Stress and Trauma

Stress, trauma, and the work of a CHW

CHWs work with people facing difficult health situations and life challenges. Both can create stress that affects health. As part of the community, you're often well-positioned to support people who are struggling — to recognize the signs, to respond with warmth, and to connect them with the right resources.

Stress is how we respond to difficult things — including trauma — that happen in life. It's normal. Sometimes it even helps us stay safe or motivated. But if it lasts too long, it hurts our health — in our body (tense muscles, chest pain), our mood (anxiety, sadness), and how we act toward others (anger, substance use).

Two types of stress

Stress is what you experience when faced with a change or challenge. It's a normal part of life — it can come from exercising, school, work, life changes, or difficult things that happen to us. Short periods of stress don't have a lasting effect on our health, but lasting stress can seriously harm physical and mental health.

Two types of stress

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What causes chronic stress

Everyone needs love, connection, belonging, and a sense of physical safety and security — these are social needs. When they're unmet, chronic stress can develop. The same is true under discrimination.

For older people, things like elder abuse, losing a spouse, or major life transitions can also cause chronic stress.

What chronic stress does to the body

When we're stressed, our brain and body produce cortisol — the "stress hormone." A little cortisol during acute stress is useful — it's the "fight or flight" response that helps us stay safe. But too much for too long causes damage.

When we're stressed for a really long time:

• Some brain cells start to die, making it difficult to remember things.
• Blood pressure stays high, causing problems with our hearts and blood vessels.
• The immune system is weakened, making it more likely we'll get sick.

Which statement best describes the difference between acute and chronic stress?

What is cortisol, and how does it relate to stress?

Tips to share — for them, and for you

Stress management isn't something only your patients need. Use these tips for yourself too.

Stress management tips

What is trauma?

Trauma is when something happens that's too much for us to handle. It can be a scary or dangerous situation we can't escape from or feel safe in. When this happens, our brain and body get so overwhelmed we can't fully understand or remember what happened.

Our brain shuts down some advanced thinking and relies on basic instincts. That's why memories of trauma feel intense and emotional, but also harder to recall in detail. People may remember how they felt, but struggle with other facts.

Traumatic stress is a normal reaction to a really bad event — an accident, war, an attack, or a natural disaster. It makes people feel unsafe and helpless. People feel tired, sad, and angry, and sleep and clear thinking can become difficult.

Trauma-informed care

Many people have experienced trauma — so use a trauma-informed approach in all your CHW work. Assume that anyone may have gone through a traumatic event before, and be mindful of how that might affect your interaction with them. Move at their pace, give them control, and avoid surprises when you can.

Adverse Childhood Experiences (ACEs)

What happens to us as children shapes who we become. ACEs are potentially traumatic events that happen when we're young. They can change how our brains and bodies develop, and they can cause health problems that last a long time — even into older adulthood.

There are 10 recognized ACEs, categorized into three groups: abuse, neglect, and household dysfunction.

Three groups of ACEs

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ACEs in California

Experiencing many ACEs is linked to higher rates of heart disease, diabetes, cancer, and many other serious conditions.

Intergenerational effects

People with higher ACE scores are more likely to experience:

• Health problems like heart disease, stroke, and cancer
• Difficulty doing everyday activities like getting dressed or going to the grocery store
• Problems thinking and remembering
• Challenges managing emotions when going through difficult times
• Depression
• Elder abuse

Older adults with high ACE scores may be especially vulnerable to stress when facing changes that can be traumatizing.

But ACEs aren't destiny — support breaks the cycle. Studies show that mothers who had a tough childhood are more likely to have a baby born too early or with low weight. These mothers benefit from doulas and home visitors, and connecting them with home visiting programs improves pregnancy, birth, and early childhood outcomes.

Match each group of ACEs to what it includes.