Compassion Fatigue/ Secondary Traumatic Stress: Caring for the Caregivers

1. Compassion Fatigue/ Secondary Traumatic Stress: Caring for the Caregivers Together We Can April Naturale, MSW, Ph.D. Lafayette, LA October 6, 2010

2. Goals and Objectives Goal: For staff working with abused and traumatized children to understand and address their risks and responses to Compassion Fatigue, Secondary Traumatic Stress and Burnout Objectives: To be able to identify the body and mind’s responses to stress To learn ways mitigate and address these responses by implementing skills and self care To monitor changes over time

3. CONCEPTS OF STRESS VARY Stress is a cognitive reaction that affects humans physiologically Individuals from different backgrounds, cultures and geographic areas perceive stress differently

4. The Physiology of Stress Good Stress • The good stress allows us to perform at a higher level (fight or flight) • The production of cortisol improves memory and enhances immune function • Spikes in blood pressure flood our muscles and brain with oxygen

5. The Physiology of Stress Bad Stress-Overload • The allostatic system becomes charged too frequently with NO CHANCE TO VENT the build up of energy • Too much cortisol will damage memory, hurt or weaken your immune system and enlarge your stomach

6. Work Stress Stress measured by increases in blood pressure is generally twice as high during the work day compared to when at home or time off. (Pickering, 2005)

7. Work Stress The worst work-related stress is caused by jobs where people have little control over activities and the rate at which they have to address them

8. Environmental Effects • Responsibility of caring for physically and/or emotionally abused, neglected children • Exposure to the fear, grief, pain, loss, separation, death of children • The community/social response (or lack of)

9. Additional Factors • Depression-5-10% of the population (NIMH, 2005) • Race-genetics, family illnesses • Diet –high salt, high fat • Social Constructs-professional women, single parents with children

10. The Population of Care Children react to caregiver’s emotional responses Child care workers put needs of children ahead of their own Increased responsibility of caring for children increases the stress response

11. Compassion Fatigue THE COST OF CARING

12. Secondary Traumatic Stress The experience of trauma symptoms in the counselors as a result of listening to the trauma material of clients

13. Differentiations • Not burnout, but can lead there (Figley, 2002) • Unlike countertransference (Green, 1992) • Differentiated from vicarious trauma (Pearlman & Saakvitne, 1995; Figley, 1999) • Compassion fatigue and secondary traumatic stress are most similar in meaning (Stamm 1999)

14. Symptoms (Trauma Specific) • High adrenaline, physical euphoria, numbness-the endorphin effect disguises distress • Coupled with fatigue, cognition can change and create an inability to recognize poor judgment • Anger is a common defense against recognizing the problem

15. Symptoms • Posttraumatic stress disorder symptoms; Symptoms that parallel those of client Monroe, 1999 • Negative cognitive schemas Pearlman & Saakvitne, 1995) • Questioning beliefs; Sense of helplessness • Isolation; Depression; Increased substance use; Increased rates of physical illness • Lower staff morale and productivity; Higher turnover and errors Stamm, 1997 Disaster Mental Health Management & Training

16. High Risk Symptoms Medicating or narcotizing Overeating, excessive drinking Extramarital affairs Suicidal gestures

17. Long Term Exposure Symptoms Tiredness/weariness yet insomnia Brooding, wistful, mournful-Depressive Increasing demoralization Intellectualizing/Religionizing the work Grandiosity (I can handle this myself/don’t consider asking for help)

18. Risk Categories • Health, mental health, social services providers • Staffs with clients who experience profound suffering • Highly exposed response staffs (media, clergy, caregivers) • Inhibited individuals in these groups (more likely to have dissociative responses)

19. Risk Variables • Lesser educated and lesser experienced counselors • Greater length of assignment results in higher STS risk • Gender and ethnicity have been found to affect STS (women and minority status)

20. Child Care Workers • Are generally self sacrificing -many place themselves in danger -many will work ‘till it hurts -many will skip breaks -many will ignore/fight direction to rotate assignments, go off duty or take benefit time even when encouraged

