 I've been working with mental health patients and clients for well over two decades. Two decades is a long time to be exposed to pain and hurt and depression and the darkness of the human soul. It rubs off on you. It affects you somehow. Never mind how well trained you are to put a distance between you and the stories of woe and depravity and horror that keep flooding through the digital lines and sometimes face to face. Never mind how trained you are to detach yourself. It gets to you. It penetrates and permeates and infiltrates and invades through all the defenses that you put up. Medical doctors are aware of this. But therapists are also subject to what is now known as vicarious traumatization or vicarious trauma. And this is the topic of today's video. My name is Sam Vaknin and I'm the author of Malignant Self-Lug, Narcissism Revisited. I'm also a professor of psychology in several universities and I work with people as clients and patients. I've been doing this for a very long time now and it's beginning to have an effect on me. I'm going to describe what I'm going through and then I'm going to review the literature and what others are saying about this phenomenon. In an age where mental illness is exploding following the pandemic, various financial crises, wars, inter-gender conflict, other transformations, technological, social, cultural. In an age where people react with depression and anxiety and suicide. In an age where people are falling apart all over the world. Therapists, psychologists, psychiatrists, mental health practitioners are the last line of defense between humanity and collective insanity, collective madness. Collective madness could have unforetold consequences. Remember the 1930s? There was collective madness. Remember the 1920s in Soviet Russia and Stalinist period? That's collective madness. Remember the 1950s in China? That's collective madness. And we are that close, that close to reenacting all these horrors. And the front line is mental health and its services. The front line is treating people with post-traumatic stress disorder, extricating people from abusive relationships and then trying to heal them and recover them, being exposed to stories of sexual assault and rape even in the early years of teenage. Things are horrible out there. They're really, really very difficult. And there's almost no redeeming feature and almost no hope. And in this blickness in the trenches, drenched with human misery, we are soldiering on, trying our best to give from our own dwindling resources and recourse. Because we are human. Well, most of us at least. And there's only that much that we can share without being depleted to the point of dysfunction, which is happening to many of us. This is known as burnout. But today's topic is not burnout. Today's topic is much, much worse. A much more egregious, difficult and ingrained phenomenon, which has come to be known as vicarious traumatization. Before we go there, another reminder. There's a free, free as in no payment seminar, seven days seminar in Romania in September. If you want to reserve your seat and we are almost out of seats. So if you want to reserve your seat, write to me, Sam Vaknin as in my name, Sam Vaknin at gmail.com. Sam Vaknin, that's Sam Vaknin at gmail.com. Write to me and I'll reserve your seat. There are well over 230 or 240 people who had registered already and the seat capacity is limited to 300. So I'd hurry. I would hurry if I were you. Okay, vicarious trauma is a term which was invented by McCann and Perlman and others. It is used to describe how working with traumatized clients has an effect on the trauma therapist. Vicarious trauma is just the latest iteration. It was previously known as secondary traumatic stress or secondary trauma. And it was really first described by Dr. Charles Figley in the in the 80s. Now I went to the website of the American Counseling Association and I downloaded fact sheet number number nine. And I was disheartened to discover the mistakes in the fact sheet. They, for example, confuse or conflate vicarious trauma with compassion, compassion fatigue. I'm going to disambiguate these two. They have nothing to do with each other. They do, however, provide some very useful overview of the syndrome. And I will refer now to a few things they're saying. So vicarious trauma was described as I said by Perlman and Sack Whitney and others in 1995. And it is, it represents the costs, the mental and emotional costs of caring for others. That's Figley's definition in 1982. STEM has written about it in 1995, 1997, and etc., etc. We are talking about therapists and counselors and psychiatrists and psychologists who treat trauma on a regular basis. They are trauma therapists or have been exposed to trauma unexpectedly with a patient. Now the new definition of post-traumatic stress disorder in the Diagnostic and Statistical Manual Edition 5 Text Revision says that you could have PTSD if you were exposed to someone