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1 Faculty/Presenter Disclosure Presenter: Patricia Baigent Mitigating the Effects of Compassion Fatigue Relationships with commercial interests: Grants/Research Support: N/A Speakers Bureau/Honoraria: N/A Consulting Fees: N/A Other: Employee of Canadian Mental Health Association Oxford Branch and Owner of Mindful Self Compassion.ca Copyright do not use without permission

2 CFPC CoI Templates: Slide 2 Disclosure of Commercial Support This program has received financial support from no organizations. This program has not received in-kind support from organizations. Potential for conflict(s) of interest: The speaker has received no payment/funding from any organizations supporting this program.

3 Mitigating the Effects of Compassion Fatigue Patricia Baigent M.S.W. R.S.W. CMHA Oxford

4 Quickie Definition Review Definitions Compassion Fatigue, Vicarious Trauma, Moral Distress, Burnout

5 Compassion Fatigue The Cost of Caring for others in emotional pain Charles Figley, Compassion Fatigue A deep erosion of our compassion, of our ability to tolerate strong emotions/difficult stories in others Evident in helpers professional and personal life

6 Vicarious Trauma Also called Secondary Trauma Repeated exposure to difficult stories that changes our view of the world forever (Saakvitne & Pearlman) Can cause nightmares, difficulty getting rid of certain images, an intense preoccupation with a particular story or event we ve been exposed to. Mathieu, Françoise (2012)

7 Moral Distress [ ] happens when there are inconsistencies between a [helper s] beliefs and his or her actions in practice (Baylis 2000) when policies or routines conflict with [ ] beliefs about [ ] patient care (Mitchell 2000) Mathieu, Françoise (2012)

8 Burnout Physical & emotional exhaustion as a result of prolonged stress and frustration (Stamm) Depleted ability to cope with work demands Feel powerlessness to achieve goals Can happen in any occupation World view not necessarily changed, can be cured instantly by quitting or changing your job Mathieu, Françoise (2012)

9 The Warning Signs Continuum Mathieu, Françoise (2012)

10 What Are CF Warning Signs?

11 Physical Signs of Compassion Fatigue Exhaustion Insomnia Headaches Increased susceptibility to illness Somatization and hypochondria Mathieu, Françoise (2012)

12 Behavioural Signs and Symptoms Increased use of alcohol and drugs Anger and Irritability Avoidance of clients Absenteeism Impaired ability to make decisions Problems in personal relationships Attrition Compromised care for clients Forgetfulness Mathieu, Françoise (2012)

13 Psychological signs and symptoms Distancing Negative self image Depression Reduced ability to feel sympathy and empathy Cynicism Resentment Dread of working with certain clients Feeling professional helplessness Depersonalization Disruption of world view Mathieu, Françoise (2012)

14 Forgetfulness Impact on memory result from the cortisol on the brain cells (neurons) Brain function slows down and the most affected part is the hippocampus where short-term memory is stored. As a result people start to work more slowly and less efficiently output is diminished Is work Killing You? Dr. David Posen

15 Psychological signs and symptoms Hypersensitivity to emotionally charged stimuli Insensitivity to emotional material Increased sense of personal vulnerability Loss of hope Difficulty separating personal and professional lives Sources: Saakvitne (1996), Figley (1995), Gentry, Baranowsky & Dunning (1997), Van Dernoot Lipsky, 2008.

16 Strategies to Reduce Exposure to Vicarious Trauma Reduce Trauma Inputs Take stock of the traumatic imagery news Hobbies different from your work? What are you talking about on your lunch breaks? movies,

17 Workplace Strategy LID Low impact debriefing (anti-sliming strategy)) Mathieu, Françoise (2012)

18 Low Impact Debriefing 1. Increased self awareness 2. Fair warning 3. Consent 4. Low impact disclosure

19 Questions to ask yourself before you share graphic details: Is the listener: Aware that you are about to share graphic details? Able to control the flow of what you are about to share with them? Read article on LID: and clicking on Resources Mathieu, Françoise (2012)

20 Invulnerability Culture We ve seen it all and it doesn t affect us anymore. The new (younger) workers are soft; you should have seen the way it used to be around here!

