SIMPLE Yoga for Compassion Fatigue

Transcription

1 SIMPLE Yoga for Compassion Fatigue Yael Calhoun, MA, MS, RTY Compassion fatigue is a state experienced by those helping people in distress; it is an extreme state of tension and preoccupation with the suffering of those being helped to the degree that it is traumatizing for the helper. ~ Dr. Charles Figley Contact Yael to schedule a 1 to 3 hour in-service on Simple Yoga for Compassion Fatigue for health care providers or caregivers. Also available for CE credits, nurses and social workers. All sizes and abilities welcome! GreenTREE Mission: to bring the healing and strengthening benefits of yoga to underserved people and those who work with them, in a variety of settings: including schools, caregivers, addiction recovery centers, senior centers, community programs, shelters and prisons.

2 Handouts include: 1. Quick Stress Break to Get Unstuck (also available as a free mp3 download on Home page link. 2. Set up for Success: Ideas for yoga in your already too-busy week 3. Support Materials: Yoga for Caregivers DVD/CD Discount for Conference participants. 4. A Renewing 5 Minute Break (also available as a free mp3 download on 5. Suggested reading resources 6. PROQOL Compassion Fatigue Self Scoring Survey for more information. 7. Yoga for PTSD by Bessell Van der Kolk, MD.

3 Support Materials: DVD/CD Retail: $30 Conference Price: $15 Available at

4 Quick Stress Break to Get Unstuck Here is a quick way to help someone stop the spiral into a stress response. When a person feels the physical signs of stress coming on, do all three parts of this one break. It can be done seated, standing, or even lying down. The pattern can be easily learned and repeated. We know there is relaxation in repetition. Keep the breaths long and steady. Part 1: Sit, stand, or lie down in a comfortable way. Perhaps let your eyes close. 1) Take a deep breath in and make tight fists. As you let the breath out, relax your hands and push out even more breath. Wait for you next breath. 2) As you take another deep breathe in, make tight fists. Breathe out, relax the hands. 3) Wait for the next breath to begin, and then make such tight fists you can feel the muscles in your arms tighten. Breathe out, relax the hands. 4) Wait for the next breath in and make tight fists. Breath out, relax the hands. 5) Wait for the next breath in and make tight fists. Breath out, relax the hands. Part 2: Now put the hands together in front of you, with just the fingertips touching, like a steeple. Again, close your eyes if you like. 1) As you breathe in, press the fingertips together, firmly and evenly. As you breathe out, let go of the breath and the pressure on the fingertips. At the end of the breath out, your fingertips are just barely touching. 2) As you feel the next breath in, press the fingertips firmly together and feel the chest rise. Breathe out, releasing the press on the fingers to just a twinkling of a touch. 3) Wait for your next breath in and press, breathe out, and release the press as you keep pushing the breath out. 4) Inhale and press, exhale and release the press. 5) And again, inhale and press the fingertips firmly and evenly, and exhale, releasing that press. And release the hands to your lap. Part 3: Take one hand and rest it on your heart or your belly. We are going to take 5 Count to Calm breaths. 1) Take a breath in and feel your hand lift, then breathe out and feel yourself begin to let go of what is bothering you. Press your thumb against your belly. 2) Take another easy breath in and take an easy breathe out. Press another finger down. 3) Feel the next slow inhale and then feel the slow breath out. And press another finger down gently. 4) Wait for the next long breath in, then feel your long breath out. And press another finger down. 5) Now feel the next breath in lifting your mood and then let go of the breath, but keep that good feeling! Then breathe out and press another finger. to download a Home Breathing Card

