Education Standards
Control_Demand_Support
Identifying_Your_Sources_of_Stress
Internal_External_Stressors-2
Learn_to_Say_No
Letting_Go
Professional_Interventions-2
Signs_Symptoms_Checklist
Wheel_of_Life_Exercise
Compassion Fatigue
Overview
Compassion Fatigue
Introduction
“Self-care is not selfish. You cannot serve from an empty vessel.” – Eleanor Brownn.
Course Introduction
The course is designed to help you understand where you personally stand in terms of experiencing Burnout, Compassion Fatigue, and Vicarious Trauma. Once you have completed the assessments, the course aims to help you navigate and manage these conditions by teaching you resilience techniques.
“Take care of your body. It’s the only place you have to live.” – Jim Rohn, author and motivational speaker.
Disclaimer
This course targets issues related to how work affects you. While working through the material, you may experience powerful feelings and reactions. This course is not meant to substitute for psychological counselling or medical care. If you’re feeling vulnerable at any time, it is best to work through the course with the help of a Mental Health Professional.
If you suspect that you are suffering from clinical depression or PTSD, immediately seek help from a Mental Health Professional.
Overview
The course emphasizes helping learners understand burnout, compassion fatigue, and vicarious trauma. It also provides assessment tools to determine one's mental, emotional, and physical status and guidelines on managing one’s personal needs.
Outline
The course is divided in 8 Sections:
- Course Introduction
- The Cost of Caring
- Risks of caring
- Professional Quality of Life
- Signs and Symptoms
- Detection: Getting Real
- Interventions
- Prevention
- References
Learning Objectives
After this course, participants should have:
- An understanding of Burnout, CF and VT
- Do self-assessments and understand where they personally stand concerning these conditions and the importance of self-assessment.
- The ability to recognize these conditions in colleagues
- The tools to manage these conditions in themselves
- Creating awareness of these conditions
The Cost of Caring
“The capacity for compassion and empathy seems to be at the core of our ability to do the work and at the core of our ability to be wounded by the work.”
— C. Figley
Introduction
Helping professionals have the vital task of meeting their clients' and patients' physical and/or emotional needs. In general, this can be an extremely rewarding experience. It is a calling, a highly specialized work, unlike any other profession. Unfortunately, these highly skilled and rewarding professions can take their toll due to increasingly stressful work environments, heavy caseloads and dwindling resources, cynicism and negativity from co-workers and low job satisfaction, leaving workers drained and traumatized.
According to Eric Gentry, Ph.D., LMHC, an internationally recognized disaster and clinical traumatology leader, CF is the sum of VT plus Burnout.
VT + Burnout = CF
Burnout
Burnout is a commonly used term when helpers feel exhausted by their work.
The World Health Organization (WHO) states: “Burn-out is a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed.”
Burnout is a response to prolonged or chronic job stress and is commonly characterized by three main dimensions: exhaustion, cynicism, and feelings of decreased professional ability. In other words, you feel exhausted, start to hate your job, and feel less capable of doing your job.
It is often tricky for people to recognize burnout in themselves, as there is a thin line between chronic stress and slipping into burnout.
Top 10 signs you are suffering from burnout
- You’re so tired you now answer the phone “Hell.”
- When your friends call to ask how you’ve been, you immediately scream, “Get off my back!”
- Your garbage can is your inbox.
- You wake up because your bed is on fire but go back to sleep because you don’t care.
- You have so much on your mind you’ve forgotten how to pee.
- Visions of the upcoming weekend help you make it through Monday.
- You sleep more at work than at home.
- You leave for a party and instinctively bring your briefcase.
- Your phone exploded a week ago.
- You think about how relaxing it would be if you were in jail right now.
—Anonymous
Compassion Fatigue (CF)
CF is the physical and mental exhaustion and emotional withdrawal experienced by those who care for sick or traumatized people over an extended period of time.
Unlike burnout, which is caused by everyday work stresses, compassion fatigue results from taking on the emotional burden of a patient's experience.
Elizabeth Bach-Von Valkenburg describes Compassion Fatigue as "The emotional residue of working with suffering clients."
CF refers to the deep emotional and physical exhaustion that helping professionals/workers can develop throughout their careers. It is a progressive deterioration of everything that keeps us connected to others: our empathy, hope, and compassion for others and ourselves. When we are suffering from compassion fatigue:
- we start seeing changes in our personal and professional lives
- we can become disheartened and progressively bitter at work
- we may contribute to a toxic work environment
- we are more prone to clinical errors
- we may violate client boundaries
- may become disrespectful towards our clients.
- We become short-tempered with our loved ones and feel constant guilt or resentment at the never-ending demands on our personal time.
CF is an occupational hazard, which means that almost everybody in a helping role will ultimately develop a certain degree of CF, varying in severity. It can happen to the most dedicated people in the helping field. Charles Figley, the father of CF, has called compassion fatigue a “disorder that affects those who do their work well.”
The level of compassion fatigue that a helper experiences can vary from one day to the next, and even very healthy helpers with optimal work/life balance and self-care strategies can experience a higher than normal level of compassion fatigue when they are overloaded. We do not develop compassion fatigue because we did something wrong—we develop it because we care!”
We cannot walk through water without getting wet. We cannot do this work without being affected by it.” - Naomi Remen
Burnt-out, worn down, fatigued, and traumatized helpers tend to work harder and more. This results in an exacerbation of their condition and can lead to serious physical and mental health difficulties.
