Secondary trauma is a stress reaction that can occur after indirect exposure to another person’s trauma—for example, when hearing accounts of violence, an accident, or a loss. Vicarious trauma, on the other hand, describes a more gradual change in how one perceives oneself, other people, and the world, resulting from repeated exposure to the suffering of others.
Both phenomena can affect psychotherapists, psychologists, doctors, nurses, first responders, police officers, social workers, lawyers, journalists, and volunteers. They do not indicate a lack of professionalism or “excessive sensitivity.” They are a possible consequence of work that requires regular exposure to the traumatic experiences of others.
In this article, I will explain the differences between secondary trauma, vicarious trauma, compassion fatigue, and burnout; what symptoms to watch for; and what can help at the individual, team, and organizational levels.
Key Takeaways
-
Secondary trauma may resemble post-traumatic reactions, even though the helper did not experience the event directly.
-
Vicarious trauma primarily involves gradual changes in beliefs, a sense of safety, and one’s worldview.
-
Compassion fatigue describes the exhaustion associated with providing long-term support to those who are suffering.
-
Burnout can occur in any profession and does not require exposure to trauma.
-
Self-care alone does not replace an organization’s responsibility for workload management, training, supervision, and psychological safety.
-
A PTSD diagnosis should not be made based on an online checklist.
What is secondary trauma? Can it lead to PTSD?
The American Counseling Association defines secondary trauma as“the emotional aftermath of exposure to the traumatic stories and experiences of others.” Secondary stress can result from witnessing the fear, pain, and horror experienced by others, or from becoming preoccupied with terrible, painful stories.
According to the DSM-5, secondary trauma can cause symptoms that meet the criteria for post-traumatic stress disorder (PTSD). According to the DSM:“repeated or extreme vicarious exposure to aversive details of a traumatic event” can be a powerful stressor that influences the risk of developing PTSD. This is especially true if appropriate measures are not taken to address secondary trauma or occupational burnout.
It is worth noting that not everyone who experiences secondary trauma will meet the criteria for PTSD; similarly, not everyone who experiences traumatic events develops a trauma-related disorder.
Exposure to Others’ Stress: Secondary Trauma vs. Vicarious Trauma
Secondary trauma and vicarious trauma share similar symptom characteristics. These categories of trauma arise as a result of exposure to the traumatic experiences of others. However, they differ in the duration of exposure to distressing stories.
Secondary trauma refers to trauma symptoms that arise after hearing a traumatic story just once or witnessing someone else’s trauma. Secondary post-traumatic stress disorder may occur suddenly, for example, after listening to 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 the suffering of many people. Experiencing vicarious trauma is often associated with a shift in one’s worldview and personal beliefs. For example, a staff member at a shelter for victims of domestic violence who regularly assists women—victims of trauma and domestic violence—may begin to believe that all men are or will become aggressive and prone to violence.
Stress and Traumatization. What Causes Vicarious Trauma?
As I mentioned earlier, vicarious trauma arises in response to repeated exposure to the traumatic events experienced by victims (post-traumatic stress disorder). Witnessing accounts of trauma, hearing about traumatic experiences, and providing support to others can be traumatic for the helper, even if they do not directly experience the trauma themselves.
Anyone exposed to such situations can develop vicarious trauma, especially those with a personal history of trauma. Furthermore, professionals who do not have access to adequate support or have not learned coping skills are more vulnerable to this experience.
Who is at risk of secondary traumatization?
Doctors, psychologists, and psychotherapists areat risk of vicarious trauma. These are professionals who listen to accounts of suffering and treat patients who are victims of trauma.
Also at risk are those who have direct contact with victims: volunteers, nurses, as well as firefighters and police officers. Anyone who works daily with people who have survived trauma and violence faces an increased risk. Factors that may make a person more susceptible to secondary traumatization include:
- previous traumatic experiences,
- social isolation, both at work and outside of it,
- a tendency to avoid feelings, withdraw, or blame others,
- difficulty expressing emotions,
- the need to make many decisions without sufficient support,
- lack of preparation, training, and supervision in one’s job,
- being new to the job, limited professional experience,
- constant and intense exposure to trauma with little or no variation in job tasks,
- a lack of an effective and supportive process for discussing the traumatic nature of the work.
