Helping professionals of all kinds are exposed to a variety of stressors related to both their workplace systems and the ongoing exposure to direct and indirect trauma. This complex combination of stressors requires helping professionals to explore the steps they can take to effectively reduce the risks involved in their work and to increase their overall resilience in order to thrive in their challenging roles.
Understood to be a natural consequence of helping those in need. compassion fatigue is a secondary traumatic stress disorder, characterized by profound physical and emotional exhaustion arising from meeting the constant demand to be compassionate and effective in caring for traumatized or suffering people and animals (Figley, 1995; Mathieu, 2012). Compassion fatigue is specific to the caregiving relationship and stems from empathetic engagement with the population being served. Symptoms may include isolation, substance abuse, hopelessness, anger, guilt, reduced empathy, chronic physical ailments, and insomnia. Professionals who experience compassion fatigue may feel powerless to effect positive changes in their lives, feel disconnected from themselves, and experience a negative change in their worldview (Mathieu, 2012).
Burnout results from prolonged exposure to severe job stress stemming from interactions with the work environment. Contributing factors may include role overload—defined by Duxbury (2010) as “having too many responsibilities and too little time in which to attend to them”—understaffing, low pay, harassment, ethical violations, and unfair policies. Over time, this can result in professionals feeling powerless, cynical, frustrated, and exhausted. Many helping professionals experience both compassion fatigue and burnout.
Higher levels of resilience are strongly associated with lower levels of burnout and compassion fatigue. Resilience-building interventions, at both the individual and organizational levels, are required in order to address both effectively (Mathieu, 2012).
What is resilience?
Resilience enables people to bounce back from and thrive in the face of adversity and helps them to adapt to stressful work experiences in a positive manner. Resilience is not a static trait, but instead can be thought of as a dynamic and multifaceted process in which individuals draw on both personal and contextual resources (relationships, workplace, etc.) and utilize specific strategies to navigate challenges and work towards adaptive outcomes (Cake et al., 2017). Studies suggest that helping professionals who are resilient and practice resilient coping skills are better able to adjust to their stressful work, less likely to develop post-traumatic stress disorder, burnout, anxiety, and depression (Rees et al, 2015), and have lower levels of compassion fatigue (Burnett & Wahl, 2015).
Resilient people have a number of factors, characteristics, and behaviors in common, including:
- An internal locus of control, which refers to the extent that they believe they can influence the events that affect them.
- Resourcefulness and good problem-solving skills (Brown, 2010)
- Choosing to focus on what they can control or change (Evans, Mealer, Jooste & Moss, 2015)
- A realistically optimistic outlook (Evans, Mealer, Jooste & Moss, 2015)
- Belief in their ability to manage feelings and cope with difficulties (Brown,)
- Social support and connections to others (Brown)
- Being connected to their values and seeing meaning and purpose in their life (Evans, Mealer, Jooste & Moss, 2015),
- A sense of humor (Evans, Mealer, Jooste & Moss, 2015)
- Experiencing and expressing gratitude (Evans, Mealer, Jooste & Moss, 2015),
- Stress hardiness, which refers to a tendency to view stressful or upsetting situations as challenges and opportunities for learning and growth (Schabram & Maitlis, 2016).
Resilient people engage in proactive behaviors that help them to better manage stress and negative experiences, such as:
- Getting regular exercise (Evans, Mealer, Jooste & Moss, 2015),
- Getting adequate sleep (Evans, Mealer, Jooste & Moss, 2015),
- Engaging in cognitive reframing
- Utilizing positive self-talk
- Asking for help (Brown)
- Practicing spirituality (Brown)
While some of these elements may be inherent or come more naturally to some individuals, these common denominators of resiliency can also be learned and increased through deliberate practice. According to Dr. Dennis Charney, Dean of Icahn School of Medicine at Mount Sinai Hospital, “…you can become a more resilient person by challenging yourself and working on things that are out of your comfort zone, so that eventually you develop a psychological toolbox that helps you overcome tough times” (Rehm, 2015).
Linda Graham, author of Bouncing Back: Rewiring Your Brain for Maximum Resilience and Well-Being explains that resiliency is a process made possible because of the brain’s neuroplasticity—the ability to grow new neurons and create new neurological structures throughout our entire lifetime. When we repeatedly experience something, positive or negative, our brain creates and strengthens neural connections and pathways. The brain has the ability to change in response to experiences and where attention is placed. In other words, the mind has the power to change the brain, which can in turn change how one relates to life’s challenges (Graham, 2013).
