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ANNOTATED BIBLIOGRAPHY on SECONDARY TRAUMA

(Prepared by the OSAC Human Factors Committee)

Andersen, J. P., Papazoglou, K., Gustafsberg, H., Collins, P., & Arnetz, B. (2016). Mental Preparedness 

Training. FBI Law Enforcement Bulletin, 1. 

This article featured on the online Law Enforcement Bulletin, provided by the FBI Training 

Division. The article states that incident response among law enforcement personnel can incur 

psychological and physiological costs, and thus recommend that law enforcement agencies 

incorporate mental preparedness training into their tactical training. Such training should provide 

an overview of physiological and mental elements of resilience and should also cover practical 

techniques that can be utilized before and during incident exposure. The authors suggest that 

appropriate mental preparedness techniques include controlled breathing, visualization, and 

developing positive mental focus. Such techniques, coupled with instruction on physiological 

response to stress (e.g., activation of ‘fight or flight’ response), may assist officers respond 

effectively in high-stress situations. The authors suggest that mental preparedness training is 

suitable for operational officers, but also other law enforcement personnel such as crime scene 

investigators and dispatchers.

Arnetz, B. B., Nevedal, D. C., Lumley, M. A., Backman, L., & Lublin, A. (2009). Trauma resilience 

training for police: Psychophysiological and performance effects. Journal of Police and Criminal 

Psychology, 24(1), 1-9.

This article does not specifically discuss indirect trauma exposure, but was included in the present 

literature review for providing a prospective solution for cultivating resilience among police 

officers. The authors begin in discussing the significance of job-related trauma exposure among 

police officers and provide an overview of the onset of PTSD among officers. They suggest the 

cost of trauma exposure among officers requires a development of a prevention intervention to 

assist officers respond optimally to stressful and traumatic events. In a randomized trial, 18 

officers participated in a critical incident simulation, where some officers received additional 

training in imagery training, while others received no additional training. Imagery training 

involved psychoeducational instruction, engagement in relaxation methods, and an exercise in 

which officers visualized work stressors and mentally rehearsed optimal responses, followed by 

cognitive and behavioral skills training. The researchers found that officers that engaged in the 

intervention experienced less negative mood and less heart rate reactivity following the stressful 

simulation.
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Cieslak, R., Shoji, K., Douglas, A., Melville, E., Luszczynska, A., & Benight, C. C. (2014). A metaanalysis of the relationship between job burnout and secondary traumatic stress among workers 

with indirect exposure to trauma. Psychological Services, 11(1), 75.

In this meta-analysis analyzing data of 8,256 workers who experienced secondary traumatic stress 

as part of their occupation, researchers found there was high correlation between job burnout and 

secondary traumatic stress, indicating that those who experienced secondary traumatic stress are 

likely to experience similar levels of job burnout. Studies under the “compassion fatigue” 

framework showed a significantly higher correlation between secondary traumatic stress and job 

burnout. Job burnout is characterized as “exhaustion, cynicism, and inefficacy,” while secondary 

posttraumatic stress is cited as having symptoms that parallel PTSD, including re-experiencing of 

traumatic material, increased physical arousal, and avoidance of trauma triggers (p. 76). The 

workers included in the meta-analysis were not specific to any one occupation. The literature cited 

job burnout and secondary traumatic stress mental health providers, soldiers, and human services 

workers more broadly.

Edelmann, R. J. (2010). Exposure to child abuse images as part of one’s work: possible psychological 

implications. Journal of Forensic Psychiatry & Psychology, 21(4), 481–489.

This article reviews literature that may inform the psychological implications of seeing child abuse 

images as part of one’s work in computer forensics. The author states such exposure can occur 

among police officers, but may include workers more broadly in organizations combating child 

pornography. As part of this line of work, professionals must categorize images based on content 

for sentencing of offenses. The author suggests exposure to such images can incite vicarious 

traumatization. The author cites literature that refers to psychological costs of trauma among 

various occupational groups, including police officers and emergency responders, to draw 

conclusions about the potential psychological costs of exposure to child abuse images. However, 

the author states there are no extant studies that analyze this topic specifically, and suggests “the 

need for an evidence base to inform counseling provision in this area is overdue” (p. 488).

