Skip to main content

Vicarious trauma

Many professionals, often on the front line of human suffering, may experience what is known as "vicarious trauma" (VT). There is growing concern about the impact of VT on professionals who frequently work with individuals suffering from trauma.

This phenomenon, also known as vicarious or vicarious trauma, initially stems from the profound changes observed in mental health professionals as they develop empathic relationships with their patients. Although early studies on the subject focused primarily on therapists in contact with victims of traumatic events, understanding of vicarious trauma has gradually broadened to include a more diverse range of professionals providing support to individuals who have experienced trauma.

View the complete PDF file

Definition

With the 2013 DSM-5 update, criterion A.4 for post-traumatic stress disorder was expanded to explicitly include "repeated or extreme exposure to horrific details of a traumatic event" as a trigger. This provision is particularly applicable to first responders, such as firefighters and emergency medical personnel, who are directly confronted with scenes of extreme violence. It is important to note that such exposure, when it occurs through visual media such as television, films or photographs, is also considered a direct PTSD trigger, but only in a professional context.

What is vicarious trauma?

Vicarious trauma, although linked to exposure to suffering, does not result from direct exposure to the physical elements of the event, but from empathic engagement with the stories of people who have directly experienced the events. For example, police officers who repeatedly listen to detailed accounts of child sexual abuse are exposed to vicarious trauma. Similarly, magistrates at the November 13, 2015 trial were exposed to direct PTSD through their examination of images and films of the attacks, and to vicarious trauma through the many traumatic accounts presented on the stand.

Numerous situations identified

According to the website of theOffice for Victims of Crime (OVC), a state institution attached to the US Department of Justice, this exposure to the trauma of others in a professional context can occur in a variety of situations "such as listening to victim testimonies, when viewing videos showing exploited children, reviewing case files, listening to or dealing with the aftermath of violence and other traumatic events on a daily basis, as well as responding to incidents of mass violence that have resulted in numerous injuries and deaths".

A change in worldview

One of the consequences of vicarious trauma, as Professor Adelaïde Blavier explains, is the change that leads the professional to adopt a worldview perceived as less just, eroding a certain hope in his or her profession and, more broadly, in the world around him or her. As we shall see, this transformation, transcending mere emotional reactions and exhaustion, clearly differentiates vicarious trauma from concepts often used interchangeably.

The word of a professional

An examining magistrate explains the situations in which she is regularly exposed to traumatic stories.

Some of the cases I deal with (organized crime, drug trafficking, etc.) are less psychologically demanding than others, where a person's integrity is at stake, as in the case of sexual violence, for example. In such cases, reading the files becomes emotionally more difficult.

ZOOM

Carole Damiani, Doctor of Psychology, General Secretary of the Association de langue française des études du stress et du trauma (ALFEST), and Director of Paris Aide aux Victimes, criticizes the widespread use of the term "vicarious trauma" to describe the experiences of professionals confronted with trauma narratives. In her view, a distinction needs to be made between being exposed to a trauma narrative and experiencing a traumatic event oneself:

Find out more

The term "trauma" is confusing. Talking about trauma for people who weren't there when the events took place is a misuse of the term. If we call everything a trauma, we're bound to implement the same care, or even the same standardized protocols, even though the situations and psychological issues are different. We need to refine our clinical analysis to grasp the major differences beneath the apparent clinical similarities. For example, "One of the most common symptoms of trauma is traumatic repetition, which is sensory in nature [...] on the other hand, professionals exposed to traumatic stories have not heard or seen the facts (editor's note: unlike classic trauma), they imagine them, they have ruminations, but no frightening sensations [...] It's not the same mechanism at all, so we're not going to treat it in the same way."

Terms often confused

The need to clearly distinguish vicarious traumatization from related concepts such as compassion fatigue, secondary traumatization and burnout is crucial to ensuring adequate care for the professionals concerned. These concepts, used to designate forms of work-related stress, although sometimes used interchangeably, describe distinct phenomena with specific implications for the well-being of professionals.

Beyond burnout

Burnout and vicarious trauma, although frequently confused, are two distinct occupational reactions. The 11th revision of the International Classification of Diseases (ICD-11) recognizes burnout as an occupational phenomenon, not a disease, resulting from unresolved chronic occupational stress, manifested by three main symptoms: intense fatigue, cynicism or detachment from one's job, and diminished performance. This type of reaction typically develops under the impact of prolonged workloads and unrealistic job expectations (WHO, 2019).

The symptoms of burnout, including depression, exhaustion and cynical behavior towards patients, are often the result of excessive professional pressure and a lack of recognition of the efforts made by the professional.

