Secondary trauma

Secondary trauma is psychological trauma which may be incurred by contact with people who have experienced traumatic events, exposure to disturbing descriptions of traumatic events by a survivor, or exposure to others inflicting cruelty on one another. Symptoms of secondary trauma are similar to those of PTSD (e.g. intrusive re-experiencing of the traumatic material, avoidance of trauma triggers/emotions, negative changes in beliefs and feelings, and hyperarousal). Secondary trauma has been researched in first responders, nurses and physicians, mental health care workers, and children of traumatized parents.

Secondary Traumatic Stress (STS) impacts many individuals in the mental health field; as of 2013, the prevalence rates for STS amongst different professions is as follows: 15.2% among social workers, 16.3% in oncology staff, 19% in substance abuse counselors, 32.8% in emergency nurses, 34% in child protective services workers, and 39% in juvenile justice education workers. There is a strong correlation between burnout and secondary traumatic stress among mental health care professionals who are indirectly exposed to trauma and there are a multitude of different risk factors that contribute to the likelihood of developing secondary traumatic stress amongst individuals who conduct therapy with trauma victims. Workers who have had a history of trauma are more likely to develop STS. Additionally, individuals who have less work support as well as less social support are at higher risk for developing STS. Lastly, as the number of patients seen by these workers increases, so do the chances of developing STS. Some of the protective factors for mental health care workers include years of experience in the profession, more time spent in self-care activities and high self-efficacy.

Another social work-related profession that is impacted by secondary trauma is librarianship. Public librarians work closely with vulnerable, at-risk populations, and often experience emotional and psychological strain while doing so.

Studies explain how secondary traumatic stress can negatively impact job performance in first responders which can lead to adverse outcomes not only for the first responders, but for the victims they seek to help. Job context is a greater risk factor for developing STS in first responders compared to the job content. This highlights the need for strategies targeted toward the organizational and systemic level in addition to the individual level. Organizational changes that can be addressed include work culture, workload, group support, supervision and education, and the modification of the work environment. Changes in these areas would foster resiliency for developing STS.

Similarly, research highlights the importance of psychological services for nurses and medical professionals. Services similar to the ones listed above for the first responder population were valuable for reducing secondary traumatic stress symptoms amongst medical staff working with traumatic populations in hospital settings.

Van Ijzendoorn et al. (2003) conducted a meta-analysis of 32 studies with 4,418 participants in which they explored secondary trauma in children of Holocaust survivors. The authors found that in non-clinical studies no evidence of secondary traumatization, while clinical studies only showed evidence for secondary traumatization when additional stressors were also present. Intergenerational trauma or transgenerational trauma is also applied to describe the process by which parental traumatic experiences may lead to secondary trauma symptoms in their offspring, when additional stressors, such as war, famine, or displacement are present. Refugee children who are exposed to these additional stressors display heightened anxiety levels, and have an increased likelihood of experiencing traumatic life events, compared with non-refugee children in the United States.

The Secondary Trauma Self-Efficacy (STSE) Scale is a seven-item measure used to assess a person's beliefs about their ability to cope with barriers associated with secondary traumatic stress. The STSE measures one's "ability to cope with the challenging demands resulting from work with traumatized clients and perceived ability to deal with the secondary traumatic stress symptoms." In addition to the STSE, there is the STSS. The Secondary Trauma Stress Scale (STSS), is a 17-item questionnaire that measures the frequency of secondary traumatic stress symptoms over the past month. Questions on the STSS addresses issues with intrusion, avoidance and arousal symptoms similar to those found in PTSD.

Phipps and Byrne (2003) detail some potential treatments for STS based on the premise that STS and PTSD symptomology are similar in nature. Some brief interventions for STS include critical incident stress debriefing (CISD), critical incident stress management (CISM) and stress inoculation training (SIT). CISD is a one session exposure-based intervention aimed at reducing distress by having the client recall and explain the traumatic event to a group and a facilitator 48–72 hours after the traumatic incident. The facilitator then provides education on the reasons for the symptoms and processes of trauma in a safe environment. The seven-phase debriefing technique includes: 1. Introduction, 2. Expectations and facts, 3. Thoughts and impressions, 4. Emotional reactions, 5. Normalization, 6. Future planning/coping and 7. Disengagement. This has been shown by multiple studies to have damaging effects on the survivors and actually exacerbates the trauma symptoms present.