Retraumatization Mediates the Effect of Adverse Childhood Experiences on Clinical Training-Related Secondary Traumatic Stress Symptoms

ABSTRACT

Previous research (Butler, Carello, & Maguin, 2016) has found that exposure to trauma-related material in graduate clinical coursework and field training can put students at risk for reactivations of feelings/memories from negative past experiences (retraumatization) and for secondary traumatic stress (STS) symptoms. The present report sought to examine the role, if any, of adverse childhood experiences (ACEs) in these outcomes. Using the Butler et al. (2016) sample, we examined: (1) rates of ACEs in 195 graduate social work students, (2) whether the total number of ACEs was associated with training-related retraumatization (TRT) and/or STS symptoms, and (3) if TRT mediated the relationship between ACEs and STS symptoms. The results indicate that more than three quarters of the sample had experienced one or more ACEs before age 18 and almost one third endorsed 4 or more. The most commonly reported ACEs were household mental illness, parental separation/divorce, household alcohol/substance abuse, and emotional abuse or neglect by a parent or household member. Higher ACE scores were associated with increased likelihood of TRT experiences and STS symptoms during training. A mediation analysis confirmed that TRT mediated the effect of ACE scores on STS symptoms; this finding also provides support for the role of proximal emotional reactions in mediating the effects of distal adverse experiences on the development of trauma symptoms. In summary, despite the evident resilience of this graduate student sample, those with ACE histories were at heightened risk for training-related distress. These results underscore the need for a trauma-informed approach to clinical training.

KEYWORDS:

• Adverse Childhood Experience (ACE)
• clinical training
• mediation
• retraumatization
• secondary traumatic stress
• trauma-informed

Acknowledgment

The authors would like to thank the students who participated in the survey; Elaine Rinfrette and Linda Beyley for their contributions to a previous pilot study; Diane Elze and program course instructors for their assistance in recruitment; and Robert W. Garlan for his feedback on an earlier version of this manuscript.

Funding

This research was supported by a grant from the Les Brun Pilot Research Endowment Fund of the Buffalo Center for Social Research.

Additional information

Funding

This research was supported by a grant from the Les Brun Pilot Research Endowment Fund of the Buffalo Center for Social Research.