APA 6 Dissertation Template

274 Pages·2016·2.59 MB·English

by  London Metropolitan University

The Effects of Secondary Trauma
on Professionals Working with Victims
and Survived Traumatized Individuals

Rita Konistan

A thesis submitted to the
Faculty of Applied Social Sciences and Humanities,
London Metropolitan University
for the degree of Doctor of Philosophy (PhD)

November 2016

Copyright © 2016 Rita Konistan
Dedication

This thesis is dedicated to my parents who encouraged me to begin my journey of education in
London.
I also dedicate this work to all loved ones that crossed my path and kept me motivated to
continue all these years of studying. Thank you all; and I am forever grateful to you.
Finally, this work is dedicated to my very missed and beloved friend, Azra, who always
told me that my determination in life will be awarded with success and happiness.
Acknowledgements

I sincerely thank my mother, father and brother for their faith in me and for providing me with
endless encouragement, hope and support.
I would like to gratefully thank Dr Amer Hosin for his guidance and most importantly, his
patience during my PhD at London Metropolitan University. He inspired me not only to grow as
a student but also as an independent thinker. It would not be possible for me to carry out my
research without his supervision, understanding and support.
Also, I would like to express my gratitude and deepest appreciation to my special friends
and loved ones in London and Sweden, whose friendship, knowledge and wisdom have
supported me throughout.
Abstract

Research on secondary traumatisation suggests that there is a certain overlap in terminologies
used in the literature that are related to the concept of secondary traumatic stress. These
interchangeable concepts include vicarious trauma, compassion fatigue, burnout and counter-
transference. The main aims of the current study are to investigate the differences between
various terms associated with post-traumatic stress disorder (PTSD) including secondary
traumatic stress, compassion fatigue and burnout. The present research also aims to investigate
the impact (direct and indirect influences) of secondary trauma on professionals working with
victims and survived traumatized individuals.
It was predicted that health workers who are exposed to psychological or physical traumas
would experience secondary traumatic stress. In addition, it was also hypothesized that there
would be gender differences in the intensity of secondary traumatic stress reactions. Longer
years of employment were predicted to relate to lower levels of secondary traumatic stress.
Furthermore, the profession would moderate the relationship between years of employment and
secondary traumatic stress.
A sample of 210 professional staff, working in several hospitals and private clinics, and
representing health and social care councils in London, United Kingdom completed four self-
reported questionnaires measuring secondary traumatic stress. Several hypotheses were
postulated and tested using correlation and hierarchical regression analyses. The results showed
that a majority of professionals working with traumatized patients displayed symptoms related to
secondary traumatic stress, in particular those professionals new to the field. However, a greater
reduction in symptoms was observed the longer an individual had spent in the profession. This
finding has suggested years of experience may help professionals employ resiliency against
severe traumatic events.
Other interesting findings reported in this study suggested that females are inclined to
experience higher secondary traumatic stress symptoms than males, regardless of years of
experience. The reported findings seem to be consistent with previously undertaken research
(Figley 1995; Miller and McGowen 2000; Robinson 2003; Sonneck and Wagner 1996; Stamm
2000).
It should be emphasized here that extra care, attention and support are essential to new
healthcare providers, especially during their first year of work. Researchers also need to develop
intervention programmes that will assist healthcare providers in their vital work in trauma care
settings – recognizing and dealing with the early stages of secondary stress symptoms and
reactions is of the utmost importance.
Table of Contents