Vicarious Trauma (VT)
VT, also known as secondary trauma, is the gradual change or disruption of a helper’s inner thought process, beliefs, feelings/emotions, images and spirit as a result of repeated exposure to other’s traumatic experiences.
Tend Academy describes VT as follows; “Vicarious trauma (VT) and Secondary Traumatic Stress (STS) are frequently used interchangeably to refer to the indirect trauma that can occur when we are exposed to difficult or disturbing images and stories second-hand.”
Laurie Anne Pearlman and Karen Saakvitne coined the term Vicarious Trauma to define the seriously altered worldviews that workers experience when working with trauma and/or trauma victims. Workers detect that their beliefs about the world have changed and are probably impaired. Although these traumatic events are not happening to us, we find it hard to free ourselves from traumatic images and stories. Pearlman and Saakvitne explain, “It is not something clients do to us; it is a human consequence of knowing, caring, and facing the reality of trauma.”
VT does not happen overnight and is not caused by a single traumatic event; it is a cumulative process; we are talking about the hundreds or even thousands of exposures to other people’s trauma we have experienced.
PTSD
In this course, we will not be dealing with PTSD, but it is important to understand the differences and similarities between PTSD and VT.
According to the Mayo Clinic: “Post-traumatic stress disorder (PTSD) is a mental health condition that's triggered by a terrifying event — either experiencing it or witnessing it.”
Three main types of symptoms characterize the disorder:
Re-experiencing the trauma through intrusive distressing recollections of the event, flashbacks, and nightmares.
Emotional numbness and avoidance of places, people, and activities that are reminders of the trauma.
Increased arousal, such as difficulty sleeping and concentrating, feeling jumpy, and being easily irritated and angered.
PTSD versus VT
Both these conditions are mental health disorders caused by trauma, PTSD by direct trauma and VT secondary exposure to trauma.
As described above, with PTSD, the re-experiencing of the trauma transpires through intrusive distressing recollections of the event, flashbacks, and nightmares. The symptoms of VT are much more subtle and often seen as normal by the person experiencing these symptoms. Intrusive symptoms in VT include:
Thoughts and images related to a client’s traumatic experience
Work/client issues infringe upon personal time
Assessing Risk.
You are not alone.
Dr Linda Duxbury, an accomplished researcher, writer, and speaker on work/life balance, studied role overload in healthcare. She defines it as having too many competing demands and too many roles (too much work, too little time).
Following are a few of her findings:
3 in 5 healthcare workers suffer from role overload
1 in 4 employees were planning to leave the jobs for a job where they have greater control over their work hours and more respect, not higher salaries
1 in 3 staff members missed work due to emotional and physical fatigue
Duxbury also found that healthcare workers are in a poorer state of physical and mental health than staff surveyed in other sectors of the population. In healthcare, 59% report high levels of stress, 36% report high levels of depressive moods and 1 in 5 poor physical health.
The Risk of Helping
We must be realistic about the risks innate to our work as helpers; only by acquiring the necessary knowledge can we be aware of possible dangers and identify and prevent them in ourselves and those around us. The risks may be quite subtle. Compassion fatigue and burnout develop over time. Compassion fatigue educator Francoise Mathieu (2011) noted, “We are not referring to the most difficult story you have ever heard; we are talking about the thousands of stories you don’t even remember hearing.”
In general, risks come from client behaviour and issues, work conditions and personal factors:
Client Issues
Client behavioural issues such as chronic depression, extreme anxiety, resistance, dependency, anger and volatility.
Client medical issues, such as chronic or terminal illness and chronic pain.
In current circumstances, high mortality rates and dealing with anxious next of kin.
Working Conditions
Office Politics
Documentation demands
Heavy caseloads
Lack of administrative support
Working in an organization that places a high demand on staff and a low priority on staff satisfaction or fulfillment
Inadequate training
Professional isolation may occur due to organizational structure, limited peer support and poor self-care.
Personal Risk Factors
Taking your work home with you
Connecting self-value to the outcome of your clients/patient
The continuous strain of hearing stories of sadness and struggle.
Symptoms are amplified in those with a great deal of non-work stress in your personal life.
Factors that raise the risk:
The secondary trauma was an act of human cruelty rather than accidental or Impersonal.
Longer exposure to the trauma of others
Several other stressors occur in the helper’s life at the time of the secondary trauma exposure.
Personal trauma history (60% of helpers have a history of trauma)
Lack of social support (this makes helpers four times more likely to experience compassion stress and two and a half times more likely to experience physical illness)
Helper is anxiety-prone or habitually negative.
Idealistic expectations of the ability to help others without consequence to self
Working in isolation
Download "Checklist: Assessing Risk"
Why do caregivers neglect self-care?
Many helping professionals take great care of others but aren’t as attentive about taking care of themselves. We may not always practice what we preach and are guilty of: “Do as I say, not as I do.”
A few reasons for this imbalance:
You may be unable to identify your distress level due to a lack of time for reflection.
Your distress may manifest in disguised ways (headaches leading to a search for a physical or medical explanation rather than a psychological one).
You may falsely attribute what is going on or what you need.
You may recognize the need for self-care, but due to limited time and multiple demands on your time, you may think that improved self-care is not feasible.
You may hold beliefs which get in the way of appropriately prioritizing self-care activities.
However, many who suffer do not reach out to peers or seek professional help. This may be because of dysfunctional beliefs regarding the need or appropriateness.
Typical examples of these kinds of dysfunctional beliefs include:
Not recognizing the severity of their distress
Not permitting themselves to seek help
Feeling that since they are helpers, they should be able to help themselves
Experiencing a sense of shame, failure or stigma if they acknowledge having issues
By seeking help, you are acting in the client's and your best interest; we should be more concerned about healthcare providers who need help but don’t seek it.
