Mental Health

 

 

 

Secondary stress and the mental health provider

Those individuals who interact with trauma survivors, such as mental health providers, are themselves exposed to a form of traumatic stress.  More recent diagnostic formulations of Post-Traumatic Stress Disorder such as those in DSM-IV have broadened the definition of trauma to include participation in others’ traumatic response.  As you see and treat clients or consumers who have experienced disaster, whether in the emergency period immediately following it or thereafter, you will be exposed to secondary stress and traumatization, the focus of this fact sheet.  

• Secondary stress has also been termed Secondary Traumatic Stress Disorder (STSD), vicarious traumatization (PDF), compassion fatigue (PDF), or empathic strain.
• Some helpers exposed to stress develop PTSD, but the experience of the full syndrome is only one of the ways in which professional helpers are affected by their exposure to secondary traumatic stress (PDF).
• Your vulnerability to secondary stress (PDF) is influenced by:
• personal history, current life circumstances, as well as proximity and personal connection to the events and people involved in the disaster
• your level of empathic engagement with your clients’ or consumers’ experience of the disaster
• your perceived similarity to the victims of the disaster
• Secondary stress involves the following features:
• A broadened sense of “what can happen,” sometimes experienced as a “loss of innocence” or as cynical detachment influencing your frame of reference and identity, worldview, and spirituality.
• Cognitive distortion around normalcy and baseline rates.  Our awareness that planes actually do crash and that storms can turn into tornados can transform into an expectation that every plane is likely to crash and that each storm is a tornado.  When we lose our sense of perspective in this way, we enter the world of the traumatized.
• Heightened arousal and vigilance, which is a way of being in which we are characteristically aroused and remain constantly on our guard because we anticipate danger at every turn.
• Avoidance, in that we may find ourselves organizing our lives around what might happen, rather than what is happening.
• Emotional consequences of involvement, experienced as:
• Threats to self-capacities of emotional management and self-worth
• Changes in basic beliefs about psychological needs, such as safety, trust, esteem, intimacy, and control
• Loss of hope and meaning, as found in increased cynicism and pessimism, nihilism, and existential despair (PDF)
• Anger at the disaster or the perceived causes
• Symptoms similar to those of the patients being treated, or a blurring of what experiences are “ours” and what belongs to the victims (a process involving dissociation)
• A sense of unworthiness and survival guilt (PDF)
• A persistent and extreme sadness, or dysphoria (PDF)
• A sense of mourning and grief (PDF)
• Behavioral changes such as:
  • Becoming judgmental of others
  • Tuning out
  • Having a reduced sense of connection with loved ones and colleagues
  • Becoming cynical or angry and losing hope and/or a sense of meaning
  • Developing rescue fantasies, becoming over-involved, taking on others' problems
  • Developing overly rigid, strict boundaries
  • Feeling heightened protectiveness as a result of a decreased sense of the safety of loved ones
  • Avoiding social contact
  • Avoiding work contact
• Secondary stress can affect your:
• Relationship with meaning and hope
• Ability to get your psychological needs met
• Intelligence
• Willpower
• Sense of humor
• Ability to protect yourself
• Memory/Imagery
• Existential sense of connection to others
• Dangers of secondary stress lie in both direct negative effects (intrusive imagery, disrupted beliefs) and in our way of responding to it (numbing, over-generalized negative expectations, cynicism).

Coping with secondary stress:

• Self-assessment: Ask yourself, "How am I doing? What do I need? How have I changed?” Discuss the questions and answers with a colleague, friend, or therapist.
• Protect yourself through awareness of your vulnerability and recognition of the negative consequences of your work as echoed in the voices of others (PDF).
• Work to cultivate:
  • A sense of strength
  • Self-knowledge
  • Confidence
  • A sense of meaning
  • Spiritual connection
  • Respect for human resiliency

Address the stress of your work through practicing self-care -- Nurture yourself by focusing on sources of pleasure and joy, and allow yourself time alone when necessary.

Fortunately, mental health professionals have tools to manage secondary stress. We have knowledge of the ways in which trauma affects people, we have skills for soothing arousal and processing states of distress, and -- most importantly -- we have each other, a support system with the potential to help each of us maintain perspective and find understanding during those times when we get caught in the web of secondary traumatic stress. We are not invulnerable, but if we maintain a strong sense of community among ourselves, we can be resilient.

Additional Resources

This American Psychological Association fact sheet, entitled “Fostering Resilience in Response to Terrorism Among Mental Health Workers,” focuses on vicarious traumatization and secondary traumatic stress. It goes over the signs of secondary stress and provides tips for coping. (PDF)

Entitled “Secondary Stress and the Professional Helper,” this is another article on secondary stress. It provides another perspective and explains the causes and impact of stress. (PDF)

Unlike the previous two articles, this one titled “Secondary Traumatization in Mental Health Care Providers,” focuses on research findings related to secondary traumatization, including a literature review. It also discusses the assessment of stress in mental health care providers and the implications of stress on training and clinical practice. (PDF)

This article defines and explains compassion fatigue and coping strategies. (PDF)

This article is also on compassion fatigue. It is extremely helpful in that it lists the symptoms and relates through examples and personal stories. (PDF)

This fact sheet from the National Center for PTSD explains the importance of understanding secondary stress and the mental health implications mental health care providers face. (PDF)