The “Double-Edge Sword” of Human Empathy: A Unifying Neurobehavioral Theory of Compassion Stress Injury
Abstract
:1. Introduction
On a clear summer night in 2006, an ambulance is urgently dispatched to the family residence of doctor “R”, a well-respected senior military psychologist and the only credentialed mental health provider for a U.S. Marine base of 6000. Initial reports by Dr. R’s frantic spouse indicated sudden paralysis, inability to speak, and unresponsiveness, suggesting possible seizure or stroke. Emergency personnel are greeted by a panic-stricken wife and two crying children. They enter the home to find the high-ranking patient sitting upright on a bed, conscious and breathing on his own, but immobilized, non-communicative, and with fixed gaze.As Dr. R.’s listless body is loaded onto a gurney, medical staff learns of his gradually worsening insomnia, night sweats, and weight loss in the context of 14-hour days, 6–7 days a week, and excessive work demands. A normally upbeat, fun-loving, and energetic personality has steadily given way to a serious, easily frustrated, fatigued, preoccupied, and socially withdrawn persona. Dr. R frequently expressed consternation, guilt, and moral outrage over his and the military’s inability to provide adequate treatment to the high volume of traumatized war veterans. Mrs. R exclaims, “My husband cares too much…it’s eating him alive, and now maybe it’s even killing him!”.[1]
2. Purpose of the Study
3. The Phenomenology of Compassion Stress Injury
“In the brain, there is evidence of structural and functional changes resulting directly from chronic or severe stress. The changes are associated with alterations of the most profound functions of the brain: memory and decision-making” ([3], p. 60) and “profound effects on multiple organ systems…the continuation of altered physiologic states over months and years contribute to the accumulation of adverse long-term health consequences.”.([3], p. 66)
4. Scope and Universality of CSI
4.1. Historical Roots of Compassion Stress Injury
We learn from Rivers the capacity of patients to teach us, and when need be, to heal us. The act of listening to individuals is fundamental, and it is not passive. It implies a willingness to be changed by what we hear. Otherwise one no longer listened attentively enough to the individual voice. There was a real danger, he thought, that in the end the stories would become one story, the voices blend into a single cry of pain.([31], p. 4)
While at Craiglockhart, Dr. Rivers began to mimic the symptoms of his shell shocked patients such as severe speech impediment, disrupted sleep, excessive fatigue, irregular heartbeat, tremors, and disturbed gait leading to the diagnosis of a CSI and mandatory respite.[30]
4.2. Non War-Related Conceptualizations of Compassion Stress Injury
5. Differentiation between Compassion Stress Injuries
5.1. Limitations of Current Classifications of Compassion Stress Injury
5.2. Linking Compassion Stress with Empirically-Based Stress-Related Conditions
Physical | Cognitive/Mental | Emotional | Behavioral |
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5.3. Comparing CSI and ASR/COSR and Traumatic Stress Injuries
5.4. Etiological Considerations of Compassion Stress Injuries
5.5. Limitations of Etiological Research on Compassion Stress Injury
6. A Neurobehavioral Model of Compassion Stress Injury
6.1. Defining Empathy and Compassion
6.2. Counseling and Psychotherapy Models of Empathy
6.3. Neuroscientific Research on Empathy
6.4. Evidence of Dual-Processing of Shared Neural Representations
6.5. Automatic Processes: Mirror Neurons, Imitation, Mimicry, and Emotional Contagion
6.6. Paired Deficits Research
6.7. Relevance of Automatic Empathic Responses and Compassion Stress
6.8. “Top-Down” Control: Self-Awareness, Re-Appraisal, and Perspective-Taking
6.9. Mental Flexibility and Self-Regulation
6.10. Research on Individual Differences in Empathic Ability
7. The Linnerooth Neurobehavioral Model of Compassion Stress Injury
7.1. Empathic Response
7.2. Compassion Stress
7.3. Compassion Stress Reactions (CSR)
7.4. Compassion Stress Injury (CSI)
7.5. Interaction of Empathic Responses, Risk/Protective Factors, and Self-Care
7.6. Slippery Slope of Dysregulated Sleep and Compassion Stress Injury
7.7. Limitations of Neurobehavioral Research and Future Direction
8. Conclusions
Acknowledgements
Author Contributions
Conflicts of Interest
Abbreviations
CF | Compassion fatigue |
CSI | Compassion stress injury |
IOM | Institute of Medicine |
WWI | First World War |
WWII | Second World War |
PB | Professional burnout |
STS | Secondary traumatic stress |
VT | Vicarious traumatization |
EDF | Empathic distress fatigue |
PTSD | Post-Traumatic Stress Disorder |
ASR | Acute stress reactions |
COSR | Combat/operational stress reactions |
HPA | Hypothalamic-Pituitary-Adrenal |
MNS | Mirror neuron system |
ACC | Anterior cingulate cortex |
aMCC | Anterior midcingulate cortex |
ERP | Event-related brain potential. |
Appendix A
Compassion Stress Injury | Symptoms, Signs, and Behavioral Indicators |
---|---|
Burnout | |
Freudenberger [42]; Freudenberger and Robbins [118] | Sleeplessness, irritability, chronic fatigue, depression, anxiety, anger, cynicism, suspicion, physiological symptoms, boredom, loss of compassion, discouragement |
Pines and Maslach [119]; Maslach [43] | Sleep disturbance, irritability, chronic fatigue, depression, anxiety, anger, pessimism, physical exhaustion, emotional exhaustion, poor work performance, reduced personal achievement, professional detachment, conflict between work and family, mental exhaustion, social isolation |
Figley [10,36] | Gradual onset; Sleeping difficulties, chronic fatigue, irritability, somatic problems, anxiety, depression, guilt, helplessness, cynicism, poor work performance, professional withdrawal |
