Secondary traumatic stress: symptoms, causes and treatment

Post-traumatic stress disorder is widely known, manifesting itself in people who have experienced or witnessed a very stressful event. These people must receive psychological treatment, because the event causes them sequelae.

However, experiencing a tragic event is not the only way to suffer from traumatic stress. People who help, both in an emergency and in a consultation, may suffer from symptoms associated with PTSD, even if they have not experienced the stressful event firsthand.

Secondary traumatic stress is a very common psychological condition among people doing humanitarian work. Below we will take a closer look at what it is, what are its risk factors, intervention and prevention.

    What is secondary traumatic stress?

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

    In other words, it happens when a person who frequently works with people who have been injured, usually in the humanitarian sector, is affected by this pain of others in a pathological way. To this psychological phenomenon too known as vicarious trauma, secondary trauma, secondary persecution, and secondary traumatic stress.

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

    Knowing about the tragedies of others is a source of stress, a stress which, when accumulated, can cause a truly psychopathological image. Secondary traumatic stress is the materialization of this accumulated stress, which could not be reduced or released for lack of seeking help.

    The reason many aid workers do not seek professional help it has to do with the very mentality of the groups involved in the victims of tragediesAssociated with the idea that those who help should be strong and not seeking help. Whether it’s because of a difficulty in recognizing that you are suffering from stress or because you fear stigma within your work group, many caregivers do not seek intervention on your stress until you have them. caused enormous physical and psychological suffering.

    Risk factors

    As we have seen, people who often suffer from secondary traumatic stress are workers who help other people, Whether in an emergency situation or in consultation treatment, both medical and psychopathological.

    Among the factors that can increase the risk of manifesting it, we find those who tend to escape their own issues or conflicting feelings, either blaming others for their difficulties or walking away when the going gets tough.

    You don’t have to be a humanitarian worker to suffer from this stress. People who have had a traumatic experience, that is, who have experienced primary traumatic stress, tend to identify more closely with people who have also suffered from a traumatic situation and may suffer from a traumatic stress. secondary traumatic stress. In other words, they would suffer twice as much.

    Not having good social support can cause this image when one knows the traumatic events of others. and, moreover, that it gets worse. Not being able to speak freely about how you feel or being afraid of what they will say, as is the case with many aid workers, is the main risk factor for professionals in the health and emergency sciences.

    Also related to professions in which other people are helped, the fact that the professional has very high expectations on how to help another person, whether in a traumatic situation, a medical illness or a mental disorder, and to see that these are not satisfied is a source of anxiety. It can alter the belief system, think it is not worth the work he is doing, and feel remorse for believing that he has not done all he can.

      Secondary traumatic stress assessment

      Since the days of DSM-III (APA, 1980), secondary traumatic stress has been established as a diagnosable clinical picture, develop, from a multidimensional perspective, various assessment and diagnostic tools for this particular disorder. It is from this multidimensional approach that has led to the development of various questionnaires, interviews and psychophysiological measures.

      Some of the assessment tools include “Mississippi Scale for Combat-Related Post-Traumatic Stress Disorder,” “PTSD Symptom Scale,” PET Symptom Severity Scale, “Questionnaire on Harvard Trauma ”and“ Penn’s Inventory for PTSD ”. These scales have the particularity of being specific, validated in specific populations, as refugees and victims of wars or natural disasters.

      As for the assessment tools in the form of an interview, we can find the “Post-traumatic stress disorder interview” and “The structured clinical interview for the DSM-III”. As a psychophysiological measure, we can find the clonidine test as markers of the state of PET.

      However, although the similarities in the diagnostic criteria already established from the DSM-IV between post-traumatic stress disorder (PTSD) and secondary traumatic stress, attention has shifted to the former, leaving a little aside for the other psychological problem. Research has focused more on treating people who have been directly affected by a traumatic event instead of working with those people who work with these types of victims.

      that’s 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 the symptoms of secondary traumatic stress in humanitarian professionals.

      This instrument is composed of 66 items, 45 which pose aspects of the person himself and 21 related to the environment of the aid, related to the context of professional rescue. 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 assesses three scales.

      1. Compassionate satisfaction

      this scale assesses the level of satisfaction of the humanitarian professional with those to whom he helps, Constant of 26 elements. High scores indicate a high degree of satisfaction in helping others.