else's PTSD. In other words, PTSD is a bit contagious. It's like an infection. It's like a virus. If you're exposed to the harrowing tale, to the agonizing and torturous path of another human being, if you are given details as to the surrealistic nightmarish experiences of someone else, you're likely to react emotionally and you're likely to react as if you were traumatized. And this is precisely vicarious trauma. So we used to think that only trauma counselors or trauma experts endure or experience vicarious traumatization. We no longer do. Anyone can experience vicarious traumatization. You go home, someone tells you about a car accident, a little deadly car accident they had witnessed. You can experience vicarious traumatization. You date a girl, she tells you how she had been raped, you can experience vicarious traumatization. The minute you share with someone an experience that is traumatic, you stand a chance of being vicariously traumatized. It is the emotional residue of exposure to the pain and suffering of other people. We empathize with other people naturally and when we do, we experience their suffering vicariously. So listening to trauma stories, becoming witnesses to the pain, to the fear, to the terror, to the horror the trauma survivors had endured could induce full-fledged post-traumatic stress disorder. I know from my own personal experience that lately, in the last four years, I have been going through a phase of post-traumatic stress disorder induced by my patients. I freeze sometimes in response to a trigger word or a location or a smell or a taste. I ruminate, I can't stop thinking. I have flashbacks to the moments, real flashbacks to the moments when I've been first exposed to the trauma. I am traumatized by the stories of my clients. Full-fledged. I have nightmares. I have insomnia. So vicarious traumatization is as bad sometimes as the original trauma. Now vicarious traumatization is not burnout. Burnout happens over time. It builds up. And just changing circumstances solves the issue. So if you're burned out in your job, you change a job. In your new job, you're not burned out. If you change a location, if you exit a relationship, any change, any meaningful change, resolves the issue of burnout. Vicarious trauma is not resolved by anything you can do. You need help. You need therapy to overcome vicarious trauma. It's a state of tension. Preoccupation with the stories and trauma experiences described by other people. And people usually vicariously traumatized people usually react in one of two ways. They avoid talking and they avoid thinking about what they had been told about the trauma experiences others had shared with them, have shared with them. And so they just avoid. They go numb. They go numb. They have reduced effect display. There's emotional numbing. They withdraw. They become ponderous and contemplative and schizoid and so on. That's one reaction, an avoidance reaction. And the other type of reaction is exactly the opposite. A vicariously traumatized person develops a permanent arousal state. He constantly immerses himself in the traumatic experience, relives it. This is why we call it revividness. He tries to process desperately in a futile way. He tries to process these experiences because they don't make any sense. Trauma is about a breakdown in order and structure and meaning. Trauma is about the arbitrariness and capriciousness of human evil, sadism and cruelty or of the indifferent forces of nature. So to resolve trauma one way is to try constantly to process it and the other is to avoid it. Now the fact sheet of the American Counseling Association provides a list of signs and symptoms of vicarious trauma. And I would like to read this to you. These are the potential emotional effects of working with trauma survivors. So having difficulty talking about their feelings, free-floating anger and or irritation. This is what happens to someone who is vicariously traumatized, like a counselor with a client. So free-floating anger and irritation, startle effect, being jumping, over-eating or under-eating, difficulty falling asleep or staying asleep, losing sleep over patients, worried that they are not doing enough for their clients, dreaming about their clients or their clients' trauma experiences, diminished joy toward things they once enjoyed and hedonia, feeling trapped by their work as a counselor or a crisis counselor, diminished feelings of satisfaction and personal accomplishment, dealing with intrusive thoughts of clients with especially severe trauma histories, feelings of hopelessness associated with the clients or work in general, blaming others. Vicarious trauma doesn't only have emotional effects, it alters your behavior. It affects the professional performance of the counselor and the functioning of the counselor. It can result in errors in judgment. And so here are some of the behaviors which are typical of vicariously traumatized people, frequent job