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  • What Is Secondary Trauma?What Is Secondary Trauma?
  • SymptomsSymptoms
  • CausesCauses
  • Who Experiences It?Who Experiences It?
  • How to RespondHow to Respond
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Trauma Articles Trauma Types of Trauma Therapy PTSD Best Online Therapy

Secondary Trauma: Definition, Symptoms, & How to Cope

Headshot of Shirley Porter, RP, RSW, CCC

Author: Shirley Porter, RP

Headshot of Shirley Porter, RP, RSW, CCC

Shirley Porter RP

With over 30 years of experience, Shirley specializes in treating trauma (PTSD/CPTSD), depression, anxiety, grief, and relationship issues, using an eclectic therapeutic approach.

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Medical Reviewer: Dena Westphalen, Pharm.D Licensed medical reviewer

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Dr. Dena Westphalen is a pharmacist with expertise in clinical research and drug information. She has interests in neurology, oncology, and global health.

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Published: July 30, 2024
  • What Is Secondary Trauma?What Is Secondary Trauma?
  • SymptomsSymptoms
  • CausesCauses
  • Who Experiences It?Who Experiences It?
  • How to RespondHow to Respond
  • TreatmentTreatment
  • In My ExperienceIn My Experience
  • InfographicsInfographics
  • Additional ResourcesAdditional Resources

Secondary trauma is experienced indirectly through hearing details about or witnessing the aftermath of a trauma experienced by another person.1 Helping professionals, BIPOC communities, and the loved ones of trauma survivors are at a greater risk of developing secondary trauma stress.2 Symptoms commonly include intrusive memories, hyperarousal, and flashbacks.

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What Is Secondary Trauma?

Secondary trauma (second-hand trauma) can occur after exposure to distressing details of trauma experienced by others.3 Those with secondary traumatic stress (STS) exhibit at least some symptoms 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

Vicarious Trauma Vs. Secondary Trauma

These terms are often used interchangeably to describe the impacts of trauma on helping professionals. Vicarious trauma is often used to describe a helper’s inner experience, such as changes in their beliefs about spirituality, their mindset or their worldview. Secondary trauma is often used to describe PTSD symptoms including hypervigilance, avoidance or re-experiencing.

Secondary Trauma Vs. Compassion Fatigue

While compassion fatigue often occurs alongside secondary trauma, it is often characterized by an increased feeling of apathy or emotional detachment. A person with compassion fatigue may feel emotionally exhausted and find it harder to empathize with the people they are helping.

Secondary Trauma Symptoms

The symptoms of secondary trauma are almost identical to symptoms of PTSD. Helping professionals who work with trauma survivors can develop their own symptoms as the result of the traumatic stories and experiences they’re exposed to in their work.

Symptoms of secondary traumatic stress may include:

  • Flashbacks
  • Intrusive memories
  • Intrusive thoughts
  • Emotional detachment or numbness
  • Hypervigilance
  • Avoidance of reminders of the trauma
  • Changes in mood
  • Difficulty functioning in daily life
  • Increased anger
  • Feelings of hopelessness

Causes of Secondary Traumatic Stress

Secondary traumatic stress occurs when a person witnesses or hears about a trauma that happened to another person directly. This includes hearing stories of abuse, assault, accidents or disasters. Hearing or witnessing these results on a regular basis in the workplace can increase the risk of secondary trauma.

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?

Anyone who witnesses or hears about a traumatic event can experience the symptoms of secondary trauma. This could include a friend or loved one, bystanders, or any number of helping professionals who come to the aid of people who have been traumatized. The more a person is exposed to these events, the greater their risk of secondary trauma.

First Responders

Paramedics, police officers, and firefighters are often first on the scene of traumatic events, where they encounter associated distressing details, images, and sounds. In some cases, only one particularly impactful event can result in a secondary trauma or PTSD response. The general prevalence rate of STS among first responders is between 4-13%.8

Nurses & Physicians

Medical professionals, particularly in emergency room settings, witness the physical effects of trauma firsthand. They are often faced with stressful and demanding situations in which they have to make critical decisions that impact whether a person survives. They are exposed to high stress situations and severe injuries on a regular basis.

