Preventing and Healing Compassion Fatigue by Janet M. Cromer, RN, LMHC, CCFE

Janet Cromer, expert on compassion fatigue among caregivers.

Janet Cromer, expert on compassion fatigue among caregivers.

Caregiving for a person with a brain injury can be exhausting

Susan couldn’t figure out why she felt so exhausted and down on herself. She had been caring for her husband, Mike, for four years. Mike was the only survivor of a multiple-car accident. Although the couple felt blessed that Mike lived, they struggled with the effects of his brain injury, chronic back pain, and headaches. Mike had also been diagnosed with post-traumatic stress disorder (PTSD) from the accident. Cognitive problems and PTSD made it hard for him to hold on to a job, so Susan worked part-time in a busy insurance office. She juggled helping Mike learn basic skills, caring for their five-year old son Jason, and paying the family’s bills.

When Susan first became Mike’s caregiver, she worked hard to understand his brain injury and to empathize with his emotions of grief, fear, anxiety, and anger. She was very aware of the pain he suffered, and the long road to recovery. Susan moved beyond empathy to compassion when her understanding fueled her commitment to relieve Mike’s suffering and help him recover in every way possible.

As time went on, Susan witnessed Mike’s frequent flashbacks to the car crash, and listened to his angry outbursts about the driver who caused the accident. She started having vivid nightmares about the crash scene. When she awakened with her heart pounding she thought, “Whew, it’s almost like I was in the crash.”  Susan’s deep empathy had blurred the boundaries between Mike’s experience and her own. She developed what is called a secondary traumatic stress response. 

Sometimes Susan and Jason were the targets of Mike’s anger. Her stress level mounted as she tried to protect her son from his father’s unpredictable behavior. Susan barely noticed that she’d become burned out. Her compassion ran dry, and she felt numb to everything except her love for Jason.

When Susan went to her support group the following month she said, “I feel like my last nerve is fraying. I wake up with a headache after being on alert all night. I screamed at Jason when he broke his toy. Mike is not even close to being the guy I married, yet he pesters me for sex all the time. He never even says “thanks” for everything I do; not that what I do seems to help his progress anymore. I can’t concentrate at work, so the boss yelled about the five mistakes I made in a report. I feel so alone that I wonder if God even cares. Maybe I should take up drinking to forget it all.”

The group facilitator said, “Susan, have you ever heard of compassion fatigue? It sounds like you might have a classic case. You are smart to recognize how much you’ve changed. Fortunately, there are many ways we can help you get better.”

What is compassion fatigue?

Exhaustion of caregivers can be physical and emotional.

Exhaustion of caregivers can be physical and emotional.

Compassion fatigue is a form of complete exhaustion that results from the prolonged stress of caring for a very sick or traumatized person. Compassion fatigue depletes our physical, emotional, and spiritual reserves, so interventions must replenish those dimensions. It even interferes with how the body and mind function. Living with this extreme stress is dangerous because it can contribute to medical illness, mood disturbances, behavior changes, and substance abuse. Compassion fatigue builds up slowly as the stress response stays in overdrive for weeks, or even months.

Some caregivers are more vulnerable to compassion fatigue because they have personal or role-related risk factors. One important risk is a personal history of trauma, abuse, violence, war, or severe illness. Witnessing another’s suffering can stir up memories or flashbacks of your own worst experiences, even if you moved on from them years earlier. Other personal risk factors include…

  • Being a “triple duty caregiver” who bears responsibility for parenting children, keeping the family afloat financially, and providing rehabilitation and support for a person with a brain injury.
  • Not prioritizing self-compassion and resilience skills.
  • Not getting enough help even though feeling isolated, depressed, or burned out.

Any caregiver can attest that there are risks inherent in the caregiving role. These risks include…

  • Caring for a person with personality changes, behavior issues, substance abuse, mental illness, PTSD, or inability to keep himself safe.
  • Threats to personal safety from verbal or physical threats or actions.
  • Responsibility for complex or painful medical treatments beyond one’s training.
  • Frustration with a person who can’t, or won’t, participate in treatment.

Compassion fatigue signals

Emotions can feel overwhelming.

Emotions can feel overwhelming.

The symptoms that Susan experienced were caused by living in a prolonged state of hyperarousal, coupled with a secondary traumatic stress response. Physical signals include hypervigilance, poor sleep, nightmares, appetite changes, muscle tension, headaches, stomach problems, or high blood pressure.

Emotional signals include losing your sense of humor, sarcastic comments, and anger. Feeling like your efforts are never enough can lead to guilt or withdrawal. Mood swings, depression, hopelessness, helplessness, or numbness should be reported to a mental health professional. If you feel like harming yourself or the person you care for, please get emergency help right away.

Susan had some of the cognitive signals such as trouble with attention, concentration, problem solving, and memory. She was bombarded with negative thoughts that kept her from thinking constructively about her family’s situation. Her brain was on overload.

Behavioral signals include avoiding or being mean to the person you care for, and displacing anger. Secret behaviors offer the temptation of short-term relief, but lead to other problems. Be alert to drinking, smoking, eating, gambling or shopping excessively. Over-using prescribed medications for pain, anxiety, or sleep is always dangerous.

Spiritual signals include feeling unable to find solace or meaning in faith. You might feel punished, angry at, or abandoned by God.

Cultivating resilience 

Susan felt relieved to learn that she wasn’t crazy or a bad caregiver. Compassion fatigue is a response to an extreme situation, not a sign of failure. Prevention is the best approach. The same skills and strategies can both prevent and heal compassion fatigue and traumatic stress.

Susan realized that she deserved and required more time for self-care. She worked with a counselor to shift some of the kindness and love she gave to others to self-compassion. She sought treatment for depression and secondary stress, and shared her spiritual confusion with her minister.

Susan scheduled a meeting with her husband’s treatment team. She advocated for more training and help at home. She requested a behavior specialist to work on Mike’s outbursts. Susan set boundaries with Mike around communicating more respectfully and finding healthier outlets for his anger. She chose which areas she wanted to focus her energy on, and then called a meeting of everyone they knew and successfully appealed for help with a long list of specific tasks.

Part of the imbalance Susan felt was from not having fun anymore. So, she signed up for a Zumba class to dance out her tension with friends. She practiced meditation daily to shift from the stress response to a more relaxed, focused state. She and Jason laughed as they built a bird house and planted a garden. Within a few months, Susan started to feel more resilient, energized, and purposeful.

Now it’s your turn to compose a compassion resilience plan with gifts for your body, mind, and spirit.

 About the Author

Janet Cromer, RN, MA, LMHC, is a psychiatric RN and the author of Professor Cromer Learns to Read: A Couple’s New Life after Brain Injury. Janet speaks nationally on family and professional caregiver issues including stress resilience, traumatic stress, compassion renewal, seasons of caregiving, and creativity and healing. See more at


Special Collection on Brain Injury Journey

Special Collection on Brain Injury Journey

This article is posted with permission from Brain Injury Journey – Hope, Help, Healing, Vol 1, 2014.


2 responses to “Preventing and Healing Compassion Fatigue by Janet M. Cromer, RN, LMHC, CCFE”

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