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It’s no secret that 2020 has been a rough year for most of us. Between hurricanes, wildfires, politics and a global pandemic – we’ve experienced a lot of stressful and negative events. In this episode, psychologist Susan Albers, PsyD, joins us to discuss what empathy fatigue is and who is most at risk. She discusses warning signs, treatment and how to show yourself some compassion during these trying times.

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Are You Experiencing Empathy Fatigue? with Dr. Susan Albers

Podcast Transcript

Cassandra Holloway:  Hi there and thanks for joining us. You're listening to the Health Essentials podcast brought to you by Cleveland Clinic. My name is Cassandra Holloway, and I'll be your host for this episode today. We're broadcasting virtually as we are practicing social distancing during the coronavirus pandemic. We're joined virtually by psychologist, Dr. Susan Albers. Dr. Albers, thank you for taking the time out of your day to speak with us.

Dr. Susan Albers:  Thank you. Thank you so much.

Cassandra Holloway:  So it's no secret that 2020 has been a trying year for all of us, between the constant stream of bad news and stressful events from wildfires, to hurricanes, protests, and politics, to what sometimes feels like the never-ending pandemic. We're all dealing with a lot right now, and dealing with so many of these negative and traumatic things can really take a toll, especially for those on the frontline like healthcare workers and first responders.

So today we're going to be talking with Dr. Albers about a phenomenon called empathy fatigue, what it is, what it means and how to work through it. Before we dive into this full episode, we want to remind listeners that this is for informational purposes only and is not intended to replace your own doctor's advice. Also, please note that this interview was pre-recorded and does not reflect any changes to COVID-19 precautions that may have been made after the recording.

So, Dr. Albers, I'm sure you've been quite busy over the past several months dealing with COVID-19 and helping people manage and cope. So I want to start off by asking you how you're doing with everything.

Dr. Susan Albers:  Thank you. You're absolutely right. The world has felt incredibly stressed. Not only are we going through a pandemic where we're dealing with a lot of medical issues, we're also dealing with a pandemic of mental health issues. So many people are feeling stressed, anxiety. So as a therapist, I've seen a number of people coming into therapy and counseling.

There's two things that I've been really grateful for being here at the Cleveland Clinic. The first thing is that we seamlessly, as soon as the pandemic hit, we moved to teletherapy. So I was able to reach out to many of my clients and give them support throughout this pandemic. So I'm incredibly grateful that we have transitioned to this model for the time being. I even have people who have experienced the coronavirus and I've been able to come to them. And during this time when we've been isolated from each other, it's been so incredibly important. So I'm grateful for that.

The second thing that I'm grateful for the Cleveland Clinic and just in the world is that we're really taking mental health issues seriously. And compassion, and compassion fatigue as we are going to be talking about today, is a pretty normal response to how stressful it's been. And we are all reaching out to each other, whether you're a caregiver or family members, trying to be supportive of each other. And what we have found is that this can be incredibly stressful. So I am very grateful that we are acknowledging that mental health issues are important and particularly for kids. I think this is one of the first times as I've been working in mental health issues that we've really normalized how important it is to pay attention to kids and their mental health issues. So I think that if there's something that I'm going to be taking away from this, it is that, that we have a whole new outlook on how to address mental health issues.

Cassandra Holloway:  Sure, absolutely. I love how you said we're starting to normalize mental health and prioritizing kind of and seeking help and then talking about it for sure. So let's dive right in here then. So what exactly is empathy fatigue?

Dr. Susan Albers:  Yeah. Sometimes we call it compassion, fatigue, and sometimes it's empathy fatigue, and I'll describe what the difference is between those two. But basically it is the emotional and physical exhaustion that happens from caring for people day, after day, after day. And this is something that is really common amongst people who are mental health workers, counselors, physicians, nurses, police officers, frontline workers. You mentioned the fires. That would be the fire department going out, the first responders who are helping people really on the front lines. And so these are often people who are incredibly caring. They want to be helpful. But doing this day after day, it becomes really stressful. And what ends up happening over time is what we see is that people experience a sense of numbness or distancing or difficulty of caring. We talk about that compassion fatigue of that they are no longer showing a lot of the compassionate responses that they have had in the past.

And this is something it doesn't feel good to people who like to help that's part of their personality. But as we just said, that we're normal and normalized. It's a normal response to prolonged periods of stress. And what's happening in the brain is that when we are under stress day, after day, after day, it's like we're having a constant drip of cortisol that's going onto our brain. And we can only do that for so long where the cortisol, we just have too much of it, and our body and our minds start to break down. So we start to distance ourselves. It's really our bodies and minds way of saying, "Stop, hey, we really got to pay attention. We got to take a step back and take care of ourselves."

