ASSESSMENT & TREATMENT OF PANDEMIC BURNOUT &

COMPASSION FATIGUE

KATHY HOPPE, LMFT

Participants will be able to:

§ Re-conceptualize clients' issues related topandemic burnout and compassion fatigue.

§ Explore diagnostic dilemmas in the identification of burnout, compassion fatigue, and moral distress occurring in the professional lives of people in the medical, educational, behavioral health, and other industries impacted by a pandemic.

§ Identify the differences in theoretical approaches to the treatment of collective pandemic burnout and compassion fatigue.

§ Outline a treatment protocol that addresses the unique factors that interfere with functioning.

OBJECTIVES

THE IMPACT

“With its lack of unpredictability and the need for distance and isolation, COVID-19 is tearing at the fabric of our most basic methods of coping, and calls for new ways of adapting to and thinking about crisis.”

Horesh & Brown, 2020

TERMS USED

Epidemic stress Toxic positivity Collective

traumaCollective

stressPandemic

virus

COVID-19 stress

Post-COVID Stress

Syndrome

CautionFatigue

Epidemic fatigue

Compassion fatigue

Burnout Peri Trauma Stress

Pandemic fatigue

ELIZABETH STUART, PHD, THE JOHNS HOPKINS BLOOMBURG SCHOOL OF HEALTH

PEW RESEARCH CENTER'S AMERICAN TRENDS PANEL (ATP)

¡ n = 9687¡ March 19–

24, 2020¡ CES-D,

GAD-7, & IES-R

China

• n = 2700• 49 - 59% dep. sx• 45% anx. sx• 34% insomnia• 72% distress

Italy

• 29.5%• PTSS

Spain

• 15.8% PTSD• 18.7%

depression• 21.6% anxiety

Ireland

• n = 1041• 17.7% PTSD• 53.8%

depression• 49.5% anxiety

HOW ARE PEOPLE DOING?

HOW ARE PEOPLE DOING?

0

5

10

15

20

25

30

35

40

45

50

4/23 - 5/5 5/7 - 5/12 5/14 -5/19

5/21 -5/26

5/28 - 6/2 6/4 - 6/9 6/11 -6/16

6/18 -6/23

6/25 -6/30

7/2 - 7/7 7/9 - 7/14 7/16 -7/21

8/19 -8/31

9/2 - 9/14 9/16 -9/28

9/30 -10/12

10/14 -10/26

10/28 -11/9

11/11 -11/23

11/25 -12/7

12/9 -12/21

CDC HOUSEHOLD PULSE SURVEY - ANXIETY SYMPTOMS

National Oklahoma

HOW ARE PEOPLE DOING?

0

5

10

15

20

25

30

35

40

4/23 -5/5

5/7 -5/12

5/14 -5/19

5/21 -5/26

5/28 -6/2

6/4 - 6/9 6/11 -6/16

6/18 -6/23

6/25 -6/30

7/2 - 7/7 7/9 -7/14

7/16 -7/21

8/19 -8/31

9/2 -9/14

9/16 -9/28

9/30 -10/12

10/14 -10/26

10/28 -11/9

11/11 -11/23

11/25 -12/7

12/9 -12/21

CDC HOUSEHOLD PULSE SURVEY - DEPRESSIVE SYMPTOMS

National Oklahoma

BALANCE OF PROTECTIVE FACTORS VS. STRESSORS

Social supportFinancial stabilityEmploymentSafe place

Wellness checks

ExposureQuarantine/IsolationIncome/job loss

Work/kids/school

Severe stressWitnessing deathHaving COVID/Family/friends

Protective Factors

Stressors

OCCUPATIONS IMPACTED

§ Medical professionals§ Emergency responders§ Healthcare workers§ Community workers§ Hospital industry§ Ministry leaders§ Education§ Other

THE DILEMMA

WHAT ARE WE TREATING?

THE DILEMMA

“There’s a big difference between ‘staying positive’ and being generative.

The first disregards hard truths and the second is the fruit of composting them.”

