Compassion Fatigue - Part 2

In Compassion Fatigue - Part 1, we explored what it is, how it looks, how it feels, and how to work out if it applies to you (see below if you missed this). In Part 2, Lift Clinical Psychologist Nicole Ferrar explores what you can do if you are suffering from Compassion Fatigue.

So, if you identified that you might be suffering from Compassion Fatigue or you are in a caring role and now know to be mindful of it showing up, what can you do?Just as flight attendants remind us on the plane, in the event of an emergency you must first secure your oxygen mask before helping others. What this means is, that you need to make sure you are okay (and breathing) before you can effectively care for someone else. 

The first step toward fitting your oxygen mask is to be aware of your own wellbeing and notice when Compassion Fatigue is creeping up (refer back to the previous newsletter article if needed). Then consider the following 5 suggestions (I know that sounds like a lot and you are already very busy caring for others, but it’s not as overwhelming as it first sounds!): 

1) Self-regulation skills (particularly, mindfulness) 

2) Look at your thinking 

3) Connect with your values and purpose 

4) Use your support system 

5) Self care & Self compassion 

1) SELF REGULATION SKILLS 

Persistent stress and trauma from the work of caring can lead you to feel on edge, like the engine of the car is constantly running. It’s important therefore, to know how to settle the physiological responses of your body. You can: 

a) Settle your breathing – slow and steady 

b) Practice mindfulness 

c) Soften your visual focus – to reduce the tension in the muscles around your eyes 

d) Spend more time in nature 

e) Pray 

f) Listen to calming music 

g) Massage your shoulders and neck 

j) Whatever works for you to reduce anxious or stressed physical arousal. 

In particular, consider introducing Mindfulness to your life. Mindfulness seems very ‘in vogue’ at present, but for good reason. There is ample evidence that mindfulness enhances wellbeing for patients, carers, people who are anxious or depressed, people who are stressed, professionals… and humans, generally. 

Mindfulness borrows from the Eastern tradition of meditation and was brought into mainstream psychology and medicine by Jon Kabat-Zinn (to whom I express gratitude for his contribution). 

Mindfulness involves the practice of, bringing close, careful attention to the present, with curiosity and without judgement. It involves focusing on the here and now by noticing what’s with you right now in your experience. 

Mindfulness can counter the tendency to ruminate about the past or worry about the future. It can also help us develop the capacity to step back and just notice our experience, rather than struggle with it, try to push it away or entangle with and get carried away by it. 

Mindfulness is a skill to be developed, which means it takes practice. Perhaps start with a few minutes a day and consider simple, accessible and portable options like Apps on your phone to help guide your mindfulness development. 

2) LOOK AT YOUR THINKING 

What are you saying to yourself? While at work? When feeling stressed or distressed? When feeling anxious? Or angry and irritable? While caring for someone? 

What we think and tell ourselves about ourselves, the world and others, has a profound and direct impact on how we feel – emotionally and physically. So by gently challenging our thoughts and checking their accuracy, we make way for new thoughts and new ways of looking at a situation. This in turn can influence our emotions in a positive direction. 

For example: If you are feeling overwhelmed, burdened or inadequate in your capacity to help patients or your loved one – stop and think, ‘who is responsible for their entire well-being or longevity?’ It’s probably not you… Notice how you are judging, criticising or assessing yourself and consider shifting your attention to your efforts and good intentions, rather the outcomes of your patients or loved one. Try doing this by asking yourself – what if being kind and present for my patient/loved one is enough? Be open to the possibility that you are actually doing a good job and all that you can. 

Also consider shifting your thinking toward that of gratitude. Research has shown that deliberately practising gratitude reduces our experience of negative emotions including resentment, frustration and regret and it alleviates symptoms of depression. It also increases positive experiences like happiness and self-esteem. 

One way to introduce a practice of gratitude is to start a ‘gratitude journal’. Before bed each night, write down a few things for which you are grateful – research has shown that it helps improve sleep and it seems to foster resilience. Or throughout the day, just shift your attention to something for which you are grateful every now and then – notice the sunshine or the fact you got a good car park! 

3) CONNECT TO YOUR VALUES & PURPOSE 

It is important to talk about our values and sense of purpose as they underpin Compassion Satisfaction and can point us toward recovery from Compassion Fatigue. 

If you feel that, in your role, you are doing something worthwhile and important, that will enhance your Compassion Satisfaction and combat Compassion Fatigue. So it is important to: a) Find meaning and purpose in what you do; and b) Believe that you make a difference. 

So think for 1 minutes about why you do what you do - Why did you apply for a caring role? Or why are you caring for your loved one? Write down your answer and put it somewhere safe. Then in the future when you are feeling stressed and overwhelmed, or you lose sight of the reasons you are doing what you do, you can refer back to what you wrote and reconnect with your sense of purpose. 

If you are committed to this field, commit to actions that will promote your compassion satisfaction – make compassion satisfaction actions part of your work routine (just like putting on your uniform)

Compassion Fatigue - Part 1

 “The expectation that we can be immersed in suffering and loss daily and not be touched by it is as unrealistic as expecting to be able to walk through water without getting wet.” Remen, 1996

People who work in caring roles, either professionally or personally, are at risk of developing Compassion Fatigue. Sometimes referred to as ‘the cost of caring’, Compassion Fatigue can emerge suddenly or gradually over time in those of us who work day in day out with patients or those of us who are caring for a loved one with illness.