Mental Health Professionals

Therapists and other mental health professionals often work with people who have directly experienced trauma. They listen to their clients’ stories and witness their healing process.  This is powerful and rewarding work, but many therapists face a time when the secondary trauma becomes too much and they start to experience symptoms of secondary trauma.

Child Protection Workers

Professionals who work for child protective services are often faced with difficult cases involving the abuse or neglect of a child. Their work can sometimes take them into unsafe and volatile situations, placing them at risk for secondary trauma and compassion fatigue.

Children of Traumatized Parents

Children who hear the graphic details of parental traumatic experiences can experience STS, with some receiving a PTSD diagnosis for severe symptoms.3 Secondary trauma can sometimes overlap with intergenerational trauma, as seen with the Holocaust and Indigenous peoples.

Loved Ones of Traumatized Individuals

People whose loved ones experience trauma often report intrusive thoughts and images of their loved one’s experiences. They may report feelings of helplessness and powerlessness due to their inability to take away the pain.

BIPOC Communities

People in marginalized communities are at greater risk of secondary trauma due to systemic, social, and historical factors. Many people in BIPOC communities have faced violence, discrimination or systemic oppression. These repeated traumatic events can affect people for generations. There is also ongoing exposure to discrimination and violence including the frequent witnessing of traumatic events in the media.

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How to Respond to Secondary Traumatic Stress

Several factors are crucial in enhancing resiliency, allowing individuals to cope, function, and maintain wellness while being exposed to secondary trauma. Witnessing the effects of trauma on others can be scarring, but seeking support, prioritizing your needs, and maintaining a work-life balance can bolster wellness and strength.

You may find the following trauma worksheets helpful in your journey to coping with secondary traumatic stress.

Free Trauma Worksheets

This collection of worksheets provides practical tools and strategies for managing trauma symptoms. Find the right one for you, or download the entire workbook here.

Trauma Workbook
The Complete Workbook Download
Identifying Trauma Triggers Worksheet
Identifying Trauma Triggers Download
Self-Care for Trauma Worksheet
Self-Care for Trauma Download
Cognitive Restructuring for Trauma Worksheet
Cognitive Restructuring Download
Setting Smart Goals for Trauma
Setting SMART Goals Download
Personal Strengths Inventory Worksheet
Personal Strengths Inventory Download
How to Set Boundaries Worksheet
Setting Healthy Boundaries Download
Shame - Trauma Worksheet
Overcoming Shame Download

Personal Strategies

Personal strategies for coping with secondary trauma include self care, finding healthy ways to express your emotions, and even engaging in some healthy distraction to take your mind off of things. These strategies can also include setting boundaries, and limiting the exposure to traumatic events in stories, media, or the news.

Below are some self-care methods to cope with secondary trauma:

  • Seek social support
  • Journal about your experience
  • Make a piece of art
  • Listen to music
  • Watch a funny TV show or movie
  • Limit exposure to trauma in news or media
  • Set healthy boundaries
  • Establish a routine

Professional Strategies

To cope with secondary trauma at work, take regular breaks and time off, and practice healthy boundaries. Take advantage of any mental health services available to you, and utilize quiet spaces or any other supportive resources. Talk to the chaplain if there is one available in your workplace. It’s also helpful to practice healthy detachment, compartmentalizing time at work, and transitioning to time at home.

Below are ways to deal with secondary trauma at work:

  • Set work boundaries
  • Have transitional rituals when leaving work
  • Learn to practice detachment
  • Get education and training on how to manage secondary trauma
  • Talk to the chaplain at your workplace
  • Share with coworkers
  • Seek supervision
  • Attend support groups
  • Take advantage of meditation or quiet spaces
  • Take regular breaks
  • Attend CISD (Critical Incident Stress Debriefing)

Organizational Strategies

Employers can do a lot at the organizational level to foster a healthy workplace culture and prevent or reduce the impact of vicarious trauma. This can include offering mental health and supportive services, as well as allowing for flexible schedules and adequate time off.

Below are ways to prevent secondary trauma as an employer:

  • Offer support services
  • Listen to employees’ grievances
  • Foster a supportive workplace culture
  • Provide adequate time off
  • Encourage regular breaks
  • Offer access to mental health support
  • Allow flexible work arrangements
  • Create peer–support programs

Treatment of Secondary Trauma

Given that STS symptoms are identical to those of PTSD, professionals will likely recommend the same approaches used in PTSD treatment. EMDR for PTSD, CBT for PTSD, and cognitive processing therapy (CPT) are evidence-based therapies that can be beneficial when coping with secondary trauma.

