Missouri Institute of Mental Health Assistant Research Professor Kimberly Werner’s background is in biopsychosocial outcomes associated with trauma exposure. (Photo courtesy of Kimberly Werner).

COVID-19 has impacted not only the physical health of those suffering from it but also the mental health of people across the world.

But the disease’s reach doesn’t end there.

There are a multitude of secondary effects, but two pernicious examples include compassion fatigue, especially in first responders, and intimate partner violence, domestic violence between those in a relationship. Compassion fatigue, which is also known as secondary trauma or vicarious trauma, occurs when an individual reacts to others who have suffered a traumatic event. It’s most common in first responders such as health care workers or police, fire or EMS personnel.

Kimberly Werner is an assistant research professor at the Missouri Institute of Mental Health and the incoming associate dean of research in the College of Nursing at the University of Missouri­­–St. Louis. Her background is in biopsychosocial outcomes associated with trauma exposure, and her research interests encompass trauma and stress exposure, substance involvement and use disorders, health disparities and prevention and intervention.

At MIMH, Werner was invited by the professional training core to lead the development of a compassion fatigue training program for first responders funded by the Centers for Disease Control and the Missouri Department of Health and Senior Services. She’s now serving as principal investigator for the study Post-traumatic Stress Disorder and Traumatic Brain Injury in Women Survivors of Intimate Partner Violence and is the project director for the Tritons United: Against Gender Based Violence project that is funded by the United States Department of Justice Office on Violence Against Women.

UMSL Daily talked with Werner by phone for the latest edition of our Q&A series.

How widespread is compassion fatigue or secondary trauma, and how do you know if someone is suffering from it?

Predominantly, research has looked at first responders, health care workers, psychologists and social workers – frontline responders to people who’ve experienced trauma and commonly interact with survivors of trauma. But, I would suggest, in the current climate, that anyone could potentially suffer from compassion fatigue.

The symptoms that define compassion fatigue are similar to post-traumatic stress symptoms. You’re preoccupied with the trauma that occurred and seeing the reaction of the other individual and reliving their and your experience. Emotional things, such as guilt and anger, helplessness, feeling like you can’t do anything to help, you’re doing everything you can, but still, it’s not enough. You may experience post-traumatic stress symptoms, like sleep disturbance, hyper vigilance and increased startle response. Then there’s physical symptoms that are part of the sympathetic response that occurs with stress, but they continue on and persist in more pathological way. That’s increased heart rate, difficulty breathing, sore muscles or an impaired immune system.

We know that lots of people experienced these symptoms in the acute aftermath of trauma and most recover with time without any type of treatment or intervention. It’s when those symptoms persist and start to become dysfunctional in your life that you really should start to seek out treatment or ways to alleviate them.

Can compassion fatigue come from an overload of news media?

We saw a lot of this happen with 9/11, where people were inundated with images of the towers falling over and over and over again on news media. Absolutely, that could be something that could be considered secondary trauma. I think anyone who lived through 9/11 and watched the coverage still feels the echo of that experience in their bones.

I have a feeling we’re going to be feeling the echo of this experience in our bones in the future as well. Acknowledging and understanding that and trying not to get stuck in the news reel can help. News about COVID can lead to negative thoughts, emotions and behaviors. Try to remove yourself and unplug.

I try to do that with my kid who’s 4, make sure we’re not traumatizing him by having the news on all the time. He’s doing OK, but he’ll say things. When we were drawing the other day, he started to draw things that looked like the virus that they show on TV. Little kids can be impacted even if they’re not explicitly being told things. Protecting them is an important piece, too.

You and your team at the Missouri Institute of Mental Health have developed trainings for first responders on how to overcome compassion fatigue. What techniques do they learn?

Trainees learn how to identify different stressors, develop a self-care plan and put resiliency strategies in place to mitigate the damages of direct trauma as well as compassion fatigue and secondary trauma. I think it’s really important to note that systematic change and institutional support ensure that personnel feel supported and have an outlet or resources available for them to develop self-care and understand that what they’re going through is a normal experience. Normalizing mental health is extremely important in protecting against compassion fatigue.

What do those self-care strategies look like?

A lot of them are “keep it simple” stuff. Things that we do generally to help ourselves with stress: meditation; literally taking a breath if you feel yourself getting overwhelmed; taking a walk; keeping good sleep hygiene; eating healthy and not junk food, moderate alcohol intake so that you keep the inflammatory response in place; and checking in with your buddies.

