We’ve probably all heard about passive smoking. Long-term exposure to cigarette smoke has adverse effects on our health and well-being. After a while, we may be breathless, we may have difficulty taking a breath, and our eyes become irritated.
The experience of “absorbing trauma” is much the same as inhaling secondhand smoke. Helping people who have experienced trauma every day can have negative consequences for the helper.
If you are involved in helping in your work, you may be exposed to a great deal of emotional strain. This, in turn, can carry the risk of experiencing secondary trauma or vicarious trauma.
Learn more about the specifics of these indirect traumas, find out the differences between them, and learn about ways to cope and how to protect yourself from this phenomenon.
What is secondary trauma? Can it lead to PTSD?
The American Counselling Association defines secondary trauma as “the emotional residue of exposure to traumatic stories and experiences of others.” Secondary trauma can result from witnessing the fear, pain and horror experienced by others, and can be the result of being preoccupied with terrible, painful stories.
According to the DSM V, secondary trauma can cause symptoms that meet the criteria for post-traumatic stress disorder (PTSD). According to the DSM: “repeated or extreme indirect exposure to the aversive details of a traumatic event” can be a powerful stressor that affects the risk of developing PTSD. This is especially true if secondary trauma or burnout is not adequately addressed.
It is worth mentioning that not everyone who experiences secondary trauma will meet the criteria for PTSD; just as not everyone who experiences traumatic events develops a trauma-related disorder.
Exposure to the stress of others. Secondary trauma vs. vicarious trauma
Secondary trauma and vicarious trauma exhibit similar symptom characteristics. These categories of trauma occur as a result of exposure to the traumatic experiences of others. However, they differ in the duration of exposure to aversive stories.
Secondary tra uma refers to trauma symptoms that occur after hearing a traumatic story once or witnessing someone else’s trauma. Secondary post-traumatic stress disorder can occur suddenly, for example, after hearing a patient’s story or after witnessing a tragedy.
Vicarious trauma refers to symptoms of trauma that develop over time in response to prolonged exposure to multiple people’s pain. Experiencing vicarious trauma often involves a change in one’s worldview and personal beliefs. For example, a domestic violence shelter worker who regularly assists women victims of trauma, victims of domestic violence, may begin to believe in the belief that all men are or will become violent and prone to violence.
Stress and traumatization. What causes vicarious trauma?
As I mentioned earlier, vicarious trauma occurs in response to repeated exposure to traumatic events experienced by victims(traumatic stress disorder). Witnessing the story, hearing about the trauma, and interacting to support other people can be traumatic for the helper, even if the helper is not directly experiencing the trauma herself.
Anyone exposed to such exposure can develop vicarious trauma, especially those with their own history of trauma. In addition, professionals who don’t have access to adequate support or haven’t learned coping skills are more likely to have this experience.
Who is at risk for secondary traumatization?
Exposed to forms of indirect trauma are doctors, psychologists, psychotherapists. Professionals who listen to stories of suffering and treat patients who are victims of trauma.
Those in direct contact with the suffering are also exposed : volunteers, nurses, but also firefighters or police officers. In anyone who works with trauma and violence survivors on a daily basis, the risk is elevated. Factors that can make a person more susceptible to the risk of secondary traumatization are:
- previous traumatic experiences,
- social isolation, both on and off the job,
- a tendency to avoid feelings, withdraw or assign blame to others,
- difficulties in expressing feelings,
- having to make many decisions without sufficient support,
- lack of preparation, training and supervision in one’s work,
- being a novice in one’s work, little work experience,
- constant and intense exposure to trauma with little or no change in work tasks,
- lack of an effective and supportive process for discussing traumatic work content.
Vicarious trauma – contact with victims of trauma
Professionals can respond to their patients’ painful stories in many ways. However, it seems that a change in their worldview is inevitable. Professional experiences affect beliefs about others and the world. Reactions to these experiences can vary; workers may become more cynical or fearful, or they may become more appreciative of what they have.
It is worth mentioning that reactions to trauma can change over time, and may vary with age and ongoing changes in the personal sphere, for example.
Reactions to encountering traumatic stories can be negative, neutral or positive.
Negative reactions to exposure to trauma include a range of symptoms and are linked to related issues such as compassion fatigue and job burnout.
Neutral reaction implies an adequate level of resilience, an adequate level of support and coping strategies to help receive the traumatic content.
Resilience and vicarious transformation are newer concepts that reflect positive responses. For example, some professionals may draw inspiration from victims’ resilience, which strengthens their own mental and emotional strength.
Another protective response is the sense of meaning gained from working on behalf of victims and helping others. Giving meaning to one’s actions strengthens one’s motivation and belief in what one is doing. And as a result, it can protect against the negative effects of exposure to trauma.
