Self-Care
Prepared by the Substance Abuse and Mental Health Services Administration
(SAMHSA) Disaster Technical Assistance Center (DTAC), ESI, under contract
with the Emergency Mental Health and Traumatic Stress Services Branch, Center
for Mental Health Services, SAMHSA.
Peer-Reviewed Journal Articles
Cassidy, J. (1991). Compassion fatigue. Healthcare professionals
are vulnerable as care giving becomes more stressful. Health Progress. 72(1):54-5,
64.
The author provides a general overview of compassion fatigue, including
warning signs, consequences, and what employers can do to help health care
workers avoid burnout. The article also provides some alternative approaches
to combating compassion fatigue
Collins, S. and Long, A. (2003). Too tired to care? The psychological
effects of working with trauma. Journal of Psychiatric Mental Health Nursing.
10(1):17-27.
A quantitative and qualitative longitudinal study assessing the effects
on caregivers of working with severely traumatized people. Findings indicate
that a sense of team spirit and life satisfaction combat compassion fatigue,
while media attention and angry, bereaved relatives contribute to compassion
fatigue.
Figley, C.R. (2002). Compassion fatigue: Psychotherapists' chronic
lack of self care. Journal of Clinical Psychology. 58(11):1433-41.
The authors compare and contrast compassion fatigue with simple burnout
and stress. The article includes a model of compassion fatigue which suggests
that learning to separate from work both emotionally and physically, managing
caseloads, and dealing with traumatic stress can all help to limit compassion
fatigue.
Enos, G. (2001). How do we help the helpers? Behavioral Healthcare
Tomorrow. 10(6):SR32-3.
The author discusses the issues surrounding a sharp increase in critical-incident
response calls for corporate clients of a behavioral health care company following
September 11.
Huggard, P. (2003). Compassion fatigue: How much can I give? Medical
Education. 37(2):163-4.
This editorial discusses empathy and its role in compassion fatigue.
The author suggests that compassion fatigue can result if the caregiver lacks
appropriate personal survival skills.
Joinson, C. (1992). Coping with compassion fatigue. Nursing. 22(4):116-20.
The author discusses the prevalence of compassion fatigue among nurses
and clergy who work in hospitals, and provides a list of characteristics to
help management recognize the symptoms of compassion fatigue.
Keidel, G.C. (2002). Burnout and compassion fatigue among hospice
caregivers. American Journal of Hospice and Palliative Care. 19(3):200-5.
This article is a literature review that discusses the concept of
burnout among hospital staff, and ways to prevent and combat compassion fatigue.
The article focuses on hospice care workers.
Kinzel, A. and Nanson, J. (2000). Education and debriefing: Strategies
for preventing crises in crisis-line volunteers. Crisis. 21(3):126-34.
This article discusses how crisis-line volunteers may be exposed
to extensive pain and suffering, the results of which may carry over into
their personal lives. Compassion fatigue may be prevented through debriefing
and education.
McNally, V.J. (1999). FBI's Employee Assistance Program: An advanced
law enforcement model. International Journal of Emergency Mental Health. 1(2):109-14.
This article describes the Federal Bureau of Investigation’s efforts
to enhance its employee assistance program by including Critical Incident
Stress Management debriefing training.
Penson, R.T., Dignan, F.L., Canellos, G.P., Picard, C.L., and Lynch,
T.J. Jr. (2000). Burnout: Caring for the caregivers. Oncologist. 5(5):425-34.
Using vignettes from The Kenneth B. Schwartz Center, the author describes
the end results of stress and emotional exhaustion on the professional lives
of hospital and hospice staff. A roundtable presentation addressing the main
issues that contribute to compassion fatigue, and preventive measures such
as coping mechanisms and psychological support of the health care team are
included.
Pickett, M., Brennan, A.M., Greenberg, H.S., Licht, L., and Worrell,
J.D. (1994). Use of debriefing techniques to prevent compassion fatigue in
research teams. Nursing Research. 43(4):250-2.
The authors discuss patterns of stress reactions observed in clinical
practice settings. The authors apply the Critical Incident Stress Debriefing
model to victims of house fires.
Radziewicz, R.M. (2001). Self-care for the caregiver. Nursing Clinics
of North America. 36(4):855-69.
The article helps nurses and other caregivers to identify personal
stressors, evaluate methods to reduce stress, and avoid burnout and compassion
fatigue. The author advises that caregivers who are compassionate toward themselves
are more aware of the needs of others and, therefore, better caregivers. Regulation
of emotional stressors, the boundaries of a therapeutic relationship, and
the biochemistry of stress are addressed.
Rowe, M.N. (1999). Teaching health-care providers coping: Results
of a two-year study. Journal of Behavioral Medicine. 22(5):511-27.
This study examines coping strategies and long-term results in health
care providers. Participants who received one-hour coping refresher sessions
throughout a two-year recovery period showed less burnout and compassion fatigue
than participants who did not receive refresher sessions.
Wagner, R., Manicavasagar, V., and Silove, D. (2002). Challenges
and early experiences in the development of an anxiety clinic in the public
health sector. General Hospital Psychiatry. 24(6):406-11.
The authors discuss the factors involved in establishing specialist
anxiety clinics in the public sector of Australia. Results indicate that the
clinics, a partnership between mental health and community health serving
as a research unit, are cost-effective, and a step-by-step model is included.
The clinics also serve as an opportunity for the public to access specialists.
Wee, D. and Myers, D. (2003). Compassion satisfaction, compassion
fatigue, and critical incident stress management. International Journal of
Emergency Mental Health. 5(1):33-7.
This study examined the risk of compassion fatigue in a group attending
a workshop on Prevention of Compassion Fatigue at an international conference
of providers of Critical Incident Stress Management services. Results indicate
that although the work is stressful, the rewards offset the sacrifices.
Welsh, D.J. (1999). Care for the caregiver: Strategies for avoiding
"compassion fatigue." Clinical Journal of Oncology Nursing. 3(4):183-4.
This is an editorial providing strategies to prevent compassion fatigue
among oncology nurses.
White, G.D. (1998). Trauma treatment training for Bosnian and Croatian
mental health workers. American Journal of Orthopsychiatry. 68(1):58-62.
An effective trauma treatment training program was developed for
Bosnian and Croatian mental health workers to combat compassion fatigue and
burnout. This article discusses plans for future development of the program
and ways to apply its base principles to other programs.
SAMHSA and Other Publications
Substance Abuse and Mental Health Services Administration (SAMHSA)
Center for Mental Health Services
Stress Prevention and Management Approaches for Rescue Workers in the Aftermath
of Terrorist Acts
SAMHSA’s National Mental Health Information Center
Center for Mental Health Services
Self-Care Tips for Emergency & Disaster Response Workers
SAMHSA’s National Mental Health Information Center
Center for Mental Health Services
After a Disaster: Self-Care Tips for Dealing with Stress
State Program Materials
South Dakota FEMA Crisis Counseling Program
Signs of Burnout
FEMA Crisis Counseling Program
Taking Care of the Caregiver
New Mexico FEMA Crisis Counseling Program
Watch Out for Compassion Fatigue
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Assistance and Training 
