Background of the Research
The research paper is fundamentally about the comparison of Compassion Fatigue and PTSD patients. The research main objective it to go along with or reject this hypothesis: People suffering from Compassion fatigue will experience similar physiological changes as those suffering from PTSD. By working towards this hypothesis, the research can be able to compare and contrast CF to PTSD and recognize how the two are related. In order to verify and distinguish the relation between these two phenomena, it is essential to know what the research will be looking for. First, it is essential to have the invariable values (constants) that are the PTSD patients. These values form the basis in which we will compare the CF results to. The variable values will be measured in terms of the inflammatory reactions witnessed in PTSD patients and it is assumed to be seen in CF patients. These inflammatory reactions include neuroendocrine disorders, such as an enhanced negative feedback regulation by cortisol (Yehuda et al 1996); and alterations in serotonin (5-HT) activity, such as a defect in the 5-HT transporter system (Arora et al 1993). In addition, increased white blood cell counts whereas the decrease in number of T helper (Th) and T cytotoxic suppressor cells and increased serum interleukin-1b (IL-1b) concentrations. If the CF patients show these reactions then the hypothesis is proven.
Post-traumatic stress disorder (PTSD) is a form of anxiety condition. It can happen following one seeing or experiencing a distressing occurrence that entailed the danger of harm or death. It may happen immediately after a serious trauma, or it can be belated for more than 6 months after the incident. When it happens immediately after the trauma, it regularly improves after 3 months. Conversely, some individuals have a longer-term type of PTSD, which can persist for several years. It can happen at any age and can be after a natural tragedy such as a flood or fire, or events such as war, a prison stay, assault, domestic abuse, or rape. The origin of PTSD is unidentified, but physical, psychological, social factors and genetic are implicated. It alters the body’s reaction to stress. It influences the stress chemicals and hormones that transmit information between the neurotransmitters. Persons with PTSD re-experience the incident repeatedly in no less than one of numerous ways. They may have terrifying dreams and reminiscences of the event, flashbacks, or become distress throughout anniversaries of the occurrence.
PTSD is associated with inflammatory-connected medical conditions, in line with a literature review. The paper reviewed in the past carried out studies that investigated the immune purposes in a assortment of people with PTSD. The researchers established that people with constant PTSD were more probable to have extreme amounts of inflammation and elevated heights of inflammatory cytokines. Consistent with The Cleveland Clinic’s website inflammation is “a progression by which the body’s white blood cells and chemicals defend us from infectivity and foreign substances such as bacteria and viruses.” While inflammation is a fraction of the body’s immune reaction, extreme inflammation is a sign that the body’s immune structure is not synchronized adequately.
The instigators of the article issued in Perspectives in Psychiatric Care report that extreme inflammation might be owing in fraction to an inadequate regulation by cortisol. Traumatic episodes and other stressors guide to elevated levels of cortisol and other chemicals that assist persons react to threatening circumstances. Regrettably, the extreme variation of cortisol also instigates a reduction in the immune system’s aptitude to defend against viruses and other infections that cause diseases. This is important since individuals who experience PTSD regularly remember the trauma they encountered through flashbacks and nightmares, which forms extra stress, making cortisol to vary accordingly, thus deteriorating their immune systems more. The journal article also states that extreme inflammation formed by the immune system may add to deteriorating health in individuals with PTSD and that treating PTSD may decrease these health risks. Consequently, not just do psychotherapy and psychiatric prescriptions aid lessen the PTSD signs and symptoms, but they also add to the improvement and hindrance of physical sickness and could perhaps add to the long life of PTSD victims. Other techniques of lessening anxiety, as well as social support, meditation, and exercise have been established to reduce anxiety disorders and depression.
