Secondary traumatic stress refers to the stress reactions that can arise when a person, without directly experiencing a traumatic event, witnesses or listens to the experience of someone who did, or is repeatedly exposed to images and accounts of the event.
What is secondary traumatic stress?
The concept has been discussed particularly in the context of helping professions, such as mental health professionals, health workers and disaster responders who work with people who have experienced trauma. The NCTSN (the US National Child Traumatic Stress Network) defines secondary traumatic stress as the emotional distress that results from hearing about another person’s firsthand traumatic experiences, and notes that its symptoms resemble those of post-traumatic stress disorder (PTSD). In the Turkish literature the concept is also referred to as “indirect trauma” and is described as a stress response a person experiences from witnessing an event, having knowledge of it, or being indirectly exposed to it because of their work (Gürkan and Yalçıner, 2017). Whether symptoms correspond to a diagnosis can be determined only through a comprehensive clinical evaluation.
Who can experience secondary traumatic stress, and how common is it?
Similar reactions can be seen not only in people who work in helping professions but also in people who care for relatives who have experienced serious illness, accidents or violence, and in people who are frequently exposed to news and images of disasters, war or violence. Whether reactions occur varies with the frequency and intensity of exposure, the person’s own past experiences, support systems and ways of coping.
The NCTSN cites studies reporting that 6% to 26% of therapists working with traumatized people, and up to 50% of child welfare workers, are at high risk of secondary traumatic stress or related conditions; a heavy caseload and social or organizational isolation may increase the risk. In a study of mental health workers in Türkiye (Zara and İçöz, 2015), 44.9% of participants were found to have above-average and 25.4% high levels of secondary traumatic stress (as reported in Gürkan and Yalçıner, 2017).
Can indirect exposure through news and social media create secondary traumatic stress?
Research has shown that intense and repeated exposure to media content about mass traumatic events can be associated with stress symptoms in some people. For example, in an online survey of about 4,700 adults after the Boston Marathon bombings (Holman, Garfin and Silver, 2014), people who spent six or more hours a day exposed to media content about the event were reported to have higher acute stress levels than people directly affected by it. Social media can spread images of events quickly and often unfiltered, which may increase the duration and intensity of exposure; however, research in this area is ongoing, and the same effect cannot be expected in every person.
The situation is different for PTSD criteria: the DSM-5 does not count exposure through electronic media, television, films or pictures as traumatic exposure unless it is work-related, and some argue that this rule should be reconsidered in the age of social media (Shoval-Zuckerman and Horesh, 2025).
What symptoms can occur?
Secondary traumatic stress reactions can vary from person to person. The NCTSN notes that the symptoms resemble those of PTSD; re-experiencing the event, increased arousal and avoidance reactions may occur. Some commonly described examples are:
- Unwanted thoughts and images of the event repeatedly coming to mind
- Avoiding news, people or situations that remind of the event
- Constantly being on guard, startling easily and tension
- Difficulty sleeping and nightmares
- Anxiety, helplessness, hopelessness, guilt, anger or emotional numbing
- Fatigue, difficulty with attention and concentration; physical complaints
These symptoms can also arise from other causes; the presence of symptoms alone does not mean secondary traumatic stress.
How do secondary traumatic stress, compassion fatigue, vicarious trauma and burnout differ?
These concepts are close to one another and can be used interchangeably in the literature; definitions can vary from author to author. The summary below is based on the NCTSN’s distinctions.
| Concept | In brief | Key point |
|---|---|---|
| Secondary traumatic stress | Emotional distress that results from hearing about another person’s firsthand traumatic experience | Symptoms resemble PTSD; can arise from at least one indirect exposure |
| Compassion fatigue | A term Figley proposed as a less stigmatizing label for secondary traumatic stress | Often used interchangeably with secondary traumatic stress |
| Vicarious trauma | Changes in the inner experience of a therapist who engages empathically with a client who has experienced trauma | Focuses on cumulative cognitive changes in the areas of trust, safety, control, esteem and intimacy |
| Burnout | Emotional exhaustion, depersonalization and a reduced sense of personal accomplishment | Develops from general occupational stress; not specific to indirect trauma exposure |
Gürkan and Yalçıner (2017) note that terms such as burnout, compassion fatigue, countertransference and cognitive change are also used in the literature in place of secondary traumatic stress. For more information about burnout, see What Is Burnout and How Is It Addressed in Psychotherapy?
How is secondary traumatic stress addressed in psychotherapy?
In psychotherapy, the aim is first to understand together what kinds of exposure the person encounters, when the symptoms began and how they affect daily life. The process may address emotion regulation and coping skills, managing exposure, recognizing one’s own limits and, when needed, trauma-focused work. Which approach is suitable is determined by the person’s needs and clinical evaluation.
The NCTSN notes that evidence on the effectiveness of interventions for secondary traumatic stress is limited, while cognitive behavioral strategies and mindfulness-based methods stand out as promising practices. For more on emotion regulation, see What Is Emotion Regulation? and Anxiety, Stress and Emotion Regulation Difficulties and How They Are Addressed in Psychotherapy; for the cognitive behavioral approach, see What Is Cognitive Behavioral Therapy (CBT)?