When finding the right therapist, focus on locating one specializing in trauma. You can request a referral from your doctor, colleagues, or loved ones. An online therapist directory allows you to filter based on expertise, location, insurance, and more. In other cases, a primary care physician or psychiatrist might prescribe medication for severe and debilitating STS symptoms, such as serotonin reuptake inhibitors (SSRIs).17, 21

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Therapy can help you live a better life. BetterHelp provides convenient and affordable online therapy, starting at $65 per week and is FSA/HSA eligible by most providers. Take a free online assessment and get matched with the right therapist for you!

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In My Experience

Headshot of Shirley Porter, RP, RSW, CCC Shirley Porter, RP

“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.”

Secondary Trauma Infographics

What Is Secondary TraumaSecondary Trauma SymptomsPeople Prone to Secondary Trauma

Some Strategies for Resilience   Treatment of Secondary Trauma

Sources Update History

ChoosingTherapy.com strives to provide our readers with mental health content that is accurate and actionable. We have high standards for what can be cited within our articles. Acceptable sources include government agencies, universities and colleges, scholarly journals, industry and professional associations, and other high-integrity sources of mental health journalism. Learn more by reviewing our full editorial policy.

  • Figley, C. R. (Ed.). (1995). Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized. New York: Brunner-Routledge.

  • Figley, C. R., & Ludick, M. (2017). Secondary traumatization and compassion fatigue. In S. N. Gold (Ed.), APA handbooks in psychology. APA handbook of trauma psychology: Foundations in knowledge (p. 573–593). American Psychological Association. https://doi.org/10.1037/0000019-029

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5. Washington, DC: American Psychiatric Association.

  • Cieslak, R., Shoji, K., Douglas, A., Melville, E., Luszczynska, A., & Benight, C. C. (2014). A meta-analysis of the relationship between job burnout and secondary traumatic stress among workers with indirect exposure to trauma. Psychological services, 11(1), 75. Retrieved from: https://nihr.uccs.edu/sites/g/files/kjihxj1331/files/inline-files/CieslakShojiDouglas2014.pdf

  • Pearlman, L. A., & Saakvitne, K. W. (1995). Trauma and the therapist: Countertransference and vicarious traumatization in psychotherapy with incest survivors. W W Norton & Co.

  • Maslach, C. (2017). Finding solutions to the problem of burnout. Consulting Psychology Journal: Practice and Research, 69(2), 143. Retrieved from: https://www.anesthesiallc.com/images/eAlertsSource/Finding-solutions-to-burnout-Maslach-CPJ-2017-3.pdf

  • Maslach, C., Schaufeli, W. B., & Leiter, M. P. (2001). Job burnout. Annual review of psychology, 52(1), 397-422. Retrieved from: https://www.annualreviews.org/doi/abs/10.1146/annurev.psych.52.1.397

  • Greinacher, A., Derezza-Greeven, C., Herzog, W., & Nikendei, C. (2019). Secondary traumatization in first responders: a systematic review. European journal of psychotraumatology, 10(1). Retrieved from: https://www.tandfonline.com/doi/pdf/10.1080/20008198.2018.1562840

  • Beck, C. T. (2011). Secondary traumatic stress in nurses: A systematic review. Archives of psychiatric nursing, 25(1), 1-10. Retrieved from: https://www.sciencedirect.com/science/article/pii/S0883941710000580

  • Dominguez-Gomez, E., & Rutledge, D. N. (2009). Prevalence of secondary traumatic stress among emergency nurses. Journal of Emergency Nursing, 35(3), 199-204. Retrieved from: https://www.sciencedirect.com/science/article/pii/S0099176708002882

  • Warren, A. M., Jones, A. L., Shafi, S., Roden-Foreman, K., Bennett, M. M., & Foreman, M. L. (2013). Does caring for trauma patients lead to psychological stress in surgeons?. Journal of Trauma and Acute Care Surgery, 75(1), 179-184. Retrieved from: https://insights.ovid.com/trauma-acute-care-surgery/tjtacs/2013/07/000/does-caring-trauma-patients-lead-psychological/31/01586154

