The Helpers’ Stress Effects of a Web-Based Intervention Aiming at Changes in Secondary Traumatic Stress and Secondary Traumatic Growth Roman Cieslak1,2, Katarzyna Zukowska1, Anna Rogala1, Ewelina Smoktunowicz1, Martyna Kowalska1 & Aleksandra Luszczynska1,2 1 - University of Social Sciences and Humanities, Warsaw, Poland 2 - University of Colorado, Colorado Springs, USA

Secondary Traumatic Stress Human service professionals working with traumatized clients are at risk of developing secondary traumatic stress due to work-related exposures to trauma Secondary traumatic stress (STS) is a reaction similar to post-traumatic stress, resulting from an indirect exposure to trauma

Resources Facilitating Adaptation After Indirect Exposure to Trauma Self-efficacy (beliefs about ability to deal with barriers) Social support Positive outcome: Secondary traumatic growth (positive changes experienced after the exposure: improving relationships with others, a greater sense of personal strength, perception of new opportunities in life, greater appreciation for life, and spiritual growth)

The Aims To test the effects of a web-based interventions (1) enhancing self-efficacy and (2) enhancing social-support on work-related secondary traumatic stress and secondary traumatic growth. To investigate if the effects of group assignment (intervention versus educational control condition) on secondary traumatic stress and secondary traumatic growth would be mediated by self-efficacy/ social support

Study Design

Methods: Intervention Conditions Self-efficacy enhancement intervention - interactive cognitive and behavioral activities aimed at increasing self-efficacy Educational intervention - educational materials presenting information on social support, self-efficacy, and coping with secondary trauma and work stress Social support enhancement intervention -interactive cognitive and behavioral activities focusing on social support enhancement In each condition: Four weekly sessions Online personal journal Automatic e-mail reminders to complete the sessions

Methods: Intervention website

Methods: Social Support Enhancement Intervention Identifying Domains, Types of Support, and Sources of Support

Methods: Self-Efficacy Enhancement Intervention Identifying Mastery Experiences in Own Life to Enhance Self-Efficacy Beliefs

Participants Inclusion criteria: (a) being at least 18 years old, (b) providing services for survivors of traumatic events for at least 1 year 168 human service professionals Mean age: 37 years old (SD = 10.39) 78% women Work experience : M = 12.21 years (SD = 9.96)

Figure 1. Flow of Participants in a Study. Enrollment (n = 370)   = Included in analysis (intention to treat): at T1 (n = 87) at T2 (n = 87) at T3 (n = 87) Lost to follow-up: at T2 (n = 46) at T3 (n = 54)     Allocated to social support intervention (n = 85) Allocated to self-efficacy intervention (n = 87) Allocated to educational intervention (n = 81) Excluded (n = 117): did not meet inclusion criteria (n = 89) did not begin baseline measurement (n = 68) did not assign to intervention (n = 58) at T1 (n = 81) at T2 (n = 81) at T3 (n = 81) Excluded from analysis (n = 85) at T2 (n = 40) at T3 (n = 56) at T2 (n = 53) at T3 (n = 66) (due to 78% dropout) Randomized (n = 253) Figure 1. Flow of Participants in a Study.

Measurement Secondary traumatic stress - Secondary Traumatic Stress Scale (Bride et al., 2004) Secondary traumatic growth - The Posttraumatic Growth Inventory – Short Form (PTGI-SF; Cann et al., 2010) Self-efficacy - The Secondary Trauma Self-efficacy Scale (STSE; Cieslak et al., 2013)

Results: Effects of the self-efficacy intervention (compared to the educational, control condition)

Educational vs. Self-efficacy Results: Changes in Self-Efficacy Mean Self-efficacy Within-group d [95% CI]   Between-group d [95% CI] Educational vs. Self-efficacy T1-T2 T1-T3 T2 T3 Control: 0.53 [ 0.23, 0.56] Control: 0.72 [0.36, 0.72] 0.45 [0.10, 0.53] 0.33 [0.02, 0.42] Self-Efficacy: 0.67 [0.35, 0.67] Self-Efficacy: 0.73 [0.39, 0.76]

