Secondary Traumatic Stress: Symptoms, Causes, and Treatment

Post-traumatic stress disorder is widely known, manifesting in people who have been victims or witnesses of a highly stressful event. These people should be helped with psychological treatment, since the event causes sequelae.

However, living through a tragic event is not the only way to experience traumatic stress. The people who help, both in an emergency and in consultations, can suffer symptoms associated with PTSD, despite not having experienced the stressful event firsthand.

Secondary traumatic stress is a very common psychological condition in people who do humanitarian work. Next we will see more in depth what it is, what are its risk factors, intervention and prevention.

• Related article: "What is trauma and how does it influence our lives?"

What is secondary traumatic stress?

Secondary traumatic stress is defined as a psychological picture in which Negative emotions and behaviors occur when learning about a traumatic event experienced by another person.

That is, it occurs when a person who frequently works with people who have seen each other victims, usually in the humanitarian sector, is affected by the pain of others in a way pathological. To this psychological phenomenon also

it is known as vicarious traumatization, secondary traumatization, secondary persecution, and traumatic secondary stress.

Natural disasters, sexual abuse and wars can affect many people psychologically. At first glance, it may appear to only affect those directly affected, such as the injured, victims or people who have lost their homes, as well as their families and eyewitnesses of the event. However, it can also affect helpers and specialized workers in emergency situations and people who, in a medical or psychological consultation, care for the victims.

Knowing the tragedies of other people is a source of stress, a stress that, accumulated, can cause a truly psychopathological picture. Secondary traumatic stress is the materialization of that accumulated stress, which could not be reduced or released because of not having asked for help.

Why many aid workers don't seek professional help It has to do with the very mentality of the groups that intervene in people who are victims of tragedies, associated with the idea that those who help should be strong, not seekers of help. Whether it is due to a difficulty in recognizing that they are suffering from stress or because they fear stigmatization within their work group, many Helping people do not request intervention on their stress until it has caused them enormous physical and psychological suffering.

Risk factor's

As we have seen, people who often experience secondary traumatic stress are workers who help other people, whether in emergency situations or treating them in consultation, both medical and psychopathological.

Among the factors that can increase the risk of manifesting it, we find those who tend to avoid problems or conflicting feelings of their own, either blaming others for their difficulties or walking away when things get tough difficult.

You don't have to be a humanitarian worker to experience this stress. People who have suffered a traumatic experience, that is, who have experienced primary traumatic stress, tend to identify more closely with people who have also suffered a traumatic event, and may experience traumatic stress secondary. That is, they would suffer twice.

Not having good social support can cause this picture to occur when learning about traumatic events from others and, furthermore, that it gets worse. Not being able to speak freely about what it feels like or being afraid of what they will say, as is the case with many humanitarian workers, is the main risk factor in emergency and life sciences professionals health.

Also related to the professions in which other people are helped, the fact that the professional has very high expectations of how one should help another person, whether in a traumatic situation, medical illness or mental disorder, and seeing that these are not fulfilled is a great source of anxiety. This can alter the belief system, thinking that it is not suitable for the job that it performs and having remorse for believing that it did not do everything it could.

• You may be interested in: "Post Traumatic Stress Disorder: Causes and Symptoms"

Secondary traumatic stress assessment

Since the time of the DSM-III (APA, 1980) secondary traumatic stress has been established as a diagnosable clinical picture, developing, from a multidimensional perspective, various evaluation and diagnostic instruments of this particular disorder. It has been starting from this multidimensional approach that has led to the development of questionnaires, interviews and various psychophysiological measures.

Among some of the evaluation instruments we can mention the "Mississippi Scale for Combat-related Posttraumatic Stress Disorder”, the “PTSD Symptom Scale”, the PTSD Symptom Severity Scale, the “Harvard Trauma Questionnaire” and the “Penn Inventory for PTSD”. These scales have the peculiarity that they are specific, validated in specific populations, such as refugees and victims of wars or natural catastrophes.

Regarding the assessment tools in interview format, we can find the "Posttraumatic Stress Disorder Interview" and the "Structured Clinical Interview for DSM-III". As a psychophysiological measure, we can find the Clonidine Test as markers of the PTE state.

However, despite the fact that the similarities in the diagnostic criteria already established from the DSM-IV between stress disorder (PTSD) and secondary traumatic stress, the focus of attention has been focused on the first, leaving the other problem a little to one side psychological. Research has focused more on treating people who have been directly victims of a traumatic event. instead of working with those people who work with these types of victims.

That is why In 1995 Charles R. Figley and B. Hudnall Stamm decided to develop the "Compassion Fatigue and Satisfaction Test", a questionnaire developed as a tool to specifically measure symptoms of secondary traumatic stress in humanitarian professionals.

