Secondary trauma is experienced indirectly through hearing details or witnessing the aftermath of a trauma experienced by another person.1 Those who work in helping professions (e.g., social workers, professional counsellors, first responders, and police officers) and the loved ones of trauma survivors are at a greater risk of experiencing secondary trauma or secondary trauma stress.2
What Is Secondary Trauma?
Secondary trauma or second-hand trauma can occur if you are repeatedly exposed to particularly distressing details of the trauma experienced by others.3 Secondary traumatic stress (STS) disorder refers to experiencing a trauma response even though you didn’t experience the trauma directly yourself.1 STS can occur after only one exposure to the details of another’s trauma or after repeated exposures.
Those who experience STS will have at least some of the symptoms that are commonly associated with post-traumatic stress disorder (PTSD). A small proportion of these individuals will experience full-blown PTSD as a result of secondary trauma exposure.3
STS is sometimes also referred to as vicarious trauma, compassion fatigue, and burnout, for which there is some overlap of symptoms; however, there are differences with respect to the cause and effect of each:4
- Vicarious trauma: Refers to permanent changes in the way you view and make sense of the world as a result of the cumulative effects of working with trauma survivors over time.5 These changes can occur in five areas:
- Sense of safety
- Ability to trust others
- Self-esteem
- Intimacy
- Sense of control
- Compassion fatigue: Described as a consequence of STS. It is characterized by emotional and physical exhaustion, and a loss of empathy or compassion for others, as a result of the ongoing “demands of being empathic and helpful to those who are suffering.”2
- Burnout: Described as a response to prolonged interpersonal work-related distress (i.e., not specifically exposure to secondary trauma). It’s characterized by three components:6,7
- Exhaustion: being emotionally and physically depleted or worn out
- Cynicism: becoming irritable, and developing negative or inappropriate attitudes toward your clients/patients
- Inefficiency: as a result of feeling overwhelmed and unable to cope, your work performance suffers
Secondary Traumatic Stress
STS is the result of exposure to the details of someone else’s trauma, causing a traumatic stress reaction even though the trauma never happened to you directly. STS symptoms are identical to symptoms of PTSD, but you might only experience one type of symptom. Alternatively, you might experience several debilitating symptoms to the point of receiving a diagnosis of PTSD.
Potential symptoms include:3
- Intrusive symptoms: You might experience unwanted and painful trauma-related memories, dreams, and/or flashbacks. You might also experience distressing psychological or physical reactions to reminders of the trauma.
- Avoidance symptoms: You might find yourself actively avoiding anything that reminds you of the trauma (e.g., memories, thoughts, emotions, people/places/things, discussions, situations)
- Arousal symptoms: You might find that you are more irritable and prone to angry outbursts, possibly engaging in self-destructive or reckless behaviors. It could be difficult to relax, too. You might experience concentration difficulties, sleep problems, and an exaggerated startle response (e.g., when someone comes up behind you unexpectedly or walks in the room).
Causes of Secondary Traumatic Stress
STS reactions can result from exposure to the distressing details of the traumatic experience of others, such as sexual assault, physical assault, or a terrorist attack.
Potential causes of secondary traumatic stress are:
- Sexual assault
- Physical assault
- Child abuse or neglect
- Motor vehicle accident
- Act of nature (e.g., flood, hurricane, tornado)
- Terrorist attack
- Torture
- War atrocities
- A violent or gruesome death
Who Experiences Secondary Trauma?
Secondary trauma has been referred to as “the cost to caring” and was initially identified as an occupational hazard for mental health professionals due to repeated exposure to details of their clients’ traumas.1,2 Over time, it was recognized as a risk for anyone who, in the course of their work or personal life, is exposed to the graphic details of trauma experienced by others.2
First Responders
Paramedics, police officers, and firefighters are often first on the scene to traumatic events. In the course of their work, they are repeatedly exposed to distressing details, images, and sounds of the trauma. In some cases, if the traumatic event was particularly disturbing, it might only take that one event to result in an STS and/or PTSD response. The general prevalence rate of STS among first responders has been found to be between 4-13%.8
Nurses & Physicians
Nurses and physicians who work in areas where they treat the injuries of trauma survivors are at risk for experiencing STS symptoms.
