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Advancing Science and Practice for Vicarious Traumatization/Secondary Traumatic Stress: A Research Agenda

June 2017
Traumatology 23(2):129-142

June 2017
23(2):129-142

DOI:10.1037/trm0000122

Authors:

Beth Molnar

Northeastern University

Ginny Sprang

University of Kentucky

Kyle D. Killian

Capella University

Ruth Gottfried

David Yellin College

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Professionals working in the fields of trauma, victim assistance, mental health, law enforcement, fire response, emergency medical services, and other professions are exposed to traumatic events on a regular basis; in some cases, workers are exposed every day. Vicarious trauma (VT) refers to the exposure to the trauma experiences of others, considered an occupational challenge for all of these professions. Research can assist in development of strategies to avoid being left vulnerable to negative impacts of this work, known as vicarious traumatization or secondary traumatic stress (STS). This article reviews existing research and outlines a research agenda for addressing vicarious traumatization/STS in the workplace. The review is organized by the 4 steps of a public health approach: (a) defining the problem including measuring the scope or prevalence, (b) identifying risk and protective factors for negative outcomes, (c) developing interventions and policies, and (d) monitoring and evaluating interventions and policies over time. A research agenda for the field is put forward following these same steps.

A conceptual model of vicarious trauma and its spectrum of impacts on workers.

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Advancing Science and Practice for Vicarious Traumatization/Secondary

Traumatic Stress: A Research Agenda

Beth E. Molnar

Northeastern University Ginny Sprang

University of Kentucky

Kyle D. Killian

Capella University Ruth Gottfried

Georgia State University

Vanessa Emery

Northeastern University Brian E. Bride

Georgia State University

Professionals working in the fields of trauma, victim assistance, mental health, law enforcement, fire

response, emergency medical services, and other professions are exposed to traumatic events on a regular

basis; in some cases, workers are exposed every day. Vicarious trauma (VT) refers to the exposure to the

trauma experiences of others, considered an occupational challenge for all of these professions. Research

can assist in development of strategies to avoid being left vulnerable to negative impacts of this work,

known as vicarious traumatization or secondary traumatic stress (STS). This article reviews existing

research and outlines a research agenda for addressing vicarious traumatization/STS in the workplace.

The review is organized by the 4 steps of a public health approach: (a) defining the problem including

measuring the scope or prevalence, (b) identifying risk and protective factors for negative outcomes, (c)

developing interventions and policies, and (d) monitoring and evaluating interventions and policies over

time. A research agenda for the field is put forward following these same steps.

Keywords: vicarious trauma, secondary traumatic stress, first responders, victim services, compassion

fatigue

The expectation that we can be immersed in suffering and loss daily

and not be touched by it is as unrealistic as expecting to be able to

walk through water without getting wet.

(Rachel Naomi Remen, 1996,Kitchen Table Wisdom,p.52)

Professionals working in the fields of trauma, victim assistance,

mental health, law enforcement, fire response, emergency medical

services, and other professions are exposed to traumatic events on

a regular basis; in some cases, workers are exposed every day.

These exposures can include both mass casualty events such as the

2012 Boston Marathon bombings and the September 11, 2001

terrorist attacks, or chronic exposure to ongoing incidents of sexual

assaults, intimate partner violence, child maltreatment, homicides,

and suicides, among others. First responders and other profession-

als bear witness to traumatic experiences and damaging, cruel

treatment experienced by others, as one author put it, “shattering

assumptions of invulnerability” (Janoff-Bulman, 1992). What she

is referring to here is the transformation of a person’s world view

from one that the world is “consistently benevolent and meaning-

ful” to a realization that malevolent, hostile events happen as

exemplified by those who have experienced trauma. While this is

a regular occupational challenge for many professions, a new

public health approach is needed to prevent and mitigate the

negative impacts of these exposures in the workplace.

Taking a public health approach to preventing negative impacts

on professionals exposed to vicarious or secondary trauma requires

four steps: (a) defining the problem including measuring the scope

or prevalence, (b) identifying risk and protective factors for neg-

ative outcomes, (c) developing interventions and policies, and (d)

monitoring and evaluating interventions and policies over time.

Editor’s Note. Cambria Walsh served as the action editor for this

article.—BEB

Beth E. Molnar, Institute on Urban Health Research and Practice, Bouvé

College of Health Sciences, Northeastern University; Ginny Sprang, De-

partment of Psychiatry, Center on Trauma and Children, University of

Kentucky; Kyle D. Killian, Marriage and Family Therapy Program, Harold

Abel School of Social & Behavioral Sciences, Capella University; Ruth

Gottfried, School of Social Work, Georgia State University; Vanessa

Emery, Institute on Urban Health Research & Practice, Bouvé College of

Health Sciences, Northeastern University; Brian E. Bride, School of Social

Work, Georgia State University

We acknowledge the funding provided to Beth E. Molnar for the Vicarious

Trauma Toolkit project, Office for Victims of Crime, from the Department of

Justice (Grant VF-GX-K011). Ruth Gottfried also acknowledges her postdoc-

toral fellowship from the Haruv Institute in Jerusalem, Israel.

Correspondence concerning this article should be addressed to Beth E.

Molnar, Institute on Urban Health Research and Practice, Northeastern

University, 360 Huntington Avenue, Mail Stop 314 INV, Boston, MA

02115. E-mail: b.molnar@northeastern.edu

This document is copyrighted by the American Psychological Association or one of its allied publishers.

This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

2017, Vol. 23, No. 2, 129–142 1085-9373/17/$12.00

http://dx.doi.org/10.1037/trm0000122

129

Previously, the professional fields where vicarious or secondary

trauma is likely to occur have been more reactive than prevention

oriented, as much of the existing research base focuses on the

aftermath of negative reactions to the exposure to the trauma of

others.

At present, the fields are poised to move beyond an expectation of

automatic resilience for workers, defined as an assumption that work-

ers possess strengths to overcome stress or crisis, either on their own

or by seeking out the appropriate resources. Instead the fields are

moving toward social norms that obligate organizations to recognize

the inevitability of vicarious/secondary exposure to trauma in these

professions, and to provide resources proactively to prevent profes-

sionals from having deleterious effects. To make these changes, a

rigorous scientific base in multiple areas must be developed. The

purpose of this article is to outline a research agenda for moving each

of these public health steps forward, starting with the state of research

evidence currently available as it applies to first responders and other

professionals who provide services to trauma exposed populations.

The proposed research agenda will build a scientific foundation for

effective intervention and policy development to mitigate the conse-

quences of vicarious/secondary trauma before they occur, in addition

to continuing to build the evidence base for effective treatments.

VT refers to the exposure to the trauma experiences of others.

Charles Figley (1995) declared that stress is a “normal and natural

byproduct of working with traumatized people” (p. 573). It makes

sense that listening to traumatic material (e.g., a case of severe war

trauma, or a survivor’s detailed, harrowing account of political

torture, or sexual assault, or investigating online child pornogra-

phy) for 40 hours a week or longer could lead to acute distress for

the listener/viewer. VT is an occupational challenge for the fields

of victim services, emergency medical services, fire services, law

enforcement and other professionals. It is also a challenge for the

medical profession, but that research is beyond the scope of this

article. Working with victims of violence and trauma has been

shown to change the worldview of responders and can also put

individuals and organizations at risk for a range of negative con-

sequences, such as changing responders’ perception of safety and

their ability to trust others (Bell, Kulkarni, & Dalton, 2003;

Knight, 2013;McCann & Pearlman, 1990;Newell & MacNeil,

2010;Pearlman & Saakvitne, 1995;Vicarious Trauma Institute,

2015).

Vicarious traumatization is a term that some in the field use to

refer to the impact of indirect trauma exposure (Canfield, 2005;

McCann & Pearlman, 1990;Pearlman & Saakvitne, 1995). A

vicarious trauma-informed organization recognizes these chal-

lenges and assumes the responsibility for proactively addressing

the impact of vicarious trauma through policies, procedures, prac-

tices, and programs.

STS, synonymous (for purposes of this article) with vicarious

traumatization, has been defined as a constellation of symptoms

that may run parallel to those of posttraumatic stress disorder

(PTSD), including symptoms of intrusion (Herman, 1992;Mc-

Cann & Pearlman, 1990), avoidance, arousal (Cloitre et al., 2009;

Courtois, 1988;Dutton & Rubinstein, 1995;Figley, 1995;Mc-

Cann & Pearlman, 1990), and emotional numbing (Klari´

c, Kvesi´

Mandi´

c, Petrov, & Francˇiškovi´

c, 2013;Nelson-Gardell & Harris,

2003;Zimering, Munroe, & Gulliver, 2003). According to Smith

Hatcher, Bride, Oh, Moultrie King, and Franklin Catrett (2011)

“STS is increasingly viewed as an occupational hazard of provid-

ing direct services to trauma survivors” (p. 210).

Compassion fatigue (CF) is another term used in the literature to

describe negative impacts of trauma-focused work, especially

among clinicians. Figley (1995) referred to it as when the work of

clinicians suffers from the negative impact of trauma experienced

by clients, to a point where they are no longer able to effectively

help those seeking their services (Figley, 1995). A related positive

phenomenon discussed in the field is compassion satisfaction,

which is the sense of reward, efficacy, and competence one feels

in one’s role as a helping professional (Sprang, Clark, & Whitt-

Woosley, 2007;B. H. Stamm & Figley, 1996). The concept of

vicarious transformation takes the concept of compassion satis-

faction a step deeper. It acknowledges a positive transformation in

one’s worldview and spirituality in response to helping others live

through trauma (Sanders, Kirby, Tellegen, & Day, 2014). A visual

depiction of VT, vicarious traumatization, STS, and related con-

cepts are depicted in Figure 1.

Steps 1 and 2 of a Public Health Approach: Defining

the Problem, Identifying Risk/Protective Factors

Defining the problem is the first step in taking a public health

approach to addressing vicarious traumatization/STS/CF (VT/

STS/CF) in the workplace. As consciousness around these issues

continues to grow, researchers have begun to study predictors and

correlates of traumatization among helping professionals (Smith

Hatcher et al., 2011). This section first describes the instruments

currently available for measuring VT/STS/CF, and follows with a

presentation of the prevalence and risk/protective factor studies

currently available involving first responders, victim services pro-

viders, and others.

Instruments for Measurement of VT/STS/CF

A widely used instrument in the field is the Secondary Trau-

matic Stress Scale (STSS), developed to specifically tap secondary

trauma symptoms in helping professionals. The 17-item STSS

contains three subscales (Intrusion, Avoidance, Arousal) and as-

sesses the frequency of STS symptoms experienced by clinicians

in the past 7 days using a 5-point, Likert-type response format,

congruent with the DSM–IV–TR definition of PTSD (Bride, Rob-

inson, Yegidis, & Figley, 2004). The STSS shows strong psycho-

metric properties including high internal consistency reliability

(.93 to .95 for the total scale; Kintzle, Yarvis, & Bride, (2013).),

convergent and discriminant validity (Bride et al., 2004), factorial

validity (Bride et al., 2004;Ting, Jacobson, Sanders, Bride, &

Harrington, 2005), and multiple methods of scoring (Bride, Radey,

& Figley, 2007).

The Compassion Fatigue Self-Test (CFST) was developed

based on clinical experience and designed to assess both compas-

sion fatigue and job burnout with two subscales (Compassion

Fatigue and Burnout). It uses a 5-point Likert-type response scale

producing scores ranging from extremely low risk to extremely

high risk (Figley, 1995) Reported internal consistency estimates

range from alphas of .86 to .94 (Figley, 1995;B. H. Stamm &

Figley, 1996).

A revised version of the CFST includes positively worded

questions about compassion satisfaction, making it a 66-item in-

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130 MOLNAR ET AL.

strument (B. H. Stamm & Figley, 1996). Pilot work on this revised

instrument shows ample evidence of internal consistency for each

of the three sections: Compassion Satisfaction (.87), Burnout (.90),

and Compassion Fatigue (.87; B. Stamm, 2002). Continued devel-

opment of this version of the CFST resulted in a renamed instru-

ment, the Professional Quality of Life Scale (ProQOL), discussed

below.

Gentry, Baranowsky, and Dunning (2002) also reported using a

different version of the CFST, which they call the Compassion

Fatigue Scale—Revised (CFS-R). R. E. Adams, Boscarino, and

Figley (2006) identified multiple underlying factors, calling into

question the factor validity of the CFST, and made refinements to

the instrument resulting in a revised instrument called the Com-

passion Fatigue-Short Scale (CF-Short Scale; which has good

internal consistency and correlated with the longer 30-item CFS-R

Scale (r⫽.83, p⬍.001; Beck, 2011).

