A Guide to Preventing Compassion Fatigue & Secondary Traumatic Stress
Let’s do a quick exercise. Close your eyes for a moment and remember a time that you had a really difficult case with one of the patients you've worked with. Remember what it was like to experience the pain or discomfort working with a struggling person or animal. As you bring that memory to mind, see if you can feel in your body what it felt like then. Meaning, notice what that sadness, anger, helplessness, or whatever it is you felt—notice what that feels like in your body. Is there tension anywhere? Any muscles contracting? How’s your heart rate and your breathing rate? Just notice these things. We aren’t trying to change any of them, just notice them.
Once you’ve done that and spent a few moments (maybe a minute or so) with that memory, I want you to call forward a memory where you experienced unbridled joy with a person or animal you worked with. Perhaps you were able to play with a goofy dog and it brought a smile to your face to see and participate in the joy he was experiencing. Maybe you saw great changes and improvements in someone you worked with. Once you’ve called forward that memory, notice what it’s like in your body now. What does joy feel like? How’s your breathing rate now? Notice what it feels like in your chest and in your belly.
Now take a second and compare the two. What were the differences of what it felt like in your body with the two memories?
When we talk about self-care, resilience and prevention of compassion fatigue, it’s important to make clear that one of the greatest tools we have for self-care and the greatest indicators we have of whether you will be able to avoid this is our self-awareness of what’s happening in our own bodies. So, for example, noticing the difference of what it felt like in your body to remember the unhappy memory versus the happy one.
Without going into too much brain & biology I want to give some background on how this works in our bodies so you can put this to use in your own experience. If any of you are already familiar with the autonomic nervous system, this will be a review for you. But the autonomic nervous system handles the automated processes within our body. So heart rate and breathing are things we don’t have to actively think about in order for them to happen. Two parts of the autonomic nervous system are the sympathetic and the parasympathetic systems. The sympathetic system handles activation— if we are about to cross the street and a bus is there that we didn’t see, it’s the sympathetic system that allows us to jump out of the way. It operates our fight or flight response. The part of you that tenses up when you’re experiencing a difficult emotion or stressful situation is your sympathetic nervous system being activated. Activation is not a bad thing—there’s a certain amount of arousal that can really help us out. A little bit of activation may help us do better on a test, for example. Or it can really get kicked up when we’re in danger and help us get out of the way of that bus that’s coming our way.
But we aren’t designed to be in the sympathetic nervous system all the time. In fact, the opposite is true. We’re designed to be in the parasympathetic system the majority of the time, and use the sympathetic system as needed. The parasympathetic system is settled and calm. It’s the resting phase. It’s the way we act and feel when there’s no imminent threat. Our heart rate is low, we’re open and curious, emotionally stable, relaxed but alert. You can think of these two systems as a scale or a see-saw—they’re binary. So if we’re really activated and our sympathetic nervous system is taking over, the parasympathetic system goes down. In a normal day when you haven’t had any major threats to your life and you’re well regulated, your system will look like this, easily flowing back and forth between being more activated or more restful, but it will stay within an optimal range:
Secondary traumatic stress is for all intents and purposes the same as if you had experienced the trauma yourself. Research has shown that if I sit down with a person who experienced a trauma first hand and record a therapy session with them where we don’t talk about how they were traumatized, we just talk about what their symptoms are, it would look remarkably similar to if I sit down and talk to the person who cared for that trauma patient, but didn’t experience the trauma first hand. The difference is that the person who experienced the trauma, they can experience the symptoms of PTSD after just one acute episode. Meaning for example if they were abused or attacked once, they can wind up with PTSD. However the person who works with that client or animal, doesn’t usually end up with symptoms after just one experience. The symptons come on more slowly in the case of Secondary Trauma.
Back to the nervous system. When we experience trauma, whether it’s our own trauma or the trauma of one of the animals or clients we work with, it raises our sympathetic nervous system. Remember what that memory felt like—probably tensed muscles, perhaps increased heart rate? It’s the system perceiving that there is a potential threat. The brain doesn’t really differentiate between a threat to ourselves versus a threat to someone we care for (animal or human). So our activation level goes up. This is normal; it’s what our body is supposed to do. But when we don’t effectively bring our system back down once the threat is gone, we can run into problems.
For example, let’s say you come into work in the morning and you’re walking one of the dogs who has aggression with other dogs. As you’re rounding a corner you almost run into another dog walker with a dog and it erupts into a dogfight. It’s up to you to separate the dogs and prevent yourself, the other dog walker and the dogs from getting hurt. Naturally, your system is very activated while this is happening. The blood is going to rush from your brain to your muscles to help you move quickly and effectively to handle this potentially dangerous situation. Here is what your system looks like at that point:
Let’s say the dogfight happened at the beginning of your day, and it’s only 9am. You don’t really have time for self-care right now because the dogs need to be fed and walked and the phone is ringing. So you take a deep breath and keep working. The deep breath probably helped to bring your activation levels down, but it didn’t really get you down to your baseline. Now you’re working at a higher level than when you started in the morning.
Next, the phone rings and it’s a donor who’s angry because she didn’t get a thank you card after she made a $20 donation. How equipped are you to handle that? Your activation level is up; you’re stressed and tense and now the new “threat” occurs and your activation levels go up again. Over time this can become a pattern, and before we know it we’re almost never getting back down into the optimal levels. Sometimes people find the only way they can effectively bring their levels down is by some unhealthy habit—drinking alcohol, eating fattening foods, zoning out with TV, video games, or shopping online.
Symptoms for secondary trauma like insomnia, anxiety, hyper-vigilance, or chronic pain start showing up when we spend too much time with the sympathetic nervous system in command. The pink line below is how we want our system to look, and the blue line is the way it probably looks after working in a caregiving position for long periods of time without effectively regulating our nervous systems.
One of the keys to avoiding those symptoms is to sufficiently and fully (every time) allow yourself to get back to your baseline before moving on. It’s called down-regulation and self-care is one of the ways we can do that.
One of the best ways to help regulate your nervous system is to practice mindfulness. Spending a few minutes each day bringing your attention to your emotions, your breathing and your internal experience is a great start.
Breathing exercises can also help. Try this out—breathe in for 3 counts, hold the breath in for 4 counts, then exhale for 6 counts. That one exercise should help move your system from the sympathetic nervous system into the parasympathetic system.
Yoga classes, regular exercise, and eating well are important aspects of self-care that you absolutely must implement into your day to day life, and this simple awareness of your own system will do wonders for helping you to combat the effects of the trauma you work with on a regular basis.
What self-care techniques and tips do you have? How do you ensure you follow through with putting self-care into practice in your everyday life?
Images adapted from Ogden, P., Minton, K., & Pain, C. (2006). Trauma and the body: A sensorimotor approach to psychotherapy. WW Norton & Company.