Exploring the Relationship Between Secondary Trauma, Compassion Fatigue, and Early Maladaptive Schemas in Mental Health Professionals Engaged in Post-Earthquake Interventions in Türkiye

Abstract

Earthquakes are a type of trauma that directly and indirectly affect people, as experts involved in post- earthquake efforts not only work with trauma victims but also face the responsibility of safeguarding their psychological well-being. Mental health professionals, even if they have not directly experienced a traumatic event, may still exhibit symptoms of Post-Traumatic Stress Disorder (PTSD) due to indirect exposure, such as witnessing the event or listening to the accounts of those affected. This condition, known as secondary trauma, encompasses the psychological effects experienced by individuals who work with trauma victims but have not directly experienced the traumatic event. Professionals involved in post-earthquake efforts are in contact with individuals who must cope with the consequences of earthquake, including those who have lost loved ones, been trapped under debris, have to undergo amputations, or have been displaced from disaster-stricken areas. Mental health experts in earthquake response can provide psychological assistance to these individuals. Each person has a unique trauma story that is worth listening to and understanding, and over time, mental health professionals may experience emotions, such as compassion fatigue, in addition to secondary trauma, which can make it challenging to perform their roles. This research in Türkiye explored the link between secondary trauma, compassion fatigue, and early maladaptive schemas among mental health professionals providing in-person and online support. Using a relational survey model, it was revealed that compassion fatigue and early maladaptive schemas jointly contributed to 49.7% of the secondary trauma variance. In addition, compassion fatigue predicted the secondary theme. Further studies should examine specific factors such as education, field of study, and professional experience of secondary trauma. The findings underscore the importance of creating tailored support programs and training for healthcare and mental health professionals to prevent or address compassion fatigue.

Keywords

• mental health professionals
• secondary trauma
• compassion fatique
• early maladaptive schemas

Türkiye'de Deprem Sonrası Müdahalelerde Bulunan Ruh Sağlığı Profesyonellerinde İkincil Travma, Merhamet Yorgunluğu ve Erken Uyumsuz Şemalar Arasındaki İlişkinin Araştırılması

Abstract

Depremler, insanları doğrudan ve dolaylı olarak etkileyen bir travma türüdür, çünkü deprem sonrası çalışmalarda yer alan uzmanlar yalnızca travma mağdurlarıyla çalışmakla kalmaz, aynı zamanda kendi psikolojik iyilik hallerini koruma sorumluluğuyla da karşı karşıya kalırlar. Ruh sağlığı profesyonelleri, travmatik bir olayı doğrudan yaşamamış olsalar bile, olaya tanık olmak veya etkilenenlerin anlattıklarını dinlemek gibi dolaylı maruziyet nedeniyle Travma Sonrası Stres Bozukluğu (TSSB) belirtileri gösterebilirler. İkincil travma olarak bilinen bu durum, travma mağdurlarıyla çalışan ancak travmatik olayı doğrudan yaşamamış olan bireylerin yaşadığı psikolojik etkileri kapsar. Deprem sonrası çalışmalarda yer alan profesyoneller, sevdiklerini kaybedenler, enkaz altında kalanlar, ampütasyon geçirenler veya afetten etkilenen bölgelerde yerlerinden edilenler de dahil olmak üzere depremin sonuçlarıyla başa çıkmak zorunda olan bireylerle temas halindedir. Deprem müdahalesinde görev alan ruh sağlığı uzmanları bu kişilere psikolojik yardım sağlayabilir. Her bireyin dinlemeye ve anlamaya değer benzersiz bir travma hikayesi vardır ve zaman içinde ruh sağlığı uzmanları ikincil travmaya ek olarak merhamet yorgunluğu gibi duygular yaşayabilir ve bu da rollerini yerine getirmelerini zorlaştırabilir. Türkiye'deki bu araştırma, yüz yüze ve çevrimiçi destek sağlayan ruh sağlığı uzmanları arasında ikincil travma, merhamet yorgunluğu ve erken dönem uyumsuz şemalar arasındaki bağlantıyı araştırmaktadır. İlişkisel bir araştırma modeli kullanılarak, merhamet yorgunluğunun ve erken dönem uyumsuz şemaların ikincil travma varyansının %49,7'sine ortaklaşa katkıda bulunduğu ortaya çıkmaktadır. Ve merhamet yorgunluğunun ikincil temayı yordamaktadır. Daha ileri çalışmalar, ikincil travma konusunda eğitim, çalışma alanı ve mesleki deneyim gibi spesifik faktörleri incelemelidir. Bulgular, merhamet yorgunluğunu önlemek veya ele almak için sağlık ve ruh sağlığı profesyonellerine yönelik özel destek programları ve eğitimler oluşturmanın önemini vurguluyor.

