The Relationship Between Secondary Traumatic Stress and Compassion Satisfaction: A Systematic Literature Review.

This systematic literature review examines the relationship between secondary traumatic stress (STS) and compassion satisfaction (CS) to identify the state of the science and directions for future research. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis framework was used to guide the identification and evaluation of studies. Eight academic databases were systematically searched between July and December of 2022 to identify articles and dissertations published in English or Hebrew between 2000 and 2022. Studies were considered for inclusion if they examined the relationship between STS and CS and met an established quality threshold. If studies used a mixed methods approach, only quantitative results were included in the review. The search strategy yielded 537 studies with 33 included in the final review. Findings of this review suggest experiences of high levels of STS can coexist with high levels of CS indicating that people can gain satisfaction from their work and experience STS. Most studies examined the relationship between STS and CS using bivariate analyses with variability found in the direction of the relationship. This variability was also found in multivariate studies included in this review. These findings suggest the need for interventions to address both STS and CS with attention paid to the potential negative impact of emotional contagion and the vulnerability of younger female practitioners. Future research should pay attention to the rigor of the analysis of STS and CS and the exploration of mediating or moderating mechanisms between these constructs.

Untangling secondary traumatic stress and vicarious traumatization: One construct or two?

OBJECTIVE: This study examined whether secondary traumatic stress (STS), defined by the expanded DMS-5-TR's depiction of traumatic stress which includes negative mood/cognition symptoms, fully captures the reactions of indirect trauma exposure or if vicarious traumatization (VT) is still a useful and separate construct to assess for. METHOD: An online survey was completed by 613 professionals working with individuals who experienced trauma. Correlations and network analysis were used to explore the overlap and distinctiveness of STS and VT reactions. RESULTS: High levels of STS and indirect trauma exposure were found in the current sample. A greater dose of daily indirect exposure was associated with a majority of STS and VT domains, and having less professional experience was associated with all STS and VT domains. Results of the network analysis suggested that STS and VT still continue to be unique yet related constructs. CONCLUSIONS: Although the negative mood/cognition addition to STS may not fully capture or replace the phenomenon of VT, these additional STS symptoms may further connect the two constructs. This indicates that current measures of STS may capture some but not all of the cognitive impacts of indirect trauma exposure. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

A Socioecological Approach to Understanding Secondary Trauma in Professionals Working with Survivors of Sex Trafficking: A Hierarchical Regression Analysis.

Individuals who are trafficked for sex have high rates of trauma exposure prior to and while being trafficked; therefore, professionals who work with this population are potentially exposed to high levels of trauma details increasing their risk of developing secondary traumatic stress (STS). This study investigated the STS symptoms of professionals working with survivors of sex trafficking utilizing a socioecological framework to guide the design and analysis. An online survey was completed by 583 respondents from a broad range of organizational settings who completed measures tapping into STS symptoms, lifetime trauma exposures, history of being sex-trafficked, dose of direct and indirect trauma exposure at work, use of emotional and instrumental support to cope, state report cards on sex trafficking policies, and organizational-level practices toward being STS informed. STS scores among professionals working with survivors of sex trafficking were high, with those in child welfare settings reporting the highest levels of STS. Hierarchical regression analysis indicates higher STS was associated with variables at all levels of the socioecological model except the macrosystem, with fewer years of experience, a history of being sex trafficked, higher dose of indirect exposure, less use of emotional support, and lower organizational STS scores predictive of higher distress. Together, study findings indicate that STS is a significant concern in the anti-trafficking workforce and that a socioecological framework is useful for understanding STS impacts, highlighting the value of multiple response strategies across levels. This analysis suggests that organizational-level strategies to ameliorate/buffer impacts of occupation-related trauma exposure among these professionals can be especially impactful.

Adversity's Impact on Adults' Self-Report and Physiological Difficulties with Emotion Regulation: Appraisal as a Moderating Mechanism.