Insufficient self-care may result in:
Crippling personal distress
Impaired relationships
Moral and spiritual issues
Impaired professional behaviour, including ethical violations
Professional Quality of Life Measure (ProQOL) bu
Dr. Beth Hudnall Stamm developed the Professional Quality of Life Measure (ProQOL). Ownership of the ProQOL has been transferred to the Center for Victims of Torture.
"Professional quality of life is the quality one feels concerning their work as a helper. Both the positive and negative aspects of doing your work influence your professional quality of life. People who work helping others may respond to individual, community, national, and even international crises. They may be healthcare professionals, social service workers, teachers, attorneys, police officers, firefighters, clergy, transportation staff, disaster responders, etc. Understanding the positive and negative aspects of helping those who experience trauma and suffering can improve your ability to help them and your ability to keep your own balance." proqol.org.
It is important to note that this is not a diagnostic tool; instead, it will indicate where you are regarding Compassion Fatigue, Vicarious Trauma and Burnout.
The ProQOL is the golden standard of all BO, VT and CF assessments and is essential to this course.
Complete the ProQOL assessment and calculate your scores before continuing to the next module.
Download the assessment by clicking on the link at the top of the page.
Signs & Symptoms
The Maslach Burnout Inventory (Maslach, Jackson & Leiter, 1996) describes three aspects of burnout:
- Emotional exhaustion (“I feel emotionally drained by my work”)
- Depersonalization (“I worry that my job is hardening me emotionally”)
- Reduced personal accomplishment (“I don’t feel that I’m positively influencing other people’s lives through my work”)
The Burnout Measure (BM) developed by Pines and Aronson (1978) measures the following:
- Physical exhaustion (feeling tired or rundown)
- Emotional exhaustion (feeling depressed or hopeless)
- Mental exhaustion (feeling disillusioned or resentful)” (Teater and Ludgate., 2014, p.14)
Tables 1.1 & 1.2 are examples of CF/Burnout symptoms (Finley 2002, p.15
Detection - Getting Real
The Green Cross “Standards of Self-Care Guidelines” stipulates:
“First, do no harm to yourself in the line of duty when helping/treating others. Second, attend to your physical, social, emotional, and spiritual needs as a way of ensuring high-quality services for those who look to you for support as a human being.”
Read the above paragraph again; it is so important!
There are two levels on which Burnout, CF and VT should be addressed:
- On an Organizational and Professional level and
- On a Personal level
This course will focus on the personal level and how to help yourself and your colleagues. (We are designing a course for managers and supervisors to deal with the organizational and professional level; this course will be available soon).
“The professional work centred on the relief of emotional suffering of clients automatically includes absorbing information that is about suffering. Often it includes absorbing that suffering as well.”
(Figley,1995, p.2)
The Management Plan outlined in this course is a combination of the work of Francois Mathieu, Compassion Fatigue and Vicarious Trauma educator, Canada; Martha Teater, International Compassion Fatigue educator and consultant; John Ludgate, Licensed Psychologist; Eric Gentry, Traumatologist; Charles Figley.
In her book The Compassion Fatigue Workbook, Francois Mathieu suggests four steps to deal with and overcome CF and VT, namely:
- Taking stock of your stressors
- Enhancing your self-care and work/life balance
- Developing resilience skills
- Committing to implement change
You should have your Burnout, VT, and CF scores by now. This module will focus on you and what you need now.
Take Stock of Your Stressors
Take Stock of Your Stressors
Specialists in the field all agree that to learn strategies to deal with these conditions, it is of the utmost importance that you are willing to take an honest look at yourself.
1. Complete the "Signs & Symptoms of Compassion Fatigue and Burnout" assessment
2. Complete the "Identifying Your Sources of Stress"
3. Complete the "How Many Burnout/Stress Factors Do you Have?" assessment
4. Complete the "How Much Control, Demand, and Support is Present In Your Situation" assessment
5. Complete the "Identifying Your External and Internal Stressors" assessment
Take Stock of your Physical Well-Being
A body scan exercise is a simple way to become aware of your body in the present moment. It is also very effective in relaxation training and stress reduction.
I know medical staff! You are so busy that you ignore your body pain and discomfort; most of us, myself included, think that if we ignore it long enough, it will go away. We all know it won’t; we get used to it, and it becomes our new normal.
Check out body-scan exercises available online; here is a modified version.
- Lie in a quiet, peaceful room, close your eyes and focus on breathing.
- Focus on what is happening in your body. Slowly work your way down from the top of your head to your feet, isolating each body part. Focus on how every part feels now.
- Remember to keep breathing, and if your mind wanders, gently bring it back.
- When you are done, take three slow, deep breaths through your nose and gently open your eyes.
Take Stock and Limit Your Trauma Inputs
At the beginning of this module, we talked about limiting your trauma input; now, let us take stock of your daily trauma input.
- Starting at home, what do you do first thing in the morning? Watching morning news on TV? Listening to the radio or reading the paper? Note how many disturbing images, difficult stories, or actual photos of dead or maimed people you come across.
- What do you do on your way to work?
- Now, look at your work. Not counting direct client work, how many difficult stories do you hear, whether in a case conference, around the water cooler, debriefing a colleague, or reading files?
- What do you do on your way home? Do you listen to the news on the radio?
- Once you are at home, do you watch TV at night? What do you watch? If you have a spouse who is also in the helping field, do you talk shop and debrief each other?
