secondary trauma

Secondary Trauma: What It Is, Who It Affects And How To Cope, According To Experts

Posted on by James Miller

James was the mental health expert for this Forbes article.

By Meaghan Harmon -Editor
Fact Checked Sarah Davis Editor
Published: May 8, 2023, 3:20pm
Originally published on Forbes Health

Many people in the U.S. may find themselves grappling with feelings of anxiety, grief and fear as a recent string of tragic and violent events unfolded over the course of just one week across the country. Such events included a mass shooting at an Allen, Texas outlet mall, killing eight individuals (and wounding seven others), marking it as the second-deadliest shooting in the U.S. in 2023, according to the Gun Violence Archive.

Violent and traumatic events, such as school shootings and episodes of gun violence, are common in the U.S., and the aforementioned organization reports 14,798 gun-related deaths thus far in 2023 at the time of publication, as well as 202 mass shootings[1]. Media outlets (including local and national news stations), as well as social media platforms, widely and repeatedly broadcast these events, which can contribute to a phenomenon known as secondary, or vicarious, trauma.

Secondary trauma can affect anyone, though certain demographic groups and people in certain professions are more susceptible. Continue reading to learn more about what vicarious trauma is, its symptoms and ways to not only cope, but also prevent its potentially debilitating repercussions.

What Is Secondary Trauma?

“Secondary trauma is a type of trauma that’s caused by indirectly experiencing a traumatic event (typically by hearing details or witnessing the outcome of a traumatic experience),” says Sabrina Romanoff, Psy.D., a licensed clinical psychologist based in New York City and member of the Forbes Health Advisory Board. She explains that the term was first coined about 30 years ago to explain symptoms of post-traumatic stress disorder (PTSD) in treatment providers, such as first-responders, physicians and therapists, who had not had experiences of first-hand trauma themselves.

“Simply speaking, a traumatic experience is anything where your life or the life of someone you love is in danger,” adds Jeff Temple, Ph.D., a licensed psychologist and member of the Forbes Health Advisory Board. “So secondary trauma can occur when you treat (in the case of a health care professional) or talk to people who have had these [traumatic] experiences.”

Some examples of recent events and situations that may lead to secondary trauma include psychologists treating child survivors of a school shooting or catastrophic natural disasters, such as the earthquakes in Turkey and tornadoes throughout the southern U.S. states, he adds.

Causes of Secondary Trauma

“Frequent exposure to other people’s trauma is the main driver of secondary trauma,” says Dr. Romanoff, adding that this exposure can include:

  • Witnessing graphic injuries
  • Seeing people in emotional distress
  • Viewing physical harm to others
  • Listening to unnerving stories and first-hand accounts

Along with news stations, Dr. Romanoff adds that sharing stories on social media is a way some people share their personal experiences and disseminate information, too.

The frequency and amount of details you witness of a traumatic event are also factors in the development of secondary trauma. Watching the news constantly or following the events on social media—including reading personal accounts—can increase the risk of developing secondary trauma, says Dr. Temple.

“Sometimes you’re just watching the TV and there’s a news bulletin,” adds London-based Nova Reid, an antiracist educator, TED speaker, former mental health care worker and author of The Good Ally (whose work often requires her to witness other peoples’ trauma). “And I find that more disarming because I’m just trying to relax and live my best life and suddenly [these traumatic events] just come to you, and that’s hard.”

Symptoms of Secondary Trauma

The symptoms of secondary trauma range from mild, such as uneasiness, to severe, such as those of PTSD. According to Dr. Temple, they may involve:

  • Constantly imagining or reliving traumatic events
  • Having nightmares
  • Having overwhelming feelings of guilt and irritability
  • Having difficulty concentrating
  • Being hypervigilant, which is when an individual is constantly on guard against a threat or danger

“The severity of this vicarious trauma, as well as the context surrounding it, may depend on how close someone is [to the traumatic event],” he adds. “For example, a parent of a child who survived a school shooting can experience direct trauma and secondary trauma. They may relive the experience from the child’s perspective or relive the morning they dropped their child off, perhaps wishing they had done something different.”

