Mindfulness Training Could Help Combat 'Compassion Fatigue'

Mindfulness Training Could Help Combat 'Compassion Fatigue'

Daniel Siegel, MD, addressed an audience of several thousand equine veterinarians about how to improve their resiliency as health providers.

Photo: Courtesy AAEP

Equine practitioners are passionate about their work, caring deeply about what they do for horses and horse owners alike. Combining this passion with the challenges of being an equine health provider, however, can come at a cost to the veterinarian. Distress, with its roots in a phenomenon often called compassion fatigue, can wear on individuals—study results have demonstrated that the veterinary profession has one of the highest rates of suicide. One researcher reports that improving resiliency (the ability to adapt and heal from trauma) with a concept called mindfulness training can equip veterinarians to combat distress and burnout, and help them lead healthier lives.

At the 2015 American Association of Equine Practitioners Convention, held Dec. 5-9 in Las Vegas, Daniel Siegel, MD, clinical professor of psychiatry at the University of California, Los Angeles, School of Medicine, addressed an audience of several thousand equine veterinarians about how to improve their resiliency as health providers. In his research focus on interpersonal neurobiology, he integrates all fields of science into one framework when he conducts this mindfulness training, which he described as a nonjudgmental moment-to-moment awareness of self.

Siegel began exploring this avenue of mental health resiliency while in medical school, where he realized that the medical profession rarely took into account the feelings of either the patient or the health care provider. Medicine was approached very clinically without the empathy so necessary for empowerment and healing.

Siegel then coined the phrase “mindsight”—the perceptual capacity to sense the mind. He said that one’s (in this case, the veterinarian’s) insight plus perception of one’s self plus empathy translates to being cognizant of the mind of others (patients and clients). He cited studies in which physicians’ patients fared better if their doctors made a 30-second empathetic comment. Despite this effect on patients’ physical health, less than 2% of mental health professionals have received any education about the mind.


One common effect of practicing veterinary medicine is burnout. Siegel described this as an internal subjective experience of the mind that manifests as toxic stress, loss of zest, and decreased passion for work. One of the hallmark stresses in veterinary medicine is the “caring/killing paradox,” or euthanasia. Siegel said researchers have attributed higher suicide rates in part to what has been called “compassion fatigue” in the wake of stress caused by euthanasia cases.

An individual’s brain function markedly influences their body health and well-being. Siegel described an enzyme called telomerase, which is necessary to maintain and repair telomeres (the caps on the ends of chromosomes). Without telomeres, as cells divide, chromosomes fray, resulting in cell dysfunction. Aging and distress are a few of the inciting causes. Siegel stressed that what we do with our minds can increase telomerase enzymes and immune system “robustness,” along with encouraging changes in non-DNA molecules such as those responsible for epigenetic regulation (how and when genes are expressed).

He continued on to explain how the mind is “relational” and “embodied.” “The mind is a process that regulates energy and information flow, and this all happens within the brain, the whole body system (i.e., muscles, heart, intestinal tract, bacterial flora in the gut), and between people,” said Siegel.

To develop a resilient mind, the individual must educate it to create “integration.” As a mathematical concept, integration allows you to differentiate and then link things together. Take a choir, for example, said Siegel: A choir’s different voice types (soprano, alto, tenor, bass) singing in harmony integrates differentiation. Similarly, integration of the mind creates harmony, health, and well-being. He said the mind should be: flexible; adaptive; coherent and resilient over time; energized with passion; and stable. His acronym for this is FACES.

A person with burnout has lost the features of FACES. “If integration is a river with a central flow, rigidity is one bank and chaos the other,” said Siegel. “Without the optimized flow of integration, the mind goes to rigidity or chaos,” and the relationship with the client or patient suffers.

In contrast, trust develops when a medical practitioner—in this case the veterinarian—is truly present with the patient, attuned to the patient, and resonating with the patient, yet doesn’t visualize him or herself as living the experience of the patient or client. “It is not enough to have empathic caring, there has to be integration with an action,” he said. In other words, the empathetic veterinarian’s mind must integrate all the elements of FACES to connect with the patient and client without suffering burnout.

The empathetic veterinarian’s mind must integrate all the elements of FACES to connect with the patient and client without suffering burnout.

Photo: Anne M. Eberhardt/The Horse

Mind Resiliency

Siegel stressed that a resilient mind is one that integrates within the body and also external to it with relationships. One way to achieve this is through networking socially with friends and professional groups, combatting isolation. “Just connecting with others in a supportive way can make the difference,” he said.

Another important element to avoiding burnout is to honor family life. Just as the airlines recommend putting on your oxygen mask before tending to the person next to you, he said it’s critical to look after one’s personal well-being first and foremost—and for many that includes spending quality time with family. In some cases, he urges people to reach out for care (in the form of counseling, for example) in order to train the mind to develop resiliency. “An integrated mind is flexible and resilient,” said Siegel, whereas an nonintegrated one is generally prone to chaos or rigidity, full of problems, depending on the neurologic structure the person has evolved or built, and might not support well-being.

Another tool to improve resiliency is insight—or the veterinarian’s relationship with his/herself. He suggested the simple act of writing in a journal can strengthen the immune system and help the individual deal with stress. He described neuroplasticity, which at its most basic is the ability to change and grow synaptic connections in the brain throughout the course of one’s life. Attention directs how the individual drives energy flow through his or her life.

“Where attention goes, neuron firing flows,” said Siegel. Each person can intentionally drive energy and information flow through the brain to encourage it to grow, he said. “If you develop presence (mindful awareness), you will increase telomerase, improve epigenetic function and the cardiovascular and immune systems, and you will strengthen circuits in the brain that integrate the brain to actually change structure to differentiate and link up the differentiated parts.” In other words, you’ll cause the brain to rewire itself to be more resilient to the rigors of daily practice.

Take-Home Message

Through mindful awareness, a practitioner can bring care from the inside out. “If you give yourself this gift, integration brings kindness and compassion,” said Siegel. “Rather than just surviving, you will be thriving.”

To improve mindfulness, he recommended practicing breathing exercise and meditation that link brain fibers to regulate emotions. You can find these and other exercises at the Mindful Awareness Research Center or at the Wheel of Awareness link on the resources tab at www.drdansiegel.com.

About the Author

Nancy S. Loving, DVM

Nancy S. Loving, DVM, owns Loving Equine Clinic in Boulder, Colorado, and has a special interest in managing the care of sport horses. Her book, All Horse Systems Go, is a comprehensive veterinary care and conditioning resource in full color that covers all facets of horse care. She has also authored the books Go the Distance as a resource for endurance horse owners, Conformation and Performance, and First Aid for Horse and Rider in addition to many veterinary articles for both horse owner and professional audiences.

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