We care about our family members, close friends, our clients, our students, and many others in our lives. We experience their accomplishments and excitement as well as their struggles and despair. Because we care about others and want to do all that we can in their best interests, this relationship can often contribute to our own emotional distress, including burnout and compassion fatigue.
Ashley Zultanky, PsyD
Michael Selbst, PhD, BCBA-D
There are many things that contribute to our burnout and compassion fatigue, including: juggling a busy schedule , educating students, working with challenging clients, managing challenging behavior, adhering to best practices in our respective work, keeping up with the paperwork, collaborating and communicating with others, attending to one’s own family, and attending to one’s own needs.
Psychological barriers often get in the way of us moving forward and successfully managing our daily lives, especially when our compassion level is moving toward empty. These may include self-statements such as: “I can’t do this”; “The drive is way too long”; “This person is just too difficult to work with”; There is too much uncertainty”; “What if I don’t do a good job?”; “I’m not as smart as others think I am”; and “I don’t think I’m being helpful.”
According to a 2014 survey by the American Psychological Association, American Institute of Stress, the primary cause of stress in America is job pressure, specifically, co-worker tension, work overload, and poor relationships with employers. Furthermore, over 70 percent of Americans surveyed regularly experience physical or psychological symptoms caused by stress. More than 50 percent also endorse work as the leading cause of relationship stressors.
Burnout and Compassion Fatigue
Burnout is a special type of stress that caregivers and professionals may experience, including a sense of reduced accomplishment and physical and/or emotional exhaustion. Compassion fatigue encompasses a much greater level of stress and exhaustion, occurring as a result of helping others who experience emotional or physical pain, oftentimes referred to as the “cost of caring;” however, someone presenting with compassion fatigue shows a significant decrease in the ability to empathize with others.
Compassion fatigue is a type of secondary traumatic stress, which occurs as a result of helping or wanting to help others who are in need. Though they share similar features, burnout generally develops more slowly over a period of time, while compassion fatigue may have an unexpected onset and can occur without warning signs. Professionals and caregivers who experience compassion fatigue may react to situations differently from the way in which others typically respond, due to an erosion of “compassion skills.” A majority of individuals in any kind of helping profession experience at least some degree of burnout or compassion fatigue in their lives.
Minimizing and managing one’s stress are important for self-care and living life more fully. This leads to greater self-compassion, including self-kindness, mindfulness, and our shared humanity.
Common signs of compassion fatigue include irritability, anxiety, agitation, frustration, and anger; depersonalization and feeling disconnected from others; decreased feelings of empathy and sympathy; increased and chronic psychological and emotional fatigue; apathy, disinterest, or dread related to working for or taking care of others; physiological and physical discomfort; difficulties in interpersonal relationships; and noticing thoughts about being “unfulfilled” in the role of professional or caregiver.
Stress is Part of Life
It is important to recognize that stress is a part of life, and it is easy to experience burnout and compassion fatigue when we do not move off of our “automatic pilot” way of steering through life instead of taking the steering wheel, recalibrating, and moving carefully and calculated in a values-driven direction. In fact, all humans will and do experience discomfort, including stress, self-doubt, fatigue, and fear. It is our attempts to eliminate discomfort that are doomed to fail at some point. We find that the more you try to get rid of discomfort the more you “got” it (just like trying to “get out” of the Chinese finger trap). We eventually realize that our solutions to eliminate discomfort now become the problem. This can exacerbate our burnout and compassion fatigue. Instead of focusing on self-care, we incorrectly focus on trying to keep digging and digging within the hole we have found ourselves. Yet, analyzing how we got in the hole or blaming the hole or the shovel does not help at all. We need to stop “struggling” with the stress and take active steps to do something different, something aligned with who and what we care about. This includes steps to care for yourself.
If you did not care you, you would not experience discomfort and there would be no potential struggle. However, there does not have to be a “struggle.” There can and is a better way of managing the situation, our thoughts, and emotions.
Self-Compassion
Individuals who practice self-compassion are more likely to endorse increased positive mood, decreased negative mood, lower depression symptom severity, and lower levels of anxiety. Self-compassion may protect against experiencing anxiety in response to significant stressful situations. Overall, increased self-compassion is associated with lower levels of mental health symptoms. Conversely, lower levels of self-compassion were associated with higher levels of psychopathology.
Deciding to make changes in your life requires acceptance that you need to do something different. This includes becoming self-compassionate and self-caring, disentangling yourself from the psychological barriers like “I can’t…” We can look to evidence-based practices for guidance.
Acceptance and Commitment Therapy
Acceptance and Commitment Therapy (ACT) is an evidence-based therapeutic approach that emphasizes processes such as psychological flexibility, mindfulness, acceptance, and values in assisting people in overcoming obstacles in their lives. ACT operates under the basic assumption that discomfort, self-doubt, suffering, and fear are a normal and unavoidable part of human experience. An individual’s attempts to control or avoid painful experiences eventually lead to long-term suffering. The goal of ACT is not to eliminate certain parts of one’s experience of life, but rather to learn how to experience life more fully, without as much struggle, and with vitality and commitment. Further, goals of ACT include reduction of suffering, increase of psychological flexibility, and an increase in one’s opportunity to change their behavior and engage in committed action toward their valued goals and outcomes.
