Skip to main content Accessibility help
Hostname: page-component-59b7f5684b-qn7h5 Total loading time: 0.341 Render date: 2022-09-26T14:21:36.770Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "useRatesEcommerce": false, "displayNetworkTab": true, "displayNetworkMapGraph": false, "useSa": true } hasContentIssue true

Vicarious Traumatization: Potential Hazards and Interventions for Disaster and Trauma Workers

Published online by Cambridge University Press:  28 June 2012

Kathleen M. Palm*
Brown Medical School and Butler Hospital, Providence, RI, USA
Melissa A. Polusny
Minneapolis Veterans Administration Medical Center and University of Minnesota Medical School, Minneapolis, MN, USA
Victoria M. Follette
University of Nevada, Reno, Nevada, USA
Addictions Research, Butler Hospital, 345 Blackstone Blvd, Providence, RI 02906USA E-mail:


Disaster and trauma workers often disregard their own reactions and needs when focusing on caring for those directly exposed to traumatic events. This article discusses the concept of vicarious traumatization, a form of post-traumatic stress response sometimes experienced by those who indirectly are exposed to traumatic events. It includes an examination of how vicarious trauma reactions are experienced across different professions, and suggestions on how to limit or prevent vicarious traumatization. The authors review self-care strategies as well as training and organizational considerations that may be beneficial for individuals and organizations to address.

Special Reports
Copyright © World Association for Disaster and Emergency Medicine 2004

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)