Globally, there is a high prevalence of adversity exposure, and there is evidence indicating a linear association between adversity exposure, particularly childhood adversity, and adults' psychological distress. To better understand this association, researchers have examined the role of emotion regulation abilities, which are thought to impact and underlie one's psychological well-being. The present study examined the association between childhood versus adulthood adversity exposure and self-reported difficulties with emotion regulation and physiological indicators of emotion regulation (e.g., resting respiratory sinus arrythmia [RSA], RSA reactivity, and RSA recovery). Further, the study assessed appraisal styles (i.e., patterns of subjective interpretations) across adverse life events as a possible moderator to help explain why some, but not all, exposed to adversity may display emotion regulation difficulties. Participants were 161 adults participating in a larger federally funded project. Results found no direct association between childhood or adulthood adversity exposure and self-reported or physiological indicators of difficulties with emotion regulation. However, adulthood adversity exposure was associated with stronger trauma appraisal styles, and stronger trauma appraisal styles were associated with greater self-reported difficulties with emotion regulation and greater RSA reactivity. Results also showed interactions between greater childhood adversity and stronger trauma appraisal styles for lower resting RSA and greater RSA recovery. The present study demonstrates that emotion regulation is complex, dynamic, and has multiple dimensions and that childhood adversity may impact internal regulatory processes, but only in conjunction with trauma appraisal styles, which are associated with adulthood adversity.

Child Traumatic Stress and COVID-19: The Impact of the Pandemic on a Clinical Sample of Children in Trauma Treatment.

Given the scope and duration of the COVID-19 pandemic, it is not surprising that research has documented negative effects to youth's mental health. Yet, there is negligible research on the impact of the pandemic among clinical samples of youth receiving treatment for pre-existing trauma exposure and symptoms. The current study investigates COVID-19 as an index trauma, and if prior traumatic stress scores mediate the relationship between pandemic-related exposure and subsequent traumatic stress. METHODS: This is a study of 130 youth ages 7-18 receiving trauma treatment at an academic medical center. The University of California Los Angeles Post-traumatic Stress Disorder-Reaction Index (UCLA-PTSD-RI) was completed by all youth during intake as part of routine data collection. From April, 2020 to March, 2022 the UCLA Brief COVID-19 Screen for Child/Adolescent PTSD was also administered to assess trauma exposures and symptoms specifically-related to the pandemic experience. Univariate and bivariate analyses were conducted on all variables of interest to describe response patterns cross-sectionally and longitudinally; a mediational analysis was used to determine if prior trauma symptoms mediate the relationship between COVID-19 exposure and response. Additionally, interviews were conducted with youth using a series of open-ended questions about their perceptions of safety, threat and coping related to the pandemic. RESULTS: A quarter of the sample reported COVID-19 related exposures that would meet Criterion A for PTSD. Participants whose UCLA-COVID scores that exceeded the clinical cutoff had lower scores on two items measuring social support. There was no evidence of full or partial mediation. Responses to interview questions revealed low levels of threat reactivity, perceptions of no to little impact, positive changes, varying opinions on social isolation, some evidence of inaccurate messaging and adaptive coping using strategies learned in treatment. IMPLICATIONS: The findings broaden our understanding of the impact of COVID-19 on vulnerable children and provide insight into how prior trauma history and the provision of evidence-based trauma treatment impact a youth's response to pandemic conditions.

The role of secondary traumatic stress breakthrough champions in reducing worker trauma and improving organizational health using a configurational analysis approach.

