VICARIOUS TRAUMA

DEFINITION

• The Vicarious Trauma Institutedefines vicarious trauma as the “indirect exposure to trauma through a first-hand account or narrative of a traumatic event.”
• Vicarious trauma is a term typically used when talking about clinicians, such as therapists, social workers, and other professionals.
• Vicarious Trauma is the emotional residue of exposure to traumatic stories and experiences of others through work; witnessing fear, pain, and terror that others have experienced; a pre-occupation with horrific stories told to the professional (American Counseling Association, 2016)
• Sometimes referred to as “secondary traumatization, secondary stress disorder, or insidious trauma” (ACA, 2016)
• Included in the DSM-5 as part of the cluster of “trauma and stressor-related disorders”
• Vicarious Trauma is not the same as “burnout”

• Vicarious trauma is an occupational challenge for people working and volunteering in the fields of victim services, law enforcement, emergency medical services, fire services, and other allied professions, due to their continuous exposure to victims of trauma and violence.
• This work-related trauma exposure can occur from such experiences as listening to individual clients recount their victimization; looking at videos of exploited children; reviewing case files; hearing about or responding to the aftermath of violence and other traumatic events day after day; and responding to mass violence incidents that have resulted in numerous injuries and deaths.

What Happens to Those Exposed to Vicarious Trauma?

• While individuals respond to vicarious trauma in a number of ways, a change in their world-view is considered inevitable—people can either become more cynical or fearful, or they can become more appreciative of what they have, or both.
• Responses to vicarious trauma can be negative, neutral, or positive; can change over time; and can vary from individual to individual, particularly with prolonged exposure.
• Vicarious traumatization is a negative reaction to trauma exposure and includes a range of psychosocial symptoms. (In the VTT, the term “vicarious traumatization” is used broadly to include other related terms such as secondary traumatic stress (STS), compassion fatigue (CF), and critical incident stress (CIS).
• A neutral reaction signifies the ways that an individual’s resilience, experiences, support, and coping strategies manage the traumatic material, not that it has no effect. Vicarious resilience and vicarious transformation are newer concepts reflecting the positive effects of this work. For instance, individuals may draw inspiration from a victim’s resilience that strengthens their own mental and emotional fortitude. Just as victims can be transformed in positive ways by their trauma, so can victim service providers and first responders.
• Compassion satisfaction reflects the sense of meaning that is gained from working in the fields of victim services and first responders. Such positive outcomes can motivate and, in turn, protect against the negative effects of trauma exposure.

Who Is at Risk of Being Affected by Vicarious Trauma?

Anyone working with survivors of trauma and violence is at risk of being negatively impacted by the varied effects of vicarious trauma. Factors that may make employees or volunteers more vulnerable to this occupational risk include—

• prior traumatic experiences;
• social isolation, both on and off the job;
• a tendency to avoid feelings, withdraw, or assign blame to others in stressful situations;
• difficulty expressing feelings;
• lack of preparation, orientation, training, and supervision in their jobs;
• being newer employees and less experienced at their jobs;
• constant and intense exposure to trauma with little or no variation in work tasks; and
• lack of an effective and supportive process for discussing traumatic content of the work.

What Are Some Common Negative Reactions to Vicarious Trauma?

Each individual may experience the effects of vicarious trauma differently. Some of the potential negative reactions include, but are not limited to:

• difficulty managing emotions;
• feeling emotionally numb or shut down;
• fatigue, sleepiness, or difficulty falling asleep;
• physical problems or complaints, such as aches, pains, and decreased resistance to illness;
• being easily distracted, which can increase one’s risk of accidents;
• loss of a sense of meaning in life and/or feeling hopeless about the future;
• relationship problems (e.g., withdrawing from friends and family, increased interpersonal conflicts, avoiding intimacy);
• feeling vulnerable or worrying excessively about potential dangers in the world and loved ones’ safety;

• increased irritability; aggressive, explosive, or violent outbursts and behavior;
• destructive coping or addictive behaviors (e.g., over/under eating, substance abuse, gambling, taking undue risks in sports or driving);
• lack of or decreased participation in activities that used to be enjoyable;
• avoiding work and interactions with clients or constituents; and
• a combination of symptoms that comprise a diagnosis of Posttraumatic Stress Disorder (PTSD).

Suggestions for Coworkers

If you believe a coworker might be experiencing negative reactions to vicarious trauma, consider—

• reaching out and talking to them individually about the impact of the work;
• helping them establish a consistent work-to-home transition that creates an important boundary and safe place outside the workplace;
• encouraging them to attend to the basics—sleep, healthy eating, hygiene, and exercise;
• supporting connections with family, friends, and coworkers;
• referring them to organizational supports such as a peer support team, employee assistance program, or chaplain; and
• encouraging them to discuss their experience with their supervisor.

