Secondary Traumatic Stress Scale

Abstract

The Secondary Traumatic Stress Scale (STSS) is a crucial 17-item self-report instrument utilized extensively in clinical and research settings to quantify the presence and severity of Secondary Traumatic Stress (STS) among professional caregivers. STS is defined as the emotional and psychological distress resulting from indirect exposure to the traumatic experiences of clients, often conceptualized as "the stress resulting from helping or wanting to help a traumatized person." Developed by Bride and colleagues, the STSS is structured to mirror the core diagnostic criteria of Post-Traumatic Stress Disorder (PTSD), making it a specialized measure of occupational stress.

The scale assesses symptoms across three distinct and empirically supported dimensions: Intrusion (re-experiencing symptoms), Avoidance (emotional numbing and detachment), and Arousal (hypervigilance and physiological reactivity). Respondents utilize a 5-point Likert scale to indicate the frequency of symptom experience, yielding a total score that reflects overall STS severity. Its robust psychometric properties, including high internal consistency and strong construct validity, affirm the STSS as a standard tool for assessing professional well-being, informing intervention strategies, and guiding research in high-exposure fields such as social work, counseling, and emergency services.

Keywords

Secondary Traumatic Stress Scale, STSS, Secondary Traumatic Stress, STS, Vicarious Trauma, Compassion Fatigue, PTSD symptoms, Occupational Stress, Psychological assessment, Professional well-being, Trauma exposure, Social Work Practice.

Authors

B.E. Bride, M.R. Robinson, B. Yegidis, C.R. Figley.

Purpose

The primary purpose of the STSS is to provide a reliable, valid, and quantitative instrument for measuring the specific psychological distress experienced by clinicians, therapists, and service providers stemming from indirect exposure to client trauma. Prior to the development of the STSS, practitioners often struggled to differentiate the unique impact of secondary trauma from general job burnout or compassion fatigue. The STSS fills this critical measurement gap by focusing precisely on the three symptomatic clusters analogous to PTSD.

By quantifying the frequency and intensity of these symptoms, the scale serves multiple critical functions. It acts as an essential screening tool in occupational health settings to identify individuals at significant risk of developing severe STS, which can severely compromise professional functioning, therapeutic effectiveness, and personal quality of life. Furthermore, in research contexts, the STSS facilitates the rigorous study of preventative measures, risk factors, and the effectiveness of targeted intervention strategies designed to mitigate the effects of secondary trauma exposure.

Construct

The STSS is designed to measure the construct of Secondary Traumatic Stress (STS). STS is fundamentally conceptualized as the natural, yet potentially debilitating, behaviors and emotional responses that arise in the helper as a result of deep, empathic engagement with a traumatized client. This repeated, indirect exposure leads to a transformation in the helper’s inner experience, often manifesting as symptoms that parallel those of the primary trauma survivor.

The construct is rigorously modeled after the diagnostic criteria for Post-Traumatic Stress Disorder (PTSD). The 17 items of the scale are distributed across the three canonical symptom clusters: Intrusion (involuntary re-experiencing of the client’s trauma through thoughts or dreams), Avoidance (efforts to suppress thoughts or feelings related to the trauma, leading to emotional numbing), and Arousal (persistent symptoms of hypervigilance, irritability, and physiological reactivity). The scale thus provides a comprehensive, structured profile of the secondary trauma experience.

Validity

The validity of the STSS has been strongly established through comprehensive psychometric evaluation since its initial publication in 2004. The original validation study conducted by Bride et al. provided compelling evidence for the scale’s fundamental structure and utility. Specifically, the STSS demonstrated excellent construct validity, confirming that the 17 individual scale items reliably load onto the hypothesized three-factor model: Intrusion, Avoidance, and Arousal. This structure confirms that the scale accurately measures the intended theoretical construct of STS as distinct from general distress.

Furthermore, studies have consistently supported the scale’s convergent validity, showing significant and expected correlations between STSS scores and measures of related concepts, such as general psychological distress and burnout. Crucially, the STSS maintains sufficient discriminant validity, confirming that while related, it captures a unique aspect of occupational distress—the specific impact of secondary trauma exposure—that is not fully accounted for by measures of generalized stress or job dissatisfaction.

Reliability

The STSS exhibits strong evidence of internal consistency, which confirms its high reliability across diverse populations of helping professionals. High internal consistency indicates that the items within each subscale reliably measure the same underlying construct. Initial psychometric findings reported impressive Cronbach’s alpha coefficients for the subscales, reflecting excellent measurement precision and stability. The reported coefficients are:

• Intrusion: 0.80
• Avoidance: 0.87
• Arousal: 0.83

These empirically derived values confirm the exceptional coherence and reliability of the STSS subscales, establishing the instrument as highly suitable for both rigorous academic research and sensitive clinical screening applications where precise measurement is essential for accurate assessment of symptom severity.

