Temperament Traits, Social Support, and Secondary Traumatic Stress Disorder Symptoms in a Sample of Trauma Therapists

Abstract

Secondary traumatic stress disorder (STSD) consists of identical symptoms as posttraumatic stress disorder (PTSD), but while PTSD originates from direct exposition to a traumatic event, STSD is a consequence of indirect exposure to trauma due to close personal contact with a trauma victim. This article examines the severity of STSD symptoms and their relationship to temperament traits and social support in a sample (N = 80) of trauma therapists in Poland. In our study, we controlled for demographic data, such as the therapist’s gender and age, and for work-related variables, such as the average number of years working as a trauma therapist, the average number of patients therapists worked with over the past 12 months, and whether therapists sought supervision for their therapeutic work. Participants filled out 3 questionnaires: the PTSD Questionnaire: Factorial Version; the Formal Characteristics of Behavior-Temperament Inventory; and the Berlin Social Support Scale. The level of STSD symptoms among trauma therapists was related to temperament traits, emotional reactivity and sensory sensitivity, as well as to perceived social support. Emotional reactivity was positively associated with level of STSD symptoms, whereas sensory sensitivity and perceived social support were negatively related to level of STSD symptoms. There was no significant relationship between therapists’ demographic characteristics and work-related variables and intensity of STSD symptoms.

Full text

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This is an Accepted Manuscript of an article published in Professional Psychology: Research
and Practice, available online:
http://psycnet.apa.org/psycinfo/2015-25429-001/
Citations details of this paper:
Rzeszutek, M., Partyka, M., & Gołąb, A. (2015). Temperament Traits, Social Support,
and Secondary Traumatic Stress Disorder Symptoms in a Sample of Trauma Therapists.
Professional Psychology: Research and Practice. Advance online publication.
http://dx.doi.org/10.1037/pro0000024

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Abstract
Secondary traumatic stress disorder (STSD) consists of identical symptoms as posttraumatic stress
disorder (PTSD), but while PTSD originates from direct exposition to a traumatic event, STSD is a
consequence of indirect exposure to trauma due to close personal contact with a trauma victim. This
article examines the severity of STSD symptoms and their relationship to temperament traits and
social support in a sample (N=80) of trauma therapists in Poland. In our study, we controlled for
demographic data, such as the therapist’s gender and age, and for work-related variables, such as the
average number of years working as a trauma therapist, the average number of patients therapists
worked with over the past 12 months, and whether therapists sought supervision for their therapeutic
work. Participants filled out three questionnaires: the PTSD Questionnaire: Factorial Version; the
Formal Characteristics of Behavior-Temperament Inventory; and the Berlin Social Support Scale.
The level of STSD symptoms among trauma therapists was related to temperament traits, emotional
reactivity and sensory sensitivity, as well as to perceived social support. Emotional reactivity was
positively associated with level of STSD symptoms, whereas sensory sensitivity and perceived social
support were negatively related to level of STSD symptoms. There was no significant relationship
between therapists’ demographic characteristics and work-related variables and intensity of STSD
symptoms.
Keywords: Secondary traumatic stress disorder (STSD), temperament traits, social support, trauma
therapist
.

