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A. Levin, L. Albert, A. Besser, D. Smith, A. Zelenski, S. Rosenkranz, Y. Neria. Secondary Traumatic Stress in Attorneys and Their Administrative Support Staff Working with Trauma-Exposed Clients. Journal of Nervous and Mental Disease. Vol 199 (12), 2011 (pp 946-955). DOI: 10.1097/NMD.0b013e3182392c26

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Abstract

Although secondary trauma has been assessed in various groups of mental health professionals, few studies, to date, have examined secondary trauma among attorneys exposed to clients' traumatic experiences. This study examined indicators of secondary trauma among attorneys (N = 238) and their administrative support staff (N = 109) in the Wisconsin State Public Defender Office. Attorney participants demonstrated significantly higher levels of post-traumatic stress disorder symptoms, depression, secondary traumatic stress, burnout , and functional impairment compared with the administrative support staff. This difference was mediated by attorneys' longer work hours and greater contact with clients who had experienced or had been directly involved with trauma. Sex, age, years on the job, office size, and personal history of trauma did not predict symptoms. These findings suggest a need to support attorneys experiencing these symptoms and to address high workloads as well as the intensity of contact with trauma-exposed clients.

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... (Vrklevski & Franklin, 2008). In comparative studies, legal professionals' distress was variously compared to that of other professions, such as social workers, MHPs, psychologists (Levin & Greisberg, 2003;Maguire & Byrne, 2017), or administrative support staff (Levin et al., 2011). ...
... All studies measured elements of indirect exposure to trauma, either through validated measures, or through development of their questionnaire items. The studies operationalised secondary trauma in various ways: VT (Jaffe et al., 2003;Levin & Greisberg, 2003;Maguire & Byrne, 2017;Vrklevski & Franklin, 2008); PTSD ; STS (Lustig et al., 2008;Piwowarczyk et al., 2009;Schrever et al., 2019); and CF (Levin et al., 2011;Miller et al., 2018). ...
... Schrever et al., 2019). When using PTSD screening tools, 9% and 11% (Levin et al., 2011) of lawyers met the criteria for PTSD. By interpreting STSS scores, Schrever et al. (2019) reported that 30.4% of the judicial officers qualified for a PTSD diagnosis. ...
Article
There has been increased scrutiny of occupations that less obviously experience adverse impacts from indirect exposure to trauma. In legal professions, repeated exposure to clients who have experienced trauma comprises a significant part in the role of lawyers, attorneys, solicitors and judges. The current review aimed to explore the prevalence and risk factors of secondary trauma reported by such legal professionals. A systematic search using seven psychological and legal databases elicited 10 articles for review. Quality appraisal revealed several methodological frailties in the reviewed articles. Thus, the findings should be interpreted with caution. Results indicated comparatively high prevalence of secondary trauma in legal professionals, and highlighted predictors and correlates of secondary trauma (gender, work experience, personal trauma and level of exposure). The review emphasised significant variability between the studies making systematic comparisons challenging, as well as the need for further conceptually consistent and scientifically robust studies.
... Seven were empirical studies and two were dissertations. One study had a longitudinal design (Levin et al., 2012) and five had a control group (Leclerc et al., 2019;Levin et al., 2011;Levin & Greisberg, 2003;Maguire & Byrne, 2017;Vrklevski & Franklin, 2008). All studies collected data via self-reported surveys. ...
... The most frequently used trauma conceptualization was secondary traumatic stress (see Goldman, 2006;Levin & Greisberg, 2003;Piwowarczyk et al., 2009;Sokol, 2014), followed by vicarious trauma (see Maguire & Byrne, 2017;Vrklevski & Franklin, 2008), and PTSD (see Leclerc et al., 2019;Levin et al., 2012). One study adopted both secondary traumatic stress and PTSD as conceptualizations of work-related trauma exposure (Levin et al., 2011). All studies that adopted the conceptualization of secondary traumatic stress considered that it involved symptoms of intrusive memories, avoidance, and hyperarousal. ...
... Maguire and Byrne (2017) conceptualized vicarious trauma as similar to PTSD, with the exception that it did not involve enough symptoms to be considered as such. Finally, Leclerc et al. (2019), Levin et al. (2012), and Levin et al. (2011) applied the DSM-5 trauma exposure criterion (the so-called Criterion A) when assessing their lawyer participants. Consistent with the DSM-5 diagnostic criteria, they defined PTSD as involving four types of symptoms: intrusive, avoidance, and hyperarousal symptoms, as well as changes in cognitive schemas. ...
Article
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Lawyers can be exposed to cases involving traumatic elements of crimes. Such exposure may result in symptoms of posttraumatic stress disorder (PTSD) and have adverse effects on the lawyers’ capacities to work. A scoping review was conducted to summarize original investigations of work-related PTSD among lawyers in terms of (a) trauma exposure conceptualization and operationalization, (b) symptom severity, (c) prevalence, and (d) risk factors. The scoping review also aimed to highlight potential directions for future studies and clinical implications. Literature searches were conducted in PsycINFO, Embase, Pubmed, MEDLINE, PILOTS, and Google Scholar. Of 341 initial publications, 9 were included. A majority conceptualized the impact of work-related trauma exposure as secondary traumatic stress and operationalized work-related trauma exposure as the number of cases or clients involving traumatic material. Levels of PTSD symptoms reported by lawyers were positively related to levels of work-related trauma exposure.
... According to several studies, lawyers report greater symptoms of PTSD, depression, anxiety and burnout compared to mental health professionals and social workers (Follette et al., 1994;Levin & Greisberg, 2003;Maguire & Byrne, 2017). Congruently, when compared to solicitors or administrative assistants, lawyers report higher levels of psychological distress (especially if exposed to multiple traumatic events), functional impairment, symptoms of PTSD, depression, burnout, stress, and greater changes in feelings of overall safety and intimacy (Levin et al., 2011;Levin, Besser, Albert, Smith, & Neria, 2012;Vrklevski & Franklin, 2008). Moreover, lawyers' PTSD symptomatology and level of functional impairment have shown to be particularly stable over time (Levin et al., 2011). ...
... Congruently, when compared to solicitors or administrative assistants, lawyers report higher levels of psychological distress (especially if exposed to multiple traumatic events), functional impairment, symptoms of PTSD, depression, burnout, stress, and greater changes in feelings of overall safety and intimacy (Levin et al., 2011;Levin, Besser, Albert, Smith, & Neria, 2012;Vrklevski & Franklin, 2008). Moreover, lawyers' PTSD symptomatology and level of functional impairment have shown to be particularly stable over time (Levin et al., 2011). While comparing lawyers to other professionals have highlighted the extent and severity to which lawyers are impacted by trauma-related exposure in the course of their work, considerable differences in professional roles and sociodemographic profiles limit the yielded comparative information. ...
... Congruent with prior research, greater number of hours of work a week is associated with less time available for: rest, self-care, socializing, leisure, leading to more fatigue and less energy, essentially interfering with functional impairment (Levin et al., 2011(Levin et al., , 2012Vrklevski & Franklin, 2008). As discussed in the introduction, lawyers are often illtrained and improperly equipped for trauma-related work, which could translate as poorer accessibility/quality health and social care. ...
Article
Limited research has been conducted on the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5; 2013) exposure criterion: “work-related exposure to aversive details of traumatic events”. This study investigated the presence and severity of post-traumatic stress disorder (PTSD) symptomatology among a national cross-sectional sample of practicing Canadian lawyers (N = 476). Participants were categorized into three groups: no, moderate, and high work-related exposure to potentially traumatic material. As hypothesized, lawyers in the moderate and high work-related trauma exposure groups obtained more elevated (severe) mean scores of PTSD symptoms, psychological distress, and reported a poorer quality of life (p < .05) compared to their unexposed colleagues. An important proportion of lawyers scored above the clinical threshold for probable PTSD (9%), psychological distress (23%), and unsatisfactory quality of life (23%). Trauma-exposed lawyers were 2.62 times (95%CI: 1.12 - 6.12, p = .027) more likely to meet the probable PTSD threshold than the unexposed lawyers. Congruent with the DSM-5 reformulation of trauma exposure, lawyers exposed to aversive details of traumatic events are at increased risk of developing PTSD symptoms requiring an intervention. Future research using random sampling and face-to-face interviews should be conducted to further establish the human cost of this emerging problem.