Suggestions for Supervisors

The VTT includes a number of suggestions for supervisors of individuals who may be experiencing vicarious trauma, including—

• discussing vicarious trauma as part of supervision;
• allowing flexible work schedules, recognizing the need for and protecting down time, while staying attuned to the possibility of withdrawal or isolation;
• creating time and a physical space at work for reflection through reading, writing, prayer, and meditation, among other activities; and
• referring to therapeutic and professional assistance, when appropriate.

Suggestions for Family Members

Family members of victim service providers and first responders are also often affected by work-related trauma exposure. In addition to the suggestions offered above, consider these additional ways to address your own needs and those of your family:

• Share your concerns and develop supportive strategies with your loved one.
• Do your best not to take your loved one’s reactions personally; remind yourself that what your loved one may be experiencing is related to the job, not you.
• Maintain daily life routines (predictability helps).
• Stay connected with family and friends.
• Discuss the demands of your loved one’s job and its impact with other family members, including responding to children’s questions in an age-appropriate manner.
• Take time to engage in social, creative, and self-care activities such as reading, writing, prayer, and meditation.
• Seek therapeutic or professional assistance, when needed.

Personal Symptoms of Vicarious Trauma (i.e., what others won’t see) (ACA)

Behavioral:

▪ Sleep disturbances

▪ Nightmares

▪ Appetite changes

▪ Hypervigilance

▪ Exaggerated startle response

▪ Losing things

▪ Clumsiness

▪ Self-harm behaviors

▪ Negative coping – smoking drinking, acting out

Physical:

▪ Panic symptoms – sweating, rapid heartrate, difficulty breathing, dizziness

▪ Aches and pains

▪ Weakened immune system

Cognitive:

▪ Minimization of vicarious trauma

▪ Lowered self-esteem and increased self-doubt

▪ Trouble concentrating

▪ Confusion/disorientation

▪ Perfectionism

▪ Racing thoughts

▪ Loss of interest in previously-enjoyed activities

▪ Lack of meaning in life

▪ Thoughts of harming yourself or others

Emotional:

▪ Helplessness and powerlessness

▪ Survivor guilt

▪ Numbness

▪ Oversensitivity

▪ Emotional unpredictability

▪ Fear

▪ Anxiety

▪ Sadness and/or depression

Social:

▪ Withdrawal and isolation

▪ Loneliness

▪ Irritability and intolerance

▪ Distrust

▪ Projection of blame and rage

▪ Decreased interest in intimacy

▪ Change in parenting style (overprotective)

Interventions for Vicarious Trauma – ABC’s: Awareness, Balance, and Connection (ACA)

Individual Level:

▪ Monitor yourself – eat well, rest, and exercise

▪ Self-care – seek balance, engage in outside activities

▪ Set professional and personal boundaries

▪ Take advantage of professional development opportunities

▪ Utilize viable, evidence-based treatments for vicarious trauma/secondary traumatic stress that focus on changes in cognitive processes

Organizational/Social Level:

▪ Reduce system causes of vicarious trauma, secondary traumatic stress, and burnout such as workload and exposure to challenging cases

▪ Provide critical incidents debriefing

▪ Work with area Employee Assistance Programs (EAP) to identify areas of improvement such as in-service trainings on self-care or counseling

▪ Provide sabbaticals, professional education, community service, and public speaking opportunities

▪ Provide a Psychologist Peer Advocate – a specially-trained therapist to assist with cognitive changes resulting from vicarious trauma

Common signs of vicarious trauma

If you are currently or have recently been working with survivors of traumatic incidents or torture survivors, you should be aware of the following signs:

• experiencing lingering feelings of anger, rage and sadness about patient’s victimisation
• becoming overly involved emotionally with the patient
• experiencing bystander guilt, shame, feelings of self-doubt
• being preoccupied with thoughts of patients outside of the work situation
• over identification with the patient (having horror and rescue fantasies)
• loss of hope, pessimism, cynicism
• distancing, numbing, detachment, cutting patients off, staying busy. Avoiding listening to client’s story of traumatic experiences
• difficulty in maintaining professional boundaries with the client, such as overextending self (trying to do more than is in the role to help the patient).

If you are experiencing any of these signs, this could indicate that you are suffering from vicarious trauma.

Strategies for reducing risk of vicarious trauma

If you feel you may be suffering from vicarious trauma, try following these coping strategies to reduce the risks.

