Articles publiés dans La Revue vétérinaire canadienne

Having previously focused on the significance of compassion (1), understanding compassion fatigue (2), the sources of compassion fatigue (3), and the signs and consequences of compassion fatigue (4), this article focuses on the approaches, strategies, and practices that can build personal resilience, thereby reducing the risk of compassion fatigue. We do not have to limit compassion or turn away from caring to prevent compassion fatigue. On the contrary; firstly, there is no such thing as prevention, and secondly, resilience requires us to do quite the opposite — to lean into caring and increase compassion. Indeed, in the face of compassion fatigue, there are many ways to build resilience.

Resilience is a complex construct with many definitions. Although it can be understood as a capacity or outcome, it is most often referred to as a process, both dynamic and multi-faceted, whereby individuals draw on their personal (internal) and contextual (external) resources, and use specific strategies, to navigate challenges and work toward adaptive outcomes (5). Examples of personal resources, as in qualities or traits, include a sense of purpose, a proactive attitude, reflective skills, enabling self-beliefs, optimism, motivation, self-compassion, and social and emotional competence, among others (6–9). Examples of contextual resources, which refer to aspects of the social and physical environment, include reliable family and friends; supportive mentors, colleagues, and supervisors; and an aesthetically pleasing and congenial workplace. Examples of strategies, meaning methods, tactics, or approaches that can be taken, include goal setting, problem-solving, selfcare, work-life balance, help-seeking, reflection, and mindfulness, among others (6–8).

Although some may think of resilience as a personality trait or natural tendency, it is actually a learned competency; one that — with awareness, intentional pursuits, and lived experience — can be strengthened over time. Those who are highly resilient are able to remain stable and function well during stress and recover from stress. They can “bounce back” from difficult experiences and move on despite the challenges.

Compassion resilience starts with awareness of compassion fatigue. This is the prerequisite to understanding the value of, and need for, resilience. The many ways in which resilience can be built can be thought of as opportunities to enable you to thrive, feel alive, and provide the very best of yourself.  From practicing selfcare to sustaining social support, compassion resilience is yours to be had.

Practice selfcare

Are you practicing medicine? Then you have to practice selfcare. Selfcare is not just the cornerstone for the mitigation of compassion fatigue (10), but also a professional, ethical responsibility. It follows the principle: To care for others, one has to first care for the self (11).

Selfcare necessitates self-stewardship, taking personal responsibility for, and investing in, one’s body, mind, heart, and spirit to wholistically sustain health and wellbeing. It involves learning — and regularly practicing — what works to sustain one’s energy, buoyancy, and hope (12), and includes engaging in creative and personally meaningful activities to feel alive, relaxed, and well. There needs to be balance between the activities of life that fatigue and those that refresh (10). Sufficient selfcare, in the infinite forms it may take, sustains that balance.

Just as selfcare necessitates self-stewardship, balance necessitates boundaries — healthy boundaries. Setting such boundaries requires reviewing and rebalancing one’s workload, delegating, and limiting one’s work availability, involvement, and personal investment. Having such boundaries prevents one area of life (e.g., work) from eclipsing or overshadowing the entirety of one’s life; a real risk for those who are highly dedicated.

The importance of selfcare cannot be overstated. Not only does it refresh, refuel, and rejuvenate, but in this it plays a vital role in sustaining the personal resources that enable resilience to start with, such as optimism, self-confidence, level-headedness, hardiness, and resourcefulness during times of adversity (13). Selfcare has much to offer, personally and professionally.

Practice mindfulness and self-compassion

Research has confirmed that mindfulness and self-compassion, both drawn from Buddhist philosophy, enhance resilience (14). These practices are suggested to not only reinforce health and wellbeing, but also, in the provision of healthcare, improve the quality of care and compassion provided, benefitting caregivers and receivers alike.

Mindfulness has been described as a conscious, passive, and real-time awareness and acceptance of one’s experience, embracing the cognitive, emotional, and sensory components without judgement (14). Just as mindlessness prompts wanderings to the past and the future, mindfulness anchors to the present. Mindfulness is associated with less stress and emotional exhaustion (6) and less anxiety, depression, and burnout, thus mitigating the risk of compassion fatigue. Mindfulness can be enhanced through mindfulness training, a variety of methods that guide the mind to stay focused in the moment. Retraining the mind relies on neuroplasticity, and as such, takes time and practice, but it has much to offer, starting with being present and awake in your life.

Self-compassion, which can be understood as “compassion directed inward towards the self” (15), is related to mindfulness. It consists of 3 components:
a – self-kindness — being kind and understanding toward one’s self in instances of pain or failure rather than being harshly self-critical;
b – common humanity — seeing one’s experiences as part of the human condition rather than as separating and isolating; and
c – mindfulness — holding painful thoughts and feelings in balanced awareness rather than over-identifying with them (15).

