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Vicarious trauma in healthcare providers: How to recognize & heal from secondary trauma

With the COVID-19 pandemic nearing its second anniversary, chances are good that you've heard of vicarious trauma at some point. That's because a higher number of healthcare workers have been experiencing it lately. Still, the term may not mean much to you unless you've been through it yourself or know someone who has.

If you work in the healthcare field, it's a good idea to understand the basics so you can be on the lookout for signs of vicarious trauma in your co-workers, loved ones or even yourself.

What is vicarious trauma?

Sometimes what we hear referred to in the media as vicarious trauma is actually direct trauma, according to Shauna Springer, Ph.D., chief psychologist at Stella, an organization that treats trauma patients, including military veterans with post-traumatic stress disorder (PTSD). However, she says that it's important to understand the distinction between the two.

Direct trauma involves any traumatic event that happens to you and affects you directly. For example, a healthcare provider who holds a dying patient's hand because family isn't allowed in the room may experience direct trauma. "Since the emergence of the global pandemic, there have been many cases where healthcare workers have been made to feel helpless or have witnessed scenes of horror," says Dr. Springer. "Direct effects of trauma will often show up over time, even for the hardiest individuals."

Vicarious trauma happens over time and comes from being exposed to other people's direct trauma. It has been pretty difficult for anyone to completely avoid witnessing others' trauma during the pandemic. Healthcare providers are particularly vulnerable to vicarious trauma, especially those who are continually exposed to trauma survivors. Dr. Springer gives the example of mental health providers who specialize in treating trauma. They may experience vicarious trauma as a result of hearing stories about traumatic incidents from their patients. "Because we are wired to connect and mirror each other's emotional states, being steeped in trauma stories can have a cumulative impact over time," Dr. Springer says.

How does vicarious trauma affect healthcare providers?

The answer is complex because the effects are highly dependent on the individual and often evolve over time. It can cause physical symptoms, which we'll go into later. And there's no question that experiencing vicarious trauma changes people's outlook; it's just a matter of how. They might find themselves being grateful for all the positive things in their lives. They may become increasingly fearful or pessimistic. Or maybe they end up somewhere in the middle, in a sort of neutral place. And, since feelings are ever-changing, a person's reaction to vicarious trauma may shift as time goes by, especially if they continue to be exposed to it.1

One of the curveballs the pandemic has thrown at healthcare providers is that they're being reassigned wherever they're needed, potentially to areas that may not be a good fit for their personality, says Dr. Springer.

For instance, physicians who go into emergency medicine have similar wiring to our nation's military, she explains. "Like our warfighters, they are generally capable of remaining calm and focused in chaotic situations. They can work under pressure and do things that many of us can't do." However, highly sensitive, empathetic people may have a harder time working in these conditions and suffer more of an impact from the continual exposure to trauma. This can potentially lead to vicarious trauma for those around them, such as their colleagues and family members.

The severity of and prolonged exposure to these experiences also play a factor in shaping vicarious trauma.

Dr. Springer believes the conditions in many emergency rooms around the country throughout this pandemic have actually been worse than war zone conditions. "ER professionals are exposed to more death and more helplessness than many of our deployed combat medics," she says. "The feeling of chronic helplessness in the face of so many deaths is a serious risk factor for these healthcare workers."

Considering that the pandemic has brought about "the perfect storm of trauma" for healthcare providers, Dr. Springer says that even the strongest, most resilient people are experiencing some sort of impact.

How can you recognize vicarious trauma in yourself, a co-worker or a loved one?

When it comes to co-workers, Dr. Springer says to look for sudden changes in behavior, especially if the person is normally high functioning. "That should be a powerful cue to healthcare leadership to assume a supportive stance – to ask them what they need, or possibly even require that they take some time and space to rest and address the impact of trauma exposure," she says.

With loved ones, it can be a sort of gut feeling, "the instinct that tells you that something has shifted," describes Dr. Springer. She says you may notice signs of vicarious trauma such as:

  • Feeling detached or disconnected
  • Spending long periods of time isolating themselves
  • Losing interest in activities they used to enjoy
  • Displaying a sudden change in behavior
  • Using substances in a problematic way
  • Crying, especially if it's not typical for them

Other possible negative reactions to vicarious trauma include:2

  • Fatigue or having a hard time falling asleep
  • Physical complaints such as headaches, stomachaches and pain
  • Becoming easily distracted
  • Feeling hopeless
  • Avoiding interactions with others
  • Becoming fearful or excessively worried
  • New or increased problems with relationships
  • Increased anger and sadness

If you notice these signs in a loved one or co-worker, talk to them about it. Encourage them to get some time away from their work if this is the source, join a support group or get professional help.