21 Reframing the Burned Out Staff What would happen that instead of condemning our cynical, negative colleague we recognize them as being a deeply fatigued caring individual? Trauma Informed Care understanding the impact of trauma on the entire organization

22 Reframing the Burned Out Staff In order to burn out, a person needs to have been on fire at one time. Ayala Pines

23 Overworking Hallmark of CF Many of us might believe, secretly or not so secretly that our commitment to our work may be measured by our willingness to martyr ourselves. Must be nice Laura van Dernoot Lipsky Trauma Stewardship

24 The Human Function Curve (*Nixon, P: Practitioner 1979) NO ONE BEATS THE CURVE!

25 Dr. Posen s 5 Lessons of the Human Function Curve 1. Be Aware 2. Don t cross the line too often. 3. Don t get out too far. 4. Don t stay out there too long. 5. When you are out past the hump working longer and/or harder is counterproductive. From Is your work killing you?

26 Loss of Insight When we keep ourselves numbed out on adrenaline or overworking or cynicism, we don t have an accurate internal gauge of ourselves and our needs. Laura van Dernoot Lipsky Trauma Stewardship

27 Emotional Numbing There is no such thing as selective emotional numbing When you numb yourself to bad emotions you also dull your experience of good feelings too Yet this is a primary defence for many fatigued professionals Gifts of Imperfection Brene Brown

28 Exquisite Empathy Richard Harrison and Marvin Westwood UBC Hazardous to try to avoid or downgrade the intensity of feelings that arise from this work Even those of us that deal with the severely traumatized deserve jobs that are enjoyable Self Compassion

29 Exquisite Empathy Overarching Skill Bring Autonomic dysregulation into conscious Control Feel better vs. feel better Conscious Oversight

30 Experiential Engagement Leaning in vs. Leaning out If you are not willing to have it you will Avoidance is the issue

31 Avoidance Embracing the suck You can t choose to feel one or the other Brene Brown There is no such thing as selective emotional numbing.

32 Strategy - Experiential Engagement 1. Set intention What are you going to do with the Emotional Pain that comes with your work? Only one rational answer I m going to feel it Soft Front and Strong back zen buddhist

33 Experiential Engagement 2. Awareness/Acknowledgement How does that make you feel? Do we ask this of ourselves? Needs to be our go to question How am I feeling, where am I feeling it

34 Experiential Engagement 3. Notice and Allow Left alone the energy of emotions will arise, strengthen and then fade Rumination cognitive process keeping the emotions going Cognitive efforts try to put it out or ramp it up

35 Experiential Engagement 4. Non-reactivity Stance It will not kill you to have your heart broken every day

36 Strategy 2 - Decreasing Rumination Decreasing Rumination All mammals except us feel the terror and let it go We have the capability to keep re-imagining this

37 Managing Rumination Killingsworth & Gilbert 2010 People are happiest when: Sex, exercise, conversation focused on activity People are unhappiest on computer, at work, resting leads to mind wandering

38 Default Mode Network What your mind is doing when its not doing anything 64% of the time worrying about survival salient thoughts Other 1/3 creative problem solving

39 Managing Rumination 1. Intention giving yourself permission to let go Longer you stay in default mode (worrying) the worse the problem solving gets

40 Managing Rumination 2. Task Positive Network Antidote to rumination

41 Managing Rumination 3. Resiliency Skills Acknowledge it (I m ruminating) Relationships interaction with another person not necessarily a debrief Activity Focus

42 Strategy - Conscious Narrative Conscious Narrative What is the story we tell ourselves about our work? Trauma is encoded in R brain Narrative is encoded in L brain We need harmony between these two Intense experience demands a narrative to move to integration

43 The Antecedent Narrative I accept my role as the steward of Supporting Mental Health Professionals in their work with clients who experience mental illness I acknowledge that this commitment is intense. If you think stress is bad it will be experienced as bad versus If you think stress is needed/necessary

44 Antecedent Narrative Very little cynicism about the central task grace and goosebumps moments

45 Concurrent Narrative I am confident of my skills to manage very difficult situations Traumatic Exposure I Can handle it leads to decreased cortisol I can t handle it leads to amygdala activation

46 Self Compassion by Kristin Neff

47 Self Compassion All suffering is worthy of compassion What do we say to ourselves when we have made a mistake? When we are disappointed with ourselves? Would you speak to your best friend this way?

