“Compassion fatigue,” including typical trajectory – Notes

On August 1st, Caregiver Teleconnection hosted a teleconference by social worker, Amy Cunningham, on the topic of compassion fatigue as experienced by caregivers.

Amy explained the difference between stress, burnout and compassion fatigue. She identified the signs, symptoms and trajectory of compassion fatigue as well as the five habits of resiliency that can help caregivers to grow, rather than be traumatized by caregiving.

There are five habits you can develop that, when practiced every day, will not only make you the best caregiver you can be (happier, more energetic), but keep your health intact so you will be able to care for your loved one for as long as they need you.  The habits of resiliency include:

#1 – Physical resiliency
#2 – Spiritual resiliency 
#3 – Emotional resiliency
#4 – Psychological resiliency
#5 – Self care

Amy reviewed the typical trajectory compassion fatigue takes:

Phase 1 “Zealot” – full of enthusiasm, go the extra mile, handholding, extra care, willingness to do anything

Phase 2 “Irritability” – begin to take shortcuts, avoid people and conversation about work, make mistakes

Phase 3 “Withdrawal” – clients become irritants, enthusiasm disappears, avoid discussing your job, avoid people & work

Phase 4 “Zombie” – go through the motions, no humor, no fun, disconnected from emotions, lost compassion, lost hope.

You can find the audio recording here:

soundcloud.com/caregiverteleconnection/compassionfatigue8118

To sign up for email announcements about these conference calls, sponsored by the WellMed Charitable Foundation, check out:

caregiversos.org/caregiver-teleconnection/

Brain Support Network volunteer Denise Dagan listened to the conference call and shared the notes below.

Robin

—————————————————————

Notes by Brain Support Network volunteer Denise Dagan

Compassion Fatigue
Speaker: Amy Cunningham, Social Worker

Caregiver Teleconnection
August 1, 2018

Amy personally experienced compassion fatigue.  Afterwards, she recovered she developed a curriculum to share with others how to identify symptoms and overcome compassion fatigue.

During a flight with her 5 children under 9, even though Amy was attentive to the flight attendant’s instructions, a flight attendant came to check with her that Amy understood the importance of putting her own mask on before helping her children.  That’s how caregiving is.  Our first instinct may be to care for our family member before ourselves, but if we are incapacitated by the stress of the situation, we are of no help to our family.  You must look after your own needs first!

Stress is difficult to define because it is subjective.  What one person finds stressful, another person may not find stressful.  Stress is unavoidable and not a bad thing with the right mindset and self care.

A good place to begin is to do a self assessment – and don’t lie to yourself or others about how you are managing.

Deviation from baseline is what you want to pay attention to in your self assessment.  Consider these personal attributes:
* If normally you have a good memory but lately you can’t remember anything – you may be overstressed.
* If normally you are in good spirits but lately you are short tempered or moody – you may be overstressed.
* If normally you are well coordinated but lately you are dropping things constantly – you may be overstressed.
* If normally…  Can you identify areas where your normal is deviated from baseline?

We all wear many hats, but how do they affect your stress level?  What is the cost to your health, family or workplace?  If you are a tired, cranky employee, you come home and are a tired, cranky Mom/Dad/daughter/son etc.

Homework:  Take 10 minutes every day to do something you enjoy.  If you have more time to devote to your own joy – do it!  This homework is especially for those of you who feel as though you don’t even have 10 minutes to take care of yourself.
Run, walk, read, meditate, watch a video w/a coffee, tea or soft drink, call a friend or relative (but don’t talk about caregiving!)

What is compassion fatigue?  For today’s talk, it encompasses vicarious traumatization, compassion fatigue and secondary traumatic stress, as follows:

* Vicarious traumatization – a state of tension and preoccupation with someone whom you have helped or are helping.  It can manifest either as reliving (PTSD) a traumatic event another experienced – OR – you begin to avoid all reminders of a traumatic event.

As an example: when Amy was working in a group home she was listening attentively to a client’s traumatic event.  In the middle of that conversation Amy’s cell phone rang.  She grabbed it and swiped the screen to silence it.  Henceforth, whenever her cell phone rang she recalled the trauma her client was describing.

Having a vicarious traumatization response happen up to a few months from the original hearing of the trauma is normal for those who devote themselves to caregiving because they tend to have a higher threshold of empathy.  Empathy is the ability to put yourself into another’s shoes.  You should be concerned if you experience a vicarious traumatization response longer than a few months or it begins to deviate your behavior from your baseline.

