Compassion Fatigue

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Definitions

Compassion Fatigue: Emotional residue from working with those suffering from the consequences of traumatic events. It is the slow loss of ability to empathize with other people and is a general loss of physical and emotional energy. See more symptoms below. It can co-exist with burnout. 

Burnout: An unintentional endpoint due to chronic stress in the work environment. Burnout can include symptoms of the following: 

  • Emotional Exhaustion: Emotional resources depleted by intense needs of clients, workplace, supervisor
     
  • Reduction in sense of accomplishment: Feelings of inadequacy when clients don’t respond to efforts to help
     
  • Depersonalization: Emotional detachment from clients and coworkers
     

Compassion fatigue and burnout can occur from exposure to one case or many cases. Compassion fatigue is also known as “vicarious” or “secondary” traumatization. It can look like PTSD (intrusive thoughts, nightmares, irritability, avoidance, hypervigilance)

Signs and Symptoms of Compassion Fatigue

Signs and symptoms of compassion fatigue: - Headaches - Mood swings - Frequent use of sick days - Digestive problems: diarrhea, constipation, upset stomach - Excessive use of substances: nicotine, alcohol, illicit drugs - Avoidance or dread of working with certain people - Muscle tension - Depression, anxiety - Reduced ability to feel empathy - Sleep disturbances - Irritability - Lack of joyfulness - Fatigue - Oversensitivity - Cardiac symptoms: chest pain/pressure, palpitations, tachycardia - Memory issues, poor concentration, focus and judgment - Anger and resentment

Different phases of Compassion Fatigue

Zealot Phase

  • Initial phase of enthusiasm when you feel you are making a difference in your profession. You may work late, put in extra hours, or go the extra mile with tasks and demands.
     
  • Though you may be over stressed, you make excuses and justify the stress by reflecting on your professional experience.
     
  • You may recognize that you are beginning to lose control, so you push through by working harder thinking the fulfillment will ease your stress and make the bad feelings disappear. 
     
  • When the stress starts to catch up with you, you may experience difficulty breathing, increased heart rate, aches and pains, dizziness, shock, and sweating.

Irritability Phase

  • In the irritability phase, you may begin noticing behaviors at work such as daydreaming and becoming distracted, an increase in mistakes and oversights, and cutting corners.
     
  • You may notice changes in your personality such as a loss in your sense of humor. You may be more cynical and critical of others, resorting to mocking them and criticizing them unfairly. 
     
  • Overall in this phase, you feel undervalued and under-resourced, like you are not good enough for your job. You may begin to blame others for not having the resources or processes that will help you overcome the obstacles of getting your work done. You might start to shame yourself and beat yourself up for not being able to handle things. 
     
  • This is in contrast to how you felt in the zealot phase or when you started the job. Maybe you did feel under-appreciated or undervalued at an earlier point, but you said to yourself, “its okay, these families need me". 
     
  • You become impatient, irritable, moody, angry.
     

Withdrawal Phase

  • In the withdrawal phase you are tired all the time. Your sleep patterns are inconsistent. You may sleep all the time or not sleep enough. You may experience difficulties getting to sleep, or you wake up in the middle of the night and you can’t fall back to sleep. 
     
  • You may experience deficits in your immune system, getting colds constantly that never seem to clear up.
     
  • You might start to experience the trap of self-entitlement, meaning you begin justifying your negative and maladaptive behaviours because of the positive things you stand for and the positive nature of your work. “I worked overtime this week so it’s okay if I get wasted this weekend, I deserve it.”
     
  • You may experience difficulty concentrating, confusion, spaciness, racing and blurring thoughts. Your work starts to blend in with each other, making it hard to distinguish between the families you are working with.
     
  • You may start to withdraw, neglect, and detach yourself from your clients, friends, family, and co-workers.
     
  • The negative consequences of this phase include using negative coping mechanisms like substance use (smoking, alcohol, and other substances that are used and misused).
     
  • There is a potential for thoughts of self-harm or harming others arises.