Hensel J.M., Ruiz C., Finney C., Dewa C.S. (2015). Meta-analysis of risk factors for secondary traumatic 

stress in therapeutic work with trauma victims. Journal of Traumatic Stress, 28, 83-91.

Jarero, I., Amaya, C., Givaudan, M., & Miranda, A. (2013). EMDR individual protocol for 

paraprofessional use: A randomized controlled trial with first responders. Journal of EMDR 

Practice and Research, 7(2), 55-64.

Eye Movement Desensitization and Reprocessing (EMDR) is a psychotherapeutic treatment 

approach that considers “dysfunctional stored memories” as the basis of psychopathology (p. 57). 

The EMDR for professional use in acute trauma situations (EMDR-PROPARA) is an adapted tool 

to teach paraprofessionals how to provide EMDR training in acute trauma contexts. Specifically, 

EMDR-PROPARA involves: gathering demographic information; inquiring about the critical 

incident; assessing emotional, physical, and symptoms; self-soothing techniques; traumatic 

memory processing, self-belief enhancement; body scan; and provision of stress management 

information. In a randomized controlled trial with first responders, the researchers found that first 

responders receiving EMDR-PROPARA treatment showed significant decrease in the Short PTSD 
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Rating Interview following a 3-month follow-up (when compared to a general supportive 

counseling intervention). This article does not deal with indirect trauma exposure specifically but 

does offer a potential intervention among one of the target populations of interest (i.e., first 

responders).

Kerig P.K. (2018). Enhancing resilience among providers of trauma-informed care: A curriculum for 

protection against secondary traumatic stress among non-mental health professionals. Journal of 

Aggression, Maltreatement & Trauma. https://doi.org/10.1080/10926771.2018.1468373

Lee, J. H., Lee, D., Kim, J., Jeon, K., & Sim, M. (2017). Duty-Related Trauma Exposure and 

Posttraumatic Stress Symptoms in Professional Firefighters. Journal of Traumatic Stress, 30(2), 

133.

In this recent article, the authors state that most extant research on trauma among rescue workers 

focuses on PTSD after workers have directly experienced a traumatic event, but that little research 

has evaluated the impact of exposure to potentially traumatic events (PTE) and indirect trauma 

exposure among this group. The authors state there is comparable PTSD prevalence among rescue 

workers who experience indirect trauma versus those who experienced direct trauma (4.6% vs. 

6.4%, respectively; Zimering, Gulliver, Knight, Munroe & Keane, 2006; as referenced by Lee et 

al, 2017). To explore the multi-dimensionality of trauma exposure, the researchers assessed 

associations between PTE exposure (measured via a list of 17 traumatic event types) and 

posttraumatic stress symptoms (measured by the Impact of Event Scale-Revised) among a sample 

of 212 firefighters. The researchers found that a composite index inclusive of both PTE and 

peritraumatic suffering (i.e., suffering during and immediately after a traumatic event) predicted 

PTSS better than either measure alone; thus, suggesting these two kinds of trauma should be 

differentially measured.

May C.L. & Wisco B.E. (2016). Defining trauma: How level of exposure and proximity affect risk for 

posttraumatic stress disorder. Psychological Trauma: Theory, Research, Practice,and Policy, 8, 

233-240.

Molnar et al., (2017). Advancing science and practice for vicarious traumatization / secondary traumatic 

stress: A research agenda. Traumatology, 23, 129-142.

Osofsky, J. D., Putnam, F. W., & Lederman, J. C. S. (2008). How to maintain emotional health when 

working with trauma. Juvenile and Family Court Journal, 59(4), 91-102.

This article discusses vicarious traumatization among various professional groups including child 

welfare workers, police officers, medical personnel, and judges. The authors state that research on 

vicarious traumatization mainly focuses on welfare workers, officers, and medical professionals, 

but should also be extended to judges in juvenile and family law. For each occupational group, the 

authors articulate symptoms, risk factors, and professional costs of prolonged exposure to trauma. 

