A Game of Resilience

Throughout the world, large populations suffering from Toxic Stress experience increased behavioral and health issues that reduce quality of life and life span. Among American Indian/Alaska Native adult populations in the United States, levels of Toxic Stress are more than double the level of the general population. Using the Adverse Childhood Experience Study (ACES) as a major root cause of Toxic Stress targets 10 parent behaviors (ACEs) as a major source of toxic stress. Adults who experienced 6 of 10 ACEs during childhood have average life span reduced by 19.5 years. Men in their mid 20's with 6 plus ACEs experience a 4,600% increase in IV Drug use over an adult with none. Children who are experiencing ACEs as they grow have lower levels of academic achievement, higher rates of dropping out, more behavioral issues and are sent to Juvenile Justice detention centers more frequently. Rates of depression, suicide, alcohol/drug abuse, domestic violence, sexual abuse, crime and numerous negative outcomes emerge from ACEs exposure through a graded, dose responsive relationship--the more ACEs experienced lead to higher outcomes of health and behavior issues.

Addressing Toxic Stress with ACEs as a significant root cause provides an answer to an ages old question, "What's wrong with me?" Adults with Toxic Stress have multiple negative outcomes in many aspects of their life. Yet treatment for this major root cause is delivered in siloes and not addressed systemically.

Science also demonstrates that many of the negative outcomes to Toxic Stress are related to nutritional deficiencies. With many ACEs victims living with limited incomes or with poverty, access to nutritious foods is hindered. 

Resetting levels of Toxic Stress is the goal of what I have been calling Restoring our Health. It is based on a very simple concept-reducing the frequency of our brain releasing cortisol in response to layered levels of fear. In addition to a systemic approach laid out in writing, we envision a digital video game that can help inform younger people about the impact of cortisol on their body.

A Game of Resilience: Filling the Gap, is in its prototype a board game that visually presents a simple Fear Feedback Loop though a Role Playing Game. The concept is to create a digital game that can be distributed widely to a younger population of adults. Characters will be able to differentiate as Normal, Tolerable and Toxically Stressed based on discovery of childhood acquired trauma (ACEs). In the course of the game, building a graded, dose responsive list of ACEs leads to increased outcomes on a scale not yet identified. Cumulating the outcomes divides a player into Normal, Tolerable and Toxic levels, impairing performance. Acquiring ACEs becomes a visible way of looking at Toxic Stress and how easy it occurs during childhood.

The Gap represents the difference between the stress balance achieved by Normal and Toxic. Being in Balance stops the flow of cortisol for Normal Stress. Toxic Stress has cortisol flows that may continue for days if not months. In the game, a range of behaviors, described as Negative, Positive and Neutral, provide a release of chemicals or hormones that alleviate stress temporarily. Consisting of Dopamine, Oxytocin, Serotonin and Endorphins (DOSE), a player can function by filling their gap with Positive, Neutral and Negative behaviors that release a DOSE and alleviate Toxic Stress for a period of time. 

Digital games command a lot of time from a young adult demographic. If designed well, this game will inform a player who may have Toxic Stress what it consists of, and provide both an exciting experience while practicing the identification of a cortisol release, intercepting it with practices that stop the release and promote healing the Gap.

Dr. Vincent Feliitti, the brilliant co-Principal Investigator of the Adverse Childhood Experience Study, stated very eloquently that the goal of a physician should not be to ask what's wrong with a patient, but to ask what happened to the patient. The Game of Resilience on a board was designed to help an individual understand that their behaviors and health outcomes are significantly dependent on what happened to them as children, and to a lesser extent as adults. Digital games can build the complexity of multiple trauma and toxic stress feedback loops into a game with healing artifacts that educate as well as entertain.

A video game can be very expensive to build, but if A Game Of Resilience is successful and reduces the cost impact of poor health and behavioral issues, the cost is justified.

The initial target population is a young American Indian/Alaska Native demographic with a high rate of Toxic Stress, defined as exposure to four or move of the ten parent behaviors examined in the ACES. According to the ACE Study, this demographic has higher rates of poverty, incarceration and mental disorders. Their behaviors have a range that can be viewed as Positive, Neutral or Negative that are driven by the Fear Response and the temporary relief provided by a release of a DOSE chemical. But the entire world population has similar experiences. For white, Western European resident of the US, there are fewer categorized as Toxically Stressed, but the game can help that demographic achieve the same healing result. ACE Studied populations worldwide have varying degrees of Toxic Stress, but the mechanisms for healing the Gap are the same, stop the release of cortisol if no physical threat is present.

