October 2022|Volume 10, Issue 4 | |
EVIDENCE IN ACTION
A quarterly research brief from the
Center on Trauma and Children
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Traumatic Stress Symptom Expression
Following Indirect Exposure
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Sprang, G., & Steckler, Z. (2022, June 30). Traumatic Stress Symptom Expression Following Indirect Exposure: A Multidisciplinary Investigation. Traumatology. Advance online publication. http://dx.doi.org/10.1037/trm0000386 | |
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In 2013, the American Psychiatric Association expanded the definition of what constitutes a traumatic stressor (Criterion A) in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM–5) to include “indirect exposure to aversive details of the trauma, usually in the course of professional duties” (American Psychiatric Association, 2013, p. 271). This inclusion recognizes the many ways that professionals are exposed to trauma details during their work. These exposures can include repeatedly hearing graphic details of other’s trauma during therapeutic work, child abuse investigations, and other encounters. Indirect exposures such as these have been found to result in 15% to 85% of professionals reporting symptoms of secondary traumatic stress.1-4 It is notable that professionals may have episodic exposures to trauma material that is not repeated or extreme (as noted in Criterion A), yet they still have traumatic stress reactions. Symptom expression has been found to range in severity from mild to extreme across professions with evidence that functional impairment at work may exist even in subthreshold Posttraumatic Stress Disorder (PTSD) cases.3,5
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The Study
This study investigates the ways trauma symptoms subsequent to indirect exposure are expressed and the domain-specific symptoms that predict membership in different diagnostic outcome categories. A multidisciplinary group of 181 professionals was interviewed using the Secondary Traumatic Stress Clinical Algorithm as a guide and the Clinician-Administered PTSD Scale-5 to establish symptom profiles.6,7 Symptoms of intrusive memories, irritability and angry outbursts, problems with concentration, hypervigilance, exaggerated startle response, and reckless or self-destructive behavior were all found in response to secondary trauma exposure in this group. Multinomial logistic regression analysis was also used to assess the relationship between secondary traumatic stress (STS) domains and symptoms, and outcomes with age, sex, age–sex interaction, and profession used as covariates. The analysis suggests that symptoms of intrusion and arousal/reactivity have the strongest effect on all outcomes when all other terms in the model are held constant. Age, sex, and profession predicted membership in various symptomatic categories. The results of the study illustrate how secondary trauma symptoms manifest, the covariates that moderate the professional’s response to indirect trauma and highlight potential areas of focus for intervention.
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STS outcome categories from this study can help identify those cases less likely to spontaneously remit (those with functional impairment), those that can be managed through self-directed action (mild cases without an impact on functioning), and cases where an evidence-based trauma treatment should be applied (subthreshold and threshold cases of PTSD.
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Symptoms of intrusion and arousal may lead to more severe distress if not addressed early and should be considered as important intervention targets.
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Clinical interventions should be considered even for those with subthreshold levels of traumatic stress.
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Establishing a treatment and support network for industry professionals who regularly navigate through trauma is critical to normalizing help seeking for those affected by STS.
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References
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Bride, B. E. (2007). Prevalence of secondary traumatic stress among social workers. Social Work, 52(1), 63–70. https://doi.org/10.1093/sw/52.1.63
- Choi, G. (2011). Organizational impacts on the secondary traumatic stress of social workers assisting family violence or sexual assault survivors. Administration in Social Work, 35(3), 225–242. https://doi.org/10.1080/ 03643107.2011.575333
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Cieslak, R., Anderson, V., Bock, J., Moore, B. A., Peterson, A. L., & Benight, C. C. (2013). Secondary traumatic stress among mental health providers working with the military: Prevalence and its work- and exposure-related correlates. The Journal of Nervous and Mental Disease, 201(11), 917–925. https://doi.org/10.1097/NMD.0000000000000034
- Sprang, G., Craig, C., & Clark, J. (2011). Secondary traumatic stress and burnout in child welfare workers: A comparative analysis of occupational distress across professional groups. Child Welfare, 90(6), 149–168.
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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), 72–81. https://doi.org/10.1037/trm0000180
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Sprang, G., Whitt-Woosley, A., & Eslinger, J. (2021). Diagnostic and Translational Utility of the Secondary Traumatic Stress Clinical Algorithm (STS-CA). Journal of Interpersonal Violence. Advance online publication. https://doi.org/10.1177/08862605211044961
- Weathers, F. W., Bovin, M. J., Lee, D. J., Sloan, D. M., Schnurr, P. P., Kaloupek, D. G., Keane, T. M., & Marx, B. P. (2018). The ClinicianAdministered PTSD Scale for DSM-5 (CAPS-5): Development and initial psychometric evaluation in military veterans. Psychological Assessment, 30(3), 383–395. https://doi.org/10.1037/pas0000486
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