Content uploaded by Yaacov G Bachner
Author content
All content in this area was uploaded by Yaacov G Bachner on Jan 26, 2024
Content may be subject to copyright.
Full Terms & Conditions of access and use can be found at
https://www.tandfonline.com/action/journalInformation?journalCode=rasw20
Australian Social Work
ISSN: (Print) (Online) Journal homepage: https://www.tandfonline.com/loi/rasw20
Thought Patterns Mediate the Development of
Secondary Traumatic Stress in Social Workers
Tali Samson, Yaacov G. Bachner & Tamar Freud
To cite this article: Tali Samson, Yaacov G. Bachner & Tamar Freud (2022) Thought Patterns
Mediate the Development of Secondary Traumatic Stress in Social Workers, Australian Social
Work, 75:4, 483-494, DOI: 10.1080/0312407X.2021.1871927
To link to this article: https://doi.org/10.1080/0312407X.2021.1871927
Published online: 17 Mar 2021.
Submit your article to this journal
Article views: 1023
View related articles
View Crossmark data
Citing articles: 2 View citing articles
Thought Patterns Mediate the Development of Secondary
Traumatic Stress in Social Workers
Tali Samson
a,b,c
, Yaacov G. Bachner
d,e
, and Tamar Freud
a
a
Department of Family Medicine, Siaal Family Medicine and Primary Care Research Center, Faculty of Health
Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel;
b
Clalit Health Services, Beer-Sheva, Israel;
c
The Kappy and Eric Flanders National Palliative Care Resource Centre, Ben-Gurion University of the Negev,
Beer-Sheva, Israel;
d
Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the
Negev, Beer-Sheva, Israel;
e
Center for Multidisciplinary Research in Aging, Faculty of Health Sciences, Ben-
Gurion University of the Negev, Beer-Sheva, Israel
ABSTRACT
Social workers’exposureto their clients’trauma canlead to secondary
traumatisation stress (STS). In light of cognitive theories suggesting
the tendency for repetitive thought (RT) as being predictive of poor
adjustment to traumatic events, the current study explores whether
RT mediates the correlation between known STS predictors and its
severity. Ninety social workers providing care to traumatised clients
completed a self-report survey. Multiple regression analysis revealed
a full mediation model, or that STS was positively associated with
RT, which in turn was positively associated with STS. In addition, the
direct effect of STS association with centrality of event was found to
no longer be of significance. These findings suggest that
interventions focused on combating rumination and increasing
social workers’awareness of their personal susceptibility could be
effective.
IMPLICATIONS
.In the course of caring for traumatised clients, social workers apply
mechanisms, similar to those applied during direct exposure to
trauma (i.e., peritraumatic dissociation).
.Social workers’thought patterns were found to mediate the
correlation between centrality of the traumatic encounter and
secondary traumatic stress level.
.Interventions focused on combating rumination could provide
social workers with suitable skills to cope with exposure to the
traumatic experiences of their clients.
ARTICLE HISTORY
Received 11 November 2019
Accepted 5 November 2020
KEYWORDS
Social Workers; Repetitive
Thought; Secondary
Traumatic Stress;
Peritraumatic Dissociation;
Centrality of Event
Social workers in Australia and other countries including Israel whose jobs involve caring
for others are repeatedly exposed to their clients’traumatic events. The objective of the
current research was to evaluate the role of social workers’thought patterns in the devel-
opment of secondary traumatic stress (STS). Two well-known traumatic stress predictors
were evaluated. The first, peritraumatic dissociation (PETD), occurs during the encoun-
ter. The association between PETD and later symptoms of STS manifests the effect of
social worker exposure to client traumatic narratives in STS development and may
© 2021 Australian Association of Social Workers
CONTACT Tali Samson samsont@bgu.ac.il
AUSTRALIAN SOCIAL WORK
2022, VOL. 75, NO. 4, 483–494
https://doi.org/10.1080/0312407X.2021.1871927
therefore predict vulnerability. The second traumatic stress predictor evaluated, central-
ity of event (COE), is a long-term outcome representing the extent to which traumatic
exposure forms a reference point for personal identity. This study aimed to determine
whether thought patterns mediate the correlation between STS and long-term outcomes
of exposure.
Literature Review
The impact of indirect trauma exposure can lead to negative work-related outcomes, alter-
nately referred to as vicarious trauma (VT), compassion fatigue (CF), and STS (Bride et al.,
2007; Molnar et al., 2017; Voss Horrell et al., 2011). These conditions, among the most
common negative work-related outcomes, are recognised as the occupational hazards of
clinical work that addresses psychological trauma, a view supported by a growing body
of empirical research. VT refers to both affective and cognitive symptoms that result
from prolonged exposure to traumatised clients. These include reduced motivation,
efficacy, empathy, self-esteem, self-perception, and reduced feelings of intimacy, safety,
and trust (Baird & Kracen, 2006; McCann & Pearlman, 1990). CF is also recognised as
an occupational hazard that may lead to negative psychological consequences (Bride
et al., 2007).