Although the manifestations of burnout differ from the reactions of vicarious trauma, which stem from empathic engagement with the traumatic experiences of those helped, these two types of reaction can nevertheless coexist among professionals in sectors such as healthcare and emergency services.

 

Also distinct from compassion fatigue

First introduced by Joinson in 1992, compassion fatigue (CF) describes the weakening of professional capacities following exposure to the suffering of others, manifested by symptoms such as fatigue, emotional exhaustion and a sense of isolation. Despite Joinson's initial proposal to define CF as a specific type of burnout in the helping professions, this idea has not been empirically corroborated.

Figley then recontextualized compassion fatigue in 1995 as a state of exhaustion and dysfunction resulting from prolonged exposure to compassion stress, presenting it as a less stigmatizing alternative to secondary trauma (see inset "secondary trauma"), focused on the emotional repercussions of the trauma experienced by others. Unlike vicarious trauma, which arises from repeated engagement with the traumatic stories of others, compassion fatigue is more the result of wear and tear, the long-term emotional exhaustion of the professional.

 

"Secondary trauma?

Often confused with compassion fatigue, secondary trauma (ST) is characterized by post-traumatic stress symptoms resulting from indirect exposure to victims' traumas, as distinct from classic PTSD, which occurs following a direct traumatic experience. Jenkins and Baird (2002) note that TS is a natural reaction to traumatic content encountered by mental health professionals. In comparison, compassion fatigue encompasses more general emotional exhaustion and burnout, exacerbated by prolonged empathic engagement with suffering people, without the specific symptoms of traumatic re-experiencing seen in TS.

What are the known reactions?

Research on the subject, particularly in the field of mental health, highlights a variety of reactions among professionals exposed to hearing traumatic stories.

Thus, repeated exposure could alter therapists' cognitive and behavioral patterns and induce a variety of reactions such as sadness, anger or fear, preoccupation with thoughts about patients outside work, and physical symptoms such as fatigue or nausea.

Although many professionals do not develop significant distress, a significant proportion may experience symptoms reminiscent of PTSD.

Vicarious trauma, tspt symptom chart

Trigger mechanisms identified?

Whether among social workers, lawyers or mental health professionals, vicarious trauma insinuates itself "insidiously" into the professional, says psychology professor Adelaïde Blavier.

The ambivalent role of empathy

At the heart of this process, empathy - the ability to deeply understand the emotional and cognitive state of others - plays a dual role. While empathy is indispensable in the helping relationship, prolonged and intense exposure to the suffering of others can erode certain limits that are necessary for the professional's well-being, making him or her too permeable to the traumas of the people encountered in the course of his or her work.

In some cases, the professional will identify more closely with the victims, especially when the latter's discourse shares common characteristics with that of the professional's life, thus accentuating the risk of vicarious trauma.

 

The word of a professional

An educator specializing in working with women who have been victims of violence talks about how some stories leave more of an impression on her than others:

Hearing women's stories of the sexual violence they suffered in their home countries has a kind of mirror effect, which makes us take the story all the more to heart.

 

In her book "Maintaining my vitality as a caregiver", Pascale Brillon, a professor in the psychology department at the Université de Québec à Montréal and a specialist in post-traumatic stress disorder, proposes a grouping of explanatory models into five major conceptualizations:

Find out more

The weight of "emotional overload
Emotional overload describes the cumulative weight of distress absorbed by professionals. This model, supported by Figley's work, highlights how repeated exposure to traumatic stories can erode caregivers' emotional boundaries, leading to compassion fatigue. Brillon stresses the importance of maintaining an empathic posture while avoiding the trap of excessive sympathy, which can undermine the necessary professional distance. Sympathy" should not be confused with "empathy", says Pascale Brillon: "Unlike empathy, a sympathetic stance is a sign of excessive commitment to the person being helped. Sympathy hinders the helping relationship and makes us vulnerable to vicarious trauma or compassion fatigue".

This professional vulnerability is also accompanied by an involuntary physical response: the phenomenon of body mimicry. Involving the activity of mirror neurons, their involvement was discussed in 2006; in the context of Rothschild & Rand's discoveries. These authors illustrate how professionals can, without being aware of it, absorb their patients' distress through physical and emotional imitation, underlining the need for awareness and strategies to manage these subtle effects.

Influence of "fear structures" on professional sensitivity
Exploring how professionals can integrate their patients' fear structures, this model builds on the work of Foa, Steketee, & Rothbaum. It reveals that constant exposure to traumatic narratives can lead the professional to react hypersensitively to stimuli associated with patients' traumatic experiences, requiring vigilance and active management of these influences.

