Are you experiencing compassion fatigue?

Psychologist Heidi Allespach, PhD, of the University of Miami’s Miller School of Medicine, knows that the big hearts that propel people into psychology and other caregiving careers also put them at risk of developing compassion fatigue. Ironically, she explains, caregivers can become so over-empathic that they find themselves growing numb to their patients’ suffering. That’s why she urges the medical residents she teaches to develop what she calls a “semi-permeable membrane” around their hearts. “Without enough of a shield, everything just comes in,” says Allespach. “And being overwhelmed with the feelings of others can feel like drowning.”

Now Allespach and other psychologists are worried that psychologists are facing increased risks of compassion fatigue as the COVID-19 pandemic stretches on.

Compassion fatigue occurs when psychologists or others take on the suffering of patients who have experienced extreme stress or trauma, explains Charles R. Figley, PhD, founder of the Traumatology Institute at Tulane University. It is an occupational hazard of “any professionals who use their emotions, their heart,” he says, and represents the psychological cost of healing others. “It’s like a dark cloud that hangs over your head, goes wherever you go and invades your thoughts,” he says.

Compassion fatigue doesn’t just make it difficult to feel empathy for your patients, says Kerry A. Schwanz, PhD, of Coastal Carolina University. One component of the condition is burnout, which is associated with too much work and not enough resources to do that work well. Burnout can result in depression and anxiety, physical and emotional exhaustion, less enjoyment of work, and more arguing. Another component of compassion fatigue is secondary traumatic stress, or indirect exposure to trauma via helping others. “I sometimes refer to this component as ‘empathy overload,’” says Schwanz, adding that symptoms include anxiety, intrusive thoughts, hypervigilance, numbness or feelings of having nothing left to give.

To keep compassion fatigue from developing or to address it if it does, compassion fatigue experts suggest that psychologists do the following.

“Psychologists and other people in helping roles really do forget that they’re vulnerable,” says Schwanz, explaining that psychologists are trained to be empathic but also to put their own emotions aside. If psychologists suspect they are experiencing compassion fatigue, Schwanz recommends they assess themselves with the free Professional Quality of Lifeopens in new window measure developed by psychologist Beth Hudnall Stamm, PhD. This self-report tool covers symptoms, such as loss of productivity, depression, intrusive thoughts, jumpiness, tiredness, feelings of being on edge or trapped, or inability to separate personal and professional life. The measure also assesses compassion satisfaction—the positive emotions associated with helping others, such as happiness, pride and satisfaction.

Psychologists should adopt the mantra of flight attendants: “Put your own oxygen mask on before helping others,” says psychologist Amy M. Williams, PhD, of the Henry Ford Health System. Good self-care means developing a routine that makes each day predictable and that includes what Williams calls the big five of self-care: adequate sleep, healthy nutrition, physical activity, relaxation and socializing. The schedule should also include five minutes for a self check-in each morning to assess tension in the body and worries in the mind. “Don’t do it 10 minutes before bed, when the mind spins off into worry,” she suggests.

It’s not enough to just go through the motions of self-care, emphasizes Schwanz. It needs to be a legitimate attempt. “In our society, we applaud people who work themselves to death, who neglect their own self-care to help others,” says Schwanz. “We rarely applaud people for taking the day off.” Psychologists may have internalized this message, viewing self-care as selfish, says Schwanz, who is studying such beliefs’ relationship with compassion fatigue. As a result, psychologists may not reap the benefit of any self-care efforts they make, because they engage in behaviors such as worrying about work on a day off. And psychologists shouldn’t feel guilty about taking time for fun and laughter during this sad, anxious time, adds Thomas Skovholt, PhD, of the University of Minnesota. Playing games, watching funny movies and the like can replenish the energy needed to help others, he says. Even a tiny dose of positive emotion, such as noticing flowers blooming, can help.

