The Cost of Caring: Compassion Fatigue Is a Special Form of Teacher Burnout

Round 1

Reviewer 1 Report

The manusript presents an interesting and current topic. Statistical data processing is adequately described, the reliability of the questionnaires was demonstrated and the size of the target group is adequate. However, I have some comments on formal requirements of a paper. The table 3 is not clear, it lacks spaces after the comma, dot or parentheses  (eg lines 70, 100, 101, 104). The line 309: authors refer to the type of a school using number: 0423, which is not an appropriate characteristic of a school, it says nothing to an unfamiliar reader - better characteristics should be provided. Finally, the references are not formally adequate - they do not follow the citation norm requested.

Author Response

The manuscript presents an interesting and current topic. Statistical data processing is adequately described, the reliability of the questionnaires was demonstrated and the size of the target group is adequate. However, I have some comments on formal requirements of a paper.

1. The table 3 is not clear, it lacks spaces after the comma, dot or parentheses (eg lines 70, 100, 101, 104).

Response: Thanks for the Reviewer’s advice. We have carefully plot the tables again to improve the clarity. Moreover, we have checked and corrected the typing errors in the text (i.e., lacks spaces after the comma, dot or parentheses). Moreover, a native English speaker was invited to help us to improve our expression.

2. The line 309: authors refer to the type of a school using number: 0423, which is not an appropriate characteristic of a school, it says nothing to an unfamiliar reader - better characteristics should be provided.

Response: Following the Reviewer’s suggestion, we have use new characteristics to refer to the type of a school, which may improve the readability and comprehensibility of the manuscript. More details can be seen in the revised manuscript.

3. Finally, the references are not formally adequate - they do not follow the citation norm requested.

Response: We appreciate the Reviewer put forward this issue. The reference format has now been corrected according to the style required by Sustainability. Moreover, we have checked the citations in the text and reference part to make it was matched one to one.

Author Response File: Author Response.pdf

Reviewer 2 Report

The article is devoted to the study of compassion fatigue is a unique form of burnout. According to the authors, compassion fatigue is composed of two parts: burnout and secondary trauma. The findings suggest that compassion fatigue among primary and secondary school teachers needs urgent attention. The authors believe that teachers have to deal with various educational and teaching problems, establish and maintain a good relationship between teachers and students, and take the initiative to pay more care and help to students, so they are prone to compassion fatigue. In the process of providing material or emotional assistance to students, teachers suffer secondary trauma, which reduces their ability and interest in empathizing. The authors conducted an extensive study. The data of study involves 28 provinces, cities, autonomous regions, and municipalities in the eastern and mid-western regions of China. According to the analysis of 1527 valid questionnaires, it was found that the professional life quality of primary and secondary school teachers in China is at a medium level. The authors found that 92.73% of primary and secondary school teachers had mild or above compassion fatigue. As a small comment - the presence of verbatim repetitions. Instead of repetitions of thoughts, one should reveal their development in other aspects.

Author Response

The article is devoted to the study of compassion fatigue is a unique form of burnout. According to the authors, compassion fatigue is composed of two parts: burnout and secondary trauma. The findings suggest that compassion fatigue among primary and secondary school teachers needs urgent attention. The authors believe that teachers have to deal with various educational and teaching problems, establish and maintain a good relationship between teachers and students, and take the initiative to pay more care and help to students, so they are prone to compassion fatigue. In the process of providing material or emotional assistance to students, teachers suffer secondary trauma, which reduces their ability and interest in empathizing. The authors conducted an extensive study. The data of study involves 28 provinces, cities, autonomous regions, and municipalities in the eastern and mid-western regions of China. According to the analysis of 1527 valid questionnaires, it was found that the professional life quality of primary and secondary school teachers in China is at a medium level. The authors found that 92.73% of primary and secondary school teachers had mild or above compassion fatigue.

1. As a small comment - the presence of verbatim repetitions. Instead of repetitions of thoughts, one should reveal their development in other aspects.

Response: We appreciate the reviewer's kind comments. We have carefully modified the manuscript to reduce the verbatim repetitions. Moreover, a native English speaker was invited to help us to improve our expression for the full manuscript. More details can be seen in the revised manuscript.

Author Response File: Author Response.pdf

Reviewer 3 Report

1. Literature study is insufficient
2. Graphical illustrations are not sufficient.
3. Improve the conclusion section based on your findings.
4. What are the merits and demerits of the study?

Author Response

Reviewer 3

1. Literature study is insufficient.

Response: We appreciate that the reviewer put forward this issue and provide some insightful comments. We have revised the introduction section to provide a comprehensive literature review. More details can be seen in the revised manuscript. Parts of the introduction can be seen as following.