Jenkins and Baird [120] | Sleep disturbance, irritability, aggression, poor work performance, professional isolation, physiological symptoms, emotional exhaustion |
Eriksson and Wallin [58] | Gradual onset; insidious, dissatisfaction with career, reject career |
Secondary Traumatic Stress | |
Figley [10,35,36,121] | Abrupt onset; Sleep disturbance, irritability, chronic fatigue, erosion of idealism, anxiety, depression, poor work performance, professional withdrawal, helplessness, ASD/PTSD symptoms matching sufferer |
Gentry, Baranowsky, and Dunning [122] | Abrupt onset; irritability, depression, outbursts of anger or rage, poor work performance, hopelessness, intrusive thoughts/images of another’s experiences, hypervigiliance, lowered frustration tolerance, social isolation, inability to separate personal and professional life |
Vicarious Traumatization | |
McCann and Pearlman [48], McCann and Pearlman [55] | Sleep disturbance, irritability, chronic fatigue, anxiety, depression, professional withdrawal, intrusive thoughts/images of another’s experiences, hypervigiliance, social isolation, helplessness, suspicion, cynicism, distrust |
Herman [47] | Sleep disturbance, irritability, chronic fatigue, anxiety, depression, anger, professional withdrawal, social isolation, intrusive thoughts/images of another’s experiences, hopelessness |
Pearlman and Saakvitne [123] | Disturbances in self-identity, spirituality, world view, and cognitive frame of reference |
Compassion Fatigue | |
Joinson [51] | Sleep disturbance, irritability, chronic fatigue, depression, anger, inability to separate personal and professional life, professional withdrawal, reduced memory capacity, physiological disturbances |
Figley [10,36,121,124] | Abrupt onset; sleep disturbance, irritability, chronic fatigue, depression, anxiety, anger, helplessness, guilt, intrusive thoughts/images of another’s experiences, hypervigiliance, poor work performance, professional withdrawal, confusion, hopelessness, disorientation, social isolation, physiological symptoms, poor communication, inability to separate personal and professional life, irresponsibility |
Appendix B
Contributing Factors | Author(s) |
---|---|
Primary/Secondary Compassion Stressors: Risk/Vulnerability | |
Exposure to client trauma | Pines and Maslach [119]; Maslach [43]; McCann and Pearlman [48]; Herman [47]; Joinson [51]; Figley [10,36,121,124]; Pearlman and Saakvitne [123]; Hesse [50]; Wee and Myers [15]; McLean, Wade, and Encel [125]; Imai et al. [45]; Creamer and Liddle [126]; Flannelly et al. [22]; Dekel et al. [127]; Moulden and Firestone [128]; Shah, Garland, and Katz [17]; Tyson [26]; Killian [129]; Bush [130]; Harrison and Westwood [49]; Robins, Meltzer, and Zelikovsky [131]; Ghahramanlou and Brodbeck [132]; Jenkins and Baird [120]; Meadors, Lamson, Swanson, White, and Sira [25] |
Helping professional’s empathetic engagement | McCann and Pearlman [48]; Herman [47]; Figley [10,36,121,124]; Pearlman and Saakvitne [123]; Jenkins and Baird [120]; Flannelly et al. [22]; Moulden and Firestone [128]; Tyson [26]; Killian [129]; Harrison and Westwood [49]; Robins et al. [131]; Meadors, Lamson, Swanson, White, and Sira [25] |
Professional isolation | Figley [121]; Flannelly et al. [22]; Killian [129]; Bush [130]; Harrison and Westwood [49]; Phelps et al. [57] |
Relationship problems | Flannelly et al. [22] |
Therapist’s trauma history | Herman [47]; Pearlman and Saakvitne [123]; McCann and Pearlman [55]; Ghahramanlou and Brodbeck [132]; Hesse [50]; Jenkins and Baird [120]; McLean et al. [125]; Creamer and Liddle [126]; Flannelly et al. [22]; Killian [129]; Bush [130]; Robins et al. [131] |
Professional disappointment | Maslach [43]; Flannelly et al. [22]; Dekel et al. [127]; Killian [129]; Vallerand et al. [44] |
Professional inexperience | McLean et al. [125]; Creamer and Liddle [126]; Dekel et al. [127]; Bush [130]; Phelps et al. [57] |
Personal life stressors | Figley [10,121]; Bush [130]; Robins et al. [131] |
Youth of therapist | Ghahramanlou and Brodbeck [132]; Creamer and Liddle [126]; Dekel et al. [127]; Bush [130] |
Job Stress | Pines and Maslach [119]; Maslach [43]; Joinson [51]; Figley [36,121]; Maytum et al. [133]; Creamer and Liddle [126]; Dekel et al. [127]; Tyson [26]; Killian [129]; Bush [130]; Phelps et al. [57]; Robins et al. [131]; Meadors, Lamson, Swanson, White, and Sira [25]; Vallerand et al. [44] |
Low Socioeconomic Status | Shah, Garland, and Katz [17] |
Self-Care: Protective/Resilience | |
Regular exercise | Hesse [50]; Maytum et al. [133]; Flannelly et al. [22]; Shah, Garland, and Katz [17]; Harrison and Westwood [49]; Linnerooth, Moore, and Mrdjenovich [20] |
Maintains boundaries home/work | Herman [47]; Joinson [51]; Pearlman and Saakvitne [123]; Figley [10,121]; Hesse [50]; Harrison and Westwood [49]; Phelps et al. [57] |
Social Support Network | Herman [47]; Figley [121]; Hesse [50]; Maytum et al. [133]; Killian [129]; Harrison and Westwood [49]; Phelps et al. [57]; Robins et al. [131] |
Professional Support Network | Figley [121]; Hesse [50]; McLean et al. [125]; Maytum et al. [133]; Killian [129]; Harrison and Westwood [49]; Phelps et al. [57]; Linnerooth, Moore, and Mrdjenovich [20] |
Humor | Joinson [51]; Maytum et al. [133] |
Professional Satisfaction | Pearlman and Saakvitne [123]; Figley [10,121]; Dekel et al. [127]; Tyson [26]; Harrison and Westwood [49]; Phelps et al. [57]; Robins et al. [131] |
Effective Training and Supervision | McCann and Pearlman [48]; Pearlman and Saakvitne [123]; Figley [121]; Hesse [50]; Dekel et al. [127]; Killian [129]; Harrison and Westwood [49] |
Appendix C
- Exposure to intense emotional or physical pain and suffering of others
- Felt demand to help or care for others
- Helping setting involves exposure to traumatic events (e.g., disaster, war, etc.)