... Previous studies examining rates of PTSD in high-risk employee groups provide wide variations both within and across occupations in their estimates of those affected, ranging from 7-19% of active duty police officers (Carlier & Gersons, 1995;Maia et al., 2007), 5-36% of active duty fire fighters (Del Ben, Scotti, Chen, & Fortson, 2006), 15-22% of ambulance personnel (Clohessy & Ehlers, 1999;Rentoul & Ravenscroft, 1993), 2-31% of search and rescue personnel (McFarlane & Papay, 1992;van der Velden, van Loon, Benight, & Eckhardt, 2012), and 4 -7% of journalists (Dworznik, 2008;Feinstein, 2006;Pyevich, Newman, & Daleiden, 2003). Rates of PTSD stemming from different types of indirect trauma exposure range from 33% in a sample of emergency room nurses (Dominguez-Gomez & Rutledge, 2009) to 25% in a group of sexual assault nursing examiners who routinely conducted rape examinations (Townsend & Campbell, 2009) to 11% of attorneys and 1% of support staff working in a public defender's office (Levin et al., 2011). ...
... Variations among and between employee groups in the rates of PTSS may be a function of differences in the frequency of PTE exposure. Frequent exposure to PTEs may provide opportunities to develop the technical and coping skills necessary to manage emotional demands of PTEs (Pyevich et al., 2003;Levin et al., 2011). However, high frequency exposure may also limit the time avail-able to recover from PTEs (MacRitchie & Liebowitz, 2010;Ortlepp & Friedman, 2002). ...
... There is less evidence on the degree to which the frequency of exposure to these events is associated with increased mental health risk, and the available evidence is mixed. Two studies, one in a sample of journalists and the other in a sample of attorneys (Pyevich et al., 2003;Levin et al., 2011) reported a positive relationship of caseload to stress symptoms, but two other studies of trauma workers did not find this relationship (MacRitchie & Liebowitz, 2010;Ortlepp & Friedman, 2002). ...
Article
Objectives: Prior research has examined the incidence of posttraumatic stress stemming from either direct or indirect trauma exposure in employees of high-risk occupations. However, few studies have examined the contribution of both direct and indirect trauma exposure in high-risk groups. One particularly salient indirect trauma often endorsed as the most stressful by many occupational groups is interacting with distressed family members of victims of crime, illness, or accidents. The present study examined the extent to which interacting with distressed families moderated the impact of cumulative potentially traumatic event (PTE) exposure on depression and posttraumatic stress disorder (PTSD) symptoms in 245 employees of medical examiner (ME) offices. Method: Employees from 9 ME office sites in the United States participated in an online survey investigating the frequency of work place PTE exposures (direct and indirect) and mental health outcomes. Results: Results revealed that cumulative PTE exposure was associated with higher PTSD symptoms (PTSS) for employees who had higher frequency of exposure to distressed family members. After controlling for cumulative and direct PTE exposure, gender, and office site, exposure to distressed families was significantly associated with depressive symptoms, but not PTSS. Conclusions: Findings of our research underscore the need for training employees in high-risk occupations to manage their reactions to exposure to distraught family members. Employee training may buffer risk for developing PTSD and depression. (PsycINFO Database Record
... Criminal law cases are considered to require a higher degree of emotional fortitude on the part of the lawyer than non-criminal cases (Gomme & Hall, 1995). Levin et al, (2011) studied the emotional impact of working with trauma on 238 lawyers and 109 administrative support staff in a U.S. State Public Defender's Office. Criminal lawyers were found to be at a higher risk of developing symptoms of secondary traumatic stress and/or burnout than the administrative staff working in the same office. ...
... The literature is equivocal in relation to the protective nature of professional experience (Dunkley & Whelan, 2006;Levin et al., 2011). The cumulative nature of VT may tend to suggest a higher degree of susceptibility for those with more experience (Levin et al., 2011). ...
... The literature is equivocal in relation to the protective nature of professional experience (Dunkley & Whelan, 2006;Levin et al., 2011). The cumulative nature of VT may tend to suggest a higher degree of susceptibility for those with more experience (Levin et al., 2011). However, to Pearlman and Saakvitne (1995), experience is considered a highly adaptive resource that allows for contextualising of, and distancing from, trauma. ...
Article
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_________________________________________________________ This qualitative, grounded theory study explored the impact of vicarious trauma on Irish barristers practising criminal law. Through a series of open exploratory interviews respondents described conditions arising out of their work that are implicated in the experience of vicarious trauma (hyper-vigilance, intrusive memories and alterations to worldview). Respondents did not report feeling impaired by these experiences. This was attributed to a variety of protective mechanisms that exist at a personal and professional/organisational level, characterised as an " armoury " of resilience. Awareness of the risks of vicarious trauma and the factors that protect against it may be useful to other occupational groups in fostering resilient professionals. So the multiple factors that contribute to such resilience are discussed within this paper. Future research may focus on an understanding of the factors that sustain the professional wellbeing of those whose work exposes them to secondhand trauma as well as the risks inherent in such work. ©University College Cork. All rights reserved
... Some of these studies have linked intensity of work-related exposure (Creamer & Liddle, 2005; Eriksson, Kemp, Gorsuch, Hoke, & Foy, 2001; Kassam-Adams, 1999) to secondary trauma symptoms, although other findings have suggested the primary importance of organizational and work-related factors (Baird & Jenkins, 2003; Devilly, Wright, & Varker, 2009; Regehr, Hemsworth, Leslie, Howe, & Chau, 2004) compared with exposure. Recently, in a large cross-sectional study, our group examined indicators of secondary trauma among attorneys (n 238) and their administrative support staff (n 109) and found that the attorneys demonstrated significantly higher levels of posttraumatic stress disorder (PTSD) symptoms, depression, secondary traumatic stress, burnout, and functional impairment compared with administrative support staff (Levin et al., 2011). In addition, we found that the difference in symptoms was mediated by attorneys' longer work hours and greater exposure to trauma-exposed clients and was not related to other variables such as gender, years on the job, office size, or personal history of trauma. ...
... In addition, we found that the difference in symptoms was mediated by attorneys' longer work hours and greater exposure to trauma-exposed clients and was not related to other variables such as gender, years on the job, office size, or personal history of trauma. The present study used a longitudinal design in a subsample of attorneys from our previously reported cohort of the Wisconsin State Public Defender's Office (Levin et al., 2011 ) to assess changes in symptoms of PTSD, depression, and functional impairment over a 10-month period. In addition, our design sought to measure the relative contributions of caseload of trauma-exposed clients and hours worked to symptom and functional impairment levels over time and the direction of effects between caseload of trauma-exposed clients, hours worked, and symptoms and functional impairment. ...
... We conducted a longitudinal follow-up study on a sample of attorneys working in the 38 offices of the Wisconsin State Public Defender's Office (Levin et al., 2011). In that study, we collected data in March 2010 via the Wisconsin State Public Defender's Office intranet to 307 attorneys, with an initial response of 238 attorneys (78%). ...