As with the Palm et al (2004) article cited in this review, the authors suggest that interventions to 

curb the effects of vicarious traumatization fall into two broad categories: individual and 

organizational. Osofsky and colleagues recommend that individuals self-assess their level of 

secondary traumatic stress via available questionnaires (Figley & Stamm, 1996; Stamm, 2002; 
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2005, as referenced by Osofsky, Putnam, & Lederman, 2008). If individuals find they have 

moderate to high secondary traumatization, the authors recommend they engage in self-care 

methods detailed in the Child Welfare Trauma Training Toolkit (available via the National Child 

Traumatic Stress Network website at:

http://www.nctsn.org/nctsn_assets/pdfs/cwt3_sho_inventory.pdf). At the organizational level, the 

authors suggest that employers should reduce caseloads, provide strong supervision for frontline 

workers, offer mental health insurance coverage, acknowledge job stress and the possibility of 

secondary traumatization, offer educational workshops and develop peer support, provide staff 

coverage and backup, and encourage discussion regarding secondary trauma among staff.

Palm, K. M., Polusny, M. A., & Follette, V. M. (2004). Vicarious traumatization: Potential hazards and 

interventions for disaster and trauma workers. Prehospital and disaster medicine, 19(1), 73-78.

The researchers review extant literature on the costs of vicarious traumatization and cite the

following consequences: intrusive thoughts, avoidance, hyper-arousal, alcohol abuse, changes in 

identity, worldview, and spirituality. They then provide a description of differential indirect 

trauma exposure among disaster professionals, healthcare providers, emergency services 

personnel, and journalists. Moreover, the authors also provide recommendations for individual and 

organizational treatment for indirect trauma exposure for disaster professionals and journalists. 

Tailored support for disaster professionals might include social support, maintaining balance with 

non-professional activities (e.g. gardening, hiking), scheduling breaks, limiting caseloads, 

attending support groups, and taking vacation time, among other strategies. Targeted strategies for 

journalists may include education in stress reactions, interventions such as critical incident stress 

debriefings, self-care, and fostering a culture in news organizations that would allow professionals 

to discuss responses to incidents without negative consequences.

Perron, B., & Hiltz, B. (2006). Burnout and Secondary Trauma Among Forensic Interviewers of Abused 

Children. Child & Adolescent Social Work Journal, 23(2), 216–234.

In this study, the researchers administered an online survey containing the Oldenburg Burnout 

Inventory, the Secondary Traumatic Stress Scale, the Satisfaction with Organization Scale, the 

General Self-Efficacy Scale, and a demographics questionnaire to forensic interviewers working at 

child abuse evaluation centers. The authors found “no substantive evidence that personal 

characteristics or the duties associated with forensic interview had a significant relationship” with 

burnout or secondary trauma. It seems that organizational satisfaction had the strongest 

relationship with burnout, and also had a small relationship with secondary trauma. The authors 

suggested this implies that organizational factors can buffer the stress of forensic interviewing.

Regambal, M. J., Alden, L. E., Wagner, S. L., Harder, H. G., Koch, W. J., Fung, K., & Parsons, C. (2015). 

Characteristics of the traumatic stressors experienced by rural first responders. Journal of Anxiety 

Disorders, 34, 86–93.

The authors state that not at all events that meet Criterion A requirements for trauma in the DSM-5 

incur PTSD. Moreover, the prevalence rates for traumatic events (e.g., combat, physical abuse, 

and accidents) are varied. In the present study, the authors sought to understand what 

characteristics of traumatic events contributed to the onset of PTSD. In a sample of rural first 

responders, which included police officers, ambulance personnel, and firefighters, researchers 

analyzed distressing events and “control events” (which are characterized as events that first 
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responders anticipated would be traumatic but were not). Participants completed the Posttraumatic 

Distress Disorder Diagnostic Scale, the Description of Event Questionnaire, the Peritraumatic 

Dissociation Experiences Questionnaire, and the Posttraumatic Cognitions Inventory-Abbreviated.

