Secondary traumatic stress: symptoms, causes and treatment.

Let us look at the characteristics of this mental disorder associated with trauma.

Post-traumatic stress disorder is widely known, manifesting itself in people who have been victims or witnesses of a highly stressful event. These people should be helped with psychological treatment, since the event causes sequelae.

However, living through a tragic event is not the only way to suffer traumatic stress. People who help, both in an emergency and in consultations, may suffer symptoms associated with PTSD, even though they did not experience the stressful event firsthand.

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

What is secondary traumatic stress?

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

That is, it occurs when a person who works frequently with people who have been affected, usually in the humanitarian sector, is affected by the Pain of others in a pathological way. This psychological phenomenon is also known as is also known as vicarious traumatization, secondary traumatization, secondary persecution and secondary traumatic stress..

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

Learning about other people's tragedies is a source of stress, a stress that, when accumulated, can lead to a truly psychopathological condition. Secondary traumatic stress is the materialization of this accumulated stress, which could not be reduced or released because of the failure to ask for help.

The reason why many aid workers do not seek professional help has to do with their own mentality. has to do with the very mentality of the groups that intervene with victims of tragedies.associated with the idea that helpers should be strong, not help-seekers. Either because of a difficulty in recognizing that they suffer from stress or because they fear stigmatization within their work group, many helpers do not ask for intervention on their stress until it has caused enormous physical and psychological suffering.

Risk factors

As we have seen, the people who tend to suffer secondary traumatic stress are workers who help other people, either in emergencies or in the field.They may be in emergency situations or treating them in medical or psychopathological consultation.

Among the factors that may increase the risk of secondary traumatic stress are those who tend to avoid their own problems or conflicting feelings, either by blaming others for their difficulties or by withdrawing when things get difficult.

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

Not having good social support can cause this condition to occur when learning about other people's traumatic events and, in addition, can worsen it. and, in addition, that it worsens. Not being able to speak freely about what one feels or being afraid of what people will say, as is the case of many humanitarian workers, is the main risk factor for emergency and health science professionals.

Also related to professions in which one helps other people, the fact that the professional has very high expectations of how to help another person, whether in a traumatic situation, medical illness or mental disorder, and seeing that these expectations are not met is a great source of anxiety. This can alter the belief system, thinking that you are not good for the job you are doing and having regrets for believing that you did not do everything you could.

Assessment of secondary traumatic stress

Since the time of the DSM-III (APA, 1980), secondary traumatic stress has been established as a diagnosable clinical condition, from a multidimensional perspective, several assessment and diagnostic instruments have been developed for this specific disorder.. This multidimensional approach has led to the development of questionnaires, interviews and various psychophysiological measures.

Among some of the evaluation instruments we can mention the "Mississippi Scale for Combat-related Posttraumatic Stress Disorder", the "PTSD Symptom Scale", the PTSD Symptom Severity Scale, the "Harvard Trauma Questionnaire" and the "Penn Inventory for PTSD". These scales have the peculiarity that they are specific, validated in specific populations, such as refugees and victims of war or natural disasters.

As for assessment tools in interview format, we can find the "Posttraumatic Stress Disorder Interview" and the "Structured Clinical Interview for DSM-III". As a psychophysiological measure, we can find the Clonidine Test as a marker of PTSD status.

However, despite the similarities in the diagnostic criteria already established from DSM-IV between post-traumatic stress disorder (PTSD) and secondary traumatic stress, the focus of attention has been on the former, leaving the other psychological problem somewhat aside. Research has focused more on treating people who have been directly victimized by a traumatic event rather than working with those who work with such victims.

This is 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 symptoms of secondary traumatic stress in humanitarian professionals.

This instrument consists of 66 items, 45 asking about aspects of the person him/herself and 21 related to the helping environment, related to the context of the rescue professional. 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. Compassion Satisfaction

This scale This scale evaluates the degree of satisfaction of the humanitarian professional with respect to those he/she is helping, consisting of 26 items.It consists of 26 items. High scores indicate a high degree of satisfaction in helping others.