In Alaska, there are few mental health resources available. And the behavioral health system has not been using innovative nor creative methods of addressing mental, behavioral and health issues. Nutritional interventions have reduced binge drinking (Omega 3 EFA supplementation), suicidal behavior (Omega 3 Supplementation and Niacin) and depression (Omega 3 and Niacin). The game concept envisions the use of support tokens that provide a nutritional supplement to enhance performance and strengthen a character to meet some of the challenges in the game. But rather than providing for Vampires to drink blood, a character takes a supplement that it earns by a positive behavior.

In a Role Playing Game that focuses on character degradation through Toxic Stress and rehabilitation through positive practices, analytics can be built in to assess whether there is any real life improvement from Toxically Stressed players. If the game is successful in supporting healing the gap caused by Toxic Stress, then word of mouth and social media discussion can speed the discussion and bring more participants. Associated books, programs, videos and training can reach a broader population based on interest. 

Over a life span, Toxic Stress imposes substantial economic cost on society and individuals. From addressing education deficiencies to suicide attempt and completion, these costs aggregate over a life span and can be reduced if resolved early in life, at a time when video games are  played extensively.

This systems approach to addressing Toxic Stress is unique and innovative. The ACE Study was published in 1998 and is still being discovered by individuals who are in the Early Adopters phase of the Rogers Innovation Curve. The healing method of addressing cortisol reduction and nutritional supports is not common among behavioral health practitioners. As a newly envisioned systems approach, this team has the only access to this systems approach to healing. 

Patrick Anderson is connected to the National Congress of American Indians and has extensive knowledge about ACES, its impact and the theories behind Toxic Stress. He has presented this information to various audiences at NCAI and has interest from potential places to implement a clinical approach he outlined five years ago. Indian Tribes have suffered from a variety of community based issues where Toxic Stress is a negative driver of results. AI/AN Tribes have been described as a "canary in the coal mine" revealing problems earlier than the rest of society. AI/AN Tribes are also served by a nationally funded health care system that addresses these issues, although using only traditional clinical services. Most of those services have not been effective.

This effort is also guided by a psychiatrist who is informed by newer healing practices similar to those represented in the Game of Resilience, and a team of innovators and creators who are working on the intersection of climate change and health in many parts of the world.

In the Rogers Innovation Curve, Dr. Rogers differentiates between Innovators and Creators and Early Adopters. Patrick Anderson's business manage process, learned in health and behavioral health care settings, fits into the Innovator and Creator category with some early adopters beginning to understand the problems and attempting various solutions, mostly using existing proposed solutions. The board game developed was a prototype that engaged a number of visitors to a booth at the National Congress of American Indians, but its primary purpose was to solicit input about its potential use. It was well received. 

The Restoration to Health program, with its two goals of preventing imposition of CAT on children and healing CAT in Adults was originally designed as a written program with coaches helping clients learn about their dosage of Toxic Stress and engage in practices, such as breathing, trauma release, nutrition and identifying/recusing their fear response cortisol dump, to reduce of eliminate the dump. Less cortisol should result in less stress.

Individual parts of the entire healing system have been extensively studied, but not used as a system. The closest use is a program developed by Dr. Joseph Gordon with his concept of Soft Belly Breathing and Shaking and Dancing, two step along the feedback look for restoring balance. Gary Craig has effectively used Emotional Freedom Technique to reduce or eliminate PTSD from U.S. Veterans who had diagnoses in place for from 5 to 30 years by 50 to 100% reduction of symptoms. 

By envisioning a video game, where Role Playing can be used for a character to acquire Toxic Stress, meet challenges and apply practices to recharge their character and strengthen it through regular picking up Tokens of healing practices seems like a way of educating a population where many might heal. If success is achieved and share, the information will be shared with many others.

Health and behavior issues are protected information in the U.S. because people don't want to reveal some secrets, especially those that have penalties. Discussing being a victim of depression can affect a person in many negative ways. A video game that can be played confidentially can help if it reveals a players Toxic Stress and demonstrates methods of healing them/

I do not have an advanced degree in health or behavior, and have approached what I refer to as a Restoration to Health approach from the perspective of a lay victim. After widely sharing the construct of a systems approach to healing, I discovered that there is heavy resistance to changing the way we work. As I build out my network, I have looked to an International partner, Planet Health, to look for places to pilot the program. I have early exploratory  interest from the Kingdom of Tonga and 2 American Indian tribes and one Alaska Native Village. Establishing a research path that unifies the siloes of treatment that exist is a second goal, and I have joined an effort to develop a healing and spirituality center at Yale University with a graduate currently practicing as a psychiatrist. I have another established relationship with another former NIH research psychiatrist who has effective used nutrition in his practice. 

My immediate need is to consolidate the program into writing and begin implementation in a test site with assessments by professionals and scientific studies. MIT was an early research institute looking at the early assessment of the management system I use, studied as the Toyota Production System or Lean Thinking. Jay Forrester's early research on systems, followed by Womack, Jones and Roos resulting in the book the Machine that Changed the World, inspired my early thinking. Stephen Spears book, Chasing the Rabbit, told me that innovation and creativity are not reserved for geniuses, and that well educated systems thinkers can change the world.

