Work and compassion fatigue

Do you feel emotionally numb or drained at the end of the day? Do you enjoy your work but feel like you have nothing left to give? If so, you might be suffering from compassion fatigue – and if that's the case, you're not alone.

Undoubtedly, the veterinary medical field attracts individuals who demonstrate a high level of compassion, empathy, and drive to care for others. Overall, veterinarians and other animal caretakers report a high level of satisfaction in their work; the caregiving work that we do rewards us with compassion satisfaction – a joy or sense of achievement found in helping and caring for others. However, repeated exposure to traumatic events (such as abuse, illness, and euthanasia) can lead to compassion fatigue.

Compassion fatigue and burnout are similar but not interchangeable. Compassion fatigue – also known as "vicarious trauma," "secondary traumatic stress" or "secondary victimization" – is the result of a medical caregiver's unique relationship with a patient, through which empathy allows the caregiver to "take on the burden" of the ill or dying patient. Dr. Frank M. Ochberg, a well-known psychiatrist and pioneer in trauma science, has been quoted widely as describing it as "basically... a low-level, chronic clouding of caring and concern for others in your life – whether you work in or outside the home. Over time, your ability to feel and care for others becomes eroded through overuse of your skills of compassion."

Veterinary professionals are very much at risk for compassion fatigue. Like other caregivers, we deal with death and illness on a daily basis. We have to deliver bad news to clients, deal with animal cruelty, and see clients struggle to balance financial needs with the needs of their pets. Research shows that veterinarians face ethical dilemmas three to five times per week, and such moral stress is a primary contributor to compassion fatigue, according to Dr. Elizabeth Strand, PhD, associate clinical professor and founding director of veterinary social work at the University of Tennessee CVM.

Symptoms of compassion fatigue

Feelings of apathy and isolation are at the top of the list of symptoms of compassion fatigue. But they are far from the only ones. This insidious disorder can cause problems both psychological and physical. Common symptoms of compassion fatigue can include:

• Bottled-up emotions
• Sadness and apathy
• Inability to get pleasure from activities that previously were enjoyable
• Isolation
• Difficulty concentrating
• Feeling mentally and physically tired
• Chronic physical ailments
• Voicing excessive complaints about your job, your manager(s) and/or co-workers
• Lack of self-care, including poor hygiene and a drop-off in your appearance
• Recurring nightmares or flashbacks
• Substance abuse or other compulsive behaviors such as over-eating or gambling

Compassion fatigue also can have systemic effects on your workplace. Look for these organizational symptoms of compassion fatigue.

Addressing compassion fatigue

Caring for yourself is critical to preventing and recovering from compassion fatigue. A growing body of scholars and mental health professionals argue that veterinarians and other caregiving professionals have a moral imperative not just to help patients but also to help themselves.

"The ethical responsibility... includes not just working really hard but also keeping oneself well so that you can continue in the work and help with the other people in the profession or in your clinics," said Strand. 

A good starting point is to use the Professional Quality of Life assessment to get a baseline reading of your current health, then build a self-care plan that charts the path you think is best designed to help bring your life back into balance. Veterinary social workers can offer help, as can counselors and mental health professionals. It's important to recognize that no one can do everything alone, and seek help when you need it.

What can you do?

It can be important to connect with colleagues who experience the same types of traumas and moral stresses as you do. "People who work in organizations that have ‘moral climates' where they can discuss their moral dilemmas and benefit from other social support seem to have better outcomes," according to JAVMA.

Important aspects of the work climate, according to Strand, include "being able to vent feelings, decrease one's emotional attachment to animals, and know that euthanasia is best under the circumstances."

There also are personal approaches that can help alleviate compassion fatigue. These include:

• Focus on building your resilience. The Substance Abuse and Mental Health Services Administration (SAMHSA), a branch of the U.S. Department of Health and Human Services, cites four areas that are key:
  • Adequate sleep
  • Good nutrition
  • Regular physical activity
  • Active relaxation such as yoga or meditation
• Take time to be alone with yourself.
• Engage in meditation and/or mindfulness-based stress reduction. For example, try this simple breathing exercise to increase physical and mental well-being, demonstrated at the 2016 AVMA Convention by Dr. Daniel J. Siegel, clinical professor of psychiatry at the UCLA School of Medicine and founding co-director of the Mindful Awareness Research Center at UCLA.
• Engage with co-workers to celebrate successes and mourn sorrows as a group.
• Connect with other colleagues, either in person or through online discussions, for shared support that can remind you that you aren't alone.
• Practice "expressive writing." Strand advises journaling for 15-20 minutes every day about what stressed you out that day.
• Practice your spiritual beliefs.
• Complete basic hygiene tasks every day, such as combing/brushing your hair and changing into and out of work clothes.
• Wash up before you leave work – even just your hands and face. "Think of it as a symbolic 'washing away' of the hardness of the day," SAMHSA advises.

How AVMA can help

Stress management for veterinarians – Stress is normal in the day-to-day life of a veterinarian, but too much stress can have negative effects on our health. Learn tips and strategies to help you cope. 

How understanding the mind and cultivating mindsight supports your wellbeing (video) – Dr. Daniel J. Siegel outlines the connections between mind and body, and teaches a simple breathing exercise proven to increase both physical and mental well-being, during this keynote address at the 2016 AVMA Convention.

Staying afloat: Professional stress and wellbeing (webinar) – Dr. Carrie La Jeunesse covers compassion fatigue and provides coping strategies, self-assessments and resources to help us recognize problems, and support ourselves and those with whom we work.

Mission possible: Creating a culture of wellbeing (webinar) – Explore the role you play in creating a culture of wellbeing in your workplace and your personal life. Veterinary CE credit available.

Organizational symptoms of compassion fatigue – In addition to affecting individuals, compassion fatigue also can cause problems in a veterinary practice. Learn to recognize the signs of compassion fatigue in your work environment.

Additional reading and resources

Self-compassion.org

Compassion Fatigue Management

Burnout, Compassion Fatigue, Depression... What's The Difference?

The Burden of Care: Know the Risks to Your Mental Health

When the Caring Gets Tough: Compassion Fatigue and Veterinary Care (PDF)

Extinguishing Burnout

Compassion Fatigue: Continuing to Give when the Well Runs Dry

Running on Empty: Compassion Fatigue in Health Professionals (PDF)

Preventing Compassion Fatigue in the Vivarium

Video: The Space Between Self-Esteem and Self Compassion: Kristin Neff at TEDx Centennial Park Women

Video: Healing the Wounded Healer

Books:

Play: How it Shapes the Brain, Opens the Imaginations, and Invigorates the Soul, by Stuart Brown and Christopher Vaughan

Train Your Brain, Engage Your Heart, Transform Your Life, by Amit Sood

When Helping Hurts: Compassion Fatigue in the Veterinary Profession, by Kathleen Ayl, AAHA Press