Have you ever felt overwhelmed by the emotional weight of your work? For those in helping professions, managing secondary trauma and distress is a common yet often overlooked challenge. This article explores how certain work experiences can lead to secondary traumatic responses and distress for those in helping and supporting roles. For example, people working in crisis or emergency response, mental health, rehabilitation, and social services with clients with Post Traumatic Stress Disorder, can find themselves outside their window of tolerance. This can impact their ability to cope with and manage the following issues:
Compassion fatigue and burnout;
Moral distress (knowing what the right thing to do is to support clients, but not having the ability to do it effectively); and
Secondary traumatic stress (emotional distress from exposure to first hand trauma experiences of clients).
Trauma Symptoms Following Indirect Exposure
The indirect exposure from some workplace experiences can result in trauma symptoms, functional impairments, and even Post Traumatic Stress Disorder. A person can develop symptoms while continuing to go to work. They can begin to develop functional impairments such as intrusive or ruminating thoughts and beliefs, hyperarousal, and avoidance behaviors.
There are a variety of symptoms that could develop including intrusive thoughts, nightmares, flashbacks, physiological reactions due to thoughts about your clients or customers; avoidance; alterations in cognition and mood (negative emotions, worry, fear); and alterations in arousal and reactivity (hypervigilance, irritability).
These symptoms can develop after several weeks, months, or years. It depends on the unique circumstances of the person and situation. For example, it is quite common for health care and social service professionals, counsellors or therapists, and case managers to develop symptoms. This can occur after listening to and hearing stories while interviewing their clients, or after frequently reading narratives in case progress notes, medical records, and psychiatric or psychological reports.
If you've been doing work for a number of years that involves supporting people with multiple barriers, impairments, limitations, injuries, illness or disease, disabling conditions, or survivors of violence and abuse, then there's a good chance you may encounter risks for secondary trauma response or distress. This is especially true if you have a personal history of lived experience with first hand trauma from adverse childhood experiences or from service in the military, law enforcement, or as an emergency first responder.
Over time, trauma exposure progresses slowly, making it difficult to gauge its effects in real time, especially for those isolated in their roles. Some people may recognize that they start to believe they are not doing enough and constantly needing to do more in their work roles. Their moral, sense of efficacy, and competency can slowly or quickly erode. They may feel hypervigilant and struggle to flow easily between sympathetic and parasympathetic nervous system arousal. There may also be tiredness in their soul or spirit; like something that is felt deep down in the bones.
The Complexity of Occupational Stress
The impacts of occupational and work stress are complex. Why do some people have little or no reaction to indirect exposure of trauma material and others have very strong reactions? Well, this seems to be related to a number of things including the nature of the exposure, their personal risk profile, the socio environmental context, organizational context, co-existing conditions, and protective or response factors. Here is a list of them:
Nature of Exposure
Type of trauma content
Severity of trauma content
Dose of trauma content
Personal Risk Profile
Prior trauma history (activates unresolved trauma issues)
PTSD risk factors (other mental health conditions; parent with mental health or PTSD issues and we learned about coping from them)
Socio Environmental Context
Historical or community trauma
Racism or disproportionality
Social support (lack of support from family and friends)
Social priorities (feeling psychological unsafe and unsupported)
Organizational Context
Type of work
How trauma informed or Secondary Traumatic Stress (STS) informed is the organization?
How does the socio environmental context impact the organization. Are they under attack, criticism, or pressure by other stakeholders?
Co-Existing Conditions
Moral distress
Burnout
General distress
Other health or mental health conditions
Protective and Response Factors (attachment style, PNS & SNS nervous system wiring, coping skills)
Resilience
Intervention utilization
Practice strategies
Window of Tolerance
The window of tolerance is when we are in our comfort zone, emotionally regulated, calm/cool/collected/connected, able to self-regulate, and our sense of danger or threat has not overwhelmed our capacity to cope. Staying in our window of tolerance allows for healthy relationships. When we are outside our window of tolerance, we may be hyper aroused (fight/flight) and feel anger/rage, aggression, overwhelm, outbursts, impulsivity, or rigidity.
Outside our window of tolerance, we may become hypo aroused (freeze), and we may become unavailable, shut down, disconnected, dissociated, separated from self, not present, or with memory loss.
Causes for Moving Outside the Window of Tolerance
There are a number of reasons that may cause us to move outside the window of tolerance. This could include experiencing high doses of indirect exposure to the trauma experience of others we are supporting or working with. It could be from feeling physically or psychologically unsafe due to the exposure to irritability, frustration, anger, rage, aggression, or hostility from others. It could be from repeated loss, threat of loss, or perceived loss of control. And it could also be due to a high exposure to trauma reminders.
Individual Assessment Tools
There are several assessment tools and resources that could be useful for yourself or others. These include the Secondary Trauma Stress Scale, ProQOL-V Burnout Scale, Moral Distress Scale-Revised, and resources at websites like STSInformed.com.
Conclusion: Ways to Address Occupational Stress
Here are some strategies to address occupational stress and help manage its impact:
Self-monitoring of thoughts/beliefs, feelings/emotions/sensations, and actions/behaviors.
Mark boundaries and limitations.
Engage in self-compassion.
Employ cognitive flexibility.
Cultivate a self-other perspective (what is my stuff vs someone else's stuff to carry?).
Express gratitude.
Manage trauma inputs.
Build your support network.
Engage in reflective meaning making.
Be your own story editor.
Enact real time practice strategies.
Seek professional help when needed.
References
Sprang, G. (2023, January 18). Staying Inside Our “Window of Tolerance”: Strategies for
Managing Secondary Trauma and Distress.
https://ktdrr.org/training/webcasts/webcast80/index.html