Secondary trauma—contact with trauma victims
Professionals may react to their patients’ painful stories in many ways. However, it seems that a shift in their worldview is inevitable. Professional experiences influence beliefs about others and the world. Reactions to these experiences can vary; employees may become more cynical or fearful, or they may come to appreciate what they have more.
It is worth noting that reactions to trauma can change over time and may vary depending on age and other changes, such as those in one’s personal life.
Reactions to exposure to traumatic stories can be negative, neutral, or positive.
A negative reaction to exposure to trauma encompasses a range of symptoms and is associated with related issues such as compassion fatigue and occupational burnout.
A neutral reaction indicates an appropriate level of resilience, adequate support, and coping strategies that help in processing traumatic content.
Resilience and vicarious transformation are newer concepts reflecting positive reactions. For example, some professionals may draw inspiration from the resilience of victims, which strengthens their own psychological and emotional fortitude.
Another protective response is the sense of meaning gained through working on behalf of victims and helping others. Finding meaning in one’s actions strengthens motivation and faith in what one is doing. Consequently, 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,
- a feeling of emotional numbness,
- fatigue, drowsiness, or difficulty falling asleep, nightmares,
- physical symptoms, such as neuralgia and a weakened immune system,
- easily becoming distracted,
- a loss of meaning in life and a sense of hopelessness about the future;
- relationship problems (e.g., withdrawing from relationships with friends and family, increased interpersonal conflicts, avoiding intimacy),
- a sense of vulnerability or excessive worry about potential threats,
- increased irritability, sudden outbursts of anger,
- addictive behaviors (e.g., eating disorders, substance abuse, gambling, taking excessive risks while playing sports),
- lack of or reduced participation in activities that were previously enjoyable,
- avoidance of work and interaction with patients.
Burnout and Vicarious Trauma
Some symptoms of occupational burnout share similar characteristics, such as irritability, interpersonal conflicts, and a sense of being overwhelmed. However, occupational burnout is a much broader concept and applies to many occupational categories. The causes of occupational burnout are numerous, ranging from a lack of support in the workplace to an excessive workload and a lack of work-life balance.
Secondary trauma occurs in individuals working in helping professions, where they witness or hear accounts of traumatic events. In the context of work involving exposure to trauma, individuals in such professions are at risk for both of these phenomena. Prolonged exposure to traumatic experiences can lead to burnout as well as the development of vicarious trauma symptoms.
Secondary Trauma Among Psychologists and Psychotherapists
Secondary traumatization poses a serious threat to those working in the fields of healthcare and psychotherapy. Stories of violence, abuse, loss, suffering, and other forms of trauma expose professionals to difficult experiences.
Empathy in acknowledging another person’s suffering sometimes leaves us feeling vulnerable. Working with patients can lead to a gradual buildup of stress and empathic overload, which in turn can have serious consequences for the therapists themselves. Empathically listening to successive stories of human suffering undermines the clinician’s deeply rooted beliefs, assumptions, and expectations, which may manifest as intrusive thoughts and images, as well as other emotional and behavioral symptoms.
Secondary trauma refers to negative changes in a clinician’s perception of self, others, and the world, resulting from repeated empathic engagement with their patients’ thoughts, memories, and emotions.
Test – Compassion Fatigue
The concept of compassion fatigue has only emerged in the last few years. Compassion fatigue is the emotional aftermath of working with human suffering. Professionals who work with people must contend not only with ordinary stress or job dissatisfaction, but also with emotional and personal feelings toward suffering.
