MANAGING COMPASSION FATIGUE WITH MINDFULNESS

AND SELF-COMPASSION

Robin Beardsley, MD CCFPGP Psychotherapist, Ottawa, ON

Care4You ConferenceJune 4 2014Kingston, ON

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

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)

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?

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

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

Evolution of the Brain

VERTICAL BRAINHORIZONTAL

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

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

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

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

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

Implicit Memory

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

Development of our BrainsYoung children are right brain dominant.

Two modalities of our lovely differentiated brain

RIGHT HEMISPHERELEFT 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

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

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-

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

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

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

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

Iceberg Metaphor

Iceberg Metaphor

Behaviour Coping-accept,deny,ignore,project

FeelingsFeelings about Feelings(judgement of feelings)

Perceptions-self, other, world Expectations- self,others,others of you

Yearnings-universalSELF- Life Force

Waterline

Ego survival“Doing”

“Being”

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

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

Mindfulness – States of Mind

WiseMind

LEFT Brain (Logical)

RIGHT Brain (Emotional and Non-verbal)

No emotionsLogicalStraight forward

Emotions control behaviourAnxious->avoidDepressed->withdrawAngry->lash outHappy->feel good

L + R + Intuition=GroundedBalanced- think about consequences of behaviour and choose how you want to act rather than reactConnect with Life Energy & Inner Wisdom

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

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?

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)

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)

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

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

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

Mindful Self Compassion

1. Self kindness vs self criticism

2. Common Humanity vs self –isolation

3. Mindfulness vs emotional entanglement

Kristen Neff

Mindfulness and Self Compassion

Mindfulness What’s arising in the

present moment experience, and can be applied to any experience- positive , negative or neutral

“Feel your 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”

Use Of SELF in TherapyDOCTOR/THERAPIST PATIENT/CLIENT

BehaviourFeelingsF about F

PerceptionsExpectations

YearningsSELF

BehaviourFeelingsF about F

PerceptionsExpectations

YearningsSELF

Thank You

dr.rbeardsley@gmail.com