Managing Compassion Fatigue with Mindfulness and Self-Compassion

1. Managing Compassion Fatigue with Mindfulness and Self-Compassion Robin Beardsley, MD CCFP GP Psychotherapist, Ottawa, ON Care4You Conference June 4 2014 Kingston, ON

2. Compassion Fatigue • Is an occupational hazard • The level of CF can ebb and flow from one day to the next • Even if we use all the strategies of work/life balance and self care we can experience a higher level of CF if we are suddenly experiencing a heavy case load or working with a lot of trauma • We don’t develop CF because we did anything wrong • We develop it because we care- or we used to care

3. Contributing Factors • Can be summarized as: • Nature of the Work • Nature of the Client • Nature of the Helper • Francoise Mathieu, 2012 • Saakvitne and Pearlman (1996)

4. Nature of the Work • Heavy case loads- either many patients or those with significant trauma history • Stressful working environments • Emergency vs hospital ward vs private office • The pace of the work ( short term vs long term care) • Feeling supported by other colleagues or employers • Dwindling resources- clients needs are greater than the system can provide • Am I doing the kind of work I enjoy?

5. Nature of the Client • Clients often project negative feelings onto us • They can be demanding and never satisfied • Litigious- fear of lawsuits • Working with stress emotions- fear confusion rage helplessness hopelessness grief, cynicism, loneliness, bitterness • Balance/ variety of clients

6. Nature of the Helper • Well trained for the job • Fulfilling social life- able to make time for yourself, hobbies activities • Healthy coping strategies • Current life stressors • Aware of own FH/past traumas • Aware of Self and own impact of the work • Mindful of own experience of working with others

7. Evolution of the Brain Vertical Brain Horizontal • Reptile (downstairs) brain- helps us to act instinctively and make split second decisions • Born to survive • Mammalian ( upstairs) brain-leads us toward connection and relationship • Left Brain-helps us think logically and • organize thoughts into rational sentences • Right brain- helps us experience emotions and • read nonverbal cues

8. The Brain helps us to Survive Cortisol • Increases at times of danger/threat • Perceived or real • Limbic system- amygdala- gets body ready for fight/flight or freeze • Limbic system primed by 8/12 gestation ready for survival of infant

9. Limbic System( Reactive Brain) • Amygdala responds to threat • Outside of our awareness • Fully ‘on line’ by ~ 28 weeks gestation • Initiates neural(brain) circuitry which more or less chooses an adaptive defensive behaviour • To flee, to fight, to freeze

10. Brain is a social organ • Cannot develop in isolation • Needs another brain to connect with • To reflect/ mirror who we are back to us • This is how we first KNOW our Selves

11. Brain is “plastic” or “moldable” • Brain physically changes throughout the course of our lives- not just in childhood • Experience molds our brains • When we undergo an experience our brain cells- neurons become active or fire • Neurons that fire together, wire together- lay down pathways to react • Hippocampus helps us to remember what happens- lay down pathways and memories (become implicit) react from these implicit memories- unconscious to us

12. Implicit Memory • Each experience is an opportunity to reinforce existing neural connections; repeated experiences shape how we see ourselves, others, and the world.

13. Development of our BrainsYoung children are right brain dominant.

14. Two modalities of our lovely differentiated brain Right hemisphere Left hemisphere • Holistic • Imaginative • Creative • Nonverbal (all the paralinguistics in communication [tone of voice, facial expressions, eye contact...]) • Receives, interprets emotional information • Is directly influenced by the body and ‘lower brain’ • Autobiographical • Focus is on Context • Logical • Linear • Language • Literal • Letter of the Law • Focus is on text

15. Too much stress • Sense of overwhelm • Impacts of stress less from external events, more from depleting emotions; • frustration, fear, impatience, anger • Self criticism-Amygdala cannot distinguish between an “attack “ from outside (others) or inside( from our own harsh judgement) • Fight, flight, freeze • Too much cortisol->depletes neurotransmitters –cannot experience pleasure

16. Chemicals of Care DHEA, Oxytocin • Oxytocin-hormone of love increases with connections, breastfeeding, bonding • DHEA-de-Hydro-epiandrosterone-produced in adrenals-most abundant circulating steroid in body-hormone of joy-

17. Soothing Touch • Soothing our own pain – taps into the mammalian caregiving system • Releases oxytocin • Increase feelings of trust, calm, safety and connectedness • Can counteract increase in blood cortisol • Facilitates warmth and compassion for ourselves • Kristin Neff

18. Virginia Satir • “Columbus of Family Therapy”- worked with families before it was seen as beneficial • BELIEFS- • believed we are all connected with life energy • believed we are all spiritual beings in a Physical Body • Believed we are all unique • So differences arise- we adjust to life by coping • Believed that our coping/survival is a reaction to an imbalance or dysregulation of Self- not our true SELF, Coping is the problem