If you feel exhausted, overwhelmed, or as though you’re losing your sense of self to your clients, check your level of compassion and your compassion resources. Take the Compassion Fatigue/Satisfaction Self-Test (CFS)
Secondary Trauma vs. Vicarious Trauma
| The Phenomenon | Shortest definition | Typical scenario | Main source |
|---|---|---|---|
| Secondary trauma | Symptoms similar to PTSD following indirect exposure to trauma | Intrusive images, avoidance, arousal, sleep problems | Exposure to traumatic details or the suffering of others |
| Vicarious trauma | Cumulative shift in beliefs and worldview | Loss of trust, sense of security, cynicism, helplessness | Long-term empathetic involvement in the stories of many people |
| Burnout | The result of chronic workplace stress that has not been effectively managed | Exhaustion, detachment, or cynicism toward work; a decline in the sense of effectiveness | Working conditions, overload, lack of influence and resources |
| Compassion fatigue | An umbrella term used to describe the costs of helping others | May combine elements of secondary stress and burnout | Prolonged helping with insufficient recovery |
The boundaries between these concepts aren’t always clear-cut, and researchers use them in different ways. That’s why it’s more important to notice specific changes—such as what’s happening with your emotions, sleep, relationships, work, and sense of safety—rather than labeling yourself.
Start taking care of yourself. How can you protect yourself from vicarious trauma?
If your job puts you at risk for vicarious trauma, you can take steps to reduce the likelihood of experiencing trauma symptoms. Each of us has individual self-care needs, so you may need to try out different strategies to see what works best for you.
- Take care of your needs. Pay attention to your emotional state and how you react to the trauma you’re exposed to. Make sure to take breaks during work.
- Stick to your sleep schedule. When you’re well-rested, it’s easier to take care of yourself.
- Maintain your daily routine (predictability helps).
- Share your concerns and develop support strategies with a loved one.
- Set strong boundaries. Many people in roles at risk of vicarious trauma are empathetic and care deeply about the people they work with, which is a good thing in itself. However, it can sometimes be difficult to set this aside when you don’t have time to work. Make sure you have clear boundaries around your work.
- Seek support. If necessary, start your own therapy— online psychotherapy. Ask your trusted confidants, friends, and family for help.
- Ask yourself: What is particularly important to you outside of work? What things bring you joy? What recharges your batteries? Taking time for these activities helps prevent vicarious trauma.
Secondary Post-Traumatic Stress Disorder. How to Protect Your Employees?
Protecting employees from trauma is a critical task for every workplace, especially in areas where stressful or traumatic situations may occur. Various measurescan be taken to support employees, such as:
- Discussing vicarious trauma during supervision. Use CBT supervision to better manage the stress.
- creating a supportive, safe work environment,
- offering flexible work schedules,
- allowing time and physical space at work for reflection and conversation,
- implementing preventive measures to protect against vicarious trauma
How to Treat Vicarious Trauma?
If you’re struggling with vicarious trauma or secondary trauma, help is available. In particular, cognitive-behavioral therapy (CBT), schema therapy, and EMDR are recommended, as they can effectively alleviate the symptoms of vicarious trauma.
Cognitive-behavioral therapy (CBT):helps identify and change negative thoughts and beliefs related to trauma and develop skills for coping with anxiety and stress.
Schema therapy: can be an effective treatment for vicarious trauma, especially if a person has experienced trauma in the past and now must cope with 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 can seek therapeutic services to treat the symptoms of trauma. You may also need to prioritize self-care and rest.
You are not alone. Many people experience vicarious trauma. You deserve help and support.
Frequently Asked Questions (FAQ)
Can secondary trauma result from a single incident?
A strong reaction can occur after a single, highly distressing exposure, but research shows that secondary traumatic stress is also often associated with repeated occupational exposure. The duration of exposure alone is not sufficient to distinguish between all these concepts.
Is vicarious trauma a diagnosis?
Vicarious traumaisa concept describing the possible cumulative impact of working with others’ trauma, rather than a separate diagnosis in diagnostic classifications.
Will every helping professional experience vicarious trauma?
No. Reactions depend on the type of exposure, resources, personal history, work organization, and available support.
How does secondary trauma differ from burnout?
Secondary trauma is associated with indirect exposure to trauma and may resemble PTSD. Burnout results from chronic occupational stress and involves exhaustion, detachment from work, and a decline in a sense of efficacy.
Does supervision prevent vicarious trauma?
Supervision is an important element of prevention and early intervention, but it offers no guarantees. It should be part of a broader system that includes a reasonable workload, training, recovery, and organizational support.
Is self-care enough?
Not always. Sleep, rest, boundaries, and relationships help, but they cannot replace changes to harmful working conditions or specialized help for persistent symptoms.
References:
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