Secondary Traumatic Stress

Impact on Mental Health Workers

History and Issue Development ‘It is inevitable that the doctor should

be influenced to a certain extent and even his nervous health should suffer. He quite literally ‘‘takes over’’ the sufferings of his patient and shares them with him. For this reason he runs a risk and must run it in the nature of things’ (Jung, 1966)

As early as 1978, Pines & Maslach found health-care workers often had high levels of burnout associated with low morale, absenteeism, high turnover, and general job stress (Collins et al. 2013).

History and Issue Development McCann & Pearlman (1990) described Vicarious

Traumatization as “the transformation in the inner experience of the therapist that comes about as a result of empathetic engagement with clients’ trauma material.”

Figley (1995) described Secondary Traumatic Stress as the natural consequent behaviors and emotions resulting from knowing about a traumatizing event experienced by a significant other – the stress resulting from helping or wanting to help a traumatized or suffering person”

Since the creation of this concept, development has been limited by unclear definitions, a lack of research, and a focus too specifically on selective groups of trauma therapists (Dunkley and Whelan, 2006).

Plurality of terms Secondary Traumatic Stress: PTSD symptoms in caregivers, likely

connected to the patient’s experience rather than that of the caregiver (Figley 1995) He later changed the name to Compassion Fatigue.

Vicarious Traumatization: the enduring psychological consequences for therapists of exposure to the traumatic experiences of victim clients (Schauben & Frazier 1995).

Symptoms

Symptoms much like PTSD, changes in frame of reference, identity, sense of safety, ability to trust, self-esteem, intimacy, and a sense of control (Bloom)

Also includes somatic complaints, like sleep difficulty, headaches or gastrointestinal distress (Herman 1992, Figley 1995)

Chose to focus on STS because it tends to have more outward, easily diagnosable symptoms rather than internal cognitive shifts that may be difficult to recognize

Relevance

The New England Journal of Medicine reported as of November of 2013 there were three times as many natural disasters between 2000 and 2009 compared to those between 1980 and 1989 (Leaning et al. 2013).

Advances warfare technology and terroristic tendencies make modern conflicts more challenging and often civilians bear the economic and psychological burden. Families are forced to move in order to escape violence, leading to severe mental and physical health issues (Leaning et al. 2013).

Hazard Assessment

A hazard is defined as "Condition, event, or circumstance that could lead to or contribute to an unplanned or undesirable event", such as the development of disease or disorder.

The primary reason for assessing hazards is to attempt to prevent them from happening.

Hazard Assessment

(1) Having a personal history of trauma is linked to the development of VT. Level-of-evidence: Persuasive (Camerlengo, 2002; Dickes, 1998; Pearlman & MacIan, 1995; Schauben & Frazier, 1995; Trippany, 2000; Young, 1999).

(2) Having a personal history of trauma is linked to the development of STS. Level-of-evidence: Reasonable (Allt, 1999; Dickes, 1998; Nelson-Gardell & Harris, 2003; Price, 2001).

(3) Having a personal trauma history is not linked to the development of STS. Level-of-evidence: Reasonable (Creamer, 2002; Follette, Polusny, & Milbeck; 1994; Simonds, 1996).

Hazard Assessment

(4) The amount of exposure (including hours with trauma clients, percentage on caseload, and cumulative exposure) to the traumatic material of clients increases the likelihood of VT. Level-of-evidence: Some (Schauben & Frazier, 1995)

(5) The amount of exposure (including hours with trauma clients, percentage on caseload, and cumulative exposure) to the traumatic material of clients does not increase the likelihood of VT. Level-of-evidence: Reasonable (Brady, Guy, Poelstra, & Brokaw, 1999; Dickes, 1998; Simonds, 1996; Young, 1999).

Hazard Assessment

(6) The amount of exposure (including hours with trauma clients, percentage on caseload, and cumulative exposure) to the traumatic material of clients increases the likelihood of STS. Level-of-evidence: Persuasive (Brady et al., 1999; Creamer, 2002; Myers & Cornille, 2002; Simonds, 1996; Wee & Myers, 2002).

(7) The amount of exposure (including hours with trauma clients, percentage on caseload, and cumulative exposure) to the traumatic material of clients does not increase the likelihood of STS. Level-of-evidence: Some (Nelson-Gardell & Harris, 2003).

(8) Perceived coping ability is a protective factor for VT. Level-of-evidence: Reasonable (Creamer, 2002; Weaks, 1999; Young, 1999)

(9) Perceived coping ability is a protective factor for STS. Level-of-evidence: Some (Follette et al., 1994).

Exposure Assessment‘Exposure assessment is the process of measuring or estimating the magnitude, frequency, and duration of human exposure to an agent in the environment, or estimating future exposures for an agent that has not yet been released.’ Epa.gov (2012)

Size: 5.2 million adults (18-54) will experience PTSD in a given year

Nature: Treating patients experiencing trauma

Populations: Under 1 million mental health workers to treat patients

Uncertainies: Specific group of professionals and specific group of patients

Risk Characterization

Susceptibility

61% Mild to Moderate

29% Moderate to Severe

Traits of Mental Health Workers Empathy

Psychological/Emotional Stability

Coping Skills/Mechanisms

Risk Characterization

No Association Association

Gender Female Age Younger Years Experience Fewer Personal Trauma Childhood Seeing a Therapist Receiving Personal

Therapy Exposure to High % of

Trauma Clients

Trauma Clients

Risk Characterization

Limitations to Studies

Different Measures/Scales

Important Variables Not Included

Not Enough Detail (i.e. Years of Experience)

Risk Characterization

Prevention

Personal Improved self-care (Well Balanced Life)

Organizational

Policy/Regulatory/Legal Solutions

WORKPLACE POLICIES

RISK MANAGEMENT

CASELOAD MANAGEMENT

HEALTHCARE AND SICK LEAVE POLICIES

HEALTHY WORKPLACE INITIATIVES

TRAINING AND PROFESSIONAL DEVELOPMENT

POLICY/REGULATORY/LEGAL SOLUTIONS CONTINUED

LAWS AND REGULATIONS

MENTAL HEALTH PARITY AND ADDICTION EQUITY ACT AND STATE PARITY LAWS

WORKERS COMPENSATION

AMERICANS WITH DISABILITIES ACT

FAMILY MEDICAL LEAVE ACT

AFFORDABLE CARE ACT

GAPS IN SOLUTIONS

OVERLAPPING AND INCONSISTENT DEFINITIONS

QUANTITATIVE STUDIES

AGREED UPON TREATMENT OPTIONS

INCLUSION IN THE DIAGNOSTIC STATISTICAL MANUAL OF MENTAL DISORDERS (DSM)

BIAS AND STIGMA RECOGNIZING AND TREATING MENTAL HEALTH ISSUES

UNINTENDED CONSEQUENCES

COUNSELORS MUST PERSONALLY ENDURE REPEATED EXPOSURE TO DISTRESS AND

USE THEIR OWN FEELINGS OF SORROW AS TOOLS FOR THERAPY. AS SUCH, IT IS

IMPOSSIBLE TO ESACPE THIS KIND OF WORK WITHOUT PERSONAL CONSEQUENCES.

(CAMPBELL, 2002)