Dedication
Acknowledgements
Abstract
Table of Contents
List of Tables
List of Figures
List of Abbreviations
Dedication ..................................................................................................... 2
Acknowledgements ...................................................................................... 3
Abstract ......................................................................................................... 4
Table of Contents ......................................................................................... 6
List of Tables .............................................................................................. 10
List of Figures ............................................................................................. 11
List of Abbreviations ................................................................................. 12
Introduction .................................................................................................. 1
0.0 Statement of the Problem ............................................................. 4
0.1 Significance of the Study ............................................................. 6
Chapter One ................................................................................................. 8
Literature Review: Part I ............................................................................ 8
1.0 A Historical Perspective of Post-traumatic Stress Disorder ........ 8
1.1 Diagnosis of Post-traumatic Stress Disorder ............................. 10
1.2 Time Course of Post-traumatic Stress Disorder......................... 13
1.3 The Psychological Oriented Theories of PTSD ......................... 18
1.4 Biological and Evolutionary Theories that Explain the Difference
between Trauma and Stress ................................................. 31
1.5 Concluding Remarks .................................................................. 39
Chapter Two ............................................................................................... 42
Literature Review: Part II ........................................................................ 42
2.0 Secondary Traumatic Stress, Compassion Fatigue and Burnout:
A Systematic Overview of Meta-Analysis Studies .............. 42
2.2 Concepts and Main Definitions of Secondary Traumatic Stress
Symptoms ............................................................................ 57
2.2.1 Counter-transference .................................................................... 60
2.3 Models of Secondary Traumatic Stress ..................................... 74
2.4 Level of Exposure to Patients’ Traumatic Material ................... 75
2.5 Type of Client Traumatic Material ............................................ 76
2.6 Personal History of Trauma ....................................................... 77
2.7 Professional Experience ............................................................. 78
2.8 Personality Factors and Personal Life Stressors ........................ 79
2.9 Support System .......................................................................... 79
2.10 Spirituality................................................................................ 80
2.11 Work Environment................................................................... 81
2.12 Supervision .............................................................................. 81
2.13 Professional Ethical Standards and Codes of Practice ............. 82
2.14 Prevention and Treatment Techniques for Secondary Traumatic
Stress .................................................................................... 83
2.15 Chapter Summary and Concluding Remarks ........................... 89
2.16 Purpose of this Research .......................................................... 90
Chapter Three ............................................................................................ 92
Methodology ............................................................................................... 92
3.0 Introduction ................................................................................ 92
3.1 Participants ................................................................................. 92
3.2 Procedure ................................................................................... 95
3.3 Instruments/Apparatus ............................................................... 96
3.4 Demographic Questionnaire ...................................................... 96
3.5 The General Health Questionnaire............................................. 96
3.6 The Pro-QOL Scale.................................................................. 100
3.7 The Secondary Traumatic Stress Scale .................................... 103
3.8 The Impact of Event Scale ....................................................... 105
3.9 Ethical Considerations ............................................................. 109
Chapter Four ............................................................................................ 110
Results ....................................................................................................... 110
4.0 Data Analysis ........................................................................... 110
4.1 Descriptive Statistics and Test of Mean Differences ............... 111
4.2 Correlation Analysis ................................................................ 117
4.3 Hierarchical Regression Modelling ................................... 130
Chapter Five ............................................................................................. 142
Discussion.................................................................................................. 142
5.0 Introduction .............................................................................. 142
5.1 Correlation Analysis of Proposed Questions ........................... 144
5.2 Tested Hypotheses ................................................................... 145
5.3 Healthcare Professionals Leaving Practice Due to the Negative
Reactions of Secondary Traumatic Stress.......................... 149
5.4 Cultural Differences in the Consequences and Prevention of
Secondary Traumatic Stress Symptoms............................. 157
5.5 Associations between Secondary Traumatic Stress Symptoms and
Professionals’ Well-being. ................................................. 164
5.6 Years of Employment and Gender Differences ....................... 170
5.7 Compassion Satisfaction .......................................................... 172
5.8 Compassion Fatigue ................................................................. 174
5.9 Burnout .................................................................................... 177
5.10 Intrusion, Avoidance and Arousal ......................................... 181
5.11 Emotional Distress ................................................................. 187
5.12 Secondary Traumatic Stress ................................................... 189
5.13 Concluding Remarks .............................................................. 191
Appendix A ............................................................................................... 208
Participant Information Sheet ................................................................ 208
Appendix B ............................................................................................... 211
Participant Consent Form ....................................................................... 211
Appendix C ............................................................................................... 212
Debriefing Sheet for Participants ........................................................... 212
Appendix D ............................................................................................... 214
Information Sheet for Manager of the Clinic ........................................ 214
Appendix E ............................................................................................... 215
Collaborating Organization Approval to be Signed by the Manager . 215
General Health Questionnaire (GHQ-30) .............................................. 216
Appendix G ............................................................................................... 219
Professional Quality of Life Scale ........................................................... 219
Appendix H ............................................................................................... 221
Emotional Impact of an Event Scale ...................................................... 221
List of Tables
Page No

3.1a Summary of Participants’ Demographic Data for Male Participants……………90

3.1b Summary of Participants’ Demographic Data for Female Participants…………90

4.1a Means and Standard Deviations for all of the Study Variables for each
Professional group……………………………………………………………....109

4.1b Kruskal-Wallis and Mann-Whitney U-test Results…………………………….109

4.2 Means, Standard Deviation, Cronbach’s alpha, and Correlations between Study
Variables Split by the Nature of Trauma Exposure…………………………….114

4.3 Means, Standard Deviation, Cronbach’s alpha and Correlations between Study
Variables Split by Gender………………………………………………………118

4.4 Means, Standard Deviation, Cronbach’s alpha and Correlations for Female
Participants according to the Nature of Trauma Exposure……………………..121

4.5 Means, Standard Deviation, Cronbach’s alpha and Correlations for Male
Participants, various variables and the Nature of Trauma Exposure…………...124

4.6a Standardized Regression Coefficients and Coefficients of Determination of the
Three-Step Hierarchical Regressions of Secondary Traumatic Stress………….126

4.6b Standardized Regression Coefficients and Coefficients of Determination of the
Three-Step Hierarchical Regressions of Secondary Traumatic Stress………….127