19. A Person is Life Energy • The experience of pure Life Energy is one of • Joy • Love • Peace • Stillness • Love • Connectedness • Harmony • We are spiritual beings embodied and in relationship with other embodied spiritual beings

20. Survival Energy • Life is tough, despite best intentions things go wrong • We tend to react ( which is the implicit automatic response)instead of responding ( a more regulated upstairs brain approach) • Keep replicating these “survival patterns” in our subconscious

21. Iceberg Metaphor

22. Iceberg Metaphor Behaviour Coping-accept,deny,ignore,project Feelings Feelings about Feelings (judgement of feelings) Perceptions-self, other, world Expectations- self,others,others of you Yearnings-universal SELF- Life Force Waterline Ego survival “Doing” “Being”

23. Dysregulation and Integration • When we are dysregulated-in our Survival energy/mode-reactive or downstairs brain • Anything to reconnect you to your SELF will help you to respond, instead of react in a situation • Brings us back to the here and now, to our essence or life energy • This is vertical and horizontal integration

24. Mindfulness • “The awareness that emerges through paying attention on purpose, in the present moment, and nonjudgementally to the unfolding of experience moment to moment”- Jon Kabat-Zinn • “Knowing what you are experiencing ,while you’re experiencing it”- Guy Armstrong

25. Mindfulness – States of Mind Wise Mind Emotions control behaviour Anxious->avoid Depressed->withdraw Angry->lash out Happy->feel good LEFT Brain (Logical) RIGHT Brain (Emotional and Non-verbal) No emotions Logical Straight forward L + R + Intuition=Grounded Balanced- think about consequences of behaviour and choose how you want to act rather than react Connect with Life Energy & Inner Wisdom

26. Compassion Compassion • “ The wish that all sentient beings may be free from suffering”- Dalai Lama • “ Deep awareness of the suffering of oneself and other living beings, coupled with the wish and effort to alleviate it” – Paul Gilbert

27. Compassion Satisfaction • What do I enjoy about my job? • What sustains me and keeps me in the field? • How have I made a difference to others, how do I connect?

28. Signs/Symptoms of Compassion Fatigue • PHYSICAL • Exhaustion, • insomnia, • headaches, • increased susceptibility to illness • BEHAVIOURAL • Increased use of alcohol and drugs • Anger and irritability , • Avoidance of/distancing from work , clients, family, hobbies • Saakvitne (1995) Figley (1995)

29. Signs/Symptoms of CF Cont’d • PSYCHOLOGICAL • Emotional exhaustion, depression • Reduced ability to feel sympathy/ empathy • Cynicism • Low job satisfaction • Disruption of world view • Intrusive thoughts, dreams • Inability to tolerate strong emotions • Heightened anxiety • Loss of hope • Saakvitne (1995) Figley (1995)

30. Common humanity • How many of you have experienced fear, shame, humiliation, anger, guilt, sadness, loneliness • We are all human and have this commonality in that we have shared these emotions. That is, we are not alone in experiencing these feelings at some time in our lives

31. Self Compassion/Kindness • We typically react when things go awry by feeling ashamed or getting self –critical • Instead of greeting difficult emotions by fighting hard against them we can bear witness to our own pain and respond with kindness and understanding • We can be kind to ourselves in the midst of suffering- which then releases oxytocin, soothes our brain and amygdala, brings our cerebral cortex back on line and we can self regulate • This is Self-Compassion

32. Mindful Self Compassion- EXERCISE • Self compassion has three components • Mindfulness, Kindness and Common Humanity • Starts with Mindfulness, then sets the intention to soothe and comfort ourselves, remembering that suffering is part of the shared human experience • Taps into our internal caregiving system. Allows us to feel safe and accepted, allowing us to turn toward and accept our painful experiences with greater ease

33. Mindful Self Compassion • 1. Self kindness vs self criticism • 2. Common Humanity vs self –isolation • 3. Mindfulness vs emotional entanglement • Kristen Neff

34. Mindfulness and Self Compassion • Mindfulness • What’s arising in the present moment experience, and can be applied to any experience- positive , negative or neutral • “Feelyour suffering with spacious awareness and it will change” • “What do I know?” • Self Compassion • Focuses on the experiencer, only relevant when the experiencer is feeling negative or distressing emotions • “Be kind to yourself in the midst of suffering and it will change” • “What do I need”

35. Use Of SELF in Therapy Doctor/Therapist PATIENT/CLIENT Behaviour Feelings F about F Perceptions Expectations Yearnings SELF Behaviour Feelings F about F Perceptions Expectations Yearnings SELF

36. Thank You • dr.rbeardsley@gmail.com