An Efficient Treatment for Posttraumatic Injury for Firefighters

Palo Alto Veterans Institute for Research

Status: Enrolling

Conditions: Posttraumatic Stress Disorder; Insomnia; Nightmare

Treatments: Behavioral: Written Exposure Therapy (WET); Behavioral: Cognitive Behavioral Therapy for Insomnia (CBTi); Behavioral: Cognitive Behavioral Therapy for Nightmares (CBTn); Behavioral: Waitlist

Study type: Interventional

Funder types: Other

Identifiers

NCT05950035

MCA0006AGG

Details and patient eligibility

About

The goal of this two-arm pilot randomized controlled trial is to test a behavioral intervention that integrates three evidence-based cognitive behavioral interventions (written exposure therapy; WET, cognitive behavioral therapy for insomnia; CBT-I, and cognitive behavioral therapy for nightmares; CBT-N) among firefighters. The main questions it aims to answer are:

• Is the behavioral intervention feasible, acceptable, and effective in reducing symptoms of posttraumatic stress, insomnia, and nightmares?
• What is the efficacy of efficient treatment vs. delayed treatment (2-4 week waitlist) in reducing symptoms of posttraumatic stress, insomnia, and nightmares?

We will beta test the intervention in 1-2 groups of 3-5 firefighters. Then we will randomize 50 participants to immediate or delayed (2-4 week waitlist) treatment. Consented participants will:

• Complete self-report and interview measures assessing posttraumatic stress disorder, insomnia (PTSD), and nightmares
• Attend an individual treatment orientation session
• Attend a 4-day (~3 hours per day over 4 consecutive days) group treatment that integrates WET, CBT-I, and CBT-N
• Attend an individual booster session held approximately one week later
• Complete self-report measures before, during, and after treatment, and at a 3-month follow up assessment and a clinical interview before and after treatment to assess program efficacy.

Enrollment: 50 estimated patients

Sex: All

Ages: 18 to 65 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• 18-65 years old
• Firefighter
• Able to speak and read English
• Clinically significant posttraumatic stress symptoms: CAPS-5 total score ≥ 25; ≥ 1 intrusion symptom; ≥ 1 avoidance symptom
• Clinically significant symptoms of insomnia: SCISD insomnia criteria are met; ISI ≥ 15
• Clinically significant symptoms of nightmare disorder: SCISD nightmare disorder criteria are met, nightmares ≥ 1 monthly.

Exclusion criteria

• Current suicide or homicide risk meriting crisis intervention
• Inability to speak and read English
• Inability to comprehend the baseline screening questionnaires
• Unwilling to remain abstinent from alcohol during treatment
• Serious mental health diagnosis such as bipolar disorder or psychosis.

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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50 participants in 2 patient groups

Immediate Intervention

Experimental group

Description:

Will begin treatment within 2 weeks of randomization.

Treatment:

Behavioral: Cognitive Behavioral Therapy for Nightmares (CBTn)

Behavioral: Cognitive Behavioral Therapy for Insomnia (CBTi)

Behavioral: Written Exposure Therapy (WET)

Delayed Intervention

Active Comparator group

Description:

Will be scheduled to begin treatment within 4-6 weeks of randomization.

Treatment:

Behavioral: Waitlist