“关怀的代价”——共情疲劳的评估及干预

"The Cost of Caring":Evaluation and Intervention of Compassion Fatigue

共情疲劳是助人者在共情和暴露于创伤情境的基础上,持续处于共情压力下导致的生理和心理疲惫和功能障碍。准确评估共情疲劳并确定最佳干预措施至关重要。共情疲劳的评估主要从继发性创伤压力、倦怠、共情满意度三方面进行,而共情疲劳的干预则需要将提高社会支持和自我关怀结合起来,从提高共情满意度和复原力两方面共同缓解共情疲劳。未来可以进一步探讨在非助人行业或是群众中是否存在共情疲劳,开发出适用范围更广、更准确有效的评估和干预措施。

Empathy and compassion play a vital role in healthcare and have been linked to positive results not only for patients but also for healthcare professionals.However,given the continuous exposure to the suffering of others,the empathy and compassion shown by healthcare professionals can be financially,physically and mentally costly.In other words,being exposed to patients experiencing trauma or distress has adverse effects on professionals’mental and physical health,and that of the people they care for.The term“compassion fatigue”was coined to describe the phenomenon of exhaustion and dysfunction as a consequence of prolonged exposure to suffering and stress.The present article gives a comprehensive review of literature on causes,symptoms,evaluations,at-risk populations,and interventions of compassion fatigue.Compassion fatigue is characterized by cognitive reexperiencing(e.g.,nightmares,intrusive thoughts),inattention,sleeplessness,sadness,depression,general anxiety,anger and irritability,emotional exhaustion and detachment,negative coping behaviors(e.g.,avoidance behaviors),escalation in self-destructive tendencies,reduced work efficiency and satisfaction,decreased capacities to experience sympathy and empathy,and compromised decision-making abilities and caregiving skills.In addition,those experiencing compassion fatigue often have a feeling of professional inadequacy,believing that they are deficient in the capacity for nurturing.Workers in caregiving and public service industries such as psychotherapists,nurses,doctors,and social workers,have been found to be particularly susceptible to compassion fatigue.Compassion fatigue is generally evaluated on three dimensions,including secondary traumatic stress,burnout,and compassion satisfaction.Secondary traumatic stress,the secondary exposure to extremely or traumatically stressful events,is related to healthcare professionals’adverse emotions resulting from helping or wanting to help others.Burnout is defined as a state of physical and emotional exhaustion stemming from a chronic state of emotional demand.Compassion satisfaction is defined as the sense of accomplishment derived from helping others,and is associated with the ability to care for others.Compassion fatigue is commonly evaluated by the Professional Quality of Life Scale,which has been widely used in workers in the caregiving and public service industries.The Professional Quality of Life Scale is a self-report questionnaire with 30-item,in which participants are required to report the frequency of their experiences over the past 30 days.Each item is rated on a 6-point Likert scale(ranging from 0=never to 5=very often).To calculate scores,responses for each subset of 10 items are summed.Notably,before computing scores,a total of 5 items(1,4,15,17,and 29)need to be reversely coded.To effectively prevent and reduce compassion fatigue,scholars have explored factors that influence the development of compassion fatigue,and found that social support and self-care are two important factors that can reduce compassion fatigue.Social support can enhance compassion satisfaction,and thereby reducing healthcare professionals’compassion fatigue.Self-care can boost resilience,which in turn reduces professionals’compassion fatigue.Thus,giving social support to healthcare professionals and teaching healthcare professionals about knowledge of self-care may be effective strategies for preventing and reducing compassion fatigue in healthcare professionals.In summary,the focus of previous studies has primarily been on the causes and symptoms of compassion fatigue.However,there are limited studies focusing on at-risk populations,and on the evaluation and intervention of compassion fatigue.In terms of at-risk populations and evaluations,previous research has centered on workers in the healthcare industries.Future research should expand the scope of at-risk populations of compassion fatigue and develop evaluation tools that are applicable to diverse at-risk populations.In terms of interventions,some existing programs are complicated and hard to implement.Thus,it is necessary to develop effective and simple interventions.Furthermore,more empirical research is needed to examine the effectiveness of interventions.