October 2022

Perspective
EXPERT INSIGHTS ON A TIMELY POLICY ISSUE

KAREN M. SUDKAMP, HEATHER J. WILLIAMS, LISA H. JAYCOX, MOLLY DUNIGAN, STEPHANIE YOUNG

Trauma in the U.S. Intelligence

Community
Risks and Responses

M
ental health consequences for U.S. military and Department of Defense
(DoD) civilian personnel and intelligence professionals, particularly for
those who have experienced decades of significant overseas deployment
responsibilities, is a topic of serious concern. In 2014, the decision to
honor a fallen U.S. Central Intelligence Agency (CIA) officer who died by suicide in
Afghanistan with a star on the Agency’s Memorial Wall brought particular atten-
tion to the mental health needs of the U.S. Intelligence Community (IC).1 Although
the pace of deployments, especially in support of stressful counter­terrorism mis-
sions, has slowed markedly, the mental health needs of IC professionals have
increased rather than diminished. Technology today brings potentially traumatic
events more rapidly and vividly to U.S. intelligence professionals, whether they are
in the United States or abroad.

C O R P O R AT I O N
 IC leaders might not always appreciate the complex
ways that trauma can affect the IC workforce, which plays
a critical and unique role in our national security system.
Members of the IC workforce
• collect and protect our nation’s secrets, a function
that often requires them to put boundaries between
their personal and professional lives
• often are an audience to violent and difficult
problems, but with little autonomy to decide how
to address events because of their professional
obligation to remain policy advisers rather than
policymakers
• frequently work under strenuous conditions, such as
long hours, shift work, work without pay—or even
work that deploys them to a warzone.
Their accomplishments and successes might go unrec-
ognized, and the IC’s reputation might be unfairly tar-
nished by the public. IC professionals are bound by law and
oath to secrecy. Such responsibility puts them at heightened
risk of experiencing trauma, either directly or indirectly,
and limits their recourse in managing such trauma.
Abbreviations
CIA Central Intelligence Agency
DIA Defense Intelligence Agency
DoD Department of Defense
FBI Federal Bureau of Investigation
EAP employee assistance program
IC U.S. Intelligence Community
PTSD posttraumatic stress disorder
2
The Diagnostic and Statistical Manual of Mental Dis-
orders defines trauma as “actual or threatened death, seri-
ous injury, or sexual violence.” There are various types of
possible trauma exposure. In addition to direct personal
trauma exposure or personally witnessing trauma to
others, there also exists “repeated or extreme exposure to
adverse details” of a traumatic event.2 This latter category
of exposure, sometimes termed secondary traumatic stress
or vicarious traumatization, can affect IC professionals (or
similar professions, such as journalists or activists) who are
exposed to trauma in their work lives.
In the course of their work, IC analysts can be exposed
to content that includes traumatic audio, images, and
video. IC collectors can be exposed to similar content and
might work in precarious or potentially unsafe environ-
ments or with unsavory collaborators to gather the infor-
mation necessary to understand adversaries. IC support
professionals can experience the same types of exposure
but might not be recognized as readily as an affected popu-
lation, given that the exposure is secondary to their main
professional functions. Traumatic exposure can be associ-
ated with intrusive symptoms (e.g., nightmares, unwanted
or upsetting thoughts), avoidance, negative thoughts or
feelings, or physiological arousal and reactivity; such
symptoms have potential implications for IC profession-
als’ mental health and their readiness to support their
assigned missions.3
This Perspective explores the potential for U.S. intelli-
gence professionals to experience trauma-related stress as a
consequence of their jobs, and the effects of such stress and
trauma on the IC as a whole. We introduce a conceptual
model, which was refined in light of literature and inter-
views with current mid- to senior-level IC managers and
a focus group composed of former IC employees who dis-
cussed the risks of trauma for IC professionals, resources to
responses, barriers to care, effects on the IC, and how the
IC could better support its workforce. The methodology
and limitations of the study are described in detail in the
box on the next page.
A Conceptual Model for Reactions
to Stress and Trauma in the IC
Workplace
To explore and elucidate this topic, a multidisciplinary
RAND research team drew upon RAND’s extensive previ-
ous work on the mental health of U.S. military and federal
employees and reviewed existing literature on trauma and
empathy-based stress, particularly among the IC or similar
fields. Using the literature most relevant to the IC context
in addition to two relevant conceptual models, the team
drafted a conceptual model for trauma in the IC.
In this model (see Figure 1), traumatic events combine
with the operational characteristics in which they occur to
create the stressors experienced, building upon a model on
the psychology of counterterrorism operations.4 How each
individual experiences the stress is affected by mitigating
and risk factors at the organizational and personal levels.
Examples of personal factors include prior trauma expo-
sure and level and types of social support.5 Organizational
factors, such as the level of organizational support, can also
affect outcomes.6 All of these factors culminate in a variety
of cognitive, affective, and behavioral outcomes, which are
detailed in the reviewed literature, much of which overlaps
in descriptions of symptom expressions. Interventions
could be useful in alleviating such problems or even in
promoting positive post-trauma growth.
Terminology to Define Different
Trauma Types
The mental health field has long focused on assessing the
effects of traumatic events on the individuals who experi-
ence them, either directly or indirectly. Past research has
focused on work, specifically, as a source of exposure to
trauma, with special considerations about not only the
effects on individuals but also the effects on work, reten-
tion, and mission. This established body of literature pro-
vides IC professionals with a way to describe their experi-
ences, as well as a way that others can better understand it,
and allows the IC to draw upon lessons from studies that
focus on professionals in similar fields (e.g., military per-
sonnel, police officers, first responders).
Drawing on our review of the literature, we consider
three types of stressors:
• Direct trauma consists of “actual or threatened
death, serious injury, or sexual violence.”7 Expo-
sures can be of various types: experiencing direct
personal exposures, personally witnessing trauma
to others, learning that a family member or close
friend was exposed to trauma, or experiencing
“repeated or extreme exposure to aversive details of
a traumatic event.”
• Secondary trauma can be exposure that involves
hearing about traumatic events through work or
the experience of supporting individuals who sur-
vive trauma. The concept of secondary trauma was
3
 Methodology and Limitations
For this exploratory research, our research team relied on a review of existing RAND research and academic literature, inter-
views with IC professionals at the middle- and senior-management levels, and a focus group of RAND experts who are former
mid-level analysts and mid- to senior-level IC managers.a The literature we consulted focused on trauma- and empathy-based
stress on civilian professional populations, particularly among the IC or similar fields, such as law enforcement professionals,
first responders, and professionals in social work fields, along with military IC professionals. Using the literature most relevant
to the IC context, along with two relevant conceptual models that relate to trauma and its effects, our research team devised a
draft conceptual model for trauma in the IC. After the research team adjusted the conceptual model to reflect the IC’s unique
nature, we presented the revised model to the current and former IC personnel in the interviews and the focus group, respec-
tively. According to their varied professional experiences, interviewees and focus group participants recommended additions
and deletions to the model. We discussed the potential updates and also referred back to the relevant research literature when
choosing which revisions to implement.

For the not-for-attribution interviews, we identified subjects via professional contacts from the research team. Moreover, we
used a snowball sampling method to gather recommendations for additional interviews from the interviewees. Our interview
pool was relatively small, consisting of nine IC professionals at the mid- to senior-management level; the focus group com-
prised eight former IC professionals. Although our interviewees and the focus group participants include individuals with expe-
rience at the Office of the Director of National Intelligence, Central Intelligence Agency, Federal Bureau of Investigation (FBI),
and other relevant organizations, many participants had spent much or all of their careers at the Defense Intelligence Agency
(DIA). Hence, limitations of this work are that the interviews and single focus group included relatively small sample sizes and
our interviews were not representative of the breadth or depth of the IC. To address this limitation, future research could focus
on interviewing a representative sample of personnel from across all 18 intelligence agencies. In addition to questions relating
to the conceptual model, the interviewees and focus group participants provided information regarding potential job categories
and tasks that could lead to trauma exposure, individual and organizational variables that could influence trauma responses,
mental health services the IC offers employees, and constraints that could prevent personnel from accessing the support they
might need. Because of the small number of interviewees, our research team also conducted an informal thematic analysis to
identify key trends and quotes to include in the Perspective.

Another limitation relates to the nature of this publication as an unclassified Perspective. Some potential interviewees declined
to participate as a result of the unclassified status; they did not want to discuss their work and its mental health effects outside
of secured environments. As discussed in the Perspective, the need-to-know culture associated with security clearances likely
limits the willingness or ability of employees to raise concerns about the traumatic effects of their work.
a The RAND National Security Research Division’s standardized human subjects research screening methods, developed in collaboration with RAND’s Institutional Re-
view Board, deemed that this does not constitute human-subjects research. Nonetheless, all interviews are attributed anonymously throughout this report in compliance
with the U.S. Federal Policy for the Protection of Human Subjects (also known as the Common Rule). Furthermore, human subject protections (HSP) protocols have
been used in this Perspective in accordance with the appropriate statutes and DoD regulations that govern HSP. The views of the interviewees, which HSP rendered
anonymously, are solely their own and do not represent the official policy or position of DoD, IC agencies, or the U.S. government.

4
FIGURE 1
Conceptual Model for Reactions to Stress and Trauma in the IC Workplace

Traumatic Events Mitigating and Risk Factors Cognitive, Affective, and

Behavioral Outcomes
• Direct trauma exposure • Individual differences
• Secondary trauma exposure • Organizational environment
Positive
• Potentially morally injurious events
• Posttraumatic growth
Trauma exposure itself does not guarantee • Compassion satisfaction
Exposure to trauma can be direct or indirect. a given outcome. A variety of individual and
organizational mitigating and risk factors
influence the exposure’s outcome.
Negative
• PTSD
• Secondary traumatic stress
Operational Characteristics
• Moral injury

• Compassion fatigue
• Environment • Depression
• Duration • Burnout
• Supervision, personnel
Interventions • Substance abuse
• Task • Fatigue
• Level of danger
• Communication • Individual or workplace
• Formal or informal
The types of trauma exposure
Operational characteristics—or specific and occupational features of
characteristics of the work or workplace— Interventions can support the workplace can lead to both
can affect the way individuals react to those who experienced positive and negative mental
trauma exposure. trauma exposure. health outcomes.

SOURCES: RAND interviews and RAND analysis of models of psychology of counterterrorism operations (Smith and Barrett, 2019) and vicarious trauma or secondary
traumatic stress (Beth E. Molnar, Ginny Sprang, Kyle D. Killian, Ruth Gottfried, Vanessa Emery, and Brian E. Bride, “Advancing Science and Practice for Vicarious
Traumatization/Secondary Traumatic Stress: A Research Agenda,” Traumatology, Vol. 23, No. 2, 2017).
NOTES: PTSD = posttraumatic stress disorder. Interventions rarely occur, so they do not merit direct placement and connection within the model’s flow. However,
because they can occur, they have a place within the conceptual model.

