Witness to Suffering: Mindfulness and
Compassion Fatigue among Traumatic
Bereavement Volunteers and Professionals
Kara Thieleman and Joanne Cacciatore
This study used a survey to investigate the relationship between mindfulness and compassion fatigue and compassion satisfaction among 41 volunteers and professionals at an agency
serving the traumatically bereaved. Compassion fatigue comprises two aspects: secondary
traumatic stress and burnout. Because prior research suggests that compassion satisfaction
may protect against compassion fatigue, the authors hypothesized that (a) mindfulness
would be positively correlated with compassion satisfaction, (b) mindfulness would be
inversely correlated with compassion fatigue, and (c) there would be differences between
respondents with a personal history of traumatic bereavement and those with no such history. Correlation analyses supported the first two hypotheses; an independent means t test
did not provide evidence for the latter hypothesis, although the number of nontraumatically
bereaved respondents was small. Overall, this sample showed surprisingly high levels of
compassion satisfaction and low levels of compassion fatigue, even among respondents
thought to be at higher risk of problems due to personal trauma. Implications of these findings are particularly relevant for social workers and other professionals employed in positions in which they encounter trauma and high emotional stress.
KEY WORDS:

burnout; compassion fatigue; mindfulness; secondary traumatic stress; traumatic bereavement

T

here are recognized risks associated with
working with traumatized individuals in a
helping capacity. Although such work may
be highly rewarding, professionals may experience
negative cognitive, emotional, and behavioral effects
that are often referred to as compassion fatigue
(Adams, Boscarino, & Figley, 2006; Bride, Radey, &
Figley, 2007). Compassion fatigue, defined in the literature as the reduced capacity for empathy toward clients resulting from the repeated exposure to their
trauma (Adams et al., 2006), affects professionals and
the clients they serve. Compassion fatigue encompasses the concepts of secondary (vicarious) trauma
and burnout. Secondary trauma may take the form
of symptoms included in the posttraumatic stress disorder diagnosis, including those related to avoidance,
intrusion, and hyperarousal (Bride et al., 2007). Provider burnout, a concern in social work practice and
other fields dealing with trauma and acute stress, also
develops in response to intense interpersonal situations with high emotional and cognitive demands.
However, it differs in that it comprises depersonalization, diminished accomplishment, and emotional
exhaustion (Adams et al., 2006).

doi: 10.1093/sw/swt044

© 2014 National Association of Social Workers

A history of personal traumatic experiences among
helping professionals is thought to increase the likelihood of compassion fatigue, and an unsupportive
workplace may increase burnout (Adams et al.,
2006). However, other factors may be protective
against compassion fatigue, including compassion
satisfaction, which results from the positive experience of being able to help others. The presence of
a supportive workplace may help reduce risk for
some aspects of compassion fatigue, especially burnout (Adams et al., 2006; Collins & Long, 2003).
Although individuals in volunteer roles may spend
fewer hours engaged with traumatized clients,
research suggests that they are nevertheless at risk of
secondary traumatic stress and burnout (Baird &
Jenkins, 2003). In one study of sexual assault and
domestic violence staff, volunteers showed higher
scores on some aspects of burnout than paid professionals, although there were no significant differences
regarding overall burnout, secondary traumatic stress,
or general distress (Baird & Jenkins, 2003).
In recent decades, there has been a growing
interest in mindfulness as a way to improve overall
well-being of clients and helping professionals.

