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The Cost of Caring: Compassion Fatigue and How To Overcome It

The Dark Side of Caring for Others

Compassion is one of the foundational elements of a thriving community.[1] Helping others has numerous benefits for the self— from improvements in emotional and social wellbeing to reductions in stress, anxiety, and depression.[2,3] But is there such a thing as too much compassion?

Compassion fatigue is a specific kind of burnout that occurs after prolonged exposure to others’ trauma. It manifests as a combination of secondary traumatic stress (STS) and general burnout.[4] STS involves vicariously experiencing the emotions of others’ trauma while burnout results in feelings of exhaustion and helplessness.[5] This results in a hindered capability to be empathetic towards others’ suffering, as well as many adverse physical and emotional symptoms.[6,7] 

Mechanisms of Compassion Fatigue

There are various potential psychological mechanisms by which exposure to others’ trauma can result in the onset of compassion fatigue:[8]

  1. Countertransference: Countertransference is a concept rooted in psychodynamic therapy. In psychotherapy, it refers to the therapist’s emotional reaction to the client and their experiences. This is essentially the reverse of transference, which refers to the client's emotional reaction to the therapist. Countertransference involves deep identification with the client and the fulfillment of needs through them on the part of the therapist. It is mediated by various sources, such as the therapist’s past experiences, their view of the client, and the specificities of the vicarious trauma brought on by the client’s experiences. Countertransference is seen as an issue in therapy as it can lead to biases in the way therapists provide care. [9]

  2. Burnout: Burnout is a state of physical and emotional exhaustion due to prolonged exposure to situations demanding intense emotional involvement.[10] Rather than a static condition, burnout is a progression that gradually increases and worsens over time if not dealt with. It involves job stress, loss of idealism, and a feeling of helplessness and non-achievement. The main manifestation of burnout is feeling helpless in dealing with the other person’s situation. It can also lead to feelings of dehumanization.[11]

  3. Emotional Contagion: Emotional contagion is an affective process that involves feeling similar emotions upon observing someone’s experiences— the specific emotional response that results may be based on the actual or expected emotions of the other person.[12] Those who view themselves as a hero or savior to others are the most likely to experience this.[13]

Presently, each of these mechanisms is studied in specific contexts. As compared to countertransference and burnout, emotional contagion is relatively infrequently cited as a mechanism of compassion fatigue. Additionally, countertransference is currently thought to be specific to the setting of therapy while the literature on burnout focuses primarily on professional settings. Emotional contagion, on the other hand, has been documented as a widespread phenomenon that can occur in almost any context involving interactions between people, from interpersonal relationships to therapy. Therefore, as noted by Figley (1995), as these mechanisms are often studied individually by different researchers, it is fairly unclear as of now how these interact to produce compassion fatigue. [14]

Who Is Affected By Compassion Fatigue?

Compassion fatigue was originally defined by Figley (1995) as “the natural consequent behaviors and emotions resulting from knowing about a traumatizing event experienced or suffered by a person.”[15] Therefore, it follows that people in professions that involve routinely helping others through traumatic experiences are the most susceptible to developing compassion fatigue— healthcare practitioners, social and emergency workers, and those in similar career fields.[16] In fact, the concept of compassion fatigue was originally developed to describe the feelings of people within these professions.[17]

However, even though it is far less researched in other populations, compassion fatigue can be experienced by anyone. A plethora of universal contexts exist that involve supporting others through traumatic experiences— such as leadership, relationships, parenting, etc. — and any of these can potentially bring about an episode of compassion fatigue.[18-20] 

Risk Factors for Developing Compassion Fatigue

Possessing certain qualities can put people at a higher risk of developing compassion fatigue. These include:

  1. Empathy: It is well-known that trauma can occur directly through the experience of disturbing events. However, trauma can also occur indirectly, from learning about a traumatic event that happened to a close acquaintance.[21] Empathy propagates this vicarious trauma, as it involves experiencing what the other person is feeling.[22,23] Empathy therefore acts as one of the primary mechanisms of compassion fatigue as it increases the likelihood of becoming traumatized and subsequently burnt out by others’ experiences. In fact, those therapists that are most impacted by compassion fatigue are the ones who are the most effective at empathizing with and mirroring their clients’ feelings.[24]

  2. Prior Traumatic Experience: Past, unresolved trauma can make one more susceptible to developing secondary trauma from listening to others’ traumatic experiences. This is particularly likely when there are similarities between the traumatic experience of both people.[25]