- Frequently facing moral, ethical, or legal dilemmas
- Managing parasuicidal, suicidal behaviors, or completed suicide
- Exposure to unusual physical or emotional demands to meet others’ needs
- Caregiving associated with severe illness, disease, or disability
- Working with death and dying of others and their family members
- Frustration with bureaucratic systems and policies
- Heightened sense of lack of control or feelings of helplessness
- Exposure to anger and/or lack of gratitude
- Dealing with non-compliance
- Being reminded of one’s own mortality or traumatic experiences
- Difficulty paying attention
- Being reminded of one’s own traumatic experiences
- Hyper vigilant response to certain cases
- Negative client behaviors and responses
- Increase in caseload sizes/decrease in staff
- Decreased individual control over work
- Increased number of work hours
- Increased time engaged in paperwork or administrative duties
- Dealing with inequities, disparities, and prejudice
- Withdrawal from colleagues, friends, or loved ones
- Impatience/intolerance
- Decrease in quality of professional and personal relationships
- Decreased interest in intimacy or sex
- Self-isolation and loneliness
- Reduced joy and sense of purpose with career
- Increased interpersonal conflicts
- Trouble separating work from personal life
- Diminished functioning in non-professional circumstances
- Increases in ineffective or self-destructive tension-reduction behaviors
- Work Performance decrease in quality, quantity
- Accident proneness
- Losing things
- Ineffective or harmful self-care practices (e.g., excessive drinking)
- Absenteeism/tardiness
- Overwork
- Frequent job changes
- Blaming clients for their experiences
- Setting perfectionist standards
- Personal illness or injury
- Changes in family relationships
- Changes in financial status
- Death of family member or close friend
- Personal exposure to trauma outside of the help setting
- Isolation from peers; limited access to supervision or consultation
Appendix D
- Setting and maintain boundaries.
- Establish clear boundaries between your personal and professional life.
- Don’t take on more than you can realistically do!
- Work only your assigned hours.
- When you go home at the end of a hard day, try your best to leave your work at work.
- Remember that it’s alright to say “No”!
- Counter isolation in professional, personal and spiritual domains of life.
- Attend Trainings, professional development, and organizational support classes.
- Diversify professional roles.
- Establish a personal support community.
- Developing mindful awareness.
- Consciously expand perspective to embrace complexity.
- Active optimism and exquisite empathy.
- Holistic self-care.
- Maintain clear boundaries and honor limits.
- Professional satisfaction.
- Create meaning in your personal and professional life.
- Must be well rested
- Utilize your positive supportive connections to process your feelings
- Take negatives and turn them into positives
- Research shows those who can “turn off thoughts about work” are more resilient during their careers
- Instead of waiting for the clinicians to become symptomatic use inventory tools to look for the presence of challenges to their fundamental assumptions, values and beliefs
- With early assessment clinicians have the opportunity to transform their discomfort into personal growth and development
References and Notes
- Ted Teluja, in discussion with the author, 25 August 2014.
- Mark C. Russell, and Charles. F. Figley. Treating Traumatic Stress Disorders in Military Personnel: An EMDR Practitioner’s Guide. New York: Routledge, 2013. [Google Scholar]
- Institute of Medicine. Treatment of Posttraumatic Stress Disorder: An Assessment of the Evidence. Washington: National Academies Press, 2008. [Google Scholar]
- Walter B. Cannon. “‘Voodoo’ death.” American Anthropologist 44 (1942): 169–81. [Google Scholar] [CrossRef]
- Martin A. Samuels. “‘Voodoo’ death revisited: The modern lessons of neurocardiology.” Cleveland Clinic Journal of Medicine 74 (2007): 880–16. [Google Scholar] [CrossRef]
- Marlene Goodfriend, and Edward. A. Wolpert. “Death from fright: Report of a case and literature review.” Psychosomatic Medicine 38 (1976): 348–56. [Google Scholar] [CrossRef] [PubMed]
- Hans Seyle, and Claude Fortier. “Adaptive reaction to stress.” Psychosomatic Medicine 12 (1950): 149–57. [Google Scholar] [CrossRef]
- J. Douglas Bremner. Does Stress Damage the Brain? Understanding Trauma-Related Disorders from a Mind-Body Perspective. New York: Norton, 2005. [Google Scholar]
- B. Hudnall Stamm, ed. Secondary Traumatic Stress: Self-Care Issues for Clinicians, Researchers, and Educators, 2nd ed. Baltimore: Sidran Press, 1999.
- Charles R. Figley. “Compassion fatigue: Psychotherapists’ chronic lack of self care.” Journal of Clinical Psychology 58 (2002): 1433–41. [Google Scholar] [CrossRef] [PubMed]
- B. Hudnall Stamm. “Measuring compassion satisfaction as well as fatigue: Developmental history of compassion satisfaction and fatigue test.” In Treating Compassion Fatigue. Edited by Charles R. Figley. New York: Brunner-Routledge, 2002, pp. 107–19. [Google Scholar]
- Richard G. Tedeschi, and Richard J. McNally. “Can we facilitate posttraumatic growth in combat veterans? ” American Psychologist 66 (2011): 19–24. [Google Scholar] [CrossRef] [PubMed]
- “Merriam-Webster.” Available online: http://www.m-w.com (accessed on 16 November 2015).
