Stress, Compassion Fatigue, and Burnout

Personal resilience—the ability to recover from stress, or painful, difficult experiences—is essential to resolving trauma. Resilience is a life skill that can be learned. Under contract with the Department of Veterans Affairs, our institute provided a year-long training in resiliency skills to treatment teams in eighteen medical facilities in New York and New Jersey. What happens when people, particularly caregivers, lose their resiliency? Under stress without relief, they can develop compassion fatigue or spiral into burnout.

Compassion Fatigue

Stress, compassion fatigue, and burnout exist on a spectrum. We all experience stress and can learn self-care techniques to dissipate its effects. When stress buildup starts to take a toll, we move into a state of depletion called compassion fatigue. Let me illustrate the difference between experiencing stress versus existing in a state of compassion fatigue.

Even when experiencing stress and secondary or vicarious trauma, caregivers and others feel that they like their jobs. They like or love the people they serve and want to continue to be there for them. They are able to maintain a healthy balance between their needs and the needs of the people they care for. They get tired, but can usually recover with a day or two of rest. They use self-care techniques that work for them to recover and return to serving others.

Caregivers and others who have not kept up self-care methods to resolve their stress and vicarious trauma will start to feel lingering dissatisfaction with aspects of their jobs. They usually still like or love the people they serve, but they feel depleted in ways that might take a week or more to replenish and refresh. They find themselves consistently putting their client or loved one’s needs first. They are less satisfied in their work and are at risk, if they don’t turn things around, for burnout.

Burnout

Compassion fatigue progresses to burnout when stressed and traumatized caregivers and others abandon self-care in essential ways. They no longer like their jobs and feel like they want to quit. They have a hard time caring for the people they’re helping and can become overwhelmed with their needs. They can become almost dysfunctional in meeting their own needs or the needs of those they care for. These caregivers and others are exhausted. It would take a significant amount of time for them to return to a healthy, rested state, capable of doing good work.

Addressing Compassion Fatigue and Burnout

Developing a repertoire of self-care techniques and practicing them regularly is essential for combatting compassion fatigue and burnout. Caregivers and others need to practice self-care that addresses all aspects of their health—physical, mental, social or emotional, and spiritual. There are many good resources available with suggestions for self-care activities. Ask others in your situation or profession, do some research on the web, or read our book, Trauma: Healing the Hidden Epidemic, for some helpful, practical guidance. With discipline and determination, you can remain resilient and effective in your calling.

Seeking Treatment: Part One

Have you ever wondered if something painful from your past, which you can’t quite let go of, is evidence that you carry unresolved trauma? In this excerpt from my book, Trauma: Healing the Hidden Epidemic, I address some of the challenges of seeking treatment. I’ll continue this topic in my next post, as well.

“If you have ever considered seeking treatment, even if you have yet to follow through with it, I acknowledge your courage. Facing reality and accepting that we need help can be a very difficult and even painful process.

“In the United States and in many other nations around the world, we embrace a culture of independence and self-reliance. Accepting help has a stigma that many people aren’t comfortable with. But disarming this ideology is an important step that we must take if we want to truly embrace our natural capacity for healing and resilience. The truth is that almost everyone needs help, and they need to be empowered to get it.

“Because we are often blind to signs that indicate a much larger, trauma-related issue, many people don’t know that they need treatment in the first place. It’s easier to ignore the parts of our lives that are dysfunctional than to look at them and think, “Something bigger is going on here.” We ignore and deny these problems, which more often than not causes additional damage.

“The effects of trauma are cumulative—they can progress and intensify over time. In fact, time does not heal all wounds. Trauma left untreated can grow from a manageable problem into a significant one. Time merely gives the effects of trauma the opportunity to fester and cause deeper wounding, both physical and emotional. Trauma-related wounds seldom subside on their own. Many victims require treatment before they can recover from their experiences and restore peace and functionality to their lives. Without treatment, they may spend a lifetime trying to figure out where their lives got off track and why physical and emotional pain seem constant. It’s an uncomfortable, if not tragic, existence.

“Happiness, joy, fulfillment, peace—all are abstract terms that may be difficult for us to define. We don’t always know when they are present in our lives, but we sure do miss them when they’re absent. If you have a history of trauma, it is affecting your current life whether you realize it or not. Treatment is the best way to liberate yourself from a past that prevents you from experiencing the great things in life that are possible. It may sound philosophical, but it has become a reality for many of our patients.”