5 SET UP FOR SUCCESS: Yoga in Your Busy Week First Step: The best place to start a yoga practice is exactly where you are now. The key is to finding a good yoga practice for you, and being aware of what works for you is part of the practice! So you are off to a good start. Time The benefit from doing yoga comes not from the amount of time every day that you do yoga, but from the commitment to do some yoga everyday even 2 minutes. So start small: make it a time commitment you can keep. Some options: 2 or 5 minute quick stress break 10 minute home break: to begin or to end your day 20 minute home break minutes: DVDs, TV, podcasts, apps, internet One hour (plus): yoga classes outside the home Place Work 2 minute stress break or 5 minute office break Home: anywhere from by the kitchen sink to a quiet room Yoga center, recreation center, church or temple Buddy system ask someone at home or at work to take the break or go to a class with you. Resources 1) DVDs/CDs 2) On-line: search: yoga podcasts, local TV 3) Community classes DVDs: Lilias Folan: Yoga Gets Better with Age Too many choices? At a library, search the yoga DVD titles. Choose the ones that sound appropriate: yoga for relaxing or yoga for strength, as examples. Watch parts of them. You will know within a few minutes if you resonate with the style and the teacher. Keep looking until you find one you like. CDS: Rod Stryker: Relax into Greatness. Meditation Lilias Folan: The Inner Smile. Simple stretching and meditation Books: Relax and Renew: Restful Yoga for Stressful Times by Judith Hansen Lasater Yoga Gets Better with Age by Lilias Folan Yoga as Medicine by Dr. Timothy McCall FREE MP3 downloads: 5 minute yoga breaks for home and office Questions: yoga@greentreeyoga.org Yael Calhoun

6 GTY 2010 A 501c3 nonprofit A RENEWING FIVE MINUTE BREAK The right word may be effective, but no word was ever as effective as a rightly timed pause. ~ Mark Twain Let Yoga Help You: ~ Perk up ~ Reduce stress ~ Calm down ~ Focus and concentrate ~ Smile ~ Lower blood pressure and heart rate Is Yoga For You? YES! Yoga can be enjoyed by anyone -- any shape, size, age or physical ability. VISIT OUR WEBSITE FOR A FREE MP3 DOWNLOAD 5 Minute Relaxation Break. What is Yoga? Yoga is an art and a science, not a religion. Yoga is a way to use the body and the breath to calm the mind Art by Carol Anne Coogan Take a 5 Minute Yoga Break. A key to reducing depression and anxiety is to move with an awareness of the breath. Sit forward on your seat with feet firmly planted on the floor. 1. Sit tall, and on breath in, sweep the arms up, on the breath out, sweep the arms down. Repeat. 2. On the breath in, lift one arm and arc it over the head. Exhale and release the arm to the lap. Repeat on the other side. 3. Sit tall, and on a breath in, sweep the arms up (#1) and on the exhale, release down, only to your point of comfort. Repeat. 4. Inhale and sit tall, exhale and twist gently as you look over your shoulder to one side. Inhale back to center, exhale and twist to the other side. 5. Inhale and roll the shoulder gently in a circle. Exhale and roll in the other direction. Repeat on other side. MORE IDEAS Repeat these poses and breathing ideas while standing. If one pose feels as though it is releasing stress, do it a few more times. Close your eyes at any time. Perhaps repeat a pose with your eyes closed. greentreeyoga@comcast.net

7 Some suggested resources for some background information exploring possibilities of using yoga as a healing tool. o Article: Yoga and PTSD by Bessel van der Kolk, MD. o The Emotional Life of Your Brain by Richard Davidson (2012) o Train Your mind, Change Your Brain. by Sharon Begley Ballantine Books. Intro by Daniel Goleman. o When the Body Says No: Understanding the Stress-Disease Connection. by Gabor Mate, M.D o Trauma Stewardship: An Everyday Guide to Caring for Self While Caring for Others. Laura van Dernoot Lipsky o Help for the Helper: The Psychophysoiolgy of Compassion Fatigue and Vicarious Trauma -- Self Care Strategies for Managing Burnout and Stress. Babette Rothschild, o Overcoming Trauma through Yoga: Reclaiming Your Body. David Emerson, et al o Yoga for Emotional Balance: Simple Practices to Help Relieve Anxiety and Depression. by Bo Forbes 2011 o In an Unspoken Voice: How the Body Releases Trauma and Restores Goodness. Peter A. Levine, PhD o Waking the Tiger: Healing Trauma. by Peter Levine. North Atlantic Books o Yoga as Medicine. by Dr. Timothy McCall. Random House, (General introduction to the value of yoga; different chapters address different clinical issue) o Yoga for Depression: A Compassionate Guide to Relieve Suffering Through Yoga. by Amy Weintraub. Broadway Books, also dvds and cds. o Emotional Yoga: How the Body Can Heal the Mind. by Bija Bennett. o Yoga from the Inside Out: Making Peace with Your Body Through Yoga. Christina Sell, Hohm Press, o Invisible Heroes: Survivors of Trauma and How They Heal. by Belleruth Naparstek and Robert Scaer. Bantam