1.Schlenger, WE, Caddell, JM, Ebert, L, et al: Psychological reactions to terrorist attacks: Findings from the National Study of Americans' Reactions to September 11. JAMA 2002;288:26842685.CrossRefGoogle ScholarPubMed
2.Schuster, MA, Stein, BD, Jaycox, LH, et al. : A national survey of stress reactions after the September 11, 2001 attacks. N Engl J Med 2001;345:15071512.CrossRefGoogle Scholar
3.Ahern, J, Galea, S, Resnick, H, et al. : Television images and psychological symptoms after the September 11 terrorist attacks. Psychiatry: Interpersonal & Biological Processes 2002;65:289300.CrossRefGoogle ScholarPubMed
4.Pfefferbaum, B, Nixon, SJ, Krug, RS, et al. : Clinical needs assessment of middle and high-school students following the 1995 Oklahoma City bombing. American Journal of Psychiatry 1999;156:10691074.Google ScholarPubMed
5.Pfefferbaum, B, Nixon, SJ, Tivis, RD, et al. : Television exposure in children after a terrorist incident. Psychiatry: Interpersonal & Biological Processes 2001;64:202211.CrossRefGoogle ScholarPubMed
6.Jenkins, SR, Baird, S: Secondary traumatic stress and vicarious trauma: A validational study. Journal of Traumatic Stress 2002;15:423432.CrossRefGoogle ScholarPubMed
7.McCarroll, JE, Ursano, RJ, Wright, KM, et al. : Handling bodies after violent death: Strategies for coping. American Journal of Orthopsychiatry 1993;63:209214.CrossRefGoogle ScholarPubMed
8.Ursano, RJ, Fullerton, CS, Vance, K, et al. : Post-traumatic stress disorder and identification in disaster workers. American Journal of Psychiatry 1999;156:353359.Google ScholarPubMed
9.McCann, L, Pearlman, LA: Vicarious traumatization: A framework for understanding the psychological effects of working with victims. Journal of Traumatic Stress 1990;3:131149.CrossRefGoogle Scholar
10.Janoff-Bulman, R: Shattered assumptions: Towards a New Psychology of Trauma. New York: Free Press, 1992.Google Scholar
11.Figley, CR: Compassion Fatigue as Secondary Traumatic Stress Disorder: An Overview. In: Figley, CR (ed), Compassion Fatigue: Coping with Secondary Traumatic Stress Disorder in Those Who Treat the Traumatized: New York: Brunner/Mazel, 1995.Google Scholar
12.Sabin-Farrell, R, Turpin, G: Vicarious traumatization: Implications for the mental health of health workers? Clinical Psychology Review 2003;23:449480.CrossRefGoogle ScholarPubMed
13.Pearlman, LA, Saakvitne, KW: Trauma and the Therapist: Countertransference and Vicarious Traumatization in Psychotherapy with Incest Survivors. New York: Norton, 1995.Google Scholar
14.Durakovic-Belko, E, Kulenovic, A, Dapic, R: Determinants of post-traumatic adjustment in adolescents from Sarajevo who experienced war. Journal of Clinical Psychology 2003;59:2740.CrossRefGoogle ScholarPubMed
15.Follette, VM: Survivors of Child Sexual Abuse: Treatment Using a Contextual Analysis. In: Hayes, SC, Jacobson, NS, Follette, VM, Dougher, MJ (eds), Acceptance and Change: Content and Context in Psychotherapy. Reno, Nevada: Context Press, 1994, pp 255268.Google Scholar
16.North, CS, Tivis, L, McMillen, JC, et al. : Psychiatric disorders in rescue workers after the Oklahoma City bombing. American Journal of Psychiatry 2002;159:857859.CrossRefGoogle ScholarPubMed
17.Baird, S, Jenkins, SR: Vicarious traumatization, secondary traumatic stress, and burnout in sexual assault and domestic violence agency volunteer and paid staff. Violence and Victims 2003;18:7186.CrossRefGoogle Scholar
18.Brady, JL, Guy, JD, Poelstra, PL, et al. : Vicarious traumatization, spirituality, and the treatment of sexual abuse survivors: A national survey of women psychotherapists. Professional Psychology: Research and Practice 1999;30:386393.CrossRefGoogle Scholar
19.Kassam-Adams, N: The Risks of Treating Sexual Trauma: Stress and Secondary Trauma in Psychotherapists. In: Stamm, BH (ed), Secondary Traumatic Stress: Self-care Issues for Clinicians, Researchers, and Educators. Lutherville, Maryland: Sidran Press, 1995.Google Scholar
20.Schauben, LJ, Frazier, PA: Vicarious trauma: The effects on female counselors of working with sexual violence survivors. Psychology of Women Quarterly 1995;19:4954.CrossRefGoogle Scholar
21.Eidelson, RJ, D'Alessio, GR, Eidelson, JI: The impact of September 11 on psychologists. Professional Psychology: Research and Practice 2003;34:144150.CrossRefGoogle Scholar
22.Pearlman, LA, Mac Ian, PS: Vicarious traumatization: An empirical study of the effects of trauma work on trauma therapists. Professional Psychology: Research and Practice 1995;26:558565.CrossRefGoogle Scholar
23.Tucker, P, Pfefferbaum, B, Doughty, DE, et al. : Body handlers after terrorism in Oklahoma City: Predictors of posttraumatic stress and other symptoms. American Journal of Orthopsychiatry 2002;72:469475.CrossRefGoogle ScholarPubMed