Educational vs. Self-efficacy Results: Changes in Secondary Traumatic Growth Mean Secondary Traumatic Growth Within-group d [95% CI]   Between-group d [95% CI] Educational vs. Self-efficacy T1-T2 T1-T3 T2 T3 Control: 0.44 [0.23, 0.54] Control: 0.35 [0.15, 0.47] 0.18 [-0.10, 0.38] 0.09 [-0.18, 0.31] Self-Efficacy: 0.06 [-0.13, 0.23] Self-Efficacy: 0.04 [-0.10, 0.20] Total: 0.24 [0.09, 0.33] Total: 0.19 [0.06, 0.28]

Educational vs. Self-efficacy Results: Changes in Secondary Traumatic Stress Mean Secondary Traumatic Stress Within-group d [95% CI]   Between-group d [95% CI] Educational vs. Self-efficacy T1-T2 T1-T3 T2 T3 Control: -0.08 [-0.14, 0.04] Control: -0.15 [-0.19, -0.00] 0.49 [0.09, 0.43] 0.08 [-0.13, 0.23] Self-Efficacy: -0.29 [-0.26, -0.05] Self-Efficacy: -0.02 [-0.13, 0.11]

Results: Effects of the self-efficacy intervention (compared to the educational, control condition) mediated by self-efficacy

(Control) Condition [0] Self-Efficacy T2 Path a Path b β = .20* β = .26*** Group assignment at T1: Self-efficacy Intervention [1] versus Educational, (Control) Condition [0] Secondary Traumatic Growth T3 Path c : β = -.21 We found indirect (via self-efficacy at T1; β = -0.07 [-0.14, -0.01] but not direct relationship between intervention type at T0 (self-efficacy enhancement intervention vs educational intervention) And secondary traumatic stress at T2. Participants assigned to self-efficacy enhancement Intervention declared higher self-efficacy at T1 (β = 0.21; path a) and the higher level of self-efficacy Was associated with decreased secondary traumatic stress (β = -0.31; path b). Similarly, we found only the indirect relationship (via self-efficacy at T1; β = 0.05, [0.01, 0.11]) Between intervention type at T0 (self-efficacy enhancement intervention vs educational intervention) and posttraumatic growth at T2. Participants in self-efficacy enhancement intervention declared higher self-efficacy at T1 (β = 0.20; path a) and higher self-efficacy was related to higher posttraumatic growth at T2 (β = 0.26; path b). Path c’: β = .05 Note. T1 = baseline; T2 = post-test; T3 = 4-weeks follow-up. The analyses controlled for T1 mediator and T1 outcome. *p < 0.05; **p < 0.01; ***p < 0.001

(Control) Condition [0] Self-Efficacy T2 Path a Path b β = .21* β = -.31*** Group assignment at T1: Self-efficacy Intervention [1] versus Educational, (Control) Condition [0] Secondary Traumatic Stress T3 Path c : β = .10 We found indirect (via self-efficacy at T1; β = -0.07 [-0.14, -0.01] but not direct relationship between intervention type at T0 (self-efficacy enhancement intervention vs educational intervention) And secondary traumatic stress at T2. Participants assigned to self-efficacy enhancement Intervention declared higher self-efficacy at T1 (β = 0.21; path a) and the higher level of self-efficacy Was associated with decreased secondary traumatic stress (β = -0.31; path b). Similarly, we found only the indirect relationship (via self-efficacy at T1; β = 0.05, [0.01, 0.11]) Between intervention type at T0 (self-efficacy enhancement intervention vs educational intervention) and posttraumatic growth at T2. Participants in self-efficacy enhancement intervention declared higher self-efficacy at T1 (β = 0.20; path a) and higher self-efficacy was related to higher posttraumatic growth at T2 (β = 0.26; path b). Path c’: β = -.07* Note. T1 = baseline; T2 = post-test; T3 = 4-weeks follow-up. The analyses controlled for T1 mediator and T1 outcome. *p < 0.05; **p < 0.01; ***p < 0.001

Conlusions Compared to the web-based educational intervention, the web-based self-efficacy intervention resulted in a stronger increase of self-efficacy and a bigger short-term reduction of secondary traumatic stress symptoms Taking part in either education or self-efficacy intervention resulted in an increase of secondary traumatic growth The effects of interventions on changes in traumatic growth and secondary traumatic stress were mediated by self-efficacy Further research should test for feasibility and acceptability of web-based social support intervention (78% dropout) Email: rocie@swps.edu.pl The study was supported by the National Science Center (NCN) in Poland (# N N106 139537).