Category Archives: Trauma Reactions

Compassion Fatigue

Compassion Fatigue

Medical professionals such as physicians, nurses, psychotherapists, and emergency workers, who help traumatized patients may develop their own Post Traumatic Stress Disorder (PTSD) symptoms as an indirect response to their patient’s suffering. This phenomenon has been referred to as compassion fatigue, vicarious traumatization or secondary traumatic stress.

A survey showed that “86.9% of emergency response personnel reported symptoms after exposure to highly distressing events with traumatized people” . . . [and] . . . “90% of new physicians, between 30 to 39 years old, say that their family life has suffered as a result of their work”. When health care professionals struggle with their responses to the trauma suffered by their patients, their mental health, relationships, effectiveness at work, and their physical health can suffer.

Caregivers who reported experiencing compassion fatigue, expressed such feelings as, “I frequently dissociated and felt that I walked around in an altered state. I didn’t realize that I had been in a gray space all year. That had sort of creeped in” and “It got to the point where I would feel physically sick before the appointment and feeling nauseous.” Others described that they picked up their client’s symptoms and explained that they had “tightness in the exact same spot” as their clients and continued to carry the sensation sometimes for days. One psychotherapist expressed, “I am the empathy lady from the old Star Trek episode and get may be 45 % hit of what my patients might be feeling 100% of.”

The helpers symptoms, frequently unnoticed, may range from psychological issues such as dissociation, anger, anxiety, sleep disturbances, nightmares, to feeling powerless. However, professionals may also experience physical symptoms such as nausea, headaches, general constriction, bodily temperature changes, dizziness, fainting spells, and impaired hearing. All important warning signals for the caregiver that need to be addressed or otherwise might lead to health issues or burnout.

Researchers and authors such as Babette Rothschild, Charles Figley, Laurie Anne Pearlman and Karen Saakvitne, and B. Hudnall Stamm have recognized that medical personnel and psychologists may experience trauma symptoms similar to those of their clients. They speculate that the emotional impact of hearing traumatic stories could be transmitted through deep psychological processes within empathy. Further, Babette Rothschild hypothesizes that it is the unconscious empathy, the empathy outside awareness and control that might interfere with the well being of the caregiver.

Hearing and witnessing horrific stories of abuse and other traumas can be very stressful and trauma experts have found that self-care techniques, both psychological and somatic, can reduce susceptibility to the internalization of traumatic stress and compassion fatigue. Bernstein indicates that paying attention to and being aware of physiological signals and somatic counter transference such as “dizziness, emptiness, hunger, fullness, claustrophobia, sleepiness, pain, restlessness, sexual arousal, and so forth” can be an important method of preventing and managing compassion fatigue. Somatic countertransference entails the psychotherapist’s reaction to a client with bodily responses such as sensations, emotions, and images that can only be noticed through body awareness. Since somatic countertransference is often neglected in both the literature and in the caregiver’s training, many are not aware of the somatic countertransference elicited in the helper-patient relationship.

Reducing compassion fatigue means not fighting the symptoms but working with  feelings which occur during and after the interactions with the traumatized patient. One psychotherapist shared;  “If I start to not feel my body, I pause and just take a moment.” There is a lot to take in. Giving oneself permission to take a break for a short time and taking care of oneself, may not only help the caregiver but may also provide a role model of self-care for the patient. Taking a break might be just to stop and feel one’s body, asking the patient to slow down, taking a deep breath, or making a small movement, which are forms of regulating the nervous system and decreasing the stress of working with traumatized patients.

Since caregivers commonly dissociate, staying connected or reconnecting to one’s identity and physical presence has been rated as very important as well. Some professional helpers use visual or kinesthetic reminders of their lives outside of their work. Visual reminders might be placing pictures of family, certificates, and favorite artwork in the office. Whereas kinesthetic reminders bring awareness back to the body and might be accomplished by feeling one’s feed on the floor, intentionally fiddling with a wedding ring or holding the office chair. One caregiver expressed, every time she closes the office door she uses the door as a kinesthetic reminder and says, “This is my life outside and that’s where I’m entering.”