The 30-item Professional Quality of Life Scale (ProQOL-V)

includes three subscales: Compassion Satisfaction, Burnout, and

Compassion Fatigue (B. Stamm, 2009) where respondents indicate

how frequently they have experienced that item in the past 30 days.

This instrument shows good alpha reliability scores on each sub-

scale (Compassion Satisfaction, 0.88; Burnout, 0.75; and Trauma/

Compassion Fatigue, 0.81; Steinberg, Brymer, Decker, & Pynoos,

2004). The ProQOL is the most commonly used scale for deter-

mining a helper’s quality of life, and has been cited in over 200

published papers (Perkins & Sprang, 2013).

The Trauma and Attachment Belief Scale (TABS; Pearlman,

2003), previously known as the Traumatic Stress Institute Belief

Scale (Pearlman, 1996), is a measure based in constructivist self-

development theory. The 84-item instrument assesses the long-

term impact of trauma on beliefs about self, others, and relation-

ships (Pearlman, 2003). It is administered through self-report

format for children ages nine and up, and “assesses beliefs about

self and others that are related to five needs commonly affected by

traumatic experience: safety, trust, self-esteem, intimacy, and con-

trol” (Pearlman, 2003, p. 3). Sample items on the TABS include “I

can keep myself safe,” and “People don’t keep their promises.”

Respondents rate each item on a 6-point scale (1 ⫽Disagree

Strongly to 6 ⫽Agree Strongly). Higher scores indicate more

disturbances of beliefs. Though the TABS was designed for use

with persons who directly experienced traumatic events, it has also

been used to assess vicarious traumatization. Overall internal con-

sistency reliability (Cronbach’s alpha) for the TABS has been

reported at .98 (Pearlman, 1996), with subscale reliabilities rang-

ing by study (Jenkins & Baird, 2002;Roth, Newman, Pelcovitz,

van der Kolk, & Mandel, 1997) and a median internal consistency

estimate of .79 (Pearlman, 2003).

Regarding construct validity, Dutton, Burghardt, Perrin, Chrest-

man, and Halle (as cited in Pearlman, 2003, p. 40) found a

correlation between TABS scores and measures of PTSD for

female victims of abuse. The construct validity of the TABS was

supported through tests of convergent and discriminant validity

although other investigators have found less support for conver-

gent, discriminant, and factor validity of the TABS (K. B. Adams,

Matto, & Harrington, 2001;Matto, Adams, & Harrington, 2000).

The Vicarious Resilience Scale (VRS) is a tool to measure the

ways in which helping professionals can be positively influenced

by exposure to the resilience displayed by their clients (Engstrom,

Hernández, & Gangsei, 2008;Hernández, Gangsei, & Engstrom,

2007;Hernandez-Wolfe, Killian, Engstrom, & Gangsei, 2014).

While helping professionals may be subject to cumulative effects

of working with traumatized clients through STS or VT, they may

also “experience personal and professional growth by being wit-

ness to and inspired by their clients’ processes of resilience” and

recovery (Hernandez-Wolfe et al., 2014, p. 5). The construct of

vicarious resilience emerged from observation, was built on

grounded theory and has been articulated through resilience and

vicarious learning theory (Bandura, 1986;Luthar, 2003;2006;

Walsh, 2006).

Figure 1. A conceptual model of vicarious trauma and its spectrum of impacts on workers.

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131

ADVANCING SCIENCE AND PRACTICE FOR VT/STS: A RESEARCH AGENDA

Given vicarious resilience represents a positive phenomenon, a

study was initiated to develop a measure of the construct as a

potential resource for clinical training and supervision. This tool,

the VRS, is in the process of development and validation. Forty-

eight items tapping professional’s increased resilience, client-

based inspiration, self-care practices, and consciousness around

the importance of power and privilege in therapeutic work were

written and revised based on the feedback of experts on traumatic

stress and resilience in the fields of psychology and family therapy.

Following factor and reliability analyses, Killian, Hernandez-

Wolfe, Engstrom, and Gangsei (2017) found the shortened 27-item

VRS possessed a normal-like distribution and seven dimensions

and subscales: (a) client-inspired hope, (b) changes in life goals/

perspective, (c) increased recognition of spirituality as a client

resource, (d) increased resourcefulness, (e) increased self-

awareness and self-care practices, (f) increased consciousness

about social location and power, and (g) increased capacity for

remaining present while listening to trauma narratives. The study

also found that the total VRS, as hypothesized, correlated with

posttraumatic growth, compassion satisfaction and work morale.

The VRS did not correlate with compassion fatigue or burnout,

suggesting VR is not merely “the opposite of” these constructs, but

instead a unique construct.

Prevalence of VT/STS/CF in Helping Professions

This section incorporates the work of authors who have

published comprehensive reviews and meta-analyses that ad-

dress the prevalence of VT/STS/CF, and adds studies that have

been published more recently. This article is working with the

definition that VT/STS/CF is an occupational hazard across all

the helping professions described. The research base and, ulti-

mately, prevention efforts, are focused on the presence or

absence of negative or positive impacts of doing trauma-

focused work, including compassion satisfaction and vicarious

resilience in newer literature.

There are notable challenges to capturing the prevalence of

VT/STS/CF, and cross-study comparisons highlight several of the

methodological issues. For example, there is wide variability

across studies as to how the constructs of VT/STS/CF are defined

and operationalized, and conflicting definitions make comparison

of these conditions difficult. Differences in research methodolo-

gies (e.g., study designs, measurement instruments, response rates,

sample sizes, data analysis, and study limitations), variations as-

sociated with the studied work-related trauma (e.g., type, severity,

duration, repetition and length of time elapsed since exposure), and

dissimilarities in data presentation need likewise to be taken into

consideration when assessing the prevalence of vicarious trauma-

tization across different professional groups. Noteworthy for the

field is that the diagnostic criteria for PTSD have changed over

time in the Diagnostic and Statistical Manual of Mental Disorders

(DSM), first incorporating indirect trauma (also synonymous with

VT) as a qualifying traumatic event in the Diagnostic and Statis-

tical Manual of Mental Disorders (5th ed.; DSM-5;American

Psychological Association, 2013;May & Wisco, 2016). A smaller

literature on risk and protective factors is described within this

section as well.

Prevalence Among First Responders

The prevalence of VT/STS/CF among first responders, includ-

ing fire services, law enforcement, emergency medical services,

and other professions related to personnel first on an emergency

rescue scene, has thus far been measured primarily using PTSD

instruments to estimate the prevalence of either posttraumatic

symptoms or full PTSD diagnoses. Currently there are no studies

that clearly delineate the effects of direct trauma from those of

secondary trauma. As such, these estimates likely reflect the men-

tal health effects of not only first responders’ exposure to duty-

related and personal primary trauma but their work-related sec-

ondary exposure to trauma as well (Lawrence, 2017). In the future,

separate screening tools for STS/VT/CF will be useful for under-

standing the separate and combined effects of STS/VT/CF and

primary trauma.

There are studies that have been done on the prevalence of

PTSD among first responders that likely include a mix of primary

and secondary trauma effects though they are not delineated that

way. For example, a systematic review and meta-analysis con-

ducted by W. Berger et al. (2012) estimated the pooled current

international probable prevalence rate of PTSD in rescue workers

as a group. A total of 28 studies over a 45-year period were

selected, reporting on 40 samples with 20,424 rescuers from 14

countries and all continents. Selected studies encompassed such

occupational groups as ambulance personnel, canine handlers,

firefighters, and policemen who took part in disaster rescue oper-

ations; less studied professionals, such as body handlers and mil-

itary medical workers were not included. The estimated pooled

worldwide PTSD prevalence among these rescuers was reported as

10% for full PTSD. As discussed by the authors, the 10% rate is

most likely an underestimate, as first responders may limit their

disclosures due to fear of personal and/or professional conse-

quences of suffering from PTSD, a mental illness to which stigma

is attached. Of particular note, W. Berger and colleagues (2012)

did not find a significant difference in PTSD prevalence between

rescue workers investigated after exposure to a major disaster and

those assessed in their daily occupational routines. In comparison

to this figure of 10% among global rescuers, an estimate of

diagnosable PTSD among general developed country populations

is 4.4% (Kessler et al., 2011).

Again not distinguishing between primary and secondary expo-

sure to trauma, Thormar et al. (2010) reported higher rates (24–

46%), in volunteer rescue workers, from nine selected studies with

cohorts ranging from 24 to 3,055 participants (Thormar et al.,

2010). Voluntary rescue workers were found to suffer from symp-

toms of PTSD more frequently than their professional counterparts

as reported by Haraldsdóttir et al. (2014) and Zhang et al. (2016).

Rates reported in the latter study by Zhang and colleagues were

cross-cultural (i.e., 176 Oklahoma City professional bombing res-

cue workers (10%), 52 Nairobi volunteer bombing rescue workers

(22%), and 105 Nairobi civilian bombing survivors (36%), as-

sessed via the Diagnostic Interview Schedule (Zhang et al., 2016).

Relatedly, associations between traumatic exposure and PTSD

symptoms were shown to be weaker in responders as compared

with civilians, in a study by Liu, Tarigan, Bromet, and Kim (2014).

First responders to the 2011 Norway twin terrorist attacks scored

low on the PTSD Checklist-Specific (1% above 50, 3% above 35)

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132 MOLNAR ET AL.

showing minimal symptomology (Bogstrand, Skogstad, & Eke-

berg, 2016).

In a review of PTSD treatment studies among first responders,

Haugen, Evces, and Weiss (2012) used national data on employ-

ment to identify approximately 1.5 million United States workers

in first responder occupations. Applying W. Berger et al.’s (2012)

estimate of 10% among rescue workers, and the estimated relative

proportion (77%) between partial and full PTSD by Weiss et al.

(1992), they estimated the total number of United States first

responders potentially needing treatment for PTSD to be 250,000.

In addition to the previously mentioned occupational groups, Hau-

gen et al.’s (2012) estimate incorporated sheriff patrol officers,

transit and railroad police, forest fire inspectors and prevention

specialists, detectives and criminal investigators, as well as foren-

sic science technicians. Again, this body of work does not separate

out the effects of direct and indirect trauma but all are professions

where both occupational challenges exist.

Wilson (2015), focusing on PTSD among first responders in the

aftermath of human-made mass violence, reported a prevalence

range of 1.3% to 22% for probable PTSD across 20 studies

(cohorts ranged from sample sizes of 41 to 11,701), 15 of which

focused on first responders following the World Trade Center

(WTC) terrorist attacks (Wilson, 2015). The majority of rates

reviewed by Wilson were consistent with the average 10% prev-

alence reported by W. Berger et al. (2012). Relatedly, a meta-

analysis by Liu et al. (2014), focusing on probable PTSD associ-

ated with WTC exposure, demonstrated a prevalence range of

5.4% to 29.2% (Liu et al., 2014). Included were 10 studies,

comprising cohorts ranging from 3,271 to 20,294, focusing on first

responders and/or civilians, at time frames ranging from a few

months to 9 years postdisaster. All but one of the included studies

incorporated the PTSD Checklist-Civilian (PCL) measure.

Additional results from studies of WTC rescuers, based on

various PCL versions utilized in longitudinal studies, are cited

below. Maslow et al. (2015), studying 16,488 WTC rescue and

recovery professional and volunteer workers, reported PTSD prev-

alence over an 8–9 year postdisaster period ranging from 4.0%

(most severe) to 53.3% (least severe; Maslow et al., 2015). As-

sessing the relationship between human remains exposure and

persistent probable PTSD 10–11 years after the WTC disaster,

Fairclough et al. (2015) reported an overall prevalence of 7.4% in

a sample of 1,592 cleanup and recovery workers (i.e., sanitation

workers, firefighters, and police; Fairclough et al., 2015). By

comparison, in a 12-year longitudinal study by Yip et al. (2015)

focusing on 2,281 fire department emergency medical service

workers (i.e., paramedics and emergency medical technicians), a

probable PTSD prevalence of 7% was found. Emergency medical

service workers who arrived earliest at the WTC site demonstrated

nearly seven times the risk for probable PTSD—as compared with

those who never worked at the disaster site (Yip et al., 2015).

PTSD findings 11–13 years post-WTC have also been studied.

Bromet et al. (2016), examining 3,231 responders, of whom the

majority (70.4%) worked in law enforcement, reported the follow-

ing: 9.7% current, 7.9% remitted, and 5.9% partial probable PTSD.