A recent theoretical framework (Stamm, 2010) distinguishes between two components
of CF, burnout, and STS. Negative outcomes such as exhaustion, frustration, anger, and
depression are typical of burnout, while negative feelings stemming from fear related to
work-related trauma are more typical of STS. Additional research suggested that there
is a substantial likelihood that a professional exposed to indirect trauma would report
similar levels of job burnout and STS (Cieslak et al., 2014). Furthermore, a significantly
strong association between job burnout and STS has been shown by previous studies,
thus indicating that STS and burnout constructs may be empirically indistinguishable
among professionals exposed indirectly through their work to trauma (Cieslak et al.,
2014). Moreover, a recently developed framework (Voss Horrell et al., 2011) presumes
that CF, burnout, VT, and STS constitute a homogenous group of negative outcomes
related to secondary exposure. Because of the similarity of these negative outcomes, the
current study focuses on STS.
STS is characterised as a professional’s sense of being overwhelmed by client suffering
(Figley, 1995). The Diagnostic and Statistical Manual of Mental Disorders (American
Psychiatric Association, 2013) recognised indirect exposure to human suffering as a
potential source of posttraumatic symptoms (Horesh, 2016). Criterion A3 characterises
secondary traumatic exposure as “indirectly, by learning that a close relative or close
friend was exposed to trauma,”while Criterion A4 describes it as “repeated or extreme
indirect exposure to aversive details of a traumatic event(s), usually as part of professional
duties”(Horesh, 2016). These criteria suggest social workers may be a group that is par-
ticularly vulnerable to STS symptoms (Levin et al., 2014).
One powerful predictor of posttraumatic symptoms is a personal tendency toward dis-
sociation during exposure to a stressful event (Ozer et al., 2003), known as peritraumatic
dissociation (PETD). Although the term dissociation has been used to describe a wide
range of processes, PETD refers specifically to detachment experienced in the course
of a traumatic event. Levels of anxiety during such exposure may mediate the association
484 T. SAMSON ET AL.
between PETD and posttraumatic symptoms (Marmar et al., 1998). The increased level of
PETD that occurs during the encounter is strongly associated with posttraumatic symp-
toms (Marmar et al., 1997; Ozer et al., 2003) and worsens the prognosis (Levin et al.,
2014). While the immediate occurrence of PETD may be adaptive by keeping trauma-
related information separate from awareness, its long-term consequences would be
pathogenic (Ozer et al., 2003). Therefore, among social workers the existence of PETD
in general increases the risk of negative psychological outcomes and of STS, in particular.
Dissociation during treatment of traumatised clients has been associated with a broad
spectrum of posttraumatic symptoms. These symptoms were observed in hospital staff
following sniper attacks (Grieger et al., 2003), emergency room personnel (Laposa &
Alden, 2003; Lavoie et al., 2016), rescue workers (Marmar et al., 1996), midwives witnes-
sing birth trauma (Leinweber et al., 2017), and ambulance personnel (Skogstad et al.,
2015). However, aside from these findings, literature concerning associations between
PETD and STS levels is relatively limited and reported among mobile crisis workers
(Plouffe, 2015), palliative care providers (Samson & Shvartzman, 2018), and social
workers (Lev-Wiesel et al., 2009).
Another characteristic affecting an individual’s reaction to a traumatic event is its cen-
trality of event (COE) to that person’s identity and life story (Berntsen & Rubin, 2006). In
other words, one highly negative, unpredictable, and probably rare event can influence
the attribution of meaning to other events. The COE scale evaluates the extent to
which memory of a stressful event forms a reference point for personal identity and
for the meaning ascribed to other life experiences; COE is associated with increased
posttraumatic symptoms and adverse psychological health (Gehrt et al., 2018). In such
cases, ruminations and future attempts to avoid similar events are likely outcomes.
Various cognitive theories suggest that prolonged or repetitive thought (RT) about
oneself or one’s world substantially affects emotional adjustment to different events
(Szabo et al., 2017; Watkins, 2008). One pattern of thinking reported to have negative
outcome potential is negative RT, which deals retrospectively with events experienced
as negative or distressed, accompanied by negative emotions (Michael et al., 2007;
Watkins, 2008). The direction of this effect varies according to the particular type of
RT, suggesting important differences in thought content and process (Segerstrom
et al., 2003). In general, the more negative the content, the more negative the emotion.
Three factors were found to have an impact on the products of repetitive thought,
namely the quality of thought (content and purpose), the individual’s interpersonal
and social context at the time repetitive thinking occurs, and the extent of thought con-
struction (Watkins, 2008). Furthermore, previous research has indicated that the ten-
dency toward unconstructive, repetitive thought in terms of rumination and worry is
not only likely to support the development and maintenance of event centrality for a
negative event (Allbaugh et al., 2016; Michael et al., 2007), but is also associated with
increased PTS symptoms in trauma-exposed adults (Szabo et al., 2017).