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Temperament Traits, Social Support and Secondary Traumatic Stress Disorder Symptoms in a
Sample of Trauma Therapists
There is a large literature on the negative psychological consequences of traumatic stress on
individuals (see, e.g., Ehlers and Clark, 2000; Strelau and Zawdzki, 2005; van der Kolk et al., 1996).
However, studies in this field have mainly been focused on people who directly experienced
traumatic events and suffered from posttraumatic stress disorder (PTSD). In contrast, a paucity of
research has been conducted to investigate the effects on those who experienced trauma indirectly,
suffering from vicarious trauma (VT) (Pearlman and Saakvitne, 1995) or secondary traumatic stress
(STS) (Figley, 1995, 2002). Although some authors use these terms interchangeably (e.g., Baird and
Jenkins, 2003), there is a growing literature that distinguishes between these concepts (Devily et al.,
2009; Newell and MacNeil, 2010).
Vicarious trauma refers to personal transformations experienced by trauma workers that stem
from a cumulative empathic engagement with another’s traumatic experiences (McCann and
Pearlman, 1990). This can lead to long-term changes to an individual’s way of experiencing
themselves, others, and the world. According to McCann and Pearlman (1990), the concept of
vicarious trauma is based on the Constructivist Self Development Theory (CSDT), which focuses on
an individual’s symptoms resulting from experiencing trauma as a means to cope with or adjust to a
traumatic event and protect one’s self and one’s belief system from the damage trauma produces
(Van Minnen and Keijsers, 2000). In this context, VT symptoms among trauma therapists can be
seen as an adaptive response to engagement with the clients’ traumatic material. For example, a
therapist who works with rape victims may start to perceive the world as a dangerous place and
maintaining this cognitive belief can force him/her to engage in behaviors consistent with the picture
of a dangerous world in order to protect him/herself from harm (Pearlman and Saakvitne, 1995). It is
worth mentioning that compared to secondary traumatic stress, VT symptoms are cumulative and
pervasive, i.e. they have potential to touch almost every aspect of therapist’s life, such as attitudes,
beliefs, assumptions about the world, as well as behaviors (Trippany et al., 2004).

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Conversely, STS is defined as stress resulting from helping or wanting to help a traumatized
person, which is a significant psychological burden for helpers and may lead to secondary traumatic
stress disorder (STSD) (Figley, 1995, 2002). In particular, Figley (1995) created the trauma
transmission model, which describes the onset of a secondary traumatic stress disorder as a possible
effect of a therapist’s empathic response to a patient’s traumatic material. STSD consists of identical
symptoms as PTSD, but while PTSD originates from direct exposition to a traumatic event, STSD is
a consequence of indirect exposure to trauma due to close personal contact with a trauma victim.
Although STSD is a relatively well-established clinical construct, it is still often confused with other
stress-related diagnostic entities, such as burnout or compassion fatigue. Burnout is described as an
experience of long-term emotional exhaustion, depersonalization and a reduced sense of personal
accomplishment, which can be observed among individuals who work with other people (Maslach,
2001; Raquepaw and Miller, 1989; Rzeszutek and Schier, 2014). Burnout differs from STSD in that
it has a different etiology (e.g. organizational stress, not exposure to client trauma), and also in that
burnout symptoms emerge gradually, while STSD is associated with a sudden onset of symptoms
(Benson and Maraith, 2005). Compassion fatigue, meanwhile, is defined as a syndrome consisting
of a combination of the symptoms of STSD and burnout, and refers to emotional and physical fatigue
that professionals experience due to the chronic use of empathy when treating patients who are
suffering in some way (Adams et al., 2006; Sodeke-Gregson et al., 2013).
Taking the aforementioned remarks into consideration, we clearly distinguish between
vicarious trauma, which is a personal transformations experienced by trauma workers that stem from
a cumulative empathic engagement with another’s traumatic experiences, and STSD, which focuses
on the symptoms that mirror the PTSD presented in the primary victim of trauma (Newell and
MacNeil, 2010). Despite these distinctions, vicarious trauma and STSD stem from the same source,
which is indirect exposure to another’s traumatic experience (Figley, 2002). In this article, we
examined the severity of STSD symptoms and their relationship to temperament traits and social
support in a sample of trauma therapists in Poland.