1. Introduction

Since the 1990s, the study of sustainable development strategies has become a common theme in social development research around the world. The sustainable development of society as a whole depends on the sustainable development of its basic cells, the individuals. The sustainable development of individuals cannot be achieved without education, and teachers play a fundamental and critical role in promoting sustainable human development. Across the globe, a growing number of countries are embarking on dramatic educational reforms that are expected to transform the current educational landscape and help students develop the knowledge, skills, and values needed for sustainable development.

Current educational reforms are more sensitive to the needs of learners than traditional ones and require teachers to adapt their teaching styles to meet those needs (Okojie, 2011). However, this requires teachers to have the resources and autonomy to meet the individual needs of their students, yet the lag in grassroots school management reforms has prevented teachers from practicing these reforms, including the deprivation of teachers' technical freedom to teach (deprivation of power over labor control) and the deprivation of educational cognition (deprivation of power to determine the pedagogical value of teachers' work). In addition, the arbitrary distribution of school work, the lack of teacher autonomy over their work, poor student quality, lack of parental support, and inadequate teacher training have led to high levels of stress in broad educational reforms, with some negative consequences for teachers (Valli & Buese 2007) . When too many reforms are implemented too quickly, reforms can negatively affect the emotional well-being of educators (Jaafar et al., 2005). A large Canadian survey revealed that 62% of teachers felt stress related to having to deal with student health and personal issues as educational reform moved forward, and since compassion fatigue can develop through the stress of wanting but not being able to help someone in distress (Figley, 1999), this may imply that educators may be more susceptible to compassion fatigue during the fast-paced educational reform process.

1.1 What is compassion fatigue

Compassion fatigue is a relatively new concept in the field of psychology. It first appeared in the report on nurse burnout (Joinson,1992) and is regarded as a unique form of burnout. Figley (1995) defines compassion fatigue as "the behaviors and emotions that naturally arise from empathizing with a significant traumatic event during help, which results from the stress of wanting to help a traumatized or suffering person. Like any other type of fatigue, compassion fatigue reduces the ability or interest of helpers in bearing the pain of others, so it is often used to describe "the cost of caring." It should be emphasized that compassion fatigue is not a pathological reaction but a "natural, predictable, treatable and preventable" response to a traumatic individual.

Compassion fatigue is considered to be the result of working directly with victims of disasters, trauma, or illness, especially in the health care industry (Jennifer & Anderson, 2011). Individuals working in other helping professions are also at risk for experiencing compassion fatigue (Figley, 1995). These include child protection workers (David et al., 2006), veterinarians(Holcombe et al., 2016), and teachers (Donahoo et al., 2017). Teachers, like medical workers, firefighters, police, social workers, and other personnel, are working to help others. Teachers are exposed to pressure sources for a long time in their work practice. They have to deal with various educational and teaching problems, establish and maintain a good relationship between teachers and students, and take the initiative to pay more care and help to students, so they are prone to compassion fatigue.

1.2 The clinical symptoms of compassion fatigue

People who experience compassion fatigue may exhibit a variety of symptoms including lowered concentration, numbness or feelings of helplessness, irritability, lack of self-satisfaction, withdrawal, aches and pains, or work absenteeism. The clinical symptoms of compassion fatigue are similar to post-traumatic stress disorder, secondary trauma, vicarious (indirect) traumatization, burnout, etc. In order to better recognize and understand the concept of compassion fatigue, Sun et al. (2011) compared and analyzed the relationship between these concepts and concluded that the essence of compassion fatigue is mainly manifested as follows: first, the clinical symptoms of helping people are similar to post-traumatic stress disorder. They are not due to the traumatic event, but a prolonged contact with traumatized person; second, the root cause of compassion fatigue in the helping group lies in the active payment of empathy and other large amounts of psychological energy during the rescue process and thus encounter empathic stress (Figley, 2002). This study holds that teachers' compassion fatigue is based on the premise that they actively give empathy to the real, implicit, or imaginary relief targets (students). In the process of providing material or emotional assistance to the relief targets (students), they suffer secondary trauma, which reduces their ability and interest in empathizing with the relief targets (students), to the emergence of academic work burnout feeling, and even changes their original values and worldview, along with a series of physical and mental discomfort symptoms.

1.3 The risk factors of compassion fatigue

Several personal characteristics may lead to compassion fatigue. Overly conscientious individuals, perfectionists, and selfless individuals are more likely to suffer from secondary traumatic stress. Those who have low levels of social support or high levels of stress in personal life are also more likely to develop STS.