Toka-Pa Turner

We the Hospital – We exist for hard times. We are seasoned professionals.We walk through hard truths and handle heavy situations.Enter Covid-19 stage right seeping into our lives, our work, our hospitals, our homes, our schools, our houses of worship, our gyms, our relationships.So, we buckle down and buckle up. We shore ourselves up for the long haul. And the long-haul, hauls on…We discover that the long haul is too long…We haven’t shored up enough. We haven’t stored for the hurricane. We haven’t stocked for the famine.We haven’t hoarded enough to sustain body, mind, spirit.Out of gas, Out of positivity, Out of energy, Out of wellness resilience, Out of coping strategies…Is this sustainable?Are WE sustainable?And still Covid-19 seeps and merges. Seeps into our hearts and souls and minds,Seeps into apathy and merges until all apathies are diseased by apathies.The virus of our apathies become more dangerous than any Covid-19 or Ebola or Bubonic Plague. Apathy seeps into our identity, into the tasks of our work. Help us, O God! Eventually, may we have some generative fruit from composting these hard truths and realities in which we live.

LAMENT OF A HOSPITAL CHAPLAIN

FROM AN ICU COVID NURSE

Have you ever sat with yourself alone, still and quiet like a mountain and then gone deep inside far below the surface until you are under it all alone with just you, the you that has always been you?Have you ever looked up from that space into a universe of tears, yours and others, held back by a fragile membrane – the relentless density of suffering, grief and loss, heavy, smothering, immense, afraid to reach up and touch it for fear of drowning in the emotion as an ocean erupts through the pin hole?Have you ever found the courage to touch it, yet it doesn’t break, and you are left with the crushing pressure bearing down on your soul. You push and prod – nothing. You yearn for release, better to drown than be crushed. Sill nothing but to hold this previous suffering like Atlas? This is this moment.

AUDREY – SPECIALTY RN

§ RN in step-down unit turned into COVID-19 unit

§ Approximately 20 patients§ Average deaths 2 - 4 per week§ Family disallowed§ Slow deaths with breathing difficulties§ Complains of anxiety & stress

CONNIE – COMMUNITY WORKER

§ Community worker in non-profit agency§ Responsible for discharging resources to

homeless§ Limited resources§ Making decisions: who gets resources or not§ Exhausted§ Complains of depression

BRIAN – HIGH SCHOOL TEACHER

§ Administration ambiguity § Teaching online & in school§ Science class – involves lots of “handling

items”§ Complains of fear§ Obsessive about cleaning things§ Requires entire family to wear masks§ Visitors in home must wear masks

LIMITATIONS TO CURRENT DIAGNOSTICS:1. MASS TRAUMA2. METHODOLOGICAL

Danny Horesh, NYU School of Medicine

Adam D. Brown, NYU School of Medicine

THE NEW ENEMY: COVID FATIGUE

WHAT IF? changed the lenses?

Lucy Johnstone, UK Consultant Clinical Psychologist, author of Users and Abusers of Psychiatry, Formulation in Psychology and

Psychotherapy, and a Straight-Talking Guide to Psychiatric Diagnoses

CONSTRUCTIVISTAPPROACH

“The single most damaging effect of psychiatric diagnosis is loss of meaning.

By divesting people’s experiences of their personal, social, and cultural significance,

diagnosis turns ”people with problems” into “patients with illnesses.”

Lucy Johnstone, PhD, UK Consultant

COLLECTIVE TRAUMA

“What we’re experiencing here is a collective trauma. If we treat this the way psychologists have in the past – as individual patients with

trauma – then we’ve missed the boat. The collective problem calls for a collective solution. It’s not just about getting rid of symptoms; it’s

about helping people make meaning out of what happened.”

Nadine Kaslow, PhD, ABPPDirector of Postdoctoral Residency Training in Health Service Psychology

Emory University School of Medicine

COLLECTIVE TRAUMA

¡ Psychological reaction to societal tragedy

¡ Potentiality of cascading crises

¡ Risk & uncertainty

Collective trauma is a cataclysmic event that shatters

the basic fabric of society. Aside from the horrific loss of life,

collective trauma is also a crisis of meaning.

Hirschberger, 2018.

FACTORS THAT INFLUENCE COLLECTIVE TRAUMA

¡ Timing – continual triggering responses

¡ Political context¡ Public authorities

¡ Mass-mediated representations

¡ Carrier groups¡ Collective memory

Major events in 2020 - 21Pandemic• Isolation, Masks,

Vaccines, economic uncertainty, massive loss of life

Recognition of systemic racism• Brutal slayings

Unstable politic system• Attack on Capitol

Extensive media coverage

Weather events • hurricanes,

heatwaves, wildfires

Personal crises

CASE CONCEPTUALIZATION¡ Etiology¡ Symptoms¡ Severity of impact on

functioning¡ Duration¡ Prognosis¡ Formulate diagnosis¡ Define treatment plan

“Since the posttraumatic phase of the COVID-19 crisis is likely

to be rather long, treating people for

acute stress disorder and/or initial posttraumatic symptoms,

which has not yet crystalized into full-blown PTSD may be of particular

importance.”

