Reactions to Secondary Traumatic Exposures

Dorothy Morgos, PH.D UNMIS Staff Counselor Ahfad University, 2010

What is Secondary Traumatic Exposure?

Exposure to traumatic material when working with traumatized individuals Traumatic situations are not a direct threat to helpers themselves

Exposures are common among: Trauma counselors Rescue workers Humanitarian workers/crisis intervention volunteers Medical workers

Exposures range from a single episode to frequent and high intensity

Reactions to Secondary Traumatic Exposures

Range from stressful to full blown traumatic reactions
Could be both short and long term

General terms used to describe a range of reactions:

Emotional exhaustion Burn out Compassion fatigue

Traumatic reactions are usually called Vicarious Trauma (VT) or Secondary Trauma (ST)

Differences Between Burnout and Vicarious Trauma (VT)

Burnout Symptoms
Result of general stress in a working environment Feeling overloaded secondary to workload Feeling overwhelmed by clients problems of chronicity and complexity Gradual progression of emotional exhaustion Does NOT usually lead to Changes of core believes known as cognitive schema Safety concerns Significant relationship difficulties

What are Traumatic Reactions

Traumatic reactions are a higher level of stressful symptoms Common term is Posttraumatic Stress Disorder ( PTSD) Symptoms are usually present for at least one month or more when stressful event is no longer present

Intrusive reactions:
Dreams/nightmares Flashbacks Obsessive thoughts Physiological reactions Persistent re-experiencing of event

What are Traumatic Reactions Cont..

Hyper-Arousal Reactions:
Hyper-vigilance Difficulty concentrating

Avoidant Reactions:
General numbing in responsiveness Avoidant behaviors related to traumatic situations

Symptoms are usually pervasive in nature

What is Vicarious Trauma

The inner transformation that occurs in the inner experience of the professional that comes about as a result of empathic engagement with the clients trauma Cumulative in nature May parallel those experienced by the traumatized victims

More common among those who work with traumatized population

What is Vicarious Trauma Cont..

Key Characteristics include:
Feeling helpless/hopeless regarding taking care of themselves and others Disillusionment about concepts of justice and freedom Change in persons beliefs ( Cognitive schema)
Self Others World

Characteristics of Vicarious Trauma Cont

Mood disturbance ( e.g. anxiety, depression) De-personalization Feeling of reduced personal accomplishments

Change in psycho-social relationships

Increased feelings of cynicism, sadness or seriousness Increased sensitivity towards violence Distrustful and alienation Alcohol and drug abuse

Impact of Vicarious Trauma

Organizations
High worker turnover Ongoing conflicts within and between organizations

Poor productivity and/or over conscientious

Re-enactment of issues Betrayal Secrecy Mistrust Rage Boundary violations

Impact of Vicarious Trauma Cont..

When working with traumatized individuals
Clinical errors and impasses Compromising boundaries with victims Anger towards clients Doubts in judgment/assessment and techniques Loss of focus on individuals resilience Avoidance or untimely intrusiveness when going in depth with traumatized individuals Reversal of roles

Effective Peer Support Strategies

Use effective listening and assessment skills Acknowledge that sharing provides social support
Vending avenue Decreases sense of isolation Increases empathy and compassion

Normalization of VT experiences
Amends cognitive distortions/disruptions Increases objectivity and empathy

Effective Peer Support Cont..

Provide an avenue to assess ideologies
Ethical issues View of self and others Spiritual struggles Views of justice

Education
Learning the different types of traumatic events and their impact Traumatic material affects different areas of ones well being Intensity of exposure, personal history and level of training impact VT

Effective Peer Support Cont..

Organizational support
Reduce case loads Provide effective and supportive supervisions Keep supervision separate from evaluation Provide debriefing opportunities Increase social interactions between co-workers Provide respite care system and means for self-care Create a non shaming work environment Encourage staff to provide feedback and suggestions on increasing a supportive working culture

Effective Peer Support

Self-Care strategies for VT
Physical self-care Diet Exercise Sleep hygiene Frequent recreational activities
Relying on religious beliefs or spirituality Social support within and outside working environment Seeking counseling/consultation as needed Socio-political involvement Continuing education Sustaining professional support outside working environment HUMOR Identifying, reminding oneself and owning success