Emotional Resilience Training for PTSD

Overseen By Jonathan Burry, PM

Age: 18 - 65

Sex: Any

Trial Phase: Academic

Sponsor: University of Regina

Disqualifiers: Non-cadets

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 2

960 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to improve the mental health of RCMP cadets by providing enhanced training that includes skills to manage stress and trauma. The goal is to reduce posttraumatic stress injuries among cadets.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

How does Emotional Resilience Training for PTSD differ from other treatments?

Emotional Resilience Training for PTSD is unique because it focuses on building emotional resilience through multimodal biopsychosocial training, incorporating techniques like mindfulness and stress management, which are not typically emphasized in standard PTSD treatments. This approach aims to preemptively reduce stress responses and improve self-management of emotional stress, making it particularly suitable for military personnel and their families. ^{1 2 3 4 5}

What data supports the effectiveness of the treatment Emotional Resilience Skills Training (ERST) for PTSD?

The research highlights that treatments like Cognitive Processing Therapy (CPT), which focus on cognitive emotional processing, can reduce dropout rates in PTSD therapy. This suggests that components of Emotional Resilience Skills Training (ERST) that enhance emotional processing may also improve treatment engagement and effectiveness. ^{3 6 7 8 9}

Who Is on the Research Team?

Nicholas Carleton

Principal Investigator

University of Regina

Are You a Good Fit for This Trial?

This trial is specifically for cadets beginning the RCMP Cadet Training Program. It aims to study mental health risk and resilience factors related to traumatic stress. Only these cadets can participate, excluding anyone else not starting this program.

Inclusion Criteria

Cadets starting the RCMP Cadet Training Program

Exclusion Criteria

Anyone other than cadets starting the RCMP Cadet Training Program

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Pre-training

Participants undergo pre-training assessments to establish baseline mental health metrics

1 week

1 visit (in-person)

Training

Participants receive either the Standard Training Condition (STC) or the Augmented Training Condition (ATC) over a 26-week period

26 weeks

Weekly assessments (virtual)

Post-training

Participants are assessed for changes in mental health symptoms following the training period

1 week

1 visit (in-person)

Follow-up

Participants are monitored annually for 5 years to assess long-term mental health outcomes

5 years

Annual assessments (in-person and virtual)

What Are the Treatments Tested in This Trial?

Interventions

• Active Monitoring
• Emotional Resilience Skills Training (ERST)

Trial Overview The trial tests Emotional Resilience Skills Training (ERST) against Active Monitoring in new RCMP cadets. They'll be assessed before and after training, then annually for five years, plus with monthly and daily surveys to measure mental health outcomes.

How Is the Trial Designed?

Group I: Augmented Training Condition (ATC) Experimental Treatment 1 Intervention

The Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders (UP) is an evidence-based cognitive-behavioral intervention designed to cultivate constructive approach-oriented emotional engagement. The 13-week Emotional Resilience Training (ERST) is an adaptation of the UP designed for use as a proactive training course. The ERST frames emotional experiences as natural responses to threat, rather than pathological occurrences to avoid; as such, the ERST is well-suited for mitigating health challenges and the skills may also help PSP to support persons in distress, including other PSP and the community members they all serve. The ERST training materials include an instructor guide, didactic PowerPoints, and a trainee workbook. The ERST was designed for seamless integration with the Cadet Training Program, effective June 2022, which is what creates the augmented training arm (i.e., the ATC).

Group II: Standard Training Condition (STC) Active Control 1 Intervention

The STC has received the "standard" RCMP Depot Division ("Depot") Cadet Training Program as has been provided to cadets prior to June 2022. The STC and the ATC will complete the same standardized self-report assessments, clinical interview assessments, and biometric assessments, and receive the same feedback and reporting based on those assessments.

Who Is Running the Clinical Trial?