In addition, previous histories of trauma that led to negative coping skills, such as bottling up or avoiding emotions, having small support systems, increase the risk for developing STS (Meadors et al., 2008).Workers in fields where STS is most prevalent, such as healthcare, are more likely to suffer compassion fatigue due to organizational characteristics. For example, a “culture of silence” where stressful events such as deaths in an intensive-care unit are not discussed after the event is linked to compassion fatigue (Ramvi et al., 2017). It may also be responsible for high rates of STS if people are not aware of symptoms and are not trained in the risks associated with high-stress jobs (Meadors et al., 2008). As the needy interact more, compassion fatigue becomes more intense. Because of this, people living in urban cities are more likely to experience compassion fatigue. People in large cities interact with more people in general, and because of this, they become desensitized towards people's problems. Homeless people often make their way to larger cities. Ordinary people often become indifferent to homelessness when they see it regularly (Levine et al., 1994).

1.4 The compassion fatigue among teachers

In response to the changing landscape of post-secondary institutions, sometimes as a result of having a more diverse and marginalized student population, both campus services and the roles of student affairs professionals have evolved. These changes are efforts to manage the increases in traumatic events and crises (Seifert et al., 2015). Due to the exposure to student crises and traumatic events, student affairs professionals, as front line workers, are at risk for developing compassion fatigue. Such crises may include sexual violence, suicidal ideation, severe mental health episodes, and hate crimes/discrimination.Student affairs professionals who are more emotionally connected to the students with whom they work and who display an internal locus of control are found to be more likely to develop compassion fatigue as compared to individuals who have an external locus of control and are able to maintain boundaries between themselves and those with whom they work.

The specificity of the object, process, nature, and purpose of teachers' work determines that teachers need to actively pay much emotion, care, and patience to students in their work. Empathy is a core professional competency of teachers (Sun et al.,2017). Teachers with high empathy also tend to be more enthusiastic about their work and will provide more care, wisdom, passion, and quality instruction for their students. The capacity to accomplish these tasks lies in the individual teachers, but this resource may be gradually exhausted when teachers are overworked, and teachers' compassion cannot be satisfied (Krop, 2013). Expressing empathy is a regular part of teachers' education and teaching process. If teachers devote a lot of empathy and other psychological energy to empathizing with students but fail to achieve a good empathy effect, they will quickly develop "compassion fatigue." Teachers in compassion fatigue will changes in physical, emotional, behavioral, cognitive, interpersonal, and professional performance, such as feeling tired, numb or distant from students, impatient or intolerant of student matters, poor teaching work, decreased sense of responsibility, and so on (Hydon et al., 2015).

1.5 Prevention of the compassion fatigue

Mindfulness. Self-awareness as a method of self-care might help to alleviate the impact of vicarious trauma (compassion fatigue). Students who took a 15 week course that emphasized stress reduction techniques and the use of mindfulness in clinical practice had significant improvements in therapeutic relationships and counseling skills (Merriman, 2015). The practice of mindfulness, according to Buddhist tradition is to release a person from “suffering” and to also come to a state of consciousness of and relationship to other people's suffering. Mindfulness utilizes the path to consciousness through the deliberate practice of engaging “the body, feelings, states of mind, and experiential phenomena (dharma).” The following therapeutic interventions may be used as mindfulness self-care practices: Somatic therapy (body); Psychotherapy (states of mind); Emotion focused therapy (feelings); Gestalt therapy (experiential phenomena) (Sun & Jessie, 2014).

Self-compassion. In order to be the best benefit for clients, practitioners must maintain a state of psychological well-being (Jeffrey et al., 2007). Unaddressed compassion fatigue may decrease a practitioners ability to effectively help their clients. Some counselors who use self-compassion as part of their self-care regime have had higher instances of psychological functioning (Neff et al., 2007). The counselors use of self-compassion may lessen experiences of vicarious trauma that the counselor might experience through hearing clients stories. Self-compassion as a self-care method is beneficial for both clients and counselors.

1.6 The aim of the current study

Compassion fatigue is a unique mental health issue that can occur after helping people by empathizing, caring, and helping others. In the helping profession, compassion fatigue is a particular kind of burnout is the price of caring. Teachers are exposed to stressors for long periods of time in their work practices, not only to deal with various educational and teaching issues, but also to establish and maintain good teacher-student relationships and take the initiative to give more care and help to students, so they are prone to the problem of compassion fatigue, which leads to inappropriate teacher behaviors and affects the professional ethics of teachers. Yet this issue has not yet attracted attention in China. The current study, using the method of empirical research, this study investigates the current situation of compassion fatigue of primary and secondary school teachers in China. These are of great significance to enrich the current international research of compassion fatigue of teachers and prevent teachers' moral anomie due to compassion fatigue.