- Laura W. McCray, Peter F. Cronholm, Hillary R. Bogner, Joesph J. Gallo, and Richard A. Neill. “Resident physician burnout: Is there hope? ” Family Medicine 40 (2008): 626–32. [Google Scholar] [PubMed]
- David Wee, and Diane Myers. “Response of mental health workers following disaster: The Oklahoma City bombing.” In Treating Compassion Fatigue. Edited by Charles R. Figley. New York: Brunner-Routledge, 2002. [Google Scholar]
- Laura Battle. “Compassion fatigue, compassion satisfaction, and burnout among police officers who have experienced previous perceived traumas.” Dissertation Abstracts International Section A: Humanities and Social Sciences 73 (2012): 6–7. [Google Scholar]
- Siddharth A. Shah, Elizabeth Garland, and Craig Katz. “Secondary traumatic stress: Prevalence in humanitarian aid workers in India.” Traumatology 13 (2007): 59–70. [Google Scholar] [CrossRef]
- Michael S. Severn, Grant D. Searchfield, and Peter Huggard. “Occupational stress amongst audiologists: Compassion satisfaction, compassion fatigue, and burnout.” International Journal of Audiology 51 (2012): 3–9. [Google Scholar] [CrossRef] [PubMed]
- Lisa A. Naig. Professional Burnout and Compassion Fatigue among Early Childhood Special Education Teachers. Ames: Iowa State University, 2010. [Google Scholar]
- Peter J. Linnerooth, Bret A. Moore, and Adam J. Mrdjenovich. “Professional burnout in clinical military psychologists: Recommendations before, during, and after deployment.” Professional Psychology: Research and Practice 42 (2011): 87–93. [Google Scholar] [CrossRef]
- Hannah C. Levy, Lauren M. Conoscenti, John F. Tillery, Benjamin D. Dickstein, and Bret T. Litz. “Deployment stressors and outcomes among Air Force chaplains.” Journal of Traumatic Stress 24 (2011): 342–46. [Google Scholar] [CrossRef] [PubMed]
- Kevin J. Flannelly, Stephen B. Roberts, and Andrew J. Weaver. “Correlates of compassion fatigue and burnout in chaplains and other clergy who responded to the September 11th attacks in New York City.” The Journal of Pastoral Care & Counseling 59 (2005): 213–24. [Google Scholar] [CrossRef]
- Brian E. Bride, Jenny L. Jones, and Samuel A. MacMaster. “Correlates of secondary traumatic stress in children protective services workers.” Journal of Evidence-Based Social Work 4 (2007): 69–80. [Google Scholar] [CrossRef]
- Elvira Dominguez-Gomez, and Dana N. Rutledge. “Prevalence of secondary traumatic stress among nurses.” Journal of Emergency Nursing 35 (2009): 199–204. [Google Scholar] [CrossRef] [PubMed]
- Patrick Meadors, Angela Lamson, Mel Swanson, Mark White, and Natalia Sira. “Secondary traumatization in pediatric healthcare providers: Compassion fatigue, burnout, and secondary traumatic stress.” Omega: Journal of Death and Dying 60 (2010): 103–28. [Google Scholar] [CrossRef]
- Jeni Tyson. “Compassion fatigue in the treatment of combat-related trauma during wartime.” Clinical Social Work Journal 35 (2007): 183–92. [Google Scholar] [CrossRef]
- Karen Alkema, Jeremy Linton, and Randall Davies. “A study of the relationship between self-care, compassion satisfaction, compassion fatigue, and burnout among hospice professionals.” Journal of Social Work in End-of-Life & Palliative Care 4 (2008): 101–19. [Google Scholar] [CrossRef] [PubMed]
- Robert Rosenheck, and Pramila Nathan. “Secondary traumatization in children of Vietnam veterans.” Hospital & Community Psychiatry 36 (1985): 538–49. [Google Scholar] [CrossRef]
- Susan H. Lynch, and Marie L. Lobo. “Compassion fatigue in family caregivers: A Wilsonian concept analysis.” Journal of Advanced Nursing 68 (2012): 2125–34. [Google Scholar] [CrossRef] [PubMed]
- Pat Barker. Regeneration. New York: Williams Abrahams Book Dutton, 1991. [Google Scholar]
- Katherine G. Nickerson, and Steven Shea. “WHR Rivers: Portrait of a great physician in Pat Barker’s Regeneration trilogy.” Lancet 350 (1997): 205–9. [Google Scholar] [CrossRef]
- Raymond Sobel. “The ‘old sergeant’ syndrome.” Psychiatry 10 (1947): 315–21. [Google Scholar] [PubMed]
- Albert J. Glass. “Psychiatry at the division level.” In Combat Psychiatry; Experiences in the North African and Mediterranean Theaters of Operation, American Ground Forces, World War II. Edited by Frederick R. Hanson. Honolulu: University Press, 1949, pp. 61–62. [Google Scholar]
- Charles R. Figley, ed. Stress Disorders among Vietnam Veterans. New York: Brunner/Mazel, 1978.