Cassandra Holloway:  I'm curious, is empathy fatigue the same as compassion fatigue, or are there little differences between the two?

Dr. Susan Albers:  There's a little bit of difference. So empathy is that sense response that we get to understanding someone else's experience. So basically someone tells us their story. And what we do is we try and mentally walk through that story with them. We don't have to experience it ourselves, but to really feel what they feel, we imagine it. And that hits the part of the brain. That is the emotional center of the brain. And our response can be many different thing to that empathy. Oh, I get it. I feel what you feel. It can be compassion or it can be some other kind of response. So compassion happens when we give care or we say things that are soothing, or we give them some sort of medical treatment or care. And so how it becomes different is that we may still sometimes feel empathy for people, but we don't have the ability to give them a compassionate response, that we kind of shy away from them.

The difficulty of what we see sometimes with people who are experiencing compassion fatigue is that they start to isolate themselves, that they no longer want to interact or do a job that they have been doing for a long time that they used to get a lot of meaning out of that they absolutely loved. And it's something that becomes more of a burden. Some other people who experience compassion fatigue are also journalists. I recently was talking with a journalist who spoke about how talking about some of the tragedies day after day, writing about it, what she noticed is she began to feel a little numb to it, that it no longer became stories about people, but about numbers.

And I think that is one of the biggest red flags I think when I see people in healthcare or in the general population who experience compassion fatigue, is that all of a sudden, they're not talking about how many like mothers and daughters and grandmothers who have coronavirus, they're talking about numbers and statistics, that this many people have coronavirus. And it becomes very distant when you're talking about people in terms of numbers, instead of this is somebody's grandma. This is their sister who is struggling with coronavirus. And again, it's kind of our brain's way of coping with bad news day, after day, after day.

Cassandra Holloway:  Sure. And since we've been going through this for several months at this point, it's hard because it's all about the statistics and the numbers that you keep seeing repeatedly on the news and in social media. And I think we can all relate to that thinking it's more of a number, but it really, like you said, it comes down to people's friends and family and grandmas. And it's very relatable, I think, to so many people at this point. So how does empathy fatigue relate to like that job burnout kind of mentality? Is it the same thing? Is it different?

Dr. Susan Albers:  Well, burnout is the result. We often see people feeling totally burned out and you can tell in some of the words that they say. They say things like, "I am just done. I can't do anymore." Or, "I have nothing left to give. I feel just sucked dry." I like that there's a saying about you can't pour from an empty cup. And I think this is really what a lot of people who are healthcare workers experience. And Mother Teresa was actually somebody who really believed in this concept of compassion fatigue. Every four to five years, she made it mandatory that her nuns would take off a year because she realized as the nuns were giving and giving that they would experience this compassion fatigue. So it's something that is really important because people can get burnt out.

And there's physical signs and emotional signs that are big warning flags. They are red flags that people are experiencing compassion fatigue. So some of the physical signs are difficulty sleeping. You're thinking about all of these stories that you've heard of the people, and you can't turn your brain off. It's very difficult to go to sleep. You're in a hyper arousal state. So difficulty sleeping. Sometimes there's a lot of GI problems because you have a lot of stress, upset stomach. You may feel exhausted all the time. I work with a lot of people who experience emotional eating as well. So they may experience some extreme changes in their eating. Also isolation, that they come home and they go in their bedroom and shut the door because they just can't handle any more stuff. So isolating, a lot of headaches.

People who are experiencing compassion fatigue contact their doctor significantly more. And some of the behavioral signs that we may see is that they start avoiding work. They have a lot more days absent. They may avoid certain patients or clients. They also sometimes start looking for different jobs. Sometimes it's extreme behaviors like alcohol and substance use to numb a lot of those feelings or to escape them. Sometimes it's also looking for things outside of yourself to fix the problem. So they think, well, I need a different job. Sometimes they get a divorce or have an affair, or something like that that is trying to solve the problem, but it's really not looking internally. It's sort of trying to fix things that are from the outside. So there are a lot of behavioral and physical signs that are big red flags that you may be struggling with compassion fatigue.

Cassandra Holloway:  How does depression and anxiety play into empathy fatigue? Is that part of the symptoms? Are those warning signs? Can it make it worse, I imagine?

