Is vicarious trauma a specific form of burnout?
Vicarious trauma is the only construct that specifically describes a cumulative, long-lasting impact on clinicians’ personal beliefs and world view. However, on closer examination, two of the three domains of burnout—cynicism or depersonalization and reduced sense of accomplishment or inefficacy—describe shifts in cognition, emotion, and behaviors. Vicarious trauma and burnout have been considered conceptually distinct from the assumption that cognitive disruptions associated with burnout are limited to work conditions while the effects of vicarious trauma are wider in scope. There are more polemical arguments about all the overlapping concepts than evidence in the literature to support this assumption. Conducting more research has been widely recommended and the accumulating literature on burnout in recent years could direct the path to conceptual clarity and significant implications for management.
Safety and wellness in the workplace
Congress created the Occupational Safety and Health Administration (OSHA), under the auspices of the Department of Labor, to assure workplace safety by reducing hazardous conditions that could cause worker illness and injury. OSHA interventions modify the work environment to minimize job-related risks from exposures to physical, biological, chemical, ergonomic, and psychosocial hazards and stressful work situations.6
Vicarious trauma is a psychological hazard for mental health clinicians and safe work conditions should demonstrate efforts at mitigating the effects of exposure to secondary trauma. In 2013, the American Psychiatric Association revised the PTSD diagnostic criteria DSM-5 and they added “repeated or extreme indirect exposure to aversive details of a traumatic event” as a qualifying stressor to meet criteria for diagnosis of PTSD. This criterion supports the assertion that secondary exposure to trauma is a job-related risk and suggests that if left unaddressed, vicarious trauma and burnout could progress to PTSD.
Studies have shown that integrating work safety and wellness programs is more effective in reducing chronic conditions.7 Wellness and self-care practices reduce individual risk-related factors while work safety reduces work-related risk factors. Examples of wellness programs are smoking cessation, weight control, healthy nutrition, physical activity, flu vaccination, meditation, and mindfulness. Combining wellness practices and psychological safety at work for clinicians is a comprehensive risk management approach to prevent vicarious trauma and burnout and foster resilience.
Meaningful action to foster resilience and prevent vicarious trauma and burnout
Integrate vicarious trauma education and training in curriculum
Residency training programs, internships/externships can adopt a primary prevention approach by integrating vicarious trauma and burnout in the academic curriculum. A course on trauma and PTSD is not complete without teaching vicarious trauma and a forum on burnout without discussing vicarious trauma is an oversight. FEMA and SAMHSA have recognized the need to better understand the negative mental health outcomes of disaster work by mandating programs to include training events and support services on compassion fatigue, secondary traumatic stress and vicarious trauma prior to deployment.8
Dr Quitangon is Clinical Assistant Professor of Psychiatry, New York University School of Medicine and Medical Director, Community Healthcare Network, New York, NY. Dr Quitangon reports that she receives royalties from Routledge for her book, Vicarious Trauma and Disaster Mental Health: Understanding Risks and Promoting Resilience.
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