- Charles R. Figley. “Catastrophes: An overview of family reactions.” In Stress and the Family, Vol. II: Coping with Catastrophe. Edited by Charles R. Figley and Hamilton I. McCubbin. New York: Brunner/Mazel, 1983, pp. 3–20. [Google Scholar]
- Charles R. Figley. “Compassion fatigue as secondary traumatic stress disorder: An overview.” In Compassion Fatigue: Coping with Secondary Traumatic Stress Disorder in Those Who Treat the Traumatized. New York: Brunnar/Mazel, 1995, pp. 1–20. [Google Scholar]
- Don M. Hartsough, and Diane G. Myers. “National Institute of Mental Health (U.S.), & Center for Mental Health Studies of Emergencies (U.S.).” In Disaster Work and Mental Health: Prevention and Control of Stress among Workers; Rockville: U.S. Department of Health and Human Services, Public Health Service, Alcohol, Drug Abuse, and Mental Health Administration, National Institte of Mental Health, 1985. [Google Scholar]
- Rory Remer, and John E. Elliott. “Characteristics of secondary victims of sexual assault.” International Journal of Family Psychiatry 9 (1988): 373–87. [Google Scholar]
- Cassandra A. Erickson. “Rape and the family.” In Treating Stress in Families. Edited by Charles Figley. New York: Brunner/Mazel, 1989. [Google Scholar]
- Sandra J. Verbosky, and Deborah A. Ryan. “Female partners of Vietnam veteran: Stress by proximity.” Issues in Mental Health Nursing 9 (1988): 95–104. [Google Scholar] [CrossRef] [PubMed]
- Yael Danieli. “The treatment and prevention of long-term effects and intergenerational transmission of victimization: A lesson from Holocaust survivors and their children.” In Trauma and Its Wake. Edited by Charles R. Figley. New York: Brunner/Mazel, 1985, pp. 295–313. [Google Scholar]
- Herbert J. Freudenberger. “Staff burn-out.” Journal of Social Issues 30 (1974): 159–65. [Google Scholar] [CrossRef]
- Christina Maslach. Burnout: The Cost of Caring. Englewood Cliffs: Prentice-Hall, 1982. [Google Scholar]
- Robert J. Vallerand, Yvan Paquet, Frederick L. Philippe, and Julie Charest. “On the role of passion for work in burnout: A process model.” Journal of Personality 78 (2010): 289–312. [Google Scholar] [CrossRef] [PubMed]
- H. Imai, H. Nakao, M. Tsuchiya, Y. Kuroda, and T. Katon. “Burnout and work environments of public health nurses involved in mental health care.” Occupational and Environmental Medicine 61 (2004): 764–68. [Google Scholar] [CrossRef] [PubMed]
- Sigmund Freud. The Future Prospects of Psycho-Analytic Therapy: Collected Papers. London: Hogarth Press, 1910. [Google Scholar]
- Judith Herman. Trauma and Recovery. New York: Basic Books, 1992. [Google Scholar]
- Lisa McCann, and Laurie A. Pearlman. “Vicarious traumatisation: A framework for understanding the psychological effects of working with victims.” Journal of Traumatic Stress 3 (1990): 131–49. [Google Scholar] [CrossRef]
- Richard L. Harrison, and Marvin J. Westwood. “Preventing vicarious traumatization of mental health therapists: Identifying protective practices.” Psychotherapy Theory, Research, Practice, Training 46 (2009): 203–19. [Google Scholar] [CrossRef] [PubMed]
- Amy R. Hesse. “Secondary trauma: How working with trauma survivors affects therapists.” Clinical Social Work Journal 30 (2002): 293–309. [Google Scholar] [CrossRef]
- Carla Joinson. “Coping with compassion fatigue.” Nursing 22 (1992): 116–21. [Google Scholar] [PubMed]
- Albert J. Glass. “Lessons learned.” In Medical Department United States Army. Neuropsychiatry in World War II Volume I: Zone of Interior. Edited by Robert S. Anderson, Albert J. Glass and Robert J. Bernucci. Washington: Office of the Surgeon General, Department of the Army, 1966, pp. 735–59. [Google Scholar]
- Olga Klimecki, and Tania Singer. “Empathic distress fatigue rather than compassion fatigue? Integrating findings from empathy research in psychology and social neuroscience.” In Pathological Altruism. Edited by Barbara Oakley, Ariel Knafo, Guruprasad Madhavan and David Sloan Wilson. New York: Oxford University Press, 2012, pp. 368–83. [Google Scholar]
- Department of Veteran’s Affairs (VA) and Department of Defense. “VA/DoD Clinical Practice Guideline for the Management of Post-Traumatic Stress.” 2010. Available online: http://www.healthquality.va.gov/guidelines/MH/ptsd/cpg_PTSD-FULL-201011612.pdf (accessed on 10 November 2015). [Google Scholar]
- Lisa McCann, and Laurie A. Pearlman. “Vicarious traumatization: A framework for understanding the psychological effects of working with victims.” In Essential Papers on Posttraumatic Stress Disorder. Edited by Mardi J. Horowitz. New York: New York University Press, 1999, pp. 498–517. [Google Scholar]
- Noreen Tehrani. “The cost of caring: The impact of secondary trauma on assumptions, values, and beliefs.” Counseling Psychology Quarterly 20 (2007): 325–39. [Google Scholar] [CrossRef]
- Andrea Phelps, Delyth Lloyd, Mark Creamer, and David Forbes. “Caring for careers in the aftermath of trauma.” Journal of Aggression, Maltreatment & Trauma 18 (2009): 313–30. [Google Scholar] [CrossRef]
- Peter S. Eriksson, and Desna L. Wallin. “Functional consequences of stress-related suppression of adult hippocampal neurogenesis: A novel hypothesis on the neurobiology of burnout.” Acta Neurology Scandenavia 110 (2004): 275–80. [Google Scholar] [CrossRef] [PubMed]
- Saar Langelaan, Arnold B. Bakker, Wilmar B. Schaufeli, Willem van Rhenen, and Lorenz J. van Doornen. “Do burned-out and work-engaged employees differ in the functioning of the hypothalamic-pituitary-adrenal axis? ” Scandinavian Journal of Work Environment Health 32 (2006): 339–48. [Google Scholar] [CrossRef]