changes, tardiness, free-floating anger, irritability as we've mentioned, absenteeism, irresponsibility, overwork, irritability, exhaustion, talking to oneself, which is a very worrying and critical symptom, going out to avoid being alone, dropping out of community affairs, rejecting physical and emotional closeness. I would add to that many other things, like freeze response, sudden freeze response, promiscuity, dysregulation, and many other. On the interpersonal level, these people, vicariously traumatized people, who tend to engage in conflict, blame others, have poor relationships, poor communication, impatience. They would avoid working with other people or clients with trauma histories. They would tend to not collaborate. They would become very bad teamwork, team workers. They would withdraw and isolate from colleagues, change in relationship with colleagues and difficulty having rewarding relationships. When we interview people with vicarious trauma, people who have been exposed to the trauma of others, and there's an open question whether these people are unusually empathetic or whether empathy plays a role at all in any of this, I'm not particularly empathic, and that's probably the understatement of the millennium, and yet I'm definitely vicariously traumatized. I experienced the horror, the entrapment, the estrangement, the pain, the agony, the hopelessness, the fear of my clients who had undergone traumatic experiences. Even if the client denies the traumatic aspect of the experience, even if the client refrains the traumatic experience as, I don't know what, an empowering experience, even if the client denies having had the experience. Even if the client is emotionally numb and has reduced effect display, so doesn't convey any pain or any hurt. Even in these cases, the trauma shines through. The trauma is communicated. It's like an emanation, like an ectoplasm, like some kind of miasma, and it's infectious, it's contagious, it's in the air, it's ambient. The pain becomes palpable, almost visible, and this creates, this has horrible effects on the exposed parties. And they report dissatisfaction, negative perception, loss of interest, apathy, blaming others on plastic defenses, lack of appreciation, lack of interest in caring, detachment, hopelessness, low self-image. They're worried, they question their frame of reference, identity, worldview, spirituality, their disruptions in self-capacity. Self-capacity is the ability to maintain a positive sense of self, ability to modulate strong effect, and ability to maintain an inner sense of connection. They have a disruption in needs, beliefs and relationships. They don't feel safe. They can't trust anyone. Their self-esteem goes down. They feel that they have an external locus of control. They don't control their lives, and their ability to be intimate declines. Job performance, of course, is affected. Job motivation, increased errors, decreased quality, avoidance of job responsibilities, over-involvement in details, perfectionism, lack of flexibility, etc. Personal life and work life and friendships. Everything is affected. And finally, the counsellor's health. The health of the person, the bodily health of the person who is exposed to vicarious trauma begins to deteriorate. Clinically speaking, vicarious trauma is indistinguishable from real trauma. It is a form of trauma. And having observed myself over a long period of time, I can say that most definitely I'm traumatized. And I have a post-traumatic condition on top of my original post-traumatic condition in childhood. I have chosen probably the wrong profession because I resonate very powerfully with other people's traumas. Having been traumatized in my own past, having been wounded in childhood, I'm able to interact and resonate with other people's wounds and traumas much more powerfully than people who have not been traumatized. This is something to consider. Vicarious trauma often builds upon an original trauma, an experienced trauma, a history of trauma. And then, together with it, there's a synergy. There's an amplification of both the original trauma, which is an experiential trauma, and the vicarious trauma, which could lead to severe disruption in functioning, including flashbacks. So the vicarious PTSD becomes real, especially in people who have had an episode of real life PTSD. And now, I promise to tell you the difference between vicarious trauma and other manifestations. Compassion fatigue is an emotional and physical exhaustion leading to a diminished ability to empathize or to feel compassion for other people. It's a negative cost of caring. It's a secondary traumatic stress reaction. And burnout and secondary traumatic stress are elements in compassion fatigue. But compassion fatigue is not the same as vicarious trauma. It's just that when you are exposed time and again to disaster, to trauma, to illness, especially chronic illness and to stress, your ability to empathize is eroded and