One significant chemical that is now being discussed in research is cortisol. The dispute is about its function in creating symptoms in those with PTSD, as the function is not up till now completely comprehended. Cortisol is a hormone manufactured in the adrenal gland. It is occasionally known as the stress hormone since it is inclined to augment blood pressure, blood sugar levels, and has an immunosuppressive outcome. For individuals who are not PTSD, it essentially assists in restoring homeostasis after stress. However, in some individuals with PTSD, there appears to be a inferior base level of cortisol manufacture to start with, and when it is secreted, their bodies have a oversensitive response to it; that is, the cortisol does not function in them normally. When an individual is under constant stress, such as in war, or a child who is encountering sequential abuse, there is a long-lasting cortisol secretion that may significantly change what is measured as ‘normal’ cortisol levels. In a normal individual, cortisol levels are maximum in the morning and minimum during slumber. These facts have wide reaching inferences concerning behaviours like sleep, getting a PTSD child up and out the door for school, or being calm enough or alert enough to carry out everyday tasks.
Other Studies corroborate that caregivers play host to an elevated level of compassion fatigue. Daily, they struggle to operate in care giving environments that continuously proffer emotional challenges. Upsetting positive transformation in society, an assignment so fundamental to those fervent about caring for others, is professed as intangible, if not unfeasible. This excruciating realism, in addition to first-hand information of society's blatant disrespect for the security and welfare of the weak and delicate, captures its levy on everyone from permanent employees to part time volunteers. Ultimately, negative attitudes triumph.
Compassion Fatigue is condition experienced by individuals helping distressed people. It is a severe condition of anxiety and preoccupation with the anguish of those being helped to the level that it is traumatizing for the aid. It also a deep spiritual, physical, and emotional exhaustion accompanied by sensitive emotional pain. Compassion Fatigue indications are standard exhibits of constant stress resultant from the care giving work individuals decides to do. A principal traumatologist Eric Gentry proposes that individuals who are engrossed in care giving frequently go in the field previously compassion fatigued. A strong recognition with vulnerable, distressed, or disturbed people is perhaps the motive. It is ordinary for such individuals to originate from a custom of what Gentry brands: “other-directed care giving”. Simply positioned, these people were trained at an early age to look after the requirements of others prior to caring for their personal needs. Genuine, ongoing self-care exercises are missing in their lives (Gill ET. Al).
Important researches have been concluded in the past addressing secondary traumatic stress (compassion fatigue) and PTSD because of vicarious traumatization in the professions of child welfare workers (Figley). Conversely, modest to no research subsists investigating these phenomena in terms of the People suffering from Compassion fatigue experiencing similar physiological changes as those suffering from PTSD. Therefore, the lack of recognition of this issue will be tackled in this research study. Exploring these phenomena in the field of social work may aid in identifying to what degree the phenomena are essentially experienced by social workers.
This study aims to examine People suffering from Compassion fatigue and PTSD. Then look at the possibility of the two sets of individuals experiencing similar physiological changes. Other purposes of the study are to establish the rate at which these phenomena happen in a population which little data has been beforehand gathered. Identifying the deficiency in or existence of the phenomena in the occurrences of social workers appearing significant to additionally scrutinize the occurrence of the phenomena among helping experts.
Literature review
Boscarino, J. Posttraumatic stress disorder and physical illness: Results from clinical and epidemiologic studies. Annals of New York Academia of Sciences.,2006. 1032.1, 141-53.
Collins, S., & Long, A. Working with the psychological effects of trauma: Consequences for mental health-care workers A literature review. Journal of Psychiatric and Mental Health Nursing. 2003. 10, 417–424.
Baranowsky, Dunning & Gentry. Accelerated Recovery Program (ARP) for Compassion Fatigue. Presented at the thirteenth.
Annual International Society for Traumatic Stress Studies Conference, Montreal Quebec. 1997, November.
De Quervain, D., Gustav, S., & Roozendaal, B. Can posttraumatic stress disorder be prevented with glucocorticoids. Annals of New York Academia of Sciences. 2006 1032.1, 158-66.
Figley, Charles R.. "compassion fatigue as secondary traumatic stress disorder: an overview." coping with secondary traumatic stress disorder in those who treat the traumitized. London: Brunner-Routledge, 1995. 1-30. Print.