5
 established as a way to fill a need to describe the
effects of trauma exposure on professionals such
as mental health practitioners, educators, journal-
ists, researchers, human rights activists, police, and
health care workers.8
• Potentially morally injurious events are situations
involving “perpetrating, failing to prevent, bearing
witness to, or learning about acts that transgress
deeply held moral beliefs and expectations.”9
Note that a single event could meet all three of these
definitions because of overlapping definitions across
the categories.
IC Personnel’s Risk for All Three
Types of Trauma
IC personnel are at risk of experiencing a variety of trau-
mas, depending on their work environment and profes-
sional focus. Figure 2 illustrates which categories of per-
sonnel within the IC could be at the highest risk for each
type of exposure. Personnel in certain positions that are,
by their nature, in the field (e.g., case officers and defense
attachés) are at risk of both direct and secondary trauma
because they often operate in hostile environments and
could run sources operating at personal risk. Staff mem-
bers who deploy to provide forward intelligence support to
combat operations (generally CIA and DIA all-source ana-
lysts and collectors) are at risk of direct trauma from the
wartime effort around them and of secondary trauma from
their involvement in supporting and observing kinetic
military action. The quick turnarounds, short nature, and
general ad hoc approaches taken to these deployments
6
increases the likelihood that these needs could go unrec-
ognized and unaddressed—particularly because analysts
often leave their home office or organization and deploy
individually to augment a fusion center or task force.10
IC professionals also can work in environments
where they are continuously exposed to reports and sto-
ries about systematic violence. This is particularly true
for IC members whose work focuses on counterterrorism,
counternarcotics, wartime conflict, instances of genocide
and ethnic cleansing, countries with prolific sexualized
violence, weapons of mass destruction, prisoners of war or
missing in action cases, refugees, and document or tech-
nical exploitation.11 Although the IC has a long history
of working with material in textual formats (recognizing
the National Security Agency’s specific work with audio
material and the National Geospatial-Intelligence Agency’s
specific work with still images), IC analysts are increasingly
likely to engage with visual violent material—for example,
when analyzing videos al-Qa’ida posted of beheadings or
reviewing gory images recovered from a laptop during a
military operation. Moreover, because of military opera-
tions, gruesome and traumatic material often is easily
accessible and can even be shared via email, which means
that, at times, such material is presented to profession-
als who are not prepared to view such material.12 Those
individuals working on such topics are at increased risk of
suffering stress reactions from their prolonged exposure to
such graphic and affecting content.
The existing literature on trauma exposure among IC
professionals has primarily been conducted in the context
of the U.S. Air Force, with special focus on drone-operator
teams.13 These professionals tend to be deployed in gar-
rison, usually piloting unmanned aircraft remotely from
FIGURE 2
Types of Trauma and the IC Professionals Who Are at the Highest Risk

A variety of mitigating and risk factors, at both the personal and organizational levels, affect levels of resilience to
trauma. Individuals serving in certain positions are more likely to experience exposure to potentially traumatic events.

Direct trauma Professionals who are in the field or deployed

Secondary trauma Professionals who work on issues where systematic violence is common

Professionals who work on controversial topics or in areas where there is

Morally injurious events wrongdoing or moral failures to act

within the United States, and their work involves stress
in the form of long hours of high vigilance, accompa-
nied by exposure to high-definition combat imagery and
occasional involvement in combat.14 A 2018 study queried
personnel engaged in remote combat and graphic media
exploitation operations via focus groups and surveys.15
The study found that certain types of experiences, such
as witnessing U.S. military or civilian casualties or atroci-
ties committed by the enemy, heightened personnel’s risk
for posttraumatic stress and moral injury. This also high-
lights the risk to IC professionals, stressing the importance
of understanding how these risks translate beyond this
narrow type of intelligence work to the broader IC.
A less appreciated and understood type of trauma
is potentially morally injurious events, for which all IC
members are at risk.16 IC professionals adhere to a codified
set of professional ethics, including seeking and speaking
the truth, conducting themselves in a lawful manner that
respects privacy and civil liberties, and being responsible
stewards of the public trust, which includes protecting
intelligence sources and methods and being accountable to
institutions and the people of the United States.17 Yet politi-
cians supported by the IC might not adhere to these same
ethics; they might leak intelligence, compromising sources
and methods, or knowingly speak falsehoods.18 IC mem-
bers can also betray this code of conduct—for example,
through espionage, as was the case of Edward Snowden’s

7
 violent event abroad, but they must defer to policymakers’
decisions on whether to act and whether such an action is
IC professionals could in the U.S. national interest. IC professionals are not simply
bystanders of these types of actions: They play a critical
feel complicit in policy role in the policymaking process and, therefore, could feel
complicit in these decisions even though they often lack
decisions even though the agency to determine policy outcomes. IC professionals

they often lack the agency can suffer similar injuries from intelligence failures or as a
result of intelligence gaps. A study of intelligence counter-
to determine policy terrorism professionals found that those professionals who
were responsible for research, analysis, and communication
outcomes. felt a sense of guilt and blame when they missed something
important.21

theft and unauthorized disclosure of intelligence docu-

ments.19 Exposure of programs that have overstepped their Outcomes of Trauma—Both
authorities or other intelligence efforts and are called into Negative and Positive
question publicly may also put IC members at risk of moral
Existing literature can help us understand specific mental
injury. Compartmentalization is the concept that IC mem-
health outcomes from trauma exposure and how those can
bers are only aware of topics about which they have a dem-
affect professionals’ well-being, as well as an organization’s
onstrated need for such knowledge; IC members are often
mission at large. Importantly, the literature reveals that
not authorized to know what their colleagues are doing,
such effects are not universally negative: A variety of both
but they need to have confidence that behavior is ethical.
negative and positive outcomes are well documented.
Wrongdoing that reflects that some parts of the IC are not
Perhaps the most well-known category of negative
adhering to its stated code of ethics raises questions about
outcomes includes PTSD and other mental health disor-
whether IC institutions can be trusted or about whether an
ders.22 Recounting this literature is beyond the scope of
IC professional is unknowingly a participant in a corrupt
this review, but the box on the next page provides a brief
or unconstitutional system.
description of symptoms that meet diagnostic criteria for
IC professionals could also be at risk of traumatic
PTSD.23 In addition to the effects on individual employees’
stress reactions from watching atrocities that they perhaps
well-being,24 an organization that employs many employees
anticipated but, from their perspective, a policy­maker did
suffering from PTSD or other negative outcomes is affected
not take action to avoid or prevent.20 For example, an IC
as well.25 Effects can include high staff turnover, reduced
professional might be aware of a pending genocide or mass

8
productivity, and reduced total workdays (although further
research is still needed).
Other negative outcomes are also possible, such as
depression and unhealthy substance use, although esti-
mates of the outcomes’ prevalence vary widely across
studies.26 Moreover, unhealthy substance use and depres-
sion often overlap.27 Some interviewees anecdotally noted
the prevalence of a happy-hour culture throughout their
respective communities, noting that alcohol is often seen as
an acceptable coping mechanism, whereas other substances
are unlikely to be used because of prohibitions and the risk
of losing a security clearance or job.28
Secondary traumatic stress presents similarly to the
symptoms of PTSD. Its symptoms, which include intrusive
symptoms, avoidance, negative thoughts and feelings, and
arousal, are usually considered in terms of severity rather
than being used to determine a diagnosis or condition.29
For individuals who support trauma survivors, includ-
ing police, health care workers, and therapists, second-
ary traumatic stress is also sometimes called compassion
fatigue.30 One of our interviewees shared a story about a
contractor analyst who slept under his desk one night as a
result of stress from his account. This analyst lived alone
and, therefore, lacked support mechanisms external to the
office. Eventually, his company did provide mental health
services, once the issue was identified.31 Another former
analyst who was pregnant recounted how she began prema-
ture labor as a result of stressful and traumatic work; she
also mentioned witnessing colleagues having heart attacks
and experiencing anxiety from the stress.32
There are a variety of negative outcomes associated
with moral injury, including psychological, physical,
social, and spiritual changes.33 Interviewees noted multiple
instances of intelligence professionals encountering moral
dilemmas throughout their careers, often surrounding the
effects that intelligence or military operations can have on
human sources or innocent civilians. One former military
and civilian analyst and manager said, “I have seen people
become very disturbed about those types of discussions,
up to and including tears in a meeting, if we do something
that might really hurt innocent people.”34 Others noted
that policymakers not respecting IC judgments and the
workforce or not preparing for events the IC warned about,
such as war crimes or invasions, can lead to similarly mor-
ally injurious feelings and reactions.35 A large study of
U.S. veterans who served in Iraq or Afghanistan showed
Posttraumatic Stress Disorder
Following exposure to a traumatic event, PTSD diagnosis
requires the following four criteria, which must persist for
at least one month following the trauma exposure:
• at least one intrusion symptom (e.g., distressing
memories, dreams, or distress in reaction to trauma
reminders)
• at least one avoidance symptom (e.g., avoiding
thoughts, feelings, or reminders of the event)
• at least two “negative alterations in cognitions
and mood” (e.g., exaggerated negative beliefs,
decreased interest in important activities, feeling
detached from others)
• at least two “alterations in arousal and reac-
tivity” (e.g., irritability, difficulty sleeping, and
concentration problems).
SOURCE: American Psychiatric Association, 2022, pp. 301–302.
9
increased rates of mental disorders and suicidal ideation
among veterans exposed to potentially morally injuri-
ous events.36 The researchers note that it is still unclear
how unique, and distinct from PTSD, these issues are and
whether specific treatments are warranted to address them;
further research is certainly warranted to determine differ-
ences between PTSD and moral injury.37
Professional burnout is another potential negative
consequence of work-related trauma exposure,38 although
it is related more to general work stress (e.g., unfair
treatment, unmanageable workload, lack of role clarity,
unreasonable time pressure, poor communication) than
to trauma content per se.39 Burnout does not involve the
specific symptoms of PTSD but rather general feelings of
hopelessness and being ineffectual at work that gradually
lead to a state of emotional exhaustion and can lead an
employee to leave their job. Moreover, our interviewees
noted the impact that burnout is having on the IC work-
force, exacerbating professional exposure to secondary
trauma. In some instances, when employees advocate for
themselves, requesting less stressful positions, managers
have responded with, “Nope, you’re too valuable to us; we
can’t move you.”40
Notably, the scientific literature has also explored poten-
tial positive outcomes associated with trauma exposure:
posttraumatic growth and compassion satisfaction.
The first positive outcome, posttraumatic growth, is
defined as transformative positive change that can result
from highly challenging life crises,41 including enhanced
perceptions of self, relationship to others, and philosophy
of life.42 This is seen as a dimension that is independent of
posttraumatic stress, and PTSD symptoms are seen as a
prerequisite for this type of growth.43 Psychological growth
10
is associated with such outcomes as improved well-being;
positive physiological changes; and positive work-related
outcomes,44 including a sense of accomplishment, mean-
ingfulness of work,45 and positive leadership behaviors.46
In one study, counterterrorism professionals identified the
importance of their work despite the negatives of being
“haunted” by experiences or feeling distant from their past
selves, from others, or from the future.47 For leaders and
policymakers, the positives centered on being a director
of useful action. For counterterrorism field professionals,
positives included the accomplishment of passing a test
of courage, admiration and affection for colleagues, and a
sense of victory when successful.
Another positive outcome is compassion satisfaction,
defined as the pleasure that one derives from being able to
do work effectively.48 In many studies, it is included along-
side measures of negative outcomes to assess the factors
related to maintaining compassion in the face of workplace
trauma exposure.
Operational Characteristics of an
Environment That Can Increase
Trauma Risks
Operational and organizational characteristics—or spe-
cific characteristics of the work or workplace—can affect
the ways in which individuals react to traumatic content.
Substantial literature shows that operational characteristics
of work environments where personnel are assigned have
an impact on subsequent mental health outcomes for mili-
tary service members, helper professionals, and personnel
responsible for internet content monitoring.49 Recognition
One might assume that direct combat exposure would
be the factor that most directly affects mental health, but
studies suggest that constant stressors related to work—
such as long hours, shift work, short-staffing, and poor
leadership—can be more frequent detrimental sources.
of the dangers of such environments exists within the IC,
but the same understanding of operational impacts might
not extend to the headquarters environment. Many of the
current and former IC professionals with whom we spoke
provided examples of situations in which resources were
not provided to support them or other employees in pro-
cessing graphic material and traumatic events.50 For exam-
ple, two professionals shared personal reflections regarding
the impact of viewing hours of video and images related to
hostage cases and the lack of institutional training or sup-
port. One stated that they compartmentalized the impact
to such a degree that they forgot the impact on new ana-
lysts until they saw one “crying at their desk as they pro-
cessed the humanity of the hostage.” Upon further reflec-
tion, the interviewee realized that the IC discusses work
in terms of mission, as if analysts were disconnected from
their empathy and feelings during business hours. This
tendency reflects a cultural acceptance of “but the job is
the job” and a failure to address the impact on employees.51
In our review of studies focused on deployment of
military personnel, we found certain aspects of deploy-
ment experiences were salient in terms of mental health
outcomes. Studies on deployment of military personnel
have shown consistent evidence that PTSD symptoms are
higher among those injured while deployed, and the single
biggest predictor is exposure to combat.52 The literature
that is most germane for the IC similarly highlights the
importance of operational factors in informing mental
health experiences: It is not simply the exposure to poten-
tially traumatic events but compounding occupational
stress that can make individuals more susceptible to expe-
riencing trauma. Although one might assume that direct
combat exposure would be the factor that most directly
affects mental health, studies suggest that the constant
stressors related to work—such as long hours, shift work,
short-staffing, and poor leadership—can be more frequent
detrimental sources.53
In terms of organizational variables, literature on
deployed military personnel has focused specifically on
mental health outcomes but also on the ways that per-
ceived unit support and unit leadership, the prevalence
of non–combat-related stressors during deployment, and
11
sustained presence in dangerous locations affect mental and lowering barriers to seeking care when it is needed,
health outcomes.54 Negative work environments within something interviewees consistently highlighted as nec-
the IC, such as poor management that fails to focus on essary. One manager noted, “You can have institutional
employee well-being, can exacerbate the risk to employees. structures, but 90 percent of management is local and
A few interviewees underscored that consistently toxic having presence.” The manager further noted the critical-
office environments, such as those where racism or sexism ity of leadership honestly engaging with their employees to
explicitly or passively exists, can be damaging to resilience. acknowledge and gauge stress levels: “Having a team where
One interviewee noted concerns about the emotional and people can be honest is important, but you also have to
professional impacts on people of color when colleagues have someone who can say, ‘I get this, you’re under stress,
make derogatory comments about adversaries who share let’s do something.’”59
the same skin tone as IC employees.55 A paper published
in 2020 focuses on how organizational factors influenced
IC security breaches, highlighting that one notable case Poor Understanding of the Risks of
was influenced by “a work environment marred by bully- Trauma Exposure
ing, physical violence, vandalism, retaliation, and negligent
Despite IC professionals being at risk of experiencing
management” within one section of the CIA.56 A study
traumatic or potentially injurious events through their
focused on Internet Crimes Against Children Task Force
professional responsibilities, these risks are poorly or not
personnel showed that low organizational support was
generally understood, which reduces the effectiveness
related to mental health outcomes.57
of mitigating risk factors and interventions. In contrast,
IC organizations that have more of a military culture,
the potential for staff to experience direct trauma from
such as DIA, were seen by interviewees as being at greater
a deployment or a colleague’s suicide is generally recog-
risk of these types of problems, both because of the poten-
nized. Supervisors receive training on employee assistance
tial for military leaders to expect civilians to have the same
program (EAP) resources and how to engage services for
temperament as service members and because of the more-
employees, but these services are generally viewed as sup-
frequent turnover for military leadership than for civilian
porting direct trauma experiences, according to interview-
leadership. These IC organizations can inherit some of the
ees and focus group participants.60 This is not to say that
negative aspects of the military’s culture, such as dismissal
IC professionals receive sufficient support for trauma. IC
of misgivings or reticence, or a “Suck it up, Buttercup”
professionals returning from deployment, for example, are
attitude, without being balanced by some of the positive
typically required to meet with a psychologist even though
elements of the military, such as chaplains, which are not
this interaction is often superficial.61 Multiple interview-
available to the IC civilian workforce.58
ees noted that pre- and post-deployment sessions were
Conversely, IC managers can provide a positive envi-
short, limiting opportunities to build trust with psycholo-
ronment by recognizing the value of mental well-being
gists, and psychologists’ security clearance statuses were