Zombie phase

  • You begin feeling like you are on autopilot. You feel less confident in your work and notice you are making mistakes.
     
  • You not only feel disconnected from yourself and others, but from your role in your profession. You begin to doubt your abilities, and your confidence that you are doing good work begins to disappear. 
     
  • You may feel like you have nothing left to give, whether that is to the people you are working with, your friends and family, and yourself. 
     
  • You feel depleted, empty, and numb.
     
  • Again, there are the potential negative consequence described in the withdrawal phase such as substance use, negative coping mechanisms, and self-harm.

Self Care

Self-Care Tips
  • Minimize trauma input outside of work (TV, news, etc.)
  • Meditation, mindfulness, exercise, yoga
  • Find time for yourself every day
  • Check-in with your emotions. Sit quietly and just name without judgment what you’re feeling.
  • Delegate tasks at work and at home. Try not to take your work home with you (literally and figuratively)
  • Have a transition from work to home (changing clothes, short walk)
  • Take another route to work. Mixing up your routine in small ways creates new neural pathways in the brain to keep it healthy.
  • Declutter and redecorate your workspace
  • Unplug for an hour. Switch everything to airplane mode and free yourself from the constant bings of social media and email.
  • Join a supervision/peer support group
  • Be selfish. Do one thing today just because it makes you happy.
  • Attend workshops/professional training
  • Ask for help—big or small, but reach out.
  • Scratch off a lurker on your to-do list, something that’s been there for ages and you’ll never do.
  • Start a compliments file. Document the great things people say about you to read later.
  • Reflect on three good things that happen every day
  • Cut yourself a break
  • Say no to strenuous demands more, and yes to more self-care

Resources

Crisis Prevention Institute https://www.crisisprevention.com/Blog/August-2015/Compassion-Fatigue

Compassion Fatigue Awareness Project http://www.compassionfatigue.org/pages/resources.html

Life Stress Test http://www.compassionfatigue.org/pages/lifestress.html

Empathy Test http://www.tarameyerrobson.com/empath-test/

Compassion Fatigue Self Test https://www.crisisprevention.com/Blog/August-2015/Compassion-Fatigue

Professional Quality of Life Measure https://proqol.org/

Figley Institute http://www.figleyinstitute.com/indexMain.html

Self-Care Resource Center - https://www.apa.org/helpcenter/self-care 

Sources:

Figley, C. R., & Roop, R. G. Compassion fatigue in the animal-care community. Humane Society Press, 2006.  https://animalstudiesrepository.org/cgi/viewcontent.cgi?article=1004&context=ebooks

Lee, E., Esaki, N., Kim, J., Kirkland, K., & Mitchell-Herzfeld, S. (2013). Organizational climate and burnout among home visitors: Testing mediating effects of empowerment. Children and Youth Services Review, 35, 594-602.

Lombardo, B., Eyre, C., (Jan 31, 2011) "Compassion Fatigue: A Nurse’s Primer" OJIN: The Online Journal of Issues in Nursing Vol. 16, No. 1, Manuscript 3. doi: 10.3912/OJIN.Vol16No01Man03

Miller, B. & Sprang, G. (2017). A components-based practice and supervision model for reducing compassion fatigue by affecting clinician experience. Traumatology, 23(2), 153-164. doi: http://dx.doi.org/10.1037/trm0000058

Newell, J. M. & MacNeil, G. A. (2010). Professional burnout, vicarious trauma, secondary traumatic stress, and compassion fatigue: A review of theoretical terms, risk factors, and preventive methods for clinicians and researchers. Best Practices in Mental Health, 6(2), 57-68

Raab, K. (2014). "Mindfulness, self-compassion, and empathy among health care professionals: a review of the literature." Journal of health care chaplaincy, 20(3), 95-108.  www.h-partners-for-life.com/wp-content/uploads/2017/04/Mindfulness-Self-Compassion-and-Empathy-Among-Health-Care-Professionals-A-Review-of-the-Literature.pdf