Stress Reaction Inventory Assessing the impact of compassion fatigue, burnout and secondary traumatic stress Instructions: Place a checkmark next to each of the items below that you have experienced in the past two months, even if it seems unrelated to work. Cognitive Diminished concentration Confusion Spaciness Loss of meaning Decreased self-esteem Preoccupation with trauma Trauma imagery Apathy Rigidity Disorientation Thoughts of self-harm or harm to others Self-doubt Perfectionism Minimization Blaming others Poor decisions Poor abstract thinking Memory problems Heightened or lowered alertness Emotional Powerlessness Anxiety Guilt Anger/rage Survivor guilt Shutdown Numbness Fear Helplessness Sadness Depression Hypersensitivity Emotional roller coaster Overwhelmed Depleted Grief Denial Severe panic Loss of emotional control Inappropriate emotional response Apprehension Behavioral Impatient Clingy Irritable Withdrawn Moody Regression Sleep disturbances Appetite changes Nightmares Hypervigilance Elevated startle response Use of negative coping (smoking; alcohol or other substance misuse) Accident proneness Losing things Self-harm behaviors Inability to rest Spiritual Questioning the meaning of life Loss of purpose Lack of self-satisfaction Pervasive hopelessness Boredom/ennui Anger at God Questioning of prior religious beliefs Despair about the pervasiveness of cruelty Loss of faith in a higher power Greater skepticism about religion Interpersonal Withdrawal Decreased interest in intimacy or sex Mistrust Isolation from friends Impact on parenting (protectiveness, concern about aggression) Projection of anger or blame Intolerance Loneliness Increased interpersonal conflicts Physical Shock Sweating Rapid heartbeat Breathing difficulties Aches and pains Dizziness Increased number and intensity of medical ailments Fatigue Nausea Muscle tremors Twitches Chest pain Elevated blood pressure Thirst Headaches Visual difficulties Vomiting Chills Fainting Grinding of teeth Information adapted from the following sources: “Preventing Secondary Traumatic Stress Disorder” by J.Yassen in Compassion Fatigue (1995); “Examples of Compassion Fatigue Burnout Symptoms” (Internet 1999); Critical Incidents Stress Management Training handout (1996). Self-Care Assessment Worksheet This assessment tool provides an overview of effective strategies to maintain self-care. After completing the full assessment, choose one item from each area that you will actively work to improve. Using the scale below, rate the following areas in terms of frequency: 5 = Frequently 4 = Occasionally 3 = Rarely 2 = Never 1 = It never occurred to me Physical Self-Care.

1. Stress Reaction Inventory
Assessing the impact of compassion fatigue, burnout and
secondary traumatic stress
Instructions: Place a checkmark next to each of the items below
that you have experienced in the past two months, even if it
seems unrelated to work.
Cognitive
Diminished
concentration
Confusion
Spaciness
Loss of meaning
Decreased
self-esteem
Preoccupation with
trauma
Trauma imagery
Apathy
Rigidity
Disorientation
Thoughts of
self-harm or harm
to others

2. Self-doubt
Perfectionism
Minimization
Blaming others
Poor decisions
Poor abstract
thinking
Memory problems
Heightened or
lowered alertness
Emotional
Powerlessness
Anxiety
Guilt
Anger/rage
Survivor guilt
Shutdown
Numbness
Fear
Helplessness
Sadness
Depression
Hypersensitivity
Emotional roller
coaster
Overwhelmed
Depleted
Grief

3. Denial
Severe panic
Loss of emotional
control
Inappropriate
emotional response
Apprehension
Behavioral
Impatient
Clingy
Irritable
Withdrawn
Moody
Regression
Sleep disturbances
Appetite changes
Nightmares
Hypervigilance
Elevated startle
response
Use of negative
coping (smoking;
alcohol or other
substance misuse)
Accident
proneness

4. Losing things
Self-harm
behaviors
Inability to rest
Spiritual
Questioning the
meaning of life
Loss of purpose
Lack of
self-satisfaction
Pervasive
hopelessness
Boredom/ennui
Anger at God
Questioning of
prior religious
beliefs
Despair about the
pervasiveness of
cruelty
Loss of faith in a
higher power
Greater skepticism
about religion

5. Interpersonal
Withdrawal
Decreased interest
in intimacy or sex
Mistrust
Isolation from
friends
Impact on
parenting
(protectiveness,
concern about
aggression)
Projection of anger
or blame
Intolerance
Loneliness
Increased
interpersonal
conflicts
Physical
Shock
Sweating

6. Rapid heartbeat
Breathing
difficulties
Aches and pains
Dizziness
Increased number
and intensity of
medical ailments
Fatigue
Nausea
Muscle tremors
Twitches
Chest pain
Elevated blood
pressure
Thirst
Headaches
Visual difficulties
Vomiting
Chills
Fainting
Grinding of teeth
Information adapted from the following sources: “Preventing
Secondary Traumatic Stress Disorder” by J.Yassen in
Compassion Fatigue (1995); “Examples of Compassion Fatigue
Burnout Symptoms” (Internet 1999); Critical Incidents Stress
Management Training handout (1996).

