Secondary traumatic stress is emotional distress from indirect exposure to someone else’s trauma. It can create PTSD-like symptoms, including intrusive thoughts, avoidance, and anxiety.
Healthcare workers, therapists, first responders, and family members of trauma survivors are most vulnerable to secondary traumatic stress. People may experience nightmares, flashbacks, and emotional numbing after repeated exposure to others’ traumatic experiences. Westwind Recovery®® offers specialized mental health treatment programs to assist individuals navigating these difficulties.
Understanding what secondary traumatic stress is and how it connects to PTSD matters because the DSM-5 recognizes indirect exposure to traumatic details as a valid PTSD stressor. When the full symptom pattern develops, indirect exposure can still meet PTSD criteria. Westwind Recovery®® offers specialized mental health treatment programs to assist individuals navigating these difficulties, which some clinicians describe as “secondary PTSD.”
What Is Secondary Traumatic Stress?
What is secondary traumatic stress in clinical terms? It’s a condition that develops when learning about someone else’s trauma causes a stress response in your own body and mind. Psychology professor Charles Figley defined this condition in 1995, describing it as the cost of caring for those who suffer. The DSM-5 recognizes indirect exposure to traumatic details as a criterion A stressor for PTSD, placing secondary traumatic stress within trauma and stressor-related disorders.
Unlike primary trauma, the person doesn’t directly experience the traumatic event. Exposure can occur through hearing narratives, witnessing others’ reactions, or viewing trauma-related images. Even with indirect exposure, the psychological impact can be severe.
Often, we hear of professionals experiencing burnout, especially among high-stress jobs such as emergency responders and medical professionals. When people ask how secondary PTSD compares to burnout, the difference is the trigger. Burnout comes from workload pressure, long hours, and low control at work. Secondary traumatic stress develops from exposure to traumatic content about other people’s experiences, even when the workload feels manageable.
Compassion fatigue is emotional exhaustion from caregiving and empathy demands. In contrast, secondary traumatic stress is a PTSD-like reaction tied to specific traumatic material, such as an assault narrative or a medical crisis. Compassion fatigue can feel more global, while secondary traumatic stress often has clear reminders and triggers.
Vicarious trauma involves longer-term changes in worldview and trust after cumulative exposure. Secondary traumatic stress is often more immediate and symptom-focused, like nightmares or avoidance after one disturbing case. Vicarious trauma builds gradually and can reshape beliefs about safety, people, and the future.
| Concept | Definition | Source of Exposure | Main Symptoms
|
| Primary Trauma | Direct experience of a traumatic event | Personal experience | PTSD symptoms |
| Secondary Traumatic Stress | Indirect exposure to trauma through others | Hearing, seeing, supporting | PTSD-like symptoms |
| Burnout | General occupational stress and exhaustion | Workload, lack of support | Fatigue, cynicism |
| Compassion Fatigue | Emotional exhaustion from caregiving demands | Empathy overload | Reduced empathy, exhaustion |
| Vicarious Trauma | Long-term changes in worldview and beliefs | Cumulative indirect trauma | Altered beliefs, cynicism |
What are the Symptoms of Secondary Traumatic Stress?
What is secondary traumatic stress likely to look like day to day? Its symptoms closely match PTSD symptoms and often fall into three clusters aligned with DSM-5 criteria. The Secondary Traumatic Stress Scale (STSS) is commonly used to assess these symptoms. Severity can range from mild distress to clear impairment.
- Intrusion Symptoms: Intrusion symptoms are unwanted re-experiencing of others’ trauma that disrupts daily life. This can include flashbacks, nightmares, and intrusive thoughts.
- Avoidance Symptoms: Avoidance means trying to stay away from trauma reminders, which can affect work and relationships. This might look like avoiding specific clients, numbing emotions, and avoiding certain activities.
- Hyperarousal Symptoms: Hyperarousal means a heightened stress response and constant alertness, even without a real threat. This causes sleep disturbances, irritability, hypervigilance, difficulty concentrating, and an increased startle response.
Secondary traumatic stress can also contribute to depression and anxiety disorders. STS can occur alongside dissociation, which is a sense of disconnection from thoughts or surroundings. Some people start using alcohol or drugs to quiet intrusive thoughts or fall asleep, which can increase risk for a substance use disorder.
Work performance can decline as symptoms worsen. Professionals may feel less job satisfaction, more absences, and thoughts of leaving the field. Emotional availability with clients or family can also decrease.
What are Risk Factors of Developing Secondary Traumatic Stress?
Secondary traumatic stress tends to develop when personal vulnerability and high trauma exposure overlap. Multiple risk factors can combine and increase the chance of symptoms, including:
Professional Risk Factors
Workplace conditions strongly affect whether secondary traumatic stress develops. While secondary stress is common in high-stakes professions, such as medical professionals, social workers, and first responders, anyone can develop this condition if their work environment involves:
- High caseloads: Many trauma cases reduce recovery time between exposures.
- Lack of supervision: Limited support leaves workers without a place to process material.
- Inadequate training: Less preparation can increase shock, guilt, or fear reactions.