There are a few examples of research studies where STS-

specific instruments have been used in crime investigators. STS

has been studied in Internet Crimes Against Children (ICAC)

personnel, commonly police officers and federal agents. Their job

is finding online victims and perpetrators of child pornography and

other violent crimes committed against children. Prevalence of

high STS symptoms in this population has been shown to range

from 18–33%; Bourke and Craun (2014) found 25% of the 600

ICAC respondents reported symptoms that met the criteria for high

to severe STS in a self-reported survey (Bourke & Craun, 2014;

Cornille & Meyers, 1999). Perez, Jones, Englert, and Sachau

(2010) found 18% high and 18% moderate symptoms in another

survey of 33 child abuse investigators using the STSS. Most

recently, Tehrani (2016) found prevalence varied according to the

online child abuse investigator’s gender, extroversion, and neurot-

icism.

Though the term “first responders” traditionally refers to the afore-

mentioned professional groups, a broader description of responders

may likewise include postdisaster and humanitarian relief workers

and researchers who also experience VT/STS/CF and may have

negative reactions (e.g., Connorton, Perry, Hemenway, & Miller,

2012;Dominey-Howes, 2015;Flannelly, Roberts, & Weaver, 2005;

McLennan, Evans, Cowlishaw, Pamment, & Wright, 2016;Pearlman,

2014;Wee & Myers, 2002). Another notable group exposed to

vicarious trauma are sexual assault nurse examiners (or SANE nurses)

who collect forensic evidence and provide specialized care to survi-

vors of sexual assault presenting in medical settings; a recent study

recruiting subjects from two professional nursing organizations

showed SANE nurses had significantly higher levels of vicarious

traumatization than other nurses working in women’s health. When

personal trauma was taken into account statistically, SANE nurses

without personal trauma had similar VT scores to non-SANE nurses

with personal trauma (Raunick, Lindell, Morris, & Backman, 2015).

Prevalence Among Social Work/Mental Health/Victim

Services Providers

Prevalence of STS has been studied more extensively among

professionals who work with survivors of trauma in therapeutic

professions. These professions include rape crisis and domestic

violence counselors and volunteers, social workers, mental health

professionals (some of whom work within first responder agen-

cies), victim services organizations such as child or adult protec-

tive services, child advocacy center personnel, and victim advo-

cates working within the legal system, among others. As in the

previous section, we focus on review studies wherever possible.

In a meta-analysis of 38 studies by Hensel, Ruiz, Finney, and

Dewa (2015), 17 risk factors for STS among professionals who do

therapeutic work with trauma victims were identified across stud-

ies. These risk factors included caseload volume, caseload fre-

quency, caseload ratio, and having a personal trauma history.

Among the studies they reviewed, prevalence of STS was reported

as 34% among child protective service workers (Bride, Jones, &

Macmaster, 2007) and 15.2% among licensed social workers using

the STSS (Bride, 2007). More than half (55%) of Bride’s sample

likewise met at least one of the core criteria for PTSD. Relatedly,

in a comparable study by Choi (2011), also assessed by the STSS,

findings indicated a 21% STS prevalence in a national sample of

social workers treating survivors of family or sexual violence (N⫽

154; Choi, 2011). About 65% of Choi’s sample also met at least

one of the core PTSD criteria. Participants in a study of mental

health therapists (i.e., 320 licensed mental health professionals

assessed via the STSS) reported comparable STS symptoms to

Bride (2007) and Choi (2011), with a mean score of 32.1 (SD ⫽

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133

ADVANCING SCIENCE AND PRACTICE FOR VT/STS: A RESEARCH AGENDA

10.0; Bride, Jones, et al., 2007;Choi, 2011;Robinson-Keilig,

2014). A 19.2% STS prevalence was also reported for mental

health providers working with military patients (N⫽224; STSS

assessment; Cieslak et al., 2013). Hensel et al. (2015), noted that

there may be differences between occupational groups with respect

to indirect trauma severity, citing Sprang, Craig, and Clark’s

(2011) study whereby child welfare workers were shown to be

more severely affected by compassion fatigue (i.e., assessed via

the ProQOL measure; N⫽577) compared with all other types of

behavioral health professionals examined. Recently Bogstrand et

al. (2016) found 40.9% of licensed clinical social workers met

criteria for PTSD (N⫽256; STSS assessment; Caringi et al.,

2016). Conrad and Kellar-Gunther (2006) found the prevalence of

CF as high as 50% in a group of 363 child protection workers

using the Compassion Satisfaction/Fatigue Self-Test (Conrad &

Kellar-Guenther, 2006).

This finding is similar to that of W. Berger et al. (2012)

discussed above, who reported that ambulance personnel showed

higher estimated PTSD prevalence rates compared with firefight-

ers and police officers (W. Berger et al., 2012). Hensel et al. (2015)

likewise suggest that mental health professionals, similar to first

responders, may be reluctant to disclose personal details due to

concerns about stigma, confidentiality, and job security (Hensel et

al., 2015).

Individual studies focusing on the impacts of vicarious trauma

among other related professional and/or volunteer groups, listed in

order of publication year, include: Kiyimba and O’Reilly (2016)

for qualitative transcriptionists; Coleman, Delahanty, Schwartz,

Murani, and Brondolo (2016) for medical examiner office employ-

ees; Becker and McCrillis (2015) for health sciences librarians;

Lusk and Terrazas (2015) for para-professionals working with

refugees; Mehus and Becher (2016) for spoken-language interpret-

ers; Ewer, Teesson, Sannibale, Roche, and Mills (2015) for alcohol

and other drug workers in Australia; Dasan, Gohil, Cornelius, and

Taylor (2015) among emergency medical consultants; Fisackerly,

Sira, Desai, and McCammon (2016) among certified child life

specialists; Mishori, Mujawar, and Ravi (2014) for asylum evalu-

ators; Johnson, Bertschinger, Snell, and Wilson (2014) for military

psychologists; Furlonger, and Taylor (2013) for telephone and

online counselors, Želeskov-Ðori´

c, Hedrih, and Ðori´

c (2012) for

psychotherapists; Levin et al. (2011) for attorneys and their ad-

ministrative support staff; Negash and Sahin (2011) for marriage

and family therapists; Robertson, Davies, and Nettleingham (2009)

for jurors; and Figley and Roop (2006) for animal caregivers.

Steps 3 and 4: Development/Monitoring of

Interventions and Policies

Trauma treatment research studies point to a range of interven-

tions, including cognitive-behavioral treatments (Bryant, Sack-

ville, Dang, Moulds, & Guthrie, 1999), eye movement desensiti-

zation and reprocessing (EMDR; Chen et al., 2014;Shapiro &

Maxfield, 2002), critical incident stress debriefing (CISD; Pack,

2013), and psychological first aid (PFA; Everly, Barnett, & Links,

2012), as efficacious in reducing the incidence of PTSD in those

who are experiencing subthreshold symptoms of traumatic stress

following direct exposure. Several studies found these approaches

superior in reducing trauma symptoms compared with informal

supportive services (e.g., Bryant et al., 1999). However, the inter-

ventions most frequently recommended to address the effects of

indirect exposure, or VT/STS/CF among victim services providers

and first responders, fall under the category of health promotion

and wellness. These include supportive services, training as treat-

ment, and psychoeducation among others. A review of treatment

research studies for VT/STS/CF follows here.

A literature review by Bercier and Maynard (2015) demon-

strates the shortage of trauma-informed STS interventions. Their

systematic literature review examined interventions for reducing

the negative effects of STS for mental health professionals; after

reviewing over 4,000 citations and 159 full-text reports, no studies

were found to meet inclusion criteria. According to the authors:

The empirical research related to CF, STS, and VT seems to be indicative

of an emerging field as the research tends to focus on the nature,

prevalence, measurement, and etiology of CF, STS, and VT rather than

effects of interventions. (Bercier & Maynard, 2015,p.84)

The types of interventions currently available are discussed in

this section, including the limited evidence of their benefits and

limitations on VT/STS/CF.

Health Promotion and Wellness

Supportive, self-directed, and nontherapeutic approaches are by

far the most utilized methods of addressing STS from a prevention

perspective, and for those who are already symptomatic. Health

promotion or wellness strategies (i.e., self-care approaches) such

as yoga, meditation, relaxation, achieving a work-life balance,

physical activity, proper nutrition, and so forth are endorsed by

some authors as the most effective means of guarding against the

development of STS or addressing those who are symptomatic

(Coetzee & Klopper, 2010;Dane, 2000;Hesse, 2002;Iliffe &

Steed, 2000;Neville & Cole, 2013;Zadeh, Gamba, Hudson, &

Wiener, 2012).

Many of the current approaches to addressing STS in clinical

therapeutic settings involve the use of self-care strategies to protect

the clinician and counteract the potential negative impact of em-

pathic engagement with a highly symptomatic trauma client

(Burke & Van Dernoot Lipsky, 2009;Figley, 2002;Mathieu,

2012;Pearlman & Saakvitne, 1995). This perspective implicitly

espouses that the provision of trauma treatment is unavoidably

depleting, and that recovery must occur during periods of nonex-

posure. There is little in the practice literature that specifies how,

or if, the empathic encounter could be modified to attenuate these

effects and still offer maximum therapeutic benefit to the client.

Bober and Regehr (2006) used a cross-sectional design to in-

vestigate if the most commonly recommended methods for pre-

venting STS were associated with lower levels of distress. In this

sample (N⫽259) they found that despite high reported beliefs that

leisure activities, self-care practices, and supervision are benefi-

cial, this did not translate into time spent engaging in these

activities. Notably, they also found no evidence that time spent

engaging in these coping strategies impacted trauma scores. Cor-

roborating these findings, Killian (2008) found that only one

personal resource, emotional self-awareness, ameliorated symp-

toms of compassion fatigue in family therapists (N⫽104) work-

ing with trauma survivors (Killian, 2008).

Mindfulness-based stress reduction (MBSR; Kabat-Zinn, 2003)

is a specific type of self-care approach that has been operational-

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134 MOLNAR ET AL.

ized into an evidence-based, protocol driven intervention to ad-

dress a variety of conditions including chronic fatigue, pain asso-

ciated with cancer, anxiety disorders, depression, and daily stress

(Grossman, Niemann, Schmidt, & Walach, 2004;Kabat-Zinn,

2003). It is increasingly recommended for preventing and treating

STS (Goodman & Schorling, 2012;Thieleman & Cacciatore,

2014).

Limited research on MBSR includes a survey administered to 41

trauma workers (paid and volunteer) that found an inverse corre-

lation between mindful attention awareness (a component of mind-

fulness) and reported levels of STS (Thieleman & Cacciatore,

2014). A meta-analysis of studies on MBSR, including seven

randomized controlled trials (RCTs), revealed no investigations of

STS as an outcome, but revealed a moderate effect size when

considering its impact on overall physical and mental health

(Grossman et al., 2004). More recently, studies have found support

for MBSR for women with PTSD (Dutton, Bermudez, Matas,

Majid, & Myers, 2013), combat veterans (King et al., 2013), and

child abuse survivors (Kimbrough, Magyari, Langenberg,

Chesney, & Berman, 2010). In a rare use of a longitudinal study

design, Williams, Ciarrochi, and Deane (2010) followed 60 police

department recruits in Australia for 1 year and found a correlation

between identifying feelings (using mindfulness, emotional aware-

ness, and resiliency) and depression, and between lower mindful-

ness and depression.

Miller and Sprang (2016) have offered a model of clinical

practice, components for enhancing clinician experience and re-

ducing trauma (CE-CERT), that proposes concrete skills that the

clinician can use during treatment, to maintain their own emotional

regulation, and metabolize reactions to indirect trauma exposure in

real time. These skills draw upon the core elements of evidence-

based trauma treatment—affective and cognitive regulation, con-

struction of a narrative, and attending to parasympathetic recov-

ery—along with experiential engagement and reducing emotional

labor (Miller & Sprang, 2016). The Resilience Alliance, a product

of the New York City Administration for Children’s Services and

New York University Children’s Trauma Institute, is another ex-

ample of organizational leadership to address STS and uses health

promotion and wellness, professional skills training, and psychoedu-

cation. The program is structured around twelve 60–90 min training

modules that teach child welfare workers about STS, self-efficacy,

optimism, self-care, and workplace dynamics through discussion,

goal-setting, and reflection activities. Like the CE-CERT, these prac-

tice models employ evidence-based measures, but remain largely

untested and have primary applicability to those working in clinical

therapeutic settings.

The accelerated recovery program (ARP) was developed by

Gentry et al. (2002) as a five-session model for treating STS that

involves building resiliency skills, self-management and self-care,

connection with others, skills acquisition or gaining a sense of

professional mastery, and internal and external conflict resolution.

A criticism of this program is that a pathway for addressing

primary traumatic stress symptoms appears to fall outside the

intervention model. Furthermore, no published study results were

located that provide the details of any investigations into the

effectiveness or efficacy of ARP; only a mention that pre- and

posttest ProQOL Scale scores improved after ARP in a book

published by the ARP team (Gentry et al., 2002).