Symptoms of vicarious trauma
Each person may experience the effects of vicarious trauma or secondary trauma differently. Some of the potential negative reactions include:
- difficulty managing emotions,
- feelings of emotional numbness,
- fatigue, drowsiness or difficulty falling asleep, nightmares,
- physical ailments, e.g., neuralgia and reduced resistance to illness,
- ease of distraction,
- loss of a sense of purpose in life and a sense of hopelessness about the future;
- relationship problems (e.g., withdrawal from relationships with friends and family, increased interpersonal conflicts, avoidance of intimacy),
- feelings of vulnerability or excessive worry about potential threats,
- increased irritability, violent outbursts of anger,
- addictive behavior (e.g., eating disorders, substance abuse, gambling, excessive risk-taking in sports),
- lack of or reduced participation in activities that were previously enjoyable,
- avoidance of work and interaction with patients.
Occupational burnout and vicarious trauma
Some symptoms of occupational burnout have similar characteristics, for example: irritability, interpersonal conflicts and feeling overwhelmed. However, occupational burnout is a much broader concept and applies to many categories of occupations. The causes of occupational burnout are many, ranging from lack of support in the workplace to excessive responsibilities and lack of work-life balance.
Vicarious trauma occurs in people working in helping professions where they witness or hear stories of traumatic events. In the context of work involving exposure to trauma, people working in such occupations are exposed to both. Long-term exposure to traumatic experiences can lead to job burnout, as well as the development of symptoms of vicarious trauma.
Vicarious trauma among psychologists and psychotherapists
Vicarious traumatization is a serious threat to those working in the fields of health care and psychotherapy. Stories of violence, abuse, loss, suffering and other forms of trauma expose professionals to difficult experiences.
Empathy in recognizing another person’s suffering sometimes creates vulnerability. Working with patients can lead to a gradual accumulation of stress and empathic overload, which can eventually lead to serious consequences for therapists themselves. Empathically listening to more stories of human suffering challenges the clinician’s deeply held beliefs, assumptions and expectations, which can manifest as intrusive thoughts and images, as well as other emotional and behavioral manifestations.
Vicarious trauma refers to negative changes in a clinician’s perceptions of self, others and the world resulting from repeated empathic engagement with the thoughts, memories and emotions of his or her patients
Test – compassion fatigue
The concept of compassion fatigue has only emerged in the last few years. Compassion fatigue is the emotional residue of working with human suffering. Professionals working with people have to contend not only with ordinary stress or dissatisfaction with their work, but also with emotional and personal feelings toward suffering.
If you feel exhausted, overwhelmed, feel like you’re losing your sense of self to clients, check the level and resources of your compassion. Take the test – Compassion Fatigue/Satisfaction Self-Test (CFS)
Start helping yourself. How to protect yourself from vicarious trauma?
If you are at risk of vicarious trauma due to your work, you can take steps to reduce the likelihood of trauma symptoms. Everyone has individual self-care needs, so you may need to try different skills to see what will work for you.
- Take care of your needs. Pay attention to your emotional state and how you respond to the trauma you are exposed to. Take care of your downtime.
- Stick to your sleep schedule. When you are rested, it is easier to take care of yourself.
- Maintain your daily routine (predictability helps).
- Share your concerns and develop support strategies with your loved one.
- Set strong boundaries. Many people in positions at risk of vicarious trauma show empathy and care for the people they work with, which is good in itself. However, sometimes having to put that aside can be difficult when you don’t have time to work. Make sure you have boundaries around your work.
- Seek support. If necessary, start your own therapy – online psychotherapy. Ask your trusted people, friends and family for help.
- Ask yourself questions, what is particularly important to you outside of work? What things give you pleasure? What recharges your batteries? Making time for these activities helps prevent vicarious trauma.
Secondary traumatic stress syndrome. How do you protect your employees?
Protecting employees from trauma is an important task for any work center, especially in areas where stressful or traumatic situations may occur. Various measures can be taken to support employees, such as:
- discussing vicarious trauma in supervision – supervising,
- creating a supportive, safe work environment,
- allowing flexible work schedules,
- creating time and physical space at work for reflection, conversation,
- preventive measures to protect against vicarious trauma
How to treat vicarious trauma?
If you are struggling with vicarious trauma or secondary trauma, there is help available. In particular, cognitive-behavioral therapy, schema therapy and EMDR are recommended, which can effectively alleviate the symptoms of vicarious trauma.
Cognitive-behavioral therapy (CBT): helps you recognize and change negative thoughts and beliefs related to the trauma, and learn skills to cope with anxiety and stress.
Schema therapy: can be an effective method of treating vicarious trauma, especially if a person has experienced trauma in the past and today must face the suffering and trauma of others.
EMDR (Eye Movement Desensitization and Reprocessing)therapy: helps process traumatic memories and reduce their impact on daily life.
If you experience vicarious trauma, you may benefit from therapy services to treat the symptoms of trauma . You may also need more self-care and rest.
You are not alone. Many people experience vicarious trauma. You deserve help and support.
Bibliography:
Sharon Rae Jenkins, Stephanie Baird, “Secondary traumatic stress and vicarious trauma: A validational study”
https://onlinelibrary.wiley.com/doi/10.1023/A:1020193526843
Jeongsuk Kim, Brittney Chesworth, Hannabeth Franchino-Olsen, Rebecca J. Macy, “A Scoping Review of Vicarious Trauma Interventions for Service Providers Working With People Who Have Experienced Traumatic Events”
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8426417/#bibr43-1524838021991310