Psychologists are having a hard time along with everyone else, says Allespach, and that’s unusual. Most psychologists are now experiencing the same problems their patients are experiencing—worries about safety, uncertainty, financial concerns and disrupted routines. “Psychologists are usually the rocks in the river of life’s uncertainty for our patients, but right now, we’re in that river with them,” she says. “For those of us in the helping professions, we’re trying to help our patients make sense of this strange new reality while doing that ourselves.” That unusual situation can increase psychologists’ stress, says Allespach. But so can psychologists’ own tendencies, says psychologist Anna Baranowsky, PhD, founder of Toronto’s Traumatology Institute, who says psychologists tend to be “over-copers.” “They are capable of working really hard and delivering great results,” says Baranowsky. “But they are very self-demanding and very focused on the perfection of what they’re delivering, until the point of total exhaustion.” It’s important for psychologists to take time to reflect—alone, with a trusted colleague, religious leader, or therapist—on any wounds that are surfacing during this uncertain time, she says. “You want to really respect the fact that you’re human, too,” she says. “Bearing witness to another person’s suffering ignites things within ourselves.” 

Connecting with like-minded others is another strategy that can help prevent compassion fatigue. “It may not sound fancy or sophisticated, but building community is the most powerful thing you can do,” says Geoffry White, PhD, a private practitioner in Los Angeles who has worked to prevent compassion fatigue in mental health practitioners responding after terrorism and war. In addition to staying connected with family and friends, psychologists could set up Zoom consultation or supervision groups to check in with each other and prevent and address signs of compassion fatigue. “Compared with other societies, the United States has a very mind-your-own business culture, prizing independence and self-reliance over community” says White. “But anything that takes away from that isolation—peer support—will help.”

The pandemic is exacerbating what was already a crisis of burnout for health-care providers, say researchers and medical professionals at Texas A&M University and Houston Methodist Hospital. They found that intensive care unit workers are facing longer shifts, increased patient deaths, lack of personal protective equipment and financial fears among other stressors (Sasangohar, F., et al., Anesthesia and Analgesiaopens in new window, published online ahead of publication, 2020). Those stressors can also lead to compassion fatigue. If psychologists see signs that a colleague, whether another psychologist or a health-care professional, is developing compassion fatigue, they should check in, says Schwanz. Psychologists and trusted colleagues can give each other permission to point out potential problems and keep at it despite attempts to deflect or deny, says Schwanz. Schwanz herself has a self-care buddy. They text each other to check in on each other’s stress levels and to report daily acts of self-care, such as taking breaks and drinking enough water to stay hydrated.

It’s also important to normalize compassion fatigue, adds Williams. “You could say, ‘These are crazy times, and I’m struggling,’” she says. “Then ask, ‘Is that something you’re going through, too?’” In the support groups she runs, for example, participants often admit that they didn’t realize compassion fatigue is normal, and so they were hesitant to ask for help. Once they realize that feeling this way is normal for others, she says, they are more willing to talk about their struggles and to accept help. 

Psychologists should celebrate the positives of helping others. “There can be terrible things going on, but focus on the wins,” suggests Schwanz, citing the celebrations health-care providers hold when patients come off ventilators. Focusing on gratitude can also help, she says.

To learn more about compassion fatigue, read “Compassion Fatigue Resilienceopens in new window” or The Resilient Practitioner: Burnout and Compassion Fatigue Prevention and Self-care Strategies for the Helping Professions. There is also a special issue of the journal Traumatology devoted to secondary traumatic stress, compassion fatigue and vicarious trauma.

Toronto’s Traumatology Instituteopens in new window offers online compassion fatigue specialist trainingopens in new window and other resourcesopens in new window. The institute also offers an entry-level online compassion fatigue resiliency and recovery trainingopens in new window for students and community members.

Get more tips on self-care by reading about how to take care of yourself and avoid burnout. To earn continuing education credit, read the Monitor article “Are you burned out? Here are signs and what to do about them.”