What is secondary traumatic stress (STS)?

Trauma is the natural emotional reaction to going through a life-threatening or terrifying event. But you can also have a trauma response just by witnessing, or even hearing about, a traumatic event that happened to someone else — even if you weren’t present.

This is called secondary traumatic stress (STS), and it’s very common in certain professions. For example, reports show up to one in four therapists working with traumatized populations and up to 50% of child welfare workers will experience secondary traumatic stress.

STS can be difficult to recognize at first, but by equipping yourself with knowledge, you can take steps to protect yourself from secondary trauma and get the treatment you deserve.

Symptoms of secondary traumatic stress 

STS isn’t listed as its own mental health condition in the Diagnostic and Statistical Manual of Mental Disorders (DSM), the text that mental health professionals use to make diagnoses. 

But some people who experience STS may be diagnosed with post-traumatic stress disorder (PTSD). According to the DSM, witnessing or hearing the details of someone else’s traumatic experience qualifies as an event that may lead to PTSD.

Regardless of how it’s diagnosed, experts agree that the symptoms of secondary traumatic stress mimic those of firsthand PTSD.

These symptoms include:

• Reliving others’ traumatic experiences as if they’re your own: This might include vivid mental imagery of the traumatic stories you’ve heard, intrusive thoughts, or feeling like you’re “in” the event despite not being there.
• Having nightmares related to others’ trauma: You may find that the details of others’ traumatic experiences appear in your dreams. 
• Avoiding reminders of others’ trauma: You might find it difficult to engage with certain work tasks, clients, or even environments that remind you of the stories you’ve been exposed to. This might include no longer wanting to work with the client whose story is traumatic for you.
• Feeling numb or detached from your own life: Secondary trauma can cause a sense of detachment, making it difficult to connect with your own emotions, loved ones, or daily activities.
• Experiencing hypervigilance or heightened startle responses: You might feel overly alert or on edge, constantly scanning for danger even when there’s no immediate threat.
• Having physical symptoms: Secondary trauma can lead to headaches, stomach issues, and other physical symptoms of prolonged emotional distress.

Who’s at risk of vicarious trauma?

Anyone who witnesses or hears the details of a traumatic event can experience secondary trauma. But certain professions are inherently more vulnerable to STS, including:

• Emergency responders
• Social workers
• Nurses
• Therapists
• Journalists
• Veterinarians
• Lawyers
• Teachers
• Clergy
• Military personnel

This doesn’t mean you can’t develop STS if you don’t work in one of these professions, nor does it mean that everyone in these professions will have it. However, because of the nature of these jobs, secondary trauma is often considered an occupational hazard.

How serious is secondary traumatic stress?

When it’s severe enough to be diagnosed, STS can and is diagnosed as PTSD. This includes severe symptoms and requires professional support to heal. 

Not everyone who experiences trauma — whether firsthand or secondhand — will develop PTSD. Some people are able to recover from the effects of the traumatic event on their own. But around 6% of people who experience a traumatic event will develop symptoms of PTSD. Remember that this isn’t a sign of weakness, and researchers are still trying to understand what makes certain people more vulnerable to PTSD.

PTSD is a serious health condition that doesn’t typically go away on its own. When left unaddressed, PTSD, including from secondary traumatic stress, can become increasingly debilitating. It can also raise the risk of other mental health conditions, including depression, anxiety, sleep disorders, and substance use disorder.

Treatment can help you process the traumatic stories that you’re living with and find a way to move forward.

Strategies for preventing secondary trauma

The best way to deal with secondary traumatic stress — especially if you work in a vulnerable profession — is to prevent it from happening in the first place. By educating yourself on secondary trauma, you can implement strategies to prevent yourself from becoming traumatized by others’ stories while still maintaining your empathy and compassion.

• Learn about the signs. Educate yourself on the symptoms of secondary trauma so you can recognize when it’s starting to affect you. The earlier you can identify the warning signs, the sooner you can take steps to address it.
• Ask for help. If you’re experiencing the effects of secondary trauma, don’t hesitate to reach out for support. Whether it’s a trusted friend, a supervisor, or a therapist, talking to someone who understands can make a huge difference.
• Don’t avoid the problem. It may feel tempting to avoid the people, stories, or environments that trigger feelings of secondary trauma. However, research shows that avoidance-based coping only worsens secondary trauma symptoms over time. Instead of avoiding, try to face your emotions head on — ideally with the support of a therapist.  
• Take time away. Regular breaks are essential for managing secondary trauma — especially if you work in a high-stress profession. Even a short vacation or a day off can help you reset and recharge. If that’s not enough, you may consider taking a longer time away from your profession.
• Share with others who understand. Connecting with colleagues or others who’ve experienced similar challenges can help you feel less alone. Sharing your experiences in a supportive environment can be a powerful way to process what you’re going through.
• Practice self-care. Make self-care a priority in your life. This includes getting enough sleep, eating nutritious meals, staying physically active, and setting boundaries to protect your mental health. It may seem simplistic, but it helps.
• Validate your feelings. It’s normal to feel overwhelmed or emotional when dealing with secondary trauma. But many people in helping professions also tend to minimize their own suffering. You might think, “I’m not the one who went through that. What right do I have to feel this way?” Remind yourself that your feelings are valid and you deserve the right support. 
• Find everyday meaning. Finding purpose in your work or experiences can help you cope with secondary trauma. Remind yourself of the positive impact you’re making, even when the work feels difficult. Meaning-making is an important part of moving forward after trauma.

How to treat secondary traumatic stress

STS needs to be treated as seriously as firsthand PTSD — especially when symptoms are more severe or getting in the way of day-to-day functioning. Fortunately, many effective treatment methods can help you process trauma and limit the power it has in your life. 

According to research, some of the most effective interventions for secondary traumatic stress include: 

• Mindfulness-based interventions: Practices like guided mindfulness and meditation have been shown to reduce stress, anxiety, and secondary trauma symptoms.
• Cognitive behavioral therapy: This form of talk therapy addresses unproductive thinking patterns and develops healthier coping mechanisms.
• Emotion regulation training: Focused sessions teach cognitive strategies to manage stress and prevent burnout.
• Guided imagery: This relaxation technique uses mental visualization of calming scenes to reduce stress and anxiety. 
• Aromatherapy: Inhaling essential oils, like lavender, can provide short-term stress relief.
• Peer support and supervision: Regular debriefings with supervisors or peers can help you share experiences and reduce feelings of isolation.
• Stress management training: Psych-educational sessions can help manage trauma exposure and build resilience.
• Compassion fatigue resiliency programs: These programs can increase awareness of secondary trauma and help people develop coping skills.
• Reduction in traumatic exposure: Adjusting workloads or offering role rotations can limit the extent of trauma exposure for each person. 

Find care with Rula

If you’re struggling with STS, you’re not alone. It’s such a common condition that it’s considered an expected occupational hazard for some professions. Trauma can make you feel alone in the world, but there are people who understand what you’re going through and want to help. 

With help from Rula, you can find a therapist who accepts your insurance and specializes in treating trauma and depression. When you’re ready, we can connect you with a mental health professional you can meet with in a convenient online setting as soon as tomorrow.

Find a therapist with Rula