Professional Skills Training

Professional skills training as a form of prevention and treat-

ment for STS is a strategy that is supported by correlational studies

suggesting that individuals who received instruction in evidence-

based practices for treating traumatic stress conditions had lower

levels of STS (Sprang et al., 2007). In addition, research by Prati,

Pietrantoni, and Cicognani (2010) found that increased self-

efficacy moderates the relationship between stress appraisal and

professional quality of life (including STS). Ortlepp and Friedman

(2002) noted that the stronger lay counselor’s perceptions that they

possessed the skills needed to do their job, the lower their STS

symptoms. A study of mental health professionals working in

communities near the Gaza Strip, with populations exposed to

rocket attacks, compared risk factors for PTSD symptoms and

vicarious traumatization; both were correlated with lower profes-

sional self-efficacy and VT was further correlated with fewer years

of education (Finklestein, Stein, Greene, Bronstein, & Solomon,

2015). Although these studies are only reporting correlates of STS,

the findings are consistent with the basic tenets of social cognitive

theory, which posits that individuals with high self-efficacy are

less affected by stressful events because of their perceived ability

to master their personal functioning and environmental demands

(Bandura, 1997).

Psychoeducation

In a rare RCT, R. Berger and Gelkopf (2011) combined the

strategy of professional skill development around service delivery

with increased knowledge and skills to identify and manage one’s

own STS responses. This intervention provided 90 pediatric nurses

in war- and terror-affected areas with 12 weeks of psychoeduca-

tion regarding identifying trauma in infants and young children,

how to use trauma-specific training tools, stress management tech-

niques that could be used with the children and their parents, as

well as self-maintenance tools, self-regulation strategies, and ways

to enhance peer support and team cohesiveness. In this RCT, the

intervention group improved on STS symptoms at posttest com-

pared with the wait-list control group. Furthermore, decreases in

STS scores covaried with improvement on professional self-

efficacy assessments, lending further support for the importance of

self-efficacy in reducing STS.

Gentry, Baggerly, and Baranowsky (2004) used the concept of

“training as treatment” to improve an individual’s understanding

and competency to identify and manage their own STS (Gentry et

al., 2004). This module focuses on self-regulation, intentionality,

perceptual maturation/self-validation, connection, and self-care.

An effectiveness study of 73 emergency nurses found statistically

significant decreases in STS scores at posttest, though the study is

limited by its nonrandomized design.

Critical Incident Stress Management (CISM)

CISM is an approach used by multiple disciplines that seeks to

prevent posttraumatic stress symptoms in the aftermath of a critical

event (Mitchell & Everly, 2000). Some organizations embed their

CISM program within employee assistance programs. A major

component of CISM is the idea of holding psychological debrief-

ings between peers after an event, referred to as CISD. This is

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135

ADVANCING SCIENCE AND PRACTICE FOR VT/STS: A RESEARCH AGENDA

typically a group intervention in use since the 1970s for people in

the same professional group, or with similar exposure to trauma, to

process their experiences using a specific seven-step psychotherapy-

and education-based model (Adler et al., 2008;Tuckey & Scott,

2014). Most studies have focused on the use of CISM/CISD for

primary, not secondary, trauma exposure (Adler et al., 2008). The

evidence base for both CISM and CISD is mixed due to several

factors including methodological inconsistencies, negative or mixed

findings, and a shortage of RCTs (Adler et al., 2008;Pack, 2013;

Tuckey & Scott, 2014).

A 2009 literature review by Pender and Prichard (2009) found a

shortage of empirical evidence to support particular CISD proto-

cols; however, most positive studies did support the use of CISD

for group interventions for homogenous groups (i.e., occupational

groups) with similar exposure to trauma (Pender & Prichard,

2009). According to the review, “Hobfoll et al.’s (2007) analysis of

essential elements in post-trauma work support the conclusion that

recovery is enhanced when people trust themselves to handle what

happened and then trust those around them to do the same”

(Pender & Prichard, 2009, p. 188). However, CISD is not recom-

mended as an intervention to prevent long-term adverse psycho-

logical outcomes by authors of several studies (Gray, Maguen, &

Litz, 2004;Mayou, Ehlers, & Hobbs, 2000;McNally, Bryant, &

Ehlers, 2003;Rose, Bisson, & Wessely, 2003;Ruzek et al., 2007).

First implemented in 1981 after a police-involved shooting in

Los Angeles, peer assistance programs are commonly found in

first responder organizations, sometimes as an element of a CISM

plan. They are based on the premise that peers are in the best

position to help others in their organization recognize and inter-

vene regarding work-related stress (Grauwiler, Barocas, & Mills,

2008). Para-professionals within organizations are trained to offer

immediate and ongoing peer support after a stressful situation with

the belief that if left unaddressed, the stress may lead to serious

substance, mental health or other problems. It is also thought that

peer support programs help ameliorate the stigma associated with

help-seeking among law enforcement officers and other first re-

sponders (Greenstone, 2000;Woody, 2005).

A literature review of the research on peer support and peer

assistance programs for police and other first responders published

between 1997 and 2007 found only three published studies focused

on workplace peer assistance and support for police, and none of

them evaluated efficacy of the programs (Grauwiler et al., 2008).

Similar to the research on CISM, efficacy studies are made more

difficult by inconsistent program designs. All three studies found

that peer support services were reported by utilizers of the program

as reducing the stigma associated with seeking professional help.

In one of them Stephens and Long (2000) found an association

between perceptions of social support and lower work-related

traumatic stress among police officers in New Zealand.

PFA (Ruzek et al., 2007) dates back to the mid-20th century

(Thorne, 1952) but has recently been used more frequently as a

method of reducing postexposure distress and supporting adaptive

functioning, especially since the Institute of Medicine recom-

mended it for postdisaster contexts in 2003 (Institute of Medicine,

2003). Guidelines and trainings are now available, some of which

are empirically based on cognitive/affective theories such as the

Johns Hopkins PFA model (Everly et al., 2012). It does not require

mandatory processing of trauma material in a group setting, which

fits with some of the mixed findings about group debriefing (Pack,

2013). A review of the literature published from 1990–2010 fo-

cused on PFA in the aftermath of a disaster or mass casualty event

found no evidence yet for its efficacy but wide support by expert

opinion (Fox et al., 2012). Studies of its efficacy for VT/STS/CF

were not found to date.

Discussion and Recommendations for Further Study

Increased interest in the impact of indirect trauma exposure in

the workplace has captured the attention of researchers, clinicians,

organizational leaders, and policymakers across a variety of ser-

vice systems. In fact, the occupational hazards of delivering ser-

vices to a traumatized and violence exposed population has be-

come a public health issue threatening workforce stability.

Attempts to document the prevalence of this phenomenon in

contemporary work life are still plagued by stigma attached to

self-disclosure of professional distress, and a lack of conceptual

clarity between related, overlapping, but perhaps distinct terms

that have been used to describe the experience of working with

trauma-exposed and victimized populations. Responses to the in-

cidence of indirect trauma exposure have spawned the application

of interventions that have grown primarily out of the health pro-

motion and wellness literature, despite the fact that vicarious

traumatization or STS is at its core a trauma response that may be

best addressed using a wide range of available traumatization

prevention and treatment strategies. The issue also remains that

repeated ongoing exposure to indirect trauma, as a natural course

of the professional’s daily work life, may require modification of

existing direct trauma treatments. Returning to the public health

approach, we recommend the following research agenda for ad-

vancing each of the steps of addressing vicarious traumatization

for the fields of first responders and victim service providers.

Step 1: Understanding the Problem

We described a number of instruments that have been developed

and tested for psychometric properties, but at present a validated

instrument that gets at the full range of VT/STS/CF symptoms is

not available in one measure. This is due to a lack of conceptual

clarity regarding the underlying constructs represented by these

terms. For example, some professionals use compassion fatigue as

synonymous to STS, while others use the term to describe a broad

range of symptoms that include STS as well as burnout. Future

research should focus on empirically disentangling and operation-

alizing the concepts of vicarious traumatization/STS from com-

passion fatigue so that assessment tools can be tailored to be

sensitive to these distinctions. With distinct naming conventions,

an appropriate theoretical framework, epidemiological research,

diagnostic criteria and interventions can be applied.

Second, the prevalence of VT/STS/CF must be measured using

consistent screening tools and population-based sampling frames

rather than treatment or convenience samples. For example, there

is currently difficulty estimating the extent that mental health

clinicians are affected. Elwood, Mott, Lohr, and Galovski (2011),

in their review of 41 studies focusing on indirect trauma primarily

in mental health clinicians who provide trauma-focused treatment,

concluded that there was no consensus regarding VT prevalence

among professional caregivers. See also Kadambi and Ennis’s

(2004) review for a discussion of difficulties in the operational-

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136 MOLNAR ET AL.

ization and measurement of VT, as well as an earlier review by

Sabin-Farrell and Turpin (2003) for a discussion of the lack of

consistent evidence for VT in the field of mental health. The

varying levels of reported severity in STS and CF rates among

clinicians exposed to traumatic experiences through therapy pro-

vision are likewise emphasized by Kadambi and Ennis (2004),

exemplifying the frequency with which nonclinical ranges of in-

direct traumatization have been reported (Kadambi & Ennis,

2004).

One solution is to have researchers determine a clinically mean-

ingful threshold/subthreshold of distress on the tool developed as

recommended above, then conduct prevalence studies with that

tool. The literature on STS and related conditions documents

symptom expression that can be characterized as mild to extreme.

Furthermore, there is an implicit assumption in some interventions

that STS can be prevented, while other approaches focus on

addressing existing symptoms. The issue of whether or not the

terminology of STS or VT is representative of a continuum of

distress responses that culminate in a disorder and if certain

interventions can prevent even mild symptoms from occurring is

an empirical question that has yet to be answered.

Finally, STS must be distinguished from primary traumatic

stress for first responder populations including fire services, law

enforcement, and emergency medical services, in order to under-

stand the separate and combined effects of primary and secondary

trauma and advance toward appropriate interventions that are

feasible and efficacious for particular types of organizational set-

tings.

Step 2: Identification of Risk and Protective Factors

for Having Negative or Positive Reactions to

Vicarious Trauma

We found there is very little research that has been conducted to

identify salient risk and protective factors. This is a key step in

addressing a public health problem, because it provides ideas for

both the etiology of these reactions and for the development of

preventive interventions. Certain fields have made progress toward

identifying risk and protective factors, although they have been

determined using observational studies. For example, multiple

studies among online child abuse investigators show that social

support and supervisory support are correlated with fewer symp-

toms of STS, while increased exposure is correlated with greater

symptoms (Bourke & Craun, 2014). Risk factors like caseload

volume and frequency, caseload ratio, having a personal trauma

history, and 13 other risk factors for STS were identified by Hensel

et al. (2015), as well as among child abuse professionals (Hensel

et al., 2015). Further studies are needed to identify risk and

protective factors for the wide range of additional occupations at

risk for VT/STS/CF.

Steps 3 and 4: Intervention Development and

Monitoring/Evaluation

While there are promising interventions for improvement in

vicarious traumatization symptoms from the fields discussed

above, there is need for rigorous study designs to demonstrate the

efficacy and effectiveness of these interventions. Much of our

review of the research has shown that the benefits to preventing or

reducing STS have not been adequately established for the inter-

ventions identified (Drewnowski & Evans, 2001;Duren, Cress, &

McCully, 2008;Gordon et al., 2008;Penedo & Dahn, 2005;Pullen

et al., 2008;Ross & Thomas, 2010;Stuck, Meyer, & Rigotti, 2003;

Zeisel, 2009). The differential impact of self-care on burnout and

STS as noted in the Ringenbach (2009) study seems to support the

notion that health and wellness promotion may not be as effective

at reducing trauma-related symptoms as they are at ameliorating

other types of organizational stress symptoms. More comparative

research such as this study is needed.

Similarly, as the research findings on the efficacy of CISM/

CISD have been mixed, additional research must be done with

rigor to be more definitive, especially given the very widespread

use among first responder organizations. Research to show the

efficacy of peer support programs is needed for the same reason.

One of the unique challenges across treatment types is that

individually tailored interventions lack consistency in how ap-

proaches are delivered or applied. This creates challenges for

researchers who are trying to investigate the efficacy and utility of

essential components. Articulation of the specifics of intervention

delivery is important so that studies may be replicated. The other

issue that remains is that repeated ongoing exposure to indirect

trauma, as a natural course of the professional’s daily work life,

may require modification of existing trauma treatments that as-

sume or require that the discrete exposure event(s) is not ongoing.

The efficacy of trauma treatments tested exclusively with those

exposed to direct trauma, including cognitive-behavioral therapy

and EMDR and others, should have their efficacy/effectiveness

with vicarious traumatization studied and established and be

adapted as necessary based on these results.