12
unclear.62 However, EAP services were viewed favorably
among interviewees and were well advertised, especially
to supervisors who could recommend them to staff. We do
not have data on how frequently these services are used or
how effectively they are received, but we spoke to individu-
als who had positive anecdotal experiences or observations.
EAPs have the benefit of being able to provide support for
staff in a classified environment and to serve as a network-
ing mechanism in cases that exceed its capacity. A couple
of the IC supervisors with whom we spoke mentioned
that they brought in EAP staff to brief their organiza-
tions during periods of increased stress.63 That said, EAP
programs were generally seen as services for individuals
who experienced direct trauma and stress.64 It is not clear
whether they are also seen as a recourse for those experi-
encing secondary traumatic stress, and their aptitude to
deal with issues of other types of empathy-based stress is
also unclear.
Secondary traumatic stress is not an issue that IC
supervisors and managers are necessarily trained and
equipped to understand. Individuals suffering from sec-
ondary traumatic stress may also fail to recognize the
effects of this stress, or they may lack the vocabulary
needed to describe their feelings so as to effectively seek
care. One interviewee noted that it is quite possible that
most employees do not think that there can be mental
health issues in the community, particularly among ana-
lysts: “I sit at a desk all day long. I write reports. How
can I think I’m having a traumatic experience from
just reading?”65
Secondary traumatic
stress is not an issue
that IC supervisors and
managers are necessarily
trained and equipped to
understand.
Mitigating and Risk Factors Can
Help Predict the Potential for
Trauma and Reduce Its Likelihood
An individual’s likelihood of experiencing a particular
outcome is not predetermined by the experience of trauma
exposure; rather, studies indicate that outcomes are influ-
enced by a variety of mitigating and risk factors. Just as the
operational characteristics of an environment can affect
the risk of trauma, there are also individual risk factors.
Despite the existence of a large body of research
directed toward understanding who recovers and who
develops lasting mental health problems following expo-
sure to trauma, there are some limitations to this work.
These studies tend to examine the factors for a particular
type of exposure (e.g., family violence, trauma experienced
by refugees, trauma experienced by firefighters), and most
do not control for different predictors simultaneously but
rather examine univariate relationships.
13
 The types of predictors span the periods before,
during, and after trauma exposure and are thus often
grouped into three categories: pre-trauma characteristics
(e.g., past history of trauma exposure), peri-traumatic fac-
tors (e.g., severity), and post-trauma factors (e.g., social
support, additional life stress). PTSD studies of the gen-
eral population show that the most-consistent pre-trauma
predictors are personal and family psychiatric history and
history of child abuse.66 Although demographics tend to be
inconsistent predictors of PTSD, the risk for PTSD appears
to be higher among women and for individuals with lower
socioeconomic status.67 Despite the fact that gender is con-
founded with the type of trauma exposure in many cases
(e.g., women are more likely to experience sexual assault,
men are more likely to experience accidental injuries),
women appear to be at higher risk even within trauma
type.68 Combat exposure is the primary risk factor for
mental disorders among service members.69
The literature on secondary traumatic stress is smaller
and tends to include not military service members but
spouses and health care providers.70 A systematic review
of 31 studies of first responders identified several risk
factors—including age; gender; exposure; emotional
exhaustion; and posttraumatic factors, such as social sup-
port and substance use—to predict secondary traumatic
stress, although levels of secondary traumatic stress were
low overall.71 Even with the end of combat operations in
Afghanistan and Iraq, it is important for the IC to consider
the risk of combat exposure in relation to secondary trau-
matic stress. Many of our interviewees and focus group
participants provided personal examples of friends being
killed or injured in suicide bombing attacks or even col-
leagues being killed in non–work-related circumstances.72
14
One former official who was based in an embassy relayed
the impact of having to identify human remains, spend-
ing hours to determine whether the body was that of an
American to provide proper notifications.73 Moreover,
the constant exposures to mass graves, counterterrorism
strikes, videos of hostages, and media exploitation were
consistently highlighted as reoccurring traumatic incidents
for IC professionals.74
It is important to recognize that trauma is not expe-
rienced equally: There are various factors that affect an
individual’s resilience to trauma. Literature that addresses
protective factors or resilience to trauma includes social
support,75 as well as the concept of hardiness, defined as a
personality construct that involves a strong sense of com-
mitment, belief that one is in control, and the perception of
difficulties as challenges rather than threats.76 Resilience is
often expected of IC professionals, and it is often perceived
as staff become accustomed to the job and experienced
at coping with difficult situations without expressing
emotion or acknowledging the mental impact. Seasoned
professionals may be so resilient to the stressful demands
of their professions that they may fail to recognize the
needs of new and junior staff, but they also may fail to
recognize when they have reached the limits of their own
emotional capacity.
IC leaders may fail to appreciate how building mental
buffers against trauma-related stress—particularly buf-
fers that reduce the practice of empathy among IC
professionals—can open professionals to cognitive biases.
Empathy may be seen as a weakness that makes someone
emotional and, therefore, not rational or analytic. One
senior manager relayed to us that other managers told
her she was not “tough enough” as an office chief.77 She
IC leaders may fail to appreciate how building mental
buffers against trauma-related stress—particularly
buffers that reduce the practice of empathy among
IC professionals—can open professionals to
cognitive biases.
added, “In our business, it’s hard for people to see that noted, “If you can never recognize and acknowledge when
you can be tough and vulnerable at the same time. I think something good happens, and it’s all bad, that’s a problem.
those skills of being available and listening are as impor- It impacts the mission.”81
tant as anything else. Because we deal with life and death,
people think that if you’re vulnerable you can’t make tough
decisions.”78 According to interviewees, empathy should Barriers for IC Employees Seeking
instead be seen as a professional asset; it is what allows Care
IC professionals to understand adversaries and targets of
Our interviews exposed concerns about the lack of a cul-
collection.79 Focus group participants noted that a lack
ture of mental wellness in the IC. There may need to be
of empathy can open individuals up to biases that impair
a systematic effort to address these problems and make
objective analysis, particularly a tendency to see the U.S.
deeper cultural changes. The needs for physical wellness
side as good or right and adversaries as wrong or evil,
are recognized—for example, many agencies authorize staff
especially after these individuals spend significant time
to spend a few hours per week exercising while on the clock
focusing on a country that, for example, consistently com-
or provide a gym in the facility—but the same philosophy
mits atrocities.80 Over time, this bias can cloud individuals’
is not applied to mental wellness. While our conversations
self-perceptions and assessments of targets and the ways
highlighted the increased advertisement of EAP services
that individuals present this information to policymakers,
throughout the IC, interviewees also noted some limita-
which then can affect the policies that are designed and
tions of these services. Foremost was that EAPs offer only
implemented. Moreover, the compassion fatigue aspect of
a handful of sessions for employees, as they are not meant
secondary traumatic stress can increase biases and decrease
to be a formal treatment. Moreover, a direct-referral ser-
objectivity among analysts. One former IC professional
vice to external mental health care, particularly one that