STS Among Social Workers
As social workers directly engage with victims of childhood abuse, domestic violence,
violent crime, disasters, war, and terrorism, they are highly susceptible to secondary
exposure of traumatic events. The reported prevalence of at least one STS symptom
AUSTRALIAN SOCIAL WORK 485
found in social workers is 70%, with many of them likely to experience two or more such
symptoms; in addition, a significant minority may meet the diagnostic criteria for PTSD
(Bride, 2007). Social workers most frequently experience intrusion symptoms, while a sig-
nificant number also report arousal and avoidance symptoms (Lee et al., 2018). In Israel,
secondary traumatisation has been reported among social workers in various fields, such as
family violence (Ben-Porat & Itzhaky, 2009), child protection (Dagan et al., 2016), residen-
tial childcare (Zerach, 2013), and palliative care (Samson et al., 2016). It should be pointed
out that the level of STS varies considerably according to the type of work done. For
example, social workers in supervisory or administrative positions (Wagaman et al.,
2015) or employed at municipal social service departments (Dagan et al., 2016), as well
as those who do not work with trauma victims (Ben-Porat & Itzhaky, 2009), experience
lower levels of STS than do social workers in direct practice.
Research Study
Current knowledge indicates that a tendency toward RT predicts poor adjustment and
stress-related symptoms (Szabo et al., 2017). As such, we hypothesised that thought pat-
terns mediate the association between COE and STS levels. In order to evaluate this
research hypothesis, we established three aims. First, similar to the association established
between PETD and posttraumatic symptoms (Marmar et al., 1998), we sought to test
whether there was an association between PETD and STS, in line with previous research
on other adult groups. In addition, we wanted to measure the correlation between STS
and COE as well as to examine whether RT mediates the correlation between COE and
STS. The study was presented on November 20, 2019, at the annual convention of the
Israeli Palliative Medical Association and the Israeli Association of Palliative Care in
Ramat Gan, Israel.
Methods
A prospective cross-sectional study was carried out in community social services and resi-
dential institutions accommodating juveniles and adults who had experienced neglect or
abuse. These included two residential institutions providing care for 140 children and
youth aged between six and 18 years. Most of the children had been removed from their
homes due to family problems and impaired parental functioning, for example, aggression.
In addition, two ambulatory clinical services provided psychosocial care for children and
youth aged between six and 18 who were survivors of sexual abuse (about 100 children per
year) or offenders (about 30 children per year). Shelters for adults comprised one residence
for women who had experience family violence and their children (providing care for 90
families per year) and one residence for female sex workers (providing care for 70 women
per year); ambulatory clinical services for adult survivors of sexual abuse (providing care
for 100 adults per year) were also provided. These services are operated by a non-profit
organisation in southern Israel in accordance with the guidelines and under the supervi-
sion of Israel’s Ministry of Social Affairs and Social Services.
Study participant exclusion criteria excluded social workers who do not provide direct
care (i.e., managers or administrators) and those without the ability to respond to a ques-
tionnaire written in Hebrew. In accordance with these criteria, a total of 105 clinical
486 T. SAMSON ET AL.
social workers were selected to participate. Study questionnaires were completed during
routine staffmeetings held between January and October 2017. Of 105 social workers
employed by the organisation, seven were absent on staffmeeting days, while another
four declined to participate. The final sample thus consisted of 94 participants (89%
response rate). All study procedures were approved by the Institutional Review Board
of Ben-Gurion University of the Negev.
Reliable Hebrew versions were employed for all four study measures: the dependent
variable, secondary traumatisation stress; peritraumatic dissociation; the centrality of
the traumatic event; and the meditator, repetitive thought. For each measure, the index
score comprised the mean of all items.
The study questionnaire contained questions about age, gender, marital status, religion,
household income, service unit, education, years of professional experience, full- or part-
time position, hours of direct care given per week to traumatised patients, trauma training,
and vacation frequency.
The original Secondary Traumatisation Scale was developed within the framework of
the professional quality of life (Stamm, 2010). In the current study the Hebrew version of
this scale (Samson et al., 2016) consisting of 10 items (e.g., I feel as though I am experi-
encing the trauma of someone I have helped; I think that I might have been affected by the
traumatic stress of those I help) was used. Rated on a 5-point Likert scale (1 = never to 5 =
very often), the higher scores represent a greater STS level. The reliability coefficient
(Cronbach’s alpha) for the Hebrew version is 0.82 (Samson et al., 2016) and 0.84 for
the present sample.