Background: Emerging research has demonstrated that organizational efforts at becoming secondary traumatic stress (STS)-informed can improve the overall well-being of the workforce, especially when implementation activity by a champion team is high. Questions remain, however, regarding the mechanisms that enable these improvements. Method: This study uses configurational analysis to determine necessary and sufficient conditions to produce reductions in STS symptoms in workers as well as organizational improvements toward being more STS-informed in a cohort survey of 6,033 professionals working with individuals exposed to trauma representing 52 organizations. The Secondary Traumatic Stress Informed Organizational Assessment (STSI-OA) was used to measure professional's perceptions of how well the unit addressed secondary trauma in the workplace, and the Secondary Traumatic Stress Scale (STSS) assessed traumatic stress symptoms in respondents. Champions' activity was scored using the categories suggested by Shea. Results: For the STSS outcome, either a STSI-OA positive increase of 10 or more points or high levels of champion problem-solving were independently sufficient for an improvement in the outcome. The STSI-OA model had two pathways: high levels of peer engagement via the scaling up of innovations using PDSAs or the combination of facilitation of peer knowledge and skills together with working in a child welfare organization. Either pathway was sufficient by itself to yield the STSI-OA outcome. Conclusions: Identifying and cultivating the champions' use of problem-solving and peer engagement strategies can transform the threat posed by indirect trauma exposure into an opportunity for shared experience and healing. Plain Language Summary: Organizational champions are individuals or teams that strive to promote change within their workplace. These champions are integral to spreading innovative ideas and strategies and creating organization-wide changes ( Powell et al., 2015). However, little is known about the processes or specific strategies that make champions successful. One area in which champions are needed is in improving organizations' response to and understanding of secondary traumatic stress (STS), among those in helping professions that are indirectly exposed to trauma through the traumatic stories of those they work with. In fact, research has shown that organizational efforts to address STS improve the well-being of individual professionals within that organization ( Sprang et al., 2021). The present study sought to better understand what champion-related processes or conditions led to organizational change in addressing the effects of indirect exposure and improving symptoms related to STS. Results showed that organizational change in addressing STS and champions' problem-solving strategies resulted in reductions in individual professionals' STS symptoms. Furthermore, champions' use of peer engagement or sharing of knowledge among peers in child welfare settings led to improvements at an organizational level. These results show that organization-level change can have a direct impact on individual well-being and there are specific champion activities that can promote this change. Specifically, results demonstrate a need to identify and support champions' use of problem-solving and peer engagement strategies to turn the individual and organizational threat posed by indirect trauma into an opportunity for shared healing.

Using Project ECHO to Keep Professionals Well at Work: Individual and Organizational Outcomes.

OBJECTIVE: The toll of COVID-19 stress on the mental health of the workforce has been well-documented. The present study examined the use of the Project ECHO framework to provide practices and resources on stress management and emotion regulation to increase individual and organizational health and well-being. METHODS: Three independent ECHOs were designed and conducted over an 18-month period. Data was collected on the implementation of new learning and comparisons of organizational efforts toward being more secondary trauma responsive from baseline to post initiative, using cloud-based survey methods. RESULTS: Findings suggest that the use of micro-interventions at the organizational level improved over time in the areas of resilience-building and policy-making, and that individuals were actively integrating skills related to managing their stress. CONCLUSIONS: Lessons learned adapting and implementing ECHO strategies in the midst of a pandemic are offered, as well as how to cultivate wellness champions in the workforce.

Parenting stress and children's trauma symptoms over the course of TF-CBT: Examining differences between relative and foster/adoptive caregivers.