We know that social support is one of the biggest predictors of resilience and recovery from post-traumatic stress symptoms. Having a support system where you can talk it out or even touching base with your friends, your colleagues, and making sure that they know that you’re there and interested in their wellbeing. That’s a real challenge now for many of us working remotely and particularly health care workers because a lot of them are removing themselves from their families to protect them from getting infected.

These sounds like things that I could do as an individual.

Absolutely. But if the symptoms start to become dysfunctional in your life or you can’t do your job or be with your family, if your actions become deviant or destructive to your life, then that’s when you need to seek professional help. But prior to that, there are lots of things people can do just taking care of themselves, basic self-care, hygiene.

Do you think that there are ways in which having this universal trauma is going to change our understanding of compassion fatigue?

I think that we’ll learn more about stress generally, compassion fatigue, how people can help themselves. This crisis is shining a light on a lot of important topics, including mental health and health disparities. Hopefully, it will reduce the stigma around mental health and people will start taking a proverbial vitamin for their mental health every day. I think that with any type of crisis or challenge there’s a way to learn and improve our understanding of ourselves as well as improve research around various topics.

Can we pivot to intimate partner violence and domestic violence?

Yes, that’s no problem. I actually just finished data collection on a research project that looks at post-traumatic stress disorder and traumatic brain injury in women survivors of intimate partner violence.

There’s been reports that intimate partner violence has increased with stay-at-home policies and social distancing.

Women and men who live with their perpetrators are now going to be cut off even more from their social support networks. They’re going to be spending more time in their homes. Though I’m not an expert in child advocacy and protection, we know that many times when children are abused, the reporters are from schools. If kids don’t have that outlet, they’re basically stuck in a house 24/7 with their abusers. The same goes for partners, if they’re stuck in the house with their abusers, they have no outlet to get out.

In a non-COVID situation, it takes women – most of the research in intimate partner violence has been done in women ­– or survivors seven attempts to try and leave their perpetrators before they’re successful. Now you layer on top being quarantined with your abuser, being cut off from any type of resources that you may have had previously, whether it be church, work or school, any friends. You’re being monitored 100 percent of the time. Maybe you lost your job or are financially unstable, so you don’t have that resource either. Think about how much more challenging it will be for individuals who are already attempting seven times on average to escape. We have this perfect storm: lack of resources, isolation, financial instability, control and stress. The resources that would respond to domestic violence, like police officers and social service providers, are also overwhelmed themselves. They are doing their best to respond with very limited resources.

Knowing that these lockdowns are necessary, do you have any thoughts about how we could minimize incidents of violence?

I think that that onus is on people like myself and people who are providers to try and figure out strategies to support victims of domestic violence. Oftentimes in domestic violence situations, all electronic devices are being monitored, so if we set up an app, or something like that, that could potentially be monitored. Telehealth is a potential option. But again, if you’re in the same house as an abuser and they’re very controlling, that could potentially be compromised as well. Some ideas include creating a safety plan, practicing self-care and trying to reach out to a trusted friend, family or coworker. You can also save resources as contacts in your phone with another nondescript name or reach out for support via social media or websites that have live chat. If you are in immediate danger, call 911. Domestic violence is isolating, and victims can feel hopeless and alone: You are not alone, and people are here to help you.

Many passionate and dedicated people are working on strategies to help victims of domestic violence and those who are experiencing compassion fatigue. Through community partnership, research and programming, I know we will continue to develop and implement strong effective strategies and avenues of support.

Resources for individuals affected by compassion fatigue
National Suicide Prevention Lifeline: 800-273-8255
Community Psychological Services: 314-516-5824
The Center for Trauma Recovery: 314-516-6738
The Child Advocacy Center: 314-516-679
UMSL Counseling Services: 314- 516-5711
UMSL Health Services: 314-51-5671

Resources for victims of intimate partner violence or domestic abuse
Women’s Safe House: 314-772-4535
Our Lady’s Inn: 314-351-4590 (St. Louis) or 636-398-5375 (St. Charles County)
Safe Connections 24-hour Crisis Helpline: 314-531-2003
The National Domestic Abuse Hotline: 800-799-7233
St. Louis City Domestic Abuse Response Team: 314-444-5385
St. Louis City Police non-emergency report line: 314-231-1212
St. Louis County Police non-emergency report line: 636-529-8210
UMSL Police non-emergency report line: 314-516-5155