Through regular resiliency training, helping professionals have the potential to rewire their brains so that, over time, they are more likely to bounce back from the adversity of the job and thrive in challenging environments.
In what follows, I’ll share how expressive writing can be an effective, beneficial, low-barrier tool to increase resilience for anyone involved in caring for animals on a regular basis, whether as a behavior consultant, veterinarian, animal care technician, or volunteer with a shelter or rescue organization.
Expressive writing and resilience
In recent years there has been an increased focus on the practice of mindfulness, especially on the benefits of mindfulness-based techniques to help build resiliency in populations as diverse as children in underserved school systems, people with mental and physical health challenges, and adults in a variety of trauma-exposed professions.
Neuroscientific research has associated mindfulness with neuroplasticity, which is thought to be critical in building resilience. The link between mindfulness and resilience is well documented and mindfulness has been shown to have numerous benefits in both clinical and non-clinical settings. However, multiple studies involving helping professionals have revealed that regular mindfulness practices can be challenging for participants to establish. Therefore, it is imperative that other resilience-building practices are introduced.
Expressive writing may be a good fit for some helping professionals. Expressive writing is defined as personal and emotional writing without regard to form or other writing conventions like spelling, punctuation, and grammar. One particularly effective expressive writing technique, often referred to as “The Pennebaker Paradigm,” is derived from James Pennebaker’s work in which participants are instructed to write about their deepest feelings for 20 minutes about a traumatic, emotional, or stressful event, repeating the process for three to five days in a row (Baikie & Wilhelm, 2005).
Research has shown that this approach can lead to significant improvement in physical and psychological health across diverse groups of people, and has also been linked to non-health benefits such as reduced staff turnover, lower absentee rates, and increased memory (Sexton et al, 2009).
Writing can improve health and resilience by addressing the intense stressors of caregiving work through:
- Safe exposure to difficult emotions, which makes them less potent and more manageable
- Cognitive restructuring, which helps people think about painful events in new and less upsetting ways
- Increased self-regulation, which allows people to cope with and better regulate their emotions (Sexton et al, 2009)
To reap the benefits of expressive writing, one needs to go beyond “venting” about a stressful event. Multiple studies have shown that in order to access lasting physical and emotional health improvements, individuals must write detailed accounts of the stressful or traumatic event, linking their feelings with the troubling events or traumatic memories (which tend to be fragmented and disorganized). Through the intentional process of writing about both the memory of the event and emotions, the mind can integrate the two, allowing people to make sense out of confusing, upsetting events and let them go (DeSalvo, 2000).
Expressive writing also offers the opportunity to reflect on the significance of the difficult event. Through the construction of a coherent story or narrative, individuals can make sense and meaning out of their experiences. This can increase resiliency and reduce the worry and rumination that are often associated with compassion fatigue and trauma (Sexton et al, 2009).
Like mindfulness, expressive writing can also be a way to tap into the potential of self-directed neuroplasticity to increase resilience. In the book Expressive Writing: Counseling and Healthcare, author Deborah Ross writes about the relationship between neuroplasticity and expressive writing, “…our brains change in response to how we focus our attention…having a regular journal-writing practice, which is a concrete and verifiable form of attention, shares common features with mindfulness-based meditation practices…paying attention, cultivating curiosity, and noticing what emerges as a function of the process of writing can be seen as similar to meditation practices that cultivate concentration and invite insight” (Ross, 2015, p.19).
More simply put, expressive writing can help us install habits of resilience such as connecting to a sense of inner resourcefulness, a willingness to face our thoughts and emotions, and self-regulation—including noticing, labeling, and coping with emotions.
Expressive writing in professional development
While it’s clear that expressive writing can be a tool to build resilience, research also shows that it can specifically support helping professionals to better cope with the stress and trauma of their work. The Care for the Caregivers program, developed at The Johns Hopkins Hospital in Baltimore, introduced a self-administered expressive writing technique based on James Pennebaker’s work. The goal was to help nurses cope with a diverse array of job-related stressors and emotional upheavals. In the initial study, an intensive care nursing unit was taught how to practice expressive writing to better to respond to on-the-job stressors, with the ultimate goal of enhancing their resilience. The nurses were instructed to write regularly about stressful situations at work, following prompts such as:
“First, find a quiet place where you won’t be disturbed. Then, for the next 20 minutes write about a stressful situation or event related to your job. This may be a medical error, a stressful work environment, difficult interactions with co-workers, job burnout, and/or issues having to do with death and dying or pain and suffering. Try to really let go and explore your very deepest emotions and thoughts. You do not need to limit your writing only to one event, and you can also write about other major conflicts or problems that you have experienced or are experiencing now. You might also tie your experience to other parts of your life. How is it related to your career, your relationships with others, your childhood, your parents, who you are, or who you want to be? Whatever you choose to write about, however, it is critical that you really delve into your deepest emotions and thoughts. Feel free to give details of the event to the extent that you would like, or to simply focus on your feelings and reactions to the event.