Like mindfulness, self-compassion is associated with less anxiety, depression, and burnout. It is also associated with improved wellbeing and greater life satisfaction. There are many ways to become more self-compassionate, including exercises and guided practices as well as in-person and online training opportunities (16). Mindfulness and self-compassion can lead to a greater sense of ease and wellbeing, enabling greater compassion resilience.

Cultivate compassion for others

Compassion informs and motivates our duties towards others, and, as such, is central to the delivery of healthcare and the essential quality to care for others (17). Research suggests that compassion does not just benefit others, but the self as well (18), lending credence to one of the most well-known and revered quotes of the Dalai Lama, ‘‘If you want others to be happy, practice compassion. If you want to be happy, practice compassion.”  Although compassion is a natural or intrinsic aspect of our nature, described as an evolutionary “instinct” of sorts it can also be taught, learned, and nurtured, or in other words, “cultivated” through training (19).

Compassion training makes use of Buddhist-derived meditative techniques. The most popular techniques are compassion meditation, which focuses on cultivating affective empathy for the suffering of others and loving kindness meditation, which focuses on cultivating a feeling of love for all beings. The benefits of compassion training are manifold. Compassion training can reduce distress, depression, and feelings of loneliness, increase positive emotions (19,20), and promote emotional wellbeing (20), all of which enhance compassion resilience. Of course, compassion training can also enhance the ability to care for others. Not only does it reduce empathic erosion, improve empathic accuracy, and deepen compassion, it increases the desire to protect and promote the wellbeing of others (i.e., prosocial motivation) and inspires actions to benefit others (i.e., prosocial behavior), all of which reinforce resilience and benefit caregivers and receivers alike.

Grow compassion satisfaction

As defined by Stamm (21), compassion satisfaction is the pleasure derived from being able to do one’s work well as a professional caregiver. Although it is not the opposite of compassion fatigue (as along a continuum), in a way, it can be thought of as an emotional counterbalance (22).  The positive feelings of reward, fulfillment, and accomplishment of compassion satisfaction can offset the negative feelings that characterize, and contribute to, compassion fatigue. Thus, a strategy to counter compassion fatigue — to build resilience — is to grow compassion satisfaction (22).

In part, growing compassion satisfaction requires being mindful of the experiences that can generate it, such as opportunities to “make a difference,” difference-making being a key predictor of compassion satisfaction (8,23). It requires being mindful of (i.e., conscious of and attentive to) the hope, joys, and rewards, and the sense of meaning and purpose within our work; and the relationships that we take pleasure in, with coworkers, clients, and patients (23). From there, it requires intentionally savoring these things, taking the time to genuinely appreciate them (22). Whether held close to the heart as quiet acknowledgments or shared openly with others, deepening these experiences can grow one’s compassion satisfaction.

Sustain social support

A crucial element of personal resilience is intentionally building a community around one’s self from which to draw support (12). Just as being a caregiver necessitates selfcare, it likewise necessitates social support. Social support, as in the assistance that is accessible through social ties to individuals, groups, and the larger community, is “exceptionally important” for maintaining good mental and physical health (24).  Of note, it is not the quantity of relationships that is most important, but the quality, although both have a bearing on health.

Although the exact biopsychosocial processes that govern the influence of social support on resilience are not yet known (24), various associations have been clearly identified. Research has found that low social support is associated with stress, anxiety, and depression, and beyond this, with medical morbidity and even mortality. In contrast, high social support is associated with reducing stress, anxiety, and depression, and having protective and buffering effects on both mental and physical illness. Social support is one of the key predictors of whether caregivers will stay well.

Caregivers often don’t realize that the challenges of their work necessitate the responsibility to build and sustain a personal support system (12). Unconsciously, they tend to assume that others will naturally step in to provide the support that they need when they need it, and in this find themselves lacking, disappointed, and feeling isolated. With intention, one can carefully craft the kind of social network that will offer the sustenance needed. It is crucial to managing work stress (25) and an essential element of resilience (12).

Live your way into resilience

As Karen Reivich stated, “Resilience is not all or nothing. It comes in amounts. You can be a little resilient, a lot resilient; resilient in some situations but not others. And no matter how resilient you are today, you can become more resilient tomorrow.” The opportunities of practicing selfcare, mindfulness and self-compassion, cultivating compassion, growing compassion satisfaction, and sustaining social support are just that: opportunities. And “opportunities” implies choice. And behind choice lies intent. You can set your intent, choose the pursuits that resonate with you, and live your way into resilience a day at a time. And before you know it, your todays will have become the tomorrows you envisioned. But resilience is not a solo endeavor!

When the opportunities to build personal resilience are respected — and more importantly promoted — within community, everyone can benefit. This, and much more, is where organizational resilience comes in. Having focused on the ways to build personal resilience, the next and final article will focus on organizational resilience, specifically the organizational approaches, strategies, and practices that can reduce the risk of compassion fatigue.

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