• Increase your self-observation – recognise and chart your signs of stress, vicarious trauma and burnout.
• Take care of yourself emotionally – engage in relaxing and self-soothing activities, nurture self-care.
• Look after your physical and mental wellbeing.
• Maintain a healthy work/life balance – have outside interests.
• Be realistic about what you can accomplish – avoid wishful thinking.
• Don’t take on responsibility for your patients’ wellbeing but supply them with tools to look after themselves.
• Balance your caseload – mix of more and less traumatised clients, victims and non-victims.
• Take regular breaks, take time off when you need to.
• Seek social support from colleagues, family members.
• Use a buddy system – particularly important for less experienced doctors.
• Use peer support and opportunities to debrief.
• Take up training opportunities.
• If you need it, take up time-limited group or individual therapy.
• There are also significant organisational factors that can increase the risk of a person being vicariously traumatised, which should be assessed and addressed.

Are there treatments for vicarious trauma?

If you’re a clinician looking for support, reaching out to a therapist can be a great starting point.

Finding ways to seek respite, such as maximizing vacation time, can also help. This can aid in coping with caregiver stress for those who care for a family member.

“Taking time-off should be nonnegotiable for those in trauma-related helping professions,” says Phillips. “It is imperative that [they] take time away from work to engage in outside interests.”

Seeking social support can be helpful for many stressful situations and can act as a buffer for people who may experience trauma.

To connect, you can consider trusted social outlets, shared hobbies, or group activities such as exercise classes. And if you’re unsure how to start connecting, “you can begin by consulting with a colleague, supervisor, or mental health professional,” says Phillips.

For people who are experiencing stress from a family member or loved one’s trauma, certain types of therapy may be particularly helpful, such as:

• cognitive behavioral therapy (CBT)
• family systems therapy
• trauma-focused CBT for children and adolescents

Trauma Denial: How to Recognize It and Why It Matters

• Denial of trauma is a defense mechanism that protects you from emotional pain.
• Sometimes, however, healing is on the other side of it.
• Healing from all types of trauma is possible, even if it takes some time.
• For some people, the first step toward that recovery may be the most difficult one, though.
• Confronting the traumatic event and what it meant to you may bring up hurtful memories and sensations.
• This is why denial is often a natural trauma response.
• Trauma denial may serve as a shield that emotionally and mentally disconnects you from the traumatic event. But it may not aid you in healing the pain.
• Understanding why trauma denial happens and accepting that you may be living with it can become a powerful healing tool.

What’s trauma denial?

• Trauma denial is a way to put distance between you and an overwhelming experience.
• It can be one of the many ways your brain tries to adapt and mitigate a reality collapse or a system overload, which can often happen after a traumatic event.
• As you might imagine, denial can be enormously useful.
• “Trauma denial may be helpful in the short term. It allows the trauma survivor to stand up and get back on their feet,” says a psychologist in Yardley, Pennsylvania.
• Yet, just like a trusty old pair of shoes, the comforts we learn to rely on may start to fall apart, if given enough time.
• Ongoing trauma denial causes more suffering than there needs to be. Although trauma survivors may learn how to suppress this unpleasant experience from their past, their body and mind will continue to carry it until the trauma is confronted, according to research.
• Addressing your trauma symptoms isn’t easy, but it can be rewarding. It can help you grow and integrate the parts of your past so you feel more solid, self-actualized, and whole.

What’s trauma?

Trauma is an emotional response to experiencing, or witnessing, a distressing event or series of events, according to the Substance Abuse and Mental Health Services Administration.

Some experiences linked to trauma include:

• accidents
• childhood abuse
• domestic violence
• loss of a loved one
• natural disaster
• sexual assault
• torture
• war

Certain mental health conditions may develop after a traumatic experience:

• anxiety
• post-traumatic stress disorder (PTSD) or complex post-traumatic stress disorder (C-PTSD)
• depression
• personality disorders
• schizophrenia
• substance use disorder

Denial as a defense mechanism

Denial is a defense mechanism, an efficient mental process that acts as a protective shield and helps you cope. It can help you minimize the impact an event has had on your life.

Trauma denial often occurs when the reality of the trauma is so great that it is psychologically safer to bury, deny, suppress, or avoid what happened than to accept that the trauma ever occurred in the first place.

The psychological function of denial is to push aside overwhelming information to buy you some time and give you room to breathe after a traumatic experience. This may be a conscious or unconscious process.

Denial is not the only psychological process that may happen after the traumatic event, though. You could also experience:

• dissociation
• emotional numbness
• anosognosia
• emotional blunting

Denial versus emotional avoidance

Denial and emotional avoidance both create distance from a traumatic experience, but they’re slightly different:

• “Denial distorts facts and events by ignoring the presence of the elephant in the room, so to speak. There is no admission of a problem,”.