corroded, and so you become tired. That's the fatigue in compassion fatigue. People with compassion fatigue are not traumatized. They're just tired. They're depleted. They just want to go home or resign or whatever. And so this is compassion fatigue. Occupational burnout or work-related burnout is yet another phenomenon which may closely resemble vicarious trauma but has nothing to do with it. The World Health Organization defines occupational burnout as chronic work-related stress. It's a syndrome. There's a feeling of energy depletion, exhaustion, increased mental distance from the job, feeling of negativism and cynicism related to the job and reduced professional efficacy. Both burnout and vicarious trauma affect mental health and bodily health but they are absolutely distinct phenomenon. They should not be confused with each other. Vicarious trauma is trauma. It's exactly the same as primary trauma. It is secondary only in the sense that it is mediated through someone else's mind and experience but it is as powerful. I can attest from personal experience. It's as powerful because I had experienced primary trauma many times in my life and I am now experiencing secondary trauma and I can tell you they're very often indistinguishable. The social withdrawal, the mood swings, the aggression, the greater sensitivity to various trigger words and trigger situations and places and smells and tastes, somatic symptoms, intrusive imagery, growing cynicism, difficulty managing boundaries, challenges to core beliefs and identity, relationship problems, trust, esteem, intimacy, control. This is all typical of both primary and secondary trauma. Vicarious trauma maybe arises especially when the client is meaningful. When the client or the other person succeeded to penetrate the natural boundaries and defenses that we put against emotional involvement. We don't want to get emotionally involved with everyone. Emotional involvement is a choice and usually attendant upon mate selection. But sometimes, some people get through these defenses. They breach the parameter and they enter deep inside. This happens also in therapeutic settings and not all therapists do the right thing and disengage and refer the client elsewhere. Not all of them do this. I would say a minority, vast majority just go on. The more they get emotionally involved with the client, the more they want to help the client. And the more they develop this savior complex, Messiah complex or the more they want to fix the client and heal the client and so they never let go. And this is really seriously bad because a traumatized client to whom you get emotionally attached can traumatize you much more easily. Your coping strategies, your support network, they're crucial in resisting vicarious trauma. And when you let someone who has been traumatized into your inner circle, when you introduce them into your mind, when you react to them emotionally, they become the center and the focus of your world. You want to ameliorate and mitigate the trauma, their trauma and your trauma, their primary trauma and your secondary vicarious trauma. You become fixated. You become obsessed. You begin to act compulsively in a desperate attempt to extricate yourself from the morass of pain, the swamp of agony that you have plunged yourself into. The client becomes or the other person with trauma becomes the center of your world. And so the vicarious trauma is highly individual, but it does rely, as I said, on a foundation of sensibility, heightened empathy on the one hand, or in the absence of empathy on previous trauma. And then it just resonates with previous trauma. In other words, vicarious trauma has two forms. One form is it amplifies your empathy. It brings it to the point where it hurts when the empathy hurts. That's one way. And the other way, it re-traumatizes you. It forces you to re-experience your own trauma, to relive it, and we call this revividness. So when one's view of the world is safe, when one has had a safe base in childhood, when one trusts basically other people, not to do harm, not to become malevolent or malicious, when one doesn't regard the world as hostile, when one doesn't catastrophize and anticipates the worst case scenarios, one is ironically more prone to vicarious traumatization. When one is a bit naive about the world, when one believes that people are essentially good, it's easier to get traumatized. If you are cynical, if you have had experiences which had taught you how corrupted human nature is, you are far less likely to be traumatized by other people's stories. But if you are truly good natured, good person, empathic, a believer in other people, and the goodness of humanity, it's far easier for you to be traumatized. So vicarious trauma is much more common among mental health practitioners and other people who grew up in functionable, happy, loving, caring families. Exposure to trauma, however indirectly, causes an interruption not only to the daily