Although people sometimes feel sad briefly, immediately after they write, there are positive long-term gains. Studies using this approach have found that when people write in this manner over 3 or 4 sessions, their emotional and physical health improves. The writing experience is useful for anyone affected by a trauma or upheaval and the content of the writings need not be shared with anyone. In fact, destroy the writings upon completion if you wish—the important thing is to put these experiences that are difficult to talk about into your own words. This jumpstarts your healing and coping process.” (Sexton et al, 2009).
Nurses reported a sense of catharsis through writing that helped them process personal and professional issues. The manager of the unit also reported that her unit showed a marked increase in morale and better staff interaction after completing the writing intervention.
This complements the results of multiple studies involving other helping professionals, for example Evans et al (2015).
Only one study (that I am aware of at this time) has tested the effectiveness of expressive writing on helping professionals who work with animals. In 2009, an animal shelter in western Canada participated in a small study in which five participants were asked to write about their feelings related to euthanasia or related areas of their work every three days for two weeks, for 15 minutes per session (Unsworth et al, 2010). While it’s not possible to draw conclusions from such a small group, four out of five participants reported a positive evaluation of the writing process. One participant shared, “When I look back it’s the clarity of my emotions and getting it off my chest [that helped]. Putting stuff down on paper gets it off of my mind.” Another participant shared that the process of writing helped her to think about euthanasia differently and that by writing about stressful events she was “…able to break them down, see why they affected her, and put them to rest” (Unsworth, 2010, p.776).
Further research is needed to determine if expressive writing is an effective stand-alone intervention for compassion fatigue and burnout in helping professionals. However, these limited findings are consistent with other, larger-scale research that documents the positive physical and emotional outcomes related to expressive writing (Balkie & Wilhelm, 2005); it appears this is a promising approach to improve the resiliency of helping professionals. At a minimum, expressive writing can be offered as a safe, low-cost, easy-to-implement stress management tool.
Writing prompts and applications
Those wishing to practice expressive writing can do so using a variety of prompts designed to increase resiliency.
1. Writing to Heal: The Pennebaker Paradigm
This approach to expressive writing removes barriers to resilience by allowing participants to heal unresolved traumatic experiences. To benefit from this approach, set aside 15 to 20 minutes, three to five days in a row, to write about a stressful or traumatic event. You may wish to use the prompt detailed above in the Care for the Caregivers program. Books such as Expressive Writing, Words that Heal (Pennebaker & Evans, 2014) offer detailed instructions and cautions for anyone wishing to engage in this practice. You can also find instructions here: https://www.psychologytoday.com/blog/write-yourself-well/201208/expressive-writing
Although the Pennebaker Paradigm is the most widely researched expressive writing–based intervention, a number of other, less-intensive expressive writing practices have also been found to produce positive results, thereby further reducing barriers to participation. For example, a 2008 study found that even two minutes of writing, done two days in a row, can be enough to affect physical health symptoms for weeks post-intervention (Burton & King, 2008).
2. Affirmative and Appreciative Writing: Building Inner Resources and Positive Emotions
Another approach that aids in increasing resilience for helping professionals is writing focused on affirming and appreciating one’s own inner strengths, available resources, support, and the positive impact of their work.
Bryan Sexton’s research on the “Three Good Things” writing exercise, developed by Martin Seligman, PhD, instructs participants to write down three things that went well each day and how the participants played a role in contributing to these positive events. Regular use of “Three Good Things” has been shown to significantly reduce burnout among nurses and increase compassion satisfaction (Sexton, n.d.).
Another way to incorporate this style of writing is to focus on the positive outcome or the “silver lining” of a traumatic event. According to one study, this exercise produced the same health benefits as writing in the classic Pennebaker Paradigm model, increased participants’ ability to self-regulate, confront and restructure their thoughts and feelings related to the traumatic event, and helped them identify and affirm their own inner resourcefulness in the face of difficult situations (Pierce, 2015, p. 157).
