, what's happening? It feels like a time when the stress thermostat, like you weren't sure how to turn it off. Are you aware of any research that's been done there in terms of kids and aces?
- [48:20]
Dr. Nadine Burke Harris
Yeah.
- [48:21]
Dr. Joy Hardin Bradford
Yes.
- [48:22]
Dr. Nadine Burke Harris
So I was working in the California Surgeon General's office when the COVID 19 pandemic hit and I remember when we were getting ready to issue the remain at home orders and you know, we had epidemiologists and Disease modeling specialists and infectious disease specialist looking at this. And I was looking at something else that I was just like, wait a minute, if we're, this is a major stressor, right? There's a lot of people who, if we're getting ready to issue remain at home orders, the biology of stress physiology can just tell us so we can predict now that stress related health conditions are going to increase. Right. And I actually wrote a memo to the governor and was just like, hey, we need to get ahead of this because we're about to see this increase. And what we saw was, and by the way, this data has been shown in other natural disasters as well, right? So from Hurricane Katrina to earthquakes in Japan to SARS and mers, we see that when there is a major public health emergency that stress related health disorders can increase. Right? And so there was actually global data that was published in 2021 that showed that between 2019 and, and 2021, anxiety, global rates of anxiety and depression among youth doubled across the world. Okay. Now obviously it wasn't that all of a sudden twice the number of children and youth had a genetic predisposition to depression and anxiety. It's that we have this massive stressor that predictably is activating the biological stress response. We also saw that, that initially in the pandemic we saw rates of child maltreatment going down, which likely because they were not being reported, right? Like kids are not at schools or in other places where, where reports would come from, where concerned adults would see, see it and be able to make a report. But what we did see was that the severity of injury and the hospitalization rate from child maltreatment went up. So we see that the number of kids being hospitalized for child abuse essentially went up. And so we definitely saw this and this is part of the reason why it was so important to that we put into place these initiatives to do early detection and evidence based intervention with the supports that we know, help to regulate the stress response and help to prevent these long term harms.
- [51:41]
Co-host or Interviewer
You already talked a lot about like why you think at the policy level we should be addressing some of this. What kinds of policies and systemic kinds of things do you think would be important for states and government to institute to really focus more on like a prevention, early intervention? As we're thinking about ACEs, it's really.
- [52:00]
Dr. Nadine Burke Harris
Important for our policies obviously to be supported by the science. I actually right now I'm working with a team to help other states that are interested in implementing the ACEs Aware model to provide them with the Technical assistance and the expertise to be able to do that. Right. But essentially, when we think about the ACEs Aware model focuses on early detection so that we can do early intervention, which is really important. But that's part of a spectrum, Right. Like number one is prevention. We want to prevent ACES and other risk factors for toxic stress, including discrimination. Right. So I think it's super clear now that understanding how ACEs and other risk factors for toxic stress impact health is massive. And the CDC actually published a report of the cost of ACEs to the United States and estimated the cost at around $14.1 trillion annually. Right, that's massive. Like, let's just. That's just absolutely massive.
- [53:30]
Co-host or Interviewer
Yeah.
- [53:30]
Dr. Nadine Burke Harris
And, and when we look at that cost, of course, when they did that analysis, they looked at a lot of things. They looked at IRS data, they looked at Department of Justice data, they looked at Department of Education data. So it's not just the health outcomes, but all of the costs, all of the social costs that are associated with ACEs. So that's just astronomical. So when we think about that huge amount of money, again, I think that for policymakers, regardless of what side of the aisle you're on, right. So for nowadays, it feels like our society is so polarized, but I think there's a lot of room for folks to agree that preventing ACES and other risk factors for toxic stress, doing early detection and effective intervention and then treatment, obviously for the ACE associated health conditions, that is, that is what a full continuum looks like, right? Like, I can just say from being on the front lines of our Covid response that we weren't just like, okay, if someone gets Covid, we're going to, you know, we're gonna treat them, we're gonna put them on a ventilator or whatever. Like, we're gonna wait until they get, we're like, whoa, whoa, no, we gotta prevent it. So we got a distance. So we gotta wash our hands and we gotta wear masks. We gotta do all that stuff then testing, right? Like, we gotta make sure that folks can get tested and they know that if they are positive, they're going to try to prevent it, the spread to others. And we gotta give people ppe, you know, personal protective equipment, all of that stuff. That's what a full public health response looks like, right? Prevention, early detection and intervention. And we want that intervention to be as early as possible and as evidence based as possible. And ultimately, vaccines made such a huge difference with COVID And similarly, when it comes to this public health issue, when we're talking about 2/3 of Americans have experienced at least 1/8. Right. Then when we're talking about policies, those policies involve preventing ACEs from happening to begin with. And that means like supporting families, making sure that parents or caregivers are able to, you know, are supported to provide safe, stable and nurturing relationships and environments. Doing that, early detection and covering early intervention, making those services available. Right. So all of those pieces are necessary as part of a policy strategy to address ACEs and toxic stress.