7. Self-Care Assessment Worksheet
This assessment tool provides an overview of effective
strategies to maintain self-care. After completing the full
assessment, choose one item from each area that you will
actively work to improve.
Using the scale below, rate the following areas in terms of
frequency:
5 = Frequently
4 = Occasionally
3 = Rarely
2 = Never
1 = It never occurred to me
Physical Self-Care
___ Eat regularly (e.g. breakfast, lunch and dinner)
___ Eat healthy
___ Exercise
___ Get regular medical care for prevention
___ Get medical care when needed
___ Take time off when needed
___ Get massages
___ Dance, swim, walk, run, play sports, sing, or do some other
physical activity that is fun

8. ___ Take time to be sexual—with yourself, with a partner
___ Get enough sleep
___ Wear clothes you like
___ Take vacations
___ Take day trips or mini-vacations
___ Make time away from telephones
___ Other:
Psychological Self-Care
___ Make time for self-reflection
___ Have your own personal psychotherapy
___ Write in a journal
___ Read literature that is unrelated to work
___ Do something at which you are not expert or in charge
___ Decrease stress in your life
Source: Transforming the Pain: A Workbook on Vicarious
Traumatization. Saakvitne, Pearlman & Staff of TSI/CAAP
(Norton, 1996)

9. ___ Let others know different aspects of you
___ Notice your inner experience—listen to your thoughts,
judgments, beliefs, attitudes, and
feelings
___ Engage your intelligence in a new area, e.g. go to an art
museum, history exhibit,
sports event, auction, theater performance
___ Practice receiving from others
___ Be curious
___ Say “no” to extra responsibilities sometimes
___ Other:
Emotional Self-Care
___ Spend time with others whose company you enjoy
___ Stay in contact with important people in your life
___ Give yourself affirmations, praise yourself
___ Love yourself
___ Re-read favorite books, re-view favorite movies
___ Identify comforting activities, objects, people,
relationships, places and seek them out

10. ___ Allow yourself to cry
___ Find things that make you laugh
___ Express your outrage in social action, letters and donations,
marches, protests
___ Play with children
___ Other:
Spiritual Self-Care
___ Make time for reflection
___ Spend time with nature
___ Find a spiritual connection or community
___ Be open to inspiration
___ Cherish your optimism and hope
___ Be aware of nonmaterial aspects of life
___ Try at times not to be in charge or the expert
___ Be open to not knowing
Source: Transforming the Pain: A Workbook on Vicarious
Traumatization. Saakvitne, Pearlman & Staff of TSI/CAAP
(Norton, 1996)

11. ___ Identify what in meaningful to you and notice its place in
your life
___ Meditate
___ Pray
___ Sing
___ Spend time with children
___ Have experiences of awe
___ Contribute to causes in which you believe
___ Read inspirational literature (talks, music, etc.)
___ Other:
Workplace or Professional Self-Care
___ Take a break during the workday (e.g. lunch)
___ Take time to chat with co-workers
___ Make quiet time to complete tasks
___ Identify projects or tasks that are exciting and rewarding
___ Set limits with your clients and colleagues
___ Balance your caseload so that no one day or part of a day is
“too much”

12. ___ Arrange your work space so it is comfortable and
comforting
___ Get regular supervision or consultation
___ Negotiate for your needs (benefits, pay raise)
___ Have a peer support group
___ Develop a non-trauma area of professional interest
___ Other:
Balance
___ Strive for balance within your work-life and workday
___ Strive for balance among work, family, relationships, play
and rest
Source: Transforming the Pain: A Workbook on Vicarious
Traumatization. Saakvitne, Pearlman & Staff of TSI/CAAP
(Norton, 1996)

13. REPLENISH THE WELL:
AN EXPERIENCE IN SELF-CARE
DIRECTIONS FOR “PIE OF LIFE” EXERCISE
The purpose of this exercise is to help you take a look at how
you are currently allocating the time
of your life. A meaningful life is one in balance, with adequate
time allocated to the activities that
express your values and priorities. Unfortunately, many people
do not live their life in balance, or
in a way that is supports and expresses what they say that value.
This exercise will help you assess whether or not you are
currently living a whole and balanced
life. Follow the steps below:
1. On a blank piece of paper, draw a large circle to represent
your life.
2. Place a smaller circle in the center to represent you, and
label it with your name.
3. Thinking of your life as a pie, divide the slices and label
them to show the various activities
that you are engaged in on a regular basis. Some of the “pie
slices” many people include
are: work, learning, family and other relationships,
contributions to others, fun and leisure,

14. physical and emotional self-care, and spiritual well-being.
4. Reflect on your current life by considering the following
questions, and share your
responses with a partner:
• Am I living a balanced life?
• Are my priorities and values reflected in this allocation of
time?
• If I had one month left to live, is this the way I would allocate
my time?
• Am I involved in too many activities?
• How much of my time is spent caring for others? For myself?
• Are there areas of my life that need my attention?
• Is there a dream or desire that keeps getting put on the back
burner that I’d like to
focus on now?
• What needs less attention? More attention?