- Organizational stress: Low staffing and poor systems increase overall strain.
Personal Risk Factors
Individual characteristics affect vulnerability beyond workplace factors. It’s possible to experience secondary stress that stems outside of the workplace. For example, if a traumatic event happens to a friend, learning about this experience can cause secondary traumatic stress. Typically, the following factors can impact an individual’s risk of this condition:
- High empathy levels: Strong emotional attunement can intensify “carrying” another person’s pain.
- Limited support systems: Less outside support can make decompression harder.
- Personal trauma history: Past trauma can reactivate with similar stories.
Some may be able to compartmentalize their stressful encounters, while others cannot. If you or a loved one are struggling with your mental health, consider treatment right away.
Treatment and Prevention of Secondary Traumatic Stress
Many people respond well to evidence-based approaches used for PTSD, combined with practical exposure-management strategies. Early identification can reduce severity and shorten how long symptoms last.
Therapy for Secondary Traumatic Stress
Therapy is one of the most effective treatments for STS. Trauma-focused methods often target the “stuck points” that form after repeated exposure to distressing details. Approaches can include cognitive processing therapy (CPT), Cognitive Behavioral Therapy (CBT), and EMDR (Eye Movement Desensitization and Reprocessing), which uses bilateral stimulation while processing memory networks.
Common therapy steps include:
- Symptom mapping: With a therapist, patients identify triggers like specific stories, shifts, or case notes.
- Thought testing: A therapist can help with checking beliefs such as “I can’t keep people safe.”
- Body regulation: Practicing grounding skills when intrusive images or panic start can help ease anxiety.
Group therapy can provide peer support with others who understand secondary trauma exposure. Medication management may also be part of care when anxiety, insomnia, or depression interferes with daily functioning.
Prevention Strategies for Secondary Traumatic Stress
Secondary traumatic stress prevention centers on reducing the intensity and frequency of exposure, while building recovery time after exposure. Regular supervision can provide a structured place to process cases, reactions, and boundaries.
Practical prevention strategies often include:
- Workload shaping: Mixing higher-trauma cases with lower-intensity tasks when possible.
- Boundary routines: Using rituals, such as a brief walk or guided breathing, can help manage anxiety in day-to-day life.
- Media limits: Reducing extra trauma exposure from news, videos, or graphic content can help decrease stress.
- Early warning tracking: Noticing signs like nightmares, irritability, or emotional numbing can help ensure the symptoms don’t persist unchecked.
What Does Recovery from Secondary Traumatic Stress Look Like?
Recovery often means fewer intrusive thoughts, improved sleep, and a return of emotional range without feeling flooded. Many people improve with trauma-informed care that includes both processing and daily regulation skills.
Evidence-based interventions include trauma therapy, cognitive processing strategies, and stress-management skills. Reconnection goals can include returning to social activities, improving focus at work, and rebuilding trust in relationships. Over time, many people report less hyperarousal, less avoidance, and steadier empathy.
Westwind Recovery®® can help you recover from stress disorders with our outpatient programs. Contact our admissions team today to start your path to recovery.
Frequently Asked Questions about Secondary Traumatic Stress
Explore these FAQs to learn more about secondary traumatic stress.
Secondary traumatic stress symptoms can persist for months or years without treatment. With appropriate intervention, symptoms often improve within several months, depending on severity and exposure level.
Yes, secondary traumatic stress can increase alcohol or drug use as a coping strategy, especially for insomnia and intrusive thoughts. Risk tends to rise when symptoms remain unaddressed, and support is limited.
Many insurance plans cover care when symptoms meet criteria for PTSD or another recognized mental health condition. Coverage depends on diagnosis, plan rules, and level of care. Our admissions team can help you verify your insurance and understand your coverage.
A conversation with a supervisor often requires documentation from a licensed clinician. Coordinate with your therapist to create a plan to discuss specific accommodations, such as adjusted caseloads or added supervision, with your employer.
Yes, family members can develop symptoms through repeated exposure to a loved one’s trauma story or distress reactions. This can happen in partners, parents, and caregivers.
Yes, secondary traumatic stress can start after one intense exposure, such as hearing a detailed assault disclosure or responding to a fatal accident scene. Risk increases when the story feels vivid and personal.
Clinicians often use a clinical interview plus tools like the STSS, which measures PTSD-like symptoms tied to indirect exposure. Diagnosis focuses on symptom severity, duration, and functional impact.
Dr. Deena is the Chief Clinical Officer of Westwind Recovery®, an award-winning outpatient treatment center in Los Angeles where she oversees the clinical and administrative program and treatment methods. Dr. Deena is a doctor of psychology and licensed clinical social worker since 1993. LCSW #20628. Originally from the East Coast, Dr. Deena has worked running treatment centers, worked as a therapist in psychiatric hospitals as well as school settings and currently has a thriving private practice in the LA area. Dr. Deena has appeared regularly on the Dr. Phil Show as an expert since 2003. She has also been featured on many other TV shows, podcasts and has contributed to written publications as well as podcasts.
