The main goal of this study was to explore the connections between social workers' personal and professional exposure to national terror in Israel and their professional and personal distress experienced due to ongoing terror attacks. Data were collected from 406 social workers from Israel who worked in agencies that provide help to victims of terror and their families. The social workers reported low levels of burnout, low levels of stress, and medium- high levels of intrusive memories. Levels of personal and professional exposure were not associated with burnout, intrusive memories, or stress level. However, professional distress (burnout and intrusive memories) was positively associated with personal distress. In addition, a two-step hierarchical regression was conducted, revealing that when burnout and intrusive memories were added to the regression equation, the explained variance of the stress level increased. Neither burnout nor intrusive memories were found to be significant mediators between the independent variables and personal stress level, except in one case. Although the social workers coped relatively well with ongoing terror, it was clear that professional distress was associated with their personal stress.
KEY WORDS: burnout; national terror; resilience; social workers; stress
The present study focused on the impact of ongoing national terror on social workers in Israel providing help to terror victims, their families, and communities. Living under the threat and horror of national terror attacks has been part of Israelis' daily experience in recent years, especially between 2000 and 2004, a period known as the "Second Intifada" (the Palestinian Uprising). The reality of national terror attacks in Israel places social workers on the frontline at three types of agencies: (1) municipal social service departments, where their tasks are to assist families searching for missing loved ones following a terror attack, accompany them to the morgue, make funeral arrangements, and offer crisis intervention to individuals, families, and communities; (2) hospital social service departments, where their tasks include informing families about injured relatives and intervening with the injured and their families during hospitalization; and (3) the National Insurance Institute, where they engage with a victim's family several days after injury or a funeral and offer long-term intervention, including supportive treatment and case management tailored to rehabilitation process requirements.
Due to the continuous threat of national terror, most of the agencies have already developed organized operational procedures for such situations. Attention is also paid to the impact of these tasks on social workers. However, existing knowledge fails to address several main issues: What happens to social workers who intervene in an ongoing situation of terror attacks? What happens to those who have the same reality as their clients? How does the penetration of terror into the supposedly safe setting of psychosocial intervention affect social workers' professional roles and personal stress levels? Thus, the main goal of this study was to explore the connections between social workers' professional and personal exposure to national terror and the professional and personal distress they experienced due to ongoing terror attacks.
IMPACT OF TERROR
National terror is defined as an act or threat of violence against noncombatants that has the objective of exacting revenge, intimidating, or otherwise influencing an audience (Primoratz, 1990; Stern, 1999). This definition highlights the two main elements that distinguish terrorism from other forms of violence: First, it is aimed at noncombatants and, therefore, differs from conventional military action; second, it uses violence for dramatic purposes, usually to instill fear in a targeted population.
Studies of direct victims of national terror attacks confirm that these individuals are at high risk of suffering from a distress reaction. Distress symptoms include generalized fear and anxiety, recurring thoughts about the attack, avoidant behavior, physiological symptoms, depression, daily functioning problems, and difficulties in relating to and trusting others. Such distress reactions can result in varying severity levels of posttraumatic stress disorder (PTSD).
One of the main predicting factors of these physical and psychological responses is the level of exposure to the terror attack. Level of exposure refers both to direct exposure--ranging from being injured in an attack to being within physical proximity of the event to being close to someone who was killed or injured--and indirect exposure, which refers to living under the threat of terror attacks and affects the entire population of Israel. If it is accepted that any relationship with a victim constitutes a type of exposure, it is reasonable to assume that social workers intervening with terror attack victims, their families, and communities are placed at high risk of experiencing some of the described symptoms. These, in turn, may lead to burnout (Maslach, 1982) or secondary traumatic stress (R. E. Adams, Figley, & Boscarino, 2008; Figley, 1995a, 1995b).
BURNOUT AND SECONDARY TRAUMATIC STRESS IN SOCIAL WORK PRACTICE
Burnout is defined as "a state of fatigue or frustration brought about by devotion to a cause, way of life, or relationship that fails to produce the expected rewards" (Freudenberger & Richelson, 1980, p. 13). In general, burnout has been equated with alienation, depression, anxiety, loss of idealism, and loss of hope in response to stress (Maslach, 1982; Soderfeldt, Soderfeldt, & Warg, 1995). Social work is a helping profession with above-average risk of practitioner burnout, being very much client oriented and involving workers in complex social situations (K. B. Adams, Matto, & Harrington, 2001; Jayaratne & Chess, 1984). This article describes a unique phenomenon of burnout at work--one in which daily life, in and of itself, can increase the probability of personal and professional burnout.
The consequences of indirect knowledge of a traumatic event, acquired by helping someone close who experienced the trauma directly, have been widely discussed in the last two decades. Several names have been applied to these phenomena: "secondary traumatic stress" or "compassion fatigue" (Figley, 1988, 1995a), "vicarious traumatization" (McCann & Pearlman, 1990), and "traumatic countertransference." However, they are all very similar. In the present study, we use the term secondary traumatic stress (STSD), as defined by Figley (1988, 1995a), according to whom STSD symptoms are identical to those of PTSD (American Psychiatric Association, 1994). The difference between the syndromes lies in the exposure to the traumatic event: PTSD is a result of direct exposure, whereas STSD is an indirect effect of empathic care provided to a traumatized person.
Studies of secondary traumatization provide knowledge of specific variables regarding STSD development, such as a worker's caseload, personal and professional experience, and exclusive exposure to traumatized clients (Ghahramanlou & Brodbeck, 2000; Hyman, 2001; Myers & Wee, 2002). However, there is a paucity of knowledge of situations in which the trauma is not limited to one discrete event, but consists of a repeated experience over months or years or of situations in which social workers and clients live with the same threats and dangers.
Although some researchers claim that STSD represents a phenomenon distinct from burnout (R. E. Adams et al., 2008; Arvay, 2001), both constructs encompass several similar symptoms (K. B. Adams et al., 2001; R. E. Adams et al., 2008) and are often described as outcomes of stress experienced by helping professionals. Yet the similarities and differences between STSD and burnout have scarcely been specified, and the particular conditions leading to each syndrome have not been identified (Butollo, 1996; Kushnir & Melamed, 1992;Vicary & Searle, 2000). R. E. Adams et al. (2008) suggested the concept of compassion fatigue as a construct of both STSD and burnout. In the present study, we focused on the main STSD symptom--intrusive memories of thoughts, voices, or images that might occur during waking hours as well as in dreams.
COPING WITH NATIONAL TERROR
Different studies have emphasized personal and social variables that are often related to personal and social resources used when coping with stress, including hardiness (Kobasa, Maddi, & Kahn, 1982), sense of coherence (Antonovski, 1991), and social support (Kessler, Price, & Wortman, 1985). These resources are considered to be components of resilience. In this study, the sense of coherence concept...