Recognizing the amount of trauma information we unconsciously absorb during the day is important. We do not necessarily need to hear about these disturbing stories in graphic detail. We must create a “trauma filter” to protect ourselves from this information overload.
Now that you have taken stock remember what you have discovered. In the module on Developing Resilience Skills, we will teach you techniques to improve your current state.
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Intervention
Caring professionals are often so consumed with caring for others that they do not take care of themselves.
Leave Your Work at Work
Working with suffering individuals makes it hard to leave your work behind when going home. However, it is of the utmost importance and requires an intentional and deliberate transition home.
Following are some ideas that may help you in this regard:
- Before leaving work, make sure all your work is done and what is not done is handed over to the next shift
- Say goodbye to your colleagues, signifying the end of your workday
- Take a moment and focus on what you did well today
- Use your commute home to begin thinking of home and what the evening might hold
- Pick a geographical spot and decide that once you pass that spot, thinking of work is done
- Deliberately take off your nametag and leave it in the car
- Change out of your work clothes as soon as you get home
- Play with your children or your pet
- Go for a walk or sit outside and feel the elements
Self-Care and Work/Life Balance
If you don't take care of yourself right now, the consequences in the long run can be devastating, not only for you but for your family and career.
Self-care and work/life balance are key to recovering from and preventing CF. close
Remember, self-care is not something we figure out once and for all; it is a process that constantly changes as our needs change. Paying close attention and continuously making changes to your lifestyle is essential.
WHEEL OF LIFE EXERCISE
This exercise aims to raise awareness and allow you to plan and prioritize goals.
Balance should be assessed over time. Regular check-ins can give insight into behavioural patterns, track goals, and make adjustments as needed. I recommend doing the Wheel of Life monthly or more often if needed and always comparing it to the previous wheels.
Complete the "Wheel of Life" exercise.
Now, let us return to your completed wheel of life. Take a few minutes to review the categories and your score on each. After doing the previous modules, do you have to adjust your original scores? If so, rescore, but remember to score what comes to mind and not think about it too much.
Your filled-in parameters represent your wheel of life. On a piece of paper, write down your responses to the following questions:
- Are you satisfied?
- Are there any surprises?
- How do you feel about your life as represented by your wheel?
- How much time do you currently spend on each category?
- What would a ten look like in each category in your current circumstance?
- Which category needs your immediate attention?
- How can you make space for making changes in these categories?
- What help and support do you need to make these changes?
Look at your answer to question no. 7. prioritize these categories and ask yourself if there is one thing you can do to make a change. I know life is busy and stressful, but ask yourself, ‘What is the smallest step I can take to get started?’ Remember, a 1% change is better than nothing.
Complete the "Self-Care Check-In" exercise.
Solitude
“In the super-connected world, it has never been more important to create solitude for ourselves. Being ALONE with ourselves is essential for us to find happiness and joy, because it’s only when we’re alone that many of us can be - and see - our true selves”
Mathieu, (2014).
In an online article, Mathieu explains that other people will always need something from us, and only when we are alone can we take off our social masks and be fully ourselves.
Unfortunately, solitude is not something we are taught, and for many of us, being alone is associated with loneliness. There is a big difference between loneliness and solitude; loneliness is where you feel alone and disconnected from others, and you can feel lonely in a crowd. Solitude, on the other hand, is a choice we make to reconnect with ourselves, and connecting with ourselves can be very empowering.
Benefits
- Self-knowledge. “Solitude is at the heart of all self-knowledge because it is when we are alone that we learn to distinguish between the false and the true, the trivial and the important” Unknown
- Disconnecting from the busy allows us to be creative
- Solitude allows you to disconnect from what others think and feel about you and what you’re doing, and you can completely and utterly please yourself
- Solitude is energizing. “I have to be alone very often. I’d be quite happy if I spent from Saturday night until Monday morning alone in my apartment. That’s how I refuel” Audrey Hepburn
- Solitude gives you the space and privacy to process life’s problems and difficult emotions and can result in clarity
- Solitude allows you the space you need to gather your strength, conquer your demons, and learn to love yourself
- It allows you to appreciate the small things and be truly grateful
- Solitude gives you the space to notice what is and what is not working in your life and give you the answers you need
- In taking the time to be alone, you are confirming that you are worth it, and this instills confidence and builds up self-esteem.
Finding Stillness
- Don’t use every spare minute to cram your mind with more information
- Stop rushing from one thing to the next
- Take the opportunity between tasks and appointments to pause
- Take a break between your personal life and your work life
- Find stillness at the start of the day at lunchtime and the end of the day
- Have a short break when you get yourself a cup of coffee
- Just pause for no reason whatsoever
- Take a break from social media
Developing Resilience Skill
Stress resilience is the ability to recover from stress, upsets, and setbacks. Resiliency skills can be learned and developed with the right tools and training.
Deep Breathing
Benefits
Breathing is a function we all perform naturally and with little conscious awareness or effort. Deep breathing involves focusing on the breathing process.
Attention and effort are brought to each breath, allowing the belly and ribcage to completely fill with each inhalation, followed by complete exhalations, letting the air out.
Breathing exercises are typically easy to learn and can quickly help decrease nervousness. The exercises can also provide a cleansing effect, making you feel more relaxed, refreshed, and energized.
Deep breathing is often the foundation for many other relaxation techniques, such as progressive muscle relaxation (PMR), meditation, and visualization.
Chest breathing, which doesn’t allow for full, complete breaths, is often associated with increased feelings of anxiety.