Additional affirmative and appreciative writing prompts may build positive emotions by focusing on various topics such as: recalling joyous and happy times, gratitude for others, reflections on one’s own strengths and gifts, as well as how one has impacted the lives of others by sharing these gifts (Evans, et al, 2015). These positive styles of expressive writing may contribute to resiliency through an increased sense of control and meaning, self-efficacy, and realistic optimism.
3. Regular Debriefing: The Daily Download
A simple way to get started is to set aside 10 minutes at the end of the work day to reflect on the stressful events of the day, how one feels, and what, if anything, needs to be done in order to cope in a healthy way.
End-of-day prompts might include:
How am I feeling today? (promotes self-awareness, mindfulness)
What stories/feelings do I need to release to feel okay about going home? (promotes self-regulation, emotional intelligence)
What do I need to do to prepare for tomorrow? (promotes self-efficacy)
What difference did I make today and what or who am I grateful for? (promotes self-efficacy, optimism, connection)
Expressive writing helps to manage compassion fatigue through the regular release of accumulated stories and emotions related to working with clients and patients who are suffering or traumatized. “Writing down personal thoughts gives one permission to let them go, no longer thinking about them with the intensity that may have cluttered the mind and drained energy” (Seaward, 2012, p.247).
Regular debriefing through journal writing empowers professionals by giving them a healthy outlet to express, process, and release what they witness each day. This is particularly important for individuals who may not have regular access to peer support or mentoring and do not feel comfortable sharing or “burdening” friends or family with work stories. Having a daily writing practice at the end of a shift has the added benefit of functioning as a work-home transition ritual, which professionals can use to help themselves process the day in order to more easily let go of work and re-enter their home life (Mathieu, 2012).
Organizations such as animal shelters and veterinary practices can support this process by offering professional development training on expressive writing for staff and volunteers. Hiring a coach or facilitator to teach the benefits of expressive writing, lead them through a number of initial exercises, and answer questions would be an ideal way to help those who are unfamiliar with and/or reluctant to try expressive writing. Once the instruction is complete, individuals can use these resiliency-building tools at their discretion.
Workplaces can also allow staff to spend a short period of time at the end of each workday, while they are still on the clock, writing and reflecting. Not only will this practice encourage self-care and resilience, but research has shown that 15 minutes of written reflection about what went well, done at the end of the workday for 10 days in a row, can lead to significantly higher performance rates in staff. Researcher Francesca Gino believe this is due to the fact that “…when people have the opportunity to reflect, they experience a boost in self-efficacy. They feel more confident that they can achieve things. As a result, they put more effort into what they’re doing and what they learn” (Baer, 2014).
Expressive writing is one of many interventions that can support and increase resiliency for helping professionals who are engaged in complex and stressful work. The beauty of writing is that there are very few barriers to using this tool. No matter where one lives, what kind of support system they have access to, or their income, a blank page and a few minutes is all one needs to start reaping the benefits of this simple yet effective resilience-building practice.
Burnett, H. J. & Wahl, K. (2015). The compassion fatigue and resilience connection: A survey of resilience, compassion fatigue, burnout, and compassion satisfaction among trauma responders. International Journal of Emergency Mental Health and Human Resilience, 17(1).
Cake, M. A., Mcarthur, M. M., Matthew, S. M. & Mansfield, C. F. (2017). Finding the balance: Uncovering resilience in the veterinary literature. Journal of Veterinary Medical Education, 44(1), 95-105.
Evans, J., Mealer, M., Jooste, K. & Moss, M. (2015). Expressive writing for caregiver resilience: a research perspective. In Thompson, K. & Adams, K. (Eds.), Expressive writing: counseling and healthcare. (pp. 43-61). Lanham: Rowman & Littlefield.
Pierce, S.S. (2015). Roots of resilience: Writing for practitioner self-care. In Thompson, K. & Adams, K. (Eds.), Expressive writing: counseling and healthcare. (pp. 43-61). Lanham: Rowman & Littlefield.
Rees, C. S., Breen, L. J., Cusack, L. & Hegney, D. (2015). Understanding individual resilience in the workplace: The international collaboration of workforce resilience model. Frontiers in Psychology, 6.
Ross, D. (2015). Your brain on ink: Expressive writing and neuroplasticity. In Thompson, K. & Adams, K. (Eds.), Expressive writing: counseling and healthcare. (pp. 19-41). Lanham: Rowman & Littlefield.