Volume 12, Issue 1, January, 2024 Evidence in Action A quarterly research brief from the Center on Trauma and Children

Listen to a short summary of this research brief (1:58)

Gusler, S., Sprang, G., Hood, C., Eslinger, J., Whitt-Woosley, A., Kinnish, K., & Wozniak, J. (2023). Untangling secondary traumatic stress and vicarious traumatization: One construct or two? Psychological Trauma: Theory, Research, Practice, and Policy. Advanced online publication. https://doi.org/10.1037/tra0001604

Background: The negative impact of indirect trauma exposure on those in helping professions has been conceptualized in multiple ways. One of which is secondary traumatic stress (STS), in which professionals experience symptoms similar to posttraumatic stress disorder (PTSD), resulting from hearing about or witnessing the effects of other’s trauma experiences.(1) Another conceptualization is vicarious traumatization (VT) which represents negative changes in professionals’ cognitions and beliefs about safety, the world, themselves, and others, which results from the cumulation of exposure to other’s trauma.(2) STS and VT have historically been defined at two separate constructs, with STS being more focused on symptoms and acute distress and VT being more focused on negative cognitive schemas.(3,4) However, the definition of STS was recently expanded, consistent with changes in the DSM-5-TR criteria for PTSD, to include symptoms of negative alterations in cognitions and mood.(3,5) The present study examined this expanded conceptualization of STS to determine if the addition of negative cognition and mood symptoms accounts for VT, or if VT and STS remain distinct constructs.

Method: This study utilized correlation analyses as well as network analysis to examine the patterns and partial correlations between individual STS and VT symptoms to determine conceptual networks between and across each construct.(6,7) Network analysis is an exploratory data driven approach which provides information on symptoms that are most strongly connected to one another and which symptoms may “bridge” comorbid disorders/constructs.(8) To measure STS, each item of the Secondary Traumatic Stress Scale for DSM-5 (STSS3) was used, and each item of the Post-Maladaptive Beliefs Scale (PMBS9) was used to capture VT. Participants also completed questions about their level of indirect trauma exposure and years of professional experience.

A national representation of 613 helping professionals was obtained through an online snowball sampling design. Participants were primarily female (79.2%) and white (69.8%). A range of professions were captured in survey responses, with the most common being child protection/advocacy, multiple settings (e.g., child protection/advocacy and legal), and behavioral health). 

Findings: Participants reported high indirect daily trauma exposure at work (e.g., over 65% of their day being indirectly exposed). Correlations indicated significant associations between STS and VT scores. Greater daily indirect trauma exposure was associated with greater STS symptoms, except for in the domain of Avoidance, and was associated with greater VT symptoms, except for in the domain of Self-Worth and Judgement. Further, correlations indicated an association between fewer years of professional experience and greater STS and VT symptoms. Although correlations using the STSS and PMBS total and subscale scores pointed to a number of similarities and potential overlap in the constructs, network analysis was used to examine individual symptoms in a more nuance and complex manner. Results from the network analysis indicated that STS and VT are associated with one another but remain distinct phenomena. Although STS and VT symptoms were found to fall into two separate clusters, there were specific symptoms that appeared to connect or bridge the clusters. Two symptoms from the STSS Negative Mood/Cognition subscale (e.g., having little interest in being around others and having negative expectations about oneself, others, or the world) connected to PMBS items from the Threat of Harm and Self-Worth and Judgement subscales. Additionally, two PMBS symptoms (e.g., feeling unsafe and believing that they are a good person) were connected to STS symptoms of intrusion as well as negative cognitions/mood. Thus, although the addition of the negative alterations in mood/cognition to the conceptualization of STS may not completely capture the phenomena of VT, it does further connect the two constructs.

1. Individuals exposed to indirect trauma are at risk for both STS and VT, and this risk appears to increase as the dose of indirect exposure increases. As such, organizational leadership should monitor individuals’ doses of indirect exposure and provide additional supports and efforts to mitigate negative effects for those experiencing high levels of daily indirect trauma exposure.
2. Organizations should also focus assessment, prevention, and intervention efforts for STS and VT on early career professionals, as having fewer years of experience was a risk factor for both STS and VT.

3. Given that STS and VT were found to be associated but distinct reactions to indirect trauma exposure, it is recommended that organizations provide screening and assessment of both STS and VT to their helping professionals.
4. Intervention development should focus on the symptoms that bridge STS and VT to help mitigate the effects of both reactions to indirect trauma exposure.

1.     Sprang, G., Ford, J., Kerig, P., & Bride, B. (2019). Defining secondary traumatic stress and developing targeted assessments and interventions: Lessons learned from research and leading experts. Traumatology, 25(2), 72. https://doi.org/10.1037/trm0000180 

2.     McCann, I. L., & Pearlman, L. A. (1992). Constructivist self-development theory: A theoretical framework for assessing and treating traumatized college students. Journal of American College Health, 40(4), 189-196. https://doi.org/10.1080/07448481.1992.9936281  

3.     Bride, B.E. (2013). The Secondary Traumatic Stress Scale, DSM 5 Revision. Unpublished Manuscript. 

4.     Branson, D. C. (2019). Vicarious trauma, themes in research, and terminology: A review of literature. Traumatology, 25(1), 2–10. https://doi.org/10.1037/trm0000161 

5.     American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787

6.     Epskamp, S., & Fried, E. I. (2018). A tutorial on regularized partial correlation networks. Psychological methods, 23(4), 617. https://doi.org/10.1037/met0000167

7.     Epskamp, S., Cramer, A. O., Waldorp, L. J., Schmittmann, V. D., & Borsboom, D. (2012). qgraph: Network visualizations of relationships in psychometric data. Journal of Statistical Software, 48(4), 1–18. https://doi.org/10.18637/jss.v048.i04  

8.     Borsboom, D., & Cramer, A. O. (2013). Network analysis: an integrative approach to the structure of psychopathology. Annual review of clinical psychology, 9, 91-121. https://doi.org/10.1146/annurev-clinpsy-050212-185608

9.     Vogt, D. S., Shipherd, J. C., & Resick, P. A. (2012). Posttraumatic Maladaptive Beliefs Scale: Evolution of the Personal Beliefs and Reactions Scale. Assessment, 19, 308-317. https://doi.org/10.1177/1073191110376161