Measures of STS Predictors
The Hebrew version of the Peritraumatic Dissociative Experiences Questionnaire
(PDEQ; Lev-Wiesel et al., 2009) is a self-administered questionnaire consisting of 10
items (e.g., What was happening seemed unreal to me, like I was in a dream or watching
a movie or play) rated on a 5-point Likert-type scale (1 = not at all true to 5 = extremely
true). In the current study participants were asked to describe their experiences during
and immediately after a traumatic encounter (Marmar et al., 1997) as well as being
asked about their immediate reactions during therapeutic sessions with traumatised
clients. The reliability coefficient (Cronbach’s alpha) is 0.85 for the Hebrew version of
the PDEQ (Lev-Wiesel et al., 2009) and 0.86 for the present sample.
The Centrality of Event Scale (CES) measures the degree to which an event is inte-
grated into an individual’s life story and identity (Berntsen & Rubin, 2006). The short
version of this scale includes seven items (e.g., This event has become a reference point
for the way I understand new experiences), which represent three factors: reference
point,identity, and turning point. All seven items are rated on a 7-point Likert scale
(1 = strongly disagree to 7 = strongly agree). The seven-item version internal coefficient
(Cronbach’s alpha) is 0.88 (Berntsen & Rubin, 2006) and 0.91 for the present sample.
The fourth study measure, the meditator of repetitive thought, was measured in the
following way. The tendency toward self-rumination was assessed in the current study
using a rumination scale that was developed within the framework of the Rumina-
tion–Reflection Questionnaire (Trapnell & Campbell, 1999). This rumination subscale
contains 12 items (e.g., My attention is often focused on aspects of myself I wish I’d stop
AUSTRALIAN SOCIAL WORK 487
thinking about) rated on a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree).
The internal coefficient (Cronbach’s alpha) is 0.90 (Trapnell & Campbell, 1999) and 0.89
for the present sample.
Procedure and Statistical Analyses
Study participants were recruited during routine team meetings attended by the principal
researcher who briefly explained the study’s objectives and clarified that participation was
voluntary. All clinical social workers (N= 105) were invited to participate; those who
agreed received a questionnaire, a return envelope, and a personal letter explaining the
importance of the study and emphasising that return of the questionnaire constituted
informed consent. To prevent their identification, participants returned questionnaires
in sealed envelopes with no personal details written on them. Because of the topic’s sen-
sitivity, social workers were not explicitly encouraged to participate, nor was any follow-
up contact made.
Data collected were first examined for outliers and missing items. Omitted data were
handled according to the professional quality of life scale manual (Stamm, 2010). Four
cases with more than 10% of items missing were excluded due to incomplete data,
leaving a final dataset of 90 questionnaires. We tested the distributions of study measures
for normality (i.e., skewness, kurtosis). Since all distributions were found to be normal,
parametric statistical tests were employed. Descriptive statistics were used to describe vari-
ables (i.e., mean, standard deviation (SD), range, percentages) to ensure the reliability and
internal consistency of each scale, Cronbach’s alphas were examined. STS, RT, CES, and
PDEQ were scored using the theoretical score established by the scale’s developers (Bernt-
sen & Rubin, 2006; Marmar et al., 1997; Stamm, 2010; Trapnell & Campbell, 1999).
Pearson correlation tests were performed to examine correlations between each of the
scales. Univariate analyses were performed to assess the sociodemographic and occu-
pational characteristics of respondents. We tested the distributions of study measures
for normality (i.e., skewness, kurtosis); all distributions were found to be normal.
To investigate the hypothesis that there is an association between STS and PETD and
that the association between STS and CE is mediated by RT, multiple regression analyses
were carried out using a four-step procedure (Kenny et al., 1998). This sequential pro-
cedure first entails that the independent variable has a significant effect on the
outcome variable, then the independent variable has a significant effect on the mediating
variable. Thirdly, the mediating variable affects the outcome variable when the indepen-
dent variable is controlled and, finally, the effect of the independent variable on the
outcome variable declines, or loses its significance, when the mediating variable is con-
trolled. Gender and age were included in the regression analysis as control variables. This
procedure was performed using PROCESS macro (Hayes, 2012). All statistical analyses
were performed using the Statistical Package Software System (SPSS version 22.0). For
all analyses, significance level was set at p<0.05.
Results
Participants’sociodemographic and occupational characteristics are presented in Table 1.
Most of the respondents were married and female, with an average age of greater than 38
488 T. SAMSON ET AL.
years and an average of greater than 11 years of professional experience. About one third
had previous training treating trauma victims, and about half worked full-time, experien-
cing an average of greater than 15 h per week of indirect exposure to traumatic events
through their interaction with clients.