Two important themes emerged regarding barriers to addressing

Steps 3 and 4. The first is the subject of stigma, which came up in

many contexts in this research review. Clearly additional work

must be done to continue to change the social norms of profes-

sional life that creates fear of personal and/or professional conse-

quences of reporting struggles with their reactions to the work they

do that exposes them to the trauma of others.

The other limitation of interventions for preventing and treating

STS is that they may unduly individualize the problem and fail to

address the contextual factors that may impact the worker. Orga-

nizational milieu and resources (or the lack thereof) may determine

how individuals understand and respond to their environments, and

the type of interventions that may be most appropriate for the

setting. Investigations into the efficacy or effectiveness of preven-

tion or intervention strategies should consider organizational level

variables as potential mediators or moderators of outcomes as well

as the level of intervention (Killian, 2008).

An organizational strategy that needs empirical testing is the use

of screening for VT/STS/CF in workplaces as part of regular

routines. Assessment of VT/STS in work settings with high rates

of indirect trauma exposure is not the norm. But, a current practice

approach in the trauma field more broadly is to take a “screen and

treat” perspective (Brewin, 2001); that is, to help those who are

having transient reactions to exposure and those most likely to

develop serious and/or chronic problems self-identify so they can

take independent action (if needed) to address their unique situa-

tion. As these conceptual and technical distinctions are made, the

development of construct specific measures can occur, the tempo-

ral sequencing of symptoms can be established and prevention

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137

ADVANCING SCIENCE AND PRACTICE FOR VT/STS: A RESEARCH AGENDA

services (if indicated) and interventions can be designed and tested

that are rigorous and phenomenon specific.

Longitudinal studies, especially those that employ random as-

signment to intervention or control conditions, are the most ap-

propriate design for evaluation of interventions and policies. How-

ever, almost no studies in this review used this level of rigor.

Conclusion

First responders, mental health care workers, and the other

professional groups discussed throughout this paper often work

long hours to serve the most vulnerable in our society, often people

suffering from trauma. Without a concerted response from re-

searchers, policymakers, and organization leaders, these profes-

sional groups are left vulnerable to the shared burden of trauma,

accrued from chronic or acute hardship, known as VT or STS. The

importance of pursuing this agenda in a logical, sequenced manner

cannot be minimized if the public health aim of improving the

health and safety of the public and the workforce is to be achieved.

References

Adams, K. B., Matto, H. C., & Harrington, D. (2001). The Traumatic Stress

Institute Belief Scale as a measure of vicarious trauma in a national

sample of clinical social workers. Families in Society, 82, 363–371.

http://dx.doi.org/10.1606/1044-3894.178

Adams, R. E., Boscarino, J. A., & Figley, C. R. (2006). Compassion fatigue

and psychological distress among social workers: A validation study.

American Journal of Orthopsychiatry, 76, 103–108. http://dx.doi.org/10

.1037/0002-9432.76.1.103

Adler, A. B., Litz, B. T., Castro, C. A., Suvak, M., Thomas, J. L., Burrell,

L.,...Bliese, P. D. (2008). A group randomized trial of critical incident

stress debriefing provided to U.S. peacekeepers. Journal of Traumatic

Stress, 21, 253–263. http://dx.doi.org/10.1002/jts.20342

American Psychiatric Association. (2013). Diagnostic and statistical man-

ual of mental disorders (5th ed.). Arlington, VA: Author. http://dx.doi

.org/10.1176/appi.books.9780890425596

Bandura, A. (1986). Social foundations of thought and action: A social

cognitive theory. Englewood Cliffs, NJ: Prentice Hall.

Bandura, A. (1997). Self-efficacy: The exercise of control. New York, NY:

Freeman.

Beck, C. T. (2011). Secondary traumatic stress in nurses: A systematic

review. Archives of Psychiatric Nursing, 25, 1–10. http://dx.doi.org/10

.1016/j.apnu.2010.05.005

Becker, R. W., & McCrillis, A. (2015). Health sciences librarians, patient

contact, and secondary traumatic stress. Journal of the Medical Library

Association, 103, 87–90. http://dx.doi.org/10.3163/1536-5050.103.2.006

Bell, H., Kulkarni, S., & Dalton, L. (2003). Organizational prevention of

vicarious trauma. Families in Society, 84, 463–470. http://dx.doi.org/10

.1606/1044-3894.131

Bercier, M. L., & Maynard, B. R. (2015). Interventions for secondary

traumatic stress with mental health workers: A systematic review. Re-

search on Social Work Practice, 25, 81–89. http://dx.doi.org/10.1177/

1049731513517142

Berger, R., & Gelkopf, M. (2011). An intervention for reducing secondary

traumatization and improving professional self-efficacy in well baby

clinic nurses following war and terror: A random control group trial.

International Journal of Nursing Studies, 48, 601–610. http://dx.doi.org/

10.1016/j.ijnurstu.2010.09.007

Berger, W., Coutinho, E. S. F., Figueira, I., Marques-Portella, C., Luz,

M. P., Neylan, T. C.,...Mendlowicz, M. V. (2012). Rescuers at risk:

A systematic review and meta-regression analysis of the worldwide

current prevalence and correlates of PTSD in rescue workers. Social

Psychiatry and Psychiatric Epidemiology, 47, 1001–1011. http://dx.doi

.org/10.1007/s00127-011-0408-2

Bober, T., & Regehr, C. (2006). Strategies for reducing secondary or

vicarious trauma: Do they work? Brief Treatment and Crisis Interven-

tion, 6, 1–9. http://dx.doi.org/10.1093/brief-treatment/mhj001

Bogstrand, S. T., Skogstad, L., & Ekeberg, Ø. (2016). The association

between alcohol, medicinal drug use and post-traumatic stress symptoms

among Norwegian rescue workers after the 22 July twin terror attacks.

International Emergency Nursing, 28, 29–33. http://dx.doi.org/10.1016/

j.ienj.2016.03.003

Bourke, M. L., & Craun, S. W. (2014). Secondary traumatic stress among

Internet Crimes Against Children task force personnel: Impact, risk

factors, and coping strategies. Sexual Abuse: Journal of Research and

Treatment, 26, 586–609. http://dx.doi.org/10.1177/1079063213509411

Brewin, C. R. (2001). Cognitive and emotional reactions to traumatic

events: Implications for short-term intervention. Advances in Mind-Body

Medicine, 17, 163–168.

Bride, B. E. (2007). Prevalence of secondary traumatic stress among social

workers. Social Work, 52, 63–70. http://dx.doi.org/10.1093/sw/52.1.63

Bride, B. E., Jones, J. L., & Macmaster, S. A. (2007). Correlates of

secondary traumatic stress in child protective services workers. Journal

of Evidence-Based Social Work, 4, 69–80. http://dx.doi.org/10.1300/

J394v04n03_05

Bride, B. E., Radey, M., & Figley, C. R. (2007). Measuring compassion

fatigue. Clinical Social Work Journal, 35, 155–163. http://dx.doi.org/10

.1007/s10615-007-0091-7

Bride, B. E., Robinson, M. M., Yegidis, B., & Figley, C. R. (2004).

Development and validation of the Secondary Traumatic Stress Scale.

Research on Social Work Practice, 14, 27–35. http://dx.doi.org/10.1177/

1049731503254106

Bromet, E. J., Hobbs, M. J., Clouston, S. A., Gonzalez, A., Kotov, R., &

Luft, B. J. (2016). DSM–IV post-traumatic stress disorder among World

Trade Center responders 11–13 years after the disaster of 11 September

2001 (9/11). Psychological Medicine, 46, 771–783. http://dx.doi.org/10

.1017/S0033291715002184

Bryant, R. A., Sackville, T., Dang, S. T., Moulds, M., & Guthrie, R. (1999).

Treating acute stress disorder: An evaluation of cognitive behavior

therapy and supportive counseling techniques. The American Journal of

Psychiatry, 156, 1780–1786.

Burke, C., & Van Dernoot Lipsky, L. (2009). Trauma stewardship. San

Francisco, CA: Berrett-Koehler.

Canfield, J. (2005). Secondary traumatization, burnout, and vicarious trau-

matization: A review of the literature as It relates to therapists who treat

trauma. Smith College Studies in Social Work, 75, 81–101. http://dx.doi

.org/10.1300/J497v75n02_06

Caringi, J. C., Hardiman, E. R., Weldon, P., Fletcher, S., Devlin, M., &

Stanick, C. (2016). Secondary traumatic stress and licensed clinical

social workers. Traumatology. Advance online publication. http://dx.doi

.org/10.1037/trm0000061

Chen, Y. R., Hung, K. W., Tsai, J. C., Chu, H., Chung, M. H., Chen, S. R.,

. . . Chou, K. R. (2014). Efficacy of eye-movement desensitization and

reprocessing for patients with posttraumatic-stress disorder: A meta-

analysis of randomized controlled trials. PLoS ONE, 9, e103676. http://

dx.doi.org/10.1371/journal.pone.0103676

Choi, G. (2011). Organizational impacts on the secondary traumatic stress

of social workers assisting family violence or sexual assault survivors.

Administration in Social Work, 35, 225–242. http://dx.doi.org/10.1080/

03643107.2011.575333

Cieslak, R., Anderson, V., Bock, J., Moore, B. A., Peterson, A. L., &

Benight, C. C. (2013). Secondary traumatic stress among mental health

providers working with the military: Prevalence and its work- and

exposure-related correlates. Journal of Nervous and Mental Disease,

201, 917–925. http://dx.doi.org/10.1097/NMD.0000000000000034

This document is copyrighted by the American Psychological Association or one of its allied publishers.

This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

138 MOLNAR ET AL.

Cloitre, M., Stolbach, B. C., Herman, J. L., van der Kolk, B., Pynoos, R.,

Wang, J., & Petkova, E. (2009). A developmental approach to complex

PTSD: Childhood and adult cumulative trauma as predictors of symptom

complexity. Journal of Traumatic Stress, 22, 399–408. http://dx.doi.org/

10.1002/jts.20444

Coetzee, S. K., & Klopper, H. C. (2010). Compassion fatigue within

nursing practice: A concept analysis. Nursing & Health Sciences, 12,

235–243. http://dx.doi.org/10.1111/j.1442-2018.2010.00526.x

Coleman, J. A., Delahanty, D. L., Schwartz, J., Murani, K., & Brondolo, E.

(2016). The moderating impact of interacting with distressed families of

decedents on trauma exposure in medical examiner personnel. Psycho-

logical Trauma: Theory, Research, Practice and Policy, 8, 668–675.

http://dx.doi.org/10.1037/tra0000097

Connorton, E., Perry, M. J., Hemenway, D., & Miller, M. (2012). Human-

itarian relief workers and trauma-related mental illness. Epidemiologic

Reviews, 34, 145–155. http://dx.doi.org/10.1093/epirev/mxr026

Conrad, D., & Kellar-Guenther, Y. (2006). Compassion fatigue, burnout,

and compassion satisfaction among Colorado child protection workers.

Child Abuse & Neglect, 30, 1071–1080. http://dx.doi.org/10.1016/j

.chiabu.2006.03.009

Cornille, T. A., & Meyers, T. (1999). Secondary traumatic stress among

child protection service workers: Prevalence, severity and predictive

factors. Traumatology, 5, 15–31. http://dx.doi.org/10.1177/153476569

900500105

Courtois, C. A. (1988). Healing the incest wound: Adult survivors in

therapy. New York, NY: Norton.

Dane, B. (2000). Child welfare workers: An innovative approach for

interacting with secondary trauma. Journal of Social Work Education,

36, 27–38.

Dasan, S., Gohil, P., Cornelius, V., & Taylor, C. (2015). Prevalence, causes

and consequences of compassion satisfaction and compassion fatigue in

emergency care: A mixed-methods study of UK NHS Consultants.

Emergency Medicine Journal, 32, 588–594. http://dx.doi.org/10.1136/

emermed-2014-203671

Dominey-Howes, D. (2015). Seeing ‘the dark passenger’–Reflections on

the emotional trauma of conducting post-disaster research. Emotion,

Space and Society, 17, 55–62. http://dx.doi.org/10.1016/j.emospa.2015

.06.008

Drewnowski, A., & Evans, W. J. (2001). Nutrition, physical activity, and

quality of life in older adults: Summary. The Journals of Gerontology.

Series A, Biological Sciences and Medical Sciences, 56, 89–94. http://

dx.doi.org/10.1093/gerona/56.suppl_2.89

Duren, C. M., Cress, M. E., & McCully, K. K. (2008). The influence of

physical activity and yoga on central arterial stiffness. Dynamic Medi-

cine, 7, 2. http://dx.doi.org/10.1186/1476-5918-7-2

Dutton, M. A., Bermudez, D., Matas, A., Majid, H., & Myers, N. L. (2013).

