Secondary traumatic stress (STS) is a form of psychological trauma that can arise from indirect exposure to traumatic events. This exposure typically occurs through contact with individuals who have experienced trauma, hearing disturbing accounts from survivors, or witnessing others inflicting cruelty. The symptoms of STS are notably similar to those of Post-Traumatic Stress Disorder (PTSD), encompassing intrusive re-experiencing of traumatic material,
avoidance of trauma triggers and emotions, negative shifts in beliefs and feelings, and hyperarousal. This condition has been extensively researched across various professions, including first responders, nurses, physicians, mental health care workers, and even children of traumatized parents, highlighting its widespread impact on those in helping roles and beyond.
Understanding the Symptoms and Their Impact
The symptoms of secondary traumatic stress closely parallel those of direct trauma, though they often manifest with less intensity. Individuals experiencing STS may exhibit a range of emotional disturbances, such as sadness, grief, irritability, and mood swings. Beyond emotional changes, common signs include social withdrawal, aggression, increased sensitivity to violence, and various somatic symptoms. Sleep difficulties, intrusive imagery, cynicism, and sexual difficulties are also frequently reported. Furthermore, STS can lead to challenges in managing boundaries with clients and difficulties in personal relationships, often reflecting underlying issues related to security, trust, esteem, intimacy, and control.
These symptoms can significantly interrupt a clinician's daily functioning, potentially reducing their effectiveness in their professional role. The constant exposure to traumatic narratives can shatter a helper's view of the world or their fundamental sense of safety. This disruption is not merely personal; it can also impact job performance in first responders, leading to adverse outcomes not only for the responders themselves but also for the victims they are trying to assist. The pervasive nature of these symptoms underscores the critical need for awareness and support for those at risk.
Prevalence Across Professions and Contributing Factors
Secondary traumatic stress impacts a significant number of individuals in the mental health field and other helping professions. As of 2013, prevalence rates for STS varied considerably across different professional groups. For instance, 15.2% of social workers, 16.3% of oncology staff, and 19% of substance abuse counselors reported experiencing STS. The rates were even higher among emergency nurses (32.8%), child protective services workers (34%), and juvenile justice education workers (39%). These statistics highlight the substantial occupational risk associated with roles that involve frequent exposure to trauma.
Several factors contribute to the likelihood of developing STS among professionals who work with trauma victims. A strong correlation exists between burnout and secondary traumatic stress among mental health care professionals indirectly exposed to trauma. Workers with a personal history of trauma are more likely to develop STS. Additionally, individuals with less work support and less social support face a higher risk. The number of patients seen by these workers also plays a role; as caseloads increase, so do the chances of developing STS. These contributing factors emphasize the complex interplay of personal history, professional environment, and social support in the development of secondary traumatic stress.
Measuring and Mitigating Secondary Traumatic Stress
To assess secondary traumatic stress, specific tools have been developed. The Secondary Trauma Self-Efficacy (STSE) Scale is a seven-item measure designed to evaluate a person's beliefs about their ability to cope with the challenges associated with STS. It gauges one's perceived ability to manage the demanding aspects of working with traumatized clients and to deal with STS symptoms. Another important tool is the Secondary Trauma Stress Scale (STSS), a 17-item questionnaire that measures the frequency of STS symptoms over the past month, addressing issues related to intrusion, avoidance, and arousal, similar to those found in PTSD.
While the primary focus for STS symptom reduction has often been at the individual level, interventions at the organizational level are also crucial. These include providing supervision, offering workshops, and fostering a supportive organizational culture. Such changes can address job context, which is a greater risk factor for STS in first responders than job content. Modifying work culture, workload, group support, and the work environment can build resilience against STS. Protective factors for mental health care workers include years of experience, more time spent in self-care activities, and high self-efficacy. These measures, both individual and organizational, are vital for supporting professionals and mitigating the impact of secondary traumatic stress.
