What is Compassion Fatigue?
Compassion fatigue is a potential experience for professionals who work in a human service related role. Compassion fatigue is more common in professions which focus on people who experience trauma.
Compassion fatigue is also referred to as secondary trauma or vicarious trauma. When a professional experiences compassion fatigue, they may be less effective at providing quality care for their clients.
“Compassion fatigue (CF) is stress resulting from exposure to a traumatized individual. CF has been described as the convergence of secondary traumatic stress (STS) and cumulative burnout (BO), a state of physical and mental exhaustion caused by a depleted ability to cope with one’s everyday environment.(2)”
Compassion Fatigue Related to PTSD
Compassion fatigue may lead to experiences of posttraumatic stress disorder (PTSD) or at least some symptoms of PTSD in the professional. For instance, the professional may begin to avoid certain situations or they experience intrusive thoughts which are both symptoms of PTSD.
Criteria for PTSD (DSM 5)
A formal diagnosis of PTSD requires that a person have been exposed to actual or threatened death, serious injury, or sexual violence. In the case of human service workers, this could be in the form of witnessing or hearing about traumatic events especially repeatedly (1).
Additionally, a person with PTSD would have intrusion symptoms which could include intrusive or distressing memories of the event, related distressing dreams, flashbacks, intense or prolonged stress as a result of exposure to reminders of the event or experience, and/or physiological reactions to reminders of the event.
PTSD also involves efforts to avoid distressing memories, thoughts, or feelings or external reminders such as people or places related to the trauma.
A person with PTSD also experiences changes in mood as a result of exposure to the trauma. For instance, they may experience persistent negative beliefs about one’s self or others, persistent negative emotional states, or feelings of detachment.
They also experience alterations in arousal and reactivity such as by having irritable behavior and angry outbursts, hypervigilance, an exaggerated startle response, problems with concentration, or sleep disturbances.
*To see the full DSM 5 criteria for PTSD, visit NIH.
Although not all professionals (including ABA professionals) will encounter traumatic experiences in their work life, it may be possible that some will encounter clients who have experienced trauma in the past or whose current life experiences are very challenging and, in some ways, could be perceived as very distressing and almost or certainly do qualify as being traumatic.
It is important that, at some time throughout life, 70.4% of people have experienced at least one type of a traumatic event (3). Therefore, being trauma-informed and educated about working with individuals who have experienced trauma is very important to a clinician’s work including those who provide applied behavior analysis.
What to do to Prevent or Address Compassion Fatigue?
If you find that you may be experiencing compassion fatigue or that you are experiencing any of the symptoms of PTSD as it relates to the experiences of your clients, consider addressing this in some way. If necessary seek out professional help.
Even if you wouldn’t consider your client’s experiences as being traumatic and don’t think you have been chronically or even acutely exposed to a trauma within the context of your work, it’s like that at some point in your career you will experience emotionally draining circumstances.
The following tips can help you to address compassion fatigue related to a client’s trauma or even to help you manage emotionally draining circumstances in your work or with your clients.
Tips for Addressing Compassion Fatigue and Emotionally Draining Work
*List adapted from Gallagher (2013)*
- Be self-aware (to explore your thoughts, feelings, and behaviors)
- Reflect on your own experience of dealing with emotionally draining circumstances
- Learn new skills
- Remind yourself of the purpose and meaning in your work
- Practice mindfulness in the moments you have (eg, while hand-washing before seeing a [client], take slow deep breaths, think of a loved one, recite a favorite line, say a prayer, or imagine you are in a favorite place)
- Stop to look out a window, or as you walk outside take time to notice something in nature or in your environment; fully attend to it for even a few moments
- Make connections with patients, family members, or colleagues; this can be through humor or by noticing something about the other person or his or her environment
- Reward yourself after completing tasks or resolving situations
- Deliberately shed your role when you leave work and do not take it home with you
- Use community resources and other professionals…
- Know your limits. This involves not only medical limits (ie, when to refer), but also with difficult [situations and for those] in which it is challenging to achieve good outcomes no matter how hard you try
- Learn from your experiences. Use challenging situations to motivate yourself to acquire new knowledge, skills, or attitudes
- Do what relieves stress (eg, exercise, visit with friends, play sports)
- Practice reflective writing or keep a diary
- Learn and practice mindfulness meditation
- Have a special place you like to visit as a “getaway”
(1) Center for Substance Abuse Treatment (US). Trauma-Informed Care in Behavioral Health Services. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2014. (Treatment Improvement Protocol (TIP) Series, No. 57.) Exhibit 1.3-4, DSM-5 Diagnostic Criteria for PTSD. Available from: https://www.ncbi.nlm.nih.gov/books/NBK207191/box/part1_ch3.box16/
(2)Cocker, F., & Joss, N. (2016). Compassion Fatigue among Healthcare, Emergency and Community Service Workers: A Systematic Review. International journal of environmental research and public health, 13(6), 618. https://doi.org/10.3390/ijerph13060618
(3) Kessler RC, Aguilar-Gaxiola S, Alonso J, Benjet C, Bromet EJ, Cardoso G, et al. Trauma and PTSD in the WHO World Mental Health Surveys. Eur J Psychotraumatol (2017) 8(5):1353383. 10.1080/20008198.2017.1353383 [PMC free article] [PubMed] [CrossRef] [Google Scholar]
(4) Gallagher R. (2013). Compassion fatigue. Canadian family physician Medecin de famille canadien, 59(3), 265–268.