Keywords

• ruh sağlığı çalışanları
• ikincil travma
• merhamet yorgunluğu
• erken dönem uyumsuz şemalar

References

1. Adams, R. E., Boscarino, J. A., & Figley, C., R. (2006). Compassion fatigue and psychological distress among social workers: A validation study. Am J Orthopsychiatry, 76(1), 103-108. https://doi.org/10.1037/0002-9432.76.1.103
2. Adhikari, Y. (2017). A Comparative Study of Professional-Quality-of-Life Factors of Mental Health and Psychosocial Support (MHPSS) Professionals Working with Earthquake Victims and Other Trauma Victims in Nepal. The University of Liverpool.
3. Akasaka, M., & Kawashima, Y. (2019). Psychological first aid for children during the Kumamoto Earthquake disaster response in Japan. Intervention, Journal of Mental Health and Psychosocial Support in Conflict Affected Areas, 17(1), 103-108. https://doi.org/10.4103/INTV.INTV_3_18
4. Alavi, S. M., Kia-Keating, M., & Nerenberg, C. (2023). Secondary traumatic stress and burnout in health care providers: A post- disaster study. Traumatology, 29(3), 389–401. https://doi.org/10.1037/trm0000418
5. Altan, B. (2020). The Relationship Between Secondary Traumatic Stress, Maladaptive schemas, Childhood Traumas, Occupational and Sociodemographic Variables in Mental Health Workers. Işık Üniversitesi, İstanbul.
6. Bamber, M., & McMahon, R. (2008). Danger—early maladaptive schemas at work!: The role of early maladaptive schemas in career choice and the development of occupational stress in health workers. Clinical Psychology & Psychotherapy, 15(2), 96-112. https://doi.org/10.1002/cpp.564
7. Baum, N. (2016). Secondary traumatization in mental health professionals: A systematic review of gender findings. Trauma Violence Abuse, 17(2), 221-235. https://doi.org/10.1177/1524838015584357
8. Beaglehole, B., Mulder, R. T., Boden, J. M., & Bell, C. J. (2019). A systematic review of the psychological impacts of the Canterbury Earthquakes on mental health. Australian and New Zealand Journal of Public Health, 43(3), 274-280. https://doi.org/10.1111/1753-6405.12894