                        From Chapter 6: Seeking Treatment

Relationships and Trauma, Part 1

Relationships and Trauma

Excerpts from Trauma: Healing the Hidden Epidemic, by Peter M. Bernstein, PhD

“Trauma and its psychological wounds often destroy relationships, families, and communities, even claiming lives.”
                                    From Chapter 7: “A Note to Veterans and Their Loved Ones”

Trauma affects, or almost “infects” relationships. The partners of individuals with unresolved trauma bear burdens that can be both practical and personal.

Practical Burdens

The lives of partners of trauma-affected individuals are burdened in practical ways because they must often fill in for their loved-one who is in some way “not there” to help with the daily demands of life. The spectrum of “not there” can range in severity from mild impairment to highly dysfunctional. Not only is the individual “not there” to help, they can add to the partner’s burdens with their trauma-related demands and needs for care. Trauma-affected individuals can have symptoms (including depression, anxiety, sleep disturbances, sexual dysfunction, mood swings, chronic fatigue, panic attacks, physical pain and disease, See Chapter 1: “Understanding Trauma”) which require care or accommodation. They can also have self-destructive behaviors (addictions, infidelity, risk-seeking activities) which result in negative consequences to the relationship.

Personal Burdens

Partners of trauma-affected individuals are also burdened personally within the relationship. Trauma-sufferers often want to avoid their pain by staying numb, isolating themselves, and refusing to be vulnerable. By limiting the amount of relating or connecting they do with their partners, they reduce the level of intimacy in their relationships, which removes the likelihood of having to feel pain. Partners become a “threat” to the traumatized individual’s sense of safety because they challenge the individual’s carefully constructed defenses against feeling.

The story of Brandon, a veteran of the war in Iraq, illustrates the desire for “numbness” shared by many traumatized individuals:

“But when he was home, the numbness began to wear off. He began to feel the emotional and physical pain of his experiences. Without the tools to successfully confront those feelings and learn to interact with his civilian family and friends, the feelings were completely overwhelming. The symptoms of his trauma were so intense that they were unbearable. Many service members, such as Brandon, feel that the only way to find relief is to be numb again.”
From Chapter 7: “A Note to Veterans and Their Loved Ones”

Self-medication through substance abuse is one way trauma-affected individuals attempt to remain numb, with often devastating effects on their relationships. They often turn to drugs and alcohol, I explain in Chapter 7, “because they want to numb symptoms of trauma. These substances keep the feelings and memories at bay. Their symptoms return when the high wears off, however, and the need to alleviate these symptoms creates an addictive pattern. It isn’t accurate to say that they want to abuse drugs and alcohol. Rather, the issue is that they will do anything to feel ‘normal’ again, or at least, comfortably numb.”

Partners of trauma-affected individuals often feel alone and rejected on some level. They may feel they must always tread lightly in their relationships. They may end up feeling helpless and powerless to make a difference in the lives of their suffering loved ones. Trauma-affected individuals often promote these feelings of powerlessness, because they are committed at all costs to maintaining control and protecting themselves from feeling their pain. Instead of cooperating with their partners by working through their traumas in order to have better relationships, they can actively resist and thwart their partner’s compassionate efforts. This conflictual, combative pattern, if it continues, can destroy trust within the relationship.

Resilience Cafe February 10th

The next meeting of Resilience Café will be held on Monday, February 10^th at Aqus Café from 7:00 to 9:00 PM. Please join us for this continuing public forum for the discussion and healing of trauma. We offer all who attend the opportunity to “Listen, Share, Heal,” as together we fight the stigma often associated with mental health challenges and the isolation trauma sufferers experience from our “hidden epidemic”.

My message – then and now – is one of hope. With help and hard work, trauma can be resolved and transformed to restore meaning and purpose to our lives.

Aqus Café is located at 189 H Street, Petaluma.

A Resolution for Hope

It’s a new year and the news sounds good. The stock market is hitting new highs, employment and housing starts are up, consumer confidence is rising. We’ve just celebrated joy-filled holidays with family and friends and now we can make a fresh start in 2014.