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Many authors have observed symptoms of STSD in helping professions, especially among
social workers (Bride, 2007), emergency workers (Moran and Britton, 1994), sexual assault
counselors (Baird and Jenkins, 2003) and health care providers (Meadors, et al., 2009). The
occurrence of STSD symptoms has also been identified in trauma therapists. Pearlman and MacIan
(1995) reported significant levels of STSD symptoms in 62% of examined trauma therapists. Adams
and Rigs (2008) found that 31% of trauma therapy trainees exceeded the clinical cut-off score in the
STSD inventory. Farrenkopf (1992) found that 33% of therapists who treated sex offenders reported
high levels of the aforementioned disorder, especially intrusive images and hyperarousal.
The studies mentioned above showed that STSD symptoms in these occupational groups were
not only related to performance at work, increasing absenteeism among employees and decreasing
job satisfaction, but were also linked to various mental and somatic problems, such as depression,
anxiety, alcohol and drug abuse. However, although these authors controlled for work-related factors
that are typically analyzed in secondary trauma studies (i.e., workload), not all of them took into
account other variables (i.e., preexisting psychopathology, supervision for their therapeutic work)
that may be also related to the severity of STSD (Harrison and Westwood, 2009; Miller, 1998).
STSD may affect all clinicians working for a long time with another’s traumatic material, rather than
a vulnerable subset of individuals (Stamm, 1997, 2005). Nevertheless, several factors appear to
contribute to a greater or lesser vulnerability to STSD among trauma therapists. On the one hand, a
therapist’s prior history of trauma or preexisting psychopathology (Osofsky, et al., 2008), a high
number of traumatized patients in a therapist’s caseload, and little experience in doing trauma
therapy (Creamer and Liddle, 2005) can be responsible for higher rates of STSD among mental
health specialists working with traumatized patients. On the other hand, clinical supervision
(Chrestman, 1999), the opportunity to engage in self-care techniques, and personal therapy
experiences (Cerney, 1995) can act as protection from possible negative consequences of doing
trauma therapy.

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There is increasing evidence for the moderating role of personality traits on the severity of
PTSD symptoms (see, e.g., Lauterbach and Vrana, 2001; Strelau and Zawadzki, 2011). In particular,
personality traits such as neuroticism (Jorm et al., 2000) and the dimensions of temperament and
character identified by Cloninger (1994) (i.e., harm avoidance and novelty seeking) (Yoon et al.,
2009) are thought to contribute particularly strongly to the exacerbation of PTSD symptoms in the
general population and several patient groups. On the other hand, Lauterbach and Vrana (2001)
found that personality traits from the NEO-Five Factor Inventory (NEO-FFI), such as extraversion
and conscientiousness are protective factors and increase PTSD resilience. Aforementioned
personality traits correlate with temperament traits from the Regulative Theory of Temperament
(RTT), which were the focus in this manuscript. For example, Kandler (2012) investigated the
phenotypic, genetic, and environmental relationships between NEO-FFI personality traits and
temperamental traits on the basis of the RTT using a multitrait-multimethod twin dataset. In addition,
Hornowska (2011) proved the relationship between Cloninger's Psychobiological Model of
Personality (1994) and RTT traits in a representative sample of the Polish population.
The importance of personality traits, and especially temperament, for human behavior in
stressful situations is emphasized in the Regulative Theory of Temperament (RTT; Strelau, 2008).
According to the RTT approach, temperament is the inborn, biological foundation of personality. In
particular, temperament traits from RTT (which are described in more detail the Method section)
relate to formal characteristics of behavior, are present since early infancy in humans and animals,
demonstrate high heritability, and reveal themselves in all behaviors and situations, especially in
situations of extreme arousal. Temperament is a stress moderator, which means that temperament co-
determines the state of stress as well as its consequences, i.e. temperament traits from RTT influence
the way people perceive and react to certain stressors, as well as how they cope with stresfull
situations (Strelau and Zawadzki, 2005). The location of RTT traits among many other temperament
and personality theories has been demonstrated by means of correlational and factor analytic studies
conducted by other authors (Kandler et al., 2012).