15

Stigma is a well-
recognized hindrance to
seeking mental health
care, but there are some
unique constraints for
IC personnel.
takes insurance coverage and geographic constraints into
account, does not exist. With a significant portion of IC
employees living in the greater Washington, D.C., area,
financial concerns and commuting times are factors that
can limit access.82 One interviewee expressed the belief that
senior IC management viewed EAPs as an “easy button”
and the primary mental health resource for staff, recom-
mending the service without a clear understanding of the
expanse of mental health issues facing employees.83 A cur-
rent manager expressed similar concerns about the limited
knowledge of the varied impacts of trauma on the work-
force and the seemingly singular agency-provided resource,
noting that this could lead to increased employee distrust
of managers and services, such as EAPs, that are offered
by IC agencies.84 Another current manager emphasized
that “mental health services [are] partly [an interpersonal]
chemistry issue; you need to feel safe.”85
Occupational trauma exposure opens up the pos-
sibility of workplace prevention for all employees and
16
early intervention for those who have been exposed to
trauma. Researchers recommend a proactive approach to
addressing the mental health impacts of workplace trauma
exposure, 86 and a recent scoping review concluded that
“[early] interventions [for] emergency responders [work
best] when these are tailored to the needs of the popula-
tion, are supported by the host organization, and harness
existing social cohesion and peer support processes within
a team or unit.”87 Intelligence organizations could also
look at other models of support, such as those used by the
Army and the FBI.88 For individuals who develop PTSD
that is impairing their daily lives, mental health treatments
are available.89
Stigma is a well-recognized hindrance to seeking
mental health care, but there are some unique constraints
for IC personnel.90 IC employees may be concerned that
seeking help will negatively affect their security clearances
and threaten their ability to maintain their positions; this
issue is reflected in military culture as well. Although the
Standard Form (SF) 86, which is required for national
security positions, states that mental health is important
and that seeking mental health treatment is encouraged,
it also states that “there may be times when such a [mental
health] condition can affect a person’s eligibility for a
security clearance.”91 The SF-86 was modified in 2016 to
ask questions about only mental health conditions that
have required hospitalization or ordered treatment or that
related to a diagnosis of psychotic disorder, schizophrenia,
schizoaffective disorder, delusional disorder, bipolar mood
disorder, borderline personality disorder, or antisocial
personality disorder or another mental health condition
that substantially adversely affects judgment, reliability,
or trustworthiness.92 These changes amounted to a rec-
ognition that the SF-86’s previous broad question about
whether an applicant had consulted with or been counseled
by a mental health practitioner for any reason was a deter-
rent to individuals seeking mental health treatment, even
though clearances were reportedly rarely denied because
of mental health counseling.93 Some individuals have won-
dered whether questions about mental health should be
removed entirely given that it rarely leads to security clear-
ance denial or revocation, and, for those cases in which it
would, there would be other indications of risk.94 With the
ongoing shift to the Continuous Evaluation Program for
the security clearance process,95 an opportunity exists to
proactively include reviews and discussions with mental
health professionals to screen current IC employees’ expo-
sure to trauma and resiliency to it, according to one of
our interviewees.96
The need for secrecy also limits IC professionals’ abil-
ity to employ some mechanisms for coping with stress
and trauma. Principally, IC employees generally cannot
discuss their work with their loved ones, so they are unable
to share concerns and experiences freely with family and
friends. Because of the requirement that individuals have
a demonstrated need to know in order to access classified
information, IC members might not be able to discuss
stressors or experiences even with cleared colleagues, fur-
ther isolating these employees. In the words of one current
IC manager, “We’re trained not to talk about anything.
You don’t talk about your work, and, if you do, you don’t
talk about the problems. First, last, and everything is
security focused.”97 Our conversations revealed concerns
over “happy hour culture” and perceived high levels of
alcohol consumption as the “acceptable” way to manage
work-related stressors and traumas throughout the IC.98
Fears over violating need to know or accusations of sharing
classified information with uncleared personnel may also
make an IC professional reliant on EAP services, which
could provide support in a classified setting. EAPs, how-
ever, may be seen as a last resort, seen as punishment for
the employee, or referred when performance has already
been adversely affected.99 Concerns regarding mental
health confidentiality within the military led to the devel-
opment of confidential avenues for nonmedical counseling
for issues that do not meet the criteria for a formal psychi-
atric diagnosis;100 similar models may prove useful for the
IC. One current manager affirmed this concern with her
own predeployment experiences relating to a long-standing
anxiety diagnosis: “I had to meet a psychologist; they asked
me some personal questions that I felt were a violation of
what they needed to know to clear me.”101
IC professionals may also be concerned about how they
will be perceived by their coworkers if it becomes known
that they are seeking support for trauma. Some of our
focus group participants noted how peer pressure influ-
enced personnel not wanting to be identified as someone
who cannot “cope with the gruesomeness” of some jobs.102
This may also have a gender dimension—for example, men
may be concerned that they need to be seen as “tough,”
whereas women may not want to be seen as “emotional,”103
an idea agreed upon by current and former personnel.
One female manager stated that, as a result of stressors
related to the coronavirus disease 2019 pandemic, she was
having more “open and honest conversations” with her
female colleagues about difficulties, but not with her male
counterparts.104 The gender divide can also directly relate
to whether an individual is seen as competent for the job,
given that so much of the credibility of an IC professional is
17

Much of the credibility
of an IC professional
is contingent on
their judgment and
mental fitness.
contingent on their judgment and mental fitness. If some-
one is perceived as overwrought or irrational, their work
may be unfairly discredited by those around them. Because
women are more likely to experience negative responses to
trauma, this concern is not unfounded.
The Way Forward
Through our literature review, initial interviews with cur-
rent IC professionals, and the focus group with former IC
professionals, we learned that exposure to trauma and the
multiple ways that such exposure manifests are a concern
within the IC. Moreover, the IC has only a limited under-
standing of the symptoms of various types of trauma and
the strict parameters that surround discussions about
trauma and mental health within the IC, and it would
benefit from a concerted effort to consider these issues by
learning more about the community’s needs. As one cur-
rent manager stated, “If they [the IC] are not going to talk
about it proactively on the inside, they’re not going to talk
about it outside. What’s prompted the discussion in the
18
military is violence—suicides and radicalization—and the
IC hasn’t had [such violence].”105
Many of our conversations with IC members high-
lighted how addressing mental health issues within the
IC is a reactive endeavor, as opposed to a proactive one,
and burdens the individual with identifying their issue
with limited education and support. One former employee
noted how the current process reflects a broader theme in
American culture in which institutions treat mental health
as the responsibility of the individual instead of provid-
ing systemic supports that recognize an employee as a
“whole person.”106 Moreover, a few of the middle managers
with whom we spoke provided recommendations related
to seeking mental health care or building resiliency skills
based on their own experiences or crowdsourcing from
their friends across the IC.107 One went so far as to say,
“The IC doesn’t talk about why you should take care of
mental health, [only] what needs to be reported.”108 These
practices further stigmatize seeking mental health care
and degrade individual and institutional efforts to build a
culture of mental wellness. Our conceptual model provided
a guide for our conversations but also, more critically,
a common language and understanding of how trauma
affects individuals and organizations. Future research
could identify the most-effective methods for communica-
tion with the IC workforce, especially from senior leaders,
about protecting mental health and emotional well-being.
Our interviews showed that the changes in report-
ing requirements probably have not reduced the stigma
associated with employees seeking treatment. Agencies,
through their security and EAP representatives, could
provide details and examples of what behaviors and activi-
ties would affect an employee’s clearance or ability to hold
a certain job;109 for supervisors, more regular and extensive
training on trauma exposure, intervention methods, and
available resources appear to be gaps that could be easily
remedied. Moreover, by frequently initiating discussions
about their own mental health and the actions they have
taken to address any concerns, senior leaders could aid in
the effort to improve the IC’s culture in relation to mental
health and trauma exposure.110 One former military ana-
lyst and manager described an instance that occurred
while he was based at an embassy, in which the ambassador
required all employees to meet with a psychiatrist after a
traumatic event.111
A proactive approach to addressing the mental health
effects of workplace trauma exposure is recommended in
the literature.112 A review of posttraumatic growth at work
concluded that two factors could enable growth: occupa-
tional support (e.g., building organizational culture and
establishing processes to support employees exposed to
trauma) and attentive companionship (e.g., creating condi-
tions that foster trust and safety, designing formal roles for
attentive companionship).113 Further research into design-
ing and implementing effective processes and resources
that could be provided by the IC for the workforce could
As the national security community shifts focus from
Iraq and Afghanistan, IC personnel will continue to be
exposed to traumatic events, such as the spring 2022
Russian invasion of Ukraine and the resulting destruction.
consider methods to foster posttraumatic growth following
trauma exposure.
IC leaders recognize that human capital is one of the
IC’s most critical resources. In her confirmation hear-
ing, Director of National Intelligence Avril Haines high-
lighted the workforce’s having “unparalleled dedication
and expertise” in its “indispensable role in protecting the
country from the most dangerous threats.”114 However, as
the national security community shifts focus from Iraq and
Afghanistan, IC personnel will continue to be exposed to
traumatic events, such as the spring 2022 Russian invasion
of Ukraine and the resulting destruction, including poten-
tial war crimes.115 The human and fiscal costs to individual
IC employees and the community as a whole will continue.
Research shows that the cost of caring for war veterans
peaks 30 to 40 years following a conflict;116 although health
care options for military veterans are different from those
offered to current and retired U.S. government civilian
employees, this analysis of long-term health needs identi-
fies only one area of potential long-term impact on IC per-
sonnel. The need for the IC to support its employees who
are exposed to trauma through their work is not simply
an ethical obligation to provide for employees’ well-being:
19
Failure to meet this need could negatively affect the quality
of work and the retention of qualified personnel within the
IC. The IC would benefit from a concerted effort to con-
sider these issues by learning more about the community’s
needs, identifying best practices, and initiating programs
to meet the workforce needs.
Notes
1  Ian Shapira, “A CIA Suicide Sparks Hard Questions About the
Agency’s Memorial Wall,” Washington Post, May 21, 2019.
2  American Psychiatric Association, Diagnostic and Statistical Manual
of Mental Disorders, 5th ed., Washington, D.C., 2013; Anushka Pai,
Alina M. Suris, and Carol S. North, “Posttraumatic Stress Disorder in
the DSM-5: Controversy, Change, and Conceptual Considerations,”
Behavioral Sciences, Vol. 7, No. 1, 2017.
3  Professional burnout and employee turnover are potential conse-
quences of emotional exhaustion associated with secondary trauma
exposure. Among IC professionals, there might also be concerns about
barriers to care or coping mechanisms (e.g., unhealthy substance use or
risky behaviors) that make analysts more vulnerable to error or recruit-
ment by foreign intelligence services.
4  Nathan Smith and Emma C. Barrett, “Psychology, Extreme Envi-
ronments, and Counter-Terrorism Operations,” Behavioral Sciences of
Terrorism and Political Aggression, Vol. 11, No. 1, 2019.
5  Richard A. Bryant, “Post-Traumatic Stress Disorder: A State-of-
the-Art Review of Evidence and Challenges,” World Psychiatry, Vol. 18,
No. 3, October 2019.
6  Patrick Q. Brady, “Crimes Against Caring: Exploring the Risk of
Secondary Traumatic Stress, Burnout, and Compassion Satisfaction
Among Child Exploitation Investigators,” Journal of Police and Criminal
Psychology, Vol. 32, No. 4, 2017.
7  American Psychiatric Association, Diagnostic and Statistical Manual
of Mental Disorders, 5th ed., text revision, Washington, D.C., 2022.
8  Brian E. Bride et al., “Development and Validation of the Secondary
Traumatic Stress Scale,” Research on Social Work Practice, Vol. 14, No. 1,
2004; Charles R. Figley, ed., Compassion Fatigue: Coping with Secondary
Traumatic Stress Disorder in Those Who Treat the Traumatized, New
20
York: Routledge, 1995; Jason M. Newell, Debra Nelson-Gardell, and
Gordon MacNeil, “Clinician Responses to Client Traumas: A Chrono-
logical Review of Constructs and Terminology,” Trauma, Violence, and
Abuse, Vol. 17, No. 3, 2016; B. Hudnall Stamm, ed., Secondary Trau-
matic Stress: Self-Care Issues for Clinicians, Researchers, and Educa-
tors, 2nd ed., Lutherville, Md.: Sidran Press, 1999; Molnar et al., 2017;
B. Hudnall Stamm, Professional Quality of Life: Compassion Satisfaction
and Fatigue Version 5 (ProQOL), questionnaire, 2009.
9  Brett T. Litz et al., “Moral Injury and Moral Repair in War Veterans:
A Preliminary Model and Intervention Strategy,” Clinical Psychology
Review, Vol. 29, No. 8, 2009.
10  Our conversations focused on analysts and collectors; however,
one discussion mentioned IC support staff being exposed to traumatic
events through their work of logistics, communications, administra-
tive support, construction, reconstruction, and life support activities
(including mortuary affairs), often in remote and dangerous regions.
Future research could consider the breadth of occupations (beyond only
analysts and collectors) that could be exposed to traumatic events.
11  Although exploitation of physical documents and textual, visual,
and audio data found on computers and cell phones rose to prominence
as a result of counterterrorism raids, the capability and its usage existed
for centuries prior. Those personnel conducting the review, summary,
and triage of such material were often exposed to extreme violence
(including beheadings or torture), violent pornography, and extreme
descriptions of violence.
12  Interview with IC official, April 29, 2021.
13  These teams include pilots, sensor operators, military intelligence
coordinators, imagery analysts, and intelligence exploitation operators.
14  Jeremiah Gertler, U.S. Unmanned Aerial Systems, Washington,
D.C.: Congressional Research Service, R42136, January 3, 2012.
15  Researchers interviewed imagery analysts from the Distributed
Common Ground System (DCGS). The interviewees displayed increased
risk for posttraumatic stress if they witnessed a civilian death (Wayne
Chappelle et al., “Emotional Reactions of Distributed Common Ground
System Imagery Analysts Exposed to Remote Combat Operations,”
Psychological Trauma: Theory, Research, Practice, and Policy, March 12,
2020). DCGS is the intelligence, surveillance, and reconnaissance col-
lection, processing, and analysis system for the U.S. Air Force. Informa-
tion collected from the larger unmanned aerial systems and fixed-wing
airborne intel platforms (including live feed, imagery, and signals intel-