Mindfulness-based stress reduction for low-income, predominantly Af-

rican American women with PTSD and a history of intimate partner

violence. Cognitive and Behavioral Practice, 20, 23–32. http://dx.doi

.org/10.1016/j.cbpra.2011.08.003

Dutton, M. A., & Rubinstein, F. L. (1995). Working with people with

PTSD: Research implications. In C. R. Figley (Ed.), Compassion fa-

tigue: Coping with secondary traumatic stress disorder in those who

treat the traumatized (pp. 82–100). New York, NY: Brunner/Mazel.

Elwood, L. S., Mott, J., Lohr, J. M., & Galovski, T. E. (2011). Secondary

trauma symptoms in clinicians: A critical review of the construct,

specificity, and implications for trauma-focused treatment. Clinical Psy-

chology Review, 31, 25–36. http://dx.doi.org/10.1016/j.cpr.2010.09.004

Engstrom, D., Hernández, P., & Gangsei, D. (2008). Vicarious resilience:

A qualitative investigation into its description. Traumatology, 14, 13–21.

http://dx.doi.org/10.1177/1534765608319323

Everly, G. S., Jr., Barnett, D. J., & Links, J. M. (2012). The Johns Hopkins

model of psychological first aid (RAPID-PFA): Curriculum develop-

ment and content validation. International Journal of Emergency Mental

Health, 14, 95–103.

Ewer, P. L., Teesson, M., Sannibale, C., Roche, A., & Mills, K. L. (2015).

The prevalence and correlates of secondary traumatic stress among

alcohol and other drug workers in Australia. Drug and Alcohol Review,

34, 252–258. http://dx.doi.org/10.1111/dar.12204

Fairclough, M. A., Miller-Archie, S. A., Cone, J. E., Dechen, T., Ekenga,

C. C., Osahan, S.,...Farfel, M. R. (2015). Relationship between

persistent post-traumatic stress disorder and human remains exposure for

Staten Island barge and landfill recovery and clean-up workers after

9/11. International Journal of Emergency Mental Health and Human

Resilience, 2015, 661–663.

Figley, C. R. (1995). Compassion fatigue: Coping with secondary trau-

matic stress disorder. New York, NY: Brunner/Mazel.

Figley, C. R. (2002). Treating compassion fatigue. New York, NY: Brun-

ner-Routledge.

Figley, C. R., & Roop, R. G. (2006). Compassion fatigue in the animal-

care community. Washington, DC: Humane Society Press.

Finklestein, M., Stein, E., Greene, T., Bronstein, I., & Solomon, Z. (2015).

Posttraumatic stress disorder and vicarious trauma in mental health

professionals. Health & Social Work, 40, e25–e31. http://dx.doi.org/10

.1093/hsw/hlv026

Fisackerly, B. L., Sira, N., Desai, P. P., & McCammon, S. (2016). An

examination of compassion fatigue risk in certified child life specialists.

Children’s Health Care, 45, 359–375. http://dx.doi.org/10.1080/

02739615.2015.1038716

Flannelly, K. J., Roberts, S. B., & Weaver, A. J. (2005). Correlates of

compassion fatigue and burnout in chaplains and other clergy who

responded to the September 11th attacks in New York City. The Journal

of Pastoral Care & Counseling, 59, 213–224. http://dx.doi.org/10.1177/

154230500505900304

Fox, J. H., Burkle, F. M., Jr., Bass, J., Pia, F. A., Epstein, J. L., &

Markenson, D. (2012). The effectiveness of psychological first aid as a

disaster intervention tool: Research analysis of peer-reviewed literature

from 1990–2010. Disaster Medicine and Public Health Preparedness,

6, 247–252. http://dx.doi.org/10.1001/dmp.2012.39

Furlonger, B., & Taylor, W. (2013). Supervision and the management of

vicarious traumatisation among Australian telephone and online coun-

sellors. Australian Journal of Guidance and Counselling, 23, 82–94.

http://dx.doi.org/10.1017/jgc.2013.3

Gentry, J. E., Baggerly, J., & Baranowsky, A. (2004). Training-as-

treatment: Effectiveness of the certified compassion fatigue specialist

training. International Journal of Emergency Mental Health, 6, 147–

155.

Gentry, J. E., Baranowsky, A. B., & Dunning, K. (2002). ARP: The

accelerated recovery program (ARP) for compassion fatigue. In C. R.

Figley (Ed.), Treating compassion fatigue (pp. 123–137). New York,

NY: Routledge.

Goodman, M. J., & Schorling, J. B. (2012). A mindfulness course de-

creases burnout and improves well-being among healthcare providers.

International Journal of Psychiatry in Medicine, 43, 119–128. http://dx

.doi.org/10.2190/PM.43.2.b

Gordon, L. A., Morrison, E. Y., McGrowder, D. A., Young, R., Fraser,

Y. T., Zamora, E. M.,...Irving, R. R. (2008). Effect of exercise therapy

on lipid profile and oxidative stress indicators in patients with type 2

diabetes. BMC Complementary and Alternative Medicine, 8, 21. http://

dx.doi.org/10.1186/1472-6882-8-21

Grauwiler, P., Barocas, B., & Mills, L. G. (2008). Police peer support

programs: Current knowledge and practice. International Journal of

Emergency Mental Health, 10, 27–38.

Gray, M. J., Maguen, S., & Litz, B. T. (2004). Acute psychological impact

of disaster and large-scale tauma: Limitations of traditional interventions

and future practice recommendations. Prehospital and Disaster Medi-

cine, 19, 64–72. http://dx.doi.org/10.1017/S1049023X00001497

This document is copyrighted by the American Psychological Association or one of its allied publishers.

This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

139

ADVANCING SCIENCE AND PRACTICE FOR VT/STS: A RESEARCH AGENDA

Greenstone, J. L. (2000). Peer support in a municipal police department:

Doing what comes naturally. The Forensic Examiner, 9, 33–36.

Grossman, P., Niemann, L., Schmidt, S., & Walach, H. (2004).

Mindfulness-based stress reduction and health benefits. Journal of Psy-

chosomatic Research, 57, 35–43. http://dx.doi.org/10.1016/S0022-

3999(03)00573-7

Haraldsdóttir, H. A., Gudmundsdóttir, D., Romano, E., Þórðardóttir, E. B.,

Guðmundsdóttir, B., & Elklit, A. (2014). Volunteers and professional

rescue workers: Traumatization and adaptation after an avalanche disas-

ter. Journal of Emergency Management, 12, 457–466. http://dx.doi.org/

10.5055/jem.2014.0209

Haugen, P. T., Evces, M., & Weiss, D. S. (2012). Treating posttraumatic

stress disorder in first responders: A systematic review. Clinical Psy-

chology Review, 32, 370–380. http://dx.doi.org/10.1016/j.cpr.2012.04

.001

Hensel, J. M., Ruiz, C., Finney, C., & Dewa, C. S. (2015). Meta-analysis

of risk factors for secondary traumatic stress in therapeutic work with

trauma victims. Journal of Traumatic Stress, 28, 83–91. http://dx.doi

.org/10.1002/jts.21998

Herman, J. L. (1992). Trauma and recovery. New York, NY: Basic Books.

Hernández, P., Gangsei, D., & Engstrom, D. (2007). Vicarious resilience:

A new concept in work with those who survive trauma. Family Process,

46, 229–241.

Hernandez-Wolfe, P., Killian, K. D., Engstrom, D., & Gangsei, D. (2015).

Vicarious resilience, vicarious trauma and awareness of equity in trauma

work. Journal of Humanistic Psychology, 55, 153–172.

Hesse, A. (2002). Secondary trauma: How working with trauma survivors

affects therapists. Clinical Social Work Journal, 30, 293–309. http://dx

.doi.org/10.1023/A:1016049632545

Iliffe, G., & Steed, L. G. (2000). Exploring the counselor’s experience of

working with perpetrators and survivors of domestic violence. Journal of

Interpersonal Violence, 15, 393–412. http://dx.doi.org/10.1177/

088626000015004004

Janoff-Bulman, R. (1992). Shattered Assumptions: Toward a New Psychol-

ogy of Trauma. New York, NY: The Free Press.

Jenkins, S. R., & Baird, S. (2002). Secondary traumatic stress and vicarious

trauma: A validational study. Journal of Traumatic Stress, 15, 423–432.

http://dx.doi.org/10.1023/A:1020193526843

Johnson, W. B., Bertschinger, M., Snell, A. K., & Wilson, A. (2014).

Secondary trauma and ethical obligations for military psychologists:

Preserving compassion and competence in the crucible of combat. Psy-

chological Services, 11, 68–74. http://dx.doi.org/10.1037/a0033913

Kabat-Zinn, J. (2003). Mindfulness-based interventions in context: Past,

present, and future. Clinical Psychology: Science and Practice, 10,

144–156. http://dx.doi.org/10.1093/clipsy.bpg016

Kadambi, M. A., & Ennis, L. (2004). Reconsidering vicarious trauma: A

review of the literature and its limitations. Journal of Trauma Practice,

3, 1–21. http://dx.doi.org/10.1300/J189v03n02_01

Kessler, R. C., Ormel, J., Petukhova, M., McLaughlin, K. A., Green, J. G.,

Russo, L. J.,...Ustün, T. B. (2011). Development of lifetime comor-

bidity in the World Health Organization world mental health surveys.

Archives of General Psychiatry, 68, 90–100. http://dx.doi.org/10.1001/

archgenpsychiatry.2010.180

Killian, K. D. (2008). Helping till it hurts? A multimethod study of

compassion fatigue, burnout, and self-care in clinicians working with

trauma survivors. Traumatology, 14, 32–44. http://dx.doi.org/10.1177/

1534765608319083

Killian, K., Hernandez-Wolfe, P., Engstrom, D., & Gangsei, D. (2017).

Development of the Vicarious Resilience Scale (VRS): A measure of

positive effects of working with trauma survivors. Psychological Trau-

ma: Theory, Research, Practice and Policy, 9, 23–31. http://dx.doi.org/

10.1037/tra0000199

Kimbrough, E., Magyari, T., Langenberg, P., Chesney, M., & Berman, B.

(2010). Mindfulness intervention for child abuse survivors. Journal of

Clinical Psychology, 66, 17–33.

King, A. P., Erickson, T. M., Giardino, N. D., Favorite, T., Rauch, S. A.,

Robinson, E.,...Liberzon, I. (2013). A pilot study of group

mindfulness-based cognitive therapy (MBCT) for combat veterans with

posttraumatic stress disorder (PTSD). Depression and Anxiety, 30, 638–

645. http://dx.doi.org/10.1002/da.22104

Kintzle, S., Yarvis, J. S., & Bride, B. E. (2013). Secondary traumatic stress

in military primary and mental health care providers. Military Medicine,

178, 1310–1315. http://dx.doi.org/10.7205/MILMED-D-13-00087

Kiyimba, N., & O’Reilly, M. (2016). An exploration of the possibility for

secondary traumatic stress among transcriptionists: A grounded theory

approach. Qualitative Research in Psychology, 13, 92–108. http://dx.doi

.org/10.1080/14780887.2015.1106630

Klari´

c, M., Kvesi´

c, A., Mandi´

c, V., Petrov, B., & Francˇiškovi´

c, T. (2013).

Secondary traumatisation and systemic traumatic stress. Psychiatria

Danubina, 25, 29–36.

Knight, C. (2013). Indirect trauma: Implications for self-care, supervision,

the organization, and the academic institution. The Clinical Supervisor,

32, 224–243. http://dx.doi.org/10.1080/07325223.2013.850139

Lawrence, M. (2017). Near-death and other transpersonal experiences

occurring during catastrophic events. American Journal Of Hospice &

Palliative Medicine, 34, 486–492. http://dx.doi.org/10.1177/

1049909116631298

Levin, A. P., Albert, L., Besser, A., Smith, D., Zelenski, A., Rosenkranz,

S., & Neria, Y. (2011). Secondary traumatic stress in attorneys and their

administrative support staff working with trauma-exposed clients. Jour-

nal of Nervous and Mental Disease, 199, 946–955.

Liu, B., Tarigan, L. H., Bromet, E. J., & Kim, H. (2014). World Trade

Center disaster exposure-related probable posttraumatic stress disorder

among responders and civilians: A meta-analysis. PLoS ONE, 9,

e101491. http://dx.doi.org/10.1371/journal.pone.0101491

Lusk, M., & Terrazas, S. (2015). Secondary trauma among caregivers who

work with Mexican and Central American refugees. Hispanic Journal of

Behavioral Sciences, 37, 257–273. http://dx.doi.org/10.1177/07399

86315578842

Luthar, S. S. (Ed.). (2003). Resilience and vulnerability. Adaptation in the

context of childhood adversities. New York, NY: Cambridge University

Press. http://dx.doi.org/10.1017/CBO9780511615788

Luthar, S. S. (2006). Resilience in development: A synthesis of research

across five decades. In D. Cicchetti & D. J. Cohen (Eds.), Developmen-

tal psychopathology: Risk, disorder, and adaptation (pp. 740–795).