Taking fuller breaths allows you to feel calmer and in control.
Breathing exercises can help decrease an accelerated heart rate and relieve muscle tension. They also clear the mind of anxious, fearful, and negative thoughts.
Watch this video:
For a more detailed version, watch video 2
A Deep Breathing Exercise
Deep breathing only requires a quiet environment and a few minutes of your time. The following are steps to a simple deep breathing exercise:
- Begin comfortably with a straight spine, such as sitting upright in a chair or lying on your back.
- Close your eyes or look down to assist in reflecting inward and focusing.
- Start to notice your breath. Are you breathing in and out of your chest? Are you breathing rapidly or slowly?
- Keep your shoulders relaxed and still, and begin to breathe with intention. Inhaling deeply and slowly through your nose, your center expands as you fill your body with breath. Gradually exhale through your mouth, letting all the stale air out.
- Continue to focus on your breath, noticing how your center rises and falls with each breath you take. Repeat for five to 10 more cycles of breath.
- As you breathe deeply, notice how you feel throughout your body. Are there areas that feel tenser than others? With each exhalation, imagine that your body releases stress and tension.
- Before ending your exercise, take a few moments to notice how you feel physically, mentally, and emotionally.
Focusing on your breath during a stressful situation is not as easy. To get the most out of deep breathing, it is important that you practice regularly and at times when you are not feeling anxious or stressed. If practiced often, you can utilize this technique during stressful situations.
Always focus on shifting from chest to abdominal breathing when practicing deep breathing. Take deep breathing exercises slowly and stop if you feel worse.
Pick a time to practice exercises that suit your lifestyle, but aim to work on your breathing for at least five to 10 minutes daily.
Self-Awareness
Self-awareness is a thought process whereby you focus on yourself: how are you doing physically, mentally and emotionally? Being self-aware will help you to tune into your feelings and behaviour as well as your feelings toward others.
Self-awareness is paramount for choice and control. If your thoughts and feelings operate outside of self-awareness, they control you. If you want to control them, the first thing to do is practice self-awareness, which would enable you to pause and consider before choosing, deciding and acting.
Self-awareness is the foundation of all other resilience and emotional intelligence skills.
Situational self-awareness
It is a process that can help you understand where you're at and what you need to do. In other words, it allows you to match your current actions to your internal standards and identify whether you need to adjust.
Dispositional self-awareness
Focusing on and reflecting on one's psychological processes and how they affect one's experience and relationships with others.
There are many ways to practice self-awareness; for this course, I have chosen the least time-consuming yet very effective methods to kickstart your self-awareness journey.
Mindful Meditation Technique
- Find a quiet space where you won’t be disturbed. Sit on a chair or the floor with a straight back and neck.
- Make a conscious effort to focus on the present moment and your breathing. Inhale through your nose for three counts and exhale through your mouth. Pay attention to the air filling your lungs and focus on releasing tension as you exhale.
- Don’t think about the past or the future; allow yourself to be in the moment.
- Pay attention to your thoughts, acknowledge them and release them as you exhale.
- Return to the present moment.
- Don’t be too hard on yourself if your mind wanders; gently bring your attention back to your breathing.
- Start aiming for a minute or so and work up to longer periods.
Guided Imagery:
Grounding Technique
Psychotherapist Dr. Sarah Allen states:
“One of the tools I teach my clients to utilize when they feel anxious is called Grounding. When your mind is racing, grounding brings you back to the here-and-now and is very helpful in managing overwhelming feelings or anxiety. It is a great way to calm down quickly. Grounding means bringing your focus to what is happening to you physically, either in your body or in your surroundings, instead of being trapped by the thoughts in your mind that are causing you to feel anxious. It helps you stay in the present moment instead of worrying about things that may happen in the future or events that have already happened, but you still find yourself going over and over them in your head.”
Grounding Chair Technique
- Sit in a comfortable chair with your feet flat on the ground and press your back into the back of the chair.
- Close your eyes and focus on your breath. Breathe in slowly for the count of three, then out slowly.
- Bring your mind’s focus to your body. Feel the contact between your body and the chair’s surface. If the chair has arms, touch it and be aware of the texture. Press your arms down the length of the chair arm, and notice how your hands hang off the end. If your chair doesn’t have arms, touch the material on the seat.
- Next, push your feet into the ground. Imagine the energy draining down from your mind, down through your body, and out through your feet into the ground. As the energy drains from your head, feel how each part of your body becomes heavy as it moves down to your feet and into the ground.
Go to drsarahallen.com for more grounding techniques.
Low-Impact Debriefing
Debriefing is an important part of our work.
Ask yourself the following questions: After/during a hard day at work, do you debrief all over your colleagues? Do your colleagues share graphic details about their day with you? Can you still debrief without using graphic details?
When working with difficult things, it is a normal reaction to want to debrief with someone to ease a bit of our burden. Returning to others for validation and support is healthy, but there is a right way.
Two kinds of debriefing:
- The informal debriefing occurs impromptu in the staff room, cafeteria or the water cooler. The main problem with informal debriefing is that the listener rarely has a choice in receiving this information. Sharing graphic details can spread vicarious trauma to others and may cause a climate of cynicism and hopelessness in the workplace.
- The formal debriefing is scheduled ahead of time. The problem with formal debriefing is the lack of immediacy; with difficult situations, helpers need to talk about it to somebody then and there. Another problem is the lack of satisfactory supervision caused by time constraints, the skill level of the supervisor, the quality of your relationship with them, trust,etc.
