Mindfulness as a Response to Compassion Fatigue A workshop for helping professionals Presented by Jean Meier, M.Ed. Jane Mayers, R.N., M.S.N.

Learning Objectives – Part 1 Describe basic principles of mindfulness Identify the characteristics of compassion fatigue Discuss the evidence for mindfulness-based interventions in compassion fatigue Use mindfulness practices to be present to symptoms of compassion fatigue Utilize short practices for immediate use with self, clients, or patients

“… paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally" Kabat-Zinn (1994) “... paying attention with openness, curiosity and flexibility.” Russ Harris (2009) “…awareness of present experience with acceptance” Germer (2005) Mindfulness is:

Mindfulness is not: relaxation. control of thoughts or emotions. passivity. moving into a pleasant state.

Compassion Fatigue...is present when helping professionals lose their nurturing ability towards patients.

Compassion fatigue symptoms can be related to our deep longing, and core value about caring for others. Share with your partner: What brought you to nursing in the first place? Did this reading speak to you?

Compassion fatigue symptoms can include: Bottled up emotions Irritability Isolation from others Sadness with an apathetic outlook Persistent ailments Difficulty concentrating Disturbed sleep Excessive complaining rooted in feelings of powerlessness

Compassion fatigue is a progressive and cumulative process which ends in burnout. You may not be aware of becoming compassion fatigued. Coetzee, S.K. & Klopper, H.C. (2010). Compassion Fatigue within Nursing Practice: A Concept Analysis. Nursing Health & Science, 12:2, Compassion Fatigue Compassion Stress Compassion Discomfort

Vicarious Trauma and Secondary Traumatic Stress Disorder Response due to empathizing with patients’ trauma experiences Symptoms may include: recurring images of the traumatic event(s) avoidance/ numbing of reminders of the event(s) persistent arousal/irritability/anger

Compassion Fatigue As you’re getting traumatized, you’re not able to be there in the way you want to be. Disconnecting can be a way of protecting yourself from suffering. Not knowing how to manage the emotional and physical pain we feel is a natural response to other’s suffering.

Situations that Stimulate Symptoms of Compassion Fatigue Secondary Traumatic Stress Environmental demands Difficulty with Co-workers Bullying Challenging patients This could be an isolated event or happen over time.

Compassion Satisfaction When we’re connected with our core value of caring for others, what we experience is compassion satisfaction. It can help buffer symptoms of compassion fatigue and be restorative. Compassion fatigue symptoms and compassion satisfaction can happen at the same time.

What can we do? Mindfulness is one response. Mindfulness-based approaches have been found to be effective in a number of ways.

Peer-reviewed publications, PubMed (through 2010)

2013 follow-up to study done at HMC in 2010 Compassion fatigue rates increased 3X. No difference in CF between units 82% nurses at risk for moderate to high CF 31% recognized they had CF, while 52% did not Health Promotion Behaviors, Compassion Fatigue, Burnout & Compassion Satisfaction

n=48 RCT EEG: ↑ left prefrontal cortex activation

Davidson R J et al. Psychosom Med 2003;65: © 2003 American Psychosomatic Society Alterations in Immune Function In response to influenza vaccine, meditators had greater rise in antibody titers.

No similar changes in other regions As Amygdala size decreases, participants are less likely to perceive situations as stressful even when the situation hasn’t changed. Holzel et. al., Stress Reduction Correlates with Structural Changes in the Amygdala, 2010.