  3. Exposure to Children’s Trauma: Suffering in children is particularly evocative of secondary trauma due to its emotional salience. Emergency workers report that they feel most susceptible to developing compassion fatigue upon witnessing children facing traumatic events.[26]

Signs & Symptoms of Compassion Fatigue

Since compassion fatigue involves both burnout and secondary traumatic stress, its symptoms can be organized based on which of these are their root cause.[27]

The symptoms caused by burnout are:[28]

  • Feeling unable to help the other person

  • Overwhelmed and exhausted

  • Feelings of failure

  • Perceived inability to do one’s job well

  • Frustration

  • Skepticism and loss of idealism

  • Apathy and withdrawal from others

  • Depression

  • Substance use

The symptoms caused by secondary traumatic stress are:[29]

  • Fear in situations that don’t necessarily warrant it

  • Paranoia about something bad happening to the self or loved ones

  • Constantly feeling on edge

  • Physiological symptoms of anxiety such as high heart rate, breathlessness, and tension headaches

  • Persistent, uncontrollable thoughts about others’ traumatic experiences

  • Experiencing others’ trauma as if having gone through it

Compassion fatigue can also result in physiological and behavioral changes such as:[30]

Compassion fatigue is sometimes difficult to distinguish from burnout since it involves the same symptoms in addition to those related to secondary traumatic stress. However, besides the fact that compassion fatigue involves additional symptoms, burnout is also distinct in that it gradually advances whereas secondary traumatic stress has a more sudden onset. Moreover, secondary traumatic stress has a faster recovery rate than burnout. Figley (1995) designed the Compassion Fatigue Self-Test for Psychotherapists to help people differentiate whether they are going through only burnout or also the additional component of secondary traumatic stress that characterizes compassion fatigue.[31,32] 

How to Overcome Compassion Fatigue

There are many strategies that individuals can adopt in order to reduce their risk of developing compassion fatigue. These include:[33]

  • Keeping a healthy work-life balance

  • Taking the time to practice relaxation techniques, such as meditation

  • Engagement in creative activities to help with emotional expression

  • Learning how and when to set boundaries

  • Cognitive restructuring through routinely running through situations with a problem-solving lens

  • Development of a plan for when compassion fatigue emerges

Additionally, there are myriad ways for individuals to alleviate symptoms if they are suffering from compassion fatigue. These are:[34]

  • Prioritizing self-care and a healthy lifestyle that involves the right amount of exercise, diet, and sleep

  • Journaling about feelings and takeaways related to caregiving

  • Using stress management techniques can help ameliorate physical symptoms 

  • Delegating tasks to co-workers during the recovery process

  • Reflecting on successes and other positives related to providing care to others 

  • Joining a support group of others going through compassion fatigue

All of these strategies essentially involve prioritizing self-care and drawing boundaries when necessary. In addition to these, seeking out professional help through counselors with specializations in trauma and its processing is also another way to alleviate compassion fatigue.[35]

The Costs of Caring Affect All of Us

Although the actual symptoms of compassion fatigue only impact the caregivers who are afflicted by it, its impacts are far more widespread than expected. Particularly within the healthcare industry, compassion fatigue has far-reaching consequences that impact not only the caregiver, but also co-workers, managers, patients, and even the healthcare system as a whole.[36,37] The performance of professionals can be severely hampered by poor judgment, frequent errors, and disconnected interactions during an episode of compassion fatigue. This leads to lower quality and less impactful care for clients. Additionally, compassion fatigue can lead to healthcare practitioners quitting their jobs. This is especially harmful to the current healthcare system, wherein there is already a lack of manpower.[38] 

As compassion fatigue can be costly to patients, professionals, and even institutions, its treatment and alleviation are key to facilitating an abundance of improvements. In order to promote well-being for all, it is important for both individuals and organizations to take the time to understand and treat compassion fatigue.[39]

Contributed by: Sanjana Bakre

Editor: Jennifer (Ghahari) Smith, Ph.D.

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REFERENCES

1 Lonczak, H. S. (2022, August 6). 20 reasons why compassion is so important in psychology. PositivePsychology.com. Retrieved September 12, 2022, from https://positivepsychology.com/why-is-compassion-important/#:~:text=There%20are%20numerous%20proven%20benefits,psychopathology%2C%20and%20increased%20social%20connectedness

2 Ibid.

3 Pogosyan, M. (2018, May 30). In helping others, you help yourself. Psychology Today. Retrieved September 15, 2022, from https://www.psychologytoday.com/us/blog/between-cultures/201805/in-helping-others-you-help-yourself 

4 Cocker F, Joss N (2016). Compassion Fatigue among Healthcare, Emergency and Community Service Workers: A Systematic Review. Int J Environ Res Public Health. 2016 Jun 22;13(6):618. doi: 10.3390/ijerph13060618. PMID: 27338436; PMCID: PMC4924075.

