A randomised controlled trial of SOLAR-m: A low-intensity, brief, psychosocial intervention for firefighters delivered via smartphone

The Skills For Life Adjustment and Resilience (SOLAR) program is a brief, psychosocial, skills based intervention designed to promote recovery and maintain wellbeing following stressful events. SOLAR is typically delivered face-to-face by non-mental health professionals. The aim of this project is to conduct a randomised controlled trial to assess whether a smartphone-based version of the SOLAR intervention, known as SOLAR-m, is more effective than a control app comparator. The SOLAR mobile (SOLAR-m) app has been culturally adapted for firefighters, and participants in this RCT will be firefighters experiencing distress. The intervention period will last for five weeks, both active and control interventions will be self-paced and will be carried out at a location(s) of each participant’s choosing, as they will be delivered entirely via smartphone app and telephone calls. Participants randomised to the Skills For Life Adjustment and Resilience (SOLAR) intervention will receive access to the SOLAR smartphone app (SOLAR-m). SOLAR-m consists of eight modules delivered in animations, videos, activities, and notifications, that participants can self-complete at their own pace. The SOLAR program comprises elements drawn from evidence-based treatments for individuals experiencing trauma-related mental health problems. Most are focused on behavioural skill development or psychoeducation, with one module on cognitive strategies. These elements include components on psychoeducation about healthy living, information about keeping relationships healthy, values-based behavioural activation, arousal and affective management, expressive writing to reduce arousal associated with stress or trauma, and dealing with worry and rumination. The specific contents of each module are as follows. Module 1: Welcome to SOLAR introduces participants to the program. Module 2: Healthy Body, Healthy Mind provides tips for improved nutrition, alcohol use, sleep and exercise. Module 3: Managing Strong Emotions offers behavioural and cognitive strategies for managing stress and other overwhelming feelings, including understanding your signs of stress and relaxation activities. Module 4: Living the Life You Value helps participants to identify the life areas and activities they value and builds a plan to make time for these things. Module 5: Managing Healthy Relationships presents effective communication strategies and ways to make time for relationships in times of stress. Module 6: Getting Control Over Your Thoughts provides participants with skills to manage rumination; including mindfulness, doing distracting activities, putting worries aside until a prescribed time and either effective problem solving or accepting that the situation cannot be changed. Module 7: Coming to Terms with Difficult Experiences is an expressive writing activity that focuses on working through distressing events from the past or present. Module 8: Planning for the Future summarises the program and prompts participants to create a personalised plan for including the skills and activities they have learnt in the SOLAR in their future life. The SOLAR program content has been modified so that it can be delivered in a smartphone app, and so that it is suitable for Fire and Rescue New South Wales (FRNSW) members who are experiencing distress as a result of disaster as well any other longer term stressors. Previous and study-specific co-design work with this population has informed our adaptations, as well as work in other high risk first responder organisations. The participants will be encouraged to complete homework activities to ensure that they are able to continue with these adaptive skills once they have completed the program. Participants will also be offered a weekly check-in with a telephone facilitator who will offer support and assistance with their progression through the program. Telephone facilitators will be non-mental health professionals who have some formal training in mental health (e.g. masters level students). They will be required to undergo training using a facilitator guide and will receive ongoing support from a registered psychologist throughout the study. Treatment adherence will be assessed using app metadata, including rates of completion of the app. Facilitators will also be in regular contact with participants to support them to use the app as intended.