September is Self-Care awareness month and is a time to remind us that taking care of yourself is essential. We often neglect self-care because we put the needs of others before our own. It is crucial to remember that we cannot fill the cups of others if our own cup is empty. Self-care can take many forms, but whatever form it takes it should be a something that helps you remain balanced and calm in the face of adversity. It includes paying attention to how you feel in the moment, speaking up for yourself, saying yes or no as needed without feeling guilty, and communicating clearly about your goals and needs. If we do not focus on our own self-care, we can develop burnout, compassion fatigue, or vicarious traumatization.
Burnout is a condition that is typically viewed as a consequence of an accumulation of work-related stressors. According to Maslach, burnout is comprised of three components: emotional exhaustion (i.e., diminution of emotional energy), depersonalization or cynicism (i.e., detachment from the job and clients/patients), and reduced personal accomplishment (i.e., belief that one can no longer perform the job well). Although burnout has been found among many occupational groups, it has been most extensively studied among individuals in service-related occupations. Five types of burnout symptoms have been identified: physical (e.g., sleep disturbances, headaches, gastrointestinal problems), emotional (e.g., irritability, depression), behavioral (e.g., poor performance at work, increased absenteeism), interpersonal (e.g., withdrawal from others), and attitudinal (e.g., callousness, dehumanization of clients/patients).
Compassion Fatigue was coined by Charles Figley as the cost of caring. He noted that those individuals who care for others often undergo pain as a consequence of their exposure to others’ traumatic material. He suggested that compassion fatigue is a natural group of behaviors and emotions resulting from knowledge about a traumatizing event experienced by someone else. Compassion fatigue results from two things: exposure to the another’s experiences and empathetic engagement with the that information. Family, friends, professionals are all susceptible and it is also seen as contagious. Compassion fatigue has a strong relationship between longevity of career, high caseloads, intensity and repeated exposure to clients’ traumatic material, and long hours to stress traumatic symptoms.
Sometimes compassion fatigue can evolve into vicarious traumatization. According to McCann & Pearlman, those who work with trauma survivors can sometimes develop the same cluster of traumatic stress symptoms as do the victims of those events. The impact on professionals vary the same way the trauma impact varies on clients. Some specific signs and symptoms of vicarious traumatization include disconnection from loved ones, social withdrawal, increased sensitivity to violence, cynicism, general despair and hopelessness, nightmares, physical aches and pains, changes in identity or world view, diminished sense of self, intrusive thoughts or images, and changes to sensory experiences.
To prevent burnout, compassion fatigue, and vicarious traumatization, people who interact frequently with survivors of trauma need to be intentional and comprehensive in our self-care efforts. What works for self-care is specific to the individual, so what may work for one person may not work for someone else. However, there are a few specific practices that might be helpful for everyone. For one, construct a self-care plan. By creating a clear and written self-care plan, you can increase your awareness of the emotional toll and regularly engage in activities that lead to relieve from stress. A self-care plan should address nine different domains: physical exercise, nutrition and hydration, sleep and rest, assertiveness, centering and solitude, creativity and enjoyment, providing and receiving support, and establishment of personal goals.
Another skill to adopt to prevent and reduce burnout, compassion fatigue, and vicarious traumatization is the ABCs (Srdanovic & Clemens). The A stands for Awareness, which involves becoming reflective, giving oneself permission to look within and conduct a self-assessment to determine the effects of your exposure to the trauma of others. This can include seeking supervision, journaling, peer support, and soliciting feedback from trusted others. The B stands for Balance, which means determining what is important in your life and making a priority for those things. This may include minimizing or eliminating parts of your life that you do not prioritize. The C stands for Connection. Establishing and maintaining relationships with family, friends, coworkers, and others who provide you both material and emotional support can be incredibly helpful in staving off burnout and other negative effects of exposure to the trauma of others.
Self-assessment can also be useful in helping you to recognize and reduce burnout and related issues. The Professional Quality of Life Scale (ProQOL) is a 30-question assessment tool that measures compassion satisfaction, burnout and compassion fatigue. The Compassion Fatigue Scale is a 13-item scale that assesses both secondary trauma and burnout and has been used with social workers, nurses and emergency personnel. NAMI also has a self-care inventory, which can be used to assess self-care practices across professional, spiritual, physical, and psychological domains. The Provider Resilience app, developed for health care professionals caring for military personnel, provides psychoeducation and self-assessment to track levels of burnout, compassion fatigue and compassion satisfaction.
There are a wealth of other resources to look to for potential self-care practices. Here are some examples:
No matter what practices work for you, make self-care an integral part of your daily life. By managing your own stress and making sure you are in a balanced and healthy place, you can not only help others more effectively but also enjoy your own life to a greater capacity.