48 How Do I Treat a Friend? In times of suffering, misfortune, failure, feeling inadequate How do you typically respond to your friends in such situations? What do you say? What tone do you use? How do you typically respond to yourself in these situations? What do you say? What tone do you use?

49 Self-Compassion The simple definition: Treating ourselves with the same kindness as we would treat a friend when things go wrong. Treating ourselves the way we would like others family and friends to treat us.

50 Self Compassion All suffering is worthy of compassion. Even yours

51 Physiological Underpinnings Self-Criticism Underpinnings Threat Defence System Cortisol and Adrenaline (Flight and Fight) When you self critical, your brain (amygdala) can t differentiate between an inside (selfjudgement) attack and an outside (others) attack

52 Physiological Underpinnings Self-Compassion Underpinnings Mammalian care-giving system Oxytocin, DHEA Oxytocin-hormone of love increases with connections, breastfeeding, bonding DHEA-de-Hydro-epiandrosterone-produced in adrenalsmost abundant circulating steroid in body-hormone of joy

53 Research on Self Compassion Using Self Compassion Scale (Neff 2003) Reductions in Anxiety, depression, stress, rumination, perfectionism, shame and negative body image Increases in Life satisfaction, happiness, connectedness, self-confidence, optimism, curiosity and gratitude More effective coping with divorce, combat trauma and chronic pain

54 Research - Self Compassion Linked with Personal Accountability Take greater responsibility over past mistakes we can own that we are fallible humans More likely to apologise, forgive others Greater compassion and empathy for others

55 Self-Compassion for Helping Professionals When we recognize how difficult it is to be there for people who are struggling, and comfort ourselves in the process, we are able to be stronger, more stable and resilient when supporting others in their suffering Self compassion is a way of emotionally recharging our batteries Self compassionate care givers are more able to help others while guarding against boundary violations and vicarious trauma and compassion fatigue

56 Self-Compassion for Helping Professionals When caregivers have self-compassion they are more likely to engage in concrete acts of self-care They ll stop to care for their own emotional needs, recognizing how hard it is to deal with such a high level of suffering on a daily basis Hardships of a care giver are just as valid and worthy of compassion as the hardships of being a trauma victim intensity and level of debilitation not withstanding All pain and suffering deserves to be held in the warm embrace of compassion so that healing can occur

57 Cultivating Self Compassion

58 Ideas to Cultivate Self-Compassion Self Compassion Mantra This is a moment of suffering (Mindfulness) Suffering is a part of life (Human condition) May I be kind to myself in this moment (Intention for self compassion) May I give myself the compassion I need

59 Ideas to Cultivate Self-Compassion Practice gentle loving touch

60 Soothing Touch Soothing our own pain Releases oxytocin Increase feelings of trust, calm, safety and connectedness Can counteract increase in blood cortisol Facilitates warmth and compassion for ourselves Kristin Neff 2012

61 Ideas to Cultivate Self-Compassion The Self-Compassion Break Mindfulness practice, noting when you are suffering, being self critical, when you are feeling reactive (anger) Take a moment to close your eyes and take 3 deep breaths. Ask yourself what am I feeling? Give yourself compassionate self talk, This is a moment of suffering, this is hard, I m feeling really drained, or I m feeling angry Asking yourself - What do I need? May I be kind to myself

62 Breathe in Something Good One for me and one for you breathing Can be done right in the difficult moment Ensures you are getting oxygen and mentally giving yourself and the person you are caring for positive intension

63 Take Care of Yourself While Taking Care of Others