With so many things on their way “up”, why can it be so easy to feel down? Here are two possibilities. The holidays – whether you recognized it at the time or not – were not as joyful as you hoped. Your family relationships may have a history of pain and conflict you’d rather not admit. Or, while the media may report that our economy is improving, your personal situation continues to look bleak. Your life may still feel like a daily grind to make ends meet.

It’s very common, after the rush of the holidays is over, for people to feel let down and depressed. For people with unresolved trauma from the past, this rebound reaction can be particularly exaggerated. Unrealistic expectations for family harmony meet with constrained finances to produce deep disappointment. Discouragement and despair often follow. Hope in the holiday season can degenerate into hopelessness in the New Year. Instead of a fresh start, we can feel stuck in the same mire of immobility.

I write about this phenomenon in my recent book, Trauma: Healing the Hidden Epidemic. In chapter 9, “Crises and Hard Times”, I explain that unresolved trauma can cause people to collapse emotionally and psychologically during prolonged hard times.

“[People] may be stuck in the ‘freeze’ portion of the stress response from prior trauma. Rather than working frantically to solve the problem at hand, these individuals will be paralyzed, absolutely unable to take action. They cannot do what needs to be done to create solutions. Unfortunately, a passive, paralytic response (or lack of response, as it were) can exacerbate their wounded physiological and psychological state, causing them to ignore the needs of the present situation.”

Let me point out something else that people suffering from unresolved trauma often ignore: options. During despair and discouragement, people often fall back into their old default coping patterns. They may put their heads down and keep plowing on without looking around for new paths of opportunity. They may allow the buildup of toxic rage beneath their helplessness to explode in destructive acts instead of looking for new outlets for their energy. The new option they need – to counteract the intensity of their negative emotions – is a new perspective.

Let me illustrate. Again, from my book:

“Remembering the lessons we have learned from past hardships and experiences can be extremely valuable in times of trial. Recognizing that the lessons we will learn from the present challenges will be highly beneficial to other areas of our lives is valuable as well. If we survived the past, we can survive the present. Life experiences – both traumatic and otherwise – prepare us for future challenges that we will be responsible to overcome. They help us develop survival mechanisms and coping skills. In a way, they are blessings in disguise.”

No matter how difficult our circumstances, we always have the power to use our rational minds to explore options and make positive, productive choices. If you are struggling with post-holiday let-down, let me encourage you to make one such choice – come to the third meeting of Resilience Café, a local forum for talking about and healing trauma. We will discuss practical ways to deal with a painful past, gain a fresh perspective, and find new options. Plan to join us Monday, January 13^th at 7:00 PM at Petaluma’s Aqus Café, 189 H Street.

I believe each of us have it in our power to make 2014 a truly new year. Add Resilience Café to your calendar and you’ll be making a great start.

The Season of Light

We are entering a season for celebrations, and the symbol of light plays a part in many of our spiritual traditions. Light in the darkness can be a powerful metaphor for important ideas: courage in spite of fear, empathy in place of judgment, love instead of animosity, faith in place of doubt, and hope in the face of despair.

The experience of trauma can cast a dark shadow over our lives. But I believe the light of healing can turn tragedy into an opportunity for change and growth. Often, we can’t find the light we need on our own. Finding the courage to take the first step – asking for help – can start us on the path to transformation.

Those in our community who attended the first Resilience Café last month were able to take some steps toward healing. People filled Aqus Café to capacity the evening of November 11^th to learn about emotional trauma, take part in small group discussions, and fight the stigma and isolation so often imposed on sufferers of our hidden epidemic. It was truly an opportunity for all to “Listen, Share, Heal.” Please join us for our next Resilience Cafés scheduled for Monday, December 9^th and Monday, January 13^th, at 7:00 PM.

Soon, 2013 will draw to a close.  For many of us – including me – this has been another challenging year of struggle and change.  As painful as many of these challenges have been, I am grateful for the opportunities they have offered me. I look forward to 2014 with excitement, trusting that great things can happen when I act with courage and strength. Take hold of this thought and put it into practice in your life. Amazing things can happen.

Resilience Cafe

Petaluma’s Aqus Café was filled to capacity November 11^th for the first meeting of Resilience Café, a public forum for the discussion and healing of trauma. Community members of all kinds – veterans, treatment professionals, ordinary individuals – came to learn about trauma and how it might be impacting their lives. Billed as an opportunity to “Listen, Share, Heal”, Resilience Café was created jointly by the Bernstein Institute and Aqus Community. Together, we want to fight the stigma often associated with mental health challenges and the isolation trauma sufferers experience from this “hidden epidemic”.