9. Bhusal, R., & Machamasi, S. (2019). Mainstreaming psychological first aid response during disaster events in Nepal.
10. International NGO Journal, 14(6), 70-75. https://doi.org/10.5897/INGOJ2019.0342
11. Boals, A., & Banks, J. B. (2020). Stress and cognitive functioning during a pandemic: Thoughts from stress researchers. Psychological Trauma: Theory, Research, Practice, and Policy, 12(1), 255-257. https://doi.org/10.1037/tra0000716
12. Borzyszkowska, A., Wojtynkiewicz, E., & Mamełka, K. (2023). Forgiveness and early maladaptive schemas and trauma among women with an alcohol-use disorder parent. Alcoholism and Drug Addiction/Alkoholizm i Narkomania, 36(1), 41-52. https://doi.org/10.5114/ain.2023.129515
13. Bride, B. E. (2001). Psychometric Properties of the Secondary Traumatic Stress Scale. The University of Georgia/Graduate Faculty, Georgia, ABD.
14. Büyüköztürk, Ş. (2009). Sosyal bilimler için veri analizi el kitabı (14. bs.). Pegem Yayıncılık.
15. Büyüköztürk, Ş., Kılıç Çakmak, E., Akgün, Ö., Karadeniz, Ş. & Demirel, F. (2013). Bilimsel araştırma yöntemleri. Pegem Akademi.
16. Clark, P., Holden, C., Russell, M., & Downs, H. (2022). The impostor phenomenon in mental health professionals: relationships among compassion fatigue, burnout, and compassion satisfaction. Contemporary Family Therapy, 44, 185-197. https://doi.org/10.1007/s10591-021-09580-y
17. Creamer, T. L., & Liddle, B., J. (2005). Secondary traumatic stress among disaster mental health workers responding to the September 11 Attacks. Journal of Traumatic Stress, 18(1), 89-96. https://doi.org/10.1002/jts.20008
18. Dar, I. A., & Iqbal, N. (2020). Beyond linear evidence: The curvilinear relationship between secondary traumatic stress and vicarious posttraumatic growth among healthcare professionals. Stress & Health, 36(2), 203- 212. https://doi.org/10.1002/smi.2932
19. Deighton, R. M., Gurris, N., & Traue, H. (2007). Factors affecting burnout and compassion fatigue in psychotherapists treating torture survivors: Is the therapist's attitude to working through trauma relevant? Journal of Traumatic Stress, 20(1), 63–75. https://doi.org/10.1002/jts.20180
20. Dinç, S., & Ekinci, M. (2019). Merhamet Yorgunluğu Kısa Ölçeği’nin Türkçeye uyarlanması, geçerlilik ve güvenirliği. Psikiyatride Güncel Yaklaşımlar 11(1), 192-202. https://doi.org/10.18863/pgy.590616
21. El-Khani, A., Calam, R., Cluver, L., Rakotomalala, S., & Maalouf, W. (2023). Urgent help needed for children affected by earthquake in Syria and Türkiye. Correspondence, 10(4), 246-247. https://doi.org/10.1016/S2215-0366(23)00060-3
22. Felix-Bonilla, B. (2019). Vicarious Trauma in Clinicians Working with the Military Community. ProQuest.
23. Figley, C. R. (1995). Compassion Fatigue: Coping with Secondary Traumatic Stress Disorder in Those Who Treat the Traumatized. Routledge.
24. Güzey, A. (2020). Mediating Role of Self-Compasiıon on the Relationship Between Early Maladaptive Schema Domains and Secondary Traumatic Stress of Refugee Aid Workers. Başkent University, Ankara.
25. Hadi, S., Widarna, D., Putri, L., & Kirana, D. L. (2020). Support Group Therapy as an Alternative to Reduce Stress in Caregiver ODGJ Lombok Earthquake Victims. In 2nd International Conference on Islam, Science and Technology (ICONIST 2019) (pp. 200-204). Atlantis Press.
26. Hesse, A. R. (2002). Secondary trauma: How working with trauma survivors affects therapists. Clinical Social Work Journal, 30(3), 293-309.
27. Harmanci-Seren, A. K., & Dikeç, G. (2023). The earthquakes in Turkey and their effects on nursing and community health. International Nursing Review, 70(3),255-455. https://doi.org/10.1111/inr.12851
28. Ivicic, R., & Motta, R. (2017). Variables associated with secondary traumatic stress among mental health professionals. Traumatology, 23(2), 196–204. https://doi.org/10.1037/trm0000065
29. Kahil, A. (2016). An Assessment of Secondary Traumatic Stress in Those Who Engage in a Helping Behavior With People Who Have Traumatic Life Events. Master’s Thesis, Ankara, 2016
30. Kahil, A., & Palabıyıkoğlu, N. R. (2018). Secondary traumatic stress. Current Approaches in Psychiatry, 10(1), 59-70. https://doi.org/10.18863/pgy.336495
31. Kalaycı, Ş. (2008). SPSS uygulamalı çok değişkenli istatistik teknikleri. İstanbul: Asil Yayın Dağıtım.
32. Leung, T., Schmidt, F., & Mushquash, C. (2023). A personal history of trauma and experience of secondary traumatic stress, vicarious trauma, and burnout in mental health workers: A systematic literature review. Psychological Trauma: Theory, Research, Practice, and Policy, 15(Suppl 2), S213–S221. https://doi.org/10.1037/tra0001277
33. Li, Y., Zhu, H., Ren, Z., Lui, S., Yuan, M., Gong, Q., Yuan, C., Gao, M., Qiu, C. & Zhang, W. (2020). Exploring memory function in earthquake trauma survivors with resting-state fMRI and machine learning. BMC Psychiatry, 20(43). https://doi.org/10.1186/s12888-020-2452-5
34. Martin-Cuellar, A., Lardier Jr, D. T., Atencio, D. J., Kelly, R. J., & Montanez, M. (2019). Vitality as a moderator of clinician history of trauma and compassion fatigue. Contemporary Family Therapy, 41, 408-419. https://doi.org/10.1007/s10591-019- 09508-7
35. Oginska-Bulik, N., Gurowiec, P. J., Michalska, P., & Kedra, E. (2021). Prevalence and predictors of secondary traumatic stress symptoms in health care professionals working with trauma victims: A cross-sectional study. PLoS ONE 16(2): e0247596. https://doi.org/10.1371/journal.pone.0247596