Gavranidou, M., & Rosner, R.. The weaker sex? Gender and posttraumatic stress disorder. Depression and Anxiety. 2003 17.3, 130-39.
Gill, J., Page, G., Saligan, L., & Woods, S.. PTSD is associated with an excess of inflammatory immune activities. Perspectives in Psychiatric Care 2009. 45.4, 262-277.
MacCann, I. L., and Laurie A. Pearlman. Psychological trauma and the adult survivor: theory, therapy, and transformation. New York: Brunner/Mazel, 1990. Print
Miranda, Y. Guzelcan, G. de Vries, J. Assies, & B. Gersons. HPA-and HPT-axis alterations in chronic posttraumatic stress disorder. Psychoneuroendocrinology,2006.. 31.10, 1220-30.
Stamm, Hundall. Professional Quality of Life: compassion satisfaction and fatigues subscales Rertived from www. Isu.edu/-bhstamm
Research methods and designs
To be able to create a longitudinal design study that tests CF and PTSD patients it is appropriate to choose a cohort study. Whereby the individuals facing one of both of the conditions are pooled with the same period and studied at intervals through time. In particular using a prospective cohort study can be an advantage to this point as it can help determine risk factors for contracting a new illness since it is a longitudinal surveillance of the person through time, and the compilation of data at regular intervals, so recall error is abridged. The cohort in this case should be the female social workers who work with abused women who do not suffer from CF or PTSD or have experienced a traumatic event. More time should be accorded to their monitoring. This Type of design should enable us to see how some of these patients became CF with the assessment. Then once these patients have CF, we can compare their immune functions and cortisol levels to control, and PTSD of child abuse women. The issue on PTSD should be the invariable values for the compassion fatigue should be compared against it.
Subjects
The Participants should be 100 young- middle-aged women of which 70 of these women were chosen because they have experienced child abuse, or work with someone who has been abused as a child (social worker). The rest were to be used as control group (30). Before the actual research, all participants have to complete the following: PTSD assessment according to the DSM-V1-TR, Compassion Fatigue/satisfaction self-test (high scores taken-at least 17 and above. Max distance between scores=2). They will also be expected to answer an additional question “whether or not any of they have experienced a direct traumatic event that impacted their lives (but not making them PTSD)”. All the assessments are to remain anonymous.
After the completion of the assessments and screening, the 100 participants are to be grouped into five categories: Group A: female social workers who work with abused women and do not suffer from CF or PTSD or have experienced no a traumatic event. Group B: female social workers who work with abused women and they suffer from CF but not PTSD. They have also not experienced any traumatic event. Group C: female social workers who work with abused women and they have experienced a traumatic event in their lives, they may have PTSD. Group D: female victims that suffer from PTSD due to child abuse. Group E that consists of female victims who do not suffer from PTSD/CF and do not work with traumatized victims or have experienced a traumatic event.
The reason of these groups varies. For instance group E acts a control in that it consist of normal individuals who do not suffer from CF nor PTSD and not in any risk whatsoever to develop CF in that they do not work with traumatized patients. The results obtained from the other cohorts or categories are to be compared against this category’s results. Group A is the main cohort to be analyzed. It consists of social workers who are still normal (No CF or PTSD) and work with PTSD or traumatized patients. The reason for this is to monitor this group to the point in time they get CF. This provides a longitudinal study approach since we see the difference of the results when they were normal to the time they had CF. The results obtained here can then be compared to the results of group D and Group E. Group D provides the invariable values. It monitors patients with PTSD due to child abuse. With this group’s results in comparison to group A’s, the hypothesis can either be proven or rejected. The other two groups can be used to validate the whole study.
