Understanding the Differences Between Secondary, Vicarious and Direct Trauma

Trauma can occur in various ways, and while many people are familiar with direct trauma, constructs like secondary trauma and vicarious trauma are less widely understood. Indeed, secondary trauma and vicarious trauma are terms that are often used interchangeably, but they have distinct meanings in the context of psychological distress experienced by professionals exposed to traumatic content. All types of trauma affect not just those who experience distressing events firsthand, but also those who are indirectly exposed to the trauma of others. Further, it can have a profound impact on the lives of those around the person impacted by trauma. Understanding the distinctions between these different forms of trauma is crucial for recognising their impact and seeking appropriate support.

Trigger warning: if you become distressed by anything written in this post, please reach out to your support network. Further, if you are experiencing trauma, please consider engaging with your GP and a psychologist to ensure you seek the support you need and can find a way forward: see section below on posttraumatic growth. You are also welcome to book online using the book online button below with our psychologists who understand the impacts of trauma on your mental health and capacity to engage in meaningful activities. 

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Direct Trauma: Firsthand Experience

Direct trauma refers to an individual's personal experience of a traumatic event. This could be a life-threatening situation, witnessing violence, or experiencing natural disasters. The defining feature of direct trauma is that the person is directly involved in the traumatic incident. People who experience direct trauma are at risk of developing post-traumatic stress disorder (PTSD), which may include symptoms such as flashbacks, nightmares, hypervigilance, and emotional numbness (American Psychiatric Association, 2013).

The physical and emotional responses to direct trauma are well-documented, and those affected often need professional support to process their experiences and heal. This type of trauma is the most recognisable because it involves an individual being an actual participant or victim of the traumatic event.
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Secondary Trauma: Emotional Toll of an Indirect Experience

Secondary trauma, also known as secondary traumatic stress (STS), occurs when individuals are indirectly exposed to someone else’s trauma. Often, professionals such as therapists, social workers, first responders, and even transcriptionists who engage with traumatic narratives in their work may develop symptoms similar to PTSD (Figley, 1995). These symptoms include emotional fatigue, anxiety, and a sense of helplessness, even though the individual has not directly experienced the traumatic event.

Secondary trauma can emerge after acute exposure to the traumatic stories or distressing content of others, making it particularly prevalent in helping professions. Unlike direct trauma, where the individual is the subject of the event, secondary trauma results from empathetic engagement and emotional proximity to another person’s suffering.
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Vicarious Trauma: Cumulative Impact Over Time

Vicarious trauma refers to the long-term effects of being repeatedly exposed to the traumatic experiences of others. Unlike secondary trauma, which can result from a single event, vicarious trauma develops cumulatively over time and impacts the person’s cognitive and emotional frameworks (McCann & Pearlman, 1990). Vicarious trauma can lead to significant changes in a person’s worldview, including feelings of mistrust, altered beliefs about safety, and a sense of hopelessness.

For example, mental health professionals or humanitarian workers who consistently engage with the trauma stories of others may slowly internalise the trauma, leading to emotional exhaustion and changes in their perception of the world. While secondary trauma presents more immediate PTSD-like symptoms, vicarious trauma alters a person's long-term belief system and emotional resilience.
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Key Differences Between Secondary,  Vicarious and Direct Trauma

• Direct trauma involves firsthand experience of the traumatic event, leading to immediate emotional and physical responses.
• Secondary trauma emerges from indirect exposure to another person’s trauma, often through listening to their stories or witnessing their pain. It mirrors PTSD symptoms but stems from empathetic engagement rather than personal involvement.
• Vicarious trauma is the gradual, long-term impact of repeated exposure to traumatic content. It causes deeper cognitive shifts, often altering the way an individual perceives themselves, others, and the world.

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Why These Differences Matter

Understanding the distinctions between these types of trauma is crucial, especially for professionals in fields such as healthcare, law enforcement, and counselling, as well as caregivers. Direct trauma is widely recognised and addressed, but secondary and vicarious trauma can go unnoticed, even as they take a toll on mental health.

Recognising the symptoms of secondary and vicarious trauma can lead to better self-care and organisational support for those working with trauma survivors. For example, professionals who frequently deal with traumatic content should have access to supervision, debriefing, and mental health resources to mitigate the effects of secondary and vicarious trauma (Lai & Costello, 2021).
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Promoting Posttraumatic Growth: Support to Move Forward

​While trauma often brings pain and emotional turmoil, and in some cases mental health diagnoses, with the right support people can achieve remarkable transformation known as posttraumatic growth (PTG). Posttraumatic growth refers to the positive psychological changes that occur as a result of struggling with highly challenging life circumstances (Tedeschi & Calhoun, 2004). Rather than simply bouncing back to a pre-trauma state, individuals who experience PTG often report feeling stronger, more resilient, and possessing a deeper appreciation for life.