Brain Changes Participation in an MBSR program results in increases in regional brain gray matter density regions: Hippocampus-learning, and explicit memory Temporal-parietal junction-perspective taking, empathy and compassion. Frontal cortex- emotion regulation, executive function, plans, directs (Holzel, Lazar et al. 2011)

Association of an Educational Program in Mindful Communication With Burnout, Empathy, and Attitudes Among Primary Care Physicians Michael S. Krasner; Ronald M. Epstein; Howard Beckman; et al. JAMA. 2009;302(12):  70 PCPs  8 week intensive intervention 2.5 hours/week + 7 hour day  10 month follow up (2.5 hours/month)

MBSR for Physicians Increase in mindfulness was positively correlated with significant improvements in a range of measures, for example: Maslach Burnout Inventory: emotional exhaustion and personal accomplishment Jefferson Scale of Physician Empathy: perspective taking Profile of Mood States: total mood disturbance Personality scale: conscientiousness and emotional stability Improvements were maintained at 12- and 15-month follow up Krasner et. al., 2009

MBSR for Nurses Cohen-Katz et. al, 2005

MBSR for Nurses Qualitative findings: Increased relaxation, calmness Self-acceptance/self-compassion Feeling more self-reliant Decreased physical pain Improved sleep Impact on relationships Feeling more connected to others Communication (listen more, talk less) Less reactive (defensive) Teaching MBSR techniques to others Increased empathy Cohen-Katz et. al, 2005

Greater openness and receptivity Increased awareness of emotions Improved ability to tolerate difficult emotions Reduced use of strategies to avoid aspects of experience See the relationship between thoughts, feelings, and actions See more clearly what’s happening and be able to respond in ways that are more connecting Communicate in assertive manner based on core values that allow for connection and understanding Mindfulness and Compassion Fatigue

STOP is a way to reconnect and tune in to your experience in the moment, regardless of how you are feeling. Observe thoughts, body sensations, and emotions with curiosity, openness and friendliness without trying to change anything. = Stop = Take a Breath = Observe = Proceed STOPSTOP

Mindfulness and the Body Signals from our bodies help us know when we’re stressed so we can respond in helpful ways before we’re incapacitated. The body is the first place that registers both pleasant and unpleasant experience

Home Practice Formal Practice: Taking time out to practice mindfulness You may use the recording of a short body scan on our website. Informal Practice: Practice in the midst of life 3 breath sigh, STOP, mindfulness in routine activities This presentation, the body scan recording, the (ProQOL) Scale to assess compassion fatigue, and other resources are available at: This presentation, the body scan recording, the (ProQOL) Scale to assess compassion fatigue, and other resources are available at:

Learning Objectives – Part 2 Utilize mindfulness practices to increase therapeutic presence and empathy and counteract compassion fatigue Use mindfulness practices to be present to symptoms of compassion fatigue Utilize short practices for immediate use with self, clients, or patients Create a self-directed resiliency plan

Listening Like a Cow If you are listening, if you are turning your big brown or blue eyes on somebody & twitching your ears at them you are earning your silage. You are listening people into existence... If we don’t fully hear someone, they don’t exist…not as a unique expression of who they are, but rather as a concept…an interpretation of who they are…which may or may not be accurate. M. R. O’Rielly

Exercise 1 Speaker: I am noticing... I am noticing... Simply describing what you are seeing, hearing, feeling...plus thoughts about what you are noticing. Listener: Listening without commenting. Noticing what takes you away. The goal is not about hearing every word. Rather noticing thoughts that come up, judgments, analysis, mind wandering…and then come back.

Exercise 2 Listener is listening for: What does the speaker care about, value, long for at the deepest level, or need in the situation? Speaker: What aspects of your work lead to you feeling heartful? What aspects lead to feeling frustrated, disconnected or discontented? In what ways do you wish to turn toward your true self and turn toward reconnection with others?

3 Minute Breathing Space AWARENESS Tuning into what the weather pattern inside you is right now, including thoughts, emotions, and body sensations Acknowledge & register your experience, even if it is unwanted GATHERING Bring full attention to the breath, as an anchor to awareness & stillness EXPANDING Awareness of the body as a whole, your posture, facial expression and other body sensations Provides a way to step out of automatic pilot mode and reconnect with the present moment

Resiliency Plan Make a commitment. What will you do this week?

Resources This presentation, references, the body scan recording, the (ProQOL) Scale to assess CF and other resources are available at: