In an age characterized by rapid technological epiphanies, the continued safety of digital spaces is critically dependent on content moderators. They review user generated material on social media, streaming and networking platforms in varying formats for alignment with usage policies, and take actions on violative material. The World Economic Forum lamented the ease the internet offers for the widespread movement of harmful content (1). While not enough formal data is accessible on the current global volume of violative content, a recent report from the UK revealed a 31% increase in harmful content in 2023 when compared to 2022 (2). Moderators, thus, face more recurrent risks of engagement with traumatic content (3). Repeated exposure can trigger mental health concerns, and calls for efforts to protect moderators from the negative impacts of content on their well-being (4). This study examines the longitudinal trends of self-reported psychological outcomes of content moderators while using a tailored psychological health intervention by tracking the well-being outcomes of participating content moderators across 18 months.

Historically, moderation work was managed on a small scale by existing employees of a given platform. Over the years, the sheer volume and diversity of user generated content has required content moderation to be set up as a full-fledged specialized department. While the job role and expectations for moderators have become more refined and systematized, attention to the human consequences of such work has not been on par, and even fewer efforts have been directed to alleviate possible occupational impact (5, 6). Prolonged interaction with harmful content while moderating potentiates the development of trauma-related symptoms and disorders. In frontline professions such as content moderation, secondary traumatic stress, burnout and compassion fatigue are very relevant and necessitate tailored mitigation strategies (4).

Secondary traumatic stress is commonly experienced by helping professionals (helpers) as they continually witness and work with victims, survivors, and records of perpetrations. Even while helpers such as content moderators may not personally encounter the traumatic incident, the nature and responsibility of helping work that involves empathizing and safeguarding others (i.e., platforms users in content moderation contexts) creates trying scenarios that can potentially trigger traumatic responses in moderators (7). Long-term helping demands emotional labor without sacrificing consistent work performance, which altogether can result in burnout (characterized by exhaustion, hopelessness, and maladaptive coping) as well as compassion fatigue (reduced ability to empathize or help) (8). In a study with news media staff, it was found that empathy or compassion expressed in one’s work moderated the impact of negative emotions on rumination tendencies which in turn mediated burnout (9). There thus appears to be a psychological pathway between traumatic contact on the job and the possible development of distress.

The elucidation of the empathy mechanism, nonetheless, offers hope to disrupt the progression from exposure to psychological injury, by training helpers in healthy coping techniques. The World Health Organization (10) acknowledged the existence of “elevated psychosocial risks” for helpers, and recommends employers to offer preventative psychoeducative training alongside other risk reduction provisions. In recent years, wellness benefits have become more common in workplaces (11). These, however, are often reactive care set-ups that place the onus on employees to reach out when in detectable distress (which may be too late). Singh et al. (12) argued for anticipatory/preventative mental health care in communities to avoid aggravations of undetected subclinical conditions, and to reduce the burden of self-diagnosis. For full-time content moderators, this is even truer given the known psychological risks in their occupation. To our knowledge, very limited scientific literature exists on wellness interventions for content moderators. Most reports have been centered on content with the goal to reduce its shock value and in turn minimize the emotional impact on moderators. These have yielded mixed results. On one hand some studies (13–15), evaluating technological interventions such as image modification through blurring and filters, found positive effects like reduced negative feelings while retaining operational efficiency. Contrastingly, in another study (16) that tried to induce positive affect (e.g., introducing cute and awe-inspiring images/videos) during work breaks, experienced moderators (with 2+ years of moderation experience) reported higher perceived stress. The authors proposed that compassion fatigue (stemming from moderators’ prolonged exposure to content) had reversed the effect of surface-level positive stimuli, thus requiring interventions that focus on the individual and address deeper psychological concerns. While content-focused interventions can support the reduction of impact, these (in and by themselves) cannot holistically protect moderators. They address merely a part of the problem (content), and do not leverage the human capacity to cope with distress.

The only comprehensive preventative intervention for content moderators documented in empirical literature to date is Steiger et al.’s (17) resilience training program called the TaskUs Method. The cyclical intervention, involving positive psychological education and theme-based activities to promote emotional regulation and adaptive coping was observed to prevent burnout and secondary traumatic stress from worsening between moderators’ 2-week and 3-month tenure timepoints. Furthermore, higher resilience predicted lower burnout and secondary traumatic stress. The study highlighted the benefits of a periodic intervention that fosters resilience in moderators to help them withstand psychosocial risks. However, two limitations are notable: the study was conducted during the stressful COVID-19 pandemic, and its long-term impact beyond the initial 3-month habituation phase for moderators remains unclear. Given that the demands of content moderation are continually evolving with the advance of digital content and newer technologies (e.g., GenAI, virtual reality), interventions must be designed to instill skills that help moderators cope with new risks and changing dynamics of their job.

This study builds on Steiger et al.’s (17) intervention report by exploring the second iteration of the program. The modules in the TaskUs Method 2.0 version were designed to be tailored, trauma-responsive and stress-inoculating in the context of content moderation work. Practical everyday skills (e.g., tricks for nervous system regulation) rather than abstract mechanisms of coping (e.g., optimistic worldview) were prioritized. The revised approach aimed to retain the central focus on resilience building against trauma for moderators while being more experiential than theoretical. This article reports the well-being outcomes of full-time content moderators participating in the TaskUs Method 2.0 program by following them up for 18 months.

Descriptive statistics can be found in Tables 1–3. Table 1 reports the number of participants with available data, means, and standard deviations for each timepoint in the full sample. Table 2 reports this information for the reduced sample of participants that had data available at all timepoints. Table 3 presents the correlations among these variables with the correlations in the full sample being represented in the lower triangle, whereas the upper triangle contains correlations from the reduced sample. Figures 2–4 depict the mean scores for compassion satisfaction, secondary traumatic stress, burnout, resilience and perceived stress in the full sample across timepoints. Figures 5, 6 illustrate the mean scores for compassion satisfaction, secondary traumatic stress, burnout, and resilience in the reduced sample across timepoints.

This section reports, at the outset, the findings of analyses with the entire sample (N = 311) regardless of the number of timepoints participants had to showcase the overall group’s well-being status. In the next part, the findings of participants with all 3 time-points (n=131) are presented to show the extent of differences in well-being aspects across time.

The aim of this study was to examine the well-being outcomes of content moderators who received the TaskUs Method 2.0 resilience training intervention. Overall, the investigation revealed that participants in the program maintained stable psychometric scores across most measures. Participants did not show significant worsening in secondary traumatic stress and perceived stress between baseline and 18 months. Outcomes such as burnout and resilience differed significantly yet with small effect size. The findings indicate that when using the program, content moderators in this study were not at risk for large declines in well-being outcomes. The results are discussed and contextualized in detail below.

The primary aim of the intervention was to promote resilience among moderators. Findings indicate that the current sample maintained moderate resilience across the study period. While there is limited comparative data on resilience from the same population, studies based on adjacent frontline professions are helpful within reasonable limits. The mean resilience score in the current sample ranging between 34 and 35 (moderate resilience as per norms) is higher than those reported for ambulance personnel (28.9) and U.S. Army combat troops (28.1) when using CD-RISC (23). Given the absence of a true control group in the current study, the past literature offers context to understand the level of resilience in frontline workers.

Secondary traumatic stress is arguably the most prominent psychological health concern in content moderation work given the unique firsthand exposure of moderators to unfiltered harmful digital content. Results showed that moderators using the current program maintained status quo in secondary traumatic stress, similar to resilience. This is a critical finding in this study underlining the protective effect of the intervention program against traumagenic risks. It sheds light on the possibility that moderators can perform their duties without suffering additional psychological damage for a considerable duration of time. Despite being exposed to potentially disturbing material as part of the job, the current sample of content moderators maintained a consistent level of secondary trauma, likely due to the support and resources provided by the intervention.

In the case of burnout, Steiger et al’s (4) participants showed an analogous trend of no significant increase. In the present study however, burnout in the reduced sample followed a small significant increase between T0 and T2. Nonetheless, the follow-up timeframe in the two studies (3 vs. 18 months) is not comparable. In fact, burnout in this investigation too did not change significantly between T0 and T1 (6 month follow-up). Therefore, the current findings strengthen the case that on average, moderators in the program experience stable levels of burnout at least up to 6 months of participation.

In a similar vein, perceived stress remained unchanged between consecutive time-points (T0 to T1, T1 to T2). Given that content moderation is a demanding, repetitive, and volatile occupation, feeling overwhelmed and frustrated is not uncommon. The finding hints that program participants experience stable stress levels, indicating their ability to cope with and control their everyday stressors. Perceived stress in this role arises from general work demands (e.g., workload, job demands, personal factors) coupled with the exposure to disturbing content (45). While the intervention may have addressed all these factors, individual differences in coping, pre-existing stress, and personal life events likely contributed to the stability of stress levels observed. Nonetheless, as seen with secondary traumatic stress, the intervention appears to prevent significant increase in perceived stress. Compassion satisfaction decreased significantly between T0 and T2 as well as T1 and T2, and resilience significantly decreased between T0 and T2, but the effect sizes were small. These point out the need to revisit the program’s capabilities post the T1 mark. Gradual diminution of resilience and compassion satisfaction might indicate the influence of stressors outside the scope of intervention. Although observed declines were small on average, additional interventional resources and support in these areas may help to eliminate these declines further.