Specific studies have indicated that:
- As many as 85% of nurses experience symptoms of STS9,10
- 65% of surgeons experience at least one symptom of STS and 22% meet the criteria for PTSD11
- Among emergency medicine staff (i.e., nurse practitioners, physicians and residents), 37% report mild to moderate symptoms of STS, while 8% reported severe symptoms12
- Mental Health Professionals
Social workers, psychologists, psychotherapists, professional counselors, and other mental health professionals who work with survivors of various types of trauma are at risk for developing STS reactions as a result of their exposure to the graphic details of their clients’ traumas, and empathy with their clients’ suffering. Up to 70% have experienced at least one symptom of STS and 15% met the criteria for a diagnosis of PTSD.13
Child Protection Workers
Witnessing the cruelty of caregivers towards vulnerable children can have a significant impact on the well-being of those whose job it is to try to protect them. Approximately 63% of child protection workers show some symptoms of STS and among these, 37% show moderate symptoms.14
Children of Traumatized Parents
If a child hears about the graphic details of their parent’s own trauma experiences (e.g., childhood abuse, a violent physical attack, living through a terrorist attack or war atrocity) they can experience STS and might even be diagnosed with PTSD if their symptoms are severe.3
STS can overlap with intergenerational trauma, which refers to trauma that occurs to one generation and continues to impact the generations that follow. This has been observed among the families of survivors of the Holocaust and Indigenous peoples who have experienced trauma. Unlike STS, it can occur regardless of whether details of the trauma are ever mentioned or referred to. Intergenerational trauma is believed to be transmitted through culture and/or the ways the parent interacts with the child.15
Family Members or Intimate Partners of Traumatized Individuals
Hearing the details and/or witnessing the suffering of a loved one who has been through a traumatic ordeal can result in STS. Although you weren’t exposed directly, you might also be traumatized and exhibit some symptoms of STS or meet the criteria for a PTSD diagnosis. For example, the family members of sexual assault survivors and the romantic partners of soldiers have shown STS symptoms.2
Other Occupations
Journalists, jurors, lawyers, researchers, and insurance claim workers who are in frequent contact with survivors of trauma and the details of their trauma are also at risk for developing STS reactions.2
Increasing Resilience to Secondary Traumatic Stress
A number of factors have been identified as crucial in enhancing resiliency, which allows you to continue to cope, function, and maintain wellness while being exposed to secondary trauma. These include personal, professional, and organizational strategies.9,16
Personal Strategies for Resilience
- Self-care: Making time to engage in activities and practices that support your emotional, physical, and social health and well-being (e.g., ensuring adequate nutrition, sleep, exercise, maintaining a healthy work-life balance, and accessing personal counseling if needed)
- Social support: Having personal relationships with genuinely caring and supportive people
Professional Strategies for Resilience
- Detachment: Cultivating the ability to detach or disengage from work and specifically from client/patient suffering
- Setting boundaries: Creating limits around your interactions with clients/patients, coworkers, and/or the organization you work for (e.g., be conscious of the number of commitments you take on and the makeup of your caseload if possible)
- Peer consultation: Regularly engaging with peers to discuss challenging cases to receive support and other perspectives
- Sense of satisfaction: Being intentionally mindful of the moments of satisfaction and fulfillment you experience in your work
Organizational Strategies for Resilience
- Provide education and opportunities for safe and respectful discussion around STS
- Provide paid time for staff to consult regularly with peers about challenging cases
- Ensure staff members have adequate time and resources to do their work
- Create a supportive working environment where staff feel appreciated for their work
Treatment of Secondary Trauma
Recommended treatment for secondary traumatic stress depends on the number, severity, and duration of symptoms you experience. In many cases of STS, the symptoms will resolve on their own over the course of a few weeks. If your symptoms persist beyond 4 weeks, and/or are interfering with your ability to function in one or more areas of your life, consult with your physician and/or a professional counselor.
Therapy
Given that STS symptoms are identical to those of PTSD, therapies that have proven effective in the treatment of PTSD are usually recommended for STS.
Recommended therapies to treat STS include:17,18
- Cognitive behavioral therapy (CBT): Might also be called cognitive therapy or cognitive processing therapy
- Exposure therapy: Might also be called prolonged exposure therapy
- Eye movement desensitization and reprocessing (EMDR)
How to Find a Therapist
When looking for a therapist to help you with STS, it is important to find one who has a specialization in trauma. You might want to ask for a referral from your doctor, colleagues, or friends/family. If you have health insurance, find out what type of specific mental health professionals you have coverage for (e.g., psychologist, professional counselor, social worker, etc.). Consider using an online directory like Choosing Therapy.
In terms of cost, health insurance might cover all or part of the cost of visits to specific practitioners. Typically, with health insurance coverage, the cost to the client will be $20-$50 per session, and without coverage, the cost is likely to be $60-$120 per session.19,20 The price you will pay will ultimately be dependent on your insurance coverage and the therapist you work with.
Medication
Your primary care physician (PCP) or a psychiatrist might prescribe medication if your STS symptoms are severe and debilitating. Some medications that are commonly used to treat anxiety or depression have also been effective to treat PTSD symptoms and thus might also be used to treat severe STS symptoms. Medications that are commonly prescribed are Serotonin Reuptake Inhibitors (SSRIs).17,21
Final Thoughts On Secondary Trauma
There are times when the cost of caring for others is high. However, you do not have to suffer indefinitely, nor do you need to go through this alone. Effective treatments are available to help you to reclaim your life, joy, and sense of purpose. It is time to show yourself the same level of compassion that you show others.