functioning of the clinician, but an interruption to the world view of the clinician. Suddenly the universe doesn't make sense anymore, suddenly it's a menacing, dark, threatening place. If this has happened to her, it could happen to me. It's suddenly the foundations of justice, reciprocity, belief, trust that shattered by the incredible tale of the suffering, the profound, abysmal suffering of another human being. Anything that interferes with the ability to help, with the ability to fulfill one's responsibility not only as a mental health practitioner, but as a human being, the responsibility to assist, to care, to support. This in itself is traumatic, this feeling of impotence, of entrapment, of like when you're faced with a real trauma, when you're faced with the inexplicability of the shadow side of the human mind, when you're faced with men who sleep with 12 year old women, girls, when you're faced with people who mutilate other people just for fun, when you're faced with rape, when you're faced with war or the experiences of war, the world doesn't make sense anymore, it becomes devoid of meaning, and there's nothing more threatening than a world which is essentially totally arbitrary, because anything can happen not only to other people, but also to you and to your loved ones. So, vicarious trauma is a real and serious presence, and it's growing, it's growing because trauma has a multiplication effect. When you traumatize, you traumatize other people, hurt people, hurt people. Traumatize other people, they traumatize other people, and it's exponential. It's exactly like the spread of a pandemic. Pandemic doesn't spread in a linear fashion, it spreads geometrically, and so does trauma. The defense style of people, their attachment styles, they also play a role in vicarious trauma. If you have a self-sacrificial defense style, you would experience increased rates of vicarious trauma. If you are a people pleaser, if you're codependent by nature, you're much more likely to experience vicarious trauma. If your attachment style is not avoidant, dismissive, is not fearful, but is secure, ironically or far more likely to experience vicarious trauma. Mental health predisposes to vicarious trauma as much as mental illness. Women are much more likely to develop secondary traumatic stress than men. And we are not quite sure why. It seems that women have a higher capacity to empathize than men, but this is not substantiated in any studies I'm aware of, or rigorous studies I'm aware of. And so we don't quite know why. Now, I repeat again, do not confuse vicarious trauma with compassion fatigue, burnout, work-related stress, or even counter-transference. Counter-transference, for example, is a therapist's response to a particular client or emotional response to a particular client. It should never be conflated or confused with vicarious traumatization because it doesn't traumatize. There's no trauma involved in this. There's just kind of emotional redirection of the psychotherapist's emotions towards the client. So counter-transference is a reallocation of emotional resources, catexis, so that the therapist reacts to the client the way the clients want the therapist to react. So the client, for example, begins to see the therapist as a parental figure, and the therapist begins to act as a parental figure. That's counter-transference. It's the emotional entanglement with the client. Again, it's a therapeutic tool and has nothing to do, absolutely nothing to do with vicarious trauma. Counter-transference does not involve trauma. Burnout does not involve trauma. Compassion fatigue does not involve trauma as an element. You could have compassion fatigue being exposed to thousands of trauma victims, for example, in a natural disaster, but you would not be reacting to the disaster and you would not be reacting to the trauma. You would be reacting to the demands on your very limited human resources. Now, what is the mechanism for vicarious trauma? So we mentioned empathy. Batson and others conducted research about ways to manage empathy, to constructively somehow channel it, reframe it, constrain it, control it, and yes, limit it. Medical doctors actually have a class in medical school I know from personal experience. We were taught how to not get emotionally involved with patients. Bedroom, sorry, bedside manners also include a certain modicum of detachment, the ability to put distance between you and the client, the patient, his family. Medical doctors do this all the time, or they would commit suicide in rates even higher than they are doing right now. Suicide is very, very high among medical doctors, precisely because this barrier between the patient and the doctor breaks down. This is especially true with children, children in the cancer ward, for example. Doctors get emotionally attached, they cry like babies having lost a client. Ironically, on the other side, grandiose medical doctors react the same way when they