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The link between temperament traits from RTT and symptoms of PTSD among individuals
exposed to trauma, as well as among clinical samples of individuals with PTSD has been noted
repeatedly in cases such as: trauma after flooding (Strelau and Zawadzki, 2005), trauma experienced
by firefighters (Strelau, 2008), trauma among participants of motor vehicle accidents (Zawadzki and
Popiel, 2012) and trauma associated with serious somatic illness (Fruehstorfer et al., 2012),
especially with HIV infection (Rzeszutek and Oniszczenko, 2013; Rzeszutek, et al. , 2012, 2015a)
and trauma among chronic pain patients (Rzeszutek et al., 2015b). However, to date, a paucity of
research has been devoted to the role of personality dimensions in STSD (Ortlepp and Friedman,
2001) and, particularly, there are no studies on the relationship between temperament traits and
STSD symptoms, so it is a key gap in the research that requires further study.
In addition to temperament variables, literature on traumatic stress also emphasizes the role of
social support as having an important role in altering the impact of PTSD (Dirkzwager et al., 2003;
Ozer et al., 2003). Social support could act as a buffer against traumatic stress, because, thanks to it,
people gain insight into their own abilities, increase their sense of resourcefulness and so change
their assessment of the traumatic stressor (Cieślak et. al., 2009). Despite this, studies on STSD have
shown conflicting results with regards to the role of social support (Adams et al., 2006; Catherall,
1995; Chrestman, 1999). Among counselors (Iliffe and Steed, 2000; Munroe et al., 1995) social
support, especially peer support groups, proved to mitigate the negative effect of secondary traumatic
stress disorder symptoms. These authors demonstrated that counselors' opportunities to process
traumatic material with peers were helpful in dealing with the negative consequences of working
with trauma victims. Peer support was especially helpful in combating feelings of isolation, and
providing an opportunity for sharing emotions and debriefing (Hunter and Schofield, 2006). The
significance of support was also noted in relation to counselors’ family and friends (Harrison and
Westwood, 2009). In contrast, Hyman (2004) found no relationship between the STSD symptoms
intensity and perceived social support among emergency workers, which can be explained by the fact
that STSD symptoms may deteriorate the level of actual support.

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The Current study
The current study explored the level of STSD symptoms in a sample of trauma therapists and
its relationship to temperament traits and aspects of social support. Due to the exploratory nature of
the research and the lack of unequivocal data in existing literature, we had non-directional
hypotheses. First, we expected an association between some temperament traits and the level of
STSD symptoms. Secondly, we expected a link between specific aspects of social support (perceived
social support, actual support, need for support and support seeking) and the level of STSD
symptoms among participants. In our analysis, we controlled for demographic data, including the
therapist’s gender and age, and work-related variables, such as the average number of years working
as a trauma therapist, the average number of patients the therapists worked with over the past 12
months, and whether participants sought supervision for their therapeutic work.
Method
Participants and procedure
The study included 80 trauma therapists working with people after various kinds of traumatic
events; the most prevalent were family violence and abuse, sexual assault, road accidents and death
of a close person. Participants' selection criteria encompassed having a master’s degree in clinical
psychology and a professional license in trauma therapy. From among the 210 therapists identified
who were eligible for the study, 80 were recruited (38%), 112 declined (53%), and 18 could not be
contacted (9%) due to appointment changes. There were 21 men and 59 women in the final sample,
aged 27-65 (M = 39.48, SD = 9.02). The number of years of working with these patient groups in
this sample ranged from 1 to 38 years (M = 9.45, SD = 8.02) and the average number of patients per
week the therapists worked with over the past 12 months or were working with at the time of the
study ranged from 3 to 45 (M = 10.44, SD = 8.89). Out of all therapists, 66 received supervision in
their therapeutic work. Participants worked in private practices or in crisis intervention centers and
clinics, in public mental hospitals, or a combination of these settings. The study was conducted in
various cities in Poland, including Warsaw, Cracow, Wroclaw and Katowice.

