Trauma-Informed Health Decision Making

Trauma-Informed Health Decision Making

Those impacted by traumatic events and toxic stress are known to have shifts in decision making related to their health (e.g., substance use, risky sexual behavior, and disordered eating; Kim & Choi, 2020). Trauma leads to risk health behavior via coping behaviors (e.g., using substances to cope with intense emotions) and impulsivity (i.e., a lack of inhibition; Bornalova et al., 2006). Thus, increasing traumatic experiences across the globe relevant to the pandemic are likely to impact health decision making and associated costs in health care needs (Mancini, 2020). One of the major features explaining the impact of trauma on health decision making is its impact on emotion regulation (Messman-Moore & Bhuptani, 2017). Experiences with trauma increase the intensity and frequency of emotions such as fear, anger, and hurt – which result in increased difficulty concentrating in day-to-day life, planning ahead, and in the moment decision making (Heilman et al., 2010). Thus, making health decisions is complicated by a history of trauma.

Often, wellness programs encourage better health decision making by self-restraint – abstinence of unhealthy eating, abstinence of substance use, and abstinence of sexual behavior (Gunning, Cooke-Jackson, & Rubinsky, 2020; Mandal et al., 2020). The problem with these approaches is that they don’t work for many people, they can encourage problematic feelings such as shame, and they assume people have the resources for alternative coping strategies (Luria & Torjman, 2009). For instance, mindfulness and meditation are now a popularly promoted activity regarding wellness and coping with daily stress. However, for individuals with significant traumatic experiences, mindfulness activities can trigger painful memories and feelings (Dobkin, Irving, & Amar, 2012). Similarly, suggestions of yoga and other physical activities by schools or workplaces must be considerate of disability status and access to resources such as gyms.

Any messaging to increase healthy decision making is much more likely to be successful if it considers the values and feelings of the people within it (i.e., is appropriately emotionally driven), is flexible (i.e., comes with a variety of options), and offers assistance (i.e., supplies necessary resources to perform healthy tasks; Stead et al., 2019). For example, providing funds for members of your community to engage in alternative coping (e.g., money for therapy), transportation or available space (e.g., quiet space for meditation), or necessary items (e.g., condoms, yoga mats, healthy foods) are all going to increase the strength of your messaging.

Cultural norms in certain environments can also send mixed messages to individuals. For example, workplaces that encourage wellness, but host events where alcohol is the central component, can unintentionally isolate individuals in recovery and trigger individuals who have experienced sexual assault and harm in spaces where people were inebriated. Developing cultural norms around safety and consent (e.g., letting people say no to alcohol), and hosting events with a varied agenda or series of activities increase inclusion and likelihood of connection that encourages healthy decision making. Thus, encouraging healthy decision-making must come with a healthy dose of thoughtfulness regarding the variety of humans within your community. With the right tools, we can improve health outcomes for everyone by finding the right approach.



Bornovalova, M. A., Gratz, K. L., Delany-Brumsey, A., Paulson, A., & Lejuez, C. W. (2006). Temperamental and environmental risk factors for borderline personality disorder among inner-city substance users in residential treatment.
Journal of personality disorders,
20(3), 218-231.


Dobkin, P. L., Irving, J. A., & Amar, S. (2012). For whom may participation in a mindfulness-based stress reduction program be contraindicated?.
3(1), 44-50.


Gunning, J. N., Cooke-Jackson, A., & Rubinsky, V. (2020). Negotiatnig shame, silence, abstinence, and period sex: Women’s shift from harmful memorable messages about reproductive and sexual health.
American Journal of Sexuality Education, 15(1), 111-137.


Heilman, R. M., Crişan, L. G., Houser, D., Miclea, M., & Miu, A. C. (2010). Emotion regulation and decision making under risk and uncertainty.
10(2), 257.


Kim, J. H., & Choi, J. Y. (2020). Influence of childhood trauma and post-traumatic stress symptoms on impulsivity: focusing on differences according to the dimensions of impulsivity.
European Journal of Psychotraumatology,
11(1), 1796276.

Luria, G., & Torjman, A. (2009). Resources and coping with stressful events.
Journal of Organizational Behavior: The International Journal of Industrial, Occupational and Organizational Psychology and Behavior,
30(6), 685-707.


Mancini, A. D. (2020). Heterogeneous mental health consequences of COVID-19: Costs and benefits.
Psychological Trauma: Theory, Research, Practice, and Policy,
12(S1), S15.


Mandal, S., Shah, C., Pena-Alves, S., Hect, M. L., Glenn, S. D., Ray, A. E., & Greene, K. (2020). Understanding the spread of prevention and cessation messages on social media for substance use in youth.
Aslib Journal of Information Management.


Messman-Moore, T. L., & Bhuptani, P. H. (2017). A review of the long‐term impact of child maltreatment on posttraumatic stress disorder and its comorbidities: An emotion dysregulation perspective.
Clinical psychology: science and practice,
24(2), 154.


Stead, M., Angus, K., Langley, T. Katikireddi, S. V., Hinds, K., Hilton, S., … & Bauld, L. (2019). Mass media to communicate public health messages in six health topic areas: A systematic review and other reviews of the evidence.
Public Health Research.


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