Notably, at all time points, a considerable portion of participants maintained scores within clinically healthy ranges across all constructs (i.e., low burnout, low secondary traumatic stress, high compassion satisfaction, moderate resilience, low to moderate stress). This is consistent with the potential benefit of the intervention, as opposed to prior literature (4, 46), which consistently emphasized the long-term negative psychological impacts of moderation work. In comparison with previous studies on content moderators wherein psychological distress was at clinically moderate to high levels (e.g., 47, 48), in the current sample, lower scores of secondary traumatic stress and burnout for instance across time were observed. Consistency in the face of ongoing exposure to potentially traumatizing content is a noteworthy finding, which suggests that the intervention may contribute to the stability of psychological well-being in this sample. Therefore, this research adds valuable knowledge to a nascent frontline field and helps address the gap in understanding how to support the vulnerable content moderation workforce.

The primary shortcoming of this design is the lack of randomization and experimental control (standard for causal inference) which restrains the generalizability of results and precludes deductions of direct program impact. Yet, it must be reiterated that the ethics of care (given the established risks in content moderation) in the organization where moderators were working require offering wellness support to moderators. Randomly assigning moderators to a control group without intervention would be no better than withholding a necessary safety measure from individuals known to be at risk. Specifically, this would violate the ethical principle of beneficence, which compels researchers to act in the best interests of participants and to maximize benefits while minimizing potential harm. Furthermore, it represents inequitable treatment. Denying a subset of employees access to this intervention for the sole purpose of empirical comparison in an RCT would expose them to exacerbated harm and would be seemingly unjust and discriminatory from a labor welfare standpoint. Given this scenario we have referenced in the paragraphs above the available evidence from former literature which have documented moderators developing psychological distress and worsening across time; this served as a proxy control against which we have contextualized the outcomes of the current sample. The lack of an internal comparator or control group (due to the ethics of care) prevents us from proposing definitive causal conclusions regarding the intervention.

Alternative methodologies that do not involve withholding a potentially beneficial intervention must be considered, a constraint upon which the present study is designed. For example, studies may explore the possibility of comparing interventions to determine which program is more efficacious and elucidate the mechanisms of interventional effects. Specifically, designs that alter the parts and dosage of the intervention that moderators receive can help us better understand which parts of the intervention are most effective.

Second, the focus was exclusively on self-reported psychological outcomes within a single organization which introduces various reporting and desirability biases. It is worth reiterating nevertheless that the investigators in the study are fully trained in research ethics and executed the present study in compliance with all ethical and labor regulations. They also did not have direct visibility or influence on the operations of the teams from which participants were sourced.

Another consideration is the nature of timepoints. The data were normalized to group the participants based on their tenure at each timepoint, which may not reflect the most reliable trends. The effects of seasonality on work and well-being cannot be ruled out as each study timepoint included data from up to two different times of the year. Additionally, such longitudinal data may have also been affected by self-selection or survival bias (i.e., contains those who did not leave the study and the company). It cannot be confirmed why the sample declined across timepoints (i.e., whether participants exited from the company or study), meaning that the dropout from the study may be considered random at best. Classifying timepoints by participants’ tenure rather than calendar time helped capture a reasonable number of participants at the three timepoints as their experience and exposure in moderation grew. However, this limited the control over other factors such as harm type and sustained sample size.

Grouping participants by the severity of content they work with was also not feasible. For instance, even in dedicated workflows, participants reported the influx of all types of content (e.g., teams working with largely egregious content saw benign or ambiguous content, while teams that work with less severe content encountered outright harmful content periodically). Nevertheless, the training for the job and the current intervention prepared moderators for all types of exposure regardless of the type of their workflow, which helped the study assume reasonable homogeneity in the sample. Prospective studies may consider the inclusion of objective metrics (mental health-related absenteeism and attrition, differentiating between participants leaving the company and those with non-response, controlling different types of harm and risk exposure) and observation reports (e.g., from line managers) alongside a more diverse sample from different organizations to balance the limitations of self-report scales and to increase the representativeness of results.

Collaborative research is the most promising direction ahead to address the demerits discussed and robustly evaluate the efficacy of relevant preventative wellness programs for content moderators. This will allow for sampling moderators from different companies in a randomized controlled design, and produce widely applicable insights regarding interventions for the Trust & Safety frontline.

Content moderators who were involved in the TaskUs Method 2.0 resilience training program overall demonstrated minimal clinical worsening of psychometric scores between baseline and 18 months of participation. Secondary traumatic stress and perceived stress had the most favorable trend with non-significant changes across time. Compassion satisfaction, resilience, and burnout showed small yet significant decline during the study period. Altogether, the study reinforces the existence of psychological burden on content moderators, and pertinently underlines the importance of preventative and evidence-based interventions for psychological health sustenance. The results of this study additionally warrant further investigation of the TaskUs Method 2.0 resilience training program to gauge its efficacy.