8 PROFESSIONAL QUALITY OF LIFE SCALE (PROQOL) COMPASSION SATISFACTION AND COMPASSION FATIGUE (PROQOL) VERSION 5 (2009) When you [help] people you have direct contact with their lives. As you may have found, your compassion for those you [help] can affect you in positive and negative ways. Below are some questions about your experiences, both positive and negative, as a [helper]. Consider each of the following questions about you and your current work situation. Select the number that honestly reflects how frequently you experienced these things in the last 30 days. 1=Never 2=Rarely 3=Sometimes 4=Often 5=Very Often 1. I am happy. 2. I am preoccupied with more than one person I [help]. 3. I get satisfaction from being able to [help] people. 4. I feel connected to others. 5. I jump or am startled by unexpected sounds. 6. I feel invigorated after working with those I [help]. 7. I find it difficult to separate my personal life from my life as a [helper]. 8. I am not as productive at work because I am losing sleep over traumatic experiences of a person I [help]. 9. I think that I might have been affected by the traumatic stress of those I [help]. 10. I feel trapped by my job as a [helper]. 11. Because of my [helping], I have felt "on edge" about various things. 12. I like my work as a [helper]. 13. I feel depressed because of the traumatic experiences of the people I [help]. 14. I feel as though I am experiencing the trauma of someone I have [helped]. 15. I have beliefs that sustain me. 16. I am pleased with how I am able to keep up with [helping] techniques and protocols. 17. I am the person I always wanted to be. 18. My work makes me feel satisfied. 19. I feel worn out because of my work as a [helper]. 20. I have happy thoughts and feelings about those I [help] and how I could help them. 21. I feel overwhelmed because my case [work] load seems endless. 22. I believe I can make a difference through my work. 23. I avoid certain activities or situations because they remind me of frightening experiences of the people I [help]. 24. I am proud of what I can do to [help]. 25. As a result of my [helping], I have intrusive, frightening thoughts. 26. I feel "bogged down" by the system. 27. I have thoughts that I am a "success" as a [helper]. 28. I can't recall important parts of my work with trauma victims. 29. I am a very caring person. 30. I am happy that I chose to do this work. B. Hudnall Stamm, Professional Quality of Life: Compassion Satisfaction and Fatigue Version 5 (ProQOL). This test may be freely copied as long as (a) author is credited, (b) no changes are made, and (c) it is not sold. Those interested in using the test should visit to verify that the copy they are using is the most current version of the test. 1

