This document discusses secondary traumatic stress and its impact on mental health workers. It provides background on the concept, including early recognition in the 1960s-70s that working with trauma clients can negatively impact caregivers' mental health. Terms like secondary traumatic stress, vicarious traumatization, and compassion fatigue are defined. Symptoms are similar to PTSD and include changes in beliefs and somatic complaints. Risk factors include personal trauma history, exposure level to clients' trauma, and poor coping abilities. Prevention strategies focus on self-care and organizational support. Gaps remain in definitions, treatment options, and addressing stigma around mental health issues in these professions.

1. Secondary Traumatic Stress
Impact on Mental Health Workers

2. History and Issue Development
 ‘It is inevitable that the doctor should be
influenced to a certain extent and even
his nervous health should suffer. He quite
literally ‘‘takes over’’ the sufferings of
his patient and shares them with him.
For this reason he runs a risk and must
run it in the nature of things’ (Jung,
1966)
 As early as 1978, Pines & Maslach found
health-care workers often had high levels
of burnout associated with low morale,
absenteeism, high turnover, and general
job stress (Collins et al. 2013).

3. History and Issue Development
 McCann & Pearlman (1990) described Vicarious Traumatization
as “the transformation in the inner experience of the therapist
that comes about as a result of empathetic engagement with
clients’ trauma material.”
 Figley (1995) described Secondary Traumatic Stress as the
natural consequent behaviors and emotions resulting from
knowing about a traumatizing event experienced by a
significant other – the stress resulting from helping or
wanting to help a traumatized or suffering person”
 Since the creation of this concept, development has been
limited by unclear definitions, a lack of research, and a focus
too specifically on selective groups of trauma therapists
(Dunkley and Whelan, 2006).

4. Plurality of terms
 Secondary Traumatic Stress: PTSD symptoms in caregivers, likely connected
to the patient’s experience rather than that of the caregiver (Figley 1995) He
later changed the name to Compassion Fatigue.
 Vicarious Traumatization: the enduring psychological consequences for
therapists of exposure to the traumatic experiences of victim clients
(Schauben & Frazier 1995).

5. Symptoms
 Symptoms much like PTSD, changes in frame of
reference, identity, sense of safety, ability to
trust, self-esteem, intimacy, and a sense of
control (Bloom)
 Also includes somatic complaints, like sleep
difficulty, headaches or gastrointestinal distress
(Herman 1992, Figley 1995)
 Chose to focus on STS because it tends to have
more outward, easily diagnosable symptoms rather
than internal cognitive shifts that may be difficult
to recognize

6. Relevance
 The New England Journal of Medicine reported
as of November of 2013 there were three
times as many natural disasters between 2000
and 2009 compared to those between 1980
and 1989 (Leaning et al. 2013).
 Advances warfare technology and terroristic
tendencies make modern conflicts more
challenging and often civilians bear the
economic and psychological burden. Families
are forced to move in order to escape
violence, leading to severe mental and
physical health issues (Leaning et al. 2013).

7. Hazard Assessment
A hazard is defined as "Condition, event, or circumstance that could lead to or
contribute to an unplanned or undesirable event", such as the development of
disease or disorder.
The primary reason for assessing hazards is to attempt to prevent them from
happening.

8. Hazard Assessment
(1) Having a personal history of trauma is linked to the development of VT. Level-
of-evidence: Persuasive (Camerlengo, 2002; Dickes, 1998; Pearlman & MacIan,
1995; Schauben & Frazier, 1995; Trippany, 2000; Young, 1999).
(2) Having a personal history of trauma is linked to the development of STS. Level-
of-evidence: Reasonable (Allt, 1999; Dickes, 1998; Nelson-Gardell & Harris, 2003;
Price, 2001).
(3) Having a personal trauma history is not linked to the development of STS.
Level-of-evidence: Reasonable (Creamer, 2002; Follette, Polusny, & Milbeck;
1994; Simonds, 1996).