Dr. Susan Albers:  Yeah. Well, and particularly if you've had a vulnerability for depression in the past, I think that it can trigger it or exacerbate it. It can also be the result of compassion fatigue. Often if you see tragedy or suffering day after day, and you're helping people, you can get to a sense of hopelessness and depression often goes hand in hand with that of some of these hopeless thoughts of things in the world are very tragic. Instead of looking at I'm here, I'm helping, I'm making a difference. I am helping people through this. Those depression thoughts are like wearing blinders and saying, "You know, the world is awful and it's hopeless." So some of those depressive thoughts are also a sign of compassion fatigue, as well as anxiety. And over time if it does not treated, it can turn into an anxiety disorder.

Now you had asked about sort of the difference between burnout and compassion fatigue. Burnout is often something that happens over time. So this is years and years and years of going into work and doing the same thing, working long hours. And compassion fatigue is something that can happen relatively quickly. And sometimes there are stories that people will tell about a particular incident or working with somebody who is very traumatized, and it sticks with them, and they have a lot of difficulty of letting it go. So it's kind of the difference between burnout, it's years and years, and compassion fatigue can happen very quickly. The good news about compassion fatigue is if you recognize it right away, it's a lot more treatable if you catch it towards the beginning, if you start see some of those signs.

Cassandra Holloway:  Do you think now more than ever, empathy fatigue is impacting you more than, you know, we mentioned healthcare workers and first responders and journalists, do you think it's affecting more of the kind of average person at this point? Whether it's in-person learning or virtual learning or both, I think just being exposed to that repeated stress, it's impacting more people, I guess then than maybe empathy fatigue did before in the past.

Dr. Susan Albers:  Absolutely. You're absolutely right on. It is not just healthcare workers, therapists, police officers. It is also kind everybody can experience a little bit of a compassion fatigue, particularly around the media. Day after day, we're hearing these bad news and the stories, and at first you might read some of these stories and be taking them to heart. And now you might find after we've got just this barrage of media, that you might be tuning it out a little bit or a little numb to it and saying, "Oh, that's just another story about a wildfire," or something, which would not be your typical response.

Also people who are caregivers at home, moms who have little kids at home, people who are caring for elderly parents, or people who are sick, are experiencing a great deal of compassion fatigue because in the past few months, the people who were coming in to help them, aides or nurses, or some respite care, things like that, they're on hiatus. So really, they don't get the break that they've had in the past. So there's a lot of caregivers who are at home who are struggling. So if you know, one of those people, be sure to reach out to them and see how they're doing. The isolation piece of it, I think, is really huge, too.

Oh, and let's get back to teachers. You said teachers. So it's not just individuals. It can be groups of people. So what I've been hearing from teachers and particularly the patients that I've been working with is that teachers have been asked to do more and more, to step out of their roles and their comfort zone, so now they're playing other roles that they didn't in the past of being counselors, and IT professionals, and cleaning staff, and nurses of taking kids' temperatures and things that they just never did before.

And so suddenly not only are they managing their own roles, but all of these other roles. And so I think teachers are one that we've now come to really appreciate if you have kids at home. And particularly parents as well, who are not only playing the role of parents, but now a teacher at home. And sometimes they can find themselves dealing with compassion fatigue as well, that this is again a role that they haven't played before. And some signs of it is becoming more impatient with your kids, or just saying, just do it. You know, I just don't care anymore. So I think that teachers and parents are people who are struggling a lot with their own emotions and compassion fatigue right now.

Cassandra Holloway:  For sure. So can we develop empathy fatigue from one traumatic or stressful event? You know, if you say it's cancer diagnosis or your home burns down. Could it be one event or does it have to be kind of that thought of repeated trauma or stressful events?

Dr. Susan Albers:  Right. No, it can absolutely be one event that can lead to compassion fatigue, and it's often something that triggers you and your own emotions in a way that is difficult for you to cope with. So, for example, in talking with another therapist who had worked with a child that had been in a traumatic incident, that she'd worked with lots of different adults over the years, but this one particular child stuck in her mind and the story kept repeating over and over again. It was really difficult for her to step aside from. That was enough for her to kind of take a little bit of a break from what she was doing. So we can experience something that's particularly out of our norm comfort zone or triggering to us that triggers this compassion fatigue, and leaves us just feeling very out of sorts, and needing to address that before we get to the place of burnout.

Someone had used the example of glitter, that sometimes it's a little bit like you're talking with somebody, and imagine that they got a little bit of glitter on you. They have their trauma and they put a little bit of glitter on you. And you walk away and you can't get that glitter off. It kind of sticks with you. And that's a little bit of what that secondary trauma can be. That we don't have to experience that trauma directly, a house burning down, but we can hear about it and imagine it, and imagine what that would be like, enough to the point where it stirs up a lot of our own emotions.