ligence) is processed by teams of analysts. (See U.S. Air Force, “Air Force
Distributed Common Ground System,” October 2015; Alan D. Ogle,
Reed Reichwald, and J. Brian Rutland, “Psychological Impact of Remote
Combat/Graphic Media Exposure Among US Air Force Intelligence
Personnel,” Military Psychology, Vol. 30, No. 6, 2018.)
16  Moral injury is a topic that is still not well understood, and strong
academic consensus does not currently exist. In 2019, a literature review
included 116 studies on the topic, but the studies contained notable
problems in assessment methods, including poorly defined variables
and measures and small sample sizes (see Brandon J. Griffin et al.,
“Moral Injury: An Integrative Review,” Journal of Traumatic Stress,
Vol. 32, No. 3, June 2019.)
17  “Principles of Professional Ethics for the Intelligence Community,”
undated.
18  Interview with IC official, May 21, 2021. Note that intelligence leaks
are often a controversial subject, both in terms of what constitutes a leak
and whether leaks are justified. Furthermore, what some IC members
might perceive as a leak by senior executive members could actually
be an authorized disclosure of classified information. The sitting U.S.
President, for example, discloses rather than leaks classified informa-
tion because information is only deemed classified under their executive
authority. It can also be difficult to confirm whether some leaks of clas-
sified information are intentional or political; consider the compromise
of Valerie Plame’s identity as a CIA operative or instances of political
manipulation of intelligence, such as those that Brian Murphy alleged of
top Department of Homeland Security officials manipulating reports to
conform to then-President Donald J. Trump’s political agenda.
19  Peter Finn and Sari Horwitz, “U.S. Charges Snowden with Espio-
nage,” Washington Post, June 21, 2013; focus group of former IC offi-
cials, June 23, 2021.
20  Focus group of former IC officials, June 23, 2021.
21  Ursula M. Wilder, “Inside the Inferno: Counterterrorism Pro-
fessionals Reflect on Their Work,” Studies in Intelligence, Vol. 58,
No. 4, 2014.
22  There is a substantial literature on the epidemiology, diagnosis,
and prevalence of PTSD among service members. For an early and
influential example, see Terri Tanielian and Lisa H. Jaycox, eds., Invis-
ible Wounds of War: Psychological and Cognitive Injuries, Their Conse-
quences, and Services to Assist Recovery, Santa Monica, Calif.: RAND
Corporation, MG-720-CCF, 2008.
23  Although there is substantial literature on PTSD, insights into
PTSD prevalence tend to be notably limited. Many studies are cross-
sectional, conducted only on treatment-seeking individuals or on a
convenience sample, who might not be representative of all of those who
are affected. Studies can also fail to control for combat exposure, which
is the strongest predictor of negative outcomes. Estimates of service
member PTSD rates therefore vary widely across studies, ranging from
0 to 48 percent in non–treatment-seeking samples and 2 to 68 percent
in treatment-seeking samples (Rajeev Ramchand et al., “Prevalence of,
Risk Factors for, and Consequences of Posttraumatic Stress Disorder
and Other Mental Health Problems in Military Populations Deployed to
Iraq and Afghanistan,” Current Psychiatry Reports, Vol. 17, 2015).
24  For instance, the review of studies about deployment to Iraq and
Afghanistan reveals that prevalence of clinical depression ranged from
4 to 45 percent and prevalence of substance use disorder ranged from 4
to 66 percent. As with PTSD, the estimates of prevalence were higher in
studies whose samples comprised treatment-seeking individuals (Ram-
chand et al., 2015).
25  Ronald C. Kessler and Richard G. Frank, “The Impact of Psychiatric
Disorders on Work Loss Days,” Psychological Medicine, Vol. 27, No. 4,
1997; Brett Drake and Gautam N. Yadama, “A Structural Equation
Model of Burnout and Job Exit Among Child Protective Services Work-
ers,” Social Work Research, Vol. 20, No. 3, September 1996; Michàl E.
Mor Barak, Jan A. Nissly, and Amy Levin, “Antecedents to Retention
and Turnover Among Child Welfare, Social Work, and Other Human
Service Employees: What Can We Learn from Past Research? A Review
and Metanalysis,” Social Service Review, Vol. 75, No. 4, 2001.
26  Bryant, 2019.
27  A 2008 RAND study (Tanielian and Jaycox, eds.) estimates point
prevalence at 14 percent each for both PTSD and depression, with
9 percent of individuals qualifying for both diagnoses and 5 percent
qualifying for each of the conditions alone, for a total of 18.5 percent
with either condition.
28  Interview with IC official, April 14, 2021; focus group of former IC
officials, June 23, 2021.
29  American Psychiatric Association, 2013.
30  Molnar et al., 2017; Stamm, 2009.
31  Focus group of former IC officials, June 23, 2021.
32  Focus group of former IC officials, June 23, 2021.
21
33  Griffin et al., 2019.
34  Focus group of former IC officials, June 23, 2021.
35  Focus group of former IC officials, June 23, 2021.
36  Blair E. Wisco et al., “Moral Injury in U.S. Combat Veterans:
Results from the National Health and Resilience in Veterans Study,”
Depression and Anxiety, Vol. 34, 2017. Other studies have focused on
police officers, refugees, and professionals and parents involved in child
protective services (see Griffin et al., 2019).
37  A 2018 review focused on studies regarding occupational exposure
to potentially morally injurious events and their relationship to PTSD,
depression, suicidality, and anxiety. Not surprisingly, the studies found
significant correlations between potentially morally injurious events
and the mental health and well-being outcomes across studies, which
mostly focused on military occupations. However, most of the studies
did not control for other traumatic experiences, life stress, or other con-
textual factors that could also be relevant to mental health (see Victoria
Williamson, Sharon A. M. Stevelink, and Neil Greenberg, “Occupa-
tional Moral Injury and Mental Health: Systematic Review and Meta-
Analysis,” British Journal of Psychiatry, Vol. 212, No. 6, 2018).
38  Christina Maslach and Michael P. Leiter, “New Insights into Burn-
out and Health Care: Strategies for Improving Civility and Alleviating
Burnout,” Medical Teacher, Vol. 39, No. 2, 2017.
39  Ben Wigert and Sangeeta Agrawal, “Employee Burnout, Part 1: The
5 Main Causes,” Gallup, July 12, 2018.
40  Focus group of former IC officials, June 23, 2021.
41  Richard G. Tedeschi and Lawrence G. Calhoun, “Posttraumatic
Growth: Conceptual Foundations and Empirical Evidence,” Psychologi-
cal Inquiry, Vol. 15, No. 1, 2004.
42  Richard G. Tedeschi and Lawrence G. Calhoun, Trauma and Trans-
formation: Growing in the Aftermath of Suffering, Thousand Oaks, Calif:
SAGE, 1995.
43  Sally Maitlis, “Posttraumatic Growth at Work,” Annual Review of
Organizational Psychology and Organizational Behavior, Vol. 7, 2020.
44  Maitlis, 2020.
45  Samantha Brooks et al., “Psychological Resilience and Post-
Traumatic Growth in Disaster-Exposed Organisations: Overview of the
Literature,” BMJ: Military Health, Vol. 166, No. 1, 2020.
22
46  Ryan M. Vogel and Mark C. Bolino, “Recurring Nightmares and
Silver Linings: Understanding How Past Abusive Supervision May Lead
to Posttraumatic Stress and Posttraumatic Growth,” Academy of Man-
agement Review, Vol. 45, No. 3, 2020. A systematic review of the litera-
ture pertaining to military personnel found evidence of growth across
14 studies. In those studies, greater growth correlated with higher levels
of social support, spirituality and rumination, and minority ethnicity
(Katharine M. Mark et al., “Post-Traumatic Growth in the Military: A
Systematic Review,” Occupational and Environmental Medicine, Vol. 75,
No. 12, 2018).
47  Wilder, 2014, p. 13.
48  Stamm, 2009.
49  For example, see Jennifer M. Hensel et al., “Meta-Analysis of Risk
Factors for Secondary Traumatic Stress in Therapeutic Work with
Trauma Victims,” Journal of Traumatic Stress, Vol. 28, No. 2, April 2015;
and Brady, 2017.
50  Focus group of former IC officials, June 23, 2021; interview with IC
official, April 23, 2021.
51  Interview with IC official, April 14, 2021; interview with IC official,
April 23, 2021.
52  Ramchand et al., 2015.
53  A 2017 review of drone-operator teams identifies the most-frequent
sources of occupational stress as operational factors, such as long hours,
low unit manning, and shift work, rather than combat-related factors,
such as participating in a strike or observing its aftermath (Cherie
Armour and Jana Ross, “The Health and Well-Being of Military Drone
Operators and Intelligence Analysts: A Systematic Review,” Military
Psychology, Vol. 29, No. 2, 2017).
Another 2017 review concludes that operational stress (e.g., long
working hours) could relate to lower levels of well-being and higher
instances of mental health problems among Australia’s unmanned aerial
vehicle operators (D. Wallace and J. Costello, “Eye in the Sky: Under-
standing the Mental Health of Unmanned Aerial Vehicle Operators,”
Journal of Military and Veterans’ Health, Vol. 25, No. 3, 2017).
A study that focused on U.S. Air Force remote warriors—a mix of
pilots and intelligence and cyberwarfare operators—and occurrences of
severe psychological distress or suicide highlighted occupational fac-
tors, such as job dissatisfaction (e.g., low responsibility or opportunities
for career advancement) and other life problems (e.g., alcohol abuse)
(Craig J. Bryan et al., “Subtypes of Severe Psychological Distress Among
US Air Force Remote Warriors: A Latent Class Analysis,” Military Psy-
chology, Vol. 30, No. 5, 2018).
54  Ramchand et al., 2015; Mulligan et al., “Mental Health of UK Mili-
tary Personnel While on Deployment in Iraq,” British Journal of Psy-
chiatry, Vol. 197, No. 5, 2010; Stephanie Booth-Kewley et al., “Correlates
of Posttraumatic Stress Disorder Symptoms in Marines Back from War,”
Journal of Traumatic Stress, Vol. 23, No. 1, 2010; Laura Goodwin et al.,
“Prevalence of Delayed-Onset Posttraumatic Stress Disorder in Military
Personnel: Is There Evidence for This Disorder? Results of a Prospective
UK Cohort Study,” Journal of Nervous and Mental Disease, Vol. 200,
No. 5, May 2012; Norman Jones et al., “Mental Health and Psychologi-
cal Support in UK Armed Forces Personnel Deployed to Afghanistan in
2010 and 2011,” British Journal of Psychiatry, Vol. 204, No. 2, 2014.
55  Interview with IC official, April 29, 2021.
56  Greta E. Creech, “‘Real’ Insider Threat: Toxic Workplace Behavior
in the Intelligence Community,” International Journal of Intelligence
and CounterIntelligence, Vol. 33, No. 4, 2020.
57  Brady, 2017.
58  Interview with IC official, May 21, 2021; focus group of former IC
officials, June 23, 2021.
59  Interview with IC official, May 21, 2021.
60  Focus group of former IC officials, June 23, 2021; interview with
IC official, April 14, 2021; interview with IC official, April 23, 2021;
interview with IC official, April 29, 2021; interview with IC official,
May 21, 2021.
61  Interview with IC official, April 23, 2021; interview with IC official,
April 14, 2021; focus group of former IC officials, June 23, 2021.
62  Interview with IC official, April 14, 2021; interview with IC official,
April 23, 2021.
63  interview with IC official, April 29, 2021; interview with IC official,
May 21, 2021.
64  A 2009 paper reviewed EAPs within the IC. Similar to findings
from our interviews, the research found that EAPs are an “integral
component” to IC human resources, leadership support, and personnel
reliability (Paul R. Clavelle, “Consulting to the Intelligence Community:
An Employee Assistance Program Model,” Consulting Psychology Jour-
nal: Practice and Research, Vol. 61, No. 1, 2009). The FBI’s EAP includes
crisis intervention and chaplain- and peer-support programs. It evolved
from a program that began in the early 1980s to address the unique
stressors that undercover FBI agents faced. The FBI’s support evolved to
adjust to the organization’s culture, needs, and priorities, as well as to
manage expectations, avoid mission creep, and define roles and respon-
sibilities. The FBI’s EAP could be a model for other IC agencies’ EAPs
(Meredith Krause, “History and Evolution of the FBI’s Undercover Safe-
guard Program,” Consulting Psychology Journal: Practice and Research,
Vol. 61, No. 1, 2009).
65  Interview with IC official, April 23, 2021.
66  Bryant, 2019; Chris R. Brewin, Bernice Andrews, and John D. Val-
entine, “Meta-Analysis of Risk Factors for Posttraumatic Stress Disorder
in Trauma-Exposed Adults,” Journal of Consulting and Clinical Psychol-
ogy, Vol. 68, No. 5, 2000.
67  Bryant, 2019. In a large study of UK police officers and staff, the
risk of PTSD, anxiety, and depression among those who experienced a
traumatic event in the prior six months was higher for women, those
not in a relationship, staff (i.e., employees of the police department who
were not police officers), and those who engaged in heavy drinking
(Sharon A. M. Stevelink et al., “Probable PTSD, Depression and Anxiety
in 40,299 UK Police Officers and Staff: Prevalence, Risk Factors and
Associations with Blood Pressure,” PLoS ONE, Vol. 15, No. 11, 2020). A
separate study showed that junior enlisted personnel and some health
care and combat specialists are more vulnerable to PTSD and depression
than officers (Ramchand et al., 2015).
68  David F. Tolin and Edna. B. Foa, “Sex Differences in Trauma and