  • Roden-Foreman, J. W., Bennett, M. M., Rainey, E. E., Garrett, J. S., Powers, M. B., & Warren, A. M. (2017). Secondary traumatic stress in emergency medicine clinicians. Cognitive Behaviour Therapy, 46(6), 522-532. Retrieved from: https://www.tandfonline.com/doi/abs/10.1080/16506073.2017.1315612

  • Bride, B. E. (2007). Prevalence of secondary traumatic stress among social workers. Social work, 52(1), 63-70. Retrieved from: https://intranet.newriver.edu/images/stories/library/stennett_psychology_articles/Prevalence%20of%20Secondary%20Traumatic%20Stress%20Among%20Social%20Workers.pdf

  • Baugerud, G. A., Vangbæk, S., & Melinder, A. (2018). Secondary traumatic stress, burnout and compassion satisfaction among Norwegian child protection workers: Protective and risk factors. British Journal of Social Work, 48(1), 215-235. Retrieved from: https://journals.sagepub.com/doi/pdf/10.1177/2516103220987227

  • Isobel, S., Goodyear, M., Furness, T., & Foster, K. (2019). Preventing intergenerational trauma transmission: A critical interpretive synthesis. Journal of clinical nursing, 28(7-8), 1100-1113. Retrieved from: https://www.researchgate.net/profile/Sophie-Isobel/publication/329708821_Preventing_intergenerational_trauma_transmission_A_critical_interpretive_synthesis/links/5e44cf74299bf1cdb924e5f4/Preventing-intergenerational-trauma-transmission-A-critical-interpretive-synthesis.pdf

  • Ludick, M., & Figley, C. R. (2017). Toward a mechanism for secondary trauma induction and reduction: Reimagining a theory of secondary traumatic stress. Traumatology, 23(1), 112. Retrieved from: https://psycnet.apa.org/record/2016-53576-001

  • American Psychological Association. (2017). Clinical Practice Guidelines for the treatment of Post-Traumatic Stress Disorder (PTSD) in Adults. Retrieved from: http://www.apa.org/ptsd-guideline/ptsd.pdf

  • Bisson, J. I., Roberts, N. P., Andrew, M., Cooper, R., & Lewis, C. (2013). Psychological therapies for chronic Post-Traumatic Stress Disorder (PTSD) in adults. Cochrane Database of Systematic Reviews, 12. Art, No. CD003388. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6991463

  • How much does therapy cost? (2021, July 15). Retrieved from https://www.thumbtack.com/p/how-much-does-therapy-cost

  • How Much Does Therapy Cost? (Per Session & Hour). Retrieved from https://thervo.com/costs/how-much-does-therapy-cost#specialist

  • Stein, D. J., Ipser, J. C., Seedat, S., Sager, C., & Amos, T. (2006). Pharmacotherapy for Post-traumatic stress disorder (PTSD). Cochrane Database of Systematic Reviews, 1, Art. No. CD002795. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6993948/

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We regularly update the articles on ChoosingTherapy.com to ensure we continue to reflect scientific consensus on the topics we cover, to incorporate new research into our articles, and to better answer our audience’s questions. When our content undergoes a significant revision, we summarize the changes that were made and the date on which they occurred. We also record the authors and medical reviewers who contributed to previous versions of the article. Read more about our editorial policies here.

July 30, 2024
Author: No Change
Reviewer: No Change
Primary Changes: Updated for readability and clarity. Revised “Vicarious Trauma Vs. Secondary Trauma”, “Secondary Trauma Vs. Compassion Fatigue”, “Secondary Trauma Symptoms”, “Causes of Secondary Traumatic Stress”, “Who Experiences Secondary Trauma?”, “Treatment of Secondary Trauma”. New content written by Michelle Risser, LISW-S and medically reviewed by Naveed Saleh, MD, MS.
May 18, 2022
Author: No Change
Reviewer: No Change
Primary Changes: Updated for readability and clarity. Reviewed and added relevant resources.
April 30, 2021
Author: Shirley Porter, RP, RSW, CCC
Reviewer: Dena Westphalen, PharmD
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