Studies have also shown that the attitude toward life such a sense of humor, self confidence, being curious, focusing on the positive, and feeling gratitude ranked high in being helpful in treating traumatized people. Additionally, support, supervision, balancing work and private life, relaxation techniques, and vacation time have been useful.

Research indicates that caregivers are not immune to trauma and might experience compassion fatigue. A better understanding and knowledge about this phenomenon as well as self care techniques that include both psychological and somatic tools can help caregivers to more effectively deal with patients’ sufferings.

Susanne Babbel, MFT, PhD is a licensed marriage and family therapist, somatic psychotherapist, and workshop leader in San Francisco. If you would like further information on this topic please visit her website: www.bodyconversations.com

Interview with Barbara Clark continued.

Dr. Babbel:

I often ask my clients who suffer from depression and/or anxiety to get a neurotransmitter test to make sure their concerns are not based on some kind of nutritional deficits. Could you briefly explain 1) what neurotransmitters and Beta Endorphins are, 2) how they relate to depression and anxiety and 3) what to look for in a neurotransmitter test?

Barbara Clark:

Neurotransmitters:
The center of the nervous system is the brain, which contains over 100 billion specialized cells called neurons. The nervous system also contains very important chemical messengers called neurotransmitters. The brain uses neurotransmitters to tell the heart to beat, the lungs to breathe, and the stomach to digest. Neurotransmitters are also necessary for thought processes, emotions, and other essential body functions including sleep, energy, and fear.

Depressive and anxiety disorders are among the most common neurotransmitter-related conditions. Neurotransmitters are chemicals that relay signals between nerve cells, called “neurons”. They are present throughout the body and are required for proper brain and body functions. Serious health problems, including depression and anxiety, can occur when neurotransmitter levels are too high or too low.

Every neurotransmitter behaves differently. Some neurotransmitters are inhibitory and tend to calm, while others are excitatory and stimulate the brain. Deficiencies involving the central nervous system’s neurotransmitters – serotonin and norepinephrine- appear to be involved in the development of depressive disorders. Disruptions in other neurotransmitters, like GABA (the central nervous system’s primary inhibitory neurotransmitter), epinephrine, glutamate and histamine may be associated with anxiety disorders.

Environmental and biological factors – including stress, poor diet, neurotoxins, or genetics – can cause imbalances in the levels of neurotransmitter chemicals in the brain. These imbalances can trigger or exacerbate depressive symptoms.

Endorphins:
Endorphins are endogenous opioid polypeptide compounds. They are produced by the pituitary gland and the hypothalamus in vertebrates during strenuous exercise, excitement, pain and orgasm and they resemble the opiates in their abilities to produce analgesia and a sense of well being. Endorphins work as “natural pain relievers “and they are actually a complex of at least fifteen potent brain and body chemicals that all amplify pleasure and make pain tolerable. Endorphin depletion is caused by physical or emotional pain, or both.  You could have been born with an endorphin deficiency, too much stress may drain the endorphins, and typically women have lower endorphin levels than men. Taking a supplemental blend of the 9 essential amino acids under the supervision of a health care provider, a good multivitamin, B vitamins and eating a protein-rich diet (proteins are precursors to amino-acids) can help get the endorphins into a more balanced state. Ideally these steps need to be supervised by an appropriate health care provider.

Neurotransmitter test:
There are laboratories who do urine testing for neurotransmitter (Neuro Science, www.neuroRelief.com) and there are laboratories who have testing available for blood platelet serotonin and catecholamines

(Vitamin Diagnostics) www.integrativepsychiatry.net/blood_platelet_neurotransmitter_test.html

Your original perceptions and filter of your world may have been altered through an overwhelming experience. In the absence of full processing of the experience you continue to have mental and physical manifestations of unresolved stress. Some of these symptoms begin shortly after the trauma; some develop later. Reactions you might have are:

Emotional Reactions:

_    You feel shame and not worthy
_    You overreact or are overemotional
_    You feel great sadness or anxiety on a regular basis
_    You have a very strong inner critic
_    You are afraid to be abandoned and feel lonely
_    You avoid certain situations
_    You can not feel emotions and are often numb
_    You lack confidence and self esteem
_    You have mood swings