lose a client. They also break down, but for a different reason, it's a challenge to their grandiosity. But at any rate, empathy management is crucial in order to avoid vicarious trauma or secondary trauma. You must not fully identify with the trauma survivor. You must not immerse yourself in thinking about what it would be like if these events happened to you. You must not replay the events in your mind all the time, obsessively. You must not allow intrusive thoughts into your mind. You must not ask the client for too many details, unnecessary details, details that have nothing to do with the therapeutic agenda or reliance. So don't go too deep. It's a rabbit hole. Your personal distress, feeling upset, feeling worried, they will only escalate the deeper you go. There's no exiting this rabbit hole except with professional assistance. So imagination is your worst enemy when you're working with trauma victims. So trying to imagine the trauma, putting yourself in the shoes of the trauma victim is a surefire way to experience vicarious traumatization. Now, this is between counselors or mental health practitioners and clients. What about loved ones? What if you're exposed to the trauma of loved ones? You fell in love with a woman and she tells you about her sexual history and most of it is actually pretty traumatic or traumatizing. You have a child, the child goes to college, she returns and she tells you that she had been exposed to mass rape. What do you do in this case? What do you do in your loved ones? The people who mean more than anyone to you come back with stories of trauma. Can you not empathize? Can you not place yourself in their shoes? Can you really put distance and detach? Of course not. So vicarious trauma is preventable, prophylactically is preventable in medical settings. But vicarious trauma is not avoidable, cannot be avoided. It's ineluctable when you are in intimate settings. Intimate settings could be romantic settings with your children, etc. When there's intimacy, there's a serious risk of vicarious trauma. And no, it's not advisable to sacrifice intimacy just to avoid vicarious trauma. Sharing is caring and sharing suffering is caring the most. So you need to prepare yourself, you need to steal yourself, steal S-T-E-E-L. You need to steal yourself to the possibility or the inevitability of vicarious trauma in intimate relationships. Perhaps I think this might be one of the main reasons that people are avoiding intimate relationships nowadays. There is a general trend of avoiding actually relationships. Well over 30% of people are lifelong singles. Another 20-30% are effective singles in between pseudo short-term relationships. About half the population choose to not be in relationships. And I think pain avoidance, hurt aversion is a main factor in why they don't go into relationships. Because relationships hurt, relationships are painful. And you're exposed to your own traumas, they are reactivated by the relationship. Plus you have to vicariously experience, experience secondhand, experience by proxy, the trauma of the man or woman you love. So relationships in today's world where most people are constantly traumatized, where many relationships are abusive, where divorces are off the charts, where I mean it's a world that is trauma generated. Every aspect and facet of modern civilization is traumatic and traumatized. So people by the time you get to, by the time you get to team up with someone intimately in a romantic relationship or by the time I mean, if you're 30, you've already experienced several traumas. So dating someone today is implicitly, implicitly agreeing or consenting to vicarious traumatization. You can't date anyone today above the age of 25 who has not been traumatized. And so you are willingly and knowingly entering the minefield of secondary trauma when you date someone, when you get married, when you establish a relationship and definitely when you have children. It's terrifying. Secondary trauma is terrifying because it's everywhere. And some people say, half of all people actually say, well, better not have a relationship with anyone. It's too damaging. I don't want to end up broken. I don't want to end up in pain that's not mine. I don't want to wade through the murky depths of someone else's soul. I don't want to, I don't want to wake up at night and trembling and shaking and perspiring just because I recall a story that she had told me. I don't want any of this. So people stay alone, which in itself is of course a traumatic experience to some extent. There are aspects of vicarious trauma that can be measured. There are various constructs now. Vicarious trauma is a new field, but already we have assessment tools. And there are various constructs which are catered to in scholarly literature, self capacities, ego resources, ego defenses, frame of reference, identity, worldview, spirituality, even psychological needs, trauma symptoms, and so on and so forth. We measure