24.Clohessy, S, Ehlers, A: PTSD symptoms, responses to intrusive memories and coping in ambulance service workers. British Journal of Clinical Psychology 1999;38:251265.CrossRefGoogle ScholarPubMed
25.Van der Ploeg, E, Kleber, RJ: Acute and chronic job stressors among ambulance personnel: Predictors of health symptoms. Occup Environ Med 2003;60:i40–i46.CrossRefGoogle ScholarPubMed
26.Simpson, R, Boggs, J: An exploratory study of traumatic stress among newspaper journalists. Journalism and Communication Monographs 1999;Spring:124.Google Scholar
27.Feinstein, A, Owen, J, Blair, N: A hazardous profession: War, journalists, and psychopathology. American Journal of Psychiatry 2002;159:15701575.CrossRefGoogle ScholarPubMed
28.Pyevich, CM, Newman, E, Daleiden, E: The relationship among cognitive schemas, job-related traumatic exposure, and post-traumatic stress disorder in journalists. Journal of Traumatic Stress 2003;16:325328.CrossRefGoogle ScholarPubMed
29.Long, N, Chamberlain, K, Vincent, C: Effect of the Gulf War on reactivation of adverse combat-related memories in Vietnam veterans. Journal of Clinical Psychology 1994;50:138144.3.0.CO;2-T>CrossRefGoogle ScholarPubMed
30.Kirmayer, LJ: Confusion of the Senses: Implications of Ethnocultural Variations in Somatoform and Dissociative Disorders for PTSD. In: Marsella, AJ, Friedman, MJ (eds), Ethnocultural Aspects of Post-traumatic Stress Disorder: Issues, Research, and Clinical Applications. Washington, DC: American Psychological Association, 1996, pp 131163.CrossRefGoogle Scholar
31.Clay, R: Tapping their own resilience. APA Monitor on Psychology 2001;32:3637.Google Scholar
32.Pearlman, LA, Saakvitne, KW: Treating Therapists With Vicarious Traumatization and Secondary Traumatic Stress Disorders. In: Figley, CR (ed), Compassion Fatigue: Coping with Secondary Traumatic Stress Disorder in Those Who Treat the Traumatized. New York:Brunner/Mazel, 1995.Google Scholar
33.Martell, CR, Addis, ME, Jacobson, NS: Depression in Context: Strategies for Guided Action. New York: WW Norton, 2001.Google Scholar
34.Mulick, P, Naugle, A: Behavioral activation in the treatment of comorbid PTSD and major depression. Paper presented at the annual meeting of the Association for the Advancement of Behavior Therapy, Reno, Nevada, 2002.Google Scholar
35.Shakespeare-Finch, J, Smith, S, Obst, P: Trauma, coping resources, and family functioning in emergency services personnel: A comparative study. Work & Stress 2002;16:275282.CrossRefGoogle Scholar
36.Polusny, MA, Follette, VM: Long-term correlates of child sexual abuse: Theory and review of the empirical literature. Applied and Preventive Psychology 1995;4:143166.CrossRefGoogle Scholar
37.Hayes, SC, Strosahl, KD, Wilson, KG: Acceptance and Commitment Therapy: An Experiential Approach to Behavior Change. New York:Guilford Press, 1999.Google Scholar
38.Silver, RC, Holman, EA, McIntosh, DN, et al. : Nationwide longitudinal study of psychological responses to September 11. JAMA 2002;288:12351244.CrossRefGoogle ScholarPubMed
39.Palm, KM, Smith, AA, Follette, VM: Trauma therapy and therapist self-care. Behavior Therapist 2002;25:4042.Google Scholar
40.Follette, VM, Batten, SV: The role of emotion in psychotherapy supervision: A contextual behavioral analysis. Cognitive and Behavioral Practice 2000;7:306312.CrossRefGoogle Scholar
41.Litz, B, Gray, M, Bryant, R, et al. : Early intervention for trauma: Current status and future directions. Clinical Psychology: Science and Practice 2002;9:112134.Google Scholar
42.Follette, VM, Polusny, MM, Milbeck, K: Mental health and law enforcement professionals: Trauma history, psychological symptoms, and impact of providing services to sexual abuse survivors. Professional Psychology: Research and Practice 1994;25:275282.CrossRefGoogle Scholar
Cited by

Save article to Kindle

To save this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the or variations. ‘’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Vicarious Traumatization: Potential Hazards and Interventions for Disaster and Trauma Workers
Available formats

Save article to Dropbox

To save this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Dropbox account. Find out more about saving content to Dropbox.

Vicarious Traumatization: Potential Hazards and Interventions for Disaster and Trauma Workers
Available formats

Save article to Google Drive

To save this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account. Find out more about saving content to Google Drive.

Vicarious Traumatization: Potential Hazards and Interventions for Disaster and Trauma Workers
Available formats

Reply to: Submit a response

Please enter your response.

Your details

Please enter a valid email address.

Conflicting interests

Do you have any conflicting interests? *