Horesh & Brown, 2020

SIMILARITIES TO PTSD & ASD

§ Hypervigilance§ Avoidance§ Negative mood and cognitions§ Intrusive thoughts related to health and

death§ But . . . not quite a good fit for all

COMPASSION FATIGUE = BURNOUT = COVID FATIGUE?

“Well-established models of secondary traumatization, compassion fatigue, moral injury, and burnout should be

applied and used to assist these workers in their daily effort to

cope with massive amounts of work and stress.”

Horesh & Brown, 2020

COMPASSION FATIGUE OR BURNOUT?

COMPASSION FATIGUE§ Burnout symptoms§ Secondary traumatic

stress symptoms§ Mitigated by compassion

satisfaction

BURNOUT§ Emotional exhaustion§ Cynicism or

depersonalization§ Reduced efficacy

CONTRIBUTING FACTORS

Burnout¡ Job Demands-Resources – Perceived

demands > perceived resources

¡ Conservation of Resources – basic motivational theory – arises due to persistent threats to available resources

¡ Areas of Worklife – person-job imbalance or mismatch: workload, control, reward, community, fairness & values

Compassion Fatigue¡ Burnout

¡ Direct or indirect exposure to trauma

¡ Moral distress

(COVID-19)

A DIFFERENT PERSPECTIVE

A TRAUMA-INFORMED APPROACH

Recent research suggests that traumatic stress reactions during the pandemic – including intrusive re-experiencing and

heightened arousal – are particularly prevalent.

Bridgland, et al., 2021

FORWARD-FACING RESILIENCE PROGRAM (POLYVAGAL THEORY + CBT/CPT + NET)CE-CERT (CBT + MBSR + NARRATIVE)COMPASSION CULTIVATION TRAINING

COMPASSION FATIGUE & BURNOUT + TRAUMA INFORMED

FORWARD-FACING RESILIENCE THERAPY

https://www.facebook.com/groups/448297342837555

Coaching• Confront threats• Identify breaches

Intentionality• Values/Code of honor• Purpose/Meaning

Education• Tools for hope• Self-regulation

SKILLS NEEDED

¡Skill 1. Self–Regulation¡Skill 2. Intentionality¡Skill 3. Perceptual Maturation¡Skill 4. Connection and Support¡Skill 5. Self–Care and Revitalization

SKILL #1: SELF REGULATION

DR. STEPHEN PORGES ON POLYVAGAL THEORY

SELF-REGULATION SKILLS

Polyvagal theory¡ Hierarchy¡ Neuroception¡ Co-regulation

SELF-REGULATION ACTIVITIES

¡ Body scan – wet noodle¡ Muscular to skeletal

awareness¡ Peripheral vision¡ Core relaxation¡ The Yawn

“According to the theory of reciprocal inhibition (Wolpe),

stress, fear, and anxiety cannot be felt in a relaxed body.”

J. Eric Gentry

DR. ERIC GENTRY ON SELF-REGULATION

SKILL #2: INTENTIONALITY

¡ Value exercise¡ Code of honor¡ Mission statement or

covenant

“Human beings cannot live in habitual & willful violation of their

integrity without getting sick.”

J. Eric Gentry

TRIGGERS

• What did they teach you?

• How do these breach your code of honor?

• Actions, words, emotions

• Words, actions, situations

TriggersReaction

to triggers

Past hurts

Current impact

DR. ERIC GENTRY ON THREAT PERCEPTION

This is who I want to be.

SKILL #3: PERCEPTUAL MATURATION

¡ Real danger versus Perceived threat¡ Demand versus Choice – nothing is demanded of you¡ Outcome-Driven versus Principle-Based¡ Relinquishing Entitlement¡ Acceptance of a Chaotic System

SELF-COMPASSION SCALE

https://self-compassion.org/self-compassion-scales-for-researchers/

SKILL #4: CONNECTION & SUPPORT

SKILL #5: SELF-CARE & REVITALIZATION

THESE MAY HELP

Faith-Based (Christian)J. Eric Gentry’s works

WRITING A STORY

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