Correlations among the four scales are presented in Table 2. All the correlations
between STS and the study variables were found to be significant. Results of the mediation
model are presented in Figure 1. As can be seen, social workers’RT fully mediates an
association between COE and STS symptoms. This mediation was significant even
when controlling for PETD as measured by the PDEQ score. COE was found to be posi-
tively associated with RT (β= .24, B= .18, t= 2.48, p= .014), which, in turn, was positively
associated with STS (β= .23, B= .19, t= 2.31, p= .023). The direct effect between CEO and
Table 1 Sociodemographic Characteristics of Respondents (N= 90)
Gender (N; %) Male 10 11.4%
Female 78 88.6%
(mis = 2)
Marital status (N; %) Unmarried 31 34.8%
Married 58 65.2%
(mis = 1)
Religion (N; %) Jewish 87 97.8%
Other 2 2.2%
(mis = 1)
Household income (N; %) Below Average 25 28.7%
Average 19 21.8%
Above average 43 49.4%
(mis = 3)
Service unit (N; %) Residential institutions for children and young
people aged 6–18
28 31.8%
Ambulatory treatment frameworks for children 34 38.6%
Out-client frameworks for traumatised adults 13 14.8%
Ambulatory treatment frameworks for adults 13 14.8%
(mis = 2)
Education (N; %) Bachelor of Social Work 31 34.4%
Master of Social Work 57 63.3%
Other 2 2.2%
Full- vs part-time job (N; %) Part-time 27 31.4%
Full-time 42 48.8%
More than full-time 17 19.8%
(mis = 4)
Trauma training (N; %) Yes 31 35.6%
No 56 64.4%
(mis = 3)
Vacation frequency (N; %) Once in three months 21 24.7%
Once in six months 31 36.5%
Once a year 31 36.5%
other 2 2.4%
(mis = 5)
Age, years (M±SD; Range) 38.8 ± 10.2 26–70
(mis = 2)
Professional experience, years (M±SD; Range) 11.3±8.9 1–39.0
(mis = 8)
Direct care for traumatised clients per week, hours
(M±SD; Range)
16.8±11.8 4–50
Secondary traumatisation stress (STS) (M±SD;
Range)
2.5 ± .57 1–5
Peritraumatic dissociation (PDEQ) (M±SD; Range) 1.7 ± .56 1–5
Centrality of event (CES) (M±SD; Range) 2.55 ± .90 1–7
Repetitive thought (RT) (M±SD;Range) 3.4 ± .68 1–5
AUSTRALIAN SOCIAL WORK 489
STS was no longer significant (β= .14, B= .09, t= 1.57, p= .119), thus implying the need
for a full mediation model. Furthermore, PETD, as measured by the PDEQ score, was
found to be a significant predictor of STS (β= .40, B= .41, t= 4.19, p= .000). Social
workers who indicated that the encounter was highly central for them reported more
repetitive thoughts, which led them to experience more stress-related symptoms. The
95% confidence interval of the full mediation model ranged from .001 to .085 (5,000 boot-
strap resamples); therefore, its effect was significantly different from zero (Hayes, 2009;
Preacher & Hayes, 2004). In short, our results confirmed our hypothesis that social
workers’RT fully mediates a positive association between centrality of the encounter
and STS (see Figure 1).
Discussion
The results of the current research confirm the hypothesis that, in the course of caring for
traumatic clients, thought patterns mediate the long-term outcomes of a social worker’s
encounter with patient traumatic experiences. Furthermore, our results also confirm
that, in the course of caring for traumatic clients, social workers apply mechanisms
similar to those applied during direct exposure to trauma. As the level of PETD among
trauma survivors is strongly associated with later stress related symptoms (Marmar
et al., 1997,1998; Ozer et al., 2003,2008), it has also been found to predict STS among
social workers who care for traumatised clients. These findings reinforce the relatively
limited current literature reported among social workers (Lev-Wiesel et al., 2009;
Samson & Shvartzman, 2018). Although STS has long been considered an occupational
risk originating in exposure to human suffering, its definition and criteria for secondary
exposure outcomes have been debated in the literature and have changed over time
(Levin et al., 2014). The recently updated Diagnostic and Statistical Manual of Mental Dis-
orders (American Psychiatric Association, 2013) suggests that exposure of workers,
including social workers, to human traumatic experiences should no longer be labelled
as secondary exposure but as a potential source of stress-related symptoms (Horesh,
2016; Levin et al., 2014).
COE measures the extent to which memories of a client’s stressful event forms a refer-
ence point for a social worker’s professional identity and the meaning attributed to other
life experiences. Current theories emphasise the cognitive organisation of this trauma
memory as a predictor of traumatic stress symptoms, arguing that the trauma memory
has become too central to the cognitive organisation of one’s life story and identity (Bernt-
sen & Rubin, 2006). Vivid memories of a patient’s traumatic experiences accompanied by
painful reliving of the traumatic experience and its associated emotions can lead to intru-
sive memories and thereby generate a need for the social worker to offer a solution. One
Table 2 Associations Between STS, PDEQ, CES, and RT
STS PDEQ CES RT
STS 1
DEQ .538
a
1
CES .302
a
0.198 1
a
Correlation is significant at the 0.001 level (2-tailed).
