Compassion Fatigue and Compassion Satisfaction

Witnessing highly emotional situations or suffering on a regular basis can have far-reaching effects on front-line, caregiving professionals. Compassion fatigue is the depletion of internal (cognitive and emotional) resources resulting from exposure to others’ traumatic suffering and/or highly emotional situations.

Some researchers say that compassion fatigue is a natural consequence of acting in the role of a caregiver, which demands that we take on the experience of the “other” in order to be of service. If we can be traumatized by watching someone else’s crisis unfold, it is essential that those of us who work with pain and trauma in our daily work learn what it means to prevent, as well as manage, the symptoms that result from exposure.

“Developing our capacity for compassion makes it possible for us to help others in a more skillful and effective way. And compassion helps us, as well.”

– Joan Halifax

Compassion fatigue commonly includes emotional, cognitive, physical and behavioral signs of trauma-related distress:

• Psycho-social symptoms: detachment, social withdrawal, “numbness,” irritability, overwhelm, and a significantly diminished capacity for pleasure or joy.
• Cognitive symptoms: diminished concentration, self-doubt, obsessive thoughts, poor judgment, apathy, impaired memory and rigidity.
• Physical symptoms: appetite disturbance, GI upset, high blood pressure, headaches, chronic pain, sleep disturbance, and exhaustion.
• Behavioral symptoms: substance use or other self-medicating behaviors, short-fused outbursts, proneness to accidents/errors, hypervigilance, and nightmares.

The fear-based reactivity that marks a trauma response is associated with sympathetic nervous system dominance and compromised cognitive functioning. Even without chronic work-related strain, the human brain’s primary function is to discern and respond to danger – not to make us feel happy and well-balanced. The amygdala, which is part of our central stress circuitry, is responsible for detecting and assessing threats. With repeated exposure to stressful stimulation, the amygdala becomes hyper-aroused, leading to prolonged activation of our stress circuitry and indiscriminate hypervigilance to otherwise innocuous stimuli. This fear-based reactivity also sets the stage for sympathetic nervous system dominance, compromised cognitive functioning, and “empathic over-arousal.” In short, compassion fatigue is not the result of caring too much, but the result of hyperarousal in the face of suffering. The good news, however, is that neuroplasticity makes recovery and resilience possible for those who are willing to engage brain-healthy habits that improve self-regulation. Self-regulation is key to being able to accurate perceive and respond to suffering without losing your sense of safety and self.

Not everyone who works with trauma develops compassion fatigue or experiences burnout! A survey of 200 veterinary practices in the United States revealed that over 50% of veterinary technicians scored between a moderate and extremely high risk of developing compassion fatigue; those same technicians, though, also noted that helping animals, working as a team, and working with grateful clients helped protect them from compassion fatigue. Cultivating “compassion satisfaction,” or deriving deep satisfaction from being of service, is a critical to counter-balancing the effects of working with suffering on a regular basis. To self-assess your current levels of both compassion fatigue and compassion satisfaction, follow this link to complete the Professional Quality of Life (ProQol) survey: http://www.proqol.org/ProQol_Test.html. The ProQol can be printed and self-scored to provide you with immediate feedback on where you are doing well, and where you may benefit from adjusting your self-care routine.

Once you have a snapshot of your compassion fatigue/compassion satisfaction levels, you can plan activities to further bolster your resilience. The “antibodies” to compassion fatigue include:

Self-regulation and reflection:

Regulating our own responses requires that we differentiate between working from a place of strength and confidence versus working from a place of fear. Learning how to discern your body’s responses to stress, and then modifying those responses, is the key to engaging the parasympathetic nervous system and accessing the higher brain. Chronically stressed workers benefit from pressing the “re-set” button by unplugging from technology, exercising to discharge negative energy, and engaging in reflective practices (such as mindfulness meditation). In fact, mindfulness practice, in particular, has been shown to improve self-regulation, empathy, and emotional stability.

Social support and connection:

Those who work with suffering need to create and utilize a safe and supportive community of others who can listen to even the most painful work experiences without judgment. Supportive relationships (personal and professional) moderate stress, improve our appraisal of stressors and threats, and reduce the symptoms of both burnout and compassion fatigue.

Purpose and meaning:

Getting back in touch with what inspired you to pursue veterinary medicine will help in clarifying your personal values and then applying those to values to your work. Intentional behaviors maximize the alignment between what you value, what you’re good at, and what you actually DO at work each day – and this kind of behavior reinforces self-regulation while building self-efficacy. By intentionally living and working in alignment with your values, your ability to work productively with suffering will grow.

Positivity and gratitude:

The power of positive thinking, and the ability to perceive and celebrate positive outcomes, are highly correlated with lower levels of compassion fatigue and higher levels of compassion satisfaction. When people are able to focus on what is going well and cultivate positive thinking, they combat the brain’s inherent negativity bias and enhance their resilience to stress.

While veterinary practice carries with it routine exposure to high stress and suffering, there is much to be done to prevent – and heal — compassion fatigue. Religious attention to self-care, when combined with healthy work-life boundaries and ample support, can ensure that helping professionals have the tools they need to counteract traumatic exposure and achieve satisfying, engaging careers over the long haul.