Feeling exhausted from working with your clients, students, or patients?
It may not be much consolation, but you certainly are not alone:
- “54.4% of physicians report at least one symptom of burnout in 2014, up from 45.5% in 2011.” (Shanafelt, Tait D. et al. 2015)
- “40%-50% of new teachers may leave their profession within the first five years. This is at a time when there are a ballooning number of new teachers entering the field.” (Riggs 2013, Ingersoll 2012)
- “Across several studies, it appears that 21-67% of mental health workers may be experiencing high levels of burnout.” (Morse, et al. 2012)
- “In a 2014 survey, 68% of family physicians and 73% of general internists would not choose the same specialty if they could start their careers anew.” (Bodenheimer & Sinsky, 2014, p 574)
- “A 2013 survey of 508 employees working for 243 health care employers found that 60% reported job burnout and 34% planned to look for a different job.” (Bodenheimer & Sinsky, 2014, p 574)
What is going on in the helping professions? More importantly, what can we do about it?
When I delve into the reasons for the exhaustion and burnout I could go on to quote research about electronic medical records (a major culprit in the fatigue and frustrations of physicians, mental health providers, and their staff.), authoritarian managerial style, or perceived school climate. But the research about the causes of fatigue and burnout, while factual, does not offer something to do right now to help.
Luckily, neuroscience research offers a hint for something to try, with no downside.
I’m writing this after an exhausting week that included battles with insurance companies, a suicidal client, a student death, and too many clients’ vivid descriptions of traumatic events. My week pushed me to investigate the concepts of compassion fatigue and burnout, because I was experiencing it myself.
Charles Figley (2017) the researcher who coined the term in 1996 states “Compassion Fatigue is a state experienced by those helping people or animals in distress; it is an extreme state of tension and preoccupation with the suffering of those being helped to the degree that it can create a secondary traumatic stress for the helper.” Compassion fatigue can lead to something worse: burnout, which Miriam Webster’s dictionary defines as, “exhaustion of physical or emotional strength or motivation usually as a result of prolonged stress or frustration.” People who experience burnout usually leave their job, their profession, or if they remain on the job can seem like zombies to others.
I discovered a peer reviewed research article that was eye opening for me and I hope for you.
First, let me briefly describe the study: The researchers advertised and found a group of thirty willing women participants, (previous research has shown differences between men and women regarding social emotions like empathy and compassion and to avoid confounding variables they decided to exclude men). They divided the participants into two groups, and began with fMRI’s for everyone. One group (control group) was then given a six-hour training in a method for memorizing lists. The second group (experimental group) was given a six-hour training in empathy. After a brief lecture about empathy the participants were guided to emotionally resonate with their own difficult experiences, visualize friends who have had difficult times in their life, and others who were not doing well. While visualizing these incidents they were told to silently repeat phrases such as “I share your suffering” or “I see your pain.” Following the trainings both groups went back into fMRI machines while they watched video clips of low emotional or highly emotional events involving other peoples’ suffering. Then there was a second day of more memory training for the control group, while the experimental group was trained in compassion, which is also known as loving kindness meditation. Like the empathy training participants were asked to visualize difficult situations for themselves, for friends or others who are suffering. This time they repeated phrases such as “”May you be sheltered by compassion” or “May you be safe.” These are the phrases often used during loving kindness meditation. After the trainings everyone returned for a final fMRI as they watched similar low emotional or highly emotional video clips of people suffering.
Here are the results quoted from the study and they gave me an idea (the emphasis is mine):
“Indeed, we found evidence for different patterns of emotional experiences and neural plasticity associated with the sequential training of [empathy and compassion] within the same participants: a short-term training in empathy increased empathic responses and negative affect in response to others’ distress. In addition, watching others’ suffering after empathy training was associated with activations in a network spanning insula, aMCC [anterior mid-cingulate cortex], temporal gyrus, DLPFC [Dorso Lateral Prefrontal Cortex], operculum and parts of basal ganglia. These results align with and extend previous cross sectional meta-analytic findings on a crucial role of insula and aMCC in empathy for pain (Fan et al., 2011; Lamm et al., 2011), as well as their involvement in self-experienced pain, and negative affect in general.”
In other words, empathy alone turned on the neural networks associated with physical and emotional pain as well as negative emotions.
“Importantly, compassion training reversed these effects: it decreased negative affect back to baseline levels and increased positive affect. On the neural level, compassion training increased brain activations in mOFC [medial Orbitofrontal Cortex], pregenual ACC [Anterior Cingulate Cortex], and striatum a network previously associated with positive affect (Kringelbach and Berridge, 2009), affiliation (Strathearn et al., 2009) and reward (Haber and Knutson, 2010). (Klimecki, Leiberg, Ricard & Singer (2013) p 5).”
The Take Away: Loving kindness meditation reversed the distress and fatigue caused by empathy for others because it used different parts of the brain.
Empathy activates the brain’s circuits that are involved with self-experienced pain and negative emotions. While compassion or loving-kindness meditation reversed these effects and was associated with a brain network involved with positive affect and human connection.
Since discovering this research, I’ve been trying an experiment on myself. I’ve been practicing short loving kindness meditations between appointments and I’ve found it helpful.
If you want to try it, I suggest you start by listening to Barbara Fredrickson’s guided meditation (she is a well known researcher in positive psychology) http://www.positivityresonance.com/meditations.html. Then using a similar format focus on an upcoming client, patient, or student.
If you do try it I’d love to hear from you about your experience firstname.lastname@example.org.
If you would like to read the full study here is the link: https://academic.oup.com/scan/article/9/6/873/1669505/Differential-pattern-of-functional-brain
Bodenheimer, T. & Sinsky, C. (2014). Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider. Annals of Family Medicine: 12:573-576. doi: 10.1370/afm.1713
Figley, C. (2017). Retrieved on line February 1, 2017. http://www.compassionfatigue.org
Ingersoll, R. M. Beginning Teacher Induction: What the Data Tell Us. The Phi Delta Kappan published in Education Week online: May 16, 2012
Klimecki, O. M., Leiberg, S., Ricard, M. & Singer, T. (2013). Differential pattern of functional brain plasticity after compassion and empathy training. Social cognitive and affective neuroscience, nst060.
Kringelbach and Berridge, (2009). Toward a functional neuroanatomy of pleasure and happiness. Trends in Cognitive Neuroscience, 13, 479-487.
Morse, G., Salyers, M. P., Rollins, A. L., Monroe-DeVita, M., & Pfahler, C. (2012). Burnout in mental health services: A review of the problem and its remediation. Administration and Policy in Mental Health, 39(5), 341–352. http://doi.org/10.1007/s10488-011-0352-1
Riggs, L (2013). Why do teachers quit? Why do they stay? The Atlantic Magazine October 2013.
Shanafelt, T. D., Hasan, O., Dyrbye, L. N., Sinsky, C., Satele, D., Sloan, J., & West, C. P. (2015, December). Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014. In Mayo Clinic Proceedings (Vol. 90, No. 12, pp. 1600-1613). Elsevier.