Notes: STS, secondary traumatic stress; PDEQ, peritraumatic dissociation; CES, centrality of event; RT, ruminative thought.
490 T. SAMSON ET AL.
way of responding to these memories involves repetitively and passively thinking about
causes and consequences, as well as the meaning of the distress. Based on current knowl-
edge indicating that susceptibility to RT predicts poor adjustment and stress-related symp-
toms, we hypothesised that social workers’thought patterns mediate the correlation
between COE and STS levels. In fact, mediation was significant and present even when
controlling for PETD (when it was also included in the regression analysis). The charac-
teristics of rumination; a compulsion to continue ruminating; efforts invested in halting
the process; and the presence of unproductive thoughts and negative emotions before
and after rumination all may constitute explanations for the significant association of
RT thought patterns with both PETD and COE.
In the present study RT was found to mediate the correlation between STS and the COE
among clinical social workers, as rumination is particularly likely to occur when individ-
uals appraise a situation as threatening but cannot forgo the reference goal (Martin &
Tesser, 1989; Roberts et al., 2013). At the same time, a personal tendency toward rumina-
tion prolongs the experience of uncontrollability and maintains awareness of an unre-
solved situation, problem or goal discrepancy (Brosschot et al., 2006). Further research
is necessary in order to evaluate whether this tendency results in increased STS risk.
Limitations and Future Directions
Several limitations must be considered when interpreting and generalising the results of
the present study. As its findings are based on retrospective accounts of the development
of STS and independent variables, it cannot address directionality or causation, only
associations. Furthermore, largely because previous research has suggested that the
effects of rumination may extend over time (Treynor et al., 2003), future additional longi-
tudinal studies could be particularly useful for investigating causal relationships and
observing the respective cumulative effects of rumination.
Figure 1 Results of the full mediation model
AUSTRALIAN SOCIAL WORK 491
Conclusions
Despite these limitations, the current study contributes to our understanding of the role
of RT in mediating the correlation between COE and STS among clinical social workers.
Although further research is essential in order to further clarify this issue, these findings
suggest that intervention focused on combating rumination could be effective in prevent-
ing STS among social workers. Application of these findings may also facilitate the devel-
opment of new prevention programs focused on increasing worker awareness of personal
vulnerability to RT and providing them with the skills necessary to cope with exposure to
patient suffering.
Disclosure Statement
No potential conflict of interest was reported by the author(s).
ORCID
Tali Samson http://orcid.org/0000-0001-9061-816X
References
Allbaugh, L. J., Wright, M. O., & Folger, S. F. (2016). The role of repetitive thought in determining
posttraumatic growth and distress following interpersonal trauma. Anxiety, Stress, & Coping,29
(1), 21–37. https://doi.org/10.1080/10615806.2015.1015422
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders
(5th ed.).
Baird, K., & Kracen, A. C. (2006). Vicarious traumatization and secondary traumatic stress: A
research synthesis. Counselling Psychology Quarterly,19(2), 181–188. https://doi.org/10.1080/
09515070600811899
Ben-Porat, A., & Itzhaky, H. (2009). Implications of treating family violence for the therapist:
Secondary traumatization, vicarious traumatization, and growth. Journal of Family Violence,
24(7), 507–515. https://doi.org/10.1007/s10896-009-9249-0
Berntsen, D., & Rubin, D. C. (2006). The centrality of event scale: A measure of integrating a
trauma into one’s identity and its relation to post-traumatic stress disorder symptoms.
Behaviour Research and Therapy,44(2), 219–231. https://doi.org/10.1016/j.brat.2005.01.009
Bride, B. E. (2007). Prevalence of secondary traumatic stress among social workers. Social Work,52
(1), 63–70. https://doi.org/10.1093/sw/52.1.63
Bride, B. E., Radey, M., & Figley, C. R. (2007). Measuring compassion fatigue. Clinical Social Work
Journal,35(3), 155–163. https://doi.org/10.1007/s10615-007-0091-7
Brosschot, J. F., Gerin, W., & Thayer, J. F. (2006). The perseverative cognition hypothesis: A review
of worry, prolonged stress-related physiological activation, and health. Journal of Psychosomatic
Research,60(2), 113–124. https://doi.org/10.1016/j.jpsychores.2005.06.074
Cieslak, R., Shoji, K., Douglas, A., Melville, E., Luszczynska, A., & Benight, C. C. (2014). A meta-
analysis of the relationship between job burnout and secondary traumatic stress among workers
with indirect exposure to trauma. Psychological Services,11(1), 75–86. https://doi.org/10.1037/
a0033798
Dagan, S. W., Ben-Porat, A., & Itzhaky, H. (2016). Child protection workers dealing with child
abuse: The contribution of personal, social and organizational resources to secondary trauma-
tization. Child Abuse & Neglect,51, 203–211. https://doi.org/10.1016/j.chiabu.2015.10.008
Figley, C. R. (1995). Compassion fatigue: Coping with secondary traumatic stress disorder in those
who treat the traumatized. Routledge.