10
Surveys were disseminated in paper form only. The research questionnaires were sent by post
to participants’ private practices (with return envelopes) and also distributed by the Authors directly
at crisis intervention centers and public mental hospitals. Participants were informed about the aims
of the study, about the anonymity and confidentiality of individual results, filled out the
questionnaires in Polish, and did not receive any remuneration for their participation.
Materials
The first part of research questionnaire contained questions about demographic variables such
as gender and age. In this part, we also asked for information about details of trauma therapists’
practice, such as the average number of years working as a trauma therapist, the average number of
trauma survivors the therapists worked with over the past 12 months or were working at the time,
and whether participants sought supervision for their therapeutic work. The other three parts of the
questionnaire consisted of standardized psychological questionnaires that measured the variables of
interest in this study.
STSD symptoms. To measure the level of STSD symptoms we used the PTSD
Questionnaire: Factorial Version, which measures quantitative (psychometric) levels of trauma
symptoms (PTSD-F; Strelau, Zawadzki, Oniszczenko and Sobolewski, 2002). This inventory
contains 30 items, which can be divided into three scales, as identified through exploratory factor
analysis: Intrusion/Arousal (15 items), Avoidance/Numbing (15 items) and a Global Scale (all
items). The Intrusion/Arousal scale refers to persistent re-experiencing of the traumatic event and
intense negative psychological or physiological responses to any objective or subjective reminder of
the traumatic event, causing chronic symptoms of increased arousal not present before. The
Avoidance/Numbing scale refers to avoidance of stimuli associated with the trauma, causing
decreased involvement in significant life activities and decreased capacity to feel certain feelings.
Scores on each scale can be summed to calculate the general intensity of PTSD symptoms score
(Global Scale). The theoretical basis for the construction of the PTSD-F was the criteria for PTSD
contained in the DSM - IV (APA, 1994). Participants are asked to report on 4-point Likert-type

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scales how often in the past several months they experienced a given thought, behavior, or emotion
related to the traumatic event. Answers are given by selecting one of four options: (1) never, (2)
rarely, (3) often, and (4) always. The PTSD-F has satisfactory psychometric properties: the
reliabilities, assessed with Cronbach’s α, for the Intrusion/Arousal scale, the Avoidance/Numbing
scale, and the Global Scale are .96, .92, and .93, respectively. The reliabilities of these scales for the
current study was α = .88, .84, .91, respectively.
Temperament. In order to assess temperament traits, we used the Formal Characteristics of
Behavior-Temperament Inventory (FCB–TI; Strelau and Zawadzki, 1995), which is an
operationalization of RTT. The FCB-TI has 120 items, 20 items per six subscales, measuring specific
temperament traits (Cronbach’s α coefficients from Strelau and Zawadzki, 1995, in parentheses):
Briskness (speed, tempo and mobility of behaviour; 0.77); Perseveration (the tendency to maintain
and repeat emotional states; 0.79); Sensory sensitivity (the capacity to react to weak stimuli; 0.73);
Emotional reactivity (the tendency to react intensely to emotogenic stimuli; 0.83); Endurance (the
capacity to react adequately in highly stimulating situations; 0.85); and Activity (the tendency to
engage in behavior that is intrinsically or extrinsically highly stimulating; 0.84). Answers are given
in a YES or NO response format. These traits have been compared with other personality and
temperament dimensions measured by such questionnaires as the Neuroticism-Extraversion-
Openness Five-Factor Inventory (NEO-FFI; Kandler et al., 2012) and Temperament and Character
Inventory (TCI; Hornowska, 2011). The correlational and factor analytic findings showed high
theoretical validity of the FCB-TI subscales, apart from the Sensory Sensitivity scale. The scales
have test-retest stability scores ranging from .69 (Briskness) to .90 (Activity) (Strelau and Zawadzki,
1995).
Social support. The nature of participants’ social support was assessed with Schwarzer and
Schulz’s (2003) Berlin Social Support Scales (BSSS), adapted to Polish by Łuszczyńska, Kowalska,
Mazurkiewicz and Schwarzer (2006). The BSSS is a set of six scales to measure cognitive and
behavioral aspects of social support, including: perceived available support (the degree to which help