Cassandra Holloway:  Sure. That glitter metaphor is really powerful when you think about it, as you read more and hear more and experience more, kind of just it really takes you for sure.

Dr. Susan Albers:  Yeah. The other example, and many people have heard this one about the oxygen mask, is that to be able to help other people. Imagine we're on a plane. You need to put your oxygen mask on. They always say to put yours on first before you can help the person next to you. And many people have heard that. But the truth of it is, is that if we are not in good working shape ourselves, we cannot be helpful to the people around us. And we really see that trickle-down effect that it happens at work, but then you carry that to home as well.

Cassandra Holloway:  Sure. Do you think empathy fatigue is contributing to, I guess, the general feeling of intolerance right now, or perhaps contributing to the idea of caution fatigue? You know, people are tired of social distancing. They're tired of wearing a mask and being told what to do. Do you think there's any correlation between that kind of intolerant feeling right now and empathy fatigue?

Dr. Susan Albers:  Yeah. We get to a point where we can only feel like take so much, and people have been doing a great job through a lot of this in washing their hands following a lot of the safety precautions, but it's a little bit being like on alert at all times. So we were washing our hands every moment and doing all these safety precautions. And eventually you get to the point where you get a little bit lax about it, that you can only be on hyper alert for so long and your body and your mind become exhausted. And I think that's where many people are at is that they've been doing many things that are out of their comfort zone or out of the routine for such a long period of time that they let a few things slide here and there. But we do have to bring it back to the point of that it's not over, and we still have a lot of safety precautions that we need to do and to help us to feel safe and in control of our own environment.

But overall, there is a feeling I think today even I was walking into a building and I had my mask on, and another woman was next to me and she did not have her mask on. And she goes, "Oh, I forgot my mask." Literally you could tell, she just forgot her mask. And she said, "I'm so over this." And I said, "I get it. I get it. I understand." That she'd been doing this for months of wearing her mask and she just walked in and totally forgot. Our minds want to protect ourselves at times from just too much.

Cassandra Holloway:  Sure, absolutely. Yeah. Protecting yourself like you said. So how long does empathy fatigue typically last? Will it go on forever if there's no treatment or intervention? Will it go away on its own? Talk to me about kind of just the length of it.

Dr. Susan Albers:  Well, it kind of depends. It depends a little bit on how long the exposure and how intense. So if you're working day after day in kind of pretty routine circumstances. And a lot of times professionals are taught in their schooling about how to keep a little bit of a distance from the experience. They know how to put up some boundaries. But here, particularly with coronavirus, it's a new experience. People have not really experienced this before. So it can develop pretty rapidly because it's a new condition. It also depends on the intensity. If you're working with victims of trauma and severe trauma, it can really last for quite a while. But the good news is, is that if you get treatment, it's something that is very treatable and something that can be prevented.

If it keeps going on and on, what I've seen in the people that I've worked with, is that they develop a lot of physical problems, that their bodies just break down and you can see it over time. But the people who have really addressed it and taken some time to take care of themselves, cannot get to that point. And it's hard because caregivers, they often don't like to be cared for. They like to be the ones who care for other people. So it's a little bit of a role reversal, but when they do it, it can be a good thing.

So I look at it as in terms of treatment, an ABC model is what we talk about. And A stands for awareness. And in this is something that we can use is mindfulness, and I talk a lot about mindfulness with my patients just in general, of being aware of what is going on for you. Sometimes we're in such go, go, go mode that we don't even take a pause to take a self-assessment, to taking a really good, hard look of what is on your plate. What part of your job is stressful to you? What are you taking home with you? What is triggering to you? Are you experiencing any stress within your body? And that takes a mindfulness of tuning in to yourself.

The second part, the B, is for balance. How much balance is in your life? Are you spending all of your time at work? Are you doing other things? Do you have other interests besides your job and taking care of people and what you're doing? Do you have balance between your self-care routine of taking care of other people and taking care of yourself? Particularly moms all the time are talking about, "I can't take a break. I got to take care of my kids." And then they get to the point where they feel really burnt out. So giving themselves some permission to have that balance, spending some time exercising is, is really, really important. And in that kind of self-care is, is there balance with your eating, with your sleep? All of those kinds of basic needs.

And then the C is connection. And I think this one is really tough right now in the world of isolation, and partly why so many people are experiencing compassion fatigue, is because one of the things that is so healing is connection. And so talking with a therapist, talking with friends when you are caring for people, you can share with them some of what you've gotten from some of your stress, or how you take care of people. So that connection is really important. And we're kind of cut off from people right now.