34

Mindfulness has been defined as “the awareness that
emerges through paying attention on purpose, in
the present moment, and nonjudgmentally to the
unfolding of experience moment by moment”
(Kabat-Zinn, 2003, p. 145). Mindfulness practices,
as used in the West, are largely adapted from Theravadan Buddhism, particularly from vipassana, or
insight, meditation practices. These practices aim
to decrease suffering and improve overall wellbeing through directing and sustaining attention in
the present moment. Examples of specific practices
include mindful eating exercises, a body scan that
focuses attention on different areas of the body,
yoga, walking meditation that emphasizes the
awareness of bodily sensations, and sitting meditation that focuses on noticing thoughts, emotions,
and sensations (Baer & Krietemeyer, 2006).
Mindfulness-based practices have been used for a
variety of purposes among medical and mental health
care providers. These purposes include to reduce
psychological distress (Rosenzweig, Reibel, Greeson,
Brainard, & Hojat, 2003) and increase empathy
among medical students (Shapiro, Schwartz, & Bonner, 1998), to decrease stress in nurses (Beddoe &
Murphy, 2004), and to decrease burnout symptoms
and improve relaxation and life satisfaction in nurses
and nurse aides (Mackenzie, Poulin, & SeidmanCarlson, 2006). Such approaches have also been used
to decrease stress, rumination, anxiety, and negative
affect while increasing the self-compassion and positive affect of therapists in training (Shapiro, Brown, &
Biegel, 2007). In samples of health care professionals,
including social workers, these approaches have been
associated with decreased burnout and stress, as well
as improved self-compassion, mental well-being, and
quality of life (Goodman & Schorling, 2012; Shapiro,
Astin, Bishop, & Cordova, 2005).
There is evidence that mindfulness meditation
improves emotional adaptation and that attention
regulation is a key component of this process (Desbordes et al., 2012). As a result, it is possible that
higher levels of mindfulness, through increased
emotional regulation, may protect against compassion fatigue and may also increase compassion satisfaction among those working with traumatized
individuals and groups. This, in turn, may benefit
both the professionals and the clients they serve. For
instance, one randomized controlled trial found that
clients of clinicians who practiced meditation had
better outcomes than clients of clinicians who did
not meditate (Grepmair et al., 2007).

Mindfulness may be a valuable tool for social
workers, as both traditions emphasize the idea of
decreasing suffering and improving lives (Turner,
2009). Mindfulness has also been identified as contributing to the development of empathy (Gerdes,
Segal, Jackson, & Mullins, 2011), which is essential
for effective social work practice. Mindfulness can
help clinicians build a strong therapeutic relationship by teaching them to be fully present, nonjudgmental, attuned, and accepting of both self
and other (Turner, 2009). The ATTEND model,
outlined below, is a mindfulness-based approach
that may provide these benefits to social workers
and the therapeutic relationship.
CURRENT STUDY

The current study draws on prior compassion
fatigue and mindfulness research to further investigate the interaction between these constructs
among professionals and volunteers at an agency
that serves the traumatically bereaved. This agency
uses a mindfulness-based model of care called the
ATTEND model (Cacciatore & Flint, 2012). Professionals and volunteers go through an intensive
30-hour training with this model. Supervision is
centered around the model, and most trainees
receive an additional four to eight hours a year in
ongoing education. The elements of the ATTEND
model are attunement, trust, therapeutic touch,
egalitarianism, nuance, and death education; all
these elements are practiced within a mindfulness
framework based on provider self-compassion and
care. Each element is briefly outlined below. For a
detailed description of how this approach can be
used in clinical practice, see Cacciatore and Flint
(2012).
Attunement has been identified as one of the
benefits of mindfulness. Attunement is practiced
by demonstrating awareness and acceptance of
unpleasant or painful emotions, building the
capacity to tolerate such emotions in oneself, and
modeling such tolerance for clients. This capacity
helps the professional or volunteer establish trust
with clients by remaining present, offering deep
listening and validation, and expressing empathy.
The element of therapeutic touch emphasizes the
importance of appropriate, culturally sensitive
touch with bereaved individuals after some degree
of trust has been established. Mindfulness, through
attention to the present moment and context,
helps strengthen the ability to determine when

Thieleman and Cacciatore / Witness to Suffering: Mindfulness and Compassion Fatigue

35

such touch is warranted and when it might be
counterproductive or unwanted. Egalitarianism is
focused on reminding professionals and staff that
they do not hold all of the answers to questions
that clients face in the aftermath of a traumatic loss.
Instead, they are encouraged to be mindful of each
client’s story and to tailor their approach to the client’s unique needs, in accord with the client’s preferences. Nuance is expressed through attentiveness
to the unique circumstances of each individual,
including their cultural background. Finally, death
education is used to provide a foundation of
knowledge regarding death, dying, and grief and
to normalize a wide range of responses so that professionals and volunteers realize that there are
many appropriate responses to loss. A commitment
to mindfulness practice, such as sitting or walking
meditation, is strongly encouraged for all professionals and volunteers at the agency.
Many of the professionals and volunteers at this
agency have experienced traumatic loss personally, and thus they may be at risk for compassion
fatigue as they see similar suffering in other individuals. It is hypothesized that mindfulness will be
positively correlated with compassion satisfaction
and negatively correlated with secondary traumatic stress and burnout. Furthermore, it is
hypothesized that there will be a difference on all
of these variables between respondents with a history of traumatic bereavement and those without
such a history.
METHOD