15. • What changes do I want to make?
• What is one commitment I can now make to change the
balance toward what I want
for my life?
Exercise developed by Catherine D. Nugent, for Replenish the
Well: An Experience in Self-Care, workshop
presented at Peer Services: A Life in the Community for
Everyone, Fifth Annual Conference of the
Substance Abuse and Mental Health Services Administration,
Center for Substance Abuse Treatment’s
Recovery Community Services Program, Washington, DC, July
13, 2004. Adapted from Richardson, C.
(1999). Take time for your life. New York: Broadway Books.
REPLENISH THE WELL:
AN EXPERIENCE IN SELF-CARE
SOCIAL SUPPORT WORKSHEET

16. Introduction: People working in the helping field are subject
to conditions that can lead to
depletion or even impairment, such as the emotionally intense
nature of the helping relationship
and increasingly heavy case loads. Receiving support from
others can replenish us and reduce our
vulnerability to professional stress (White, 1986). In addition,
social support has been positively
correlated with improved health and mental health outcomes
(Cobb, 1976), and shown to be a
positive factor in making healthy lifestyle changes (Hanna,
2002; Prochaska et al, 1994).
Four types of social support have been identified (Salser, 2003;
Cobb, 1976):
Emotional support - refers to demonstrations of empathy, love,
caring, concern.
Emotional support bolsters one’s self-esteem and confidence.
An emotional supporter
serves as a confidante, offering acceptance, care, and
understanding.
Informational support - refers to assistance with knowledge,
information, and skills. Can
include providing information on where to go for resources or
teaching a skill.
Instrumental support - refers to concrete assistance in helping
others to do things or get
things done, especially stressful or unpleasant tasks.

17. Companion support - refers to companionship, feeling
connected, people in whose
company you enjoy being, especially for recreational activities.
The exercise on the following page will help you assess your
current level of social support and
think about areas in which you may need to extend your
network. As you consider those who offer
social support to you, it is also useful to think about the people
for whom you play support roles,
and to assess your level of comfort in those roles.
References:
Cobb, S. (1976). Social support as a moderator of life stress.
Psychosomatic Medicine, 38(5), 300-314.
Hanna, F. (2001). Therapy with difficult clients: Using the
precursors model to awaken change. Washington, DC:
American Psychological Assocation.
Prochaska, J., Norcross, J., DiClemente, C., and Crawley, B.
(1995). Changing for good: A revolutionary, six-stage
program for overcoming bad habits and moving your life
positively forward. New York: William Morrow.
Salzer, M. (2002). Consumer-delivered services as a best
practice in mental health care delivery and the development
of practice guidelines. Psychiatric Rehabilitation Skills 6(3),
355-382.
White, W. (1986). Incest in the organizational family: The
ecology of burnout in closed systems. Bloomington, IL:
Lighthouse Training Institute Publications.

18. ASSESSING YOUR CURRENT SOCIAL SUPPORT
List at least three people who provide each of the types of
social support described on
the previous page. (It is OK to put the same person in more than
one area.)
Emotional Informational Instrumental Companion
Now reflect on the following questions. (You could write out
your answers and/or share your
responses with a friend or colleague. If you discuss your
answers with a friend, you will be putting
social support into action.)
• In general, how do you feel about your social support
network?
• Does your current support network meet your needs for social
support?
Are all of different types of social support (emotional,
informational,
instrumental, companion) covered adequately?
Do you have enough people in your social support network? Do

19. you think anyone in your
support network might be feeling overextended?
Do the people in your network provide the quality of support
you would like? If not, what
could you do to make the situation better?
Have their been any recent changes in your support network? If
yes, what has been the
impact? In what area(s) are you most feeling the change?
• Do you have “job openings” in your support network? If yes,
how will go you about
filling these? Try to come up with at least three ideas for ways
to expand your social
support network in the areas where you perceive a lack.
Exercise developed by Catherine D. Nugent, for Replenish the
Well: An Experience in Self-Care, workshop presented
at Peer Services: A Life in the Community for Everyone, Fifth
Annual Conference of the Substance Abuse and Mental
Health Services Administration, Center for Substance Abuse
Treatment’s Recovery Community Services Program,
Washington, DC, July 13, 2004.