Factor Analysis

The theoretical framework of the STSS is underpinned by a stable and replicable three-factor structure, which was rigorously derived and confirmed through both exploratory and confirmatory factor analysis techniques. This structure is a deliberate reflection of the internationally recognized symptom clusters for PTSD, ensuring clinical relevance and theoretical alignment. The 17 items are precisely distributed across the three subscales:

• Intrusion: (Items 2, 3, 6, 10, 13) This five-item factor assesses the re-experiencing component of trauma, capturing phenomena such as disturbing thoughts, dreams, or physiological reactions triggered by client trauma narratives.
• Avoidance: (Items 1, 5, 7, 9, 12, 14, 17) Comprising seven items, this subscale measures efforts to avoid reminders of the trauma, emotional detachment, reduced social engagement, and feelings of emotional numbing.
• Arousal: (Items 4, 8, 11, 15, 16) This five-item factor assesses symptoms of heightened physiological reactivity and hypervigilance, including difficulty sleeping, concentration problems, irritability, and an expectation of impending danger.

The consistency of this three-factor model across various cross-cultural and occupational studies solidifies the STSS as a robust and theoretically sound measure of Secondary Traumatic Stress.

Instrument

Test Type: Self-report questionnaire, psychometric scale.

Format: 17 items rated on a 5-point frequency Likert scale.

Language Available: Primarily English; translated versions exist across various languages following international validation studies.

Population Group: Helping professionals exposed indirectly to trauma.

Age Group: Adult (typically professionals aged 18 and older).

Population Details: Social workers, counselors, therapists, medical personnel, emergency responders, and other caregivers who work directly with traumatized clients.

Test Methodology: Respondents rate how often they have experienced each symptom in relation to their work with clients over a specified period. The rating scale is: 1-Never, 2- Rarely, 3- Occasionally, 4- Often, 5- Very Often. Scores are totaled for each subscale (Intrusion, Avoidance, and Arousal) and summed to provide a total STS score.

Keywords

Secondary Traumatic Stress Scale, STSS, Intrusion, Avoidance, Arousal, Trauma workers, Professional well-being, Screening tool, Social Work, Caregiver stress.

Authors

Author ORCID Identifier: N/A

Affiliation Email addresses: N/A

Correspondence Address: N/A

Permissions & Fee and Test Year

The STSS was initially developed and validated in 2004 by Bride, Robinson, Yegidis, and Figley. The scale is frequently used freely for non-commercial research and clinical applications. Users seeking formal permissions for commercial use or large-scale distribution should consult the primary authors or the publishing journal, Research on Social Work Practice. The instrument is widely accessible for academic purposes, and scoring sheets are often shared openly online.

Reference’s

Bride, B.E., Robinson, M.R., Yegidis, B., & Figley, C.R. (2004). Development and validation of the Secondary Traumatic Stress Scale. Research on Social Work Practice, 14: 27-35.

Ting, Laura., Frey J. J., Sanders, Sara., Harrington, D. (2005). The Secondary Traumatic Stress Scale (STSS). Journal of Human Behavior in the Social Environment 11(3-4): 177-194.

Kazemi AS. (2011). Psychometric ch‎aracteristics of STSS. Contemporary Psychology, 5: 638-40.

The original PDF of the scoring and scalesheets can be downloaded here: http://ja.cuyahogacounty.us/pdf_ja/en-us/defendingchildhood/drch‎arlesfigley-scoring-scalesheets.pdf

An additional resource PDF for the scale is available here: http://academy.extensiondlc.net/file.php/1/resources/TMCrisis20CohenSTSScale.pdf

Items of the Secondary Traumatic Stress Scale

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

1. I felt emotionally numb
2. My heart started pounding when I thought about my work with clients
3. It seemed as if I was reliving the trauma(s) experienced by my client(s)
4. I had trouble sleeping
5. I felt discouraged about the future
6. Reminders of my work with clients upset me
7. I had little interest in being around others
8. I felt jumpy
9. I was less active than usual
10. I thought about my work with clients when I didn’t intend to
11. I had trouble concentrating
12. I avoided people‚ places‚ or things that reminded me of my work with clients
13. I had disturbing dreams about my work with clients
14. I wanted to avoid working with some clients
15. I was easily annoyed
16. I expected something bad to happen
17. I noticed gaps in my memory about client sessions

Scoring Categories:

• Intrusion: (Items 2, 3, 6, 10, 13)
• Avoidance: (Items 1, 5, 7, 9, 12, 14, 17)
• Arousal: (Items 4, 8, 11, 15, 16)

Response Scale: 1-Never‚ 2- Rarely‚ 3- Occasionally‚ 4- Often‚ 5- Very Often