New York, NY: Wiley.

Maslow, C. B., Caramanica, K., Welch, A. E., Stellman, S. D., Brackbill,

R. M., & Farfel, M. R. (2015). Trajectories of scores on a screening

instrument for PTSD among World Trade Center rescue, recovery, and

clean-up workers. Journal of Traumatic Stress, 28, 198–205. http://dx

.doi.org/10.1002/jts.22011

Mathieu, F. (2012). The compassion fatigue workbook: Creative tools for

transforming compassion fatigue and vicarious traumatization. New

York, NY: Routledge.

Matto, H. C., Adams, K. B., & Harrington, D. (2000). The Traumatic Stress

Institute Belief Scale as a measure of vicarious trauma: Confirmatory

factor analysis in a national sample of clinical social workers. Paper

presented at the 4th Annual Meeting of the Society of Social Work and

Research, Charleston, SC.

May, C. L., & Wisco, B. E. (2016). Defining trauma: How level of

exposure and proximity affect risk for posttraumatic stress disorder.

Psychological Trauma: Theory, Research, Practice and Policy, 8, 233–

240. http://dx.doi.org/10.1037/tra0000077

Mayou, R. A., Ehlers, A., & Hobbs, M. (2000). Psychological debriefing

for road traffic accident victims. Three-year follow-up of a randomised

This document is copyrighted by the American Psychological Association or one of its allied publishers.

This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

140 MOLNAR ET AL.

controlled trial. The British Journal of Psychiatry, 176, 589–593. http://

dx.doi.org/10.1192/bjp.176.6.589

McCann, I. L., & Pearlman, L. A. (1990). Vicarious traumatization: A

framework for understanding the psychological effects of working with

victims. Journal of Traumatic Stress, 3, 131–149. http://dx.doi.org/10

.1007/BF00975140

McLennan, J., Evans, L., Cowlishaw, S., Pamment, L., & Wright, L.

(2016). Secondary traumatic stress in postdisaster field research inter-

viewers. Journal of Traumatic Stress, 29, 101–105. http://dx.doi.org/10

.1002/jts.22072

McNally, R. J., Bryant, R. A., & Ehlers, A. (2003). Does early psycho-

logical intervention promote recovery from posttraumatic stress? Psy-

chological Science in the Public Interest, 4, 45–79. http://dx.doi.org/10

.1111/1529-1006.01421

Institute of Medicine. (2003). Preparing for the psychological conse-

quences of terrorism. Washington, DC: National Academies Press.

Mehus, C. J., & Becher, E. H. (2016). Secondary traumatic stress, burnout,

and compassion satisfaction in a sample of spoken-language interpreters.

Traumatology, 22, 249–254.

Miller, B., & Sprang, G. (2016). A components-based practice and super-

vision model for reducing compassion fatigue by affecting clinician

experience. Traumatology. Advance online publication. http://dx.doi

.org/10.1037/trm0000058

Mishori, R., Mujawar, I., & Ravi, N. (2014). Self-reported vicarious trauma

in asylum evaluators: A preliminary survey. Journal of Immigrant and

Minority Health, 16, 1232–1237. http://dx.doi.org/10.1007/s10903-013-

9958-6

Mitchell, J. T., & Everly, G. S. (2000). Critical incident stress management

and critical incident stress debriefings: Evolutions, effects and outcomes.

In B. Raphael & J. Wilson (Eds.), Psychological Debriefing: Theory,

Practice and Evidence (pp. 71–90). New York, NY: Cambridge Uni-

versity Press. http://dx.doi.org/10.1017/CBO9780511570148.006

Negash, S., & Sahin, S. (2011). Compassion fatigue in marriage and family

therapy: Implications for therapists and clients. Journal of Marital and

Family Therapy, 37, 1–13. http://dx.doi.org/10.1111/j.1752-0606.2009

.00147.x

Nelson-Gardell, D., & Harris, D. (2003). Childhood abuse history, second-

ary traumatic stress, and child welfare workers. Child Welfare: Journal

of Policy, Practice, and Program, 82, 5–26.

Neville, K., & Cole, D. A. (2013). The relationships among health promo-

tion behaviors, compassion fatigue, burnout, and compassion satisfac-

tion in nurses practicing in a community medical center. The Journal of

Nursing Administration, 43, 348–354. http://dx.doi.org/10.1097/NNA

.0b013e3182942c23

Newell, J. M., & MacNeil, G. A. (2010). Professional burnout, vicarious

trauma, secondary traumatic stress, and compassion fatigue. Best Prac-

tices in Mental Health: An International Journal, 6, 57–68.

Ortlepp, K., & Friedman, M. (2002). Prevalence and correlates of second-

ary traumatic stress in workplace lay trauma counselors. Journal of

Traumatic Stress, 15, 213–222. http://dx.doi.org/10.1023/A:1015

203327767

Pack, M. J. (2013). Critical incident stress management: A review of the

literature with implications for social work. International Social Work,

56, 608–627. http://dx.doi.org/10.1177/0020872811435371

Pearlman, L. A. (1996). Psychometric review of TSI Belief Scale, revision

L. In B. H. Stamm (Ed.), Measurement of stress, trauma, and adaptation

(pp. 415–417). Lutherville, MD: Sidran Press.

Pearlman, L. A. (2003). Trauma and Attachment Belief Scale. Los Angeles,

CA: Western Psychological Services.

Pearlman, L. A. (2014). Vicarious traumatization in mass violence re-

searchers. In I. Macˇek (Ed.), Engaging violence: Trauma, memory and

representation (pp. 171–197). New York, NY: Routledge.

Pearlman, L., & Saakvitne, K. (1995). Treating therapists with vicarious

traumatization and secondary traumatic stress disorders. In C. Figley

(Ed.), Compassion fatigue: Coping with secondary traumatic stress

disorder in those who treat the traumatized (pp. 150–177). New York,

NY: Brunner/Mazel.

Pender, D. A., & Prichard, K. K. (2009). ASGW best practice guidelines as

a research tool: A comprehensive examination of the critical incident

stress debriefing. Journal for Specialists in Group Work, 34, 175–192.

http://dx.doi.org/10.1080/01933920902807147

Penedo, F. J., & Dahn, J. R. (2005). Exercise and well-being: A review of

mental and physical health benefits associated with physical activity.

Current Opinion in Psychiatry, 18, 189–193. http://dx.doi.org/10.1097/

00001504-200503000-00013

Perez, L. M., Jones, J., Englert, D. R., & Sachau, D. (2010). Secondary

traumatic stress and burnout among law enforcement investigators ex-

posed to disturbing media images. Journal of Police and Criminal

Psychology, 25, 113–124. http://dx.doi.org/10.1007/s11896-010-9066-7

Perkins, E. B., & Sprang, G. (2013). Results from the Pro-QOL-IV for

substance abuse counselors working with offenders. International Jour-

nal of Mental Health and Addiction, 11, 199–213. http://dx.doi.org/10

.1007/s11469-012-9412-3

Prati, G., Pietrantoni, L., & Cicognani, E. (2010). Self-efficacy moderates

the relationship between stress appraisal and quality of life among rescue

workers. Anxiety, Stress & Coping: An International Journal, 23, 463–

470. http://dx.doi.org/10.1080/10615800903431699

Pullen, P. R., Nagamia, S. H., Mehta, P. K., Thompson, W. R., Benardot,

D., Hammoud, R.,...Khan, B. V. (2008). Effects of yoga on inflam-

mation and exercise capacity in patients with chronic heart failure.

Journal of Cardiac Failure, 14, 407–413. http://dx.doi.org/10.1016/j

.cardfail.2007.12.007

Raunick, C. B., Lindell, D. F., Morris, D. L., & Backman, T. (2015).

Vicarious trauma among sexual assault nurse examiners. Journal of

Forensic Nursing, 11, 123–128. http://dx.doi.org/10.1097/JFN.00000

00000000085

Remen, R. N. (1996). Kitchen table wisdom: Stories that heal. New York,

NY: Riverhead Books.

Ringenbach, R. (2009). A comparison between counselors who practice

meditation and those who do not on compassion fatigue, compassion

satisfaction, burnout and self-compassion (Doctoral dissertation). Re-

trieved from http://rave.ohiolink.edu/etdc/view?acc_num⫽akron

1239650446

Robertson, N., Davies, G., & Nettleingham, A. (2009). Vicarious trauma-

tisation as a consequence of jury service. Howard Journal of Criminal

Justice, 48, 1–12. http://dx.doi.org/10.1111/j.1468-2311.2008.00539.x

Robinson-Keilig, R. A. (2014). Secondary traumatic stress and disruptions

to interpersonal functioning among mental health therapists. Journal of

Interpersonal Violence, 29, 1477–1496. http://dx.doi.org/10.1177/

0886260513507135

Rose, S., Bisson, J., & Wessely, S. (2003). A systematic review of

single-session psychological interventions (‘debriefing’) following trau-

ma. Psychotherapy and Psychosomatics, 72, 176–184. http://dx.doi.org/

10.1159/000070781

Ross, A., & Thomas, S. (2010). The health benefits of yoga and exercise:

A review of comparison studies. The Journal of Alternative and Com-

plementary Medicine, 16, 3–12. http://dx.doi.org/10.1089/acm.2009

.0044

Roth, S., Newman, E., Pelcovitz, D., van der Kolk, B., & Mandel, F. S.

(1997). Complex PTSD in victims exposed to sexual and physical abuse:

Results from the DSM–IV field trial for posttraumatic stress disorder.

Journal of Traumatic Stress, 10, 539–555. http://dx.doi.org/10.1002/jts

.2490100403

Ruzek, J. I., Brymer, M., Jacobs, A. K., Layne, C. M., Vernberg, E. M., &

Watson, P. J. (2007). Psychological first aid. Journal of Mental Health

Counseling, 29, 17–49. http://dx.doi.org/10.17744/mehc.29.1.5rac-

qxjueafabgwp

This document is copyrighted by the American Psychological Association or one of its allied publishers.

This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

141

ADVANCING SCIENCE AND PRACTICE FOR VT/STS: A RESEARCH AGENDA

Sabin-Farrell, R., & Turpin, G. (2003). Vicarious traumatization: Implica-

tions for the mental health of health workers? Clinical Psychology

Review, 23, 449–480. http://dx.doi.org/10.1016/S0272-7358(03)

00030-8

Sanders, M. R., Kirby, J. N., Tellegen, C. L., & Day, J. J. (2014). The

Triple P-Positive Parenting Program: A systematic review and meta-

analysis of a multi-level system of parenting support. Clinical Psychol-

ogy Review, 34, 337–357. http://dx.doi.org/10.1016/j.cpr.2014.04.003

Shapiro, F., & Maxfield, L. (2002). Eye movement desensitization and

reprocessing (EMDR): Information processing in the treatment of trau-

ma. Journal of Clinical Psychology, 58, 933–946. http://dx.doi.org/10

.1002/jclp.10068

Smith Hatcher, S., Bride, B. E., Oh, H., Moultrie King, D., & Franklin

Catrett, J. (2011). An assessment of secondary traumatic stress in juve-

nile justice education workers. Journal of Correctional Health Care, 17,

208–217. http://dx.doi.org/10.1177/1078345811401509

Sprang, G., Clark, J. J., & Whitt-Woosley, A. (2007). Compassion fatigue,

compassion satisfaction, and burnout: Factors impacting a professional’s

quality of life. Journal of Loss and Trauma, 12, 259–280. http://dx.doi

.org/10.1080/15325020701238093

Stamm, B. (2002). Measuring compassion satisfaction as well as fatigue:

Developmental history of the Compassion Satisfaction and Fatigue Test.

In C. R. Finley (Ed.), Treating compassion fatigue (pp. 107–119). New

York, NY: Brunner-Routledge.

Stamm, B. (2009). Professional Quality of Life: Compassion Satisfaction

and Fatigue Version 5 (ProQOL). Retrieved from http://www.proqol

.org/uploads/ProQOL_5_English.pdf

Stamm, B. H., & Figley, C. R. (1996). Compassion Satisfaction and

Fatigue Test. Retrieved from http://www.isu.edu/~bstamm/tests.htm

Steinberg, A. M., Brymer, M. J., Decker, K. B., & Pynoos, R. S. (2004).

