• Recognize high-exposure moderation roles as involving significant psychosocial and trauma-related occupational risks and manage them within occupational health and safety systems. Adopt a prevention-first hierarchy of controls including exposure limits, task rotation, scheduled breaks, realistic performance targets, and adequate supervision.   

• Build trauma-informed organizational cultures with supportive leadership, stigma reduction, peer support opportunities, and protected time for processing difficult material.   

• Ensure access to high-quality, culturally appropriate care with clinicians trained in the unique challenges of this work, while extending reasonable post-employment support.   

• Require regular, privacy-preserving wellness monitoring and program evaluation to drive continuous improvement.

Peer-reviewed research shows that repeated exposure to extreme content is associated with a range of psychological difficulties, and that more frequent or intense exposure is generally linked to worse outcomes(Spence et al., 2024; Spence et al., 2023). Impacts may be delayed, with some CMs recognizing effects only months or years later. While many workers remain functional or resilient, organizational factors substantially shape the level of risk (Steiger et al., 2021; Riedl et al., 2020). 
Wellbeing services and individual coping strategies matter, but they are not substitutes for prevention-oriented work design, exposure controls and supportive organizational cultures (Spence & DeMarco, 2025).  

Key findings that support stronger workplace standards include:   

• Cross-sectional, comparison, and qualitative studies of CMs demonstrate significant associations between repeated exposure to distressing content and trauma-relevant symptoms, secondary traumatic stress, and psychological distress. A dose-response relationship exists, with higher frequency of exposure linked to worse outcomes. Supportive colleagues and feeling the role is valued can buffer these relationships (Gauthier et al., Submitted); Spence et al., 2024; Spence et al., 2023).   
• Problem-focused and approach-oriented coping strategies (such as seeking support from colleagues) are associated with lower psychological distress and secondary trauma, as well as higher wellbeing, whereas avoidant coping and increased substance use show the opposite pattern; confidentiality concerns are also associated with poorer outcomes (Spence & DeMarco, 2025).   
• Two comprehensive literature reviews of CMs highlight the emotional labor involved and the risk of lasting psychological distress from repeated exposure to graphic content, drawing parallels to trauma-exposed occupations and emphasizing the need for improved support mechanisms (DeMarco, Watson, & Norman, 2026; Steiger et al., 2021).
• Experimental research on moderation tasks demonstrates that exposure to uncivil or disturbing content contributes to emotional exhaustion, with organizational factors like workload and support structures playing a key role in outcomes (Riedl et al., 2020).   
• Remote content moderation work might offer flexibility and concentration benefits for some workers, but it can also intensify isolation, break down protective boundaries between work and home (potentially detrimental for both workers and cohabitants), and reduce peer support amongst CMs (Martellozzo et al, 2024). 
• Parallel findings from related high-exposure professions, such as Internet Crimes Against Children (ICAC) task force investigators, show similar patterns of secondary traumatic stress linked to repeated exposure to child exploitation material, reinforcing that workplace design and culture are key modifiers of risk (Bourke & Craun, 2014).  

At the same time, not all CMs experience the same level of risk and outcomes are shaped by exposure intensity, task type, organizational support, coping resources and broader working conditions. 

Define and assess psychosocial risks.
 Treat routine high-exposure moderation as work involving significant psychosocial and trauma-related risk and require documented psychosocial risk assessments with clear control measures. Require documented psychosocial risk assessments and implementation of controls, to systematically identify, evaluate, and actively manage the psychological and social hazards inherent in content moderation work, rather than treating them as an unavoidable or individual burden, with particular attention to outsourced and globally dispersed workforces. 

Build supportive organizational culture and leadership. Train leaders to treat wellbeing as an organizational (not worker) responsibility, promote psychological safety, mutual trust, role validation, and reduced overload. Implement policies that recognize the importance of CMs’ contributions to child and public safety. Reduce stigma around help-seeking and encourage open discussion of reactions without fear of judgment or career impact. Seeking help, requesting adjustments or transferring out of high-exposure work should not carry stigma, retaliation or career penalty. Provide quiet rooms, community spaces, and scheduled opportunities for team connection. 

Ensure access to appropriate care and support.
Offer high-quality, accessible medical and mental health services with clinicians trained in trauma exposure specific to graphic content moderation (evidence-based treatments for PTSD and related conditions, including moral injury elements). Provide adjunct supports such as peer coaching, helplines, and family resources. Consider providing defined, time-limited post-employment access to appropriate support, proportionate to exposure and need. Ensure policies explicitly permit confidential disclosure to appropriate licensed health professionals, consistent with legal, privacy and safeguarding obligations.