      2. Burnout

      The burnout scale assesses the risk of the humanitarian worker suffering from this syndrome. It consists of 17 elements with which, the higher the score obtained, the greater the risk that the professional will be burned by his work.

        3. Compassion fatigue

        The Compassion Fatigue Scale includes 23 items that assess symptoms of post-traumatic stress related to work or exposure to very stressful material, (E.g., Child pornography videos confiscated from a pedophile, photographs of a crime scene)


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

        Accelerated Empathy Wear Recovery Program

        This program was developed to help professionals put in place strategies allowing them to regain their personal and professional life, trying to fix both the symptoms and the source of the secondary traumatic stress.

        The objectives of this program are diverse:

        • Identify and understand the factors that triggered their symptoms.
        • Review the skills that keep it going.
        • 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 establishing self-care.
        • Learn and master internal conflicts.
        • Development of post-treatment self-administration.

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

        The first session is based on an assessment with the Figley Compassion-Revised Fatigue Scale, combined with others such as the Baranowsky Silence Response Scale (1997) and the Solution-Centered Trauma Recovery Scale. by Gentry (1997).

        Arriving at the second session, a personal and professional life program is established, Specify the objectives of the program and train the patient in relaxation and visualization techniques, such as guided relaxation, the Jacobson technique …

        During the third session traumatic situations are reviewed and the aim is to detect self-regulatory strategies, In addition to introducing and providing training in various techniques and therapies, such as time-limited trauma therapy, field reflection therapy, desensitization and video dialogue, visual visualization.

        Then, during the fourth session, all strategies and skills acquired are reviewed, Detect possible areas of the professional field where it is necessary 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, as well as skills that were improved.

        The results of this program show that workers, once submitted, are better prepared to deal with the after-effects of traumatic stress, both primary and secondary. In addition, they manage to develop a state conducive to the exercise of their profession, both in the emergency sector and in the face of people traumatized by past events.


        Preventing the onset of traumatic stress is complicatedSince influencing how an emergency or misfortune happens to another person is virtually impossible. However, it is possible to reduce its occurrence in people who do not work directly in emerging humanitarian situations, such as doctors or consulting psychologists.

        One of the proposals, proposed by DR Catherall, is to reduce the number of patients in treatment, avoiding the professional to over-saturate in the face of serious listening situations, such as having suffered sexual abuse, suffering from a serious psychological disorder. or suffering from a terminal illness.

        Bibliographical references:

        • Moreno-Jiménez, B .; Morante-Benadero, ME; Losada-Novoa, MM; Rodriguez-Carvajal, R .; Garrosa Hernández, I. (2004) Secondary traumatic stress. Assessment, prevention and intervention. Psychological therapy, 22 (1), 69-76.
        • Catherall RD (1998). Treatment of traumatized families. In CR Figley (ed.). Burnout in family: the systemic cost of care (p. 187-216).
        • Keane, TM; Caddell, JM and Taylor, KL (1988). Mississippi Scale for Combat-related Posttraumatic Stress Disorder: Three Studies on Reliability and Validity. Journal of Consulting and Clinical Psychology, 56, 85-90.
        • Baranowsky, AB and Gentry, JE (1997). Revised Compassion Fatigue Scale. In CR Figley (ed.). Compassionate fatigue (vol. 2.). New York: Brunner / Mazel.
        • Zubizarreta, I .; Sarasúa, B .; Echeburúa, E .; Del Corral, P .; Sauca, D. and Emparanza, I. (1994). Psychological consequences of domestic violence. To E. Echeburúa (ed.). Violent personalities. Madrid.
        • Spring, RF; Caspi-Yavin, Y; Seals, P .; Truong, T .; Tor, S. and Lavelle,
        • J. (1992). Harvard Trauma Questionnaire. Validate an intercultural instrument to measure torture, trauma and post-traumatic stress disorder among Indochinese refugees. The Journal of Nervous and Mental Disease, 180, 111-116.
        • Watson, CG; Juba, deputy; Multiple, V .; Kucala, T. and Anderson, PED
        • (1991). The PTSD interview: basis, description, reliability and simultaneous validity of a technique based on the DSM-III. Journal of Clinical Psychology, 47, 179-188

        Leave a Comment