9 YOUR SCORES ON THE PROQOL: PROFESSIONAL QUALITY OF LIFE SCREENING Based on your responses, place your personal scores below. If you have any concerns, you should discuss them with a physical or mental health care professional. Compassion Satisfaction Compassion satisfaction is about the pleasure you derive from being able to do your work well. For example, you may feel like it is a pleasure to help others through your work. You may feel positively about your colleagues or your ability to contribute to the work setting or even the greater good of society. Higher scores on this scale represent a greater satisfaction related to your ability to be an effective caregiver in your job. The average score is 50 (SD 10; alpha scale reliability.88). About 25% of people score higher than 57 and about 25% of people score below 43. If you are in the higher range, you probably derive a good deal of professional satisfaction from your position. If your scores are below 40, you may either find problems with your job, or there may be some other reason for example, you might derive your satisfaction from activities other than your job. Burnout Most people have an intuitive idea of what burnout is. From the research perspective, burnout is one of the elements of Compassion Fatigue (CF). It is associated with feelings of hopelessness and difficulties in dealing with work or in doing your job effectively. These negative feelings usually have a gradual onset. They can reflect the feeling that your efforts make no difference, or they can be associated with a very high workload or a nonsupportive work environment. Higher scores on this scale mean that you are at higher risk for burnout. The average score on the burnout scale is 50 (SD 10; alpha scale reliability.75). About 25% of people score above 57 and about 25% of people score below 43. If your score is below 43, this probably reflects positive feelings about your ability to be effective in your work. If you score above 57 you may wish to think about what at work makes you feel like you are not effective in your position. Your score may reflect your mood; perhaps you were having a bad day or are in need of some time off. If the high score persists or if it is reflective of other worries, it may be a cause for concern. Secondary Traumatic Stress The second component of Compassion Fatigue (CF) is secondary traumatic stress (STS). It is about your work related, secondary exposure to extremely or traumatically stressful events. Developing problems due to exposure to other s trauma is somewhat rare but does happen to many people who care for those who have experienced extremely or traumatically stressful events. For example, you may repeatedly hear stories about the traumatic things that happen to other people, commonly called Vicarious Traumatization. If your work puts you directly in the path of danger, for example, field work in a war or area of civil violence, this is not secondary exposure; your exposure is primary. However, if you are exposed to others traumatic events as a result of your work, for example, as a therapist or an emergency worker, this is secondary exposure. The symptoms of STS are usually rapid in onset and associated with a particular event. They may include being afraid, having difficulty sleeping, having images of the upsetting event pop into your mind, or avoiding things that remind you of the event. The average score on this scale is 50 (SD 10; alpha scale reliability.81). About 25% of people score below 43 and about 25% of people score above 57. If your score is above 57, you may want to take some time to think about what at work may be frightening to you or if there is some other reason for the elevated score. While higher scores do not mean that you do have a problem, they are an indication that you may want to examine how you feel about your work and your work environment. You may wish to discuss this with your supervisor, a colleague, or a health care professional. B. Hudnall Stamm, Professional Quality of Life: Compassion Satisfaction and Fatigue Version 5 (ProQOL). This test may be freely copied as long as (a) author is credited, (b) no changes are made, and (c) it is not sold. Those interested in using the test should visit to verify that the copy they are using is the most current version of the test. 2

10 WHAT IS MY SCORE AND WHAT DOES IT MEAN? In this section, you will score your test and then you can compare your score to the interpretation below. To find your score on each section, total the questions listed on the left in each section and then find your score in the table on the right of the section. Compassion Satisfaction Scale: T o tal: Burnout Scale: *1. = *4. = *15. = *17. = *29. = The sum of my Compassion Satisfaction questions So My Score Equals My Level of Compassion 22 or less 43 or less Low Between 23 and 41 Around 50 Average 42 or more 57 or more High The sum of my Burnout Questions So My Score Equals My Level of Burnout 22 or less 43 or less Low Between 23 and 41 Around 50 Average 42 or more 57 or more High Reverse the scores for those that are starred. 0=0, 1=5, 2=4, 3=3, 4=2, 5=1 T o tal: Secondary Trauma Scale: T o tal: The sum of my Secondary Traumatic Stress questions So My Score Equals My Level of Secondary Traumatic Stress 22 or less 43 or less Low Between 23 and 41 Around 50 Average 42 or more 57 or more High B. Hudnall Stamm, Professional Quality of Life: Compassion Satisfaction and Fatigue Version 5 (ProQOL). This test may be freely copied as long as (a) author is credited, (b) no changes are made, and (c) it is not sold. Those interested in using the test should visit to verify that the copy they are using is the most current version of the test. 3

