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

J Trauma Dissociation. 2018 Jan-Feb;19(1):25-38. doi: 10.1080/15299732.2017.1304488. Epub 2017 Apr 5.


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.

MeSH terms

  • Adult
  • Adult Survivors of Child Abuse / psychology*
  • Education, Professional*
  • Female
  • Humans
  • Life Change Events*
  • Male
  • Mental Disorders / psychology
  • Parent-Child Relations
  • Recurrence
  • Risk Factors
  • Social Work / education*
  • Stress Disorders, Post-Traumatic / psychology*
  • Substance-Related Disorders / psychology
  • Surveys and Questionnaires