Burnout

The burnout scale evaluates the risk of the humanitarian professional suffering from this syndrome. It is made up of 17 items, The higher the score obtained, the greater the risk that the professional is burned out with his or her work..

3. Compassion fatigue

The compassion fatigue scale is made up of 23 items which assess symptoms of post-traumatic stress related to work or exposure to highly stressful material (e.g., videos, videos, etc.).(e.g., child pornographic videos seized from a pedophile, crime scene photographs).

Treatment

The lines of intervention for secondary traumatic stress are very similar to those for PTSD. The most prominent treatment, specially designed for this particular type of stress, is J. Eric Gentry, Anne Baranowsky and Kathy Dunning's 1992 Accelerated Recovery Program for Empathic Attrition. from 1992.

Accelerated Recovery from Empathy Burnout Program

This program has been developed to help professionals establish strategies that will enable them to recover their personal and professional lives, addressing both the symptoms and the source of the secondary traumatic stress..

There are several objectives of this program:

• Identify and understand the factors that have triggered your symptomatology.
• To review the skills that maintain it.
• 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.
• Learning and mastering internal conflict.
• Developing post-treatment self-management.

The program protocol consists of five sessionsThe program protocol consists of five sessions, which are intended to cover all these objectives.

During the first session we start with the assessment with the Figley Compassion Fatigue Scale-Revised, combined with others such as Silencing Response Scale by Baranowsky (1997) and Solution Focused Trauma Recovery Scale by Gentry (1997).

At the second session, a personal and professional life program is established, specifying the objectives of the program and training the patient in relaxation and visualization techniques.The objectives of the program are specified and the patient is trained in relaxation and visualization techniques, such as guided relaxation, Jacobson's technique...

During the third session the traumatic situations are reviewed and self-regulation strategies are detected.During the third session, we review the traumatic situations and try to detect self-regulation strategies, as well as introduce and carry out training in various techniques and therapies, such as trauma time-limited therapy, field thinking therapy, desensitization and video-dialogue, visual visual visualization.

Then, during the fourth session all the acquired strategies and skills are reviewed.In the fourth session, all the acquired strategies and skills are reviewed, detecting the possible areas in the professional field where they may be applied.

In the fifth session an inventory is made of the objectives achieved, lines of self-care and maintenance of what has been learned during the program are established, together with the skills that have been improved. during the program, along with the skills that have been improved.

The results of this program show that workers, once they have undergone the program, are better prepared to face the after-effects of traumatic stress, both primary and secondary. In addition, they are able to develop an adequate state to exercise their profession, both in the emergency sector and in dealing with people traumatized by past events.

Prevention

Preventing the occurrence of traumatic stress is complicatedIt is practically impossible to influence how an emergency or misfortune happens to another person. However, it is possible to reduce its occurrence in those who do not work directly in emergent humanitarian situations, such as physicians or consulting psychologists.

One of the proposals, offered by D. R. Catherall, is to reduce the number of patients in treatment, preventing the professional from becoming oversaturated when listening to serious situations, such as having suffered sexual abuse, having a serious psychological disorder or suffering from a terminal illness.

Bibliographic references:

• Moreno-Jiménez, B.; Morante-Benadero, M. E.; Losada-Novoa, M. M.; Rodríguez-Carvajal, R.; Garrosa Hernández, E. (2004) Secondary traumatic stress. Assessment, prevention and intervention. Terapia Psicológica, 22(1), 69-76.
• Catherall R. D. (1998). Treating traumatized families. In C. R. Figley (ed.). Burnout in families: the systemic cost of caring (pp. 187-216).
• Keane, T.M.; Caddell, J.M. & Taylor, K.L. (1988). Mississippi Scale for Combat-related Posttraumatic Stress Disorder: Three studies in reliability and validity. Journal of Consulting and Clinical Psychology, 56, 85-90.
• Baranowsky, A.B. & Gentry, J.E. (1997). Compassion Fatigue Scale Revised. En C.R. Figley (ed.). Compassion fatigue (vol. 2.). Nueva York: Brunner/Mazel.
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