11 Special Section I: Yoga & the Emotional Body Y o g a a n d P o s t - T r a u m a t i c S t r e s s D i s o r d e r An Interview with Bessel van der Kolk, MD Dr. Bessel van der Kolk is considered one of the world s leading authorities on Post-Traumatic Stress Disorder (PTSD). He has pioneered the use of Yoga as a therapy that is helping these individuals to work through their PTSD and regain a sense of mastery. He discusses mind-body connections in trauma, how Yoga works and precautions for teaching trauma-sensitive Yoga students. Integral Yoga Magazine (IYM): How did you get interested in Yoga for the treatment of PTSD? Bessel van der Kolk (BvdK): I began my own practice six years ago. I was looking for a way for people to regulate the core arousal system in the brain and feel safe inside their bodies. My interest came from doing research that discovered how trauma affects the brain. Yoga turned out to be a way to get people to safely feel their physical sensations and to develop a quiet practice of stillness. Lots of Yoga sites claimed that Yoga could change basic brain functions, but that was based on intuition, not scientific investigation. So I decided to see if Yoga can positively affect the core regulatory mechanism in the brain. Some trauma-sensitive people can feel frightfully unsafe experiencing the sensations that are evoked by certain asanas. What most people do not realize is that trauma is not the story of something awful that happened in the past, but the residue of imprints left behind in people s sensory and hormonal systems. Traumatized people often are terrified of the sensations in their own bodies. Most trauma-sensitive people need some form of bodyoriented psychotherapy or bodywork to regain a sense of safety in their bodies. IYM: How does extreme stress affect brain function? BvdK: Neuroimaging studies of human beings in highly emotional states reveal that intense emotions, such as anger, fear or sadness, cause increased activity in brain regions related to fear and self-preservation and reduced activity in the brain regions related to feeling fully present. People with PTSD lose their way in the world. Their bodies continue to live in an internal environment of the trauma. We all are biologically and neurologically programmed to deal with emergencies, but time stops in people who suffer from PTSD. That makes it hard to take pleasure in the present because the body keeps replaying the past. If you practice Yoga and can develop a body that is strong and feels comfortable, this can contribute substantially to help you to come into the here and now rather than staying stuck in the past. IYM: What is the main challenge for the trauma sensitive? BvdK: The challenge is to learn how to tolerate feelings and sensations by increasing the capacity for interoception or sitting with yourself, noticing what s going on inside the basic principle of meditation. They need to learn how to modulate arousal. Trauma-sensitive people have their sense of time thrown off and think something will last forever. Their challenge is to learn how to notice what is happening and how things can and will shift, rather than running away or turning to alcohol or drugs to self-medicate. IYM: You have said that those with chronically overwhelming emotions lose their capacity to use emotions as guides for effective action. BvdK: The function of emotion is e-motion, to engage in action. If you are afraid, you want to move away from the object of fear. If you become angry, you feel as if you want to engage or get physical with whomever is making you angry. If you love someone, you want to make some movement toward that person. That is the purpose of emotion to propel us toward action. When you are traumatized your motion is paralyzed. A victim of violence almost invariably has been trapped, pinned down or unable to move. Later, if there is a perceived threat, the body reacts as if it has to move but it once again feels helpless and paralyzed, prevented from being able to act effectively. All the chemicals are released to engage in action but the body doesn t know how to move. Their challenge is that after confrontation with physical helplessness, it is essential to engage in taking effective action. IYM: What about self-care challenges? BvdK: The rational brain is the crowning glory of human beings. It is there to help us to engage in the world, but it is not very good in helping us take care of ourselves. In other words, the rational mind, while able to organize feelings and impulses, is not well equipped to abolish emotions, thoughts and impulses. People with PTSD, usually are out of touch with their physical sensations, and, as a consequence, they have trouble taking care of themselves. On the other end of the brain, the reptilian part is not good in quieting and taking care of the mind. However, when that system is harnessed the mind gets clearer, it s easier to regain perspective on one s life. It is surprising that, in contrast to Asian and African cultures, western traditions hardly pay any attention to the cultivation of techniques to quiet ourselves we have been urged to better living through chemistry. 12