21. Automatic Responses • Caregivers react to stressful situations by training- without the benefit of thought-they go right to caring for others • Concerns for family don’t disappear-We put our own emotions on hold • Cognitive reactions reinforce physical reactions (our thinking controls our actions) Disaster Mental Health Management & Training

22. What Can You Do? Learn Be Aware Monitor Think Practice Change Manage

23. Prevention: Structural • Vary caseload of trauma and non trauma cases • Utilize buddy system • Access supervision routinely (Dugall, Herberman, Delahanty, Inslicht & Baum, 2000). • Supervisors-mandate case rotation and use of benefit time (Monroe, 1999)

24. Prevention: Professional Perspective Expect, seek & accept peer support Master controlled, limited empathy Define structure and boundaries Monitor overidentification Self assess-PRO QUAL-IV Commit to implementing self-care

25. Prevention: Personal Recognize when you are: Hungry Angry Lonely Tired Maintain support systems Schedule personal time, engage in pleasurable activities Maintain a balance Practice Self Care

26. Prevention: Professional Perspective Be realistic Commit to implementing self-care Recognize that the world won’t fall apart without you LET GO

27. As a Unit Give yourselves permission to celebrate even in the midst enormous stress- play, laugh, experience joy Be together-don’t isolate Communicate, communicate, communicate (e.g. I need you to understand, we will get through this together, let’s stay connected) Plan for every day 27

28. Simple Stress Management Managers, Professionals and Front Line staff can mitigate compassion fatigue and burnout by using stress management techniques. Learn those personally effective ways of using relaxation: - focused breathing; - distraction; - seek support, comfort from loved ones - use positive self talk

29. Physical Tools Breathing, Stretching, Walking Healthy Diet-Avoid excesses Body Work Body Work Body Work (Exercise, Yoga, Meditation, Guided Imagery, Self Hypnosis) Meditation Music

30. Start with the 333 STOP Method STOP Where You Are 3 Minutes 3 Breaths 3 Times a day Graduate to the Relaxation Response Disaster Mental Health Management & Training

31. Cognitive Tools • Interrupt the Automatic Response/Reduce the Reaction • CBT (Messaging; Thought Stopping/Insertion) • Emotion Regulation (Turn Down the Vibration) • Reintroduce Routing-Return to Normal Activity Disaster Mental Health Management & Training

32. Affirmations • Familiarize yourself with the action of affirmations both auditory and visual • Sample different expert’s work-choose voices and images that are pleasant to your eyes/ears • Schedule the use of these tools to obtain maximum benefit

33. Leisure Tools Try Acupuncture, Art, Awareness, Create, Cook, Dance, Dream, Draw, Exercise, Enjoy, Explore, Go Home, Kick-Box, Laugh, Limit work, Loosen up, Listen to music, Massage, Meditate, Practice Yoga, Paint, Pet the Pet, Sing, Sit Quietly, Sleep, Start a Book, Stretch, Talk to Yourself, Family and Friends, Wade, Walk, Watch a bug, or a movie or the sunset, Whistle, Wish Do Something other than WORK

34. Stay focused on answering the question that is being asked. • Read the introductory words and think for a moment how you will respond to the questions by starting with the introductory words. • What problem(s) do this work bring to your life? Begin your response: • “Being a child care worker brings ________________to my life….” (e.g.: excessive worry ) • How has this problem affected your family life or other relationships? Begin your response: • “This problem, _________________, has affected my life by…” • What have you done to cope with or address this problem? Begin your response: • “To cope with this problem, I have….”

35. Publications Website National Mental Health Information Ctr www.mentalhealth.samhsa.gov/cmhs/katrina/pub_respond.asp National Center for Posttraumatic Stress Disorder www.ncptsd.org Compassion Satisfaction & Fatigue Test www.isu.edu/~bhstamm/tests/satfat.htm