Aqus Community founder John Crowley opened the evening with a welcome for the packed crowd and an explanation of our goals for the event. In my remarks, I offered a definition for trauma and then briefly outlined the several types of trauma and their symptoms and effects, in simple terms for everyone to understand. Wes Easley, a military and law enforcement veteran and staff member at the Bernstein Institute, shared a personal account of his self-isolating tendencies following a sudden career-ending injury in the line of duty. Small group discussions followed, with an opportunity for all to open up, if they wished, to be heard and to receive support. The evening ended with summaries of each group discussion and my parting message.

My message – then and now – is one of hope. With help and hard work, trauma can be resolved and transformed to restore meaning and purpose to our lives.

Steve Rustad, board chairman for Sonoma Coast Trauma Treatment, filmed portions of the evening and his recording is available on UTube, by following this link.

We plan to make Resilience Café a monthly event at the Aqus Café, 189 H Street, Petaluma. We encourage everyone to join us at our next meeting, December 9^th from 7:00 – 9:00 PM.

Meet Me at the Sebastopol Copperfield’s on Saturday, November 2nd!

On Saturday, November 2nd, from 12:00 to 2:00 PM I will be signing copies of my new book, Trauma: Healing the Hidden Epidemic, at Copperfield’s Books, 138 N Main Street in Sebastopol.  Please drop by.  I would love to meet you and personally autograph your copy.

As I’ve mentioned in recent posts, I’ve written my book to describe trauma—its nature, symptoms, and effects—in terms everyone can understand. I’ve included very practical actions you can take to begin to heal the often minimized or dismissed burdens of trauma, for yourself or for someone you love.

I’ll be happy to answer any questions you have about trauma and how it can be healed.  I’d also like to ask you to consider buying an additional copy—or copies—to give to people you know who are struggling with difficult circumstances or have been exposed to trauma.  I want to get my book into the hands of anyone and everyone who needs to hear a message of hope in hard times.

My thanks to Michael Fanning, and to Sebastopol Copperfield’s for hosting this event and for being an all-around great bookstore!

Hope to see you then!

Inaugural Issue of the Trauma Newsletter

I’m excited to announce the arrival of the first issue of our newest publication, the Bernstein Institute Trauma Newsletter.  Each issue of the newsletter will contain helpful, practical articles on the subject of trauma, along with a personal note from me on a vital issue catching my attention.  My aim is to consistently provide accurate information and positive inspiration for everyone who has been touched by what I’m calling the “hidden epidemic” of our time.

This first issue includes two articles: “Financial Crisis, Trauma, and Reinvention”, covering the continuing, painful repercussions from our Great Recession; and “Military Suicides: Part One”, the first in a series exploring the facts and trauma-related issues underlying the dismaying spike in suicides by military personnel.  Also, in “From Peter”, my personal answer to the question, “What is emotional trauma?”

Soon, we’ll have a way for readers to subscribe to the newsletter through our website.  For now, please follow the link to download your copy today.

Meet Me at the Montgomery Village Copperfield’s on Sunday, October 6th!

On Sunday, October 6th, from 1:30 to 3:30 PM I will be signing copies of my new book, Trauma: Healing the Hidden Epidemic, at Copperfield’s Books in the Montgomery Village shopping center, 775 Village Court in Santa Rosa.  Please drop by!  I would love to meet you and personally autograph your copy.

As I’ve mentioned in recent posts, I’ve written my book to describe trauma—its nature, symptoms, and effects—in terms everyone can understand. I’ve included very practical actions you can take to begin to heal the often minimized or dismissed burdens of trauma, for yourself or for someone you love.

I’ll be happy to answer any questions you have about trauma and how it can be healed.  I’d also like to ask you to consider buying an additional copy—or copies—to give to people you know who are struggling with difficult circumstances or have been exposed to trauma.  I want to get my book into the hands of anyone and everyone who needs to hear a message of hope in hard times.

My thanks to the Montgomery Village Copperfield’s for hosting this event, and for being an all-around great bookstore!

Hope to see you then!