12 IYM: Have Western psychotherapies failed to address this? BvdK: Western psychotherapy has hardly paid any attention to the experience and interpretation of disturbed physical sensations and action patterns. Yoga is one of the Asian traditions that clearly help reintegrate body and mind. For someone to heal from PTSD, one must learn how to control bodily reflexes. PTSD causes memory to be stored at a sensory level in the body. Yoga offers a way to reprogram automatic physical responses. Mindfulness, learning to become a careful observer of the ebb and flow of internal experience, and noticing whatever thoughts, feelings, body sensations and impulses emerge are important components in healing PTSD. IYM: How does Yoga do that? BvdK: Yoga helps regulate emotional and physiological states. It allows the body to regain its natural movement and teaches the use of breath for self-regulation. What is beautiful about Yoga is that it teaches us and this is a critical point for those who feel trapped in their memory sensations that things come to an end. While doing certain asanas, uncomfortable sensations may be evoked. But, by keeping time as they stay in a posture for a limited amount of time, they get to observe that discomfort can be tolerated until they shift into a different posture. The process of being in a safe space and staying with whatever sensations emerge and seeing how they come to an end is a positive imprinting process. Yoga helps them befriend their bodies that have betrayed them by failing to guarantee safety. Another important aspect of Yoga is utilizing the breath. It s very striking that there s nothing in western culture that teaches us that we can learn to master our own physiology solutions always come from outside, starting with relationships, and if those fail, alcohol or drugs. Yoga teaches us that there are things we can do to change our brainstem arousal system, our sympathetic and parasympathetic nervous systems and to quiet the brain. IYM: Is meditation okay for those with PTSD? BvdK: The Dalai Lama and Yoga masters like Swami Satchidananda have made meditation almost mainstream. The neurobiology of meditation that the brain can grow new cells and reshape itself is becoming better known and finding its way into mental health services. If we meditate regularly, this can modulate the fear center and help us be more focused. However, if you are traumatized, being in silence is often terrifying. Memory of trauma is stored, so when you are stilled, demons come out. Those with PTSD should first learn to regulate their physiology with breath, postures and relaxation and work toward meditation. IYM: Do you have any advice for Yoga teachers who work with trauma-sensitive students? Dr. Bessel van der Kolk BvdK: When we practice Yoga, we open ourselves up and psychological imprints are activated. Yoga teachers need to be aware that material will come up during class and they need to be prepared at all times to help people to calm down their bodies, by working work with the breath and quieting poses. Teachers should create a safe space in the class, keep the focus on the breath and the flow of the asanas. It is best to refrain from excessive talking, explaining or preaching during the class the job of the Yoga teacher is to help people to feel safe in every aspect of their self-experience. We have a trauma-sensitive Yoga program and a nationwide trauma Yoga teacher training course. Dave Emerson helps teachers understand how people get triggered and how to teach them to focus on self-regulation. We tell Yoga teachers to make no physical adjustments without carefully checking first with people. Some poses like Balasana (child s pose) can be very sensitive. We don t avoid these, but it s important that trauma-sensitive students are taught by teachers who are skilled in facilitating self-regulation techniques and who can help people use pranayama and movement to stay relaxed and in the present moment. Bessel A. van der Kolk MD has been a clinician, researcher and teacher in the area of posttraumatic stress since the 1970s. He has done pioneering work on the neuroscience of trauma, its impact on development, thinking, feeling and body sensations. For all inquiries about Trauma-Sensitive Yoga Teacher Training, please contact David Emerson, E-RYT at (617) , ext. 222, or demerson@traumacenter.org 13