The concept of compassion fatigue has been around for twenty five years. Often closely linked (and at times incorrectly used interchangeably with) burnout, compassion fatigue has been a focus for researchers interested in mitigating the risks workers face with prolonged exposure to the suffering of others. Leading experts are calling for a change in terminology, suggesting that ‘empathic strain’ is a more accurate term due to the differing neural networks involved in empathy and compassion. See below for a brief overview of the discussion.
Three organising principles of polyvagal theory

Polyvagal theory describes the science of feeling safe enough to fall in love with life.
A couple of weeks ago I was lucky enough to attend some sessions at the Online International Child Trauma Symposium. On the first day the wonderful Deb Dana spoke - what a font of wisdom, compassion and practical know-how she is!
Dana, a social worker in the US, is well known for her ability to translate the complex neurobiology of Polyvagal Theory, conceptualised by Stephen Porges, into accessible and relatable gems of support for everyday. In fact, they've teamed up and created the Polyvagal Institute to help spread the 'art and science of human connection' that is polyvagal theory.
What is Polyvagal Theory?
Polyvagal Theory (PVT) describes the evolution of mammalian nervous systems to connect, feel safe and loved in relationship, and respond without thinking to real or perceived threat in order to survive.
The vagus nerve is the longest autonomic nerve in the human body. Connected from the brain to the nerves of the face, the heart, the lungs and the key organs all the way down to our digestion, the functioning of the vagus nerve, is central to
- connecting our minds and bodies
- how we find safe connection in relationship with others
- how we brace to protect ourselves through fight, flight, freeze or shut down.
Three organising principles
The purpose of this post is not to go into the detail of the neurobiology of PVT but to explore what Dana calls the three organising principles of PVT:
- hierarchy
- neuroception and
- co-regulation.
1. Hierarchy
Our nervous systems are wired to help us to connect and survive.
PVT describes a three-tiered hierarchy of nervous system states:
- Connection (ventral vagal):
We feel safe and seek out connection for comfort and companionship. We feel at ease and relaxed.
- Mobilisation:
A high energy state where our bodies mobilise to get ready to fight or flee from real or perceived danger. We feel agitated, on edge, our heartbeat races, we may get hot and flushed and our muscles are tense, ready to spring into action.
- Disconnection (dorsal vagal):
A low energy state where we may feel flat and lethargic. We may withdraw, become small, try to disappear, or in extreme cases go into a state of shut down.
This hierarchy shows that when faced with threat, we will initially reach out to connect with others for safety.
If this is not an option, we go into a mobilised state of fight or flight to protect ourselves.
When fight or flight will not alleviate the danger, our body goes into a state of shut down in order to protect us.
You may have seen a mouse ‘play dead’ when a cat approaches, in the hope that the cat will assume it is already dead, and then spring into action to run away when the cat has passed?
This is the shutdown response.
2. Neuroception
Neuroception is our nervous system’s ability to respond to signals of warning or welcome, out of our conscious awareness. Dana conceptualises three ways that the nervous systems explores and decides whether we should move into connection or protection:
- Inside us – the body’s internal sensations and cues
- Outside – what is happening in the environment around us
- Between – ourselves and another person (ie. two nervous systems); in relationship
3. Co-regulation
We are wired to be in connection with others.
Before we can self regulate we need many repetitions of co-regulation. And even then, because neuroception occurs outside of conscious awareness, we often need what Dana calls “an organising other” to help us to return to a state of safety and connection. Then we are more able to bring our conscious awareness to our neuroception in order to support ourselves.
So, why does any of this matter?
Our neuroception is always assessing whether or not we are safe. Because this happens all the time, out of our conscious awareness, we don’t always know why we might react in certain ways.
It’s always helpful to know if we’re feeling safe or not. Sometimes it’s very subtle, and can be quite tricky! But, if we are able to tune into our feelings and sensations, this helps to increase our awareness. If you are interested in some way that you can tune in to your body, you can see this post from last month: What's the body got to do with it?
The more aware we are of our internal states, the more we are able to seek the support we need from
- ourselves
- another with whom we can be vulnerable and safely co-regulate
This is not only true for humans but for all mammals - the horses pictured clearly feel safe and connected.
It is our responsibility to tune into what happens in our own nervous system… and to be curious about what is happening in another.
Related Resources
What's the body got to do with it?
The body is our home. But what happens when we become disconnected from this home, unable to feel it, or to notice when it needs a break or nourishment? What happens when we tune out from it, turn away and ignore the vital messages it is sharing with us? See below as we explore the role of being aware of, and connecting with the body and its sensations for embodied health and wellbeing - for yourself and the wellbeing of those in your care.
How being present protects you at work
We don’t leave ourselves behind when we go to work, we take our whole selves in. Some days it is easy to keep ourselves separate. But when we are tired, have a special connection to a client or patient, have difficulties of our own, or are touched by the moment, it is not always possible, or appropriate, to maintain a separation. We feel their joy and we feel their pain. And sometimes it touches ours.
The 'Joy - Pain Spectrum' in helping: vicarious resilience (Part 1/5)
Post-traumatic growth is a familiar concept to many. But what about other positive impacts that workers can experience? Vicarious resilience and compassion satisfaction help us to understand the ways that workers in helping or caring roles can be positively impacted, or even transformed, by witnessing the strength and resilience of others. Holding an awareness of both ends of the spectrum - the joy and the pain in the work - may hold the key for a healthy, successful and durable career.
The 'Joy - Pain Spectrum' in helping: compassion satisfaction (Part 2/5)
Within the helping professions we often focus on the more challenging end of the joy - pain spectrum in this work: exhaustion, compassion fatigue, secondary stress and vicarious trauma. This blog series seeks to rectify that, with Part 1 focusing on vicarious resilience, Part 2 unpacking compassion satisfaction, Part 3 looks at suggested changes in terminology and Part 4 addressing the importance of, and risks associated with, connecting with others when in a helping role. Cultivating awareness of both ends of the joy - pain spectrum in the helping professions is essential in supporting worker wellbeing.
Header image: Claire Nolan