Authors’ note: The increased attention surrounding veterinary mental health and well-being in the past few years has spurred critically important conversations in our profession. Many have thoughts and ideas about how and why so many in the profession are struggling. As a profession, we continue to gain knowledge from research studies, as well as each of us continuing to explore what is true for ourselves. What is clear is that there are profession-wide factors that influence our mental health, as well as individual-level factors.
This article largely focuses on individual-level factors and strategies because that is what each of us has the most control over. However, it’s important to appreciate doing so is an oversimplification, and that we recognize that systemic level changes are necessary to create a thriving profession. Finally, experiences of compassion fatigue and trauma are particularly complex, we encourage readers to seek support if they are concerned about their well-being or mental health through public or private caregivers and by reading aaep.org/wellness/emotional-social-wellness.
Despite compassion fatigue having a name composed of words we understand, its definition is not as obvious as they would suggest—it is not simply exhaustion due to providing compassionate care. Compassion fatigue is comprised of two components: burnout and secondary traumatic stress.
Burnout
In general, burnout is a state that is reached where one’s capacity to function is diminished or lost as a result of depleted physical and mental resources.1 When there are more demands than there are resources to meet them, burnout can result. The pathogenesis of burnout is most often related to the work environment, workplace culture or amount of work itself.2
We can also experience burnout in non-work environments, such as caretaking at home, volunteer work and so on. The visual that the term burnout evokes—that of a fire or match that has burned out—is an accurate way to envision burnout. There simply isn’t enough “fuel” for the fire to continue.
Secondary Traumatic Stress
Secondary traumatic stress is different; its origins lie in the nature of the work. Veterinary medicine, and any caring profession, involves outlay of emotion and exposure to the traumatic experiences of others (both clients and patients). It is this exposure that places us at risk because when we are exposed to the trauma of others, it can impact us the same way it would if we were directly experiencing the trauma.
It is critical to appreciate that trauma impacts each of us differently, which means that compassion fatigue can present with a wide variety of clinical signs and symptoms. Individuals tend to respond to the types of frequent and/or continuous stressors that lead to compassion fatigue in one of two ways: one can conserve energy or remain overcharged.3 These can be seen in a variety of scenarios, including physical, spiritual, behavioral, emotional and cognitive.4 If you are wondering if you are experiencing compassion fatigue, there is a self-test accessible from proqol.org/ProQol_Test.html.
When burnout and secondary traumatic stress occur together, compassion fatigue can result. It can be defined as “the final result of a progressive and cumulative process that is caused by prolonged, continuous and intense contact with patients [and clients], the use of self, and exposure to stress.”5
It’s important to appreciate that compassion fatigue can occur due to acute or chronic experiences. That means it can be due to one very difficult experience, or it can build up over time. While the definition is important to know, it doesn’t necessarily provide us with the information we need to understand how our daily experiences might lead to compassion fatigue. To start, we need to explore how our bodies respond to stress and trauma and how that impacts us in the short and long term.
Trauma and Stress: Occupational Hazards
First, let’s take a moment to better understand the term trauma in this context. Trauma is often a word we reserve for serious or grave events or experiences, for instance a catastrophic car accident or a life-threatening diagnosis. However, our nervous system isn’t as discerning. Everyday events can be traumatic, threatening and/or stressful. This means that our body’s stress response is activated and we experience feelings of fear, helplessness, worry or anxiety. This is important to appreciate because of the consequences of an activated sympathetic nervous system. It changes how our body codes stress and our ability to access tools for coping with the stressor (i.e., trauma or threat).
Trauma an unavoidable occupational hazard. This is a difficult truth, and often we seek to fight against it because these hazards are unpleasant and dealing with them is difficult. However, this denial requires a lot of energy and is often unsuccessful.
Instead, we can choose small things to reduce the harm caused by these experiences, and we must in order to be able to withstand storms and stress that will inevitably happen.
Ultimately, this is the essence of resilience and self-care—lowering the effect of occupational hazards on your body. Just as you wouldn’t take radiographs without a lead gown or do certain procedures without a twitch and sedation, you shouldn’t take on veterinary practice without taking protective measures. These fall into the category of self-care.
The Relationship Between Stress, Trauma and Compassion Fatigue
We exist in a world of stress and stressors. We experience differing amounts of stress on a daily basis. However, the ways in which we respond to any given experience or stressor—whether physically, emotionally or cognitively—varies in relation to a number of different factors. A critical consideration in the context of trauma and compassion fatigue is the total amount of stress we are under and the length of time we’ve been experiencing it. These two things markedly influence the downstream effects of our experiences.