Low Impact Debriefing
Laurie Pearlman and Karen Saakvitne developed a strategy to lessen the contamination of helpers during informal briefings called limited disclosure, which later became known as Limited Impact Disclosure (LID). Over the past decade this strategy has proven to be very effective.
Here are four key steps of LID:
- Self-awareness
- Fair warning
- Consent
- Low impact debriefing
1. Increased self-awareness
First, you must look at how your briefing looked over a typical work week and note all the formal and informal debriefings you were involved in. Note the amount of detail you relayed and received and in what manner it was done in a formal way or just informally. Now, ask yourself what is the most helpful in dealing with difficult stories.
2. Fair warning
It is important to give the listener a fair warning before telling a difficult story. If the listener has been warned, they will be better prepared to deal with the information and will find it less traumatic.
3. Consent
After warning the listener it is important to ask their permission to continue, you could say I need to debrief. Is this a good time? This allows the listener to decline.
4. Limited Disclosure
Once you have consent from the listener, it is time to decide how much or little information to share. “I suggest imagining you are telling a story starting on the outer circle of the story, the least traumatic information, and slowly moving in towards the core, the very traumatic information at a gradual pace you may, in the end, need to tell the graphic details or you may not depending on how disturbing the story has been for you.” Francoise Mathieu (2012). P. 102
Laughter
“Humor is mankind's built-in coping mechanism that distracts us from the difficulty of the situation we are living in and allows us to release some built-up tension. It's a type of mental armour that allows us to manage the unmanageable.” Linda Star (2020).
Humour can result in a reduction of tension and a re-interpretation of events or situations. It has been proved that a dispositional sense of humour lessens the effects of stress; people with a good sense of humour do not experience fewer stresses; they are just less upset by the stress they experience (Martin and Lefcourt, 1983; Nevo, Keinan, & Teshimovsky-Arditi, 1993; Nezu, Nezu & Blissett, 1998).
Although human suffering is not funny, it is important to remember the old saying, “Laughter is the best medicine.”
Humour helps us regain our sense of power in a powerless situation and helps us connect with others. Science suggests that humour may be just what we need to ease the overwhelming fear, anxiety, grief, and even loneliness many of us experience daily.
Benefits of Laughter
As mentioned above, human suffering is no laughing matter. Still, we all need to find a way to cope with the dangers and limitations we face and the risk it poses in developing serious mental health consequences.
Some of the benefits of laughter are:
- The activation of important feel-good hormones in the brain and a reduction of stress-related hormones such as cortisol.
- Increasing the number of antibody-producing cells enhances T-cells, which are at the core of all adaptive immunity and help tailor our immune response. This is associated with a stronger immune system.
- Research indicates that humour benefits both a person's physical and psychological state. Studies show that humour has the ability to provide pain relief, improve positive emotions, regulate stress, disengage from distress, and improve interpersonal communication. According to the Association of Applied and Therapeutic Humor, people experience a 39% reduction in stress just by anticipating humour, Elizabeth Scott, (2020).
Ways to Incorporate Humor in Your Life
Laughter is a free and easy stress management tool that can be used by just about anyone to lighten the mood and improve mental health.
Here are some ways to add a little humour into your life during this challenging time:
- Subscribe to Funny YouTube Channels
- Watch Comedians Online
- Share Old Stories
- Tell Jokes
- Play Games
- Laugh at Yourself
Affirmation
Positive affirmations are a great tool for reprogramming your unconscious mind from negative thinking to positive. The idea is to take positive statements of what you would like to embody and repeat them enough to be part of your way of thinking and your world outlook. Positive affirmations help us to reduce stress, change our thinking, and stay motivated.
Tips for Writing Personalized Positive Affirmations
Look at your intentions. Think about what you are trying to create in your life.
Create statements. Once you get an idea of what you’re aiming for, try to put that idea into a few simple statements that reflect the reality of what you want to create. Phrase the statements as if they are already true, not as if you would like them to be true.
Remember to make them positive. When making positive affirmations, be sure they’re positive. This means saying what you want to see and experience, not what you don’t want to see and experience.
Be realistic. Your subconscious mind can benefit from positive affirmations that stretch and expand your perspective, but when your affirmations are unrealistic, your "inner judge" steps in and negates the affirmations.
Get Inspiration from others. Google affirmations of what you are trying to create.
Tips for Introducing Positive Affirmations in Your Life
Once you’ve compiled your statement collection, here are some fun ways to introduce positive affirmations into your life.
- Repetition is the most popular way to use affirmations' power. Repeat them mentally regularly during the day. Repeating them out loud is even more effective because you hear them more clearly.
- Make a recording and play it while you are doing your daily activities. Use a calm voice and play your favourite soothing music in the background.
- Use post-its. Placing them around the house to give yourself positive messages throughout the day.
- Self-hypnosis increases the effectiveness of affirmations. This is a way to imprint them into your subconscious, thinking much more quickly than repeating them in your normal conscious state.
Well-thought-out positive affirmations can help you get into a better state of mind and build resilience and enjoyment in your life. That's a lot of benefits for a relatively low time investment.
Meditation
The benefits of meditation, according to The Mayo Clinic, includes:
- Giving you a new way to look at things that cause stress.
- Building skills to manage your stress.
- Making you more self-aware.
- Focusing on the present.
- Reducing negative feelings.
- Helping you be more creative.
- Helping you be more patient.
- Lowering resting heart rate.
Give it time: Meditation takes practice and a lot of it.