Article
To date, few studies have examined mental health consequences among attorneys exposed to clients' traumatic experiences. A longitudinal, 2-wave, cross-lagged study was used in a cohort of attorneys (N = 107) from the Wisconsin State Public Defender's Office. We assessed changes in posttraumatic stress disorder (PTSD), depression, and functional impairment over a 10-month period and tested the effects of intensity of contact with trauma-exposed clients on symptom levels over time. Attorneys demonstrated strong and significant symptom stability over time in PTSD, depression, functional impairment, and levels of exposure. Analyses involving cross-lagged panel correlation structural equation modeling path models revealed that attorneys' levels of exposure to trauma-exposed clients had significant positive effects, over time, on PTSD, depression, and functional impairment. Gender, age, years on the job, and office size did not predict any of the outcomes. Level of exposure to trauma-exposed clients predicted reduction of weekly working hours over time, but there was no reciprocal relationship between PTSD, depression, and functional impairment and level of exposure over time. These findings underscore the central role of exposure to trauma-exposed clients in predicting mental health outcomes and emphasize the need to support attorneys by managing the intensity of exposure as well as addressing emerging symptoms. (PsycINFO Database Record (c) 2012 APA, all rights reserved).
... It is increasingly recognized that front-line justice system professionals are frequently exposed to traumatic stressors in the line of duty, including witnessing or experiencing violence and hearing details of trauma experienced by crime victims or youth offenders (Chamberlain & Miller, 2008;Kunst, 2011;Rainville, 2015). A growing literature reveals high rates of moderate to severe traumatic stress symptoms in samples of correctional staff, probation officers, law enforcement, and attorneys (Denhof & Spinaris, 2013;Levin et al., 2011;Skogstad et al., 2013). Traumatic stress is associated with impaired job performance among justice system professionals (Denhof & Spinaris, 2013). ...
... Notably, only five publications recommended agency-level efforts to prevent work-related traumatic stress among front-line staff, which is consistently identified as a core component of TIC in definitions for other service systems (Hopper et al., 2010). This is a troubling omission given that work-related traumatic stress symptoms are prevalent and associated with impaired job performance among front-line staff (e.g., attorneys, probation/ correctional officers, law enforcement) in the justice system (Denhof & Spinaris, 2013;Levin et al., 2011;Skogstad et al., 2013). Additionally, several groups of justice system professionals have expressed their desire for greater organizational support around these matters (Donisch et al., 2016;Knowlton, 2015;Severson & Pettus-Davis, 2013). ...
Article
Full-text available
Objective: The U.S. Department of Justice has called for the creation of trauma-informed juvenile justice systems in order to combat the negative impact of trauma on youth offenders and frontline staff. Definitions of trauma-informed care have been proposed for various service systems, yet there is not currently a widely accepted definition for juvenile justice. The current systematic review examined published definitions of a trauma-informed juvenile justice system in an effort to identify the most commonly named core elements and specific interventions or policies. Method: A systematic literature search was conducted in 10 databases to identify publications that defined trauma-informed care or recommended specific practices or policies for the juvenile justice system. Results: We reviewed 950 unique records, of which 10 met criteria for inclusion. The 10 publications included 71 different recommended interventions or policies that reflected 10 core domains of trauma-informed practice. We found 8 specific practice or policy recommendations with relative consensus, including staff training on trauma and trauma-specific treatment, while most recommendations were included in 2 or less definitions. Conclusion: The extant literature offers relative consensus around the core domains of a trauma-informed juvenile justice system, but much less agreement on the specific practices and policies. A logical next step is a review of the empirical research to determine which practices or policies produce positive impacts on outcomes for youth, staff, and the broader agency environment, which will help refine the core definitional elements that comprise a unified theory of trauma-informed practice for juvenile justice. (PsycINFO Database Record
... We used the Mplus version 8.3 software to evaluate our hypothesized path analysis model (see Figure 1) and compared it to an alternative path analysis model, the fit indices of which are summarized in Table 3. We controlled for two known correlates of attorney health and well-being: (1) average hours worked per week; and (2) age range (hereinafter collectively referred to as the "control variables"; Chrobak-Kasprzyk & Jośko-Ochojska, 2020; Levin et al., 2011;Tsai & Chan, 2011;Welch, 2018). ...
Article
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Existing evidence suggests that perfectionism is related to depressive symptoms, burnout, and clinical disorders and that socially prescribed, rather than self‐oriented, perfectionism is the most maladaptive. Thus, social expectations of perfection can have detrimental effects on workers that may result in negative organizational outcomes. Using a sample of 176 Arizona attorneys, this two‐wave longitudinal study examined whether psychosocial safety climate (PSC) may reduce perfectionist ideals and, in turn, improve employee well‐being. Expectedly, PSC negatively influenced physical and psychological distress 2 months later directly and indirectly via socially prescribed perfectionism, suggesting that the beneficial impacts of positive PSCs may manifest over a relatively short period of time. Contrarily, self‐oriented perfectionism was not related to PSC, suggesting a demand‐resource mismatch, and positively related to physical symptoms only. These results suggest a more complex relationship between self‐oriented perfectionism and employee well‐being, perhaps depending on other variables.
... Regardless of the terminology used, professionals working with trauma survivors are susceptible to developing WRD, particularly in the caring professions across diverse healthcare settings (Huggard et al., 2017;Sorenson et al., 2016;Williams et al., 2019), first-responders (Greinacher et al., 2019), and emergency service personnel including firefighters (Jo et al., 2018), ambulance officers (Regehr et al., 2002) and police officers (Sherwood et al., 2019). Moreover, the prevalence of WRD has been evidenced by nonclinical staff groups within the criminal justice system, notably judges (Lustig et al., 2008), lawyers (Levin et al., 2011) and jurors (Lonergan et al., 2016). Given CCOs' exposure to offenders, victims of crime and a context of trauma, it seems timely to examine how they might be affected. ...
Article
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Research indicates that indirect exposure to trauma can have a detrimental psychological impact on professionals working within, and interfacing with, law enforcement and the criminal justice system. This systematic review aimed to explore the extent and predictors of work-related distress amongst community corrections personnel. A search of five databases identified 19 papers eligible for inclusion; 16 addressed burnout, and the remainder investigated secondary trauma, vicarious trauma and compassion fatigue. Synthesis revealed that community corrections personnel reported burnout at levels akin to those of other professions working in forensic contexts, though reports of secondary trauma appeared higher. Predictive factors encompassed personal, role-based and organisational factors. Research reporting work-related distress in correctional officers is focused on burnout but uses divergent models of stress, reveals methodological weaknesses, and to date has little examined responses to indirect trauma. The limitations of this review are discussed, alongside clinical implications and areas for future research.
... Murray and Royer (2008) and Levin (2008) argue that we need to consider how the hostile court environment, conflict, heavy caseloads and the adversarial nature of criminal law influence lawyers' experiences. Other studies have demonstrated how work hours predict STS in lawyers (Levin et al., 2011;Piwowarczyk et al., 2009). Furthermore, the rhetoric around the legal culture in Australia suggests that lawyers are trained to be 'aggressive and to be emotionally detached. . . . ...
Article
Lawyers experience significant levels of psychological distress. We argue that one reason, which has received insufficient attention from researchers, is their exposure to traumatic material. Our study examined the lived experience of lawyers who are exposed to traumatic material, including the role their organisation and profession play in shaping their experiences. Thirty-five lawyers or barristers, from both the public and the private sector, participated in in-depth interviews about how their exposure to traumatic material affected them, and how their organisation shaped their experiences. Our analysis identified six themes: when material becomes traumatic, fear of stigma, everyday recovery, boundaries through denial and distancing, using social support normatively and making meaning. Our findings identify that lawyers can experience strong emotional reactions to traumatic material, and their experience is influenced by the professional norms and training in law. Moreover, their organisation has an important role in either ameliorating or exacerbating their responses.
... 3 Studies of burnout in working populations have identified poor physical outcomes in a diverse range of professions, including dentists, forest industry employees, firefighters, correctional officers, lawyers, school teachers, manufacturers, child welfare workers, and software developers. 2,[4][5][6] Burnout is more likely to occur in individuals who experience vicarious trauma 7 and is disproportionately present in medical students, residents, and practicing physicians. 8 Characterization of burnout at each step of medical education is important for determining outcomes and prevention strategies. ...