When we are stressed, our sympathetic nervous system (SNS) is activated. This response prepares us to manage a physically threatening situation. SNS activation results in increased heart rate, respiratory rate and muscle tension, as well as decreasing our executive function and other complex brain operations.
When the stimulus or stimuli for stress persists over time, our SNS can become dominant (vs. the usual state of parasympathetic nervous system dominance). In that case, our brain becomes more vulnerable to traumatic situations that we encounter. This occurs because in states of stress, we process and encode experiences differently. This can lead to an increased risk of developing secondary traumatic stress in response to an individual experience or chronically over time.
Types of Stress
You might be wondering what sort of “stress” counts. That is different for everyone.
It’s important to consider that our experience of stress is not black and white. We are often in the gray zone between not stressed at all and incredibly stressed. To this end, even small stressors—such as not sleeping well or skipping breakfast—can influence how our body and mind process trauma.
What does all this mean? When we seek to manage the stress we are under on a daily basis, we are protecting ourselves against the trauma we encounter as part of our jobs.
Taking Action
Self-care is one mechanism through which we can manage our day-to-day stressors. It is important to note that self-care is an incredibly broad term, and we are all caring for ourselves with reasonable success already!
However, we can strive to fine-tune the care we provide to ourselves to reduce our stress on a daily basis.
Evidence shows that making small swaps on a more regular basis for even slightly better choices leads to more long-term success.6 This is particularly helpful for those of us who feel like we don’t have any space to add anything else to our days.
Instead of thinking of self-care as something you need to add to your plate, think of replacing an old behavior with a different one that better supports your well-being and goals. This idea also encourages us to ditch all-or-nothing thinking where we’re either all-in with new habits, or not at all.
Listen to Your Body
Getting into and through veterinary school is an overwhelmingly difficult task. For many of us, we pushed aside our basic needs in favor studying and doing whatever it took to succeed academically. Over time, this can result in us being disconnected from our bodies and minds, making it difficult to understand what we “want” never mind what we “need.” To this end, we need to consider how to reprogram ourselves to better understand what types of things we find restorative and what our basic needs are.
This information is foundational to self-care and how we manage stress because when we are disconnected from ourselves, we are unlikely to notice that we are stressed or experiencing trauma. This is problematic because then we are left without the knowledge that we could use more robust self-care to support ourselves.
When we can appreciate the impact of small stressors in the moment, small interventions or amounts of self-care are likely to be successful.
Dr. Jen Brandt, AVMA Director of Wellbeing, Diversity and Inclusion Initiatives, has an acronym to help us remember what we fundamentally need to be cognizant of addressing on an ongoing basis:
M–move
E–eat
D–(drink) water
S–sleep
These reflect our fundamental physiologic needs. When we neglect these, our body’s stress levels start to increase.
The next step is to ask, “What do I need? What will I do to help myself right now?” Then we need to find a way to make it happen, which can feel overwhelming.
Remember, even connecting with yourself to acknowledge what you need is progress and is valuable. You can use that information to help you plan forward and have the resources available for the next time that situation arises.
Take-Home Message
We need to equip ourselves with knowledge about our occupational risks and hazards, such as secondary traumatic stress, burnout and compassion fatigue. Then w can assemble a toolbox that can help us thrive. Appreciating the connection between managing our stress and decreasing the impact of the trauma we encounter as veterinarians can help reduce our risk of compassion fatigue. DINGBAT
References
- Boudreau, R.A.; Grieco, R.L.; Cahoon, S.L.; et al. The Pandemic from Within: Two Surveys of Physician Burnout in Canada. Can J Commun Ment Health 2006;25:71–88.
- Maslach, C.; Jackson, S.E.; Leiter, M.P. Maslach Burnout Inventory Manual. Third Ed. Palo Alto, CA: Consulting Psychologists Press; 1996:1–74.
- Cohen, S.P. Compassion fatigue and the veterinary health team. Vet Clin North Am Small Anim Pract 2007;37(1):123-34.
- Portnoy, D. Burnout and Compassion Fatigue, watch for the signs. Health Progress 2011, July/Aug:47-50.
- Coetzee, S.K.; Klopper, H.C. Compassion fatigue within nursing practice: a concept analysis. Nurs Health Sci 2010;12(2):235-243.
- Lahey, L.L.; Kegan, R. Immunity to change: How to overcome it and unlock the potential in yourself and your organization. Harvard Business Review Press, 2009.
About the Author: Colleen Best, DVM, PhD, CCFP (Certificate of the College of Family Physicians in Compassion Fatigue), operates Best Vet Coaching and Consulting in Ontario, Canada. She did her PhD research focused on relationships in equine practice, including veterinarian-client and referring veterinarian-specialist communication.