- Christine Heim, D. Jeffery Newport, Andrew H. Miller, and Charles B. Nemeroff. “Long-term neuroendocrine effects of childhood maltreatment.” Journal of American Medical Association 8 (2000): 2321. [Google Scholar]
- Gilles van Luijtelaar, Marc Verbraak, Martijn van den Bunt, Ger Keijsers, and Martijn Arns. “EEG Findings in burnout patients.” The Journal of Neuropsychiatry and Clinical Neurosciences 22 (2010): 208–17. [Google Scholar] [CrossRef] [PubMed]
- Renzo Bianchi, Claire Boffy, Coraline Hingray, Didier Truchot, and Eric Laurent. “Comparative symptomatology of burnout and depression.” Journal of Health Psychology 18 (2013): 782–87. [Google Scholar] [CrossRef] [PubMed]
- Ezequiel Gleichgerrcht, and Jean Decety. “The relationship between different facets of empathy, pain perception and compassion fatigue among physicians.” Frontiers in Behavioral Neuroscience 8 (2014): 1–9. [Google Scholar] [CrossRef] [PubMed]
- Tania Singer, and Claus Lamm. “The social neuroscience of empathy.” Annals of the New York Academy of Sciences 1156 (2009): 81–96. [Google Scholar] [CrossRef] [PubMed]
- Olga M. Klimecki, Susanne Leiberg, Matthieu Riccard, and Tania Singer. “Differential pattern of functional brain plasticity after compassion and empathy training.” SCAN 9 (2014): 873–79. [Google Scholar] [CrossRef] [PubMed]
- Donald W. Winnicott. Home Is Where We Start from: Essays by a Psychoanalyst. New York: Norton, 1990. [Google Scholar]
- Carl R. Rogers, and David E. Russell. Carl Rogers the Quiet Revolution: An Oral History. Roseville: Penmarin Books, 2002. [Google Scholar]
- Philip L. Jackson, Pierre Rainville, and Jean Decety. “To what extent do we share the pain of others? Insight from the neural bases of pain empathy.” Pain 125 (2006): 5–9. [Google Scholar] [CrossRef] [PubMed]
- Claus Lamm, Jean Decety, and Tania Singer. “Meta-analytic evidence for common and distinct neural networks associated with directly experienced pain and empathy for pain.” Neuroimage 54 (2011): 2492–502. [Google Scholar] [CrossRef] [PubMed]
- Henrik Walter. “Social cognitive neuroscience of empathy: Concepts, circuits, and genes.” Emotion Review 4 (2012): 9–17. [Google Scholar] [CrossRef]
- Marco Iacoboni. “Imitation, empathy, and mirror neurons.” Annual Review of Psychology 60 (2009): 653–70. [Google Scholar] [CrossRef] [PubMed]
- Matteo Martini, Elia Valentini, and Salvatore Maria Aglioti. “Emotional conflict in a model modulates nociceptive processing in an onlooker: A laser-evoked potentials study.” Experimental Brain Research 225 (2013): 237–45. [Google Scholar] [CrossRef] [PubMed]
- Theodor Lipps. Grundlegung der Asthetik. Hamburg and Leipzig: Leopold Voss, 1903. [Google Scholar]
- Jean Decety, and Philip L. Jackson. “The functional architecture of human empathy.” Behavioral and Cognitive Neuroscience Reviews 3 (2004): 71–100. [Google Scholar] [CrossRef] [PubMed]
- Rebecca R. Pillai-Riddell, and Kenneth D. Craig. “Judgments of infant pain: The impact of caregiver identity and infant age.” Journal of Pediatric Psychology 32 (2007): 501–11. [Google Scholar] [CrossRef] [PubMed]
- Giacomo Rizzolatti, Luciano Fadiga, Vittorio Gallese, and Leonardo Fogassi. “Premotor cortex and the recognition of motor actions.” Cognitive Brain Research 3 (1996): 131–41. [Google Scholar] [CrossRef]
- Giacomo Rizzolatti, Leonardo Fogassi, and Vittorio Gallese. “Cortical mechanisms subserving object grasping, action understanding, and imitation.” In The Cognitive Neurosciences. Edited by Michael S. Gazzaniga. Cambridge: MIT Press, 2004, vol. 3, pp. 427–40. [Google Scholar]
- Luciano Fadiga, Leonardo Fogassi, Giovanni Pavesi, and Giacomo Rizzolatti. “Motor facilitation during action observation: A magnetic stimulation study.” Journal of Neurophysiology 73 (1995): 2608–11. [Google Scholar] [PubMed]
- Michael V. Lombardo, Jennifer L. Barnes, Sally J. Wheelwright, and Simon Baron-Cohen. “Self-referential cognition and empathy in autism.” PLos ONE 2 (2007): 1–11. [Google Scholar] [CrossRef] [PubMed]
- Laurie Carr, Marco Iacobni, Marie-Charlotte Dubeau, John C. Mazziotaa, and Gian Luigi Lenzi. “Neural mechanisms of empathy in humans: A relay from neural systems for imitation to limbic areas.” Proceedings of the National Academy of Sciences of the United States of America 100 (2003): 5497–502. [Google Scholar] [CrossRef] [PubMed]
- Alfonso Caramazza, Stefano Anzellotti, Lukas Strnad, and Angelika Lingnau. “Mirror neurons: A critical assessment.” Annual Review of Neuroscience 37 (2014): 1–15. [Google Scholar] [CrossRef] [PubMed]
- Nikolass N. Oosterhof, Steven P. Tipper, and Paul E. Downing. “Crossmodal and action-specific: Neuroimaging the human mirror neuron system.” Trends in Cognitive Sciences 17 (2013): 311–18. [Google Scholar] [CrossRef] [PubMed]
- Andrew N. Meltzoff, and M. Keith Moore. “Imitation of facial and manual gestures by human neonates.” Science 198 (1977): 75–78. [Google Scholar] [CrossRef] [PubMed]
- Andrew N. Meltzoff, and Jean Decety. “What imitation tells us about social cognition: A rapprochement between developmental psychology and cognitive neuroscience.” Philosophical Transactions: Biological Sciences 358 (2003): 491–500. [Google Scholar] [CrossRef] [PubMed]
- John A. Bargh, and Tanya L. Chartrand. “The unbearable automaticity of being.” American Psychologist 54 (1999): 462–79. [Google Scholar] [CrossRef]
- Rick B. Van Baaren, Rob W. Holland, Kerry Kawakami, and Ad Van Knippenberg. “Mimicry and pro-social behavior.” Psychological Science 15 (2004): 71–74. [Google Scholar] [CrossRef] [PubMed]