36. Pak-Güre, M. D. (2022). How to help the helpers?: Integrative group therapy practices with professionals in disasters. Turkish Journal of Social Work, 6(1), 29-40. Retrieved from https://dergipark.org.tr/tr/pub/scd/issue/70388/1096597
37. Patwary, M. M., Ashraf, S., Swed, S., Beaglehole, B., & Shoib, S. (2023). Natural disaster and mental health of emergency rescue workers: Lessons learned from Turkey-Syria Earthquake. Annals of Work Exposures and Health, 67(8), 1018- 1021. https://doi.org/10.1093/annweh/wxad043
38. Pilkington, P. D., Spicer, L., & Wilson, M. (2022). Schema therapists’ perceptions of the influence of their early maladaptive schemas on therapy. Psychotherapy Research, 32(7), 833-846, https://doi.org/10.1080/10503307.2022.2038804
39. Pirelli, G., Formon, D. L., & Maloney, K. (2020). Preventing vicarious trauma (VT), compassion fatigue (CF), and burnout (BO)in forensic mental health: Forensic psychology as exemplar. Professional Psychology: Research and Practice, 51(5), 454–466. https://doi.org/10.1037/pro0000293
40. Rauvola, R. S., Vega, D. M., & Lavigne, K. N. (2019). Compassion fatigue, secondary traumatic stress, and vicarious traumatization: a qualitative review and research agenda. Occupational Health Science, 3, 297-336. https://doi.org/10.1007/s41542-019-00045-1
41. Rezaei, M., Ghazanfari, F., & Rezaee, F. (2016). The role of childhood trauma, early maladaptive schemas, emotional schemas and experimental avoidance on depression: A structural equation modeling. Psychiatry Research, 246, 407-414. http://dx.doi.org/10.1016/j.psychres.2016.10.037
42. Rivera-Kloeppel, B., & Mendenhall, T. (2023). Examining the relationship between self-care and compassion fatigue in mental health professionals: A critical review. Traumatology, 29(2), 163–173. https://doi.org/10.1037/trm0000362
43. Saddichha, S., Kumar, A., & Pradhan, N. (2012). Cognitive schemas among mental health professionals: Adaptive or maladaptive?. Journal of Research in Medical Sciences, 17(6), 523-526.
44. Salloum, A., Kondrat, D. C., Johnco, C., & Olson, K. R. (2015). The role of self-care on compassion satisfaction, burnout and secondary trauma among child welfare workers. Children and youth Services Review, 49, 54-61. http://dx.doi.org/10.1016/j.childyouth.2014.12.023
45. Simpson, S., Simionata, G., Smout, M., van Vreeswijk, M. F., Hayes, C., Sougleris, C., & Reid, C. (2018). Burnout amongst clinical and counselling psychologist: The role of early maladaptive schemas and coping modes as vulnerability factors. Clinical Psychology & Psychotherapy, 26(1), 35-46. https://doi.org/10.1002/cpp.2328
46. Singh, J., Karanika-Murray, M., Baguley, T., & Hudson, J. (2020). A systematic review of job demands and resources associated with compassion fatigue in mental health professionals. International Journal of Environmental Research and Public Health, 17(19), 6987. https://doi.org/10.3390/ijerph17196987
47. Somoray, K., Shakespeare‐Finch, J., & Armstrong, D. (2017). The impact of personality and workplace belongingness on mental health workers' professional quality of life. Australian Psychologist, 52(1), 52– 60. https://doi.org/10.1111/ap.12182
48. Soygüt, G., Karaosmanoğlu, A., & Çakır, Z. (2009). Assessment of early maladaptive schemas: A psychometric study of the Turkish Young Schema Questionnaire-Short Form-3. Turkish Journal of Psychiatry, 20(1), 75-84.
49. Sprang, G., Ford, J., Kerig, P., & Bride, B. (2019). Defining secondary traumatic stress and developing targeted assessments and interventions: Lessons learned from research and leading experts. Traumatology, 25(2), 72-81. https://doi.org/10.1037/trm0000180
50. Tabachnick, B. G., Fidell, L. S., & Ullman, J. B. (2007). Using Multivariate Statistics (Vol. 5, pp. 481-498). Boston, MA: Pearson.
51. Tominaga, Y., Goto, T., Shelby, J., Oshio, A., Nishi, D., & Takahashi, S. (2020). Secondary trauma and posttraumatic growth among mental health clinicians involved in disaster relief activities following the 2011 Tohoku earthquake and tsunami in Japan. Counseling Psychology Quarterly, 33(4), 427-447. https://doi.org/10.1080/09515070.2019.1639493
52. Vagni, M., Maiorano, T., Giostra, V., & Pajardi, D. (2020). Coping with COVID-19: Emergency stress, secondary trauma and self-efficacy in healthcare and emergency workers in Italy. Frontiers in Psychology, 11. https://doi.org/10.3389/fpsyg.2020.566912
53. Vasilopoulou, E., Karatzias, T., Hyland, P., Wallace, H., & Guzman, A. (2020). The mediating role of early maladaptive schemas in the relationship between childhood traumatic events and complex posttraumatic stress disorder symptoms in older adults (>64 years). Journal of Loss and Trauma, 25(2), 141-158. https://doi.org/10.1080/15325024.2019.1661598
54. Young, J. E., Klosko, J. S, & Weishaar, M. E. (2003). Schema Therapy: A Practitioner’s Guide. The Guilford Press.
55. Zheng, S., Stewart, J. G., Bagby, M., & Harkness, K. L. (2022). Specific early maladaptive schemas differentially mediate the relations of emotional and sexual maltreatment to recent life events in youth with depression. Clinical Psychology & Psychotherapy, 29(3), 1020-1033. https://doi.org/10.1002/cpp.2681