What is Vicarious Trauma?

Vicarious trauma, also known as secondary trauma, is a psychological phenomenon that occurs when individuals, typically caregivers, therapists, or professionals in helping roles, are indirectly exposed to the traumatic experiences of others. Unlike direct trauma, which involves personal firsthand experiences, vicarious trauma stems from empathetic engagement with trauma survivors.

Over time, consistently hearing or witnessing the stories and suffering of trauma survivors can have a profound emotional and psychological impact. People in proximity to this pain may begin to internalise the trauma, experiencing symptoms similar to those of direct trauma, including flashbacks, nightmares, heightened anxiety, and emotional numbness. This can lead to burnout, increased stress, and a sense of emotional exhaustion.

Vicarious trauma (VT) highlights the interconnectedness of human empathy and the importance of self-care and professional support for those regularly exposed to trauma. It is crucial for individuals in caregiving roles to recognize and address VT to maintain their own well-being and continue providing effective support to those they support.

Causes of Vicarious Trauma

Vicarious trauma occurs in a variety of settings and refers to the transformation of a person’s inner experience resulting from deeply engaging with a client’s traumatic material. This involves an empathic connection to another person’s trauma, being a helpless witness to past events or reenactments, and evoking feelings of helplessness.

Personal History 

Research indicates a strong link between a clinician’s own trauma history and the development of symptoms. Additionally, research suggests that insecure attachment styles can contribute to secondary traumatic stress among professionals. Other risk factors for VT include professional inexperience and inadequate supervision.

Mirroring Mechanism

Research also suggests that our understanding of others’ thoughts and emotions may involve simulating similar mental states within ourselves. This process engages mirror neurons, a brain area that activates not only when we perform an action or feel an emotion but also when we observe someone else doing the same.1 This mirroring mechanism may shed light on the cause of, potentially explaining why professionals can exhibit symptoms similar to their clients.

The Amygdala

The amygdala plays a critical role in fear activation, transmitting signals to the hypothalamus triggering neuroendocrine and autonomic responses. In the context of therapy and medicine, this system may become overwhelmed, leading to instinctive rather than cognitive responses. An overactive amygdala is known to be related to hyperarousal symptoms, common in those experiencing VT. 

The Autonomic Nervous System

The autonomic nervous system (ANS) is composed of the sympathetic nervous system (SNS) and parasympathetic nervous system (PNS). The SNS is activated during trauma material processing, possibly resulting in short-term symptoms and fight-or-flight responses. Conversely, the PNS may cause a freeze response, contributing to detachment and superficial engagement, which is common in VT. 

The Hippocampus

The hippocampus, essential for processing explicit memory and transferring information, can be affected by stress hormones, potentially interfering with memory functioning. Trauma therapists often report experiencing visual imagery of a client’s traumatic experiences, possibly due to altered memory processing. 

Attachment

Attachment strongly influences affect regulation and trauma processing. Early caregiver interactions shape brain development, impacting socioemotional function. Professionals’ attachment styles can affect how they manage others’ trauma, with secure attachments correlating with fewer symptoms. Attachment style also influences how clinicians seek support from colleagues and supervisors to cope with the negative impacts of . For example, a person with an avoidant attachment style might tend to withdraw to a private space, being less likely to seek assistance from coworkers or supervisors when overwhelmed.

Symptoms and Signs

People respond differently to this, altering their perspectives and emotions. Reactions can be negative, neutral, or positive, evolving and varying individually, particularly with prolonged exposure. The impact often extends to their worldview, influencing how they perceive themselves, others, and the world around them. This transformative effect can manifest in various ways.

For some,  it might lead to a heightened sense of cynicism or fearfulness. The exposure to distressing events through indirect experiences, such as through the stories of others or media, can erode their trust in humanity or their belief in a just and safe world. This can result in a more cautious and guarded outlook on life.

Others may undergo a shift towards increased appreciation for what they have.  can serve as a stark reminder of the fragility of life and the preciousness of everyday moments. This realisation can cultivate gratitude and a deeper understanding of the value of relationships, health, and stability.

Responses to VT exist along a spectrum, encompassing a range of emotions and perspectives. Some individuals may experience a mixture of both negative and positive reactions, evolving and fluctuating over time. Additionally, the duration and intensity of exposure to vicarious trauma can significantly influence these responses, making it a unique and individualised experience for each person.

Emotional Numbing: Feeling detached and experiencing reduced emotional response due to exposure to trauma, leading to decreased empathy.

Chronic Fatigue: Suffering from prolonged exhaustion and tiredness stemming from the emotional and psychological strain caused by VT.

Intrusive Thoughts and Images: Distressing and unwanted mental imagery or thoughts related to the traumatic experiences, interfering with daily focus and causing anxiety.

Avoidance Behaviours: Actively steering away from reminders of trauma, such as avoiding conversations or situations that may trigger distressing emotions or memories.

Difficulty Sleeping or Nightmares: Disrupted sleep patterns, including insomnia and recurrent distressing dreams, often related to the traumatic content experienced indirectly.

Social Isolation: Withdrawing from social interactions and distancing oneself from others due to difficulty in relating to people or feeling disconnected after VT exposure.

Mood Swings: Experiencing rapid and intense mood shifts, swinging between highs and lows, impacting emotional stability and interpersonal relationships.

Difficulty Concentrating: Struggling to focus, make decisions, or think clearly due to intrusive thoughts or emotional distress caused by VT, affecting overall productivity.

Sense of Helplessness: Feeling overwhelmed and believing one is powerless to make a positive impact or effect change after being exposed to VT.

Psychosomatic Symptoms: Physical symptoms, such as headaches, muscle tension, or gastrointestinal issues, that have no clear medical cause but arise from the psychological impact of VT.

Ways to Cope and Mitigate Vicarious Trauma

For those working in helping professions, regular proximity to suffering, violence, trauma, and pain can be challenging and lonely. In many cases, such as therapy, the job requires absolute confidentiality, making the therapist unable to release the traumatic stress they have held with their client in the way that other professionals might discuss challenges with co-workers or clients. For others, such as paramedics, the events and scenes they witness may simply be too distressing and graphic to share over a cup of tea with a partner or friend, as those in other professions might, sharing the burden of work stress with others and experiencing the support and catharsis that can come from such processes.

At an organisational or social level, reducing systemic stressors like workload and challenging cases is crucial. Support structures like critical incident debriefing, employee assistance programs, and opportunities for professional growth can significantly help mitigate VT and secondary traumatic stress. 

At an individual level, it’s vital to monitor and care for oneself through proper diet, rest, and exercise. Setting clear professional and personal boundaries is essential, along with recognising and charting your signs of stress and VT, and accessing evidence-based treatments for VT such as CBT, EMDR, and narrative exposure therapy (NET).

Endnotes

1. Rasmussen, B. and Bliss, S. (2014) ‘Beneath the Surface: An Exploration of Neurobiological Alterations in Therapists Working With Trauma’, Smith College studies in social work, 84(2-3), pp. 332–349. Available at: https://doi.org/10.1080/00377317.2014.923714.
2. https://www.bma.org.uk/advice-and-support/your-wellbeing/vicarious-trauma/vicarious-trauma-signs-and-strategies-for-coping