5 Substance Abuse and Mental Health Administration. (2014). Tips for Disaster Responders: Understanding Compassion Fatigue. Understanding Compassion Fatigue | SAMHSA Publications and Digital Products. Retrieved September 28, 2022, from https://store.samhsa.gov/product/Understanding-Compassion-Fatigue/sma14-4869 

6 Adams RE, Boscarino JA, Figley CR (2006). Compassion fatigue and psychological distress among social workers: a validation study. Am J Orthopsychiatry. 2006 Jan;76(1):103-8. doi: 10.1037/0002-9432.76.1.103. PMID: 16569133; PMCID: PMC2699394.

7 Cleveland Clinic (2021, August 29). Empathy fatigue: How it takes a toll on you. Cleveland Clinic. Retrieved September 16, 2022, from https://health.clevelandclinic.org/empathy-fatigue-how-stress-and-trauma-can-take-a-toll-on-you/ 

8 Adams et al. (2006)

9 Figley, C. (1995). Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized. New York, NY: Brunner-Routledge. 

10 Pines, A., & Aronson, E. (1988). Career burnout: Causes and cures. Free Press.

11 Figley (1995)

12 Miller, K. I. , Stiff, J. B. , & Ellis, B. H. (1988). Communication and empathy as precursors to burnout among human service workers. Communication Monographs , 55 (9), 336–341.

13 Figley (1995)

14 Ibid.

15 Ibid.

16 Adams et al. (2006)

17 Figley (1995)

18 Smith, D. (2022, March 30). Compassion Fatigue is real and it may be weighing you down. Harvard Business Review. Retrieved September 20, 2022, from https://hbr.org/2022/03/compassion-fatigue-is-real-and-it-may-be-weighing-you-down 

19 Koza, J. (2019, August 21). 5 signs you're experiencing compassion fatigue. One Love Foundation. Retrieved September 21, 2022, from https://www.joinonelove.org/learn/5-signs-youre-experiencing-compassion-fatigue/ 

20 Robertson, B. (2021, February 26). Preventing compassion fatigue in Foster and adoptive parents through therapeutic support and self-care. enCircle. Retrieved September 21, 2022, from https://encircleall.org/blog-2/preventing-compassion-fatigue-in-foster-and-adoptive-parents-through-therapeutic-support-and-self-care#:~:text=Compassion%20fatigue%20is%20a%20combination,apathy%2C%20exhaustion%20and%20ultimately%20burnout

21 Figley (1995)

22 Ibid.

23 American Psychological Association. (n.d.) Empathy. American Psychological Association. Retrieved September 13, 2022, from https://dictionary.apa.org/empathy

24 Figley (1995)

25 Ibid.

26 Ibid.

27 Substance Abuse and Mental Health Administration (2014)

28 Ibid.

29 Ibid.

30 Administration for Children & Families. (n.d.). Secondary Traumatic Stress. Administration for Children & Families. Retrieved September 21, 2022, from https://www.acf.hhs.gov/trauma-toolkit/secondary-traumatic-stress

31 Figley (1995)

32 Stamm, H.B. (1998). Compassion Satisfaction/Fatigue Self-Test for Helpers National Child Welfare Workforce Institute. Retrieved September 30, 2022, from https://ncwwi.org/files/Incentives__Work_Conditions/Compassion-Satisfaction-Fatigue-Self-Test.pdf

33 Administration for Children & Families (n.d.).

34 Ibid.

35 Ibid.

36 Chaudoin, K. (2020, July 27). Pandemic leads to compassion fatigue, burnout for health care workers. Lipscomb University. Retrieved September 30, 2022, from https://www.lipscomb.edu/news/pandemic-leads-compassion-fatigue-burnout-health-care-workers

37 Lombardo, B., Eyre, C., (Jan 31, 2011) "Compassion Fatigue: A Nurse’s Primer" OJIN: The Online Journal of Issues in Nursing Vol. 16, No. 1, Manuscript 3. https://doi.org/10.3912/OJIN.Vol16No01Man03 

38 Chaudoin, K (2020)

39 Ibid.