Understanding Transformational Experience

Understanding transformational experience is important to every caregiving discipline. At the end of the day, caregiving almost always involves a partnership between the caregiver and the patient or the client. There is a tacit agreement between them that they share a common goal—healing, whatever that means for each individual’s situation. Clearly, this goal needs to be patient centered. Caregivers are not rescuers with their own agenda that barge in on people’s lives irrespective of their wishes and dictate what is needed. On the contrary, caregivers practice listening skills that strengthen the caregiving partnership. However, under the best of circumstances, the goal of healing can be difficult to achieve. Sometimes this is true even when technology can deliver a cure.

A cure, when possible, is an important accomplishment that deserves to be celebrated, yet we know that of itself it does not mean the goal of healing has necessarily been achieved. For many people a significant health risk remains if underlying psychosocial and spiritual issues are left unaddressed, particularly when those issues contributed to the condition that brought the patient or client to the caregiver’s attention in the first place. In that case the health problem or a related one will almost certainly return. Caregivers are challenged by this all-too-familiar scenario in the caregiving partnership.

This year’s ETIP Conference has been specifically planned to address this challenge. Advances in understanding transformational experience have been occurring that have gone largely unrecognized by mainstream caregivers. These advances have illuminated conditions that can be seen to interfere with healing. This understanding, in turn, has contributed to development of clinical caregiving practices that empower patients to escape the determinants of health leading to chronic diseases, suffering, and early death. Researchers are exploring the role of forgiveness, for example, both of self and others on health outcomes. For some people the correlation will be surprising. Similarly, the role of gratitude, as simple as that may sound, was found to have a profound influence that began almost immediately once a particular practice of gratitude was adopted by a research cohort.

This science-backed foray into the realm of transformational experience is showing promise.  While not yet producing a generalizable theory explaining the details of personal transformational experiences, the theory may not be far behind. In that respect, ETIP participants will participate in discussions with researchers that explore how new tools used in studying epigenetics are being applied to the deeper understanding of what healing really involves. The implications support a deeper appreciation of how important the partnership is between caregivers and their patients. The practical implications for practitioners and the caregiving community will then be developed in the ETIP workgroups as they work together to develop specific strategies for implementation with patients and clients.

The ETIP 2014 Conference is focusing on immediate and short-term impact!

The ETIP 2014 Conference is focusing on immediate and short-term impact!

http://emergingtoolsforinnovativeproviders.com/

Last year at ETIP we reviewed the relationship between spirituality and health, noting the research that demonstrates these are closely linked. We then delved into the possibility that spiritual care can physiologically benefit patients or clients.

We started the conference by looking at key physiological mechanisms – asking and answering the question, “What is it that underlies the connection between spirituality and health?” We discovered the underlying mechanisms are probably related to the pathways by which stress and trauma contribute to disease, which may then be interrupted by spiritual care. While stress is an important part of living, stress is not healthy for us over extended periods – no surprise – which we refer to as chronic stress. Chronic stress is well known to have deleterious effects on our immune system that contribute to the development of diseases like cancer, cardiovascular disease, sometimes autoimmune disease, etc. and it exacerbates many other diseases as well. This may be even truer for intense stress and emotionally traumatic experiences.

We learned that this relationship affects our health not only directly but also indirectly. Chronic stress and trauma introduce an epigenetic effect (involving a change in DNA function that occurs after conception). Apparently, the mechanism involves the influence of chronic stress and trauma as it contributes to methylation of DNA in the stress response center of our brain. This means that molecules called methyl groups affix to the cell’s DNA, which then alters people’s stress reactivity, i.e., people become more sensitive to stress. This can result in behavioral changes and a different behavioral trajectory than would otherwise have occurred. Essentially, people become more stress reactive when they’ve been through considerable trauma or experienced chronic stress that has caused DNA methylation in the stress center of their brain. Becoming more stress reactive, in turn, has some predictable influences on our behavior.

First, it triggers aversion responses in us. Hence, as soon as we feel stressed about something, we have a tendency to want to avoid it. That means, for example, if we feel stressed about our diet, then we avoid making changes that would improve our diet; if we feel stressed about our weight, we avoid addressing the changes that would reduce it; likewise, if we feel stressed about any of the healthy behaviors that might be pointed out to us, it can trigger an aversion response. Understandably, it’s harder for people who experience aversion responses to engage in healthy behaviors. It can be hard for them to develop personal discipline or make life changes in any area that triggers a stress response.