BACKGROUND: Through Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), the gold standard in children's trauma treatment, caregivers participate in sessions parallel to the child. However, much of the research examining the impact of this caregiver involvement has focused on biological or relative caregivers, despite the high prevalence of trauma and trauma symptoms among youth in foster care and high rates of parenting stress among foster/adoptive caregivers. OBJECTIVE: The current study examined differences among relative and foster/adoptive caregivers' levels of parenting stress throughout the course of TF-CBT and how these differences were associated with child trauma symptoms throughout treatment. PARTICIPANTS AND SETTING: Participants were 130 caregiver-child dyads (84 = foster/adoptive; 46 = biological/relative) who completed TF-CBT in either an academic-based clinic or an associated mental health agency. Providing clinicians were trained in TF-CBT, participated in case consultation, and received ongoing clinical supervision. METHODS: Children and caregivers completed baseline measures prior to beginning treatment and termination measures at the completion of treatment. RESULTS: Prior to treatment, foster/adoptive caregivers reported greater dysfunction in their parent-child interactions and relative caregivers reported greater personal stress. These differences were not seen at treatment termination, and significant reductions in child trauma symptoms and caregiver parenting stress were evidenced from pre to post treatment. Significant covariation between child trauma symptoms and relative caregiver parenting stress at termination was also found. CONCLUSIONS: There were different profiles of parenting stress for relative versus foster/adoptive caregivers, but treatment completion attenuated group differences in parenting stress over the course of treatment.

Cumulative Risk for Children's Behavior Problems and Child Abuse Potential among Mothers Receiving Substance Use Treatment: The Unique Role of Parenting Stress.

There is a high prevalence of children whose parents suffer with a substance use disorder (SUD), which is associated with negative outcomes for children such as behavior problems and parents' child abuse potential. To understand negative consequences for children, it is important to consider a cumulative risk model, examining the impact of multiple co-occurring risks, as well as examine unique singular risk factors, such as parenting stress, which may have a direct effect on outcomes as well as mediate an association between cumulative risk and outcomes. Data came from 99 mothers with SUD, engaged in a substance treatment program. Results found support for a cumulative risk model for child behavior problems and parents' child abuse potential, without the inclusion of parenting stress. However, parenting stress partially and fully mediated the relation between cumulative risk and child behavior problems and cumulative risk and parent child abuse potential, respectively. Results suggest the importance of intervention programs targeting parenting stress, to help reduce child behavior problems and parents' child abuse potential, among parents with high levels of risk and SUD.

Effects of Parents' Adversity Exposure on General and Child-Specific Hostile Attribution Bias.

Hostile attribution bias (HAB), or the tendency to interpret others' intent as hostile, has been linked to a variety of maladaptive outcomes including aggression and harsh parenting practices. The current cross-sectional study examined the influence of parents' childhood and adulthood adversity exposure (i.e., frequency and polyvictimization) in the development of HAB. Parents of 324 preschool-age children answered questions about hypothetical social scenarios to examine their general hostile attributions of others, hostile attributions specific to their children, and their endorsement of aggressive responses as a behavioral solution to the scenario. Results from structural equation modeling indicated parents' frequency of adversity and polyvictimization in adulthood were each positively associated with both general and child-specific HAB. However, parents' childhood adversity polyvictimization was negatively associated with child-specific HAB. Further, neither childhood nor adulthood adversity exposure were significantly associated with aggressive responding. The results highlight the importance of adulthood adversity exposure in understanding the relation between adversity and HAB. Future directions and implications of these findings are discussed.

Adversity Interpreted: A Scoping Review of Adversity Appraisal Measurement.

Although evidence suggests that individuals' appraisals (i.e., subjective interpretations) of adverse or traumatic life events may serve as a mechanism accounting for differences in adversity exposure and psychological adjustment, understanding this mechanism is contingent on our ability to reliably and consistently measure appraisals. However, measures have varied widely between studies, making conclusions about how best to measure appraisal a challenge for the field. To address this issue, the present study reviewed 88 articles from three research databases, assessing adults' appraisals of adversity. To be included in the scoping review, articles had to meet the following criteria: (1) published no earlier than 1999, (2) available in English, (3) published as a primary source manuscript, and (4) included a measure assessing for adults' (over the age of 18) subjective primary and/or secondary interpretations of adversity. Each article was thoroughly reviewed and coded based on the following information: study demographics, appraisal measurement tool(s), category of appraisal, appraisal dimensions (e.g., self-blame, impact, and threat), and the tool's reliability and validity. Further, information was coded according to the type of adversity appraised, the time in which the appraised event occurred, and which outcomes were assessed in relation to appraisal. Results highlight the importance of continued examination of adversity appraisals and reveal which appraisal tools, categories, and dimensions are most commonly assessed for. These results provide guidance to researchers in how to examine adversity appraisals and what gaps among the measurement of adversity appraisal which need to be addressed in the future research.