9. Hazard Assessment
(4) The amount of exposure (including hours with trauma clients, percentage on
caseload, and cumulative exposure) to the traumatic material of clients
increases the likelihood of VT. Level-of-evidence: Some (Schauben & Frazier,
1995)
(5) The amount of exposure (including hours with trauma clients, percentage on
caseload, and cumulative exposure) to the traumatic material of clients does
not increase the likelihood of VT. Level-of-evidence: Reasonable (Brady, Guy,
Poelstra, & Brokaw, 1999; Dickes, 1998; Simonds, 1996; Young, 1999).

10. Hazard Assessment
 (6) The amount of exposure (including hours with trauma clients, percentage
on caseload, and cumulative exposure) to the traumatic material of clients
increases the likelihood of STS. Level-of-evidence: Persuasive (Brady et al.,
1999; Creamer, 2002; Myers & Cornille, 2002; Simonds, 1996; Wee & Myers,
2002).
(7) The amount of exposure (including hours with trauma clients, percentage on
caseload, and cumulative exposure) to the traumatic material of clients does
not increase the likelihood of STS. Level-of-evidence: Some (Nelson-Gardell &
Harris, 2003).
(8) Perceived coping ability is a protective factor for VT. Level-of-evidence:
Reasonable (Creamer, 2002; Weaks, 1999; Young, 1999)
(9) Perceived coping ability is a protective factor for STS. Level-of-evidence:
Some (Follette et al., 1994).

11. Exposure Assessment
‘Exposure assessment is the process of measuring or estimating the
magnitude, frequency, and duration of human exposure to an agent in
the environment, or estimating future exposures for an agent that has
not yet been released.’ Epa.gov (2012)
 Size: 5.2 million adults (18-54) will experience PTSD in a given year
 Nature: Treating patients experiencing trauma
 Populations: Under 1 million mental health workers to treat patients
 Uncertainies: Specific group of professionals and specific group of patients

12. Risk Characterization
 Susceptibility
 61% Mild to Moderate
 29% Moderate to Severe
 Traits of Mental Health Workers
 Empathy
 Psychological/Emotional Stability
 Coping Skills/Mechanisms

13. Risk Characterization
 No Association Association
 Gender Female
 Age Younger
 Years Experience Fewer
 Personal Trauma Childhood
 Seeing a Therapist Receiving Personal Therapy
 Exposure to High % of Trauma Clients
Trauma Clients

14. Risk Characterization
 Limitations to Studies
 Different Measures/Scales
 Important Variables Not Included
 Not Enough Detail (i.e. Years of Experience)

15. Risk Characterization
 Prevention
 Personal
 Improved self-care (Well Balanced Life)
 Organizational

16. Policy/Regulatory/Legal Solutions
 WORKPLACE POLICIES
 RISK MANAGEMENT
 CASELOAD MANAGEMENT
 HEALTHCARE AND SICK LEAVE POLICIES
 HEALTHY WORKPLACE INITIATIVES
 TRAINING AND PROFESSIONAL DEVELOPMENT

17. POLICY/REGULATORY/LEGAL SOLUTIONS
CONTINUED
 LAWS AND REGULATIONS
 MENTAL HEALTH PARITY AND ADDICTION EQUITY ACT AND STATE PARITY LAWS
 WORKERS COMPENSATION
 AMERICANS WITH DISABILITIES ACT
 FAMILY MEDICAL LEAVE ACT
 AFFORDABLE CARE ACT

18. GAPS IN SOLUTIONS
 OVERLAPPING AND INCONSISTENT DEFINITIONS
 QUANTITATIVE STUDIES
 AGREED UPON TREATMENT OPTIONS
 INCLUSION IN THE DIAGNOSTIC STATISTICAL MANUAL OF MENTAL DISORDERS (DSM)
 BIAS AND STIGMA RECOGNIZING AND TREATING MENTAL HEALTH ISSUES

19. UNINTENDED CONSEQUENCES
COUNSELORS MUST PERSONALLY ENDURE REPEATED EXPOSURE TO DISTRESS AND
USE THEIR OWN FEELINGS OF SORROW AS TOOLS FOR THERAPY. AS SUCH, IT IS
IMPOSSIBLE TO ESACPE THIS KIND OF WORK WITHOUT PERSONAL CONSEQUENCES.
(CAMPBELL, 2002)