Post Traumatic Stress Disorder, Post Traumatic Stress Injury
Conditions
Brief summary
Repeated exposure to trauma is an unavoidable part of the job for firefighters. Because of this, many Canadian firefighters screen positive for posttraumatic stress disorder/injury (PTSD/I). Unfortunately, like the general population, firefighters face many barriers to accessing mental health care. As a result, additional efforts are needed to increase timely access to effective PTSD/I services that are delivered in a way that reduces confidentiality and stigma risk. This research study will test the preliminary efficacy and feasibility of distance-delivered Narrative Exposure Therapy (NET) delivered by a paraprofessional for firefighters with PTSD/I. NET is an evidence-based intervention approach developed specifically for PTSD/I resulting from repeated and continuous trauma. The intervention will be conducted via videoconference with a trained paraprofessional supervised by a clinical psychologist. The NET intervention will consist of 12 weekly 90-minute videoconference sessions. Approximately 25 firefighters will be recruited to participate in the study. To test the efficacy of the intervention, participants will complete self-report questionnaires about PTSD/I and other mental health symptoms pre- and post-intervention as well as two- and six-months following intervention completion. Participants will also complete an open-ended interview at the end of the intervention to assess feasibility and participant satisfaction.
Interventions
BEHAVIORALDistance-delivered NET
One-on-one intervention delivered by a paraprofessional; 12 weekly videoconference sessions at 90 minutes.
Sponsors
Canadian Institutes of Health Research (CIHR)
University of New Brunswick
IWK Health Centre
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
19 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Participants must meet the following criteria to be eligible to move on to Consent 1. Be at least 19 years of age 2. Be able to understand spoken and written English at a Grade 8 level 3. Be employed, or have been employed, by the fire service or be current or past fire service volunteers. 4. Fulfill the criteria of full or subclinical PTSD/I according to the PCL-5. 5. Have access to a computer with Internet. 6. Live in Atlantic Canada or Ontario. 7. Consent to be audio- (for consent and interview) and video-recorded (for intervention sessions).
Exclusion criteria
1. Having a psychotropic medication change in the past three weeks. 2. Are currently engaged in or have previously been engaged in exposure therapy for PTSD/I. 3. Meet criteria for current mania or psychosis. 4. Endorse suicidal ideation with plan or intent. 5. Experience high levels of dissociation (as assessed by a score of \>18.5 on the Shutdown Dissociation Scale).
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in PTSD/I symptoms | Baseline, Immediately Post- intervention, 2 month follow up, 6 month follow up | PTSD/I symptoms are measured with the PTSD Checklist - 5 (PCL-5) |
| Change in depressive symptoms | Baseline,Immediately Post-intervention, 2 month follow up, 6 month follow up | Depression symptoms will be measured using the Patient Health Questionnaire (PHQ-9) |
| Disability | Baseline, Immediately Post-intervention, 2 month follow up, 6 month follow up | Disability will be measured with the Sheehan Disability Scale |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Recruitment Rates | Baseline | Recruitment rates will be tracked by research staff throughout the study |
| Intervention Adherence | Immediately Post-Intervention | Intervention adherence will be measured via attendance records of participants kept by their coach. These attendance records will be used to measure the average number of completed sessions and the percentage of participants who did not complete the intervention. |
| Anxiety Symptoms | Baseline, Immediately Post-intervention, 2 month follow up, 6 month follow up | Anxiety symptoms will be measured using the Generalized Anxiety Disorder - 7 item (GAD-7) |
| Intervention Perceptions and Satisfaction | Immediately Post-Intervention | Intervention perceptions and satisfaction will be measured via open-ended questions administered through a post-intervention interview |
| Coach Alliance | Immediately Post-Intervention | Coach alliance will be measured using the Working Alliance Inventory - Short Form Revised (WAI-SR) |
| Physical Health | Baseline, Immediately Post-intervention, 2 month follow up, 6 month follow up | Physical health will be measured with the Patient Health Questionnaire Physical Symptoms (PHQ-15) |
| Health Service Use | Baseline, Immediately Post-intervention, 2 month follow up, 6 month follow up | Health service use will be measured using a series of questions regarding participant's use of health services as well as frequency and intensity of service use |
Countries
Canada
Outcome results
None listed