Physical Symptoms:

_    Your body may stay in alert and stress mode until it knows it is safe (Hyperarousal)
_    You have a hard time relaxing and do not know how to settle down (Constriction)
_    You have difficulty sleeping and have nightmares
_    You have body image and weight problems
_    Your memory is not fully functioning
_    You feel numb and cannot feel your body (dissociation)
_    You are suffering from chronic pain
_    Skin disorders
_    Constipation

Relationship Patterns:

_    You may have developed specific patterns that you keep repeating
_    You try to control your partner, friends and family
_    You have a hard time saying no, setting limits or boundaries
_    Relationships can be difficult for you
_    You feel disconnected and detached

If you recognize yourself in these examples, you might have an unresolved traumatic experience.

Trauma symptoms can be expressed days, months, or even years after the traumatic event. Symptoms may suddenly arrive through a trigger in the environment and might appear as emotional, cognitive, or physical reactions. Sometimes the mind is not able to make sense of the internal signals, especially when the person has experienced an overwhelming event or stressful situation. The mind might continue to communicate to the nervous system the necessity to prepare to flee, fight, or freeze. Adrenaline is disbursed and the cycle might perpetually continue until the body-mind perceives that it is safe and recognizes it can rest.

If not addressed these can turn into long-term symptoms such as:

•    Panic attack
•    Avoidance behavior
•    Addictions
•    Risk taking behavior
•    Constant dissociation
•    Memory loss
•    Midlife crisis and fear of dying
•    Self-harming behavior
•    Obsessive or lack of sexual feelings
•    Feeling disconnected

Trauma leaves memories not only in the mind but also in the body. Sapolsky explains that PTSD is a physiological reaction to overwhelming and ongoing stress and is a fight or flight response. As a result, specific hormones are released that alter such things as skin sensitivity, alertness, heart rate, digestion, and learning skills. Additionally, hormones such as cortisol are excreted to expand pain tolerance. Cortisol can also cause hypervigilance, preparing the traumatized person to act at a moment’s notice.

Other physiological reactions include an adrenaline rush which can raise heart rate, cause heart palpitations, produce pupil dilation (increasing visual changes), and stop digestive physiology. Due to a disbursement of glucocorticoids, the body may react with constipation, diarrhea, headaches, and sleep disturbances. Epinephrine and norepinephrine slow down the blood flow to the digestive system and extremities. These hormones can even inhibit learning skills and cause attention deficit or confusion.

Studies have found that sexually abused women and veterans show a decrease in the size of the hippocampus, causing learning and memory loss.

PTSD affects parts of the brain that are associated with language, visual, and motor responses. During flashbacks, the Broca areas of the brain (responsible for verbal functions) slow down which may cause an inhibition of verbal expression of feelings while sensorimotor memories including visual images, tastes, sounds, smells, anxieties, fears, and pressures can still be recalled.

All non-verbal messages (such as those perceived by our senses) are collected in the implicit memory (subconsciously) whereas verbal messages are processed by the linear language centers of the brain and are stored in explicit memory (consciously) for easy access. Rothschild explains, “When PTSD splits mind and body, implicitly remembered images, emotions, somatic sensations, and behaviors become disengaged from explicitly stored facts and meanings about the traumatic event(s), whether they are consciously remembered or not.” van der Kolk emphasizes that contemporary research on the biology of PTSD affirms that stress hormones and memory processing are altered by traumatic events. It is now thought that people hold an implicit memory of trauma in their brains and bodies.

Candace Pert, author of Molecules of Emotions: The Science Behind Mind-Body Medicine, suggests that not only does the brain carry memories but that cells and proteins (referred to as neuropeptides) hold and transport them throughout the entire body. Levine points out that memories are not literal recordings of events but rather a complex of images that are influenced by arousal, emotional context, and prior experience. Memories may even transform over time as new experiences add layers of meaning to the images.

Levine asserts that psychological wounds are reversible and that healing comes when physical and mental releases occur.