Article
Context: Burnout is a psychological syndrome that results from prolonged exposure to stressful work activities and includes 3 dimensions: emotional exhaustion (EE), depersonalization (DP), and low sense of personal accomplishment (PA). Burnout is a widespread problem in numerous professions but is particularly high among medical students, residents, and early-career physicians compared with college graduates of similar age. However, minimal research has addressed burnout in osteopathic medical students. Objective: To assess levels of burnout in osteopathic medical students and to examine the relationship among burnout, perceived stress, sleep quality, and smartphone use. Methods: This study used a cross-sectional study design and an anonymous, electronic questionnaire service to administer the Maslach Burnout Inventory, the Perceived Stress Scale-4, the Pittsburgh Sleep Quality index, and the Smartphone Addiction Scale Short Version. Results: A total of 385 participants (mean [SD] age, 25 [2.4] years; 208 [54.0%] women; 286 [74.3%] white; 138 [35.8%] second-year osteopathic medical students [OMSs]) completed the survey. Of the 385 participants, 9 (2.3%) reported high EE, 67 (17.4) reported high DP, and 310 (80.5) reported a high level of low PA. When comparing dimensions of burnout by gender, only levels of PA differed by gender, with men reporting higher levels of burnout compared with women (χ12=5.2, P=.022). Further, levels of DP differed by year in medical school (χ 2=17.3, P=.008), with post-hoc comparisons showing differences between OMS I and OMS III (F=4.530, df=3, P=.004). Linear regression models showed that higher perceived stress (standardized β=0.5, P<.001), poorer sleep quality (standardized β=0.2, P=.001), and higher smartphone addiction scores (standardized β=0.1, P<.001) were associated with higher EE. Similarly, higher perceived stress (standardized β=0.2, P<.001), poorer sleep quality (standardized β=0.2, P=.001), and higher smartphone addiction scores (standardized β=0.2, P=.001) were associated with higher DP. Only higher perceived stress was associated with higher levels of low PA (standardized β=-0.4, P<.001). Conclusions: These findings suggest independent associations with EE, DP, perceived stress, sleep quality, and smartphone use. Additional research with a larger, more diverse sample is needed to confirm these findings. If confirmed, wellness interventions can be designed to target 2 modifiable factors: sleep quality and smartphone use.
... In the context of the criminal justice system, some limited focus has recently been directed toward lawyers working with assault victims (Brobst, 2014;Levin & Greisberg, 2003;Levin et al., 2011;Piwowarczyk et al., 2009;Sokol, 2014). Levin and Greisberg, for instance, found that attorneys working with victims reported secondary trauma symptoms stemming from becoming overextended and overidentified with clients, and frustration with what they viewed to be hostile courts and policing services (Levin & Greisberg, 2003). ...
Article
Stemming from work on emergency professionals directly affected by trauma exposure, attention has turned to the impact of work-related trauma on their families, including media and public scrutiny, trauma contagion, marital discord, and overprotective parenting. More recently, colleagues in forensic mental health are speaking anecdotally not only about the personal impact of exposure to violence, but also the impact on their families. This study uses a narrative approach to elicit stories from adult children of forensic psychiatrists to explore the extent of exposure to disturbing material, the impact of exposure, and mechanisms employed by parents to mitigate risk and exposure.
... By 2008, Chamberlain and Miller made a nationwide call for researchers to develop intervention strategies to alleviate the many problematic sources of stress, including a high prevalence of STS, in judges and courtroom workers. In addition, Levin et al. (2011) reported significant levels of PTSD and STS in a group of attorneys, compared with their administrative support staff, who were much less affected. The difference in prevalence rates was attributed largely to the attorneys' constant contact with trauma-exposed clients. ...
Chapter
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The chapter reviews the literature and, among other things, suggests that the mechanism for the induction and reduction of symptoms of secondary trauma is the empathy applied to the "interpersonal response" that is the gateway for experiencing the distress of others.
... Clearly interventions are required to minimise psychological distress and, in turn, maximise wellbeing and performance while at university. However after university, graduates face new challenges as frequent exposure to clients who are experiencing psychological distress has been shown to put practitioners at risk of experiencing psychological burnout in both law (Levin et al., 2011; Lustig et al., 2008; Murdoch, 2000; Resnick, Myatt & Marotta, 2011; Vrklevski & Frankiln, 2008) and the mental health professions (Craig & Sprang, 2010; Newell & MacNeil, 2010; Ray, Wong, White & Heaslip, 2013; Thompson, Amatea & Thompson, 2014). Instilling healthy stress-buffering lifestyle habits in students will serve them well both during their time at university and in their chosen career. ...
Article
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Research indicates that, in comparison to other university students, law students are at greater risk of experiencing high levels of psychological distress. There is also a large body of literature supporting a general negative association between exercise and stress, anxiety and depression. However, we are not aware of any studies exploring the impact of exercise on the mental health of law students specifically. This article reports evidence of a negative association between exercise and psychological distress in 206 law and psychology students. Compared to psychology students, the law students not only reported greater psychological distress, but, in addition, there was a stronger association between their levels of distress and their levels of exercise. Based on the results of this study, we suggest a simple yet effective way law schools might support the mental health of their students.
... Secondary traumatic stress describes the psychological duress that results from learning about another person's traumatic experiences or experiencing that person's posttraumatic stress reactions in firsthand interactions (National Child Traumatic Stress Network Secondary Traumatic Stress Committee, 2011). Research reveals high rates of secondary traumatic stress reactions among juvenile justice professionals, including court and correctional staff (Denhoff & Spinaris, 2013; Levin et al., 2011). Secondary traumatic stress reactions increase the risk for burnout and turnover among justice staff (Denhoff & Spinaris, 2013; Lewis, Lewis, & Garby, 2013). ...
... Second, due to the high staff turnover rate at Safe Harbor, over half of the advocates I interviewed had been employed at the agency for less than 1 year. A handful of recent studies (e.g., Pack, 2014; Robinson-Keilig, 2014 ) suggest that symptoms of vicarious trauma are particularly acute during the first few years of practice and may best be conceptualized as a common characteristic of the early stages of one's career development; however, other studies (e.g., Baird & Jenkins, 2003; Levin et al., 2011; Perron & Hiltz, 2006) have found no statistically significant relationship between workers' length of employment and secondary traumatic stress. Further research is needed in this area. ...
Article
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This study extends prior research on vicarious traumatization and emotion management by exploring a deeper, more life-altering effect of working with traumatized clients?namely, ?soul pain.? Analyses of in-depth interviews with 29 advocates working with survivors of physical and sexual violence reveal that, as a direct consequence of hearing countless stories of human brutality, some staff members experience a profound wounding of their spirit. This finding expands our understanding of the occupational hazards of the helping professions by revealing another dimension of advocates? lives?that of the soul or spirit?that may be affected by their work with trauma survivors.
... an individual who is indirectly exposed to a traumatic event, usually through narrative accounts. This type of stress is commonly experienced by professionals who frequently provide services to traumatized populations, such as but not limited to mental health professionals (Bride, 2007;Schauben & Frazier, 1995;Pearlman & Mac Ian, 1995;Ortlepp & Friedman, 2002;Elwood, Mott, Lohr, & Galovski, 2011;Shoji et al., 2014), 911 telecommunicators (Pierce & Lilly, 2012), medical professionals (Peltzer, Matseke, & Louw, 2014), police officers (Brady & Hofstra, 2009), attorneys and their administrative staff (Levin et al., 2011), funeral directors (Brady & Hofstra, 2009), and television journalists (Weidmann & Papsdorf, 2010). This type of indirect exposure is referred to using a number of terms, such as "secondary traumatic stress" (Bride, 2007;Figley, 1995;Ortlepp & Friedman, 2002), "compassion fatigue" (Figley, 2002), and "vicarious traumatization" (McCann & Pearlman, 1990). ...