The Impact of Maltreatment on Internalizing Symptoms for Foster Youth: an Examination of Spirituality and Appraisals as Moderators.

Research shows that exposure to child maltreatment increases the risk of internalizing symptoms for youth, and that youth in foster care are at a particularly high risk of symptoms. However, not all youth who experience maltreatment evidence maladjustment, making the link between exposure and mental health outcomes unclear and creating a need to examine what factors buffer against symptomatology. A sample of youth in foster care was used to provide a new examination of the relation between child maltreatment exposure and internalizing symptoms, to test the possible moderating effects of both appraisals and spirituality, and examine differences between children and adolescents. Participants were 486 youth in foster care (M age = 13; 204 children; 282 adolescents). Youth completed self-report measures through the SPARK project (Studying Pathways to Adjustment and Resilience in Kids). Although appraisals and spirituality were not significant moderators, significant main effects emerged. For children, regression analyses showed that maltreatment exposure and lower scores on spiritual prosocial attitudes accounted for the majority of the 21% of the variance in internalizing symptoms. For adolescents 28% of the variance in internalizing symptoms was accounted for by greater maltreatment exposure, lower scores on spiritual prosocial attitudes, higher scores on relationship with a God/Higher Power, and more negative appraisals of stressful life events. The current study provides support for cognitive-based interventions for adolescents aimed at increasing appraisal flexibility and suggests that both children and adolescents could benefit from the development of prosocial attitudes often tied to spirituality but could be reinforced in additional settings.

Adversity exposure and obesogenic food consumption in young children: The transgenerational role of emotion dysregulation.

BACKGROUND: Childhood adversity is linked with unhealthy eating behaviours and obesity, but the mechanisms underlying this association are unclear, specifically the transgenerational behavioural precursors that develop in early childhood. OBJECTIVE: To determine whether adversity predicts change in obesogenic food consumption through child emotion dysregulation, and whether caregiver emotion dysregulation modifies this association. METHODS: Participants included 190 low-income caregiver-child dyads (mean child age = 4.31 years [SD = 0.85]). Cumulative lifetime adversity exposure was assessed via study-created measure. The Difficulties with Emotion Regulation Scale and Emotion Regulation Checklist assessed caregiver and child emotion dysregulation, respectively. Children's obesogenic food consumption was assessed at two time points 6 months apart using a caregiver-report measure: the Children's Eating Habits Questionnaire. Moderated mediation models were tested using autoregressive structural equation modelling. RESULTS: Cumulative lifetime adversity was associated with child emotion dysregulation only when caregiver emotion dysregulation was high. Child emotion dysregulation in turn was associated with greater obesogenic food consumption 6 months later. CONCLUSIONS: Among young children with caregivers high in emotion dysregulation, cumulative lifetime adversity was linked to an increase in obesogenic food consumption through child emotion dysregulation.

Spirituality and its Relation to Mental Health Outcomes: An Examination of Youth in Foster Care.

The effects of spirituality and youth relationships with others on internalizing, externalizing, and adaptive outcomes were examined in a sample of 159 youth between the ages of 8 and 21 in foster or residential care. Indirect effects of direct coping and perceived social support on the relations between these factors and youth outcomes were examined. Preliminary analyses indicated a significant relation between youth spirituality and adaptive outcomes, with a significant indirect effect of perceived social support on these relations. However, these relations were nonsignificant when accounting for youth relationships with others. Final results indicated that youth relationships with others significantly affected youth adaptive functioning through both coping and perceived social support. Youth relationships also significantly affected youth internalizing symptoms, albeit only through youths' perceived levels of social support. These findings suggest that, while spiritual beliefs are potentially an important factor in affecting outcomes for foster youth, the strongest effects likely occur through youths' relationships with others, social support, and coping in relation to adaptive outcomes for these youth.