After managing health, clinical, behavioral and substance use services, I became aware of how difficult healing was and began to look for a more focused solution. After extensive study of the Adverse Childhood Experience Study and its findings of a link between parental behaviors and negative health/behavioral outcomes, I found research linking the fear response to a requirement for movement, fight or flight. The third response, freeze, did not involve movement. Research linked a release of cortisol in the body to preparation for movement and healing. Adrenaline, epinephrine and norepinephrine, plus other body actions, prepared the body to react of a physical threat. When the threat was addressed by movement, the human body quickly returned to balance in preparation for the next threat.

If movement didn't occur, the cortisol response was not used and the body likely interpreted lack of movement as a call for more cortisol. In an individual with a high fear response developed during childhood, the body stayed in a state of preparation for movement, with higher blood pressure, heart rate, cortisol levels and inflammation in preparation for healing woulds. Without movement or wounds to heal, the body started to cause certain feelings that needed a response, often described as fear or anxiety.

The human body feels emotion and a cortisol escalation seems to require distraction and other chemical stimulation for temporary relief. That stimulation is likely provided by activation of response that activates the DOSE chemicals, Dopamine, Oxytocin, Serotonin and Endorphins, each capable of providing pleasurable relief. But the relief doesn't last, but because the brain feels the relief, requires more, leading to an addictive response. This led to the idea of a gap in the fear feedback look requiring DOSE chemical release. This response was expanded from negative outcomes to positive and neutral behaviors that elicited praise or positive reaction from peers. Multiple responses to fear saw a "Start" of responses adopted by people. The behaviors used to elicit responses in the stack can be categorized as positive, neutral or negative behaviors based on how they are perceived. 

Athletes, singers, comedians and other performers receive praise for their involvement and extra praise for excellence. Seeking more opportunities for a positive reaction to behaviors releases DOSE Chemicals. Temporary Relief follows.

The Restoration to Health Program recognizes that the gap is not reduced by DOSE responses, only temporarily alleviated. Reducing the size of the gap requires understanding why and when cortisol is released and preventing the release. A variety of practice can reduce or stop a cortisol release, or follow it with movement to top the cortisol response.With practice, the gap can be decreased in size, requiring fewer responses in the stack, and might be capable of eventual elimination of the gap.

The Restoration to Health Program addresses practices that end a fear response: breathing, trauma release movement, reversing nutritional deficits and energy practices to start reducing the fear response.

Early research on emotion states that emotion has no language. Instead, the way we describe what is happening to us is through development of a constructed language describing emotion. Lisa Feldman Barratt's theory is being expanded in a way that explains how different cultures develop an emotional language to describe what we feel. That is what we talk about in current behavioral services. Yet what we feel is linked to a lack of movement after a fear response. The loop is not balanced so our feelings become trauma which is carried in the body. This is likely what Bessel Van der Kolk discusses in his book, The Body Keeps The Score. 

Reduction of cortisol in the body as the likely solution to trauma has promising results in the work of Gary Craig, the Founder of Emotional freedom Technique, or EFT. Research about EFT found it reduces the cortisol response by 40 to 60 percent, and has healed U.S. Veterans suffering from PTSD. Meditation, Mindfulness, EMDR, Ericksonian Hypnosis, Dialectical Behavioral Therapy and practices such as Yoga have a role in reducing cortisol releases. Trauma Release Exercise as a means of inducing tremoring, helps remove cortisol because of the movement caused. James Gordon's soft belly breathing and shaking and dancing inspire the same response and release endorphins. 

Many individuals also suffer from nutritional deficiencies that feed behavioral and mental disorders. Bill W., a cofounder of Alcoholics Anonymous, was advised to take 3 grams of niacin daily and within 14 days reported that eh finally found relief from the depression that fueled his drinking. Dr. Abram Hoffer was able to relieve schizophrenia with large doses of B Vitamins. Alexander Schaluss was able to withdraw opioid addicts in five days without symptoms by using 26 grams of Vitamin C daily for 2 days before withdrawal and 5 days following. Dr. Joesph Hubbell found that Omega 3 EFA's reduced suicides completions among U.S. Veterans, provided a 1/3rd reduction in serious violence in juvenile and adult correctional facilities as well as reduced binge drinking by 880%.

Change will require considerable practice and support. ApplyingRobin Dunbar's trust paradox requires establishing the Game of Resilience: Filling the Gap, as a trusted cultural and traditional practice with appropriate results and symbolism, similar to Alcoholics Anonymous. Healing together in small groups of 6 to 10, which is bounding the intimate trust circle discussed by Dunbar, should create a healing support group. 