Article
Objective: The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) includes significant changes to Criterion A for posttraumatic stress disorder (PTSD), the criterion that defines which events qualify as "traumatic." This systematic review explores the fundamental question of how to define a trauma by reviewing the difference between direct and indirect trauma exposure and the risk for PTSD associated with both exposure types. Direct exposure includes experiencing a trauma firsthand or witnessing a trauma as it occurs to others. In contrast, indirect exposure may occur by learning about the violent or accidental death of a close associate, through secondary narrative accounts (e.g., in service-related professions), or through work-related media reports. This review examines whether indirect trauma exposure can lead to PTSD and the role of proximity in symptom development. Method: We conducted a systematic review of the research assessing changes to PTSD Criterion A in DSM-5, various levels of traumatic exposure, and proximity as a risk factor for PTSD. Results: Our review indicates that indirect exposure can lead to PTSD, although the probability of developing the disorder from indirect exposure is lower than that from direct exposure. Proximity to a trauma also increases risk, but this may be limited to direct exposure. Conclusions: Knowledge of the impact of level of exposure (direct vs. indirect) and proximity will help to better define what events meet PTSD Criterion A. Future research is needed to examine DSM-5's requirement that exposure through media must be related to one's work. (PsycINFO Database Record
... Our results show that high EE or intense stress is associated with higher risk for prison workers to develop PTSD symptoms. This result is particularly interesting because researches investigating the link between PTSD and burnout have started to consider burnout as a " vicarious trauma " or as a " secondary trauma " (Iliffe & Steed, 2000; Jenkins, Mitchell, Baird, Whitfield, & Meyer, 2011; Levin et al., 2011 ). However, it is surprising because correctional duty is not a " counseling occupation, " prone to secondary-vicarious trauma development (Bride, 2004; Jenkins & Baird, 2002; Ortlepp & Friedlman, 2002; Sabin-Farrell & Turpin, 2003). ...
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The purpose of this study is to explore how professional employment impacts mental health among people with mental illness, and how having a mental illness impacts job performance, both positively and negatively. The research is based on in-depth interview data from 56 professionals diagnosed with mental illness, and the interview transcripts are analyzed in accordance with the flexible coding model of qualitative data analysis. We find that working conditions of professional jobs pose challenges to managing symptoms of mental illness, including the pressures of responsibility and exposure to secondary trauma. However, professional employment also provides benefits such as social connections and feeling accountable. Similarly, symptoms cause problems at work like having angry outbursts, yet experience with mental illness informs job performance such as by increasing empathy with others. We use these findings to recommend new directions for research and argue for inclusion of people with mental illness in the workplace.
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Those who work with immigrants in detention centers may be at increased risk of secondary trauma. This study used Photovoice to capture reflections on how the lives of volunteers are affected by their work on behalf of immigrant family detainees. Participants were recruited over a two-month period in 2018 from amongst the volunteers of a non-governmental organization that provides legal services to the detainees at one immigration detention center. Participants submitted photos and captions that explored their experiences with their work. Thirteen volunteers consented to participate and submitted 44 photos with captions to the project. Major themes included emotional challenges of the work, frustrations with the U.S. government, comparison of their experiences to those of their clients’, and finding uplifting moments. Our findings regarding the significant emotional challenges of this work are of particular importance given the increasing coverage of immigration detention in the media and the increased interest in volunteer opportunities to support this population.
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Although vicarious traumatisation has been documented in numerous professional groups, the research on asylum lawyers is sparse. This pilot study aimed to explore whether asylum lawyers are affected by their work with traumatised clients. Seventy asylum lawyers completed a pilot survey consisting of the Trauma and Attachment Belief Scale; Impact of Event Scale–Revised; Depression, Anxiety and Stress Scales; and a work-characteristics questionnaire. The results included significant association between higher contacts with trauma-exposed clients and anxiety; higher weekly work hours and fewer years of experience in asylum law with more stress; fewer years of experience with general trauma scores and intrusion symptoms; and more clients per week with cognitive changes regarding trust in others. The findings highlight the potentially detrimental impact on asylum lawyers of working with traumatised clients and the need for further investigation.
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Vicarious or secondary trauma experience has always been part of legal practice although many do not acknowledge the risk it can have on the mental health, well-being and performance of legal professionals. The listening to, observing and then detailing of traumatic events for the purposes of legal process in some cases may harm lawyers who need to work closely with clients, victims and witnesses. This article reviews the research on trauma in many areas of professional human services that could inform and improve our understanding of legal practice. It examines the discursive history of trauma and recent studies on lawyer well-being, before discussing the controversies about recognising vicarious trauma and the stigma against mental health concerns in the legal profession. The article concludes by reviewing options to assist law firms in considering trauma-informed policy, practices and supervision strategies and to help individual lawyers recognise the value of self-care.
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In this article, we ask why public defenders remain on the job despite a number of unique and testing work-related challenges. To answer this question, we analyze original data collected through 87 semistructured interviews with public defenders from government, nonprofit, and appointed counsel systems across the United States. Participants explicated a set of intrinsic and extrinsic motivations salient to their decision to remain in public defense: interacting with clients, defending the Constitution, fighting social inequality, pursuing personal values, appreciating camaraderie with colleagues, and earning public sector benefits. We discuss how our findings relate to prior research, identify directions for future studies, and tentatively engage policy implications.
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Because judges experience a myriad of occupational stressors, they are at risk of experiencing secondary trauma, burnout, negative mental/physical health, poor job performance and low job satisfaction. These experiences might not be uniform, however, as gender and social support might mitigate such stress-related outcomes. Judges from two states in the United States completed a variety of stress and subjective performance measures. Social support was related to less perceived stress, less burnout, and more job satisfaction, but only for males. This suggests that males and females might receive qualitatively different types of social support. Different types of social support could differ in their ability to buffer judges from these stress-related outcomes. Further, among judges with high social support, females scored higher than males on subjective job performance; the opposite pattern occurred for judges with low social support. Thus, a lack of social support appears to have a negative effect on performance self-appraisals but only for females. Results have implications for the psychological study of stress and for programs designed to reduce judges’ stress.
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This chapter summarizes the most relevant data we gathered related to prevalence of secondary trauma and burnout in military mental health providers as well as other trauma therapists. A number of published papers from our laboratory, as well as relevant research findings from other researchers, are provided. We compare our results with other published investigations of different provider populations offering important insights. We report on important differences between on-post and off-post providers. Important clinical implications related to how to help these military mental health providers based on our findings are offered. Lastly, suggestions for how these findings can help the broader therapeutic community close out this chapter.
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Family law attorneys frequently encounter intimate partner violence (IPV) when they represent individuals in divorce and custody suits. Understanding the challenges that IPV presents for these attorneys is critical because case outcomes affect safety for clients and their children. To explore these challenges, the authors conducted three focus groups with family law attorneys to learn their personal attitudes and experiences with IPV in their practice. Attorneys reported that their scope of practice often encompassed the psychosocial context of their clients’ lives, and identified IPV assessment, client reaction, and variance in legal system response as prevalent difficulties. This study contributes to the literature by assessing family law attorneys’ perceptions about IPV and considering how they might inform their procedures and practices.
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The latest iteration of the posttraumatic stress disorder (PTSD) criteria presented in The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) includes specific elaborations of the gatekeeper criteria, a new category of stressor, an expansion in the number of symptoms, addition of a new subtype of PTSD, and an enlarged text discussion that breaks new ground in defining the criteria. We first trace the rationale underlying these changes and their impact on the prevalence of PTSD diagnoses in clinical studies and then present potential implications of the new criteria for forensic assessment methodology and the detection of malingering, interpretations of criminal responsibility and mitigation, evaluation of the reliability of witnesses, the scope of claims in civil and employment cases, and eligibility for disability.