Procedures and measures
The procedure is quite straightforward. All the groups are initially subjected to blood test-total counts and function assays for immune system markers. This should be continuous at intervals before and after each experimental days starting at 8am each morning. In order to give a longitudinal approach the total experimental time should be 6 months or more depending on the changes in the cohort (group A). The Immune cells we will be testing for: inflammatory cytokines (IL6, TNF-a, IL-1B) ,C-reactive protein (CRP) and serum amyloid A, Secretory Immunoglobulin A and Natural Killer Cells (NK), Cortisol, Glucocorticoid sensitivity and receptor number. The salivary cortisol tests can also be done before and after each experimental day.
The study is to be focused on two theoretical domains: compassion fatigue and PTSD. These domains are to be gauged using the Professional Quality of Life Scale (ProQOL R-IV) (Stamm). This 30-item self-report questionnaire measures levels of PTSD and compassion fatigue. The psychometric properties of the Prop-QOL R-IV are compassion satisfaction alpha =.87, compassion fatigue alpha = .80 and PTSD alpha = .72. This amended account of the scale has augmented specificity and abridged co linearity when contrasted to the older questionnaire (Stamm). The survey is employed to asked participants to consider each scale item and indicate how directly it mirrors their incidents using a 5 point Likert scale (rarely =0 to very often = 5) (Stamm).
Other items included in the questionnaire can be questions recognizing professional and personal description of each participant. These questions can incorporate years of formal education age, ethnicity, gender, marital status, years employed as a social worker, and current job assignment. Other questions can be asking participants to examine if any relation subsists between attributed feelings to compassion and job assignments.
Higher scores on the CF (compassion fatigue) subscale (10 questions) indicate the participant may be at a higher risk of experiencing compassion fatigue. Higher scores on the PTDS subscale (10 items) indicate the subject is experiencing PTDS.
A packet containing a letter of explanation, a letter of consent, survey instructions, the two-part questionnaire and a list of resources to be delivered to 100% of the sample of 100 social workers during the course of their workday. This can be achieved by depositing the packets in all of the participant’s department mailboxes. The letter of consent explains the purpose of the study, voluntary participation and the confidentiality of all participants’ responses.
The letter of explanation explains the questionnaires should be deposited in a locked box and the location of the locked box within the department. The letter also informs participants the questionnaires would be collected approximately three business days after they had been delivered. A locked box could be left at each department for participants to confidentially return their surveys. The locked box containing all surveys can then be picked up three days after the surveys were initially handed out. Data obtained from the questionnaire will include data measured at the nominal level as well as the ordinal level of measurement. Furthermore, data collected from the Pro-QOL R-IV will include analysis of responses from the Likert type scale. A correlation coefficient will be determined to examine the reliability of the data obtained for the study.
Data analysis will also include the response rate of participants as well as a summary of distribution of variables.
Construction of frequency distribution tables and graphs will be utilized to present data. Frequency distributions will include information on cumulative frequencies and cumulative percentages will also be determined. Bar charts, histograms or pie charts may also be utilized to represent the distribution of variables. Measures of central tendency, such as mode, median and mean will also be utilized in data analysis. Measures of dispersion such as range, variance and standard deviation will also be documented in data analysis. Furthermore, inferential statistical analysis as well as the examination of statistically significant relationships between variables will also be explored.
Hypothesis and implications of this proposal
The main objective for the research is to see how some of these patients became CF with the assessment and then once these patients have CF, they are compared to PTSD patients in terms of their immune functions and cortisol levels.
Thus the Hypothesis:
People suffering from Compassion fatigue will experience similar physiological changes as those suffering from PTSD.
Implications of this proposal include PTSD and social workers (both of child abuse) will have similar immune function and cortisol responses towards child abuse (Trauma), even though social workers did not experience child abuse directly. Awareness towards Compassion Fatigue; further focus on increased risk autoimmune and inflammatory disorders associated with PTSD and More resources to social workers. Behavioral comparison, possibly through journal entries (provide some insights into the psychology and coping strategies within these disorders) and Longitudinal study, working with a social care centre with new employees and their new clients may help in understanding coping and progression