Acceptance incorporates the ability to notice and experience all thoughts and feelings as they occur organically, without trying to reduce or eliminate any unpleasant thoughts and feelings, or to replace them with positive alternatives. Values reflect who or what is important and who or what we truly care about. “Values are your heart’s deepest desires for how you want to behave as a human being. Values are not about what you want to get or achieve; they are about how you want to behave or act on an ongoing basis” (Harris, 2010). One exercise designed to practice values and committed action is replacing the term “but” with “and;” for example, “I want to stop this behavior and it’s very difficult to change what I have always done.”
Self-Care
“Taking care of yourself doesn’t mean me first, it means me too” (L.R. Knost). In order to practice self-care, there needs to be present moment awareness of stress and fatigue levels, as well as personal accountability that previous efforts have not worked effectively. As you notice that these thoughts and feelings “get in the way” of moving toward desired values, there exists an opportunity to choose actions consistent with what or who is meaningful. Self-care practices that minimize or protect against compassion fatigue include mindful eating, exercising, connecting with others, maintaining a consistent sleep schedule, planning and committing time for meaningful leisure activities, and increasing vitality.
It is important to create a Self-Care Plan in different areas: physical, social, emotional, workplace / professional, etc. Here are examples with the underlined words serving as those that you would include to personalize each plan:
- Physical Self-Care Plan may include the following: I choose to exercise on the treadmill. I will do this every day (frequency) at 6:00 am (time) for 30 minutes (duration) when I am at home (location).
- Social Self-Care Plan may consist of: I choose to join my friends for breakfast. I will do this the 1st Saturday of each month (frequency) at 9:00 am (time) for 2 hours (duration) at the Diner (location).
- Emotional Self-Care Plan could include: I choose to keep a reflective journal. I will do this every day (frequency) at bedtime after I change into my pajamas before I brush my teeth (time) for 5 minutes (duration) when I am in my bedroom (location).
- Workplace Self-Care Plan could have the following: I choose to consult with my colleague. I will do this every Monday (frequency) at 3:30 pm (time) for 15 minutes (duration) when I am at work (location).
It is critical to schedule these self-care events and to commit to them as if they were the most important “appointment” you have scheduled that day. Gary Keller (2018), author of “The ONE Thing: The Surprisingly Simple Truth Behind Extraordinary Results”, provides excellent advice when he explains that you need to say “Yes” to scheduled time for yourself and say “No” to other events that could get in the way of your own committed time. Alternatively, saying “Yes” to anything else is equivalent to saying “No” to yourself. If you’re experiencing burnout and compassion fatigue, it is likely that you have been saying “Yes” to many things and to others at the cost of your own well-being. You may notice “stinking thinking” that shows up like “I want to work out but I’m so tired.” Replace this with “I want to work out even though I feel tired.” Additionally, when your thought of “I don’t deserve time for myself” shows up, notice how this puts you right back into the hole and into a negative feedback loop. It is important to stick to the plan and notice the “stinking thinking” that is already there.
Many people find that keeping a Thought Diary / Journal is helpful. This may include writing down one’s thoughts and feelings about the day. It is important to notice and accept your thoughts and feelings for what they are, rather than question, challenge, or try to change them or minimize them. You might tell yourself, “I’m noticing I’m having the thought that…”, or “Thanks mind for telling me.” This changes the relationship you have with your thoughts and feelings, allowing you to “lead” your mind where you want to go (toward self-care and self-compassion), instead of allowing your mind to take you where it wants to go.
For those working in the healthcare (mental health and medical) and education fields, it is particularly important when engaging in self-care practices to be aware of potential obstacles that impede your ability to be successful. This includes setting boundaries with others (clients, patients, students, colleagues), maintaining ethical and legal guidelines regarding communication with others, and taking a break when necessary. For those struggling with burnout and compassion fatigue who have difficult turning off the “struggle switch” to engage in better self-care, it may be helpful to contact a mental health professional. Executive coaching is another effective method of managing stress, in which the coach focuses on increasing an individual’s potential and level of awareness. The coach and client work collaboratively in a forward-moving direction to act consistent with the client’s values.
Conclusion
Professionals in the healthcare and education fields are at a greater risk for developing burnout and compassion fatigue due to excessive practice of compassion-focused skills. Yet, we are all susceptible to this where and when we care. When one notices negative thoughts and feelings related to their ability to provide care and support to others, there are effective coping strategies to bring them back to the present moment. These strategies include taking a deep breath, identifying values, and determining what, if any, solutions are actually problematic. Through choosing to accept negative thoughts and feelings as a part of life and moving toward identified values with committed actions, individuals create distance between thoughts and feelings and do not allow themselves to be controlled by the narrative they created. This leads to a more fulfilled life. Perhaps the Dalai Lama said it best: ‘‘If you want others to be happy, practice compassion. If you want to be happy, practice compassion.’’
Michael C. Selbst, PhD, BCBA-D is Executive Director of Behavior Therapy Associates and Ashley M. Zultanky, PsyD is a clinical psychology Post-Doctoral Fellow at Behavior Therapy Associates in Somerset, New Jersey.
They can be reached via Email at mselbst@BehaviorTherapyAssociates.com or azultanky@BehaviorTherapyAssociates.com. Please visit their online website at www.BehaviorTherapyAssociates.com.