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The aim of this study was to evaluate secondary trauma and job burnout and associated factors in a sample of 71 HIV lay counsellors in South Africa. Results indicate that 49.5% were not satisfied with their work environment and 51.4% were potentially secondary traumatic stress cases. In univariate analysis, seeing more HIV counselling and testing clients, being HIV positive and a higher number of lifetime traumas was associated with secondary trauma, while in multivariable analysis only the higher number of lifetime traumas was associated with secondary trauma. In both univariate and multivariable analysis, seeing more HIV counselling and testing clients and a higher number of lifetime traumas were associated with job burnout.
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A Monte Carlo study compared 14 methods to test the statistical significance of the intervening variable effect. An intervening variable (mediator) transmits the effect of an independent variable to a dependent variable. The commonly used R. M. Baron and D. A. Kenny (1986) approach has low statistical power. Two methods based on the distribution of the product and 2 difference-in-coefficients methods have the most accurate Type I error rates and greatest statistical power except in 1 important case in which Type I error rates are too high. The best balance of Type I error and statistical power across all cases is the test of the joint significance of the two effects comprising the intervening variable effect.
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In this article, we attempt to distinguish between the properties of moderator and mediator variables at a number of levels. First, we seek to make theorists and researchers aware of the importance of not using the terms moderator and mediator interchangeably by carefully elaborating, both conceptually and strategically, the many ways in which moderators and mediators differ. We then go beyond this largely pedagogical function and delineate the conceptual and strategic implications of making use of such distinctions with regard to a wide range of phenomena, including control and stress, attitudes, and personality traits. We also provide a specific compendium of analytic procedures appropriate for making the most effective use of the moderator and mediator distinction, both separately and in terms of a broader causal system that includes both moderators and mediators. (46 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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This study explored vicarious trauma in the legal profession. A random sample of male and female criminal law (n = 50) and noncriminal law (n = 50) solicitors completed a research pack containing the following questionnaires: a demographic questionnaire; Vicarious Trauma Scale; Satisfaction With Work Scale; Depression, Anxiety, and Stress Scales; Impact of Event Scale—Revised; and Trauma and Attachment Belief Scale. Criminal lawyers reported significantly higher levels of subjective distress and vicarious trauma, depression, stress, and cognitive changes in relation to self-safety, other safety, and other intimacy. No significant differences were found between the two groups on measures of satisfaction with work or coping strategies in relation to work-related distress. Multiple trauma history was associated with higher scores on measures of symptomatic distress.
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The purpose of this study was to add to the limited research on secondary traumatic stress in child welfare by investigating correlates of secondary traumatic stress (STS) in child protective services workers. Specifically, we examined the relationship between levels of STS in CPS professionals and personal history of trauma, peer and administrative support, intent to remain employed in child welfare, professional experience, and size of caseload. This study documents the existence of secondary traumatic stress in the population and the relationship between levels of secondary traumatic stress in CPS professionals and the group of potential correlates: personal history of trauma in the past year and lifetime, peer support, administrative support, intent to remain employed in child welfare, professional experience, and size of caseload.
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Conducted 2-hr semistructured interviews with a heterogeneous group of 60 psychotherapists to investigate their experiences of therapeutic practice. According to the Ss, professional satisfaction derives from the ability to promote a helpful therapeutic relationship; dissatisfaction stems primarily from lack of therapeutic success; and burnout is primarily a consequence of the nonreciprocated attentiveness, giving, and responsibility demanded by the therapeutic relationship. Other reasons for burnout included overwork, isolation, and discouragement as a function of the slow pace of the work. Most Ss felt that support systems were essential to resisting burnout. The data suggest that although therapists expect their work to be difficult and even stressful, they also expect their efforts to be rewarding. Burnout is not only psychologically debilitating to therapists, it also critically impairs the delivery of mental health services. (48 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Factor analysis, path analysis, structural equation modeling, and related multivariate statistical methods are based on maximum likelihood or generalized least squares estimation developed for covariance structure models (CSMs). Large-sample theory provides a chi-square goodness-of-fit test for comparing a model (M) against a general alternative M based on correlated variables. It is suggested that this comparison is insufficient for M evaluation. A general null M based on modified independence among variables is proposed as an additional reference point for the statistical and scientific evaluation of CSMs. Use of the null M in the context of a procedure that sequentially evaluates the statistical necessity of various sets of parameters places statistical methods in covariance structure analysis into a more complete framework. The concepts of ideal Ms and pseudo chi-square tests are introduced, and their roles in hypothesis testing are developed. The importance of supplementing statistical evaluation with incremental fit indices associated with the comparison of hierarchical Ms is also emphasized. Normed and nonnormed fit indices are developed and illustrated. (43 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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This article reports on a computer-based, psychologist-assisted technology for addressing posttraumatic responses in Chernobyl-disaster-affected children. Mental health professionals who worked with this population reveal substantially distorted thoughts and feelings about the children's past, present, and future more than others of their age. Chernobyl-affected and evacuated children are aware that they can never return to their homes, illnesses may befall them in childhood, their parents may die sooner than normal, and that their environment is poisoned. The LifeLine psychotherapeutic software program (available from A. Kronik), which is based on the goal-and-causal theory of psychological time is described and suggestions are given for further school-based intervention and prevention services. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Burnout is a prolonged response to chronic emotional and interpersonal stressors on the job, and is defined by the three dimensions of exhaustion, cynicism, and inefficacy. The past 25 years of research has established the complexity of the construct, and places the individual stress experience within a larger organizational context of people's relation to their work. Recently, the work on burnout has expanded internationally and has led to new conceptual models. The focus on engagement, the positive antithesis of burnout, promises to yield new perspectives on interventions to alleviate burnout. The social focus of burnout, the solid research basis concerning the syndrome, and its specific ties to the work domain make a distinct and valuable contribution to people's health and well-being.
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[Correction Notice: An erratum for this article was reported in Vol 51(2) of Journal of Counseling Psychology (see record 2007-16897-001). On page 134, line 8, right column, under the heading Checklist for Evaluating Mediation Analyses Using Multiple Regression, the question incorrectly asks, "Was the relation between the predictor and the outcome (Path b) greater than or equal to the relation between the predictor and the mediator (Path a)?" The correct question is "Was the relation between the mediator and the outcome (Path b) greater than or equal to the relation between the predictor and the mediator (Path a)?"] The goals of this article are to (a) describe differences between moderator and mediator effects; (b) provide nontechnical descriptions of how to examine each type of effect, including study design, analysis, and interpretation of results; (c) demonstrate how to analyze each type of effect; and (d) provide suggestions for further reading. The authors focus on the use of multiple regression because it is an accessible data-analytic technique contained in major statistical packages. When appropriate, they also note limitations of using regression to detect moderator and mediator effects and describe alternative procedures, particularly structural equation modeling. Finally, to illustrate areas of confusion in counseling psychology research, they review research testing moderation and mediation that was published in the Journal of Counseling Psychology during 2001. (PsycINFO Database Record (c) 2007 APA, all rights reserved) (journal abstract)
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This cross-sectional design study sought to assess whether therapists believed and engaged in commonly recommended forms of prevention for secondary and vicarious trauma and whether engaging in these activities resulted in lower levels of distress. In this study of 259 therapists, time spent with counseling trauma victims was the best predictor of trauma scores. Although participants generally believed in the usefulness of recommended coping strategies including leisure activities, self-care activities and supervision, these beliefs did not translate into time devoted to engaging in the activities. Most importantly, there was no association between time devoted to coping strategies and traumatic stress scores. Intervention strategies for trauma counselors that focus on education of therapists and augmenting coping skills unduly individualize the problem.