all these things. So we have, for example, the trauma and attachment belief scale. We have the inner experience questionnaire, the inventory of altered self capacities, the PTSD checklist, the impact of events scale, the impact of events scale revise. There are two different things, by the way, the for children we have the impact of events scale for children and then we have trauma symptoms scale. We have secondary traumatic stress scale and we have the professional quality of life. The latest version is fine. So we have quite a few tools which allow us to zero in vicarious trauma and diagnose it with certainty or certitude that, you know, it's there. It's really happening. Now, what to do? How to avoid vicarious trauma in a world where every second person or maybe everyone is traumatized? Should we not communicate with people? Should we not have sex with people? Should we not date people? Should we not talk to them? Should we avoid them? Should we isolate ourselves in an ivory tower or a cocoon? Should we be alone for life maybe? Vicarious traumatization can be very, very serious. As I said at the beginning, it resembles PTSD. It's almost indistinguishable. Who wants to go through this knowingly? No one does. No one does. And so what can we do? How to avoid this? Well, the only effective tools we have are community and happiness. But the first thing to understand, you're responsible. You're responsible for your well-being. You're in charge of your self-care. You should work responsibly and reflectively. You should communicate with other people the same way. You should engage in regular, frequent consultations or counseling if you're affected. There are many ways to address vicarious traumatization. But you need to have awareness. You need to have balance. You need to be centered and grounded. And you need to have a connection with other people. You need to develop coping strategies. And I'm not limiting myself now to mental health practitioners. Everyone needs to develop coping strategies. Because as I said, everyone is traumatized. Everyone traumatizes others. Just by sharing your traumatic experience with other people, you're traumatizing them. And so self-care, rest, escape, play, entertainment, transformational strategies. You need to embed yourself in a community. You need to find meaning in your work. You need to apply to your personal and to your professional life. Everything that can counter trauma or at the very least somehow ameliorate it. Somehow reduce it the same way we reduce anxiety. You need to work on your happiness as a goal, as a project. You need to increase it. Happiness, or at least well-being, reduces the potential for vicarious traumatization. When it happens, it reduces secondary trauma to a manageable level. If you're most socially connected, you tend to be happier. And you tend to resist secondary trauma much better than if you're a loner or a lone wolf. People who consciously practice gratitude are also happier. Creativity is a bulwark, is a defense against trauma of all types, primary and secondary. You should create an alternative world where you are happy so that it can counter your constant exposure to other people's agony and pain and suffering. Bodily techniques such as yoga, meditation and so on have also been proven useful. But ultimately, if you have contracted the disease, if you're vicariously traumatized, you need to boost your resilience. The only way to do this is therapy. Therapy helps you to increase self-efficacy, provides a respite and appropriate professional help usually buffers against the effects, the ongoing effects of vicarious trauma. We know how to do it and it's very, very successful. Many groups are vicariously traumatized very commonly. That's not only mental health practitioners. For example, children, foster parents, members of minorities, they're all vicariously traumatized, all the same. So all this should be aware of the potential of being traumatized even if not in a primary way, even if you didn't have any direct experience. They should be more protective of themselves because they are vulnerable to vicarious trauma. I've worked through my vicarious trauma and I'm not much better, but it took me years and I'm trained to imagine. And I've used the help of others who've been around me, mental health practitioners and others, and they pulled me through. I knew what to do and I went for it and I did not allow my grandiosity to stand in the way of seeking help, but vicarious trauma is bad, it's seriously bad. And if you feel that you have been traumatized by someone else's story, if you suddenly cease to function, if you freeze, if you can't sleep, if you have an eating disorder of some kind, over-eating, under-eating, if you're irritable and aggressive and disempathic and impatient and tired all the time and frightened and jumpy at any of these signs, seek help. Seek help before it gets really, really bad and then even treatment might be too late.