Christian Totty, an Afro-Indigenous artist, community acupuncturist and mother to a 4-year-old who resides in Ohio shares that she’e experienced this type of trauma in response to recent traumatic events, such as the Nashville school shooting in March 2023.

“The primary emotion that comes up for me is grief,” says Totty. “There is fear present, too, and this goes beyond the common concerns that many parents and caretakers [normally] experience.” The axis between grief and fear has led to restlessness, sleepless nights, an inability to focus, as well as a sympathetic nervous system arousal, she adds.

Indeed, secondary trauma can have a significant impact on a person’s ability to function normally, says Dr. Romanoff. This includes being able to perform work-related duties, as well as tasks at home.

“What you’ll typically find are a lot of negative coping skills that come out when people are overly charged with secondary trauma,” adds James Miller, a licensed psychotherapist based in Reston, Virginia who specializes in trauma and mood disorders and is the host of Lifeology Radio. “An individual’s ability to cope can become increasingly debilitated, leading to symptoms such as overreactions and an inability to problem solve.” Miller adds that everyone has different triggers when it comes to secondary trauma, and its effects can last from just a few hours or days to weeks or months.

Furthermore, research suggests prolonged periods of heightened stress due to secondary trauma can take a physical toll, ranging from sleep disturbances to gastrointestinal effects.

“Trauma impacts every single system in our body,” says Reid, whose work often exposes her to personal stories of trauma. “If something stressful happens to me, I will always have some sort of manifestation that’s physical,” she adds.

In fact, in 2020, Reid says she experienced clear physical repercussions—specifically hair loss—from heightened secondary trauma following viewing footage and images of the murder of George Floyd.

“[My hair falling out] was a physical response to not just secondary trauma, but also historical trauma when people from a specific cultural group have a shared history of harm and social suffering,” she explains.

Who Can Experience Secondary Trauma?

While anyone can experience secondary trauma, certain groups of people and individuals in certain professions may be at a higher risk.

People who have a significant history of exposure to trauma, such as first responders, nurses, therapists and even people who watch TV frequently, or individuals who are survivors of traumatic events in the past, are more susceptible to secondary trauma, says Dr. Romanoff. The higher prevalence of vicarious trauma among these groups is due to the fact that the secondary trauma acts as trigger for a prior, potentially unprocessed, event, she adds.

Women and people with more empathic natures may also be more likely to experience secondary trauma, adds Dr. Temple, in addition to the following groups.

BIPOC and Marginalized Communities

“Because of the every day and systemic racism and discrimination that marginalized communities face, they [can be] more likely to be exposed to traumatic events, and thus potentially more susceptible to experiencing secondary trauma, since we know that prior personal trauma predisposes individuals to secondary trauma,” says Dr. Temple.

Secondary trauma is likely to be prevalent in marginalized groups because people within these groups are often witnessing traumatic events occur to people who look like or identify similarly to them, says Deborah Courtney, Ph.D., a licensed therapist in New York City and a member of the Forbes Health Advisory Board. Examples of this might include recent incidents of Black men being beaten by police officers leading to secondary trauma among Black men or shootings at gay nightclubs leading to secondary trauma in members of the LGBTQ community.

“There’s typically an inner thought of ‘that could have been me’ or ‘that could have been my child,’ she adds.

For example, Totty, who is a member of the Afro-Indigenous community, explains that hypervigilance is a common feeling for her. “It has been passed on through generational trauma, both racial and ecological,” she says. “Due to the hyperactivity within the media that allows for constant access to information, the sensations [of nervous system arousal] are heightened and prolonged.”

First Responders and Emergency Health Workers

First responders are at a high risk of experiencing secondary trauma, so they may struggle to be present and perform the duties of their jobs effectively if they’ve experienced vicarious trauma, says Dr. Romanoff. “Many [first responders] will adapt through desensitization to the disturbing stories and emotional distress they witness. These coping strategies tend to generalize to their lives outside of work and lead to consequences in their relationships and [their] ability to function with friends and family,” she adds.