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The aim of the present study was to perform an assessment for secondary traumatic stress (STS), vicarious trauma (VT) and workplace burnout for Australian mental health professionals involved in clinical practice. Recruited directly by mail, randomly selected participants were invited to submit a questionnaire by post or online. Of the 480 participants contacted, 152 mental health professionals completed the questionnaire, which contained measures of STS, VT and burnout. Exposure to patients' traumatic material did not affect STS, VT or burnout, contradicting the theory of the originators of STS and VT. Rather, it was found that work-related stressors best predicted therapist distress. These findings have significant implications for the direction of research and theory development in traumatic stress studies, calling into question the existence of secondary trauma-related phenomena and enterprises aimed at treating the consultants.
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In this article, we attempt to distinguish between the properties of moderator and mediator variables at a number of levels. First, we seek to make theorists and researchers aware of the importance of not using the terms moderator and mediator interchangeably by carefully elaborating, both conceptually and strategically, the many ways in which moderators and mediators differ. We then go beyond this largely pedagogical function and delineate the conceptual and strategic implications of making use of such distinctions with regard to a wide range of phenomena, including control and stress, attitudes, and personality traits. We also provide a specific compendium of analytic procedures appropriate for making the most effective use of the moderator and mediator distinction, both separately and in terms of a broader causal system that includes both moderators and mediators.
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International relief and development personnel may be directly or indirectly exposed to traumatic events that put them at risk for developing symptoms of Post‐traumatic Stress Disorder (PTSD). In order to identify areas of risk and related reactions, surveys were administered to 113 recently returned staff from 5 humanitarian aid agencies. Respondents reported high rates of direct and indirect exposure to life‐threatening events. Approximately 30% of those surveyed reported significant symptoms of PTSD. Multiple regression analysis revealed that personal and vicarious exposure to life‐threatening events and an interaction between social support and exposure to life threat accounted for a significant amount of variance in PTSD severity. These results suggest the need for personnel programs; prede‐ployment training, risk assessment, and contingency planning may better prepare personnel for service.
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This article reports on a computer-based, psychologist-assisted technology for addressing posttraumatic responses in Chernobyl-disaster-affected children. Mental health professionals who worked with this population reveal substantially distorted thoughts and feelings about the children's past, present, and future more than others of their age. Chernobyl-affected and evacuated children are aware that they can never return to their homes, illnesses may befall them in childhood, their parents may die sooner than normal, and that their environment is poisoned. The LifeLine psychotherapeutic software program (available from A. Kronik), which is based on the goal-and-causal theory of psychological time is described and suggestions are given for further school-based intervention and prevention services.
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Should psychotherapists limit their clinical work with trauma survivors to avoid being traumatized themselves? Vicarious traumatization (VT)-the symptoms similar to posttraumatic stress disorder and the disruption in cognitive-schemas reported in clinicians who are exposed to the trauma material of their clients-was assessed in a national survey of 1,000 women psychotherapists. Therapists with higher levels of exposure to sequel abuse material reported significantly more trauma symptoms but no significant disruption of cognitive schemas. Spiritual well-being, a key area thought to be damaged by VT, was found to be higher for those clinicians who saw more sexual abuse survivors.
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Background: Data were obtained on the general population epidemiology of DSM-III-R posttraumatic stress disorder (PTSD), including information on estimated lifetime prevalence, the kinds of traumas most often associated with PTSD, sociodemographic correlates, the comorbidity of PTSD with other lifetime psychiatric disorders, and the duration of an index episode.Methods: Modified versions of the DSM-III-R PTSD module from the Diagnostic Interview Schedule and of the Composite International Diagnostic Interview were administered to a representative national sample of 5877 persons aged 15 to 54 years in the part II subsample of the National Comorbidity Survey.Results: The estimated lifetime prevalence of PTSD is 7.8%. Prevalence is elevated among women and the previously married. The traumas most commonly associated with PTSD are combat exposure and witnessing among men and rape and sexual molestation among women. Posttraumatic stress disorder is strongly comorbid with other lifetime DSM-III-R disorders. Survival analysis shows that more than one third of people with an index episode of PTSD fail to recover even after many years.Conclusions: Posttraumatic stress disorder is more prevalent than previously believed, and is often persistent. Progress in estimating age-at-onset distributions, cohort effects, and the conditional probabilities of PTSD from different types of trauma will require future epidemiologic studies to assess PTSD for all lifetime traumas rather than for only a small number of retrospectively reported "most serious" traumas.
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A substantial literature testifies to the potential negative effects of therapy work on therapists. However, little is known about the potential positive effects of this work. The present study explored both positive aspects (personal growth, compassion satisfaction) and negative aspects (compassion fatigue, burnout) of therapists' well-being in 156 therapists. Analyses of occupational factors (personal therapy, supervision, therapeutic training and practice orientation, length of therapy career, current therapy workload, personal trauma history, gender) and psychological factors (sense of coherence, social support, empathy, the bond from the working alliance) revealed hypothesized associations with therapist well-being. The findings illustrate some of the factors associated with positive and negative well-being in therapists, while the discussion considers future research directions and possible implications for counseling and clinical practice.
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The primary purpose of this study was to assess the effects on counselors of working with sexual violence survivors. Members of a women psychologists' organization and a group of sexual violence counselors completed questionnaires regarding the extent of their work with survivors and their psychological functioning. Counselors who had a higher percentage of survivors in their caseload reported more disrupted beliefs, (particularly about the goodness of other people), more symptoms of post-traumatic stress disorder, and more self-reported vicarious trauma. Symptomatology was not related to counselors' own history of victimization. Qualitative data regarding difficult and enjoyable aspects of working with survivors also were gathered, along with data on the strategies used by counselors to cope with work-related stress. Implications for counselor training are discussed.
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The CES-D scale is a short self-report scale designed to measure depressive symptomatology in the general population. The items of the scale are symptoms associated with depression which have been used in previously validated longer scales. The new scale was tested in household interview surveys and in psychiatric settings. It was found to have very high internal consistency and adequate test- retest repeatability. Validity was established by pat terns of correlations with other self-report measures, by correlations with clinical ratings of depression, and by relationships with other variables which support its construct validity. Reliability, validity, and factor structure were similar across a wide variety of demographic characteristics in the general population samples tested. The scale should be a useful tool for epidemiologic studies of de pression.
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There has been relatively little systematic investigation of the effect of the number of variables on measures of model fit in structural equation modeling. There is conflicting evidence as to whether measures of fit tend to improve or decline as more variables are added to the model. We consider 3 different types of specification error: minor factors, 2-factor models, and method errors. Using a formal method based on the noncentrality parameter (NCP), we find that root mean squared error of approximation (RMSEA) tends to improve regardless of the type of specification error and that the comparative fit index (CFI) and Tucker-Lewis Index (TLI), generally, though not always, tend to worsen as the number of variables in the model increases. The formal method that we develop can be used to investigate other measures of fit and other types of misspecification.