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from others is available); need for support (the degree to which social support in stressful situations
is important to the respondent); support seeking (the frequency or range of support from others that
the respondent seeks); actual support (the actual amount of support received from others); provided
support (a scale filled out by those who provide support to the respondent); and protective-buffering
support (this is a new construct that refers to protecting close others from bad news; this scale is
filled out by both the person receiving and the person providing support). Taking into consideration
that the two last scales should also be filled out by the support provider, which would be essentially
impossible within the temporal and logistical constraints of this study, only the first four scales were
used. Participants indicate their agreement with thirty-two statements on four-point Likert-type
scales, with the following answer options: strongly disagree (1), somewhat disagree (2), somewhat
agree (3), and strongly agree (4). The psychometric properties of the Polish version of the BSSS,
assessed on various groups of patients with chronic somatic illness (bypass operations, patients with
degenerative disease of the spine) proved to be satisfactory - results for particular subscales vary
from α = .74 to α = .90 (Łuszczyńska et al., 2006). The reliabilities of the BSSS subscales for the
current study were: perceived social support (α = .85); need for support (α = .78); support seeking (α
=.77); actually received support (α = .81).
Results
The statistical analysis of the data was conducted using IBM SPSS 21 statistical software
(SPSS Inc., 2012). First, we calculated the r-Pearson correlation coefficients for relationships
between the PTSD-F Global Scale
1
, control variables (gender, age, average number of years working
as a trauma therapist, average number of patients the therapist worked with over the past 12 months,
and whether participants sought supervision for their therapeutic work), the FCB-TI, and the BSSS.
Insert Table 1 about here
1
Authors also calculated the r-Pearson correlation coefficients for the Intrusion/Arousal and Avoidance/Numbing scales,
separately, with the FCB-TI and the BSSS and control variables. The results were similar to those presented in the Table
1. These results are available from the first Author upon request.

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As shown in Table 1, a moderate and significant positive correlation was observed between the
PTSD-F Global Scale and emotional reactivity. A moderate and significant negative correlation was
observed for the PTSD-F Global Scale and sensory sensitivity and perceived social support. No
significant correlation between the control variables, other examined temperament traits, aspects of
social support, and the PTSD-F Global Scale were observed.
We conducted a hierarchical regression analysis (inclusion model), examining all the
variables that correlated significantly with the PTSD-F Global Scale as predictors of STSD
symptoms (see Table 2). Emotional reactivity explained 11% of variance in the PTSD-F Global
Scale and proved to be a significant positive predictor of STSD symptoms among trauma therapists.
Sensory sensitivity (8% of variance explained) and perceived social support (7%) were both
negatively associated with STSD symptoms. These three variables explained 26% of variance in
STSD symptoms.
Insert Table 2 about here
Discussion
The performed correlation analysis and hierarchical regression analysis supported the idea
that there was a positive association between levels of emotional reactivity, and a negative
association between both sensory sensitivity and perceived social support with the level of STSD
symptoms in the group of trauma therapists. We did not observe a significant relationship between
demographic data or work-related variables and the intensity of STSD symptoms.
On the one hand, these results once again show the importance of emotional reactivity to
posttraumatic stress among individuals exposed to trauma, as well as among clinical samples of
individuals with PTSD (Oniszcznko and Laskowska, 2014; Strelau and Zawadzki, 2005). Emotional
reactivity is a tendency to react intensely to emotogenic stimuli, and it manifests in high sensitivity
and low emotional resistance (Strelau, 2008). This temperament trait is associated with chronically
high levels of emotional agitation and high excitability, which could intensify the consequences of
stress and make individuals more prone to experiencing negative emotional consequences of

