The increase in emotional symptoms of novice clinical psychology trainees compared with a control cohort

Complete Reference

Ruiz, F. J., Dereix-Calonge, I., & Sierra, M. A. (2019). The increase in emotional symptoms of novice clinical psychology trainees compared with a control cohort. Revista Latinoamericana de Psicología, 51(3), 177-186.

Study Type

Longitudinal experimental study with two groups: trainees in clinical training versus control group of regular students, with repeated measures design and Bayesian analysis.

Context and Objectives

Training in clinical psychology is widely acknowledged as a stressful experience. Prior cross-sectional research has consistently demonstrated that clinical psychology trainees face multiple stressors and typically present higher levels of emotional symptoms than other psychology students. However, most prior studies have been cross-sectional or qualitative, meaning high symptom levels could stem from self-help selection bias rather than role-induced changes. The only prior longitudinal study (Kuyken et al., 2000) followed 167 UK trainees but did not include a control cohort. The present study analyzed the evolution of emotional symptoms in novice clinical psychology trainees during their first months of training compared with a control cohort of students attending regular semesters without clinical practice.

Method

Participants. The sample consisted of 575 undergraduate Psychology students from a Colombian university (mean age = 22.62, SD = 3.70; 83.7% women). Approximately half (52.9%) were in the 9th semester (beginning clinical practice under supervision) and the other half (47.1%) in the 8th semester (regular semester without clinical practice).

Design. Longitudinal study with two measurement points: Time 1 (T1) at semester start and Time 2 (T2) approximately two months later.

Instruments. The DASS-21 (internal consistency at T1 and T2: DASS-Total α = 0.91 and 0.93, Depression α = 0.87 and 0.90, Anxiety α = 0.75 and 0.81, Stress α = 0.82 and 0.84) and the GHQ-12 (α = 0.86 and 0.88).

Analysis. Bayesian analyses using JASP 0.9.0.1. Bayes factors were calculated for five competing repeated-measures ANOVA models evaluating Time (T1 vs T2) and Semester (8th vs 9th) effects, with Cauchy prior r = 0.35 and sensitivity analyses at r = 0.2 and r = 0.5.

Results

Of 575 T1 participants, 367 responded at T2 (63.8%) with no systematic differences between completers and non-completers. At T1, both groups were equivalent on all emotional symptom measures. Bayesian repeated-measures ANOVAs showed: for DASS-Total, the Time + Semester + Interaction model was superior (P(M|data) = 0.968, BFM = 120.706); for DASS-Depression, the same model was best (P(M|data) = 0.849, BFM = 22.553); for DASS-Stress, the interaction model was most appropriate (P(M|data) = 0.986, BFM = 273.534). Clinical psychology trainees showed more pronounced increases from T1 to T2 in DASS-Total, Depression, and Stress compared with regular-semester students. Results were robust across sensitivity analyses.

Discussion and Conclusions

This is the first study demonstrating longitudinally that novice clinical psychology trainees experience significant increases in emotional symptoms during their first months of clinical practice compared with a control cohort. Limitations include the single-university undergraduate Colombian sample, the 63.8% follow-up rate, and the absence of mediator/moderator exploration. Findings have important implications for training programs: emotional difficulties should be addressed during clinical supervision.

Importance and Contribution

This study makes three significant contributions: (1) first longitudinal evidence of emotional symptom increases in novice trainees compared with a control cohort; (2) rigorous Bayesian methodology quantifying evidence for both null and alternative hypotheses; (3) establishing that high symptom levels in trainees are not due to self-help selection bias but to real role-induced changes. The study emphasizes the need for early psychological support interventions during clinical training and supervision models integrating trainee mental health.

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