Participants

Forty-one participants who volunteer or work at a
local agency serving individuals who have experienced a traumatic death completed this survey.
The mean age of the sample was 40.98 years (SD
= 9.21). Respondents were 92.7 percent female
and 82.9 percent White, with 48.8 percent identifying as Christian, 26.8 percent indicating no religious preference, and the remainder of the sample
indicating other faith traditions or an atheist/
agnostic orientation. The sample was predominantly partnered or married (90.2 percent), and
73.1 percent had earned a college degree. The
mode for annual household income was between
$50,001 and $75,000. This agency relies heavily on
support from volunteers, most of whom are
bereaved parents (82.9 percent in this sample).
Among bereaved parents, the average time since

36

Table 1: Demographic Information (N = 41)
Characteristic

n

%

M

SD

Age (in years)
Bereaved parent
Time since death of child
Years in agency role
Female
Ethnicity
White
Other
Religion
Christian
Other
No preference
Atheist/agnostic
Partnered/married
Education
High school only
Some college courses
College degree
Some graduate courses
Graduate or professional degree
Employed outside the home
Annual household income
$0–$25,000
$25,001–$50,000
$50,001–$75,000
$75,001–$100,000
$100,001–$150,000
> $150,001
Role within agency
Support group facilitator
Unspecified volunteer
Mentor
Online forums
Counselor
Other

41
34
34
41
38

100
82.9
82.9
100
92.7

40.98

9.21

6.41
3.44

3.65
2.36

34
7

82.9
17.1

20
7
11
3
37

48.8
17.1
26.8
7.3
90.2

1
8
16
2
14
38

2.4
19.5
39
4.9
34.1
92.7

2
6
11
7
8
7

4.9
14.6
26.8
17.1
19.5
17.1

15
9
7
3
3
4

36.6
22
17.1
7.3
7.3
9.8

the death of a child was 6.5 years (SD = 3.72), with
a range of two to 15 years. Regarding the primary
role within the agency, 36.6 percent were support
group facilitators, some of whom were licensed clinicians in their communities, 17.1 percent were
mentors, 7.3 percent were social workers or counselors providing grief counseling, and 39.1 percent
served in other roles. Years of experience in this
role ranged from one to seven years, with a mean
of 3.44 years (SD = 2.36). Complete demographic
information is provided in Table 1.
Procedures

Potential participants were contacted via e-mail
after agency board approval. Information about

Social Work

Volume 59, Number 1 January 2014

informed consent and a link to the survey were
included. Continuing from the informed consent
page to the survey was considered to indicate consent, as outlined to participants. The institutional
review board at Arizona State University also
approved the project. The survey was anonymous
and contained questions regarding demographic
information and personal experiences of child loss.
It also used two validated instruments—the Mindful Attention Awareness Scale and the Professional
Quality of Life Scale. The invitation to participate
was sent to 76 professionals and volunteers. Fortysix took the survey, comprising a 61 percent
response rate, although only 41 participants completed all items (54 percent response rate).
Instruments

