Vicarious Trauma

May 30, 2019

Written by: Jennifer B. Hughes, PhD
Sad woman speaking to her therapist while she is taking notesAt times, it can feel nearly impossible to find the motivation to keep showing up to work week after week, especially after working long hours or dealing with crises and looming deadlines. As health care professionals, we may often feel overwhelmed with caring for patients who have experienced violence, pain, and trauma. Over time, this can dramatically alter the way we perceive and understand ourselves, others, and the world. The clinical term for this phenomena is vicarious trauma (VT).

What is Vicarious Trauma?
Vicarious trauma (VT) occurs when there is a change in a health care professional’s physical and emotional functioning after working with patients who have experienced stressful or traumatic events. Trauma can be defined as a deeply distressing event that one directly witnesses or hears about. Potentially traumatic events include natural disasters, interpersonal violence, traumatic injury, war, divorce, and childhood abuse.

Signs and Symptoms of VT
Some of the most common signs and symptoms of VT fall under these 5 categories:

  1. Cognitive: Intrusive thoughts, sounds or images about the trauma an individual has been exposed to; difficulty concentrating; constantly thinking about survivors outside of work; becoming more cynical or negative in one’s thinking patterns.
  2. Physiological: Ulcers, headaches, chronic pain, stomach aches, sweating, or racing heart when reminded of a trauma
  3. Spiritual: Loss of hope; perceiving others as bad or evil; losing sight of the good in humanity; difficulty trusting our own beliefs
  4. Behavioral: Hair-trigger temper; isolation; using unhelpful coping strategies to manage difficult emotions (drinking, substance use, gambling); need to control everything and everyone
  5. Emotional: Losing touch with one’s own self-worth; isolating from loved ones; feeling overwhelmed or emotionally restricted

Is VT the same as burnout?
VT, burnout, and compassion fatigue are all closely related but different occurrences. VT occurs as a result of working with survivors of trauma. Compassion fatigue, which also occurs in the health care field, is a general sense of fatigue, frustration, and dissatisfaction in one’s work. Burnout develops when VT and/or compassion fatigue are not addressed and turn into a state of chronic stress. This can lead to physical and emotional exhaustion, cynicism, detachment, feelings of worthlessness, and high rates of employee turnover. While none of these is a diagnosis, each can lead to the development of depression, anxiety, or other mental and physical problems. Although the symptoms are similar, burnout is generally not rooted in trauma exposure.

Does everyone experience VT?
VT is a natural result of being an empathic human, especially for those who work with survivors of traumatic events. Those most commonly impacted by VT include behavioral health care professionals – such as social workers, psychologists, and psychiatrists – case managers, doctors, nurses, and first responders. Although VT may be unavoidable, it can be addressed and managed.

The first step is knowing whether you are suffering from VT. The Professional Quality of Life Scale can help you assess whether and how much you are suffering from VT, compassion fatigue, and burnout. Once you know your scores, you can begin to see opportunities for overcoming VT. The Professional Quality of Life Scale can help you assess whether and how much you are suffering from VT, compassion fatigue, and burnout. Once you know your scores, you can again begin to see opportunities for overcoming VT.

How does VT impact my life?
VT is an ongoing process that slowly builds over time. It generally begins to impact us in three different areas:

  1. Identity: VT changes the way we see and define ourselves.
  2. Worldview: VT skews our perceptions of others (e.g. everyone is bad) and changes how we interact with those around us.
  3. Spirituality: VT can replace feelings of hope with cynicism and despair.

So now that we have the language to define the symptoms we are experiencing, what can we do about it?

Thankfully there is an answer for this and it can be broken down into three phases:

Anticipate and Protect, Address and Transform

  1. Anticipate and Protect: Arrange things ahead of time to anticipate the stress of your work and its impact on you.
    • Become aware of VT and start to look out for signs and symptoms. Intentionally plan for a healthy balance between your work life and personal life.
    • Find a support system, particularly amongst colleagues who share this language and can support you as needed.
  2. Address: How you take care of yourself in and out of work
    • Engage in self-care: Attending to yourself physically, spiritually, emotionally, and psychologically
    • Self-nurture: Engaging in activities or things that provide comfort, relaxation, and play
    • Escape: Getting away, whether literally or mentally
  3. Transform: Transform the negative aspects of this work into positive connection and meaning
    • Create meaning: Find ways to hold onto your values and identity even in the face of trauma
    • Infuse current activities with new meaning through mindfulness and connection to others
    • Challenge negative beliefs: Actively challenge negative thoughts or cynicism; re-frame your thinking

Additional VT Resources:

Vicarious TraumaMindfulness
Provider Resilience
Insight Timer
What About You: A Workbook for Those Who Work With Others
Mindfulness for Beginners
A Mindfulness Based Stress Reduction Workbook
Full Catastrophe Living
The Vicarious Trauma Toolkit

While VT is very common in the work that we do, we have the tools to effectively address and manage symptoms. This is an ongoing process that changes at different stages of our careers. Therefore, it is a process we must continuously be engaged in. Both individually and collaboratively, begin to identify the signs of VT in your own life and use the template above to make a plan for how to begin addressing and counteracting these symptoms. Remember, you are not alone with your VT and do not have to manage it alone either.

Jennifer B. Hughes, PhD, is an assistant professor in the Department of Psychiatry and Behavioral Sciences at McGovern Medical School. She is a licensed clinical psychologist. Her research interests include the assessment and treatment of PTSD in adults, children and infants, trauma-focused interventions following traumatic injury and the use of virtual reality to treat PTSD.