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Vicarious Trauma and How Healthcare Workers Can Avoid It

When an individual is repeatedly exposed to the pain, suffering, and fear of other people who have experienced trauma, they can develop trauma symptoms themselves.

This phenomenon is known as “vicarious trauma.” According to the American Counseling Association, the definition of 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; [and] a preoccupation with horrific stories told to the professional.”

People who experience vicarious trauma can experience symptoms that meet the criteria for PTSD, though this isn’t always the case. Vicarious trauma is also distinct from burnout, even though the two conditions share many similar symptoms.

As you might imagine, healthcare workers are particularly susceptible to developing symptoms of vicarious trauma. In this article, we’ll closely examine what you need to know about vicarious trauma and what you can do to avoid it as a healthcare professional.

What Is Vicarious Trauma?

Individuals who work in environments where they are continuously exposed to trauma and violence victims face a challenge known as vicarious trauma. This includes workers in healthcare, law enforcement, fire services, and victim services, to name a few.

First identified as the “cost of caring” back in the 1980s, vicarious trauma is also sometimes referred to as secondary stress disorder, secondary traumatization, insidious trauma, or secondary stress disorder. It can be found in the DSM-5, grouped with other “trauma and stressor-related disorders.” It’s worth noting that secondary trauma is sometimes used as a term that describes exposure to another person’s trauma on one single occasion, while vicarious trauma results from long-term exposure to the pain and suffering of many people.

A Doctor Facing Vicarious Trauma

Vicarious trauma is, essentially, an experience that individuals can have when they are exposed to other people’s trauma over a prolonged period. Though they did not experience the trauma firsthand, they secondarily experienced it through listening to individuals recount their victimization, reviewing case files, responding to the aftermath of traumatic events, and other means.

This type of trauma can lead to psychological, cognitive, and physiological changes. In the next sections, we will explore the causes and symptoms associated with this occupational challenge.

The Causes of Vicarious Trauma

Anyone who engages with trauma survivors, particularly on an ongoing basis, could potentially experience vicarious trauma.

A Team of Paramedics

For this reason, individuals who work in professions that focus on helping others, such as paramedics, doctors, nurses, therapists, firefighters, police officers, and social workers, are prone to experiencing this condition.

The Symptoms of Vicarious Trauma in the Workplace

Vicarious trauma can result in physical, behavioral, and emotional symptoms. These symptoms can affect an individual’s professional life as well as their personal life.

A Doctor Experiencing Symptoms of Vicarious Trauma

In the workplace, a number of behavioral symptoms can emerge when someone has been repeatedly exposed to other people’s trauma, including:

  • Absenteeism
  • Tardiness
  • Frequent job changes
  • Irresponsibility
  • Irritability and increased anger
  • Exhaustion
  • Withdrawing and rejecting professional relationships with colleagues
  • Dropping out of professional and community engagements
  • Avoiding spending time alone
  • Talking to oneself

At the interpersonal level, someone who is dealing with vicarious trauma might display some of the following symptoms:

  • Poor communication
  • Poor relationships
  • Tendency to blame other people
  • Frequent conflicts with other staff members
  • Impatience
  • Lack of willingness to collaborate
  • Avoidance of working with individuals that have traumatic pasts
  • A significant change in relationships with co-workers and colleagues
  • Isolation and withdrawal from colleagues

As you might imagine, a healthcare worker’s job performance can suffer when they are dealing with secondary traumatization. Some of the signs that can emerge include:

  • Increased error rate
  • Low motivation
  • Lack of flexibility
  • Perfectionism
  • Decreased quality of work
  • Avoidance of responsibilities

Being confronted with the horrors of other peoples’ experiences can also take a toll on the personal values and beliefs of healthcare workers and individuals in helping professions. Some of the symptoms to watch out for include:

  • Detachment
  • Lack of appreciation
  • Apathy
  • Negative perception
  • Dissatisfaction
  • Loss of interest
  • Hopelessness
  • Low self-image
  • Questioning identity, spirituality, and worldview

The Symptoms of Vicarious Trauma in One’s Personal Life

The symptoms of secondary traumatization don’t go away when a healthcare worker clocks out for the day. Individuals can continue to deal with the troubling impact of frequently engaging with other people’s traumatic experiences in their lives outside of work.

Experiencing Symptoms of Vicarious Trauma

Some of the behavioral symptoms of vicarious trauma include:

  • Hypervigilance
  • Nightmares
  • Sleep disturbances
  • Clumsiness
  • Exaggerated startle response
  • Frequently losing things
  • Changes in appetite
  • Negative coping mechanisms
  • Self-harm behaviors

At the cognitive level, secondary stress disorder can leave healthcare workers dealing with the following symptoms:

  • Trouble concentrating
  • Minimization of their vicarious trauma
  • Racing thoughts
  • Confusion or disorientation
  • Increased self-doubt and lowered self-esteem
  • Loss of interest in activities they previously enjoyed
  • Thoughts of self-harm or harming others
  • Lack of meaning in life

As you might imagine, the toll on one’s emotional health can be extreme. Some of the symptoms to watch out for include:

  • Anxiety
  • Depression
  • Fear
  • Oversensitivity
  • Survivor guilt
  • Powerlessness and helplessness
  • Emotional unpredictability
  • Numbness

A person who is dealing with vicarious trauma will also potentially experience symptoms that impact their relationships with others. Some of the social symptoms include:

  • Distrust
  • Decreased interest in intimacy
  • Intolerance and irritability
  • Loneliness
  • Isolation and withdrawal
  • Change in parenting style to become more protective
  • Projection of rage and blame

The symptoms of vicarious trauma aren’t just emotional, psychological, and behavioral. They can also have a negative impact on a healthcare worker’s physical health. For example, an individual suffering from vicarious trauma might experience any of the following:

  • Rapid heart rate
  • Sweating
  • Dizziness
  • Difficulty breathing
  • Other panic symptoms
  • Weakened immune system
  • Aches and pains

How Can Healthcare Workers Avoid Vicarious Trauma?