Start Small and Work Up to Longer Sessions: Begin slowly with a 5-minute session. Once you are comfortable, increase the time until you can comfortably meditate for 30. With practice, this type of meditation becomes easier and more effective. You will come out of a meditation session feeling relaxed and refreshed, ready to face the rest of your day.
Track your time and set goals: It is easy to lose track of time while meditating; in the beginning, a minute might feel like a lifetime. This can cause you to worry about all sorts of time issues. These thoughts defeat the purpose of clearing your mind;to combat this, use a timer.
There are many apps available; I would recommend Calm.
Professional Interventions
For some individuals, the level of distress reaches an unsustainable level of severity where professional help may be desirable or even necessary. “Surveys have shown that up to 60% of professional helpers may experience clinical depression at some time in their lives, which is significantly above the rates found in the general population (Epstein &Bower, 1997).
Additionally, these authors report that one in four will experience suicidal thoughts, and one in 16 will make suicide attempts. Moreover, divorce rates are significantly higher for mental health professionals” Teater & Ludgate (2014) p.110.
When is professional help indicated?
According to Teater and Ludgate:
- When self-directed or other less intensive efforts have not reduced significant levels of distress.
- When symptoms are severe and continuous, they impact personal, social and occupational functioning.
- When safety becomes an issue associated with clinical depression, hopelessness, demoralization or reckless, self-destructive behaviour.
- When trusted colleagues, peers, family or friends are worried enough to suggest the need for professional interventions.
Complete the "Professional Interventions" exercise.
Prevention
“Do you recall Remen's quote that it’s unrealistic to expect that we can walk through water and not get wet? On the surface, that appears to be true. Of course, we’ll get wet if we walk through water. That seems like a no-brainer. However, it is possible to stay dry while walking through water. We can do that if we are protected. If we anticipate that we’ll be walking through water, we can prepare for it. We can wear a wet suit, we can put on fishing waders, or we can pull on rain boots. We can be surrounded by water and not end up waterlogged if we have a solid self-care plan in place.” Teater & Lugate (2014), p.115. This is the perfect analogy as far as I’m concerned.
As mentioned before, the key strategies for reducing CF and VT in helping professionals are:
- Strong social support at home and work
- Increase self-awareness
- Good self-care
- Better work/life balance
- Job satisfaction
- Rebalancing caseload and workload reduction
- Limiting trauma input
- Attending regular professional development and ongoing training
This holds true in prevention as well.
Early warning system
Developing an early warning system allows you to track your emotional and physical depletion levels by implementing the tools and strategies learnt in the previous module to get yourself back on track.
You must do regular check-ins, and it is recommended that you schedule one once a week and make it a habit.
Go back to the module on signs and symptoms and make a list of the symptoms that are appropriate to you; once you’ve identified them, make a list with a scale from 0 to 10, 0 being the best you have ever felt and 10 the worst you have ever felt.
Over time, you will learn to identify what a 0 to a 10 looks like for you personally and when it is time to intervene.
Think of your warning system as a traffic light; only you can figure out which numbers are associated with which colour.
Learn to Say "No"
Complete the "Learn to Say No" exercise
Helpful Tips &Techniques for Saying "No"
Helpful Tips:
- Tell the truth: ALWAYS find a way to be truthful. There's nothing worse than being caught in a lie. But you can leave out information (like that you could reschedule an appointment, so you are available) to protect your "No"…
- Timing can be everything: No does not mean "No forever.” Sometimes, you need time or circumstances to be right. So, don't allow yourself to be pressured into giving a response if you're not ready. Sometimes, you need time to figure out if it's a "No," a "Not now," or a "Never."
- Stay firm: People who are used to relying on you saying yes will try to persuade you. Don't get drawn into the discussion. Just repeat your No and have phrases ready. "I'm unavailable," "I can't right now," or "I have other commitments.”
Helpful Techniques:
SIMPLE
1. A simple "No, but thanks for asking/thinking of me."
SOMETHING ELSE
2. A simple "I’m already doing ________ / have a dentist appointment."
BUY YOURSELF TIME – when unsure how you feel or need time to prepare a response
3. "I'm away from my desk right now. Can I let you know once I have my diary in front of me?"
4. "I'm just in the middle of something/a tight deadline. Can I get back to you tomorrow/next week?"
DEFERRAL - good for other people's problems and issues
5. "I'm crazy busy this week/month. Can it wait until next week/month?"
TRANSFER - good for maintaining relationships and still being helpful
6. Suggest who else could do it, "I know John loves that kind of thing."
7. "I don't feel comfortable/have enough experience to help you with that, but Sarah might be able to."
RETURNING THE NO - good for those who take advantage of your good nature!
8. "I can't do it right now - but I could show you how for yourself."
REQUESTING PRIORITY - good for dealing with your boss/when you're at work!
9. Ask for the priority. "Which one do you think I need to focus on first?"
OR "If I do this, what would you like me to stop working on?"
PRIORITISING YOURSELF - stay in control of your life and feel good about yourself!
10. "I’d love to help, but I'm focusing on ________ (this report) right now."
OR "I don’t have time for anything except ________ (this project/my family) at the moment."
Letting Go
“Two Buddhist monks return to their monastery after the rains. They reach a swollen river, and in front of them is a beautiful woman in a delicate silk kimono, distressed because she cannot cross the river by herself. The older monk scoops her up and carries her safely to the other side, and the two monks continue in silence. Later, as the monks reach their destination, the younger monk finally bursts out, having fumed for the last 5 hours, "How could you do it? We're not allowed to touch a woman!” The older monk, surprised, replies, "I put her down 5 hours ago, but you are still carrying her with you." Unknown.