But the most critical aspect of healing is inspiring adherence to a system, which comes with confidence in the results. With a psychiatrist, a planned university based healing and spiritualism research program and a nonprofit focused on underserved areas of the world, the results should become apparent quickly.

Childhood Acquired Trauma has a plethora of negative effects that burden humans by early adulthood. Education is slowed before school starts and dropping out is higher among toxically stressed students. Many social indicators of health are caused by CAT, including behaviors that affect employability, health issues, risky behaviors and poor relationship choices. Incarceration, disciplinary actions and other societal impacts prevent many adults from achieving a happy and successful life. 

Preventing CAT is the best solution and presents the best outcomes. But for the toxically stressed, understanding how that happened and adhering to proven practices for reducing or eliminating toxic stress is a secondary solution. It will be necessary to support healing with programs for backfilling the education, emotional and cultural deficiencies acquired because of CAT.

The Game of Resilience is intended to work on reducing a stack when the client is ready. If a stack is supporting a client, we don't know the impact of removing a supporting behavior if it is still necessary. When a stack support isn't available for some time, the client may swap for another behavior temporarily, either improving frequency of an existing stack behavior or adopting a new one for a time. When a behavior is no longer available, the client may switch to another behavior. This might mean progressing to more damaging behaviors in the stack. 

Current programs are aimed at single behaviors and services delivered in siloes. Smoking cessation is one such program, but research doesn't examine whenever quitting smoking is followed by an increase in or addition to the stack. Perhaps the new behavior is increased domestic violence and causes more damage than continuing the behavior. By addressing multiple siloed behavioral treatments in one program, escalation or adoption of behaviors can be monitored and extinguished more readily.

One measure is to measure the cortisol in the blood regularly for increases or decreases. Monitoring stress and associating higher levels with certain behaviors and body feelings help alert the client to use cortisol reduction techniques. 

The actual video game that is the subject of this application should be designed to educate a potential client in a zone of safety where risks can occur without real damage, and behaviors intentionally changed as actions in the game.

For example, a young adult might find out through the game that they 8 parent 8 parent behaviors causing a very toxic level of stress. as they pursue goals of the game, their disabilities hinder performance. But by picking up a package of Breathing, Trauma Release Exercise, Niacin, Omega 3's, a medication pack or mindfulness pack, they gain a small measure of temporary relief. As use of packs accumulate, the body starts to heal and perform longer without the packs until it is healed. At that time, the supplement packs can change into enhancement packs and advancements though the game becomes easier.

The fear response is the foundation that determines good or poor health. Research by Joseph LeDoux, Ph.D. at New York University helped promote understanding of the brain in new ways. Robert Sapolsky explains the fear response and how it works in Zebras through his book, Why Zebra's Don't Get Ulcers. He expands our understanding through his book, "Behave, The Biology of Humans At Our Best and Worst. This foundation of knowledge inspires a theory of response to fear by reducing it in toxically stressed adults with a clear message. Cortisol is a friend for normal stress, and an enemy for toxic stress. Let's reduce it.

Many of the interventions mentioned above are science based, but suppressed because of competitive and political blockers. The video game is capable of being spread using the internet and can be augmented by virtual reality to categorize CAT symptoms, its impact on performance and application of healing technologies to exchange performed. 

In the concept stage, we have only volunteers. Planet Health and a proposed Yale Mental Health and Spirituality Center, inspired by psychiatrist Dr. Anna Yusim. 

Planet Health is another collaborator currently working on strategies for world health andthe mental challenges of climate change. The Nation of Tonga has indicated interest in the healing program and a companion program referred to as a Village of the Future.

A variation of the Restoration to Health Program has been taught to a staff member of AIME, an Australian based indigenous coaching program, and may be introduced in the next 6 months. 

This was started in 2008. In 2010, a program was held in Anchorage AK with pioneer researchers in historical trauma, indigenous childhood behavioral services, Adverse Childhood Experiences and services for the homeless. The program has been presented to Indians Tribes, The Annual White Earth Brain Conference, Alaska Native Villages and various audiences at Princeton University, The Cisco Native Network and the National Congress of American Indians.

The program is, by its potential client audience, applicable to a diverse population across the world. Because victims of CAT increase in minority and gender discriminated populations, they have the possibility of benefitting from the inclusive, non siloed nature of the solution, as well as benefitting from any reductions of negative behaviors expressed in their community.

This program was designed to be administer as a group, with coaches and publications or apps providing the content. When fully implemented it is easy to expand within a population or community with similar interested. 

The business model is still in development, but will involve written guides, video instructions, the Game of Resilience video game and various recommended apps from other providers that teach valuable skills incorporated into the program.

Grants will initially fund the program, with a gradual shift to selling materials and training to coaches and instructors.