14
traumatic stressors (Strelau and Zawadzki, 2011). Like other temperament traits from the RTT,
emotional reactivity is a temperament trait that exists prior to the traumatic events and influences the
state of stress as well as its consequences (Strelau, 2008). This trait is also positively correlated with
other personality traits that contribute to the intensification of PTSD symptoms, such as neuroticism,
introversion, anxiety, and harm avoidance (Hornowska, 2011).
On the other hand, we were quite surprised to find that sensory sensitivity correlated
negatively with the level of STSD symptoms among trauma therapists, because this finding had only
been reported in one other study till now, i.e. PTSD symptoms following HIV infection (Rzeszutek
and Oniszczenko, 2013). Sensory sensitivity is the capacity to react to weak stimuli (e.g.: scent, taste,
color, etc.) and this trait compensates excessive or insufficient stimulation (Strelau, 2008). It means
that sensory sensitivity is one's ability to perceive stimuli and then to regulate their response to
stimuli by either seeking out further stimulation or removing excessive stimulation depending on the
strength of the stimuli. Secondary trauma symptoms often lead to chronic, internal arousal (Stamm,
2005). On the other hand, individuals suffering from STSD usually experience increased social
isolation, which may deprive them of environmental stimulation (Newell and MacNeil, 2010). In this
context, intensification of sensory sensitivity may compensate for these processes by restoring
effective stimulation regulation, which may be disturbed by STSD symptoms. Nevertheless, this was
the first study to explore the role of sensory sensitivity in the case of such a specific topic, and it
needs further investigation.
Among all aspects of social support, only perceived social support was found to be
significantly and negatively related to the level of STSD symptoms among trauma therapists.
Insufficient social support in the aftermath of a traumatic event is a well-established factor altering
the impact of trauma on an individual (Ozer et al., 2003). In particular, some theorists have posited
that greater social support may be related to PTSD by impeding the development and persistence of
negative post-trauma cognitions (Ehlers and Clark, 2000; Vogt et al., 2007). However, some authors
have found that poor perceived social support, not actual support, seemed to be associated with

15
maintenance of PTSD symptoms severity (Robinaugh et al., 2011). The subjective belief that one has
a strong network could be a stronger protective factor for a therapist’s mental health against
secondary trauma than actual support, which sometimes could be inadequate to expectations.
Nevertheless, there is still no clear evidence if perceived social support helps to mitigate the
consequences of PTSD symptoms, or if the negative effects of traumatic events cause a decline in the
level perceived support (Łuszczyńska et al., 2013).
We did not observe a statistically significant relationship between therapists’ demographic
characteristics and work-related variables and the intensity of STSD symptoms in our sample. This
result is intriguing, as several other studies found that female gender (Sprang, et al., 2007), younger
age (Adams et al., 2006), fewer years of counseling experience (Kadambi and Truscott, 2004), high
caseload (Devilly et al., 2009) and a lack of professional support in the form of clinical supervision
(Pearlman and Saakvitne, 1995; Figley, 2002) may be predictive of more severe symptoms of STSD.
However, it worth remembering that 66 of the final 80 trauma therapists group were receiving
supervision and that 59 of the 80 were women. Both of these numbers may have caused reduced
variability in demographic and work variables and at the very least may partly explain the lack of
impact of those factors on the level of STSD in our sample. In contrast, in our sample only
intrapsychic variables, such as temperament traits and non-professional social support, were
associated with the degree of STDS symptoms. No studies to date have been conducted on the role of
temperament and STSD symptoms among trauma therapists, although a few authors draw attention
on the role of this kind of support and secondary trauma among therapists (Adams et al., 2006;
Catherall, 1995).
This study was not free of limitations. First of all, causality cannot be determined within this
study design. It is not fully clear, for example, how temperament traits or aspects of social support
change as a result of STSD symptoms. In addition, all measures were assessed at the same time, so
temporal precedence could not be tested.