- Sally J. Rogers, and Bruce F. Pennington. “A theoretical approach to the deficits in infantile autism.” Development and Psychopathology 3 (1991): 137–62. [Google Scholar] [CrossRef]
- Carol Zander Malatesta, and Jeannette M. Haviland. “Learning display rules: The socialization of emotional expression in infancy.” Child Development 53 (1982): 991–1003. [Google Scholar] [CrossRef] [PubMed]
- James E. Swain, Jeffrey P. Lorberbaum, Samet Kose, and Lane Strathearn. “Brain basis of early parent-infant interactions: Psychology, physiology, and in vivo functional neuroimaging studies.” Journal of Child Psychology and Psychiatry 48 (2007): 262–87. [Google Scholar] [CrossRef] [PubMed]
- Mbemba Jabbi, Marte Swart, and Christian Keysers. “Empathy for positive and negative emotions in the gustatory cortex.” Neuroimage 34 (2007): 1744–53. [Google Scholar] [CrossRef] [PubMed]
- Robert W. Levenson, and Anna M. Ruef. “Empathy: A physiological substrate.” Journal of Personality and Social Psychology 663 (1992): 234–46. [Google Scholar] [CrossRef]
- A. D. Craig. “Human feelings: Why are some more aware than others? ” Trends in Cognitive Sciences 8 (2004): 239–41. [Google Scholar] [CrossRef] [PubMed]
- Kenneth D. Craig, Judith Versloot, Liesbet Goubert, Tine Vervoort, and Geert Crombez. “Perceiving Pain in Others: Automatic and Controlled Mechanisms.” Journal of Pain 11 (2010): 101–8. [Google Scholar] [CrossRef] [PubMed]
- Kalie N. McCrystal, Kenneth D. Craig, Judith Versloot, Samantha R. Fashler, and Daniel N. Jones. “Perceiving pain in others: Validation of a dual processing model.” Pain 152 (2011): 1083–89. [Google Scholar] [CrossRef] [PubMed]
- Michael S. Gazzaniga. Human: The Science behind What Makes Your Brain Unique. New York: Harper Perennial, 2008. [Google Scholar]
- Herta Flor, Dennis C. Turk, and O. Berndt Scholz. “Impact of chronic pain on the spouse: Marital, emotional and physical consequences.” Journal of Psychosomatic Research 31 (1987): 63–71. [Google Scholar] [CrossRef]
- Michelle T. Leonard, and Annmarie Cano. “Pain affects spouses too: Personal experience with pain and catastrophizing as correlates of spouse distress.” Pain 126 (2006): 139–46. [Google Scholar] [CrossRef] [PubMed]
- Grit Hein, and Tania Singer. “I feel how you feel but not always: The empathic brain and its modulation.” Current Opinion in Neurobiology 18 (2008): 153–58. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Kevin N. Ochsner, Silvia A. Bunge, James J. Gross, and John D. E. Gabrieli. “Rethinking feelings: An fMRI study of the cognitive regulation of emotion.” Journal of Cognitive Neuroscience 14 (2002): 1215–29. [Google Scholar] [CrossRef] [PubMed]
- Linda van der Heiden, Sigrid Scherpiet, Lilian Konicar, Niels Birbaumer, and Ralf Veit. “Inter-individual differences in successful perspective taking during pain perception mediates emotional responsiveness in self and others: An fMRI study.” Neuroimage 65 (2013): 387–94. [Google Scholar] [CrossRef] [PubMed]
- Paul J. Eslinger. “Neurological and neuropsychological bases of empathy.” European Neurology 39 (1998): 193–99. [Google Scholar] [CrossRef] [PubMed]
- Bruce H. Price, Kirk R. Daffner, Robert M. Stowe, and M. Marsel Mesulam. “The comportmental learning disabilities of early frontal lobe damage.” Brain 113 (1990): 1383–93. [Google Scholar] [CrossRef] [PubMed]
- Wei Li, and Shihui Han. “Perspective taking modulates event-related potentials to perceived pain.” Neuroscience Letters 469 (2010): 328–32. [Google Scholar] [CrossRef] [PubMed]
- Alessio Avenanti, Angela Sirigu, and Salvatore M. Aglioti. “Racial bias reduces empathic sensorimotor resonance with other-race pain.” Current Biology 20 (2010): 1018–22. [Google Scholar] [CrossRef] [PubMed]
- James J. Gross. “Emotion regulation: Affective, cognitive, and social consequences.” Psychophysiology 39 (2002): 281–91. [Google Scholar] [CrossRef] [PubMed]
- Michel-Pierre Coll, Lesley Budell, Pierre Rainville, Jean Decety, and Philip L. Jackson. “The role of gender in the interaction between self-pain and the perception of pain in others.” The Journal of Pain 13 (2012): 695–703. [Google Scholar] [CrossRef] [PubMed]
- Joan Y. Chiao. “Towards a cultural neuroscience of empathy and prosociality.” Emotion Review 3 (2011): 111–12. [Google Scholar] [CrossRef]
- Chiara F. Sambo, Matthew Howard, Michael Kopelman, Steven Williams, and Aikaterini Fotopoulou. “Corrigendum to ‘knowing you care: Effects of perceived empathy and attachment style on pain perception’.” Pain 152 (2011): 703. [Google Scholar] [CrossRef]
- Helen Riess, John Kelley, Robert Bailey, Emily Dunn, and Margot Phillips. “Empathy training for resident physicians: A randomized controlled trial of a neuroscience-informed curriculum.” Journal of General Internal Medicine 27 (2012): 1280–86. [Google Scholar] [CrossRef] [PubMed]
- Jean-Phillipe Mailhot, Etienne Vachon-Presseau, Philip L. Jackson, and Pierre Rainville. “Dispositional empathy modulates vicarious effects of dynamic pain expressions on spinal nociception, facial responses and acute pain.” European Journal of Neuroscience 35 (2012): 271–78. [Google Scholar] [CrossRef] [PubMed]
- Marco L. Loggia, Jeffrey S. Mogil, and M. Catherine Bushnell. “Empathy hurts: Compassion for another increases both sensory and affective components of pain perception.” Pain 136 (2008): 1–2. [Google Scholar] [CrossRef] [PubMed]
- Mark Thompson. “Dr. Peter J. N. Linnerooth, 1970–2013.” Time U.S. 11 January 2013. Available online: http://nation.time.com/2013/01/11/dr-peter-j-n-linnerooth-1970–2013/ (accessed on 1 June 2013).