Posttraumatic Stress Disorder: A Quantitative Review of 25 Years of
Research,” Psychological Bulletin, Vol. 132, No. 6, 2008. A review of
192 studies of disaster survivors concluded that degree of exposure to
a disaster, gender, history of prior traumas or psychiatric difficulties,
and low social support all consistently predict PTSD (Sandro Galea,
Arijit Nandi, and David Vlahov, “The Epidemiology of Post-Traumatic
Stress Disorder After Disasters,” Epidemiologic Reviews, Vol. 27, No. 1,
July 2005).
69  Ramchand et al., 2015. The studies we considered use different
scales to define the term combat exposure. One commonly used scale
includes 11 nonoverlapping items that were empirically derived from
a longer list of 24 items that is often used by DoD. Some items are
specific to direct trauma (e.g., smelling decomposing bodies, being
injured, engaging in hand-to-hand combat), whereas others would also
be applicable to other types of exposure (e.g., having a friend who was
23
seriously wounded or killed, being responsible for the death of a civil-
ian). However, the scales usually count different types of exposures
for the total score, meaning that people in rear support positions or in
remote drone operations will always score lower than people deployed to
a combat zone.
70  Julia Diehle, Samantha K. Brooks, and Neil Greenberg, “Veterans
Are Not the Only Ones Suffering from Posttraumatic Stress Symp-
toms: What Do We Know About Dependents’ Secondary Traumatic
Stress?” Social Psychiatry and Psychiatric Epidemiology, Vol. 52, 2017;
Elizabeth A. Penix et al., “Secondary Traumatic Stress in Deployed
Healthcare Staff,” Psychological Trauma: Theory, Research, Practice, and
Policy, Vol. 11, No. 1, 2019; Elizabeth A. Penix et al., “Risk of Secondary
Traumatic Stress in Treating Traumatized Military Populations: Results
from the PTSD Clinicians Exchange,” Military Medicine, Vol. 185,
Nos. 9–10, 2020.
71  Anja Greinacher et al., “Secondary Traumatization in First
Responders: A Systematic Review,” European Journal of Psychotrauma-
tology, Vol. 10, No. 1, 2019. The authors of a 2015 metanalysis on second-
ary trauma stress reviewed 38 studies among therapists who work with
trauma victims and found small but significant correlations between
secondary trauma stress and personal trauma history or low levels of
social support, in addition to trauma exposure and low levels of work
support (Jennifer M. Hensel et al., “Meta-Analysis of Risk Factors for
Secondary Traumatic Stress in Therapeutic Work with Trauma Vic-
tims,” Journal of Traumatic Stress, Vol. 28, No. 2, April 2015).
72  Interview with IC official, May 21, 2021; focus group of former IC
officials, June 23, 2021.
73  Focus group of former IC officials, June 23, 2021.
74  Interview with IC official, April 14, 2021; interview with IC offi-
cial, April 23, 2021; interview with IC official, April 29, 2021; inter-
view with IC official, May 21, 2021; focus group of former IC officials,
June 23, 2021.
75  Johnrev Guilaran et al., “Psychological Outcomes in Disaster
Responders: A Systematic Review and Meta-Analysis on the Effect of
Social Support,” International Journal of Disaster Risk Science, Vol. 9,
2018. A study of Vietnam War veterans showed a strong mediating role
for both social support and hardiness (Lynda A. King et al., “Resilience–
Recovery Factors in Post-Traumatic Stress Disorder Among Female
and Male Vietnam Veterans: Hardiness, Postwar Social Support, and
Additional Stressful Life Events,” Journal of Personality and Social Psy-
chology, Vol. 74, No. 2, 1998), and a review study of disaster responders
24
(police, rescue, and recovery workers) found that social support relates
to a variety of mental health outcomes with effect sizes in the range of
0.36 to 0.57 (Guilaran et al., 2018). Studies of police officers also sug-
gest that hardiness is a protective factor against job burnout or a factor
related to lower perceived stress (Tonje Fyhn, Kristin Konglevoll Fjell,
and Bjørn Helge Johnsen, “Resilience Factors Among Police Investiga-
tors: Hardiness-Commitment a Unique Contributor,” Journal of Police
and Criminal Psychology, Vol. 31, 2016; Fiona Ward, Helen St Clair-
Thompson, and Alex Postlethwaite, “Mental Toughness and Perceived
Stress in Police and Fire Officers,” Policing: An International Journal,
Vol. 41, No. 6, 2018).
76  Kevin J. Eschleman, Nathan A. Bowling, and Gene M. Alarcon,
“A Meta-Analytic Examination of Hardiness,” International Journal of
Stress Management, Vol. 17, No. 4, 2010.
77  Interview with IC official, May 21, 2021.
78  Interview with IC official, May 21, 2021.
79  Focus group of former IC officials, June 23, 2021.
80  Focus group of former IC officials, June 23, 2021.
81  Focus group of former IC officials, June 23, 2021.
82  Interview with IC official, April 29, 2021; interview with IC official,
April 14, 2021.
83  Interview with IC official, April 23, 2021.
84  Interview with IC official, April 29, 2021.
85  Interview with IC official, April 23, 2021.
86  Marné Ludick, and Charles R. Figley, “Toward a Mechanism for
Secondary Trauma Induction and Reduction: Reimagining a Theory of
Secondary Traumatic Stress,” Traumatology, Vol. 23, No. 1, 2017; Molnar
et al., 2017.
87  Matt T. Richins et al., “Early Post-Trauma Interventions in Orga-
nizations: A Scoping Review,” Frontiers in Psychology, Vol. 11, No. 1176,
2020, p. 1.
88  Amy B. Adler et al., “Battlemind Debriefing and Battlemind Train-
ing as Early Interventions with Soldiers Returning from Iraq: Random-
ization by Platoon,” Journal of Consultative Clinical Psychology, Vol. 77,
No. 5, 2009; Krause, 2009.
89  Bryant, 2019; Tanielian and Jaycox, 2008.
90  A 2009 study on EAPs in the IC found that stigma around EAP
help-seeking, as well as concerns about maintaining a security clear-
ance, are barriers. Since the study’s publication, some of the recom-
mendations for reducing employee resistance have been implemented,
such as “unequivocal” management support, including statements
about confidentiality and a broad array of wellness activities that help
EAPs collaborate with managers and employees and acclimate to the
culture of the organization. Because of the parameters of the study, we
do not know whether other recommendations have been implemented
(Clavelle, 2009). For more information about stigma-related barriers in
seeking mental health treatment that are present in the military, see S. J.
Coleman et al., “Stigma-Related Barriers and Facilitators to Help Seek-
ing for Mental Health Issues in the Armed Forces: A Systematic Review
and Thematic Synthesis of Qualitative Literature,” Psychological Medi-
cine, Vol. 47, No. 11, 2017.
91  U.S. Office of Personnel Management, “Questionnaire for National
Security Positions,” OPM Standard Form 86, 2016.
92  Sean Bigley, “You’re Not Imagining Things: The SF-86’s Mental
Health Questions Have Changed If You Submitted Your First SF-86
Before 2016,” ClearanceJobs, March 29, 2020.
93  Tamara Haire, “Financial Problems or PTSD Need Not Affect Secu-
rity Clearance,” U.S. Army website, July 8, 2009.
94  William Henderson, “Changes to the Security Clearance Mental
Health Question,” ClearanceJobs.com, July 6, 2013.
95  Office of the Director of National Intelligence, “Continuous
Evaluation—Overview,” National Counterintelligence and Security
Center, undated.
96  Interview with IC official, April 14, 2021.
97  Interview with IC official, April 14, 2021.
98  Interview with IC official, April 14, 2021; interview with IC official,
April 29, 2021.
99  Interview with IC official, May 21, 2021; interview with IC official,
April 29, 2021.
100  Thomas E. Trail et al., Charting Progress: U.S. Military Non-
Medical Counseling Programs, Santa Monica, Calif: RAND Corporation,
RR-1861/1-OSD, 2018.
101  Interview with IC official, April 23, 2021.
102  Focus group of former IC officials, June 23, 2021.
103  Interview with IC official, April 23, 2021; focus group of former IC
officials, June 23, 2021; interview with IC official, May 21, 2021.
104  Interview with IC official, April 23, 2021.
105  Interview with IC official, April 14, 2021.
106  Focus group of former IC officials, June 23, 2021.
107  Interview with IC official, April 14, 2021; interview with IC offi-
cial, April 23, 2021.
108  Interview with IC official, April 14, 2021.
109  Interview with IC official, April 14, 2021; interview with IC offi-
cial, April 23, 2021; interview with IC official, May 21, 2021.
110  One interviewee commented that a departing senior executive,
in his retirement email, implored employees to attend to their mental
health. The interviewee noted frustration in their anecdotal discussions
with colleagues that this senior leader did not discuss mental health
previously and did not provide an opportunity to engage with the work-
force about the issue at the agency (RAND interview with IC official,
April 23, 2021).
111  Focus group of former IC officials, June 23, 2021.
112  Molnar et al., 2017; Ludick and Figley, 2017; Richins et al., 2020.
113  Maitlis, 2020.
114  U.S. Senate, On the Nomination of Avril D. Haines to Be Director of
National Intelligence: Hearing Before the Select Committee on Intelligence
of the United States Senate, Washington, D.C.: U.S. Government Print-
ing Office, 2021.
115  Human Rights Watch, “Ukraine: Apparent War Crimes in Russia-
Controlled Areas; Summary Executions, Other Grave Abuses by Rus-
sian Forces,” April 3, 2022.
116  Linda J. Blimes, “Current and Projected Future Costs of Caring for
Veterans of the Iraq and Afghanistan Wars,” M-RCBG Faculty Affiliate
working paper, Mossavar-Rahmani Center for Business and Govern-
ment, Harvard Kennedy School, June 13, 2011; Linda J. Blimes, “The
Long-Term Costs of United States Care for Veterans of the Afghanistan
and Iraq Wars,” 20 Years of War: A Costs of War Research Series, paper,
Watson Institute, Brown University, August 18, 2021.
25
References
Adler, Amy B., Paul D. Bliese, Dennis McGurk, Charles W. Hoge,
and Carl Andrew Castro, “Battlemind Debriefing and Battlemind
Training as Early Interventions with Soldiers Returning from Iraq:
Randomization by Platoon,” Journal of Consultative Clinical Psychology,
Vol. 77, No. 5, 2009, pp. 928–940.
American Psychiatric Association, Diagnostic and Statistical Manual of
Mental Disorders, 5th ed., Washington, D.C.: 2013.
———, Diagnostic and Statistical Manual of Mental Disorders, 5th ed.,
text revision, Washington, D.C., 2022.
Armour, Cherie, and Jana Ross, “The Health and Well-Being of Military
Drone Operators and Intelligence Analysts: A Systematic Review,”
Military Psychology, Vol. 29, No. 2, 2017, pp. 83–98.
Bigley, Sean, “You’re Not Imagining Things: The SF-86’s Mental Health
Questions Have Changed If You Submitted Your First SF-86 Before
2016,” ClearanceJobs, March 29, 2020. As of February 18, 2022:
https://news.clearancejobs.com/2020/03/29/
youre-not-imagining-things-the-sf-86s-mental-health-questions-have-
changed-if-you-submitted-your-first-sf-86-before-2016/
Blimes, Linda J., “Current and Projected Future Costs of Caring
for Veterans of the Iraq and Afghanistan Wars,” M-RCBG Faculty
Affiliate working paper, Mossavar-Rahmani Center for Business and
Government, Harvard Kennedy School, June 13, 2011.
———, “The Long-Term Costs of United States Care for Veterans of the
Afghanistan and Iraq Wars,” 20 Years of War: A Costs of War Research
Series, paper, Watson Institute, Brown University, August 18, 2021.
Booth-Kewley, Stephanie, Gerald E. Larson, Robyn M. Highfill-McRoy,
Cedric F. Garland, and Thomas A. Gaskin, “Correlates of Posttraumatic
Stress Disorder Symptoms in Marines Back from War,” Journal of
Traumatic Stress, Vol. 23, No. 1, 2010, pp. 69–77.
Brady, Patrick Q., “Crimes Against Caring: Exploring the Risk of
Secondary Traumatic Stress, Burnout, and Compassion Satisfaction
Among Child Exploitation Investigators,” Journal of Police and Criminal
Psychology, Vol. 32, No. 4, 2017, pp. 305–318.
Brewin, Chris R., Bernice Andrews, and John D. Valentine,
“Meta-Analysis of Risk Factors for Posttraumatic Stress Disorder in
Trauma-Exposed Adults,” Journal of Consulting and Clinical Psychology,
Vol. 68, No. 5, 2000, pp. 748–766.
Bride, Brian E., Margaret M. Robinson, Bonnie Yegidis, and Charles R.
Figley, “Development and Validation of the Secondary Traumatic Stress
Scale,” Research on Social Work Practice, Vol. 14, No. 1, 2004, pp. 27–35.
26
Brooks, Samantha, R. Amlôt, G. J. Rubin, and N. Greenberg,
“Psychological Resilience and Post-Traumatic Growth in Disaster-
Exposed Organisations: Overview of the Literature,” BMJ: Military
Health, Vol. 166, No. 1, 2020, pp. 52–56.
Bryan, Craig J., Tanya Goodman, Wayne Chappelle, Lillian Prince, and
William Thompson, “Subtypes of Severe Psychological Distress Among
US Air Force Remote Warriors: A Latent Class Analysis,” Military
Psychology, Vol. 30, No. 5, 2018, pp. 437–448.
Bryant, Richard A., “Post-Traumatic Stress Disorder: A State-of-the-Art
Review of Evidence and Challenges,” World Psychiatry, Vol. 18, No. 3,
October 2019, pp. 259–269.
Chappelle, Wayne, Julie Swearingen, Tyler Mulhearn, Tanya Goodman,
Lillian Prince, and Anna Frise, “Emotional Reactions of Distributed
Common Ground System Imagery Analysts Exposed to Remote Combat
Operations,” Psychological Trauma: Theory, Research, Practice, and
Policy, March 12, 2020.
Clavelle, Paul R., “Consulting to the Intelligence Community: An
Employee Assistance Program Model,” Consulting Psychology Journal:
Practice and Research, Vol. 61, No. 1, 2009, pp. 14–24.