* Compassion fatigue – used to just be called, ‘burnout.’  It is a state of tension and preoccupation with someone whom you are taking care of, a traumatized survivor.  Generally a work related secondary exposure to an extremely traumatic, stressful event.  ‘Work’ includes unpaid, family caregivers, as they are still at risk.

* Secondary traumatic stress is about being afraid.  This is especially seen in child protective services workers where they begin to believe everyone is out to threaten them and their family.  That is an extreme example of how stress affects your behavior.

The term, ‘burnout,’ encompasses a range of degree all the way up to compassion fatigue.  In its simplest form burnout is a state of extreme dissatisfaction with your work.  It is a work related hopelessness and a feeling of being ineffective.

To distinguish between burnout and compassion fatigue.  Ask yourself, “Do you love the kind of work you’re doing?”  If the answer is yes, but you feel some of the symptoms Amy will describe, you may have compassion fatigue.

Symptoms of compassion fatigue:  Significant deviation from your individual normal in these areas are common symptoms of compassion fatigue.

* Emotional indicators – anger, irritability, sadness, depression, prolonged grief, numbness (not wanting to feel anything).  There are some incidents where the timeframe for grief is nearly infinite.  Amy is not talking about those circumstances.

* Personal indicators – isolation (pushing others away, not wanting to communicate), cynical, pessimistic, critical, mood swings, substance abuse (alcohol, drugs, food, sex, attention, TV binging) to fill a void, memory or concentration problems, self entitlement (justification of negative maladaptive behavior because of the things you do, e.g. social worker stays up all night with a client but the next day they are cranky with coworkers, e.g. someone who worked 60hrs in a week helping others, then announce they will be wasted all weekend)

* Physical indicators – general sickness, cold of flu symptoms, sleep issues, no energy, insomnia.  Note: Disruption of normal sleep patterns can cement PTSD symptoms because sleep is when the brain cleanses itself of traumatic events.  If you are not getting good sleep as a caregiver, you should make sleep a priority by trading the night shift with another caregiver so you do not further traumatize yourself and contribute to caregiver fatigue.

* Work indicators – avoiding certain people, missing appointments, suddenly becoming tardy frequently, lack of motivation, just ‘going through the motions,’ being a workaholic (certain personality type: when things get tough, they get tougher), becoming demoralized, feeling under appreciated or under-resourced (when those challenges of the job didn’t used to bother you)

Compassion fatigue can be arrested and treated at any time.  You just need to identify it to be able to move beyond it.

The typical trajectory compassion fatigue takes:

Phase 1 “Zealot” – full of enthusiasm, go the extra mile, handholding, extra care, willingness to do anything

Phase 2 “Irritability” – begin to take shortcuts, avoid people and conversation about work, make mistakes

Phase 3 “Withdrawal” – clients become irritants, enthusiasm disappears, avoid discussing your job, avoid people & work

Phase 4 “Zombie” – go through the motions, no humor, no fun, disconnected from emotions, lost compassion, lost hope

One student of Amy’s compassion fatigue said she is in phase 1 Monday, phase 2 Tuesday, phase 3 Wednesday and phase 4 Thursday and Friday.  Amy wonders how true that is for many people.  The idea is that if you can take care of yourself and find balance between what you need and what you need to do, you can be your best for both yourself and your care recipient.

One study found people who experienced growth after trauma, so they studied them to find out what they did differently.

They found 5 habits of resiliency that, when implemented daily, result in retraining your brain resulting in personal growth and longevity.

#1 – Physical resiliency: good sleep (6-8hrs, 5dys/wk), nutrition (Mediterranean diet), exercise (take stairs, park at edges of parking lots to get more steps in a day).  It is important to tell yourself that you are intentionally doing these things for your own well being because our brains are hard wired to recognize threats to our safety.  You have to reinforce the positives that you do for yourself to get the most benefit, to remind yourself to make these changes and to reinforce these new habits.

#2 – Spiritual resiliency: prayer, meditation and strong relationships (at least 1-2 people who know your good, bad & ugly)

#3 – Emotional resiliency: cry (releases endorphins which are natural pain relievers), laugh (laughing can relax you for up to 45 minutes, reduce risk of heart disease), give & get physical contact (increases oxytocin, making you feel more bonded to others)

#4 – Psychological resiliency: acknowledge your own personal victories (even if it is for something you do every day like put food on the table for your family.  Acknowledge that the meal is well balanced, it is on time, or that you dressed the table with a cloth or flowers.  Give yourself credit for a job well done throughout your day, every day)

#5 – Self Care: especially in your transition from work to personal time – take off your badge, change clothes, give yourself some music or meditation on your commute home.

Question and Answer