Using a factor analysis, the researchers found two factors that characterize distressing, PTSDinducing events: (1) chaos, and (2) resource limitations. Chaos entailed that first responders could 

not engage in normal procedures, felt unprepared to deal with the situation, and could not keep up 

with the demands of the event. Resource limitations reflect perceptions of insufficient personnel 

and a challenging environment. These factors were also associated with dissociation within the 

traumatic event.

Shoji, K., Lesnierowska, M., Smoktunowicz, E., Bock, J., Luszczynska, A., Benight, C. C., & Cieslak, R. 

(2015). What comes first, job burnout or secondary traumatic stress? Findings from two 

longitudinal studies from the US and Poland. PloS one, 10(8), e0136730.

As implied by the title, the researchers sought to answer the question: “What comes first, job 

burnout or secondary traumatic stress?” The researchers tested this question with two longitudinal 

studies. The researchers tested whether burnout predicted secondary traumatic stress after 6-month 

follow-up or whether secondary traumatic stress predicted burnout in a 6-month follow-up among 

two participants pools: (1) U.S. mental healthcare providers working with U.S. military service 

members suffering from trauma, and (2) Polish social workers, healthcare professionals, and other 

human services professionals providing services for civilian trauma members. The researchers 

found that burnout predicted secondary traumatic stress (but not the inverse). This finding 

contradicts other literature suggesting that burnout and secondary traumatic stress co-occur. 

Rather, there appears to be a unidirectional relationship. Shoji and colleagues suggest this offers 

support of the Conservation of Resources Theory (COR), which articulates that as resources are 

depleted to cope with stressors, this compromises ability to deal with further exposure to indirect 

trauma. The researchers conclude in citing other research that might assist with resource 

maintenance such as caseload size and self-efficacy.

Sprang, G., Craig, C., & Clark, J. (2011). Secondary traumatic stress and burnout in child welfare 

workers: a comparative analysis of occupational distress across professional groups. Child 

Welfare, 90(6).

This study attempts to identify predictors of secondary traumatic stress and burnout among child 

welfare workers. In an online survey among 669 child welfare workers, the researchers 

administered the Professional Quality of Life IV, which assesses compassion fatigue and burnout 

symptoms. They found that significant predictors of secondary traumatic stress: “being male, 

young, Hispanic, holding rural residence, and endorsing a lack of religious participation,” while 

significant predictors of burnout included being male and young. To abate costs of secondary 

traumatic stress and burnout in this line of work, researchers advise that, “supervisors are key 

organizational players for developing the socioemotional and task environments that prevent 

worker attrition and distress” (p. 164). Supervisors can alleviate the burden associated with child 

welfare work by providing a balanced caseload with cases that vary in severity. As with other 

literature cited in the current annotated bibliography (Palm, Polusny, & Follette, 2004; Shoji et al, 

2015), other strategies might include providing formal training on secondary stress, promoting 

work-life balance, and self-care.
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Sprang G., Ford J., Kerig P., & Bride B. Defining secondary traumatic stress and developing targeted 

assessments and interventions: Lessons learned from research and leading experts. Traumatology. 

Advance online publication.

Walker, A., McKune, A., Ferguson, S., Pyne, D. B., & Rattray, B. (2016). Chronic occupational 

exposures can influence the rate of PTSD and depressive disorders in first responders and military 

personnel. Extreme Physiology & Medicine, 5(1), 8.

In this literature review, Walker and colleagues suggest that occupational exposures such as heat, 

smoke, disruptions to sleep, and injury, contribute to inflammatory activity and dysregulation of 

the HPA-axis, which may, in turn, contribute to PTSD and depression among first responders and 

military personnel. The authors suggest that future research should test their hypothesis. Finally, 

the researchers suggest that linking occupational exposure to increases in inflammatory activity 

would implicate the need for risk management for first responders and military personnel. Such 

risk management may include improving physical fitness and post-incident rehabilitation (e.g., 

restoring sleep). This article is not particularly insightful in examining secondary stress among the 

occupational populations of interest, but it does offer a novel perspective on the importance of 

physiological rehabilitation following distressing events (as compared to other articles reviewed 

which discuss psychological interventions).