If you’re a healthcare worker suffering from vicarious trauma or concerned that you could fall prey to the symptoms if you continue to carry on in your profession in the same capacity, it’s important to recognize that getting help is ok. Individuals with secondary traumatization tend to minimize their experience because the trauma didn’t occur “firsthand.” Just because you weren’t physically present for the initial traumatic experience doesn’t mean your struggle isn’t real.

You can do several things to help reduce the risk of developing vicarious trauma or work to heal secondary traumatization.

Observe Yourself

One of the most important things you can do is to actively work on increasing your self-awareness. Pay attention to yourself. Notice when you’re starting to get stressed and when the signs of burnout or vicarious trauma are starting to appear.

A Doctor Working to Increase Their Self-Awareness

Furthermore, stay tuned into your core beliefs, personal goals, and professional ambitions. Take note when you see that things seem to be shifting. There’s nothing wrong with one’s perspectives evolving over time, but if you notice that things seem to be turning in a dark direction, you might be dealing with negative symptoms of vicarious trauma.

Take Care of Your Emotional and Spiritual Well-Being

Another essential activity is to invest time into your own emotional well-being. You spend so much time every week caring for other people that it can be easy to neglect your own needs. Make the time and take the time to engage in relaxing activities that help reduce your stress levels and keep you emotionally balanced.

Spending Time With Family

There are a number of activities you can engage in to help mitigate the impact of vicarious trauma. For example, meditation and prayer, playing sports, spending time with family, and engaging in creative activities can all support you emotionally and spiritually.

Take Care of Yourself Physically and Mentally

Relatedly, you’ll want to ensure that you are taking good care of yourself physically and mentally. Exercise, healthy eating, hydration, and self-care practices are essential when you work in such a physically and emotionally demanding job.

A Group Therapy Session

Additionally, you might find that finding a therapist you feel comfortable talking to or joining group therapy sessions helps you make sense of your feelings. The emotional and psychological impacts of vicarious trauma can be quite complex, and talking with others and hearing their experiences could be a useful tool as you heal.

Create and Maintain Boundaries

Healthcare workers should also be careful not to take on too much responsibility for the well-being of their patients. Instead, get into the habit of providing them with the tools you can offer that will help them take care of themselves. It isn’t uncommon for individuals dealing with vicarious trauma to become over-involved with their patients emotionally and overextend themselves by trying to do more than their role demands.

These individuals might find that they spend a significant amount of time outside of work preoccupied with the thoughts of their patients and experiencing lingering feelings of rage, sadness, and anger about the trauma of their patients. Some might find that they fantasize about saving their patients from their traumatic situations or visualize the horrific experiences.

A Doctor With a Patient

While some healthcare workers can become too close to patients as a result of vicarious trauma, others can cut patients off and become detached, numb, and distanced. These individuals might try to avoid hearing their clients’ stories.

Either way, it’s important to set up reasonable and healthy boundaries. Creating a realistic understanding of one’s role in a patient’s healing can help you overcome the symptoms of becoming overly attached or distant and avoidant.

Make Changes at Work

Depending on your specific role in the healthcare industry and your employer, the thought of making changes at your work might sound like a pipedream. However, it’s important to recognize that you are not an expendable resource. If your employer is unsupportive when you make reasonable requests that will help you physically, mentally, and emotionally, it might be time to question whether working for this employer is truly sustainable.

For example, you might find that it’s possible to balance your caseload so that you have a mix of patients, not all of whom are the victims of traumatic experiences. This could help give you a bit of breathing room when it comes to secondary exposure to trauma and suffering.

Seeking Social Support From Colleagues

Another useful thing to do at work is to seek social support from colleagues and even set up a buddy system. This is particularly important for healthcare workers who are new to the profession, as it can take time to develop healthy coping mechanisms and boundaries in response to the potential of secondary traumatization.

Take Steps to Balance Your Work and Your Life

It’s all too common for healthcare workers to be overly focused on their work at the expense of other aspects of life. 

This might sound like a tall order if you feel your workplace demands far more than you can give weekly. If you’re working long hours, dealing with an unforgiving commute, and otherwise exhausted when you’re off the clock, the notion of achieving a greater work-life balance can feel like a pie-in-the-sky proposal.

That being said, taking time off when you need to and allowing yourself to rest and recharge is important. Beyond that, let yourself invest in non-work-related hobbies and spend time with the people you love. Allowing yourself to have interests and purposes outside of work can help you keep things in perspective and combat the negative impact of continuously engaging with trauma victims.

A Doctor With a Healthy Work-Life Balance

Depending on your specific role and career path, you might feel that having a healthy work-life balance is simply incompatible with your current profession. It just demands too much of your time and too much of yourself for you to be able to live the life you really want.

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