The relation between dimensions of maltreatment, placement instability, and mental health among youth in foster care.

Youth in foster care with maltreatment experiences often demonstrate higher rates of mental and behavioral health problems compared to youth in the general population as well as maltreated youth who remain at home. Previous research has demonstrated that dimensions of maltreatment (type, frequency, and severity) and placement instability are two prominent factors that account for high rates of psychopathology (e.g., depression, anxiety, and disruptive behavior disorders). The present study sought to clarify the relation between maltreatment and mental health among youth in foster care by studying both the isolated dimensions of maltreatment and cumulative maltreatment, and to determine whether the effects of maltreatment on mental health operated indirectly through placement instability. Information on youth in foster care's (N = 496, Mage = 13.14) mental and behavioral health, maltreatment history, and placement changes were obtained from state records and primary caregivers. Using a SEM framework, the results suggest that maltreatment and placement instability each independently relate to mental and behavioral health problems. Further, none of the maltreatment types predicted greater placement instability in the current models. These findings suggest that placement stability is critical for mental health for youth in foster care, regardless of the type, severity, or frequency of their maltreatment experiences. Results also indicated that, although cumulative maltreatment predicted both internalizing and externalizing symptoms, maltreatment frequency and severity had direct relations to externalizing symptoms only. These findings underscore the utility of comprehensive maltreatment assessment, encouraging researchers and clinicians to assess and carefully consider the relation between maltreatment dimensions and outcomes.

Mental Health Outcomes for Youth Living in Refugee Camps: A Review.

Currently, there are approximately 10.8 million child refugees worldwide. Youth living in refugee camps face a wide range of difficulties placing them at risk for trauma exposure and negative mental health outcomes. However, little is known about the mental health functioning of these youth. The present review provides a systematic review of mental health outcomes for refugee/displaced youth residing in refugee camps. Twenty studies were included in the present review. Among these studies, the prevalence of mental health disorders varied greatly with some studies reporting null effects for disorders like posttraumatic stress disorder and others reporting prevalence as high as 87%. Levels of anxiety, somatic symptoms, depression, and aggression also varied across studies. The results point to the significant need for more research on the mental health of youth residing in refugee camps. Despite the wide range of measurement approaches, the evidence points to a fairly consistent finding of a range of maladjustment problems for youth living in refugee camps. Implications for improving the methodology for investigating mental health are discussed.

The role of poly-victimization in predicting differences in foster youths' appraisals.

The present article examines the role of poly-victimization (i.e., number of categories of maltreatment experiences and total maltreatment exposure) in predicting differences in appraisals for 272 youth in foster care (ages 8-21). Poly-victimization was hypothesized to be predictive of negative appraisal valence (i.e., interpreting the impact of a stressful life event as being bad/negative) and appraisal rigidity (i.e., interpreting the impact of life events as being consistently positive or negative across different events) above and beyond any single category of maltreatment. Results show a high prevalence of poly-victimization, such that those youth who experience only one form of maltreatment (e.g., physical, sexual, psychological, or neglect) are among the minority of maltreated youth. Additionally, results show that total maltreatment exposure, accounting for not only different categories of maltreatment but also different types or forms of maltreatment within those broader categories, is the most predictive of negative appraisal valence, above and beyond single categories of maltreatment and number of categories of maltreatment experienced. Contrary to the study's hypothesis, neither total exposure nor number of maltreatment categories experienced is significantly predictive of appraisal rigidity above and beyond single categories. Correlations also show that less rigid or more flexible appraisals are associated with more maltreatment experiences than are rigid appraisals. The current study highlights the importance of examining maltreatment from a poly-victimization perspective and begins to explain why some youth have more negative appraisals than others.