Some jobs, like being a first-responder, require a lot of empathy, making it easy for chronic stress to take hold. In this PsychCentral article, Mindpath Health’s Julian Lagoy, MD, discusses the signs of secondary trauma and how to work through it.

woman looking at a lake

woman looking at a lake

Some jobs require a lot of empathy. Many people in helping professions — such as nurses, therapists, social workers, and first responders — show up to work with big hearts, ready to help others.

Supporting people through their traumatic situations can be a trauma of its own, called secondary trauma. It’s especially common among helping professionals.

The chronic stress of taking in others’ trauma can lead to symptoms similar to post-traumatic stress disorder (PTSD) such as emotional exhaustion or hypervigilance. Taking time to relax and decompress away from work can help ease your symptoms.

What is secondary trauma?

Secondary trauma — aka compassion fatigue, vicarious trauma, or secondary traumatic stress — occurs when someone is significantly impacted by someone else’s trauma.

According to Saba Harouni Lurie, LMFT and founder of Take Root Therapy, secondary trauma is a stress response in reaction to hearing about or being witness to the firsthand traumatic experience of another. Firsthand trauma can be in the form of emotional distress or physical pain.

This means the indirect exposure to trauma — often through discussion of traumatic events or direct caregiving — causes trauma to the listener.

Secondary trauma typically develops when hearing about someone else’s trauma, and the intense, persistent stress that can come with that is a consistent part of someone’s life.

Burnout is sometimes conflated with secondary trauma. While it’s similar in symptoms and presentation, secondary trauma can be a direct result of engaging with or witnessing trauma. But burnout can occur for a variety of reasons such as an unrelenting workload.

Definitions of secondary trauma and related conditions vary in scientific studies. Some describe it as the co-occurrence of emotional exhaustion from secondary traumatic stress and physical exhaustion of burnout.

All these conditions can impact the caregiver’s mental health and their ability to continue showing the same level of empathy to patients.

Signs and symptoms

According to a 2016 review, signs of secondary trauma are similar to symptoms of PTSD.

Common symptoms include:

  • nightmares about a patient’s story
  • intrusive thoughts
  • sleep problems
  • avoiding clients or discouraging them to share trauma
  • hypervigilance or hyperarousal
  • anger
  • anxiety
  • apathy or depression
  • physical exhaustion
  • increased drinking, substance use, or eating to cope with stress
  • increase in judgment or resentment toward clients or job

People with secondary trauma who are in caregiving professions likely won’t be able to care for their patients with the same degree of empathy, effectiveness, or sound decision making.

It’s also common for the relationship between the provider and patient to start to disintegrate, according to a 2015 review on professionals in intensive care units (ICUs).

Who is impacted?

Secondary trauma is often described as a symptom of people who work in direct service, especially those who deal directly with people experiencing or working through trauma.

Secondary trauma is most prevalent in professions such as:

  • mental health professionals
  • first responders
  • trauma and palliative care nurses
  • intensive care and emergency room medical professionals
  • social workers
  • child and disability protection officers
  • police officers
  • firefighters

According to research from 2020, an estimated 15%-35% of social workers experience symptoms of secondary traumatic stress.

A 2013 review found that approximately 19% of mental health professionals who work with people in the military experience symptoms of secondary traumatic stress such as intrusion, avoidance, and arousal.

Secondary traumatic stress isn’t limited to these fields and can occur after an isolated incident or a series.

What leads to secondary trauma?

Frequent exposure to other people’s trauma can lead to secondary trauma. This can include:

  • listening to heart-wrenching or disturbing stories
  • seeing people in physical or emotional distress
  • witnessing others’ graphic injuries

“Working with those that have experienced trauma, these professionals are exposed to stories of trauma that include intricate details,” Lurie says. “Hearing the recounting of the traumatic stories, the professional may visualize and endure the account as though they had lived it themselves.”

Occupation and exposure to trauma are the primary contributing factors. Others include:

  • frequent exposure
  • having experienced trauma personally
  • being the child of a parent with trauma
  • parents of children with trauma
  • social or organizational isolation
  • lack of proper professional training
  • physical and emotionally demanding shifts

How to help yourself or others

Working in a field where you’re helping others all day can make it easy to set aside your own needs. Caring for others doesn’t have to overshadow your needs, and it’s crucial not to ignore your personal experiences.

“Helping professionals often put their own needs and their own mental health behind those of their patients and clients,” Lurie says. “But there’s a cost, and it can be high. If you need support too, please do your best to take care of yourself.”

If you’re feeling symptoms of secondary trauma, the American Academy of Pediatrics recommends:

  • taking days off work when possible to spend time relaxing alone or with family and friends
  • taking time to decompress before going home
  • leaving work at work, including your computer
  • getting enough rest
  • making sure you’re eating enough and drinking plenty of water
  • talking about your secondary trauma with someone

Julian C. Lagoy, a psychiatrist with Mindpath Health says, “I would advise someone who’s experienced secondary trauma to talk about it with loved ones who truly care for them and have their best intentions at heart.”

If what you’re experiencing seems to play a role in your day-to-day, also consider connecting with a mental health professional who specializes in trauma to support you.

They can provide you with tools and strategies to navigate your environment in a way that’s healthy for you moving forward. You may also find this training and support through a professional group or organization.

How you can offer support

Lurie says that a major way you can support a loved one is by validating their experience.

“The best way to support someone who has experienced secondary trauma is to listen to them with compassion and understanding,” Lagoy says.

A tangible way to support them could be helping them with regular tasks that may be more difficult right now.

Consider these tips:

  1. Help them eat regularly. This could be through offering to drop off groceries, making some food and eating with them for dinner, or sending them their favorite takeout through a delivery service.
  2. Keep their space organized. If you’re at their home, you can offer to wash or stack dishes or throw a load of clothes in the laundry.
  3. Spend time outdoors for fresh air and sun. Plan a hike if that’s enjoyable for you two, or simply suggest going to a park to sit and talk.
  4. Remember to discuss what would be helpful with your friend or family member. Just knowing you’re present and supportive could be enough.

In the workplace

According to Lurie, in the workplace, someone who has experienced secondary trauma could be further supported by having their experience validated.

If you’re experiencing secondary trauma in the workplace, consider speaking with your colleagues about discussing your concerns collectively and potentially asking leadership to offer additional support systems.

If you’re a person who’s within the leadership of a direct service field, this could look like:

  • creating designated space for employees to process their feelings
  • organizing additional training for managing job stressors
  • providing ample professional supervision, including reflective supervision
  • encouraging workplace self-care groups and other work partnerships
  • creating a culture of healthy work-life boundaries
  • helping manage or reduce their trauma caseload

Many of these workplace adjustments have been shown to reduce the impact of secondary trauma, according to the National Child Traumatic Stress Network.

Read the full PsychCentral article with sources.

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Julian Lagoy, M.D.

San Jose, CA

Julian Lagoy, M.D. is a board-certified psychiatrist. He received his bachelor’s degree in philosophy from the University of Notre Dame and his medical degree from St. George’s University. Dr. Lagoy completed his psychiatry residency at Virginia Tech Carilion School of Medicine. Dr. Lagoy has published in multiple medical journals and has presented his research at the American Psychiatric Association National ... Read Full Bio »

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