- [56:28]
Dr. Joy Hardin Bradford
Dr. Burke Harris, what gives you hope.
- [56:30]
Co-host or Interviewer
About the future of this work?
- [56:32]
Dr. Nadine Burke Harris
Oh, my gosh, so much. I would say what gives me hope, number one, is that. So when I started doing this work, I started screening my patients for ACEs in 2009. Right. So it's 20, 25 now. And at the time that I started doing that, I would go give a talk and I'd be speaking to a room of a thousand people and I'd say, how many of you have heard of ACEs or toxic stress? And three people would raise their hands, literally. Right. And between that time and where we are today, I have just seen a transformation. I have seen, number one, more and more people being aware of this issue. And it started with folks being aware. And initially the response was kind of like, okay, what can we do on this personal level? Which is really important, right? So like, how do we address it? You know, how do I address it for myself? What do I do? And that's, frankly, that's where I started too. Like, what do I do with my patients? What are these evidence based interventions? And then as those become more widely known, I think folks have really taken to looking at our systems and saying, okay, wait a minute, how do we set up our systems so that we can respond systematically at scale with these evidence based interventions? Because I think before people were thinking like, okay, you have aces and you have increased risk, but is there anything you can do about it?
- [58:23]
Dr. Joy Hardin Bradford
Right.
- [58:23]
Dr. Nadine Burke Harris
I think now we're past that. I think the science is clear that there is actually a lot that we can do that when we apply these evidence based interventions, we actually can improve outcomes for folks. And so just like the fact that between science and technology and research, when we come together and we make this a priority and we raise our voices and we advocate, we actually can transform our systems. And that's what makes me excited and gives me hope.
- [59:01]
Co-host or Interviewer
Thank you so much for that. Dr. Burke Harris, it has been such a pleasure to hear so much more about your work. Please let us know where we can stay connected with you. What is your website as well as any social media channels you'd like to share.
- [59:13]
Dr. Nadine Burke Harris
So I'm like big on Insta which is where I share updates and also all of my gardening tips because gardening is my self care and it is what is brings me so much joy. So that's at Dr. Burke Harris on insta and also nadineberkeris.com is my website and so folks can can look there to follow more about my speaking and other stuff.
- [59:40]
Dr. Joy Hardin Bradford
Perfect.
- [59:41]
Co-host or Interviewer
We'll be sure to include all of that in the show notes. Thank you so much for spending some.
- [59:44]
Dr. Nadine Burke Harris
Time with us today.
- [59:45]
Co-host or Interviewer
I appreciate it.
- [59:46]
Dr. Nadine Burke Harris
Oh it's been my privilege. Thank you so much for having me.
- [59:50]
Dr. Joy Hardin Bradford
Absolutely. I'm so glad Dr. Burke Harris was able to join us for such an insightful conversation today. To learn more about her and her work. Be sure to visit the show notes at therapy for black girls.com session 432 and don't forget to text two of your girls right now to tell them to check out the episode before we go. I also want to highlight another important conversation from our archives in session 376, Sexuality as we age, I was joined by Dr. Sharon Malone who shared powerful insights about embracing our sexuality throughout Life. And now Dr. Sharon has just launched her very own podcast, the Second Opinion with Dr. Sharon, where women take back the conversation on health with honesty, expertise and the care we all deserve. Make sure to check out our earlier conversation in session 376 and then subscribe to her new show. Wherever you get your podcast, did you know that you could leave us a voicemail with your questions or suggestions for the podcast? If you have a topic you'd like us to discuss or a guest you'd like to hear, leave us a message at Memo FM Therapy for Black Girls and let us know what's on your mind. We just might feature it on the podcast. If you're looking for a therapist in your area, visit our Therapist Directory at therapy for black girls.com directory. Don't forget to follow us on Instagram at Therapy for Black Girls and come on over and join us in our Patreon Channel for more exclusive updates and behind the scenes content. You can join us at community.therapy for black girls.com this episode was produced by Elise Ellis, Inde Chubu and Tyree Rush. Editing was done by Dennison Bradford. Thank y' all so much for joining me again this week. I look forward to continuing this conversation with you all real soon. Take good care. This episode of Therapy for Black Girls is brought to you by Chase Sapphire Reserve. Whether you are booking your next trip or a weekend escape. Chase Sapphire Reserve is your gateway to the world's most captivating destinations. When you use your Chase Sapphire Reserve Card, you get eight times points on all purchases made through Chase Travel and even access to one of a kind experiences like music festivals and sports events. And that's not even mentioning how the card gets you into the Sapphire Lounge by the club at select airports nationwide. Travel is more rewarding with Chase Sapphire Reserve. Trust me. Discover more@chase.com Sapphire Reserve cards issued by JP Morgan Chase Bank NA member FDIC subject to credit approval terms apply. This is an iHeart podcast.