Evaluating the feasibility, acceptability, and preliminary impact of a self-compassion program on self-compassion, compassion fatigue, compassion satisfaction, and well-being amongst peer mentors within community-based spinal cord injury organizations in Canada

A spinal cord injury (SCI) is defined as any impairment to sensory, motor, or autonomic function caused by damage to the nerves of the spinal cord that leads to temporary or permanent changes in function (Praxis Spinal Cord Institute, 2019). To help individuals living with a SCI adapt to their new realities and thrive in life, nine SCI community-based organizations in Canada have developed peer mentorship programs (Canadian SCI Peer Mentorship Community-University Research Group, 2020). The premise of these programs is to connect individuals who have experience in living with a SCI (peer mentors) with fellow individuals with SCI (mentees). A meta-analysis concluded that SCI peer mentorship programs are beneficial to mentees in terms of promoting independence (i.e., enhanced self-sufficiency), personal growth (i.e., positive psychological changes), activities and participation (i.e., greater participation in activities/events), adaptation (i.e., adapting to life with disability), knowledge (i.e., obtaining new information/resources/opportunities), and connection (Rocchi et al., 2021). From the mentor perspective, studies have shown that being an SCI mentor can lead to gaining gratitude, confidence, pride, and personal growth (Sweet et al., 2021). Importantly, being a mentor can also lead to negative outcomes. For example, the impact of negativity (e.g., difficult conversations), emotional toll, (e.g., reliving traumatic experiences), disappointment (e.g., when expected outcomes were not attained with a mentee), time/energy demands/boundaries (i.e., needing to assert boundaries to mediate needs that exceed mentor’s capacity/time/tolerance), and lack of engagement (e.g., working with unmotivated mentees). Alexander et al. (2021) specifically highlighted this “dark” side of providing SCI mentorship whereby mentors occasionally experience feelings of physical, mental, and emotional exhaustion. Mentor exhaustion resulted from engaging in conversations about assisted suicide and being surrounded by pain, grief, loss, and despair, which led to feelings of apprehension in bringing that sadness home to their family. Consequently, mentors’ felt a sense of apathy towards their mentees. In recent conversations with two Canadian SCI community-based organizations (SCI British Columbia, SCI Ontario), mentors are stepping down from their roles because of this emotional toll. This phenomenon is often experienced in caring professions and is specifically referred to as compassion fatigue. Compassion fatigue is defined as a state of exhaustion and dysfunction as a consequence of prolonged exposure to trauma/suffering and stress (Figley & Figley, 2017). Signs and symptoms of compassion fatigue include depression and anxiety, anger/irritability, dread of working with clients/patients, inability to concentrate, and ironically reduced ability to feel sympathy and empathy (Harr et al., 2014; Hegney et al., 2014). One model that aims to describe the factors and processes that lead to compassion fatigue – or one’s resilience to it – is the Compassion Fatigue Resilience Model or CFRM (Figley & Ludick, 2017). According to the CFRM, there are a set of factors that can make individuals more susceptible (i.e., risk factors) or resilient (i.e., protective factors) to experiencing compassion fatigue. Within the CFRM is the category of self-care, which refers to “a proactive, holistic, and personalized approach to the promotion of health and well-being through a variety of strategies, in both personal and professional settings, to enhance capacity for care of patients and their families” (Mills et al., 2018, p.1). One variable that can fit within the category of self-care and that has been found to help reduce compassion fatigue amongst individuals in caring professions is self-compassion (Finlay-Jones et al., 2018). Self-compassion is broadly defined as a healthy way of relating to the self (Neff, 2003a). Self-compassion is comprised of three subcomponents and their counterparts, which include 1) Self-Kindness (vs. Self-Judgement), which refers to having a gentle stance towards the self rather than being harsh and critical, 2) Mindfulness (vs. Over-Identification), which is having a balanced awareness of one’s thoughts and emotions rather than becoming swept away with them, and 3) Common Humanity (vs. Isolation), which refers to understanding the universality of one’s own suffering as opposed to feeling alone (Neff, 2003a). Meta-analyses and systematic reviews have shown that self-compassion is associated with improved well-being (e.g., happiness, life satisfaction) and reduced ill-being (e.g., depression, anxiety) with medium-to-large effects in clinical and non-clinical samples (Athanasakou et al., 2020; Neff et al., 2018; Zessin et al., 2015). Self-compassion can be cultivated in various ways (Germer & Neff, 2019) and therefore self-compassion programs have been developed (e.g., Mindful Self-Compassion Program; Neff & Germer, 2013). In healthcare workers, a systematic review confirmed that generalized self-compassion programs were effective in increasing self-compassion and well-being (Eriksson et al., 2018; Sinclair et al., 2017). There have also been recent suggestions to adapt self-compassion to the targeted population (Germer et al., 2015). As such, researchers and practitioners should set out to fully understand the context and unique population and individual needs, for example within the context of SCI mentorship. This adaptation has been done within the context of care workers. For instance, the Mindful Self-Compassion Program for Healthcare Communities was created (Neff et al., 2020). Compared to a control group, this program was effective in increasing self-compassion, well-being, and compassion for others, as well as reducing secondary traumatic stress and burnout. This program likely has more utility for care workers compared to the original Mindful Self-Compassion program. For example, it is of shorter duration (i.e., 1 hour a week for 6-weeks instead of 2-3 hours a week for 8-weeks), is conducted at work (as opposed to separately after work hours), and is geared towards caring professions (e.g., having a session on compassion fatigue). Though this program has been tested in healthcare communities (e.g., nurses, physicians), it’s potential role in reducing compassion fatigue and promoting self-compassion, well-being, and compassion satisfaction in SCI mentors is unknown. Further, it is unknown as to whether this program is feasible or acceptable within the context of SCI peer support programs and within their larger organizations. Thus, the overall purpose of this study is to examine the feasibility (e.g., recruitment rate, adherence), acceptability, and preliminary impact of an adapted self-compassion program on self-compassion, compassion fatigue (primary outcomes), well-being, and compassion satisfaction (secondary outcomes) amongst SCI peer mentors.

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