(PS14-55) The Role of Experiential Avoidance in the Relationship Between Trauma and Mental Health Outcomes in Student Nurses

Background: Nurses and nursing students experience multiple types of trauma at higher rates than the general population and have a greater risk for mental health problems. Nurses also tend to report a greater number of adverse childhood experiences (ACEs) than the general population and are frequently exposed to trauma on the job. Experiential avoidance, or the avoidance of uncomfortable thoughts and emotions, is a potential mechanism through which the relationship between trauma and mental health symptoms develops. The current study examined the moderating role of experiential avoidance in the relationship between childhood and nursing-related trauma and mental health symptoms.

Method: Undergraduate nursing students (N = 248) completed an online survey regarding their mental health symptoms, trauma history, and experience as nursing students. Two moderation analyses were conducted to examine the role of experiential avoidance in the association between trauma and psychological symptoms for both childhood and nursing-related trauma. Experiential avoidance was measured using the Acceptance and Action Questionnaire (AAQ-7) and mental health symptomology was measured using the Brief Symptom Inventory (BSI-18) global severity index (GSI). Childhood trauma was assessed through the Adverse Childhood Experiences (ACEs) questionnaire and nursing school-related trauma was assessed by a single-item.

Results: The overall model examining experiential avoidance as a moderator of the association of ACEs with GSI scores was significant (R-Square = .42, p < .001). There was a significant main effect of AAQ-7 (b = .74, p < .001) and a main effect approaching significance of ACEs (b = 1.1, p = .058). However, the AAQ-7 x ACEs interaction effect did not reach significance (b = -.03, p = .114).Exploratory examination of the interaction trend suggested that participants with high experiential avoidance reported high distress regardless of ACEs (b = .01, p = .970), whereas for participants with low experiential avoidance, ACEs was positively associated with distress (b = .64, p = .052). The overall model examining experiential avoidance as a moderator of the association of nursing-related trauma with GSI scores was also significant (R-Square = .42, p < .001). Similarly, there was a main effect of AAQ-7 (b = 1.0, p < .001), but no main effect of nursing-related trauma (b = 7.1, p = .097) or AAQ-7 x nursing trauma interaction effect (b = -.28; p = .940) on GSI scores. Specifically, GSI scores increased with greater AAQ-7 scores, regardless of whether students experienced nursing-related trauma.

Implications: Experiential avoidance did not moderate the relationship between childhood or nursing-related trauma and global mental health symptoms. However, avoiding uncomfortable thoughts and emotions was independently associated with mental health symptomology. Experiential avoidance, even at low exposure to ACEs, was associated with high distress. These findings suggest that nursing students may benefit from addressing experiential avoidance through emotional acceptance practices, such as Acceptance and Commitment Therapy (ACT) techniques.