Mindful Attention Awareness Scale (MAAS). The
MAAS is a 15-item self-report scale designed by
Brown and Ryan (2003) to assess mindful attention
awareness, a key component of mindfulness. This
component is thought to be an important aspect of
emotional regulation (Desbordes et al., 2012) and is
at the core of vipassana meditation practices. MAAS
items (for example, “I find myself doing things
without paying attention”) are rated on a six-point
Likert-type scale (1 = almost always; 6 = almost
never) regarding current experiences. A mean score
is obtained by dividing the total score by the number of items, with higher scores indicating higher
levels of this aspect of mindfulness. Mean scores can
range from one to six. The developers report norms
for community adults (M = 4.20, SD = 0.69) and
college students (M = 3.83, SD = 0.70) in the preface to the instrument. Across samples, Cronbach’s α
for the MAAS ranged from .80 to .90 (Brown &
Ryan, 2003).
Professional Quality of Life Scale (PRoQOL).
The PRoQOL is a 30-item self-report measure
developed by Stamm (2005) and adapted from the
Compassion Fatigue Self-Test (Figley & Stamm,
1996). It includes three subscales: compassion satisfaction (for example, “I like my work as a helper”),
secondary traumatic stress (for example, “I can’t
recall important parts of my work with trauma victims”), and burnout (for example, “I feel worn out
because of my work as a helper”). Items are scored
on a five-point Likert-type scale (1 = never; 5 =
very often) within the timeframe of the past 30
days. The subscale scores are created by summing
all the items in that subscale. Some items on the

burnout subscale are reverse scored. The range of
possible scores on each subscale is five to 50, with
higher scores reflecting higher levels of that component. Scores between 23 and 41 are considered
average for all subscales. Scores of 22 and below on
the compassion satisfaction subscale indicate low
satisfaction with work, while scores of 42 and
higher indicate high satisfaction. On the secondary
traumatic stress and burnout subscales, scores of 42
and higher indicate potential problems in these
areas and scores of 22 and below indicate low risk
of problems in these areas (Stamm, 2009). A total
score of all items is not derived. The developers
report that Cronbach’s α for the subscales are .88
for compassion satisfaction, .81 for secondary traumatic stress, and .75 for burnout (Stamm, 2009).
It may seem that the inclusion of volunteers in
the current study would render the PRoQOL less
applicable to this group, but a close evaluation of
specific items on the scale reveals that many of the
items are as relevant to volunteers as to paid professionals (see examples above). In addition, research
suggests that volunteers who work with trauma survivors may share a similar risk of secondary traumatic
stress and burnout compared to paid staff working
with the same population (Baird & Jenkins, 2003).
Because volunteers are asked to make substantial
time commitments to this agency, they may feel as
invested as paid professionals. Many of the volunteers also have some clinical training.
RESULTS

The responses of the 41 participants who completed the survey were included in the analyses.
Outliers were found in the MAAS and three
PRoQOL subscales (four in MAAS, two in compassion satisfaction, one in secondary traumatic
stress, and two in burnout) and were corrected to
create a more normally distributed sample using
the nearest score-plus-one method (Field, 2009).
Reliability analyses were run for all scales: Cronbach’s α was high for the MAAS (.91) and the compassion satisfaction subscale (.88) and was acceptable
for the secondary traumatic stress subscale (.78), but
it was low for the burnout subscale (.65).
Descriptive Statistics

The mean MAAS score for the sample was 4.25
(SD = 0.64). The mean scores for the PRoQOL
subscales were 42.39 (SD = 4.80) for compassion
satisfaction, 20.66 (SD = 4.00) for secondary

Thieleman and Cacciatore / Witness to Suffering: Mindfulness and Compassion Fatigue

37

traumatic stress, and 19.63 (SD = 4.93) for burnout. No participants scored in the low range for
compassion satisfaction, and 71 percent (n = 29)
scored in the high range. For secondary traumatic
stress, 71 percent (n = 29) scored in the low range,
and no participants scored in the high range that
indicates problems. For burnout, no participants
scored in the high range that indicates problems,
and 76 percent scored in the low range. These
results are summarized in Table 2.
Correlation

Correlation analyses were run to determine whether
there was a correlation between MAAS score and
scores on each of the PRoQOL subscales. Results
revealed three significant relationships. There was a
strong positive relationship between MAAS and compassion satisfaction (r = .52, p = .001, 95 percent confidence interval (CI) [.25, .71], R2 = .27), a negative
relationship of moderate strength between MAAS
and secondary traumatic stress (r = –.39, p = .01, 95
percent CI [–.62, –.09], R2 = .16), and a strong negative relationship between MAAS and burnout (r =
–.54, p < .001, 95 percent CI [–.73, –.28], R2 = .30).
These findings provide support for the hypothesized
relationship between these variables, namely that
mindfulness (specifically, attention awareness) is associated with greater compassion satisfaction scores and
lower secondary traumatic stress and burnout scores.