Second but closely related, the DNA methylation that causes stress reactivity is also likely to generate impulsive behaviors. In people who experience chronic stress or trauma these behaviors are companions to aversion responses. Rather than endure the anxiety and associated discomfort of a stress reactive response that’s triggered, for example, by addressing the need to develop personal discipline including healthy behaviors, people instead may tend to act out impulsively. They don’t want to pay attention to whether they’re drinking too much or eating right or driving too fast, or perhaps even whether they’re wearing a seatbelt. Thinking about these things can all trigger aversion responses that seek to avoid changing behavior; instead people are prone to act impulsively and engage in high risk behaviors. Hence, people who become stress reactive are more likely to smoke, more likely to drink in excess, more likely to do drugs, more likely to have unwanted pregnancies, more likely to become involved in criminal behavior, etc. These impulsive behaviors, resulting from aversion responses, indirectly affect people’s health.

To sum it up, there is a direct and an indirect correlation between chronic stress and trauma, and disease. The direct response is cumulatively physiological and it results, as noted, in high blood pressure, etc., dysregulated immune function and inflammatory response that, as we also noted, causes cancer and heart disease, and makes other diseases worse. The indirect response, in comparison, is the effect on behavior, making a person less likely to develop consistent healthy behaviors and more prone to engaging in high risk behaviors, resulting in poor health outcomes or accidental injuries.

That is how we started the conference discussion last year. Then, we looked at how spirituality contributes to an opposite set of circumstances. Spirituality, for example, produces a relaxation response instead of a stress response. The relaxation response is correlated with lower blood pressure, etc., a regulated immune system, with higher probability of healthy behaviors, and a longer healthier life. We also learned that spiritual care may potentially be designed to interrupt the stress response, and we formed our work groups around developing tools that help clinicians identify the indications of stress reactivity in their patients and clients – especially as it may be related to chronic stress and trauma – and then in conversation with their clients and patients, to review the trajectory of how the stress response affects the person over their lifetime. That includes, first, recognizing the indicators that stress reactivity is contributing to poor health and then, second, interacting with the patient or client in a manner that involves listening to their story and identifying the elements that are predisposing health risk. Perhaps there was a major trauma(s) experienced in childhood, for example, that started the stress reactive trajectory, then aversion responses and impulsive behaviors contributed to poor health outcomes ever since.

The spiritual care element comes into play in listening to the stories – non-judgmentally acknowledging each patient/client’s personal history, helping the person gain insight into - and acceptance for - what is really happening, and then guiding development of a strategy for interrupting the unhealthy trajectory with a relaxation response. A wide variety of spiritual care tools may be seen as aiding this process.

Last year we only began the conversation about what clinicians and caregivers can do, when armed with this understanding, to help their patients or clients. This year, we’re focusing on what clinicians can do in the short term to produce immediate benefit. Of course, we’re going to review what it is needed to recognize the stress-reactive pattern in our patients and clients, to identify the trajectory from its source through various life experiences and in its current manifestation in poor health or mental health outcomes, as well as the importance of encouraging them in telling their story, and all the while acknowledging the legitimacy of the physical and emotional toll they have experienced.

This year, however, we’re focusing on developing strategies for interrupting the stress response in an acute care situation. As a group, we will learn how caregivers can employ spiritual care to interrupt the stress response for immediate benefit; also, how we can help patients or clients understand how to interrupt the response; and, how they can transition from a stress response to a relaxation response. Interestingly, this is something that can actually happen in a few seconds, physiologically. Yet, it often doesn’t happen at all, or to a very limited degree, for people who are stuck in a stress reactive pattern. However, once patients learn that the stress response can be interrupted, and how to interrupt it, the physiological shift from producing stress hormones to producing relaxation hormones can happen very quickly. This shift can immediately, though transiently, produce health and wellness benefit for the patient in the short term, which may then help them get through a tough situation.

Of course, this doesn’t “fix” the patient or client. The patient still has a stress reactive life trajectory that is going to be heavily influenced by the epigenetic methylation of DNA in the stress response center of their brain. This condition is very likely to continue triggering aversion responses, including avoidance and impulsive behaviors that can feed the development of future chronic stressors with a corresponding elevation of inflammatory mediators, dysregulated immune responses, etc. However, the patient or client and the caregiver, working together, have the potential to interrupt that pattern in an acute care situation/environment, such as may occur around a hospitalization or other short-term caregiving event. Moreover, we can teach the patient to interrupt it as well (our intention for next year’s ETIP conference is to explore long-term applications).

This year at the ETIP Conference doctors and nurses, chaplains, social workers therapists and clergy, etc. will develop strategies and techniques that interrupt the stress response for distinctly identified populations of patients or clients. And, they will learn to teach these strategies to the patients or clients as well. Conference participants will also learn to recognize the kind of acute care context where these interventions have immediate impact and produce immediate benefit as a short-term strategy to help patients and clients through a potentially difficult experience.

Each of this year’s speakers will contribute to this discussion. They have been specifically selected for that purpose. Conference participants will want to note the topic theme for each day and the title of each presentation as well as review the background of each presenter to see how each day and each presentation fits together in support of the week’s overall objectives. This detailed information can be found on the ETIP website at:

http://emergingtoolsforinnovativeproviders.com/