- As with the younger monk in the story, the things we hold onto (e.g., feelings of anger, hurt, and guilt) cloud our minds and prevent us from fully enjoying life. Whatever you're holding onto, it's probably bothering you much more than anyone else.
- Letting go usually involves some form of forgiveness or acceptance - whether it's of yourself, someone else, a situation or even an unknown third party.
- Letting go doesn't mean we condone a situation or behaviour; it's about lightening OUR load. When we let go of whatever bothers us, we free ourselves and reclaim that energy.
- You don't need to know how to let go; you must be willing. While you can't change the past, you can learn from it and change how you feel going forward.
- Remember - whatever you find hardest to let go of is probably what you need to let go of the most…
Complete the "Letting Go" exercise
Energy Drainers
What is draining your energy?
To determine what might be limiting you right now, write down what you are putting up with at home and at work on a piece of paper.
Pick one action to take immediately (now or in the next few days). Now that you’ve bought what is draining your energy into your awareness, you’ll naturally begin to fix and resolve them.
Remember that clearing the things that drain us (whatever they may be) frees up energy to do what we want and need to do.
A good way to start would be to make a list:
Action___________________________________
By When ________________________________
Building Resilience
An important way to prevent CF and increase compassion satisfaction is to work on building resilience. Resilience is the ability to return to one’s old normal.
Things that you can work on to help build your resilience:
- Resourcefulness
- Social support
- Compassion with healthy detachment
- Having vision, goals, and purpose
- Altruism
- Emotional hardiness and flexibility
- Humour
- Optimism and hope
- Flexibility, open-mindedness and adaptability
- Healthy, strong self-esteem
- Spirituality
- Willingness to seek meaning in stressful events
Vicarious Resilience
There are powerful and positive aspects of being around people who hurt. Just as we can experience vicarious trauma, we can also experience vicarious resilience.
Our empathetic engagement with suffering people is not always negative. We can experience positive transformation and empowerment through watching others and how they respond positively through trying times. We can develop an enhanced sense of hope and meaning and find a greater ability to put our stressors into perspective.
A grateful diary is a great tool, specifically after a hard day.
References
Bach-Van Valkenburgh, E. https://www.centerforebp.case.edu/client-files/events-supportmaterials/conf2016cebp-E2-valkenburgh.pdf
Blackett, G. Stress Resilience Blueprinthttps://www.stressresilientmind.co.uk/articles/five-key-stress-resilience-skills
Brinck, I. (2001). An outline of a theory of person-consciousness: Three kinds of self-awareness (2001-09-05) Lund Philosophy Preprints
Borritz, M., Rugulies, R., Bjorner, J., Villadsen, M., Mikelson, O.A., & Kristensen, T. (2006). Burnout among employees in human service work; Design and baseline findings. The PUMA study. Journal of Public Health, 34, 49-58.
Centre for Victims of Torture. https://www.proqol.org
Chodron, P. (1994). Start where you are: A guide to compassionate living. Boston: Shambhala Press, Inc.
Fisher, J. (2013). Overcoming trauma related shame and self-loathing. WI: PESI Healthcare.
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Freudenburger, H. (1983). Burnout: The high cost of high achievement. Norwell, MA: Anchor Books
Gentry, E, J. (2020). Compassion Fatigue Prevention & Resiliency: Fitness for the Frontline (Digital Seminar)
Lefkowitz, S. (2020). Nurses in the COVID-19 Pandemic: Work and Home Strategies to Reduce Your Stress, Fear and Frustration (Digital Seminar)
Kabat-Zinn, J. (2005). Coming to our senses: Healing ourselves and the world through mindfulness. New York: Hyperion Books.
Lederer, D., & Hall, M. (1990). Instant relaxation: How to reduce stress at work, at home and in your daily life.London, U.K.: Crown House.
Mathieu, F. (2013). Achieve more why do you need stillness to be productive the hppts//www.coachingtoolcompany.com
Mathieu, F. (2014). Solitude: 9 powerful reasons to spend time with you! hppts//www.thecoachingtoolcompany.com
Mathieu, F. (2011). The compassion fatigue workbook: Creative tools for transforming compassion fatigue and vicarious traumatization. New York: Routledge.
McCann, L., & Pearlman, L.A. (1990). Vicarious traumatization: A framework for understanding the psychological effects of working with victims. Journal of Traumatic Stress, 3, 131-149.
Saakvitne, K.W., & Pearlman, L.A. (1996). Transforming the pain: A workbook on vicarious traumatization. New York: Norton Professional Books.
Sinclair, S., Raffin-Bouchal, S., Venturato, S.,Mijovic-Kondejewski, J., Smith-MacDonald, L. (2017). Compassion fatigue: A meta-narrative review of the healthcare literature https://doi.org/10.1016/j.ijnurstu.2017.01.003
Skovholt, T.M., & Trotter-Mathison, M. (2011). The resilient practitioner: Burnout prevention and self-care strategies for counsellors, therapists, teachers and health professionals (2nd ed.). New York: Routledge Press.
Stamm, B.H. (2003). Secondary traumatic stress: Self-care issues for clinicians, researchers and educators. Eau Claire, WI: PESI Healthcare.
Teater, M., & Ludgate, J. (2014). Overcoming compassion fatigue: a practical resilience workbook. WI: PESI Healthcare.
Villines, Z. (2020). Mental Health Awareness Month: Health Care Workers’ Mental Health and COVID-19. https://www.goodtherapy.org/blog/health-care-workers-mental-health-and-covid-19