Coleman, S. J., S. A. M. Stevelink, S. L. Hatch, S. L., J. A. Denny, and N.
Greenberg, “Stigma-Related Barriers and Facilitators to Help Seeking
for Mental Health Issues in the Armed Forces: A Systematic Review and
Thematic Synthesis of Qualitative Literature,” Psychological Medicine,
Vol. 47, No. 11, 2017, pp. 1880–1892.
Creech, Greta E., “‘Real’ Insider Threat: Toxic Workplace Behavior in
the Intelligence Community,” International Journal of Intelligence and
CounterIntelligence, Vol. 33, No. 4, 2020, pp. 682–708.
Diehle, Julia, Samantha K. Brooks, and Neil Greenberg, “Veterans Are
Not the Only Ones Suffering from Posttraumatic Stress Symptoms:
What Do We Know About Dependents’ Secondary Traumatic Stress?”
Social Psychiatry and Psychiatric Epidemiology, Vol. 52, 2017, pp. 35–44.
Drake, Brett, and Gautam N. Yadama, “A Structural Equation Model of
Burnout and Job Exit Among Child Protective Services Workers,” Social
Work Research, Vol. 20, No. 3, September 1996, pp. 179–187.
Eschleman, Kevin J., Nathan A. Bowling, and Gene M. Alarcon, “A
Meta-Analytic Examination of Hardiness,” International Journal of
Stress Management, Vol. 17, No. 4, 2010, pp. 277–307.
Figley, Charles R., ed., Compassion Fatigue: Coping with Secondary
Traumatic Stress Disorder in Those Who Treat the Traumatized, New
York: Routledge, 1995.
Finn, Peter, and Sari Horwitz, “U.S. Charges Snowden with Espionage,”
Washington Post, June 21, 2013.
Fyhn, Tonje, Kristin Konglevoll Fjell, and Bjørn Helge Johnsen,
“Resilience Factors Among Police Investigators: Hardiness-
Commitment a Unique Contributor,” Journal of Police and Criminal
Psychology, Vol. 31, 2016, pp. 261–269.
Galea, Sandro, Arijit Nandi, and David Vlahov, “The Epidemiology of
Post-Traumatic Stress Disorder After Disasters,” Epidemiologic Reviews,
Vol. 27, No. 1, July 2005, pp. 78–91.
Gertler, Jeremiah, U.S. Unmanned Aerial Systems, Washington, D.C.:
Congressional Research Service, R42136, January 3, 2012.
Goodwin, Laura, Margaret Jones, Roberto J. Rona, Josefin Sundin,
Simon Wessely, and Nicola T. Fear, “Prevalence of Delayed-Onset
Posttraumatic Stress Disorder in Military Personnel: Is There Evidence
for This Disorder? Results of a Prospective UK Cohort Study,” Journal of
Nervous and Mental Disease, Vol. 200, No. 5, May 2012, pp. 429–437.
Greinacher, Anja, Cassandra Derezza-Greeven, Wolfgang Herzog, and
Christoph Nikendei, “Secondary Traumatization in First Responders:
A Systematic Review,” European Journal of Psychotraumatology, Vol. 10,
No. 1, 2019.
Griffin, Brandon J., Natalie Purcell, Kristine Burkman, Brett T. Litz,
Craig J. Bryan, Martha Schmitz, Claudia Villierme, Jessica Walsh,
and Shira Maguen, “Moral Injury: An Integrative Review,” Journal of
Traumatic Stress, Vol. 32, No. 3, June 2019, pp. 350–362.
Guilaran, Johnrev, Ian de Terte, Krzysztof Kaniasty, and Christine
Stephens, “Psychological Outcomes in Disaster Responders: A
Systematic Review and Meta-Analysis on the Effect of Social Support,”
International Journal of Disaster Risk Science, Vol. 9, 2018, pp. 344–358.
Haire, Tamara, “Financial Problems or PTSD Need Not Affect Security
Clearance,” U.S. Army website, July 8, 2009. As of August 4, 2022:
https://www.army.mil/article/24053/
financial_problems_or_ptsd_need_not_affect_security_clearance
Henderson, William, “Changes to the Security Clearance Mental Health
Question,” ClearanceJobs, July 6, 2013. As of August 4, 2022:
https://news.clearancejobs.com/2013/07/06/
changes-to-the-security-clearance-mental-health-question/
Hensel, Jennifer M., Carlos Ruiz, Caitlin Finney, and Carolyn S. Dewa,
“Meta-Analysis of Risk Factors for Secondary Traumatic Stress in
Therapeutic Work with Trauma Victims,” Journal of Traumatic Stress,
Vol. 28, No. 2, April 2015, pp. 83–91.
Human Rights Watch, “Ukraine: Apparent War Crimes in Russia-
Controlled Areas; Summary Executions, Other Grave Abuses by
Russian Forces,” April 3, 2022. As of April 4, 2022:
https://www.hrw.org/news/2022/04/03/
ukraine-apparent-war-crimes-russia-controlled-areas#
Jones, Norman, Paul Mitchell, John Clack, Mohammed Fertout,
Nicola T. Fear, Simon Wessely, and Neil Greenberg, “Mental Health
and Psychological Support in UK Armed Forces Personnel Deployed to
Afghanistan in 2010 and 2011,” British Journal of Psychiatry, Vol. 204,
No. 2, 2014, pp. 157–162.
Kessler, Ronald C., and Richard G. Frank, “The Impact of Psychiatric
Disorders on Work Loss Days,” Psychological Medicine, Vol. 27, No. 4,
1997, pp. 861–873.
King, Lynda A., Daniel W. King, John A. Fairbank, Terence M. Keane,
and Gary A. Adams, “Resilience–Recovery Factors in Post-Traumatic
Stress Disorder Among Female and Male Vietnam Veterans: Hardiness,
Postwar Social Support, and Additional Stressful Life Events,” Journal of
Personality and Social Psychology, Vol. 74, No. 2, 1998, pp. 420–434.
Krause, Meredith, “History and Evolution of the FBI’s Undercover
Safeguard Program,” Consulting Psychology Journal: Practice and
Research, Vol. 61, No. 1, 2009, pp. 5–13.
Litz, Brett T., Nathan Stein, Eileen Delaney, Leslie Lebowitz, William P.
Nash, Caroline Silva, and Shira Maguen, “Moral Injury and Moral
Repair in War Veterans: A Preliminary Model and Intervention
Strategy,” Clinical Psychology Review, Vol. 29, No. 8, 2009, pp. 695–706.
Ludick, Marné, and Charles R. Figley, “Toward a Mechanism for
Secondary Trauma Induction and Reduction: Reimagining a Theory
of Secondary Traumatic Stress,” Traumatology, Vol. 23, No. 1, 2017,
pp. 112–123.
Maitlis, Sally, “Posttraumatic Growth at Work,” Annual Review of
Organizational Psychology and Organizational Behavior, Vol. 7, 2020,
pp. 395–419.
Mark, Katharine M., Sharon A. M. Stevelink, Jeesoo Choi, and Nicola T.
Fear, “Post-Traumatic Growth in the Military: A Systematic Review,”
Occupational and Environmental Medicine, Vol. 75, No. 12, 2018,
pp. 904–915.
Maslach, Christina, and Michael P. Leiter, “New Insights into Burnout
and Health Care: Strategies for Improving Civility and Alleviating
Burnout,” Medical Teacher, Vol. 39, No. 2, 2017, pp. 160–163.
27
Molnar, Beth E., Ginny Sprang, Kyle D. Killian, Ruth Gottfried,
Vanessa Emery, and Brian E. Bride, “Advancing Science and Practice
for Vicarious Traumatization/Secondary Traumatic Stress: A Research
Agenda,” Traumatology, Vol. 23, No. 2, 2017, pp. 129–142.
Mor Barak, Michàl E., Jan A. Nissly, and Amy Levin, “Antecedents to
Retention and Turnover Among Child Welfare, Social Work, and Other
Human Service Employees: What Can We Learn from Past Research?
A Review and Metanalysis,” Social Service Review, Vol. 75, No. 4, 2001,
pp. 625–661.
Mulligan, Kathleen, Norman Jones, Charlotte Woodhead, Mark Davies,
Simon Wessely, and Neil Greenberg, “Mental Health of UK Military
Personnel While on Deployment in Iraq,” British Journal of Psychiatry,
Vol. 197, No. 5, 2010, pp. 405–410.
Newell, Jason M., Debra Nelson-Gardell, and Gordon MacNeil,
“Clinician Responses to Client Traumas: A Chronological Review of
Constructs and Terminology,” Trauma, Violence, and Abuse, Vol. 17,
No. 3, 2016, pp. 306–313.
Office of the Director of National Intelligence, “Continuous
Evaluation—Overview,” National Counterintelligence and Security
Center, undated. As of February 18, 2022:
https://www.dni.gov/index.php/ncsc-how-we-work/
ncsc-security-executive-agent/ncsc-continuous-evaluation-overview
Ogle, Alan D., Reed Reichwald, and J. Brian Rutland, “Psychological
Impact of Remote Combat/Graphic Media Exposure Among US Air
Force Intelligence Personnel,” Military Psychology, Vol. 30, No. 6, 2018,
pp. 476–486.
Pai, Anushka, Alina M. Suris, and Carol S. North, “Posttraumatic
Stress Disorder in the DSM-5: Controversy, Change, and Conceptual
Considerations,” Behavioral Sciences, Vol. 7, No. 1, 2017.
Penix, Elizabeth A., Kristina M. Clarke-Walper, Felicia L. Trachtenberg,
Ashley M. Magnavita, Erica Simon, Kile Ortigo, Julia Coleman, Lisa
Marceau, Josef I. Ruzek, Raymond C. Rosen, and Joshua E. Wilk,
“Risk of Secondary Traumatic Stress in Treating Traumatized Military
Populations: Results from the PTSD Clinicians Exchange,” Military
Medicine, Vol. 185, Nos. 9–10, 2020, pp. e1728–e1735.
Penix, Elizabeth A., Paul Y. Kim, Joshua E. Wilk, and Amy B.
Adler, “Secondary Traumatic Stress in Deployed Healthcare Staff,”
Psychological Trauma: Theory, Research, Practice, and Policy, Vol. 11,
No. 1, 2019.
“Principles of Professional Ethics for the Intelligence Community,”
undated. As of July 14, 2022:
https://www.dni.gov/files/documents/CLPO/
Principles%20of%20Professional%20Ethics%20for%20the%20IC.pdf
28
Ramchand, Rajeev, Rena Rudavsky, Sean Grant, Terri Tanielian, and
Lisa Jaycox, “Prevalence of, Risk Factors for, and Consequences of
Posttraumatic Stress Disorder and Other Mental Health Problems
in Military Populations Deployed to Iraq and Afghanistan,” Current
Psychiatry Reports, Vol. 17, 2015.
Richins, Matt T., Louis Gauntlett, Noreen Tehrani, Ian Hesketh,
Dale Weston, Holly Carter, and Richard Amlôt, “Early Post-Trauma
Interventions in Organizations: A Scoping Review,” Frontiers in
Psychology, Vol. 11, No. 1176, 2020, pp. 1–11.
SF-96—See U.S. Office of Personnel Management, 2016.
Shapira, Ian, “A CIA Suicide Sparks Hard Questions About the Agency’s
Memorial Wall,” Washington Post, May 21, 2019.
Smith, Nathan, and Emma C. Barrett, “Psychology, Extreme
Environments, and Counter-Terrorism Operations,” Behavioral Sciences
of Terrorism and Political Aggression, Vol. 11, No. 1, 2019, pp. 48–72.
Stamm, B. Hudnall, ed., Secondary Traumatic Stress: Self-Care Issues for
Clinicians, Researchers, and Educators, 2nd ed., Lutherville, Md.: Sidran
Press, 1999.
———, Professional Quality of Life: Compassion Satisfaction and Fatigue
Version 5 (ProQOL), questionnaire, 2009. As of June 20, 2022:
http://socialwork.buffalo.edu/content/dam/socialwork/home/
self-care-kit/compassion-satisfaction-and-fatigue-stamm-2009.pdf
Stevelink, Sharon A. M., Elena Opie, David Pernet, He Gao, Paul Elliott,
Simon Wessely, Nicola T. Fear, Matthew Hotopf, and Neil Greenberg,
“Probable PTSD, Depression and Anxiety in 40,299 UK Police Officers
and Staff: Prevalence, Risk Factors and Associations with Blood
Pressure,” PLoS ONE, Vol. 15, No. 11, 2020.
Tanielian, Terri, and Lisa H. Jaycox, eds., Invisible Wounds of War:
Psychological and Cognitive Injuries, Their Consequences, and
Services to Assist Recovery, Santa Monica, Calif.: RAND Corporation,
MG-720-CCF, 2008. As of June 21, 2022:
https://www.rand.org/pubs/monographs/MG720.html
Tedeschi, Richard G., and Lawrence G. Calhoun, Trauma and
Transformation: Growing in the Aftermath of Suffering, Thousand Oaks,
Calif: SAGE, 1995.
———, “Posttraumatic Growth: Conceptual Foundations and Empirical
Evidence,” Psychological Inquiry, Vol. 15, No. 1, 2004.
Tolin, David F., and Edna B. Foa, “Sex Differences in Trauma and
Posttraumatic Stress Disorder: A Quantitative Review of 25 Years of
Research,” Psychological Bulletin, Vol. 132, No. 6, 2008, pp. 959–992.
Trail, Thomas E., Laurie T. Martin, Lane F. Burgette, Linnea Warren
May, Ammarah Mahmud, Nupur Nanda, and Anita Chandra,
Charting Progress: U.S. Military Non-Medical Counseling Programs,
Santa Monica, Calif: RAND Corporation, RR-1861/1-OSD, 2018. As of
June 21, 2022:
https://www.rand.org/pubs/research_reports/RR1861z1.html
U.S. Air Force, “Air Force Distributed Common Ground System,”
October 2015.
U.S. Office of Personnel Management, “Questionnaire for National
Security Positions,” OPM Standard Form 86, 2016. As of June 21, 2022:
https://www.opm.gov/forms/pdf_fill/sf86.pdf
U.S. Senate, On the Nomination of Avril D. Haines to Be Director of
National Intelligence: Hearing Before the Select Committee on Intelligence
of the United States Senate, Washington, D.C.: U.S. Government
Printing Office, 2021.
Vogel, Ryan M., and Mark C. Bolino, “Recurring Nightmares and
Silver Linings: Understanding How Past Abusive Supervision May
Lead to Posttraumatic Stress and Posttraumatic Growth,” Academy of
Management Review, Vol. 45, No. 3, 2020, pp. 549–569.
Wallace, D., and J. Costello, “Eye in the Sky: Understanding the Mental
Health of Unmanned Aerial Vehicle Operators,” Journal of Military and
Veterans’ Health, Vol. 25, No. 3, 2017, pp. 36–41.
Ward, Fiona, Helen St Clair-Thompson, and Alex Postlethwaite, “Mental
Toughness and Perceived Stress in Police and Fire Officers,” Policing: An
International Journal, Vol. 41, No. 6, 2018, pp. 674–686.
Wigert, Ben, and Sangeeta Agrawal, “Employee Burnout, Part 1: The 5
Main Causes,” Gallup, July 12, 2018. As of February 25, 2022:
https://www.gallup.com/workplace/237059/
employee-burnout-part-main-causes.aspx
Wilder, Ursula M., “Inside the Inferno: Counterterrorism Professionals
Reflect on Their Work,” Studies in Intelligence, Vol. 58, No. 4, 2014,
pp. 3–18.
Williamson, Victoria, Sharon A. M. Stevelink, and Neil Greenberg,
“Occupational Moral Injury and Mental Health: Systematic Review
and Meta-Analysis,” British Journal of Psychiatry, Vol. 212, No. 6, 2018,
pp. 339–346.
Wisco, Blair E., Brian P. Marx, Casey L. May, Brenda Martini, John H.
Krystal, Steven M. Southwick, and Robert H. Pietrzak, “Moral Injury in
U.S. Combat Veterans: Results from the National Health and Resilience
in Veterans Study,” Depression and Anxiety, Vol. 34, 2017, pp. 340–347.
29
About the Authors
Karen M. Sudkamp is a management scientist at RAND. Her research focuses on Middle East regional issues, migration and refu-
gees, and intelligence policy and personnel topics. She has an M.B.A. and an M.A. in national security and strategic studies.

