In my work with human service organizations, compassion fatigue is one of the most requested training or consultation topic. I have found that organizations are getting better at recognizing the need for self-care. However, most efforts lack a true understanding of what compassion fatigue is and how to best combat it, both individually and within the organizational culture.
Compassion fatigue is a condition effecting those who routinely care for others such as social workers, nurses, physicians and first responders. It is the cumulative effect of chronic stress and exposure to the trauma of others (known as secondary or vicarious trauma.) Those who routinely witness the aftermath or hear stories of trauma, can experience symptoms that mirror PTSD. Repeated exposure to secondary trauma is exacerbated by the chronic stress associated with the work. This leaves helping professionals feeling both mentally and physically exhausted. Those who suffer from compassion fatigue often report experiencing dissociative symptoms such as being “in a fog.” They can also struggle to feel empathetic towards clients. Additional psychological symptoms can include distractibility, irritability, anxiety, anger and sleep disturbances as well as physical symptoms such as headaches and nausea.
Although it is important to recognize the symptoms, truly understanding compassion fatigue begins with understanding the brain. One of primary goals of our complicated brain is survival.
Our nervous system has billions of pathways that send and receive messages across different regions of the brain and to the body. Our autonomic nervous system controls unconscious body functions such as breathing, heart rate, circulation and digestion. It is made up of two opposing systems. When the parasympathetic side of the autonomic nervous system is stimulated, it helps to regulate our normal body functions. But, when the brain sends the distress signal, the sympathetic side prepares the body for fight or flight by increasing heart rate, concentrating blood flow, and slowing down the body functions it determines to be less essential.
Compassion fatigue is our survival response to chronic stress and exposure to the pain and trauma of others. Mirror neurons that help us to be empathetic, allow us to feel another’s suffering. Because being empathetic and compassionate can be painful, our brain interprets empathy and compassion as a threat which triggers our body to prepare for a fight, flight or freeze survival response.
In addition to stimulating the “fight or flight” responses of the sympathetic nervous system, the brain can also trigger a “freeze” survival response. This can include the numbing of emotions and avoiding empathetic responses that leave us vulnerable to more pain.
This can lead us to believe that we are depleted of compassion. In fact, this is not the case. Compassion is renewable.
A good analogy to help us understand compassion fatigue is the circuit breaker box in our homes. We have probably all had the experience of having too many electrical appliances running at once. As a safety feature, this condition can sometimes “trip the breaker.” When this happens, the power goes out. This does not mean that we are out of electricity. We just need to unplug a few things and reset the circuit breaker to restore power.
Too often, caring professionals don’t take the time or are unaware of the need to reset.
The great paradox of compassion fatigue is that compassion is not only the trigger, it is the antidote. We don’t need less compassion, we need to restore its ability to heal and connect us. Therefore, combatting compassion fatigue requires cultivating compassion. It involves skill sets and mindsets that go beyond self-care (though this is an important component.) In individuals, these skills involve practice until they become habit. Cultivating compassion in organizations involves embedding these practices in the culture:
Self-awareness: This includes the ability to be able to identify thoughts and feelings, both emotions and body sensations, and recognizing our triggers and responses.
Self-regulation: Deep breathing, mindfulness exercises and other techniques can help “reset the breaker” and restore our autonomic nervous system to the parasympathetic state.
Exercising empathy: Responding with empathy instead of judgment enhances our ability to connect.
Clarifying boundaries: All healthy human interactions need boundaries. Healthy boundaries are clearly defined and communicated. They help us to be able to function safely and allow us to safely practice empathy.
Routine debriefing: Develop a habit of processing the events of the day including thoughts and feelings without judgment. Debriefing not only increases self-awareness, but it creates a healthy boundary that allows us to put the day behind us and be present for other aspects of our life.
Expressing gratitude: Cultivating a gratitude mindset helps us to focus on the positive and is linked to increased overall well-being.
Connecting: The benefits of social connectivity are numerous. In addition to the support and added resources a strong social network can provide, the oxytocin produced when we connect socially promotes well being and stress recovery.
Practicing self-care: Developing habits that are good for the mind, body and spirit increases our well-being and decreases our vulnerability to compassion fatigue.
It is an inevitable truth that we cannot deny compassion for others without denying compassion for ourselves and we cannot withhold self-compassion without eventually withholding it from others. Therefore, combating compassion fatigue and restoring compassion is crucial for both human service organizations and each individual care provider.