There is debate in the literature about the exact definition of Compassion Fatigue, but it is more than just feeling worn out or tired of caring for others, and it is more than the common effects of work place stress.

The following is a list of possible signs of Compassion Fatigue, taken from various articles, that you may recognise in yourself – the first 4 on the list are particularly relevant:

• Deep physical and emotional exhaustion

• Pronounced loss or deterioration in empathy for patients, loved ones and/or colleagues

• Feelings of worthlessness and inefficacy (at work)

• Irritability

• Feeling overwhelmed and depleted

• Chronic dissatisfaction with work-related issues (ie. politics and resourcing)

• Loss of interest of motivation for helping

• Extreme state of physical and mental stress

• Hyper arousal and hyper vigilance

• Preoccupation with thoughts about the suffering and traumatic experiences of others

• Anxiety

• Feeling numb or shutdown

• Anger and irritability

• Dread of working with certain patients or seeing ill loved ones

• Irrational fears

• Hypersensitivity or insensitivity to emotional content

• Impaired ability to make decisions and care for patients

• Low mood

• Low motivation generally

• Loss of passion and enthusiasm

• Unhappiness

• Sense of foreshortened future

• Exaggerated startle response

• Difficulty concentrating

• Self-doubt

• Increased use of alcohol or drugs

• Intrusive imagery or dissociation

• Stress-related illness, headaches, digestive issues

• Absenteeism

• Sleep changes

• Nightmares

• Appetite and weight changes

• Loss of interest in social activities or connecting with others

• Relationship issues

You are not experiencing Compassion Fatigue (even just Burnout) if you have just a few of these symptoms – you need a whole bunch. And we need to be aware that many of the signs of Compassion Fatigue listed above also look a lot like a mood disorder, like depression, or an anxiety disorder.

So, what makes us vulnerable to compassion fatigue?

For professional helpers (nurses, doctors, physios etc), work or environmental factors play a role, such as: work pressure; the volume of patients and paperwork; support resources (or lack thereof); and long-term exposure to illness or deaths are all factors. For personal carers (loved ones), these environmental/work factors can have an impact also.  

But many personal factors also play a role in how vulnerable a helper may be to developing Compassion Fatigue. Personal factors include: work-life balance (some people are better at that than others); perfectionism (how hard you drive yourself, how self-critical you are and your expectations of yourself; use of social support; past care giving experiences; work experience; personal relationship boundaries; and many others.

Health care professionals are particularly vulnerable to Compassion Fatigue, as they often enter the lives of patients at very critical and are trying to alleviate the patients fear and sadness.  The emotion, empathy and intuition required for helping can leave us vulnerable to Compassion Fatigue, as we can feel like we aren’t doing enough.

So, if you are concerned about your wellbeing or wonder how you are tracking in your caring role, consider doing the ProQOL measure. It is an easy, self-report, free online 30-item questionnaire that includes information about how to score your results. The questionnaire assesses 3 areas, which the creators determined contribute to professional quality of life (as a carer) – Burn Out and Secondary Traumatic Stress, which they collate to get a Compassion Fatigue score, and Compassion Satisfaction.

The QOL is nice because it introduces the concept of Compassion Satisfaction. Compassion Satisfaction is the ability to enjoy or feel satisfied with what you do as a carer/helper.

It is a great concept to contemplate because keeping it front of mind can help us balance out Compassion Fatigue. They are on a spectrum and can coexist, so the goal is to increase Compassion Satisfaction and reduce Compassion Fatigue. Think about Compassion Satisfaction as the benefit of caring (as opposed to the cost of caring) and allow yourself to stop and notice every now and then, what benefits you are gaining from your caring role.

Try the measure here: https://proqol.org/uploads/ProQOL_5_English.pdf

How can you safely access exercise when you have cancer?

Despite the growing body of evidence around the benefits for people with cancer accessing exercise while they undergoing treatment, there are still significant barriers.

As a result, people who are having treatment for cancer commonly reduce their exercise levels and miss out on the positive outcomes exercise offers such tumour suppression and reduced tumour presence, reduced fatigue associated with cancer treatment and improved chemotherapy completion rates.

• People who are undergoing treatment for cancer will commonly experience physical barriers to exercise, such as fatigue, nausea, pain and weakness.

• Treatments such as chemotherapy will often result in a compromised immune system, meaning increased vulnerability to infection and further sickness from people in the community. Going to a regular gym is not safe when you are in this position as infection control risk is not adequately managed.

• Treatments for cancer will commonly result in the body responding differently to exercise. Examples of this include changes in blood pressure and variations in heart rate as a response to exercise. Clinical observations such as these must be monitored and managed in the context of the patient's full medical history and current cancer treatment regime, so that exercise can be accessed safely.

• People undergoing treatment for cancer are required to be continually assessed and monitored each time they want to exercise as their medical stability and therefore safety to accessing exercise is highly variable.

So how can exercise be made safe for people who are having treatment for cancer?

• Exercise needs to be prescribed under the supervision and monitoring of a medical practitioner.

• Exercise needs to be accessed in an environment which has specifically been designed to cater for the infection control and chemotoxic precautions required by this population.

• Patients need to be educated by health professionals about the significant benefits appropriately designed exercise can provide to their treatment outcomes and quality of life.