For several years I have been researching stress and the effects of secondary trauma on aid personnel and how to mitigate these. The study is now complete and I would like to summarize key findings here.
Secondary traumatic Stress (STS) is a condition that arises in response to indirect exposure to a traumatic event/s (commonly by hearing a traumatic story experienced by a loved one or a client). Symptoms can be as debilitating as post traumatic stress disorder. STS is increasingly recognized as a grave occupational hazard to aid workers and others who interact with traumatized people for extended period of times.
The strategy most widely used by organizations to reduce STS in aid workers is training. Workshops typically include information about trauma and its affects and a review of strategies for addressing it and are delivered in the format of short, one-off training events (mostly a few hours to a day).
My research studied the impact of such training, by taking “before” and “after” measurements of secondary traumatic stress symptoms of two different groups of caregivers who had taken such training workshops, and also of a third group who received no training and thus served as a control group.
The results raise questions about short, one-off training as a first line of protection against STS among caregivers. Neither of the workshops resulted in a statistically measurable reduction in STS in aid personnel. Despite their involvement in a two or three day workshop, participants reported almost as many symptoms of STS a month after the workshops as the control group who received no training.
Whether further research will substantiate this discouraging finding regarding the impact of training remains to be seen. Due to factors beyond control of the researchers, members of the intervention group, made up mostly of senior professional workers, were exposed to a far higher number of incidents of trauma, on average than the two control groups during the one month period between the baseline (“before”) and the “after” measurements. Possibly, they would have reported more stress had they not had the training workshop.
Nevertheless, these findings underscore how little we know about what really works in preventing and reducing secondary trauma in caregivers, and call into question the assumption that short, one-off training events like the two studied are an adequate answer.
A Positive Note
On the positive side, the data showed that experiential training methods increase retention of content in educating aid workers about stress, trauma and secondary trauma. One control group workshop was largely an oratorical review of information about trauma. The intervention group workshop was purely experiential, using art based approaches to apply psychoeducation and cognitive and bahvioral resolutions. Participants in the intervention workshop displayed markedly higher retention of content two months later than those in the control group.
As a researcher, practitioner, and trainer, I don’t consider these results as invalidating training as a strategy for mitigating STS in caregivers. Rather, I think they point towards training interventions other than the short-term ones that seem to predominate current responses.
A Promising Alternative
While so far I am only able to provide data from a small sample, I am encouraged by results with an alternative model that I began developing during the pilot stage (2013) of the above research. Key features involve 4-6 rounds of input, reflection, and practice over a period of a few weeks while engaging participants deeply and personally, either one-on-one or in very small group sessions that are highly experiential in the learning approach used.
This study has implications for a variety of actors involved in work with individuals and communities affected by trauma. 1. It underscores the need for aid and relief organizations to evaluate the effectiveness of their strategies for reducing STS. 2. It strengthens the case for giving a priority to experiential and expressive methods in trauma therapy training and highlights the need for evaluation of pedagogical methods.
3. The widespread existence of STS among caregivers documented in the study suggests the need for university programs that prepare students for work with trauma survivors to give increased attention to self-care for professionals in managing stress and possible effects of STS as a standard part of their curricula.
4. Human service practitioners, especially aid workers, are encouraged to give more attention to their own on-going education about trauma, cumulative stress, and possible signs of burnout and STS; and to develop an appropriate self-care and stress-management plan before, during, and after deployment to fieldwork.
5. Funders, while understandably preoccupied with the needs of target populations, might recognize in these findings the urgency of care for caregiver and of gaining a better understanding of what actually works in mitigating STS among human services practitioners.
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Abstract of Research:
Existing studies indicate the widespread existence of secondary traumatic stress (STS) in aid personnel and suggest the need for preventive and response strategies. This study examined the effectiveness of an integrated approach to reducing STS among aid personnel through a model that used psychoeducation, psychodrama, and cognitive behavioral resolution techniques.
Data were collected pre- and post-intervention with the Professional Quality of Life Scale (ProQOL) (Stamm, 2009) and at a two-month follow-up (TMFU) for the intervention and control groups. An analysis of variance test was used to evaluate whether the intervention group showed more change on ProQOL scores than did the control groups.
The results were not significant, indicating a small decrease in STS and burnout symptoms and a slight increase in compassion satisfaction. However, results from the TMFU open questionnaire suggested that retention of learning was higher with the intervention group than with the active control group.
This finding challenges the widely held assumption that training is an effective modality of support for aid personnel exposed to trauma and traumatized populations, and underscores the urgent need to conduct evidence-based study of the efficacy of training for STS mitigation. The pilot research the author conducted (Gertel Kraybill, 2013) as antecedent to this dissertation, using the expressive trauma integration (ETI) model in a format of six individual sessions incorporating expressive therapy and psychoeducation, offers a promising alternative to existing STS training.
The reality of increasing natural disasters and conflicts means that the number of aid personnel exposed to traumatized populations is certain to grow, and aid agencies must, as a matter of priority, expand their understanding of what is effective in supporting trauma-exposed staff.
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Reference: Gertel Kraybill, O. (2015). Experiential Training to Address Secondary Traumatic Stress in Aid Personnel. (Doctoral Dissertation). Lesley University, Cambridge, MA.