The University of California at Los Angeles Post-traumatic Stress Dis-

order Reaction Index. Current Psychiatry Reports, 6, 96–100. http://dx

.doi.org/10.1007/s11920-004-0048-2

Stephens, C., & Long, N. (2000). Communication with police supervisors

and peers as a buffer of work-related traumatic stress. Journal of

Organizational Behavior, 21, 407–424. http://dx.doi.org/10.1002/

(SICI)1099-1379(200006)21:4⬍407::AID-JOB17⬎3.0.CO;2-N

Stuck, M., Meyer, K., & Rigotti, T. (2003). Evaluation of a yoga based

stress management training for teachers: Effects on immunoglobulin A

secretion and subjective relaxation. Journal for Meditation and Medita-

tion Research, 13, 1–8.

Tehrani, N. (2016). Extraversion, neuroticism and secondary trauma in

Internet child abuse investigators. Occupational Medicine, 66, 403–407.

http://dx.doi.org/10.1093/occmed/kqw004

Thieleman, K., & Cacciatore, J. (2014). Witness to suffering: Mindfulness

and compassion fatigue among traumatic bereavement volunteers and

professionals. Social Work, 59, 34–41. http://dx.doi.org/10.1093/sw/

swt044

Thormar, S. B., Gersons, B. P. R., Juen, B., Marschang, A., Djakababa,

M. N., & Olff, M. (2010). The mental health impact of volunteering in

a disaster setting: A review. Journal of Nervous and Mental Disease,

198, 529–538. http://dx.doi.org/10.1097/NMD.0b013e3181ea1fa9

Thorne, F. C. (1952). Psychological first aid. Journal of Clinical Psychol-

ogy, 8, 210–211.

Ting, L., Jacobson, J., Sanders, S., Bride, B. E., & Harrington, D. (2005).

The Secondary Traumatic Stress Scale (STSS). Journal of Human Be-

havior in the Social Environment, 11, 177–194. http://dx.doi.org/10

.1300/J137v11n03_09

Tuckey, M. R., & Scott, J. E. (2014). Group critical incident stress

debriefing with emergency services personnel: A randomized controlled

trial. Anxiety, Stress & Coping: An International Journal, 27, 38–54.

http://dx.doi.org/10.1080/10615806.2013.809421

Vicarious Trauma Institute. (2015). What is vicarious trauma? Retrieved

from Vicarious Trauma Institute website: http://www.vicarioustrauma

.com/whatis.html

Walsh, F. (2006). Strengthening family resilience. New York, NY: Guil-

ford Press.

Wee, D. F., & Myers, D. (2002). Stress responses of mental health workers

following disaster: The Oklahoma City bombing. New York, NY: Brun-

ner-Routledge.

Weiss, D. S., Marmar, C. R., Schlenger, W. E., Fairbank, J. A., Jordan,

K. B., Hough, R. L., Kulka, R. A. (1992). The prevalence of lifetime and

partial post-traumatic stress disorder in Vietnam theater veterans. Jour-

nal of Traumatic Stress, 5, 365–376.

Williams, V., Ciarrochi, J., & Deane, F. P. (2010). On being mindful,

emotionally aware, and more resilient: Longitudinal pilot study of police

recruits. Australian Psychologist, 45, 274–282. http://dx.doi.org/10

.1080/00050060903573197

Wilson, L. C. (2015). A systematic review of probable posttraumatic stress

disorder in first responders following man-made mass violence. Psychi-

atry Research, 229(1–2), 21–26. http://dx.doi.org/10.1016/j.psychres

.2015.06.015

Woody, R. H. (2005). The police culture: Research implications for psy-

chological services. Professional Psychology: Research and Practice,

36, 525–529. http://dx.doi.org/10.1037/0735-7028.36.5.525

Yip, J., Zeig-Owens, R., Webber, M. P., Kablanian, A., Hall, C. B.,

Vossbrinck, M.,...Kelly, K. J. (2015). World Trade Center-related

physical and mental health burden among New York City Fire Depart-

ment emergency medical service workers. Occupational and Environ-

mental Medicine, 73, 13–20.

Zadeh, S., Gamba, N., Hudson, C., & Wiener, L. (2012). Taking care of

care providers: A wellness program for pediatric nurses. Journal of

Pediatric Oncology Nursing, 29, 294–299.

Zeisel, S. H. (2009). Epigenetic mechanisms for nutrition determinants of

later health outcomes. The American Journal of Clinical Nutrition, 89,

1488S–1493S. http://dx.doi.org/10.3945/ajcn.2009.27113B

Želeskov-Ðori´

c, J., Hedrih, V., & Ðori´

c, P. (2012). Relations of resilience

and personal meaning with vicarious traumatization in psychotherapists.

International Journal of Psychotherapy, 16, 44–55.

Zhang, G., Pfefferbaum, B., Narayanan, P., Lee, S., Thielman, S., & North,

C. S. (2016). Psychiatric disorders after terrorist bombings among rescue

workers and bombing survivors in Nairobi and rescue workers in Okla-

homa City. Annals of Clinical Psychiatry, 28, 22–30.

Zimering, R., Munroe, J., & Gulliver, S. B. (2003). Secondary traumati-

zation in mental health care providers. The Psychiatric Times, 20,

43–46.

Received December 9, 2016

Revision received March 30, 2017

Accepted May 9, 2017 䡲

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Objectives: Prior research has examined the incidence of posttraumatic stress stemming from either direct or indirect trauma exposure in employees of high-risk occupations. However, few studies have examined the contribution of both direct and indirect trauma exposure in high-risk groups. One particularly salient indirect trauma often endorsed as the most stressful by many occupational groups is interacting with distressed family members of victims of crime, illness, or accidents. The present study examined the extent to which interacting with distressed families moderated the impact of cumulative potentially traumatic event (PTE) exposure on depression and posttraumatic stress disorder (PTSD) symptoms in 245 employees of medical examiner (ME) offices. Method: Employees from 9 ME office sites in the United States participated in an online survey investigating the frequency of work place PTE exposures (direct and indirect) and mental health outcomes. Results: Results revealed that cumulative PTE exposure was associated with higher PTSD symptoms (PTSS) for employees who had higher frequency of exposure to distressed family members. After controlling for cumulative and direct PTE exposure, gender, and office site, exposure to distressed families was significantly associated with depressive symptoms, but not PTSS. Conclusions: Findings of our research underscore the need for training employees in high-risk occupations to manage their reactions to exposure to distraught family members. Employee training may buffer risk for developing PTSD and depression. (PsycINFO Database Record

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This study examines levels of secondary traumatic stress (STS), compassion fatigue, burnout, and compassion satisfaction in social workers in the State of Montana. It also seeks to explain how specific organizational factors or peer support can potentially reduce the impact of these phenomena. A mixed methodology was utilized. Respondents (N = 256, response rate = 56%) completed 4 short measures: (a) the Social Work Demographics/Workplace Questionnaire, (b) the Secondary Traumatic Stress Scale (STSS; Bride, Robinson, Yegidis, & Figley, 2004), (c) the Professional Quality of Life Scale (ProQOL) (Stamm, 2010), and (d) an original peer support survey. A smaller sample (N = 15) of follow-up interviews were conducted to collect qualitative data. A theory-based approach guided the qualitative data analysis, for which ATLAS-Ti software was used. Findings indicate that social workers in the sample experience significant levels of STS (M = 33.63, SD = 11.30), with 40.9% (n = 105) meeting the criteria for posttraumatic stress disorder, using the STSS (α = .92) as a proxy measure. ProQOL (α = .76) results confirm the presence of high levels of burnout and compassion fatigue on subscale scores, with t tests indicating that individuals performing case management reported lower levels than other groups. Age and time in current job were not found to be significant factors, whereas lower levels of job satisfaction and intent to look for other work were predictive of higher burnout and compassion fatigue scores. Qualitative data analysis revealed themes related to worker perceptions of factors that contributed to their levels of STS. Implications for policy and practice changes are offered.

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Background: The aim of this study was to assess whether the use of alcohol and medicinal drugs among rescue workers as a consequence of the 22 July terrorist attack was associated with post-traumatic stress symptoms, and explore if there were differences between affiliated and unaffiliated rescue workers. Methods: Ten months after the bombing in the Oslo government district and the shooting at the youth camp on Utøya Island, a cross-sectional study of 1790 rescue and healthcare workers was conducted. The questionnaire included information on medicinal drug and alcohol use, experiences during rescue work and PTSS. Results: Few rescue workers reported alcohol (6.8% n = 119) or medicinal drug (5.5% n = 95) use as a consequence of participation in the 22 July terror attacks. Alcohol and medicinal drug use was associated with an elevated level of PTSS among the rescue workers who reported to use medicinal drugs (11.1 95% CI: 5.7-21.8) or alcohol (10.0 95% CI: 5.2-19.0) as a consequence of the terror attacks. Conclusion: The study found a low level of post-traumatic stress symptoms (PTSS) and alcohol and medicinal drug use among the rescue workers after the terror attacks in Norway on 22 July 2011. There was a strong association between both medicinal drug and alcohol use and elevated PTSS.

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Madelaine Lawrence

The purpose of this article is to describe examples of near-death and other transpersonal experiences occurring during catastrophic events like floods, wars, bombings, and death camps. To date, researchers have limited their investigations of these transpersonal events to those occurring to seriously ill patients in hospitals, those dying from terminal illnesses, or to individuals experiencing a period of grief after the death of a loved one. Missing is awareness by first responders and emergency healthcare professionals about these transpersonal experiences and what to say to the individuals who have them. Some responders experience not only deaths of the victims they assist, but also deaths of their colleagues. Information about these transpersonal experiences can also be of comfort to them. The examples in this article include a near-death experience during the Vietnam War, an out-of-body experience after a bomb explosion during the Iraq War, a near-death visit to a woman imprisoned at Auschwitz, and two after-death communications, one from a person killed in Auschwitz and another from a soldier during World War I. Also included are interviews with two New York City policemen who were September 11, 2001 responders. It is hoped the information will provide knowledge of these experiences to those who care for those near death, or dying, or grieving because of catastrophic events, and encourage researchers to further investigate these experiences during disasters.

Extraversion, neuroticism and secondary trauma in Internet child abuse investigators

Article

Mar 2016
OCCUP MED-OXFORD

Noreen Tehrani

Background: Working with victims and perpetrators of child sexual abuse has been shown to cause secondary traumatic stress (STS) in child protection professionals. Aims: To examine the role of gender and personality on the development of secondary trauma responses. Methods: A study of Internet child abuse investigators (ICAIs) from two UK police forces. Participants completed a personality test together with tests for anxiety, depression, burnout, STS and post-traumatic stress disorder to assess secondary trauma. The data were normally distributed and the results were analysed using an independent t-test, Pearson correlation and linear regression. Results: Among 126 study subjects (50 females and 75 males), there was a higher incidence of STS in investigators who were female, introverted and neurotic. However, there were lower levels of STS in the participants in this study than those found in other studies. Conclusions: Psychological screening and surveillance of ICAI teams can help to identify risk factors for the development of STS and identify where additional support may be required.

Psychiatric disorders after terrorist bombings among rescue workers and bombing survivors in Nairobi and rescue workers in Oklahoma City

Article

Feb 2016
Ann Clin Psychiatr

Background: To examine the prevalence of psychopathology in 52 male rescue workers responding to the 1998 U.S. Embassy bombing in Nairobi, Kenya, comparing them with 176 male rescue workers responding to the 1995 Oklahoma City, Oklahoma, bombing and with 105 directly exposed male civilian survivors of the Nairobi bombing. Methods: The Diagnostic Interview Schedule/Disaster Supplement assessed pre-disaster and post-disaster psychiatric disorders and variables related to demographics, exposure, disaster perceptions, and coping in all 3 disaster subgroups. Results: The most prevalent post-disaster disorders were posttraumatic stress disorder (PTSD) (22%) and major depressive disorder (MDD) (27%) among Nairobi rescue workers, which were more than 2 and 4 times higher, respectively, than among Oklahoma City rescue workers. Alcohol use disorder was the most prevalent pre- and post-disaster disorder among Oklahoma City rescue workers. Nairobi rescue workers had a prevalence of PTSD and MDD not significantly different from Nairobi civilian survivors. Conclusions: Nairobi rescue workers were more symptomatic than Oklahoma City rescue workers and were as symptomatic as Nairobi civilian survivors. The vulnerability of Nairobi rescue workers to psychological sequelae may be a reflection of their volunteer, rather than professional, status. These findings contribute to understanding rescue worker mental health, especially among volunteer rescue workers, with potential implications for the importance of professional status of rescue workers in conferring protection from adverse mental health outcomes.

Advancing Science and Practice for Vicarious Traumatization/Secondary Traumatic Stress: A Research Agenda

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