- Brian E. Bride, Melissa Radey, and Charles R. Figley. “Measuring Compassion Fatigue.” Clinical Social Work Journal 35 (2007): 155–63. [Google Scholar] [CrossRef]
- Ihori Kobayashi, Jessica M. Boarts, and Douglas L. Delahanty. “Polysomnographically measured sleep abnormalities in PTSD: A meta-analytic review.” Psychophysiology 44 (2007): 660–69. [Google Scholar] [CrossRef] [PubMed]
- Kimberly A. Babson, and Matthew T. Feldner. “Temporal relations between sleep problems and both traumatic event exposure and PTSD: A critical review of the empirical literature.” Journal of Anxiety Disorders 24 (2010): 1–15. [Google Scholar] [CrossRef] [PubMed]
- Jamil Zaki, and Kevin Ochsner. “The neuroscience of empathy: Progress, pitfalls and promise.” Nature Neuroscience 15 (2012): 675–80. [Google Scholar] [CrossRef] [PubMed]
- Michael J. Lambert, and Benjamin M. Ogles. “The efficacy and effectiveness of psychotherapy.” In Bergin and Garfield’s Handbook of Psychotherapy and Behavior Change, 5th ed. Edited by Michael J. Lambert. New York: John Wiley & Sons, 2004. [Google Scholar]
- Herbert J. Freudenberger, and Arthur Robbins. “The hazards of being a psychoanalyst.” Psychoanalytic Review 66 (1979): 275–96. [Google Scholar] [PubMed]
- Ayala Pines, and Christina Maslach. “Characteristics of staff burnout in mental health settings.” Hospital & Community Psychiatry 29 (1978): 233–37. [Google Scholar] [CrossRef]
- Sharon Rae Jenkins, and Stephanie Baird. “Secondary traumatic stress and vicarious trauma: A validation study.” Journal of Traumatic Stress 15 (2002): 423–32. [Google Scholar] [CrossRef] [PubMed]
- Charles R. Figley. Treating Compassion Fatigue. New York: Brunner-Routledge, 2002. [Google Scholar]
- J. Eric Gentry, Anna B. Baranowsky, and Kathleen Dunning. “ARP: The Accelerated Recovery Program (ARP) for compassion fatigue.” In Treating Compassion Fatigue. Edited by Charles R. Figley. New York: Brunner-Rutledge, 2002, pp. 123–37. [Google Scholar]
- Laurie Anne Pearlman, and Karen Saakvitne. Trauma and the therapist: Countertransference and vicarious traumatization in psychotherapy with incest survivors. New York: W.W. Norton, 1995. [Google Scholar]
- Charles R. Figley. “Review of the Compassion Fatigue Self-Test.” In Measurement of Stress, Trauma, and Adaptation. Edited by Hudnall B. Stamm. Baltimore: Sidran Press, 1996. [Google Scholar]
- Sara McLean, Tracey D. Wade, and Jason S. Encel. “The contribution of therapist beliefs to psychological distress in therapists: An investigation of vicarious traumatization, burnout, and symptoms of avoidance and intrusion.” Behavioural and Cognitive Psychotherapy 31 (2003): 417–28. [Google Scholar] [CrossRef]
- Terri Lynn Creamer, and Becky J. Liddle. “Secondary traumatic stress among disaster mental health workers responding to the September 11 attacks.” Journal of Traumatic Stress 18 (2005): 89–96. [Google Scholar] [CrossRef] [PubMed]
- Rachel Dekel, Shira Hantman, Karni Ginzburg, and Zahava Solomon. “The cost of caring? Social workers in hospitals confront ongoing terrorism.” British Journal of Social Work 37 (2007): 1247–62. [Google Scholar] [CrossRef]
- Heather M. Moulden, and Philip Firestone. “Vicarious traumatization: The impact on therapists who work with sexual offenders.” Trauma, Violence & Abuse 8 (2007): 67–83. [Google Scholar] [CrossRef] [PubMed]
- Kyle D. Killian. “Helping till it hurts? A multimethod study of compassion fatigue, burnout, and self-care in clinicians working with trauma survivors.” Traumatology 14 (2008): 32–44. [Google Scholar] [CrossRef]
- Nancy Jo Bush. “Compassion fatigue: Are you at risk? ” Oncology Nursing Forum 36 (2009): 24–28. [Google Scholar] [CrossRef] [PubMed]
- Paul M. Robins, Lisa Meltzer, and Nataliya Zelikovsky. “The experience of secondary traumatic stress upon care providers working within a children’s hospital.” Journal of Pediatric Nursing 24 (2009): 270–79. [Google Scholar] [CrossRef] [PubMed]
- Marjan Ghahramanlou, and Carolyn Brodbeck. “Predictors of secondary trauma in sexual assault trauma counselors.” International Journal of Emergency Mental Health 2 (2000): 229–40. [Google Scholar] [PubMed]
- Jennifer C. Maytum, Mary Bielski Heiman, and Ann W. Garwick. “Compassion fatigue and burnout in nurses who work with children with chronic conditions and their families.” Journal of Pediatric Health Care 18 (2004): 171–79. [Google Scholar] [CrossRef] [PubMed]
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Russell, M.; Brickell, M. The “Double-Edge Sword” of Human Empathy: A Unifying Neurobehavioral Theory of Compassion Stress Injury. Soc. Sci. 2015, 4, 1087-1117. https://doi.org/10.3390/socsci4041087
Russell M, Brickell M. The “Double-Edge Sword” of Human Empathy: A Unifying Neurobehavioral Theory of Compassion Stress Injury. Social Sciences. 2015; 4(4):1087-1117. https://doi.org/10.3390/socsci4041087
Chicago/Turabian StyleRussell, Mark, and Matt Brickell. 2015. "The “Double-Edge Sword” of Human Empathy: A Unifying Neurobehavioral Theory of Compassion Stress Injury" Social Sciences 4, no. 4: 1087-1117. https://doi.org/10.3390/socsci4041087
APA StyleRussell, M., & Brickell, M. (2015). The “Double-Edge Sword” of Human Empathy: A Unifying Neurobehavioral Theory of Compassion Stress Injury. Social Sciences, 4(4), 1087-1117. https://doi.org/10.3390/socsci4041087