PTG doesn't mean that the trauma is minimised or forgotten, but that the struggle can lead to personal growth in several areas. These include improved relationships, greater sense of personal strength, a heightened appreciation for life, and sometimes a reevaluation of life goals or spiritual beliefs (Tedeschi & Calhoun, 1996). Research shows that the process of growth often involves deep reflection and making sense of the trauma, which can foster resilience over time (Linley & Joseph, 2004).

It's important to recognize that posttraumatic growth is not universal. It depends on factors like individual coping strategies, support systems, and personality traits. However, with the right environment and support, many people can find meaning and strength in the aftermath of trauma, creating a new sense of purpose and appreciation for life.

Acceptance and Commitment Therapy for Posttraumatic Growth 

Acceptance and Commitment Therapy (ACT) is a modern therapeutic approach that helps individuals cope with trauma by fostering psychological flexibility. Rather than avoiding or suppressing painful memories, ACT encourages individuals to accept their emotions and thoughts, while committing to actions aligned with their values. This acceptance process allows individuals to make room for distressing experiences without letting them dominate their lives (Hayes et al., 2006).

ACT is particularly effective in promoting PTG by helping individuals find meaning in their trauma and move toward a more value-driven life (Follette & Briere, 2016). By accepting emotional pain and focusing on personal growth, individuals can transform their trauma into opportunities for resilience, improved relationships, and a stronger sense of purpose.

ACT has emerged as a promising treatment for individuals with post-traumatic stress disorder (PTSD). ACT focuses on helping individuals accept their traumatic experiences and the accompanying emotions rather than avoiding or attempting to control them. Through mindfulness and cognitive defusion techniques, ACT encourages individuals to observe their thoughts and feelings without becoming overwhelmed by them (Hayes et al., 2006).

Unlike traditional cognitive-behavioral therapies that aim to reduce symptoms by directly challenging negative thoughts, ACT emphasises psychological flexibility. This involves accepting traumatic memories, recognising their presence without judgment, and committing to living in alignment with personal values. Studies show that this approach can be particularly effective in reducing PTSD symptoms, as it allows individuals to focus less on eliminating distress and more on living meaningful lives despite their trauma (Batten & Hayes, 2005).

In a meta-analysis, ACT was found to be effective for PTSD by promoting acceptance, reducing avoidance behaviors, and fostering long-term recovery (Powers et al., 2009). The therapeutic process encourages patients to stop battling their trauma and start building a life based on what truly matters to them, making it a powerful intervention for PTSD.

If you feel you would like to speak with one of our Psychologists in Chermside (North Brisbane) or via Telehealth, please feel free to contact us via phone (07 3707 1090) or email ([email protected]) or book online using the button below. 

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References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).

Batten, S. V., & Hayes, S. C. (2005). Acceptance and Commitment Therapy in the treatment of posttraumatic stress disorder. Behavior Modification, 29(1), 94-129.

Deaton, S. (2023). Promoting vicarious posttraumatic growth: A new approach to trauma exposure. Trauma Informed Care Journal, 12(3), 45-58.

Figley, C. R. (1995). Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized. New York: Brunner-Routledge.

Follette, V. M., & Briere, J. (2016). Mindfulness and acceptance-based interventions in trauma treatment. In V. M. Follette, J. Briere, D. Rozelle, J. Hopper, & D. I. Rome (Eds.), Mindfulness-Oriented Interventions for Trauma: Integrating Contemplative Practices (pp. 47-64). Guilford Press

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2006). Acceptance and Commitment Therapy: An experiential approach to behavior change. Guilford Press.

Lai, M., & Costello, C. (2021). Managing vicarious trauma in professional interpreters: Recommendations for organizations. Interpreter and Translator Trainer, 15(1), 25-42.

Linley, P. A., & Joseph, S. (2004). Positive change following trauma and adversity: A review. Journal of Traumatic Stress, 17(1), 11-21.

McCann, I. L., & Pearlman, L. A. (1990). Vicarious traumatization: A framework for understanding the psychological effects of working with victims. Journal of Traumatic Stress, 3(1), 131-149.

Powers, M. B., Zum Vörde Sive Vörding, M. B., & Emmelkamp, P. M. (2009). Acceptance and Commitment Therapy: A meta-analytic review. Psychotherapy and Psychosomatics, 78(2), 73-80.

Tedeschi, R. G., & Calhoun, L. G. (1996). The posttraumatic growth inventory: Measuring the positive legacy of trauma. Journal of Traumatic Stress, 9(3), 455-471.

Tedeschi, R. G., & Calhoun, L. G. (2004). Posttraumatic growth: Conceptual foundations and empirical evidence. Psychological Inquiry, 15(1), 1-18.