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PTSD: National Center for PTSD

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Working with Trauma Survivors


Provider Toolkit


Impact of Working with Trauma Survivors

Working with trauma survivors can be enormously rewarding. Providing good care that leads to positive outcomes fosters a sense of accomplishment. Many providers report that they have been inspired by their clients and appreciate the ability to take different perspectives on their own challenges as a result. Providers have noted positive changes in goals or priorities, increased hopefulness, and greater resilience.1,2

As in all professions, workplace stress can impact you. There are a number of research studies that identify unique stress reactions among those who provide trauma care. Burnout, secondary traumatic stress (STS), compassion fatigue (CF), and vicarious traumatization (VT) are some of the terms used to describe the emotional impact that some providers experience when treating those who have experienced traumatic stress.

Provider Experiences

Burnout, STS, CF, and VT are overlapping concepts that can be experienced by providers who work with trauma survivors. Despite differences, the terms are often used interchangeably.15 Click any icon to learn more.
Burnout icon
Secondary Traumatic Stress (STS) icon
Compassion Fatigue (CF) icon
Vicarious Traumatization (VT) icon
Burnout refers to emotional and physical exhaustion resulting from both occupational and personal stressors.3-5 If you are experiencing burnout, you may feel exhausted, cynical, and low in energy. You may be struggling to fully participate or even to stay engaged in your work. More severe burnout can lead people to feel that their personal contributions at work are meaningless or insignificant.
Secondary Traumatic Stress (STS)
STS includes symptoms similar to posttraumatic stress disorder (PTSD) that can occur in providers who frequently listen to trauma histories.6,7 STS symptoms include re-experiencing, avoidance, and hyperarousal. It has cognitive, emotional, and interpersonal aspects as well, including anger, low mood, and social isolation.8 STS can also lead to a reduction in self-efficacy.9
Compassion Fatigue (CF)
CF is broader than STS,10 and it can be experienced by any caregiver who has direct or indirect contact with trauma survivors. CF is characterized by the emotional strain experienced when working with individuals coping with traumatic stress. It also includes more general symptoms of burnout (e.g., emotional exhaustion).10 CF may occur in other professional and caregiving experiences, such as working with the chronically ill.11
Vicarious Traumatization (VT)
VT describes the cognitive, emotional, social, and behavioral changes that may occur while working with traumatized individuals. Providers' views about self, others, and the world may change. In particular, views of trust, safety, control, and esteem may be called into question.12-14
The association between burnout and STS is high, and they are likely to co-occur among those exposed indirectly to trauma through their work.16 Additionally, there is variability in research studies about which best predicts therapist distress, with recent reviews noting that burnout and personal beliefs may have more impact on distress than STS, VT, and CF factors.14,15 In this toolkit:

  • Burnout will be used to define prolonged work stress.
  • STS will be used to describe the PTSD-like symptoms and/or negative changes in belief systems that result from working with trauma survivors.
For more in-depth information on these concepts, please see our free, online course offering continuing education credits: Provider Strategies for Coping with Burnout and Secondary Traumatic Stress.

PTSD Information Voice Mail: (802) 296-6300
Also see: VA Mental Health