Confronting core beliefs and moral wounds
This conceptualization addresses the disruption of personal beliefs in the face of trauma exposure. It reveals how professionals can be shaken in their fundamental beliefs about life, human nature and justice, leading to heightened vulnerability to vicarious trauma and requiring reflective work and psychological support.

The crucial importance of self-care strategies
Highlighting the neglect of self-care practices among professionals, this model links back to earlier work that criticizes a professional culture often focused on self-sacrifice. This work supports the need to balance dedication to others with attention to oneself as a central pillar in preventing vicarious trauma.

The combination of disruptive events and vulnerability
Based on numerous studies, this fifth conceptualization presented by Pascale Brillon examines how a disruptive event, in combination with accumulated risk factors, can make helping professionals vulnerable. These triggering events, such as a conflict with a patient or a patient's suicide, occur against a backdrop of pre-existing stress and vulnerabilities, influencing the professional's reaction. Pre- and post-event conditions, including the professional's psychological and physical state, as well as personality traits and experienced stresses, thus play a crucial role in managing the event, and can either reduce or exacerbate its impact.

 

"The constructivist-self development theory

According to McCann & Pearlman's (1990) founding theory of vicarious trauma, our understanding of ourselves, others and the world is shaped by cognitive structures or schemas, which filter and interpret our experiences. In the context of vicarious trauma, repeated exposure to traumatic material can challenge these fundamental schemas, causing distress when new traumatic information does not fit into our pre-existing beliefs. To adapt, individuals must then modify their cognitive schemas through a process of accommodation, often in a negative way, reflecting the deleterious impact of vicarious trauma on the professional's worldview. This transformation of schemas can cause significant distress, leading to heightened awareness of information that reinforces these new, negatively modified perspectives.

Are there any intervention strategies?

The management of vicarious trauma requires specifically designed, evidence-based approaches. As such, the systematic review conducted by Kim and colleagues analyzes over 1,315 publications, selecting 27 relevant studies that illustrate current interventions, categorized into four main types:

Find out more

Although revealing a diversity of interventions, this recent analysis highlights the shortcomings of current research, which struggles to precisely define vicarious trauma and specifically target its consequences. Current approaches are often too generalist, focusing primarily on the overall management of stress rather than on the particularities of vicarious traumatization.

Consequently, the authors recommend adapting interventions to the specific features of different health and social service establishments, as well as to the individual characteristics of professionals. In addition, it would be necessary to develop preventive strategies within organizations to better prevent the emergence of vicarious trauma.

  • Psychoeducation: programs to make professionals aware of TV symptoms and provide tools for managing them.
  • Mindfulness: techniques such as meditation and yoga, designed to reduce stress and improve emotional management.
  • Artistic and recreational activities: using creativity to help express and manage stress and emotions.
  • Alternative therapies: approaches such as acupuncture and Reiki, mentioned but to be used with caution, due to still limited evidence of their specific efficacy for TV.
Vicarious trauma - thematic dossier

Outlook: the role of organizations and avenues for future research

Recent studies have highlighted the influence of organizational factors on the risk of vicarious trauma, going beyond the previous consideration of individual factors such as personal history of trauma or the professional's level of empathy. Thus, some authors emphasize that organizations have a key role to play in preventing and managing worker well-being, notably through the quality of supervision and support policies.

Need for long-term studies

Although significant progress has been made in the understanding and recognition of traumatic risks among professionals, further advances are needed to identify precisely the organizational aspects necessary for their prevention and mitigation. Adopting a public health approach would be relevant, notably by encouraging longitudinal studies that explore how organizational cultures that support the well-being of professionals and value their work can reduce the prevalence of vicarious trauma.

 

Developing supportive cultures

As such, future research should look in detail at the implementation and impact of programs such as ongoing supervision, stress management training, and the development of organizational cultures that foster mutual support. The aim being to create working environments where professionals are not only supported and valued, but where risks to their mental health can be reduced.

 

The word of a professional

A director of a reception and care facility for adolescents explains the procedures put in place to ensure effective management of suicidal crises and violence, while taking care to protect professionals:

Training plays a crucial role, enabling professionals to feel competent and to limit their interventions to their area of expertise, thus avoiding task-shifting and undue responsibility. We have drawn up a facility project to precisely define everyone's missions, covering all teenage-related themes from screening to guidance, to ensure that each function is clearly delineated and actions well directed.

 

The sources for this dossier are available in the pdf document at the top of the page.

View the complete PDF file
Go to main content