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This study examined vicarious traumatization (i.e., the deleterious effects of trauma therapy on the therapist) in 188 self-identified trauma therapists. Participants completed questionnaires about their exposure to survivor clients' trauma material as well as their own psychological well-being. Those newest to the work were experiencing the most psychological difficulties (as measured by the Traumatic Stress Institute Belief Scale; L. A. Pearlman, in press) and Symptom Checklist-90—Revised (L. Derogatis, 1977) symptoms. Trauma therapists with a personal trauma history showed more negative effects from the work than those without a personal history. Trauma work appeared to affect those without a personal trauma history in the area of other-esteem. The study indicates the need for more training in trauma therapy and more supervision and support for both newer and survivor trauma therapists. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Should psychotherapists limit their clinical work with trauma survivors to avoid being traumatized themselves? Vicarious traumatization (VT—the symptoms similar to posttraumatic stress disorder and the disruption in cognitive schemas reported in clinicians who are exposed to the trauma material of their clients—was assessed in a national survey of 1,000 women psychotherapists. Therapists with higher levels of exposure to sexual abuse material reported significantly more trauma symptoms but no significant disruption of cognitive schemas. Spiritual well-being, a key area thought to be damaged by VT, was found to be higher for those clinicians who saw more sexual abuse survivors. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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The prevalence of depression has rarely been studied in a manner permitting comparisons across a range of occupations. This analysis reveals considerable range in prevalence in 104 occupations of major depressive disorder as defined by the Diagnostic and Statistical Manual (ed 3), and measured by the National Institute of Mental Health's Diagnostic Interview Schedule. Five occupations had prevalence rates above 10%. When adjusted for sociodemographic factors, three occupations yield prevalences with statistically significant elevations in the rate, compared with employed persons generally. The three are lawyers, with an odds ratio of 3.6; other teachers and counselors, with an odds ratio of 2.8; and secretaries, with an odds ratio of 1.9. Exploration of possible sources of these differences concludes the paper. (C)1990 The American College of Occupational and Environmental Medicine
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This article examines the adequacy of the “rules of thumb” conventional cutoff criteria and several new alternatives for various fit indexes used to evaluate model fit in practice. Using a 2‐index presentation strategy, which includes using the maximum likelihood (ML)‐based standardized root mean squared residual (SRMR) and supplementing it with either Tucker‐Lewis Index (TLI), Bollen's (1989) Fit Index (BL89), Relative Noncentrality Index (RNI), Comparative Fit Index (CFI), Gamma Hat, McDonald's Centrality Index (Mc), or root mean squared error of approximation (RMSEA), various combinations of cutoff values from selected ranges of cutoff criteria for the ML‐based SRMR and a given supplemental fit index were used to calculate rejection rates for various types of true‐population and misspecified models; that is, models with misspecified factor covariance(s) and models with misspecified factor loading(s). The results suggest that, for the ML method, a cutoff value close to .95 for TLI, BL89, CFI, RNI, and Gamma Hat; a cutoff value close to .90 for Mc; a cutoff value close to .08 for SRMR; and a cutoff value close to .06 for RMSEA are needed before we can conclude that there is a relatively good fit between the hypothesized model and the observed data. Furthermore, the 2‐index presentation strategy is required to reject reasonable proportions of various types of true‐population and misspecified models. Finally, using the proposed cutoff criteria, the ML‐based TLI, Mc, and RMSEA tend to overreject true‐population models at small sample size and thus are less preferable when sample size is small.
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The present study examined whether parenting and child characteristics of 2- and 3H-year-old children had common paths of influence on their 4H-year independent cognitive and social functioning. Structural equation modeling was guided by hypotheses that assumed children's later independence is facilitated by specialized parental support in early social interactions. To address the importance of variability in early development for understanding children's later independence, we included 104 term and 185 preterm children, as they are known to differ in early skills. As predicted, mothers' maintaining of children's interests indirectly supported 4H-year cognitive and social independence through a direct, positive influence on 2- and 3H-year skills. Directiveness positively supported children's early cognitive and responsiveness skills but by 3H years, high levels of this behavior had a direct, negative influence on their cognitive and social independence at 4H years. Whereas high levels of maintaining interests across these ages support later independence, directiveness needs to decrease in relation to children's increasing competencies. Results support a theoretical framework that emphasizes the importance of the social context for understanding the origins of children's later independent functioning.
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Symptoms of vicarious trauma, coping strategies, and prevention suggestions were investigated with 105 judges. Participants completed a self-report measure developed for this study. The majority of judges (63%) reported one or more symptoms that they identified as work-related vicarious trauma experiences. Female judges reported more symptoms, as did judges with seven or more years of experience. In addition, female judges were more likely to report internalizing difficulties, while judges with more experience reported higher levels of externalizing/hostility symptoms. Coping and prevention strategies were multi-domain (i.e., personal, professional, and societal) and underscored the need for greater awareness and support for judges.
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International relief and development personnel may be directly or indirectly exposed to traumatic events that put them at risk for developing symptoms of Posttraumatic Stress Disorder (PTSD). In order to identify areas of risk and related reactions, surveys were administered to 113 recently returned staff from 5 humanitarian aid agencies. Respondents reported high rates of direct and indirect exposure to life-threatening events. Approximately 30% of those surveyed reported significant symptoms of PTSD. Multiple regression analysis revealed that personal and vicarious exposure to life-threatening events and an interaction between social support and exposure to life threat accounted for a significant amount of variance in PTSD severity. These results suggest the need for personnel programs; predeployment training, risk assessment, and contingency planning may better prepare personnel for service.
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Within the context of their new constructivist self-development theory, the authors discuss therapists'' reactions to clients'' traumatic material. The phenomenon they term vicarious traumatization can be understood as related both to the graphic and painful material trauma clients often present and to the therapist''s unique cognitive schemas or beliefs, expectations, and assumptions about self and others. The authors suggest ways that therapists can transform and integrate clients'' traumatic material in order to provide the best services to clients, as well as to protect themselves against serious harmful effects.
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Two important bodies of literature explore the issue of stress in social workers, that investigating the impact of burnout and that investigating the impact of traumatic events. This study integrates these two concepts and tests a hypothesized model for predicting post-traumatic distress in child welfare workers. In this model, individual, incident and organizational factors combined to produce post-traumatic stress distress in child welfare workers. That is, individuals with a greater sense of control over their lives and a better ability to engage in meaningful relationships with others reported lower levels of distress. In addition, those who had less recent and less frequent exposures reported lower levels of distress. However, the strongest predictor was the organizational environment one aspect of which was ongoing, chronic stressors. It thus appears that critical events in child welfare practice are encountered by individuals whose resources may already be taxed through coping on an ongoing basis with high levels of challenge and stress, thereby increasing the intensity of trauma reactions.
Article
Advocates of the concept of secondary traumatization propose that clinicians who provide trauma-focused treatment may be particularly at risk for experiencing secondary trauma symptoms. This specific symptom presentation purportedly develops following exposure to the traumatic experiences described by their clients. Consequently, these professionals have advocated for increases in resources devoted to the prevention and treatment of secondary trauma symptoms (e.g., enhanced clinician training, increase in availability of treatment options for affected trauma workers, etc.). A review of empirical literature examining prevalence and specificity of secondary trauma symptoms in trauma clinicians is provided. Findings are mixed and often indicate that trauma clinicians are not frequently experiencing "clinically significant" levels of symptoms and that these symptoms may not be uniquely associated with trauma-focused treatment. Finally, it is argued that additional clarification and research on the criterion, course, and associated impairment are needed. Recommendations for future research are provided.
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Hard quantitative research about occupational stress among public defenders is rare. Given the central role of public defenders in the courts, research is desperately needed to identify the most aggravating stressors plaguing public defenders. Two hundred and seventeen public defenders in New York State ranked various potential stressors by frequency and intensity. Stressors that occurred with both high frequency and high intensity were having too much work; not knowing when a case might be called into trial; having no defense if a case were called; satisfying conflicting parties; dealing with upset clients and their families; arguing with prosecutors; and having no trial options because of harsh sentences. Though some of these stressors come with the territory, such reforms as caseload reduction, docket reform, and increased judicial tolerance for trials could bring some relief.
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Thesis (Ph. D.)--University of Virginia, 1995. Includes bibliographical references (leaves 85-91).
Article
The prevalence of depression has rarely been studied in a manner permitting comparisons across a range of occupations. This analysis reveals considerable range in prevalence in 104 occupations of major depressive disorder as defined by the Diagnostic and Statistical Manual (ed 3), and measured by the National Institute of Mental Health's Diagnostic Interview Schedule. Five occupations had prevalence rates above 10%. When adjusted for sociodemographic factors, three occupations yield prevalences with statistically significant elevations in the rate, compared with employed persons generally. The three are lawyers, with an odds ratio of 3.6; other teachers and counselors, with an odds ratio of 2.8; and secretaries, with an odds ratio of 1.9. Exploration of possible sources of these differences concludes the paper.