Heather J. Williams is a senior policy researcher at RAND. Her research focuses on violent extremism and targeted violence,
Middle East regional issues, and intelligence policy and methodology. Williams has an M.S. in strategic intelligence.

Lisa H. Jaycox is a senior behavioral scientist at RAND. Her research focuses on the mental health consequences of exposure to
stress and trauma, as well as interventions designed to alleviate those impacts. She has a Ph.D. in clinical psychology.

Molly Dunigan is a senior political scientist at RAND. Her research focuses on civilian deployment, civil-military relations, military
privatization, and deployment-related mental health among civilian populations. She has a Ph.D. in government with a focus on inter-
national relations and military studies.

Stephanie Young is a senior political scientist at RAND. Her research focuses on logistics, sustainment, acquisition, and industrial
base issues; security cooperation; special operations; and security in the Middle East and South Asia. Young has a Ph.D. in history.

30
About This Perspective
The mental health of U.S. military and Department of Defense civilian
personnel and intelligence professionals, particularly after decades of
significant overseas deployment responsibilities, is a topic of concern.
Although the pace of deployments, especially in support of stressful
counterterrorism missions, has slowed markedly, the mental health
needs of intelligence professionals is evolving rather than diminishing.
The 20 years following the September 11, 2001, terrorist attacks have
illustrated that intelligence support occurs both in forward locations and
throughout the United States, with technology ensuring that traumatic
events and information can be shared globally and in nearly real time.
That said, U.S. Intelligence Community (IC) leaders might not always
appreciate the complex ways that trauma can affect the intelligence
workforce. Intelligence professionals play a critical and unique role in
the U.S. national security system, and these responsibilities put those
professionals at risk of experiencing trauma, either directly or indirectly,
and limit their recourse in managing such trauma. This Perspective
explores the potential for U.S. intelligence professionals to experience
trauma-related stress reactions because of their jobs, as well as the
effects of any such stress and trauma on the IC.
RAND National Defense Research Institute (NDRI), a federally funded
research and development center sponsored by the Office of the Secre-
tary of Defense, the Joint Staff, the Unified Combatant Commands, the
Navy, the Marine Corps, the defense agencies, and the defense intel-
ligence enterprise.
For more information on the RAND Forces and Resources Policy
Center, see www.rand.org/nsrd/frp or contact the director (contact
information is provided on the webpage).
Acknowledgments
We are grateful to the leadership of RAND’s National Security Research
Division and the Forces and Resources Policy Center, who supported
this research. Rich Girven was an initial advocate of funding this criti-
cal research; we could not have written this Perspective without his
support. We are also grateful to the current and former IC employees
who participated in interviews and focus groups, whose professional
and personal observations and insights were key in allowing us to
shed a light on this issue. We thank Kimberly Hepner of RAND and Joe
Gartin of Georgetown University for their helpful and thorough review of
this Perspective.

RAND National Security Research Division

This research was sponsored by the Office of the Secretary of Defense
and conducted within the Forces and Resources Policy Center of the
RAND National Security Research Division (NSRD), which operates the

The RAND Corporation is a research organization that develops solutions to public policy challenges to help make communities throughout the
world safer and more secure, healthier and more prosperous. RAND is nonprofit, nonpartisan, and committed to the public interest.
Research Integrity
Our mission to help improve policy and decisionmaking through research and analysis is enabled through our core values of quality and
objectivity and our unwavering commitment to the highest level of integrity and ethical behavior. To help ensure our research and analysis
are rigorous, objective, and nonpartisan, we subject our research publications to a robust and exacting quality-assurance process; avoid
both the appearance and reality of financial and other conflicts of interest through staff training, project screening, and a policy of mandatory
disclosure; and pursue transparency in our research engagements through our commitment to the open publication of our research findings
and recommendations, disclosure of the source of funding of published research, and policies to ensure intellectual independence. For more
information, visit www.rand.org/about/research-integrity.
RAND’s publications do not necessarily reflect the opinions of its research clients and sponsors. is a registered trademark.
Limited Print and Electronic Distribution Rights
This publication and trademark(s) contained herein are protected by law. This representation of RAND intellectual property is provided for
noncommercial use only. Unauthorized posting of this publication online is prohibited; linking directly to its webpage on rand.org is encouraged.
Permission is required from RAND to reproduce, or reuse in another form, any of its research products for commercial purposes. For
C O R P O R AT I O N information on reprint and reuse permissions, please visit www.rand.org/pubs/permissions.
For more information on this publication, visit www.rand.org/t/PEA1027-1.
www.rand.org © 2022 RAND Corporation

PE-A1027-1