Avoidance, on the other hand, can be an attempt to refrain from feeling painful emotions by withdrawing or dissociating from specific experiences.

• It could also involve avoidance of situations or interactions that may become emotional in any way.
• For example, denial would be saying, believing, and acting like the traumatic experience didn’t affect you.
• Emotional avoidance, on the other hand, could be using alcohol to prevent thinking about the event or feeling detached from friends and family in general.

Denial in unresolved trauma

There may be many benefits of denial, which could help explain why people develop this defense mechanism for unresolved trauma.

Denial can help you:

• avoid pain
• get on with your life
• maintain an illusion of control
• remain loyal to someone who hurts you
• stick out a tough situation until you can safely get away
• protect your self-esteem

Researchers have also found that those who deny or minimize their childhood trauma have a positivity bias that can protect against other mental health conditions in the future, like depression.

And for those who’ve picked up on the fact that trauma may be more difficult to heal without the help of professional support, avoidance can provide yet another respite: a reason to steer clear of a therapist’s office.

Psychologically, it can help people avoid stigmas that come along with diagnoses such as post-traumatic stress disorder (PTSD).

The problem with denying it is that until you acknowledge and recognize trauma for what it is, you deny your own experience. The trauma denial ultimately creates a barrier to the ability to heal from it.

How to tell if you’re in denial

If you’re living with trauma or PTSD denial, or you suspect that someone you love is, there are some signs that’ll help you identify this process.

Avoidance is one of them.

• If someone brings up the event, you may be the first to change the subject. You may also feel uncomfortable when people around you get emotional or vulnerable.
• If someone is asking you questions, you may divert attention away from yourself, preferring to learn more about whoever you’re talking with instead.
• You may have symptoms of avoidance, like staying busy in romantic relationships, using work as an escape, or engaging in substance abuse.
• One of the most common signs that someone is in denial is minimization. It often comes out in the way you talk about (or, rather, don’t talk about) what happened.

Minimization can sound like:

• “It’s fine. I’m OK, really.”
• “That was then. This is now.”
• “I’m sure that happens to everyone.”
• “It wasn’t a big deal. I’ve moved on.”
• “There’s no use talking about the past.”
• “It wasn’t bad enough to be called trauma.”
• “That didn’t happen to me.”
• “I’m strong. I can deal with it fine.”
• “I just prefer not thinking about it.”

Everyone’s different, and these examples may not be what you relate to. Maybe you’re handling it in a different way. Self-exploration, ideally with the help of a health professional, may provide you with clearer signs.

How to resolve trauma (and why)

Healing from trauma takes time, but it’s possible. When you can work through it, you may feel like taking off a heavy backpack you never even knew was there. And when you finally reach the other side of trauma, there may be a new range of emotions available to you: relief, completion, lightness, closure, liberation, or joy.

To start your healing path, consider these tips to manage avoidance behaviors:

• Professional support
• While it may be intimidating to think about reaching out for help, trauma-informed therapists are trained to help you process and integrate trauma in a way that is safe and appropriately paced.
• A common myth that keeps many survivors from seeking help is the idea that you have to re-tell every minute detail of what happened to you. That isn’t true.
• You can engage in transformative trauma therapyand never verbally describe the events.
• A good trauma therapist will help you use your body, art, and other expressive modalities to work through your trauma.

 

• There’s no one-size-fits-all approach
• Trauma impacts everyone differently.
• Recovery is a process unique to each individual.
• Allowing yourself to gravitate toward the approach that feels the most authentic for you can he helpful in maximizing your recovery process.
• There are multiple ways to address this; talking to a doctor, a counselor, a psychologist, a trauma-informed minister are all options.
• Some individuals take great comfort through exercises, stretches, and maintaining relaxation in the body.
• Not everyone desires to talk to professionals after experiencing a trauma, and that is OK.
• The important thing is going with whatever feels the most supportive. Meet yourself where you’re at. When and if you’re ready, you can always find help from a therapist.

REFERENCES

1) https://ovc.ojp.gov/program/vtt/what-is-vicarious-trauma

2) chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.cdcr.ca.gov/bph/wp-content/uploads/sites/161/2021/10/Trauma-Fact-Sheets-October-2021.pdf

3) https://www.bma.org.uk/advice-and-support/your-wellbeing/vicarious-trauma/vicarious-trauma-signs-and-strategies-for-coping

4) https://psychcentral.com/blog/denial-of-trauma-signs