One of the things I think is also in speaking of that connection is for healthcare workers. One of the ways that they express empathy is through their facial expressions. And we're wearing masks. We're hidden behind our mass right now. So to convey to your patients that you care, it's often twice as difficult because you can only see your eyes, or you have to really vocalize in your tone, "I care." And that has to come through instead of the facial expression. Oh, and you can't touch your patients. We show a lot of compassion from a touch or letting people know that we're there. And so now we're standing six feet apart from them, way far away, and it's very difficult to communicate compassion in an easy way.

So some people have to learn whole new ways of doing it. We've seen healthcare workers with buttons and the smile on their face to show, "I'm here. I'm thinking about you. I care about you." So we've kind of started to work around that a little bit, but it adds a whole new level of stress of how do I let my patient know that I'm here for them?

Cassandra Holloway:  Yeah, absolutely. And I keep thinking in my mind about grocery store workers who have been on the front lines since the beginning, and dealing with the changing guidelines, and the stress of it, and wearing a mask all day, and dealing with the public. And I keep thinking obviously healthcare workers, but I keep thinking about those essential workers as well and really feeling for them with this empathy fatigue.

Dr. Susan Albers:  Absolutely. Everybody has had new stresses added to their job. And as you said, people in their jobs every day are now wearing masks and having to figure out how to breathe, and live behind a mask and communicate.

Cassandra Holloway:  Yeah. So, you mentioned the ABCs, the awareness, the balance and the connection. Is there anything else in terms of treatment that people who might be listening to this podcast, who might be thinking about maybe they have this, is there anything else you would kind of recommend they try in terms of treatment?

Dr. Susan Albers:  Well, in getting back to that awareness, is start really listening to yourself. If you notice that you're complaining a lot about your job or blaming other people for things, or you find that you are traumatized watching a lot of the news, one of the things that I really recommend is that it can be traumatic just watching the news. So trying to limit that or do it in very strategic times and ways, and avoid putting yourself in situations that could be re-traumatizing. So, for example, if you are somebody who is working with a lot of people who have COVID, maybe going on websites and looking at the numbers and looking at a lot of the sites may be difficult for you, so limiting the amount of time that you do that.

Sometimes people work harder, which is also something not to do. Making sure that you put up limits and boundaries. Know what your limits are. And sometimes we have to do a self-assessment about that, of doing some reflections and writing about that. You can also consult a therapist to help you to talk it out. I think that's one of the things, when we talk about the connection, is having somebody in your life who is going to help you to process some of the things that you've seen in your job, or some of the things that you find stressful. We can also delegate. Caregivers are awful sometimes about delegating things to other people, because they want to do it themselves. But really that's one of the most helpful things that they could do is get help with some of the things in their life that they don't need to be doing, they don't need to be doing everything.

Cassandra Holloway:  Sure. So Dr. Albers, I know we've unpacked a lot in this episode. So my last question for you is what is your parting advice for listeners listening to this podcast? And we talked about the symptoms. We talked about treatment. What would be your kind of general advice to someone listening, thinking they have empathy fatigue? As a friend, as a therapist, what would you tell them?

Dr. Susan Albers:  I would say that, as we've said before, that one, it's very normal, to normalize it. Our tendency is to want to judge yourself. Why am I feeling this way, or how could I be so unfeeling or numb to people's experience? And really to realize that this is a normal reaction, and it's our body and brain's way of saying stop, and that we need to take a little bit of a step back, and to take care of yourself. And it's okay to take care of yourself. It's important to get treatment, some help with compassion fatigue, and it's something is very treatable.

Cassandra Holloway:  Absolutely. Showing yourself some compassion, I think is a great-

Dr. Susan Albers:  I love that. I love how you put that. Yes, to show yourself the compassion that you give to other people, I think, is something that you can use for yourself.

Cassandra Holloway:  Absolutely. Thank you, Dr. Albers, for taking the time to speak with us. You've offered a lot of great information. I know our listeners will really find value in this podcast, so thank you.

Dr. Susan Albers:  Thank you.

Cassandra Holloway:  For the latest news about COVID-19, visit Clevelandclinic.org/coronavirus. If you want to listen to more Health Essentials podcast featuring experts at Cleveland Clinic, subscribe wherever you get your podcasts from or visit Clevelandclinic.org/hepodcast. Also don't forget, follow us on Facebook, Twitter, and Instagram at ClevelandClinic, all one word, to stay up to date on the latest news and information. Thanks again for listening and stay safe.

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