What can be considered at the individual and organizational level?
In exposure to news and social media
- Setting a time limit for news and social media consumption and avoiding this content, especially before sleep
- Not watching the same images and videos repeatedly; turning off the autoplay of videos
- Getting information from reliable and verified sources (see What Is Mental Health Literacy?)
- Maintaining basic routines such as sleep, nutrition and physical activity
- Sharing feelings with people they trust
In helping professions
The NCTSN states that the most important strategy for preventing secondary traumatic stress is the triad of psychoeducation, skills training and supervision, and that balancing caseloads, flexible scheduling and workplace self-care groups may also be preventive. Gürkan and Yalçıner (2017) likewise mention regular professional supervision and support groups. This information is general.
When can a mental health professional be consulted?
A mental health professional can be consulted if symptoms affect daily life significantly; for broader information, see When can psychological support be considered? If a person has thoughts of harming themselves, they do not need to carry these alone; telling someone they trust and contacting a health facility is recommended. If there is an immediate danger, the 112 Emergency Call Center in Türkiye can be contacted or the nearest hospital emergency department can be visited; whenever possible, it is important that the person is not left alone.
Common misconceptions about secondary traumatic stress
- “Secondary traumatic stress occurs only in mental health professionals.” The concept was defined in the context of helping professions; however, similar reactions can also be seen in relatives who provide care and in people who are frequently exposed to news or images.
- “Everyone who follows the news is affected.” The effect of media exposure varies from person to person; duration, intensity, past experiences and support systems play a role.
- “Being affected by another person’s experiences is a weakness.” The NCTSN notes that secondary traumatic stress is recognized as a common occupational hazard for professionals who work with children who have experienced trauma.
Expert note
When indirect exposure is involved, a person’s reaction is shaped not only by the nature of the event but also by their own past experiences, the load they carry at that time and their support network. For this reason, different people can be expected to react differently to the same news or the same account; in clinical work, these reactions are understood within the context of the person’s life story.
A perspective that draws on cognitive behavioral and psychodynamic theories considers thoughts, emotions, behaviors and relationship patterns together. Which approach, or which combination, is suitable usually becomes clear only after an evaluation process; the information in this article does not replace that evaluation.
Clinical Psychologist Özgün Emre Yaylacı
Frequently asked questions
Is secondary traumatic stress the same as post-traumatic stress disorder?
Symptoms can be similar; however, secondary traumatic stress refers to reactions that arise through indirect exposure in a person who did not directly experience the traumatic event. PTSD requires that specific diagnostic criteria be met; for example, exposure to news and images may not meet the traumatic exposure criterion unless it is work-related.
Are compassion fatigue and secondary traumatic stress the same?
The NCTSN states that compassion fatigue was proposed by Figley as a less stigmatizing label for secondary traumatic stress and is often used interchangeably with it. Definitions can vary from author to author.
Does following the news cause secondary traumatic stress in everyone?
No. The effect of media exposure varies from person to person; factors such as the duration and intensity of exposure, the person’s past experiences and support systems play a role.
How can a person protect themselves from secondary traumatic stress?
The NCTSN lists psychoeducation, skills training and supervision as the core prevention strategy, and adds that basic routines such as sleep, nutrition and exercise also matter. Evidence on the effectiveness of these interventions is limited.
When can support be considered for secondary traumatic stress?
Psychological support can be considered if symptoms have lasted for a long time and significantly affect sleep, work and relationships. If a person has thoughts of harming themselves, contacting a health facility is recommended; if there is an immediate danger, contacting the 112 Emergency Call Center in Türkiye is recommended.
Sources
This article is intended for general information; the following sources were consulted during its preparation (Turkish-language sources are marked, the others are in English):
- NCTSN (US National Child Traumatic Stress Network, 2011): Secondary Traumatic Stress: A Fact Sheet for Child-Serving Professionals
- Gürkan, A. and Yalçıner, N. (2017): Sağlık Çalışanlarında İkincil Travmatik Stres. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi, 6(2), 90–95 (in Turkish)
- Holman, E. A., Garfin, D. R. and Silver, R. C. (2014): Media’s role in broadcasting acute stress following the Boston Marathon bombings. PNAS, 111(1), 93–98
- Shoval-Zuckerman, Y. and Horesh, D. (2025): The DSM-5 exclusion of media exposure to traumatic events: A critical reexamination in light of the October 7, 2023, attacks. Psychological Trauma, 17(7), 1548–1550
- T.C. Sağlık Bakanlığı, Giresun İl Sağlık Müdürlüğü (Turkish Ministry of Health, Giresun Provincial Health Directorate): Hangi Durumlarda 112 Aranmalıdır? (in Turkish)
This article was prepared by Clinical Psychologist Özgün Emre Yaylacı. Last updated: October 23, 2026. The content is for general information only and does not constitute diagnosis, treatment or personal guidance.
