The Cost of Caring:
Secondary Traumatic Stress and the Impact of Working with High-Risk Children and Families

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Lesson 2: Post-Traumatic Stress Disorders and Secondary Trauma

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In order to understand how Post-Traumatic Stress Disorders and Secondary Trauma Symptoms develop, it is important to first understand how the human mind and body respond to threat.  The human brain changes with repetition.  If the brain is continually in a state of alarm due to a chaotic, hostile or unpredictable work situations -- the brain adapts to stay in a continuous state of alarm which alters the way they think, feel and behave.  Chronic activation of the stress response causes the body to essentially wear down -- and, ultimately, wear out.   Hence, fatigue, lethargy, amotivation, sleep and eating problems, cardiovascular and respiratory problems result.

But first, read on to learn more about "The Alarm State."

The Alarm State

The human body and human mind have a set of very important and very predictable responses to threat.  Threat may come from an internal (e.g., pain) or external (e.g., an assailant) source.  One common reaction to danger or threat has been labeled the ‘fight or flight’ reaction.  In the initial stages of this reaction there is a response called the alarm reaction.

As the individual begins to feel threatened, the initial stages of a complex, total-body response will begin. The brain orchestrates, directs and controls this response.  If the individual feels more threatened, their brain and body will be shifted further along an arousal continuum in an attempt to ensure appropriate mental and physical responses to the challenges of the threat.  The cognitive, emotional and behavioral functioning of the individual will reflect this shift along the arousal continuum.  During the traumatic event, all aspects of functioning of the individual change – feeling, thinking, behaving all change.  Someone being assaulted doesn’t spend a lot of time thinking about the future or making an abstract plan for survival.  At that moment, their thinking, behaving and feeling is being directed by more ‘primitive’ parts of the brain (see Table in Appendix).  A frightened child doesn’t focus on the words; they attend to the threat related signals in their environment – the non-verbal signs of communication such as eye contact, facial expression, body posture or proximity to the threat.  The internal state of the child shifts with the level of perceived threat.  With increased threat, a child moves along the arousal continuum from vigilance through to terror.

The alarm continuum is characterized by a graded increase in sympathetic nervous system activity, in turn, causing increased heart rate, blood pressure, and respiration, a release of glucose stored in muscle and increased muscle tone.  Changes in the central nervous system cause hypervigilance; the child tunes out all non-critical information. These actions prepare the child to fight with, or run away from, the potential threat. This total body mobilization, the “fight or flight” response, has been well characterized and described in great detail for adults. These responses are highly adaptive and involve many coordinated and integrated neurophysiological responses across multiple brain areas such as the locus coeruleus, the amygdala, the hypothalamus and the brainstem nuclei responsible for autonomic nervous system regulation. 

Post-Traumatic Stress Disorders and Secondary Trauma

In the first days and weeks following the traumatic event, the symptoms listed above, 1) re-experiencing phenomena, 2) attempts to avoid reminders of the original event and 3) physiological hyper-reactivity are all relatively predictable, and indeed, highly adaptive physiological and mental responses to a trauma.

Unfortunately, the more prolonged the trauma and the more pronounced the symptoms during the immediate post-traumatic period, the more likely there will be long term chronic and potentially permanent changes in the emotional, behavioral, cognitive and physiological functioning of the child. It is this abnormal persistence of the originally adaptive responses that result in trauma-related neuropsychiatric disorders such as Post-traumatic Stress Disorder (PTSD).

The symptoms developed by persons suffering from PTSD or Secondary Trauma are nearly identical. The only difference is that, with Secondary Trauma, the traumatizing event experienced by one person becomes a traumatizing event for the second person.


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