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Second, we decided to use the PTSD-F questionnaire to measure STSD symptoms. Measures
like this are very sensitive to general distress, which could significantly impact the validity of the
findings (Renshaw et al., 2011). We also did not ask therapists about their own traumatic experiences
or preexisting psychopathology, which would likely affect their responses in this questionnaire.
However, we used this tool for two main reasons. First, researchers in the field of secondary trauma
generally agree that symptoms of STSD parallel symptoms of PTSD and mirror the experiences of
individuals who are directly exposed to trauma (Figley, 2002; Newell and MacNeil, 2010). The sole
differentiating feature between STSD and PTSD is whether an individual experiences trauma directly
or indirectly. In addition, other studies on STS also used tools prepared to measure PTSD (see, e.g.
Adams and Riggs, 2008; Hunter and Schofield, 2006; Creamer and Liddle, 2005). The second
argument was a practical one. At the time we conducted our research, there was no standardized
questionnaire to measure STSD symptoms adapted to Polish. Taking the above arguments, and the
very good psychometric properties of the PTSD-F into account, we decided to use this tool to
measure STSD symptoms in our sample, despite these limitations.
Thirdly, the vast majority of studies on STSD are based on the concept of trauma and post-
traumatic stress symptoms as defined by the DSM-IV (APA, 1994). Similarly, in our study we used
the PTSD-F questionnaire to measure STSD symptoms and the theoretical basis for the the PTSD-F
was the criteria for PTSD contained in the DSM - IV. Nowadays, there is an intensive debate on
changes in STSD definition according to DSM-V (APA, 2013) criteria and future research on the
conceptualization of STSD in the light of DSM-V is sorely needed (Briere and Scott, 2013).
Finally, we did not have full data on the diagnostic breakdown of patients being treated by the
therapists who participated in this study, i.e. we cannot directly state whether all these patients had a
full clinical diagnosis of PTSD. In addition, from among the 210 therapists who were eligible for the
study, only 80 were recruited (38%), 112 declined (53%), and 18 could not be contacted (9%), which
may raise doubt about how representative these proportions are to the larger population of trauma
therapists in Poland.

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To conclude, it is worth mentioning that further research on determinants of secondary
trauma among therapists is justified, as STSD symptoms may not only impact therapists’ clinical
effectiveness, but are also linked to the level of their quality of life (Newell and MacNeil, 2010). In
particular, trauma therapists should take into an account the role of social support as an important
factor protecting them from STSD symptoms. It is also important that trauma therapists be aware
that not only work settings, but also some intrapsychic variables, i.e. temperament traits, may be
linked to STSD symptoms.
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25
Tables
Table 1
r – Pearson correlation coefficients between PTSD-F Global Scale and control variables and
FCB-TI and BSSS scales in the entire sample of trauma therapists (N=80).
Control variables
PTSD-F Global Scale
Sex
-.19
Age
-.01
Years of experience
-.11
Number of patients over the
past 12 months
-.03
Clinical supervision
.14
FCB – TI scales
(N = 80)
Briskness
-.17
Perseveration
.16
Sensory sensitivity
-.29**
Emotional reactivity
.33**
Endurance
.19
Activity
.18
BSSS scales
(N = 80)
Perceived support
-.32**
Need for support
-.11
Support seeking
.07
Actual support
-.14
Note: **p<.01.
Table 2
Hierarchical regression analysis of selected temperament traits and social support aspects as predictors
of level of secondary traumatic stress disorder symptoms among the entire sample of trauma therapists
(N=80).
Model
F
F Δ
R
R²
Predictor
Semipartial
correlation
+Emotional
reactivity
9.64
a
***
-
.33
.11
Emotional
reactivity
.33***
+ Sensory
sensitivity
9.06
b
***
7.64***
.45
.19
Emotional
reactivity
Sensory sensitivity
.32***
-.29***
+ Perceived support
8.87
c
***
7.07**
.51
.26
Emotional
reactivity
Sensory sensitivity
Perceived support
.31***
-.24**
-.26**
Note:
a
df = 78;
b
df = 77;
c
df = 76; ** p<.01; *** p < .001.