Skylee Campbell and Ta-Keisha Smith
One concept that is not often discussed or taught in the process of training is the cost of caring (Figley & Ludick, 2017). “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” (Remen, 1996, p. 52). In the fields of medical services, law enforcement, fire response, victim assistance, and mental health, professionals are frequently exposed to traumatic events, sometimes even on a daily basis (Molnar et al., 2017). Numerous terms are used to describe this concept of witnessing other’s trauma and the impact that this can have on our physical, emotional, cognitive, mental, and/or spiritual functioning (Branson, 2018). While some studies incorporate specific definitions for each of these terms, others use them interchangeably (Greinacher et al., 2019). Some of these terms include secondary traumatic stress, compassion fatigue, and vicarious trauma (Branson, 2018). It is essential to understand these terms, as well as the impact they can have on professionals, specifically first responders.
Definition of Terms
The term “secondary traumatic stress” will be used for the purpose of this article as it most closely relates to first responders. Figley (1995) coined the term secondary traumatic stress and described it as the phenomenon that occurs as a result of professionals (i.e., first responders, medical personnel, etc.) being “psychologically overwhelmed by their desire to provide assistance and comfort to their observations of trauma and suffering” (Branson, 2018, p. 3). It is most often used to describe professionals who frequently are exposed to the trauma of others, but who do not develop a continuous empathetic relationship with these individuals (Branson, 2018).
While secondary traumatic stress is the focus of this article, it is important to understand the definitions of the other terms as well. Compassion fatigue, also coined by Figley (1995) is similar to secondary traumatic stress and is often used interchangeably, as it also focuses on the observations of trauma and desire to help those individuals (Figley, 1995; Branson, 2018). Vicarious trauma was coined by McCann and Pearlman (1990) and can be defined as “the unique, negative, and accumulative changes that can occur to clinicians who engage in an empathetic relationship with clients” (Branson, 2018, p.2). While this original definition has been primarily studied as it relates to mental health professionals, it has been expanded to encompass first responders, to address their frequent exposure to the traumatic experiences of others (Molnar et al., 2017).
Symptoms of Secondary Traumatic Stress
The symptoms of secondary traumatic stress are similar to those of primary trauma in that they can manifest in diverse ways and in four categories, including arousal, intrusive imagery, negative changes to cognitions, and avoidance behaviors (Branson, 2018). Some common symptoms include social isolation, negative coping skills, poor decision making, unwanted mental images, high sensitivity to trauma reminders, loss of motivation, and stress-induced medical conditions (Branson, 2018). In contrast to vicarious trauma and compassion fatigue, where symptoms develop after several exposures, it has been observed that symptoms originating in secondary traumatic stress can occur after a single exposure (Branson, 2018).
Prevalence in First Responders
First responders are frequently exposed to traumatic events as part of their daily job duties. They are continuously managing unpredictable situations that can be emotionally challenging for everyone involved (Greinacher et al., 2019). Repeatedly experiencing these events, including assisting survivors and their families, and being exposed to the dead and severely injured, can cause a high level of distress and prevent the first responder from being able to adequately adapt and cope with these situations (Greinacher et al., 2019). Although little research has been conducted, some studies have shown up to 35% of first responders being at risk of developing symptoms of secondary trauma. While first responders technically encompass law enforcement, fire fighters, and emergency paramedics, similar rates have been shown for medical and mental health professionals (Greinacher et al., 2019). Concerns of those working as first responders around potential job loss and social desirability suggests the possibility that these rates have been underestimated (Greinacher et al., 2019).
Risk and Protective Factors
While certain fields have begun to identify risk and protective factors, there is very little research on this topic. However, some risk factors that have been identified in first responders and related fields include caseload frequency, caseload volume, and having a personal trauma history (Molnar et al., 2017). Other risk factors can include age, gender, emotional exhaustion, exposure, and substance use (Greinacher et al., 2019). Some protective factors include having social support and adequate support from supervisors (Molnar et al., 2017). Additional protective or resilience factors that have been identified include self-efficacy, internal locus of control, a cohesive organization, engagement, and mindfulness (Greinacher et al., 2019).
Treatment Recommendations and Conclusion
The treatment of first responders is something that is not often addressed outside of the forensic realm. In the forensic arena, law enforcement receives psychological services after a major shootout or a traumatic event where they begin exhibiting signs and symptoms of distress. In those instances, they are encouraged to seek psychological help. However, many do not because they fear losing their jobs. Thus, it is imperative that outside psychologists are aware of the traumas this population encounters and that they are mindful of potential apprehension. As much as therapy is warranted among first responders, there are other steps organizations can take to assist their workers, such as installing a gym at the facility, a quiet room for meditation, hiring a wellness coach, and fostering an environment of social support. As mental health professionals working with first responders, we know the ramifications of trauma can manifest in variety of ways; it is imperative to advocate for treating the whole person.
Branson, D. C. (2019). Vicarious trauma, themes in research, and terminology: A review of literature. Traumatology 25(1), 2-10. http://dx.doi.org/10.1037/trm0000161
Figley, C. R. (1995). Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized. Brummer/Mazel
Figley, C. R. & Ludick M. (2017). Secondary traumatization and compassion fatigue. APA Handbook of Trauma Psychology 1(1), 1-21. doi: 10.1037/00000019-029
Greinacher, A., Derezza-Greeven, C., Herzog, W., & Nikendei, C. (2019). Secondary traumatization in first responders: A systematic review. European Journal of Psychotraumatology 10(1), 1-21. doi: 10.1080/20008198.2018.1562840
McCann, I. L. & Pearlman, L. A. (1990). Vicarious trauma: A framework for understanding thepsychological effects of working with victims. Journal of Traumatic Stress, 3(1), 131-149. http://dx.doi.org/10.1007/BF00975140
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. http://dx.doi.org/10.1037/trm00001122
Remen, R. N. (1996). Kitchen table wisdom: Stories that heal. Riverhead Books.
Skylee Campbell is a 5th year doctoral student at The Chicago School of Professional Psychology, Washington, D.C. campus. She is pursuing her Psy.D. in clinical psychology with a forensic specialization. Her employment and training experiences include administering assessments and providing individual and group therapy services in a variety of settings (i.e., neuropsychology private practice, inpatient psychiatric hospitals, and residential substance abuse). Skylee’s research interests focus primarily on forensic and police psychology. Her career goals include working in an inpatient/correctional facility, as well as consulting with law enforcement by focusing on the effects of trauma on the brain, employee assistance, and program development/management in these areas.
Ta-Keisha Smith is a 5th year doctoral student at The Chicago School of Professional Psychology in pursuit of her PsyD in clinical psychology. She is a licensed psychological associate, former applied behavioral analyst therapist and registered behavioral technician. In 2014, while working as a juvenile probation officer, working with “at risk” youth, Ta-Keisha received her master’s degree in forensic psychology. Her passion for helping others led her to the field of psychology. As a doctor of clinical psychology, she plans to provide comprehensive assessments. Her philosophy is the “assessment is the first step on the journey to obtaining services.”