492 T. SAMSON ET AL.
Gehrt, T. B., Berntsen, D., Hoyle, R. H., & Rubin, D. C. (2018). Psychological and clinical correlates
of the centrality of event scale: A systematic review. Clinical Psychology Review,65,57–80.
https://doi.org/10.1016/j.cpr.2018.07.006
Grieger, T. A., Fullerton, C. S., Ursano, R. J., & Reeves, J. J. (2003). Acute stress disorder, alcohol
use, and perception of safety among hospital staffafter the sniper attacks. Psychiatric Services,54
(10), 1383–1387. https://doi.org/10.1176/appi.ps.54.10.1383
Hayes, A. F. (2009). Beyond Baron and Kenny: Statistical mediation analysis in the new
millennium. Communication Monographs,76(4), 408–420. https://doi.org/10.1080/03637750
903310360
Hayes, A. F. (2012). PROCESS [macro]. The Ohio State University.
Horesh, D. (2016). The reconstruction of criterion a in DSM-5: Is it a true incorporation of sec-
ondary traumatization into the PTSD diagnosis? Journal of Loss and Trauma,21(5), 345–349.
https://doi.org/10.1080/15325024.2015.1072016
Kenny, D. A., Kashy, D. A., & Bolger, N. (1998). Data analysis in social psychology. In D. T.
Gilbert, S. T. Fiske, & G. Lindzey (Eds.), The handbook of social psychology. Volume 1 (4th
ed.; pp. 233–265). McGraw-Hill.
Laposa, J. M., & Alden, L. E. (2003). Posttraumatic stress disorder in the emergency room:
Exploration of a cognitive model. Behaviour Research and Therapy,41(1), 49–65. https://doi.
org/10.1016/S0005-7967(01)00123-1
Lavoie, S., Talbot, L. R., Mathieu, L., Dallaire, C., Dubois, M., & Courcy, F. (2016). An exploration
of factors associated with post-traumatic stress in ER nurses. Journal of Nursing Management,
24(2), 174–183. https://doi.org/10.1111/jonm.12294
Lee, J. J., Gottfried, R., & Bride, B. E. (2018). Exposure to client trauma, secondary traumatic stress,
and the health of clinical social workers: A mediation analysis. Clinical Social Work Journal,46
(3), 228–235. https://doi.org/10.1007/s10615-017-0638-1
Leinweber, J., Creedy, D. K., Rowe, H., & Gamble, J. (2017). Responses to birth trauma and preva-
lence of posttraumatic stress among Australian midwives. Women and Birth,30(1), 40–45.
https://doi.org/10.1016/j.wombi.2016.06.006
Lev-Wiesel, R., Goldblatt, H., Eisikovits, Z., & Admi, H. (2009). Growth in the shadow of war: The
case of social workers and nurses working in a shared war reality. British Journal of Social Work,
39(6), 1154–1174. https://doi.org/10.1093/bjsw/bcn021
Levin, A. P., Kleinman, S. B., & Adler, J. S. (2014). DSM-5 and posttraumatic stress disorder. The
Journal of the American Academy of Psychiatry and the Law,42(2), 146–158. https://doi.org/146
[pii]
Marmar, C. R., Weiss, D. S., & Metzler, T. J. (1997). The peritraumatic dissociative experiences
questionnaire. In J. P. Wilson, & T. M. Keane (Eds.), Assessing psychological trauma and
PTSD (pp. 412–428). Guilford Press.
Marmar, C. R., Weiss, D. S., & Metzler, T. J. (1998). Peritraumatic dissociation and posttraumatic
stress disorder. In J. D. Bremner & C. R. Marmar (Eds.), Trauma, memory, and dissociation (pp.
229–252). American Psychiatric Press, Inc.
Marmar, C. R., Weiss, D. S., Metzler, T. J., & Delucchi, K. (1996). Characteristics of emergency
services personnel related to peritraumatic dissociation during critical incident exposure. The
American Journal of Psychiatry,153(Suppl), 94–102.
Martin, L. L., & Tesser, A. (1989). Toward a motivational and structural theory of ruminative
thought. In J. S. Uleman, & J. A. Bargh (Eds.), Unintended thought (pp. 306–326). Guilford
Press.
McCann, I. L., & Pearlman, L. A. (1990). Vicarious traumatization: A framework for understand-
ing the psychological effects of working with victims. Journal of Traumatic Stress,3(1), 131–149.
Michael, T., Halligan, S. L., Clark, D. M., & Ehlers, A. (2007). Rumination in posttraumatic stress
disorder. Depression and Anxiety,24(5), 307–317. https://doi.org/10.1002/da.20228
Molnar, B. E., Sprang, G., Killian, K. D., Gottfried, R., Emery, V., & Bride, B. E. (2017). Advancing
science and practice for vicarious traumatization/secondary traumatic stress: A research agenda.