Independent Means t Tests

An independent means t test was run to examine
whether bereaved parents (n = 34), some of whom
were licensed professionals, differed from nonbereaved parents (n = 7) on the four measures. None
of the relationships between bereavement status and
the four measures was significant. Two relationships
—secondary traumatic stress and burnout—showed
medium effect sizes. The study has a very small number of nonbereaved parents in the sample, so it is
possible that a significant result would be obtained
with a larger sample. In this case, the null hypothesis
was retained, as there was no significant relationship
between bereavement status and any of the four
measures. Full results for the t tests are provided in
Table 3.
DISCUSSION

This study investigated the relationship between a
core component of mindfulness, attention awareness, and compassion satisfaction and compassion
fatigue among a group of professionals and volunteers who serve traumatically bereaved individuals. Social workers often find themselves in these
types of high-stress or crisis roles within their
communities, and research suggests they are at
risk of experiencing burnout and other adverse
psychological outcomes, especially if other personal risk factors or organizational conditions are

Table 2: MAAS and PRoQOL Descriptive Statistics and Reliability (N = 41)
Instrument

M

SD

Minimum

Maximum

Cronbach’s α

MAAS
PRoQOLs
Compassion satisfaction
Secondary traumatic stress
Burnout

4.25

0.64

3.13

5.47

0.91

42.39
20.66
19.63

4.80
4.00
4.93

33
13
11

50
30
31

0.88
0.78
0.65

Note: MAAS = Mindful Attention Awareness Scale; ProQOL = Professional Quality of Life Scale.

Table 3: Independent Means t Tests for MAAS and PRoQOL Subscales (N = 41)
Bereaved

Instrument

MAAS
PRoQOL
Compassion satisfaction
Secondary traumatic stress
Burnout

Yes
(n = 34)
M (SD)

No
(n = 7)
M (SD)

tdf

p

95% CI

Cohen’s d

4.25 (0.65)

4.26 (0.65)

–0.03

39

.98

[–0.55, 0.54]

–0.02

42.47 (5.03)
20.21 (4.04)
20.00 (5.27)

42.00 (3.79)
22.86 (3.24)
17.86 (2.19)

0.23
–1.63
1.05

39
39
39

.82
.11
.30

[–3.61, 4.55]
[–5.95, 0.64]
[–1.99, 6.28]

0.11
–0.72
0.53

Note: MAAS = Mindful Attention Awareness Scale; PRoQOL = Professional Quality of Life Scale.

38

Social Work

Volume 59, Number 1 January 2014

present (Adams et al., 2006; Lloyd, King, &
Chenoweth, 2002).
The reliability of the two instruments was found
to be similar to what has been previously reported,
with the exception of the burnout subscale of the
PRoQOL. Though the burnout subscale has been
noted to have lower reliability than the other two
subscales that make up the PRoQOL (Stamm,
2009), the reliability of this scale was substantially
lower than previously reported; thus, results involving this subscale should be interpreted with caution.
This sample showed slightly higher mindfulness
scores (4.25) than the community average (4.20)
reported by the developers of the MAAS. The
majority of participants scored in the high range of
the compassion satisfaction subscale of the PRoQOL, indicating high levels of satisfaction. The
majority scored in the low range of the secondary
traumatic stress and burnout subscales, indicating a
low rate of symptoms in these areas. These findings
suggest that respondents in this survey are not at
high risk for compassion fatigue and instead have
high levels of compassion satisfaction, thought to be
protective against compassion fatigue.
This study found a significant positive relationship between mindfulness (attention awareness) and
compassion satisfaction and significant inverse relationships between mindfulness and secondary traumatic stress and mindfulness and burnout in the
correlation analyses. These results tentatively suggest
that greater levels of mindfulness are associated with
greater levels of compassion satisfaction, which is
also thought to be protective against compassion
fatigue, secondary traumatic stress, and burnout,
although this latter subscale had low reliability.
These findings are supported by past research showing that mindfulness is associated with overall wellbeing (Brown & Ryan, 2003).
Contrary to prior research that suggests that individuals with a personal history of trauma may be at
greater risk for compassion fatigue, this sample
showed lower than average secondary traumatic
stress and burnout scores and higher than average
compassion satisfaction scores. In addition, no differences were observed between bereaved parents and
nonbereaved parents in any of the four scales used
in this study, though the number of nonbereaved
participants was very small. These are very encouraging findings, particularly in light of prior research
that showed intense and enduring psychological