And if you see any of these signs in yourself, it's time to ask the people you love and trust for help. "Acknowledging the personal impact of trauma is always the first step towards healing," says Dr. Springer. While therapy isn't always needed, she says that in some cases it can be extremely helpful in the healing process.

What types of strategies can help in the healing process?

Dr. Springer views the process of healing in a holistic way, in the manner of the biopsychosocial approach. This concept emphasizes that there are not just biological/physical factors involved in a person's health and wellness, but that there are psychological and social factors, too.2 Addressing all three areas is important for deep healing.

Social approach

"The antidote to trauma is safe connection. If I had one core saying to unify the work I do, it's this: When we connect, we survive," Dr. Springer says. She believes it's important for healthcare providers to have thoroughly safe spaces, staffed by trusted healers and peers who understand their pain and can empathize. They need places where they can talk about what they're thinking or feeling without any judgment or having to worry about consequences to their job, places where they can simply sit and decompress.

Biological approach

Trauma actually causes a physical injury, says Dr. Springer, one that you can see in the brain with the right type of scan. The good news? It can be healed. In fact, her organization does just that. The treatment they use is called a stellate ganglion block, or SGB, which has been used for almost a century to treat pain-related conditions, such as shingles, complex regional pain syndrome and phantom limb pain.

The treatment itself is actually quite simple. The healthcare provider injects an anesthetic medication into the stellate ganglion, a bundle of nerves in the neck a few inches above the collarbone; these are the nerves that send the fight or flight response from your brain to the rest of your body. When you experience exposure to trauma, the stellate ganglion may become hyperactivated. But in only a matter of hours after the injection, the numbness wears off and you're left with a sense of calm and well-being.

Long term, SGB helps relieve trauma symptoms such as disrupted sleep, sudden surges of anger, panic attacks, irritability, hypervigilance and concentration difficulties. Amazingly, the effects can last for years. No one knows exactly why it works or how it can last so long, but Dr. Springer says the belief is that by numbing the stellate ganglion, your body has a chance to reset itself back to a calm state.

Since 2006, SGB has been used to treat thousands of military members and it's used as a primary treatment for trauma in some special forces units as well. It's also offered at a number of VA facilities.3 Though Dr. Springer and her team have treated healthcare providers, athletes and C-suite leaders with great outcomes, "relatively few civilians have heard of this treatment," she says. "It's really something people need to see to believe."4 You can find SGB at various specialty clinics around the country.

Psychological approach

Getting SGB without also investing time in talk therapy is like getting knee surgery and not doing physical therapy, says Dr. Springer. In order to maintain the effects of the SGB, it's important to see a therapist, too, so that you can nail down the thoughts, perceptions and behaviors related to the trauma. Talk therapy helps you heal more completely and gives you the best outcome, one that can potentially last for years. "I think it's the fusion of the biological and psychological that really has the power to get these long-lasting outcomes," says Dr. Springer.

What can healthcare providers do to become more resilient to trauma?

"One of the critical insights I've gained from years of working with individuals who face trauma is this: We're ALL resilient, until we're not," says Dr. Springer. "All of us, even the strongest and bravest of us, must recognize that trauma has a cumulative impact."

In other words, the more trauma you experience, the more the effects can pile up. This is true for direct as well as second-hand, or vicarious, trauma.

This is why it's so important to address trauma – even when it's someone else's – when it occurs, before it all catches up with you and turns into a crisis. Letting everything bounce off you when you deal with your own or others' trauma might work for a while, but eventually, it won't, especially because we don't always realize we've experienced trauma in the first place, as Dr. Springer explains.

Healthcare providers are often referred to as heroes, especially these days. But there may be a problem with people thinking of them this way.

"The myth of the 'unbreakable hero' creates a serious barrier to getting support. It creates a false image that some people are above being traumatized by traumatic events," Dr. Springer points out. Just like the warfighters she has worked with, medical professionals are not immune to the impacts of trauma, whether direct or vicarious. "We need to respect these professionals and their valuable skills while seeing them as fully human," she says.

Working in the field of healthcare puts people at high risk for vicarious trauma. If you think you, a loved one or a co-worker may be dealing with the effects of trauma, remember there are resources out there that can make a big difference.





© 2021 McKesson Medical-Surgical Inc.