Traumatology,23(2), 129–142. https://doi.org/10.1037/trm0000122
AUSTRALIAN SOCIAL WORK 493
Ozer, E. J., Best, S. R., Lipsey, T. L., & Weiss, D. S. (2003). Predictors of posttraumatic stress dis-
order and symptoms in adults: A meta-analysis. Psychological Bulletin,129(1), 52–73. https://
doi.org/10.1037/0033-2909.129.1.52
Ozer, E. J., Best, S. R., Lipsey, T. L., & Weiss, D. S. (2008). Predictors of posttraumatic stress dis-
order and symptoms in adults: A meta-analysis. Psychological Trauma: Theory, Research,
Practice, and Policy,S(1), 3–36. https://doi.org/10.1037/1942-9681.S.1.3
Plouffe, K. A. (2015). The relationship of dissociation proneness to secondary trauma, burnout,
and compassion satisfaction in mobile crisis workers. International Journal of Social Science
Studies,3(3), 235–242. https://doi.org/10.11114/ijsss.v3i3.738
Preacher, K. J., & Hayes, A. F. (2004). SPSS and SAS procedures for estimating indirect effects in
simple mediation models. Behavior Research Methods, Instruments, & Computers,36(4), 717–
731. https://doi.org/10.3758/BF03206553
Roberts, H., Watkins, E. R., & Wills, A. J. (2013). Cueing an unresolved personal goal causes per-
sistent ruminative self-focus: An experimental evaluation of control theories of rumination.
Journal of Behavior Therapy and Experimental Psychiatry,44(4), 449–455. https://doi.org/10.
1016/j.jbtep.2013.05.004
Samson, T., Iecovich, E., & Shvartzman, P. (2016). Psychometric characteristics of the Hebrew
version of the professional quality of life (ProQol) scale. Journal of Pain and Symptom
Management,52(4), 575–581. https://doi.org/10.1016/j.jpainsymman.2016.03.019 doi:10.1016/
j.jpainsymman.2016.03.019
Samson, T., & Shvartzman, P. (2018). Secondary traumatization and proneness to dissociation
among palliative care workers: A cross-sectional study. Journal of Pain and Symptom
Management,56(2), 245–251. https://doi.org/10.1016/j.jpainsymman.2018.04.012
Segerstrom, S. C., Stanton, A. L., Alden, L. E., & Shortridge, B. E. (2003). A multidimensional
structure for repetitive thought: What’s on your mind, and how, and how much? Journal of
Personality and Social Psychology,85(5), 909–921. https://doi.org/10.1037/0022-3514.85.5.909
Skogstad, L., Fjetland, A. M., & Ekeberg, Ø. (2015). Exposure and posttraumatic stress symptoms
among first responders working in proximity to the terror sites in Norway on July 22, 2011: A
cross-sectional study. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine,
23(1), 23. https://doi.org/10.1186/s13049-015-0104-4
Stamm, B. H. (2010). The concise ProQOL manual (2nd ed.). ID: ProQOL.org.
Szabo, Y. Z., Warnecke, A. J., Newton, T. L., & Valentine, J. C. (2017). Rumination and posttrau-
matic stress symptoms in trauma-exposed adults: A systematic review and meta-analysis.
Anxiety, Stress, & Coping,30(4), 396–414. https://doi.org/10.1080/10615806.2017.1313835
Trapnell, P. D., & Campbell, J. D. (1999). Private self-consciousness and the five-factor model of
personality: Distinguishing rumination from reflection. Journal of Personality and Social
Psychology,76(2), 284.
Treynor, W., Gonzalez, R., & Nolen-Hoeksema, S. (2003). Rumination reconsidered: A psycho-
metric analysis. Cognitive Therapy and Research,27(3), 247–259.
Voss Horrell, S. C., Holohan, D. R., Didion, L. M., & Vance, T. G. (2011). Treating traumatized
OEF/OIF veterans: How does trauma treatment affect the clinician? Professional Psychology:
Research and Practice,42(1), 79–86. https://doi.org/10.1037/a0022297
Wagaman, M. A., Geiger, J. M., Shockley, C., & Segal, E. A. (2015). The role of empathy in
burnout, compassion satisfaction, and secondary traumatic stress among social workers.
Social Work,60(3), 201–209. https://doi.org/10.1093/sw/swv014
Watkins, E. R. (2008). Constructive and unconstructive repetitive thought. Psychological Bulletin,
134(2), 163–206. https://doi.org/10.1037/0033-2909.134.2.163
Zerach, G. (2013). Compassion fatigue and compassion satisfaction among residential child care
workers: The role of personality resources. Residential Treatment for Children & Youth,30(1),
72–91. https://doi.org/10.1080/0886571X.2012.761515
494 T. SAMSON ET AL.