distress in bereaved parents compared to other
bereaved groups (Leahy, 1992; Sanders, 1979).
These findings raise the possibility that elements
of the agency’s mindfulness-based ATTEND model
may contribute to a decreased risk of secondary
traumatic stress and increased levels of compassion
satisfaction in this group. The unexpectedly high
levels of compassion satisfaction and low levels of
secondary traumatic stress and burnout found in this
sample suggest that this particular agency may provide a model for supporting the well-being of individuals who work with clients after a traumatic loss.
However, this study is not able to investigate this
possibility directly, and more research is needed to
investigate whether this, or other factors, may be
responsible for the findings noted here. If further
research supports the efficacy and benefits of this
mindfulness-based model, it could be expanded and
adapted for use in other high-intensity areas of social
work, such as hospice settings or clinical work with
trauma victims.
Limitations

This study has a number of limitations. It was conducted with a small, homogenous sample (n = 41)
drawn from a single agency. This population has
some unique features, such as the narrow group
they serve (traumatically bereaved) and the finding
that the majority (83 percent) has experienced a
traumatic event in the form of child death. Due to
the small number of nonbereaved parents, potential
differences between these two groups could not be
adequately explored. In addition, participants may
have experienced other forms of trauma not captured by this survey. A similar study with a different
helping population might yield different results.
Even though responses were anonymous, respondents may have been motivated by social desirability
bias. In addition, approximately 39 percent of
potential participants did not take the survey, and
some who participated (11 percent) did not complete all items. There may be important differences
between these groups. Information regarding the
amount of actual time participants spent with the
traumatically bereaved was not obtained. There may
be differences between those who work full-time
with this population and those who spend fewer
hours engaged with this group. The majority of
respondents held other jobs in addition to their
involvement with this agency, with only 7.3

Thieleman and Cacciatore / Witness to Suffering: Mindfulness and Compassion Fatigue

39

percent reporting not being employed outside the
home. The inclusion of volunteers in this sample
may have also influenced results. Despite the limitations, this study provides preliminary data regarding
the relationship between mindfulness (attention
awareness) and compassion fatigue and compassion
satisfaction.
Conclusion

Prior research suggests that mindfulness is associated
with greater overall well-being, but the relationship
between mindfulness and compassion fatigue and
satisfaction has not been adequately explored. This
study builds on prior research regarding the benefits
of mindfulness, going beyond what has previously
been studied to examine a new population. Though
this study found a significant positive relationship
between mindfulness and compassion satisfaction
and a significant negative relationship between
mindfulness and compassion fatigue (secondary
traumatic stress and burnout), more research is warranted. This study’s most surprising findings were
the high levels of compassion satisfaction and the
low levels of compassion fatigue among volunteers
and professionals at this agency. Further research is
needed to test whether this finding is directly due to
the mindfulness-based model used at the agency, as
this cannot be determined by these data. Future
research could use an experimental design to test
whether and how mindfulness training impacts
compassion fatigue among social work practitioners
with and without a history of personal trauma.
There is evidence that mindfulness can be an effective self-care strategy. Because mindfulness is teachable and has been shown to have a positive
influence on emotional well-being, mindfulnessbased approaches could be adapted to benefit social
workers as clinicians, interns, or volunteers working
with individuals who have experienced trauma.
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Kara Thieleman, MSW, is a doctoral student, and Joanne
Cacciatore, PhD, is assistant professor, School of Social
Work, Arizona State University, Phoenix. Address correspondence to Kara Thieleman, School of Social Work, Arizona State
University, 411 North Central Avenue, 822K, Phoenix, AZ
85004; e-mail: karajt@gmail.com.
Original manuscript received January 15, 2013
Final revision received March 9, 2013
Accepted March 24, 2013
Advance Access Publication January 1, 2014

Thieleman and Cacciatore / Witness to Suffering: Mindfulness and Compassion Fatigue

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