2. Graphical illustrations are not sufficient.

Response: Following the Reviewer’s suggestion, we revised the illustrations of the figures to make it clearly and stand alone. More details can be seen as following and in the revised manuscript.

Figure Legends

Figure 1. Results of compassion fatigue detection among elementary and secondary school teachers. The level of compassion fatigue of the teachers was divided into no detection, mild, moderate and severe. The no detection level means the score of the teachers in the dimension of compassion satisfaction (CS) was higher than 33, burnout (BO) was lower than 26, and secondary traumatic stress (STS) lower than 17; the mild level means the score of the teachers in the dimension of CS was lower than 33, or BO was higher than 26, or STS higher than 17; in the moderate level means the score of the teachers in any two dimensions of professional quality of life scale was exceeds the critical value; in the severe level means the score of the teachers in the dimension of CS was lower than 33, BO was higher than 26, and STS higher than 17.

Figure 2. The results of the logistic regression of the influencing factors of compassion fatigue among the primary and secondary school teachers. Logistic regression compares each category to one reference category. The odds ratio (OR) represents the odds that an outcome will occur given a particular exposure, compared to the odds of the outcome occurring in the absence of that exposure. p-value is a statistical measurement used to validate a hypothesis against observed data. The 95% confidence interval (CI) is a range of values that can be 95% confident contains the true mean of the population.

3. Improve the conclusion section based on your findings.

Response: Based on the helpful suggestions of the reviewer. We have clarified the conclusions in a more detail way according to the findings of the current study. More details can be seen as following.

This study examined the current status of Chinese teachers' compassion fatigue and differences in demographic factors through a research study involving 28 provinces, cities, autonomous regions, and municipalities directly under the central government in the eastern, central, and western regions of China. The findings revealed that Chinese primary and secondary school teachers had an intermediate quality of professional life and generally experienced more than mild compassion fatigue; individual differences in teachers' levels of empathy satisfaction and burnout existed. The findings of this study suggest that education authorities or school administrators should pay more attention to teachers' compassion fatigue while paying attention to primary and secondary school teachers' burnout, help teachers recognize compassion fatigue and improve controllable adverse environmental factors; and actively carry out prevention and interventions for primary and secondary school teachers' compassion fatigue. At the same time and teachers need to clarify the boundaries of their professional competence: teachers need to take responsibility for their profession, but not all of it.

4. What are the merits and demerits of the study?

Response: We appreciate that the reviewer put forward this issue, we have added a section named “Merits and limitations in the current study” in the discussion part to discuss the merits and the limitations of the current study. More details can be seen as following.

4.4 Merits and limitations in the current study

This study examined the current status of Chinese teachers' compassion fatigue and differences in demographic factors. The current study has some merits and limitations. First, compassion fatigue is a unique mental health issue that can occur after helping people by empathizing, caring, and helping others. In the helping profession, compassion fatigue is a particular kind of burnout is the price of caring. Teachers are exposed to stressors for long periods of time in their work practices, not only to deal with various educational and teaching issues, but also to establish and maintain good teacher-student relationships and take the initiative to give more care and help to students, so they are prone to the problem of compassion fatigue, which leads to inappropriate teacher behaviors and affects the professional ethics of teachers. Yet this issue has not yet attracted attention in China. The current study mainly explored the current situation of Chinese primary and secondary school teachers' compassion fatigue and the influence of demographic factors on compassion fatigue Subsequent studies can further explore the factors affecting primary and secondary school teachers' compassion fatigue, study the influencing factors of teachers' compassion fatigue in depth, and propose targeted coping strategies to provide data for international research on compassion fatigue.

Second, this study used the Chinese version of the ProQOL-5 scale to conduct the first questionnaire survey on the current situation of compassion fatigue among 1,558 primary and secondary school teachers in 28 provincial-level administrative regions in China, which provides a comprehensive understanding of the current situation of compassion fatigue among primary and secondary school teachers in China. The study not only focused on the effects of individual factors and group types on the degree of compassion fatigue among primary and secondary school teachers, but also on the differences in compassion fatigue among teachers in the eastern and western regions of China, trying to understand the differences in the occurrence of compassion fatigue among teachers in regions with different economic levels, educational inputs and family parenting styles. This is of great importance to enrich the current international research findings on teacher compassion fatigue and to prevent teachers' professional ethical failures due to compassion fatigue. However, it is worth noting that although the sample size of the current study is widely distributed, there are large differences in the number of investigators. Although the overall sample size in the East, Central and Western regions is not very different, the sample size in some provinces is still relatively small, and the study could be more optimized if some samples were added in these provinces.

Author Response File: Author Response.pdf

Round 2

Reviewer 3 Report

The revisions are done satisfactorily.