For example, more than 45% of frontline health care workers during the COVID-19 pandemic—and more than 67% of health care workers exposed to patients’ deaths—displayed symptoms of moderate to severe secondary trauma, according to a 2021 study in the International Journal of Environmental Research and Public Health[2].

Mental Health Care Professionals

Mental health care providers are constantly exposed to varying degrees of vicarious trauma due to the nature of their work.

Miller, who specializes in treating individuals who have been through trauma, recalls a moment when he came to terms with experiencing burnout as a result of secondary trauma. “I was reading paperwork about what could have been a very traumatic experience to read,” he explains. “I really should have been affected by it, but I wasn’t. And although I didn’t have a term for it then, I learned I was experiencing compassion fatigue.”

Secondary Trauma Treatments and Coping Mechanisms

Therapeutic techniques, such as eye movement desensitization and reprocessing (EMDR) somatic experiencing, trauma-focused cognitive behavioral therapy (CBT), as well as trauma-informed yoga and mindfulness are among the strategies Dr. Courtney and other experts recommend for individuals who may be experiencing the symptoms of secondary trauma. She also recommends getting out into nature, creating space for joyful activities, journaling, meditating and deep breathing.

“Breathwork is the practice I continue to return to as a way to reconnect with my body and move through emotions that arise—whether someone else’s or my own,” says Totty. “The breath is so powerful, and [it’s] a wonderful ally when dealing with trauma.”

Dr. Temple recommends leaning on natural coping mechanisms, which may include hanging out with friends, exercising, playing video games or anything that makes an individual feel better.

For Reid, these natural coping mechanisms include writing. “Trauma causes confusion, and one of the things that reduces confusion is writing down what’s happened to us so there’s a visual record of it [and] we don’t end up gaslighting ourselves” she says. “Naming what’s happening to us also reduces that confusion because you’re able to recognize it. And if you’re able to recognize it, then you can start to process what’s going on and address it.”

Vocalizing a traumatic moment as it happens is also an important grounding technique utilized by both Reid and Miller to address secondary trauma in the moment.

“I also find naming what’s going on is helpful,” says Reid. “[I’ll say] ‘I’m having a trauma response right now,’ or ‘I’m feeling shame,’ or ‘My hands are sweating and my heart is racing’— just naming what’s going on so I don’t feel so out of control.’”

“I’ll speak aloud,” adds Miller. “I’ll say, ‘James, stop.’ When I speak aloud it puts a slight interruption in my thought process, and I am able to ground myself.”

Secondary Trauma Prevention Techniques

Experts agree that in addition to having coping mechanisms in place during an acute episode of trauma, prevention is key when it comes to effectively addressing compassion fatigue and secondary trauma in the long term.

“Nowadays, there’s more need for implementing self care and coping mechanism training,” says Miller. In a professional environment, this might look like debriefing all staff members after a traumatic event and implementing on-site services, such as trauma therapy, he adds.

Regarding exposure to violence and trauma via the news or social media, Miller recommends considering three factors: Time (such as a time limit to how long you’ll watch the news or be on social media), place (watching traumatic events at home may lead to feeling unsafe at home)  and emotional availability. He advises conducting an internal scan prior to exposing yourself to potentially triggering or traumatic images to determine if you are grounded and mindful.

“There are things we can do to manage what we are consuming,” adds Reid. She recommends altering settings on social media platforms, such as Twitter, to hinder video auto-plays, thus giving people more control over the content they see. Reid also says she takes sabbaticals and social media breaks during which time she disconnects from the media as much as possible.

“I can’t emphasize enough that if you are experiencing secondary trauma, there is nothing wrong with you,” says Dr. Courtney. “It speaks to the fact that you are an empathetic human being whose brain and body are reacting appropriately to devastating traumatic experiences.”

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