This instrument consists of 66 items, 45 that ask aspects of the person himself and 21 related to the help environment, related to the context of the rescue professional. The response format consists of a six-category Likert scale, ranging from 0 (never) to 5 (always). As measures of secondary traumatic stress, the questionnaire evaluates three scales.

1. compassion satisfaction

this scale evaluates the degree of satisfaction of the humanitarian professional with respect to those people to whom he provides help, consisting of 26 items. High scores indicate a high degree of satisfaction helping other people.

2. Burnout

The burnout scale assesses the risk of the humanitarian professional suffering from this syndrome. It is made up of 17 items with which, the higher the score obtained, the greater the risk that the professional is burned with his work.

• You may be interested in: "Burnout (Burn Syndrome): how to detect it and take action"

3. compassion fatigue

The compassion fatigue scale is made up of 23 items that assess for post-traumatic stress symptoms related to work or exposure to highly stressful material, (p. (e.g., child pornographic videos seized from a pedophile, crime scene photographs)

Treatment

The lines of intervention for secondary traumatic stress are very similar to those for PTSD. The most notable treatment, specially designed for this type of stress in particular, is The Empathy Burnout Accelerated Recovery Program by J. Eric Gentry, Anne Baranowsky, and Kathy Dunning from 1992.

Empathy Burnout Accelerated Recovery Program

This program has been developed to help professionals establish strategies that allow them to recover their personal and professional life, trying to address both the symptoms and the source of secondary traumatic stress.

There are several objectives of this program:

• Identify and understand the factors that have triggered your symptoms.
• Revise the skills that maintain it.
• Identify the resources available to develop and maintain good resilience.
• Learn innovative techniques for reducing negative activation.
• Learn and master containment and maintenance skills.
• Acquire skills for the establishment of self-care.
• Learn and master the internal conflict.
• Development of self-administration after treatment.

The protocol of the program consists of five sessions, with which we try to cover all these objectives.

During the first session, the evaluation starts with the Figley Compassion Fatigue Scale-Revised scale, combined with others such as Silencing Response. Baranowsky Scale (1997) and Gentry's Solution Focused Trauma Recovery Scale (1997).

Arrival of the second session a personal and professional life program is established, specifying the objectives of the program and training the patient in relaxation and visualization techniques, such as guided relaxation, Jacobson technique...

During the third session traumatic situations are reviewed and attempts are made to detect self-regulation strategies, as well as introduce and carry out training in various techniques and therapies, such as time therapy limited to trauma, thought field therapy, desensitization and video-dialogue, visualization visual.

Then, during the fourth session, all strategies and skills acquired are reviewed, detecting the possible areas of the professional field where it is required to apply them.

In the fifth session an inventory of the objectives achieved is made, lines of self-care and maintenance of what has been learned are established during the program, along with the skills that have been improved.

The results of this program show that the workers, once they have been subjected to it, are better prepared to deal with the consequences of traumatic stress, both primary and secondary secondary. In addition, they manage to develop an adequate state to practice their profession, both in the emergency sector and in the face of people traumatized by past events.

Prevention

Preventing the onset of traumatic stress is complicated, since influencing how an emergency or misfortune happens to another person is practically impossible. However, it is possible to reduce its appearance in those people who do not work directly in emergent humanitarian situations, such as consulting doctors or psychologists.

One of the proposals, offered by carried out by D. R. Catherall, is to reduce the number of patients in treatment, preventing the professional from becoming overloaded when listening to situations seriously, such as having suffered sexual abuse, suffering from a serious psychological disorder or suffering from a terminal illness.

Bibliographic references:

• Moreno-Jimenez, B.; Morante-Benadero, M. AND.; Losada-Novoa, M. M.; Rodriguez-Carvajal, R.; Garrosa Hernandez, E. (2004) Secondary traumatic stress. Assessment, prevention and intervention. Psychological Therapy, 22(1), 69-76.
• Catherine R. d. (1998). Treating traumatized families. In C.R. Figley (ed.). Burnout in families: the systemic cost of caring (pp. 187-216).
• Keane, T.M.; Caddell, J.M. & Taylor, K.L. (1988). Mississippi Scale for Combat-related Posttraumatic Stress Disorder: Three studies in reliability and validity. Journal of Consulting and Clinical Psychology, 56, 85-90.
• Baranowsky, A.B. & Gentry, J.E. (1997). Compassion Fatigue Scale Revised. In C.R. Figley (ed.). Compassion fatigue (vol. 2.). New York: Brunner/Mazel.
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