University of Regina

Lead Sponsor

Trials

59

Recruited

9,100+

Royal Canadian Mounted Police

Collaborator

Trials

1

Recruited

960+

Government of Canada

Collaborator

Trials

13

Recruited

2,400+

Ministry of Public Safety and Emergency Preparedness

Collaborator

Trials

1

Recruited

960+

Canadian Institute for Public Safety Research and Treatment

Collaborator

Trials

3

Recruited

2,100+

Published Research Related to This Trial

In a study of 51 adults with PTSD undergoing cognitive processing therapy (CPT), dropout rates were significantly higher in CPT (39.7%) compared to written exposure therapy (WET) (6.4%), indicating a need for improved engagement strategies in CPT.

Analysis of trauma narratives revealed that more negative emotions and ruminative processing were associated with lower dropout rates, while overgeneralized beliefs increased dropout risk, suggesting that monitoring these narrative elements could help clinicians identify at-risk patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Predictors of Dropout in Cognitive Processing Therapy for PTSD: An Examination of Trauma Narrative Content. Alpert, E., Hayes, AM., Barnes, JB., et al.[2021]

Prolonged Exposure and Cognitive Processing Therapy are recognized as gold-standard treatments for PTSD, showing positive outcomes in randomized controlled trials (RCTs) with reasonable patient retention.

However, real-world studies reveal a significant dropout rate among patients undergoing these therapies, highlighting the need for further research on retention strategies to ensure effective treatment delivery outside of controlled environments.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The problem of dropout from "gold standard" PTSD therapies. Najavits, LM.[2020]

In a study of 53 adults with PTSD undergoing cognitive processing therapy (CPT), dropout rates were significantly higher (39.7%) compared to written exposure therapy (6.4%), indicating a need to address factors influencing treatment retention.

The research identified that higher levels of physiological distress and cognitive emotional processing were associated with lower dropout rates, while avoidance behaviors predicted higher dropout, suggesting that targeting these factors early in treatment could improve engagement and outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Predictors of dropout in cognitive processing therapy for PTSD: An examination of in-session treatment processes. Shayani, DR., Canale, CA., Sloan, DM., et al.[2023]

Over a 4-year period, training for evidence-based treatments (EBTs) for PTSD, specifically prolonged exposure (PE) and cognitive processing therapy (CPT), improved among providers in U.S. Department of Veterans Affairs programs, with significant increases in the number of trained and certified providers.

Despite improvements in training, many programs reported no change in the actual use of PE and CPT, indicating that while training is essential, ongoing support and resources are necessary for effective implementation of these therapies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Changes in implementation of two evidence-based psychotherapies for PTSD in VA residential treatment programs: a national investigation. Cook, JM., Dinnen, S., Thompson, R., et al.[2022]

In a study of 557 military service members undergoing PTSD treatment, dropout rates were found to be 30.7%, with individually delivered treatments leading to higher attendance compared to group therapy.

Younger age and a history of traumatic brain injury (TBI) were significant predictors of lower attendance and higher dropout rates, highlighting the need for targeted strategies to improve retention in PTSD treatments, especially for these vulnerable groups.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Predictors of attendance and dropout in three randomized controlled trials of PTSD treatment for active duty service members. Berke, DS., Kline, NK., Wachen, JS., et al.[2020]

Multimodal biopsychosocial training programs, which include techniques like mindfulness and cognitive behavioral stress management, can effectively reduce stress-related symptoms in combat-exposed troops and their families.

The systematic review highlights the feasibility of implementing these self-management techniques within military training cycles, suggesting they can help preempt or lessen posttraumatic stress responses.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A systematic review of biopsychosocial training programs for the self-management of emotional stress: potential applications for the military. Crawford, C., Wallerstedt, DB., Khorsan, R., et al.[2021]

The pilot-tested resilience skills training program for pediatric residents resulted in 76% of participants rating the skills as important and 60% expressing satisfaction with the training.

Post-training, 82% of residents reported a change in their response to patient-related grief and trauma, indicating increased awareness of stress signs and improved coping strategies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Adaptation and Evaluation of Military Resilience Skills Training for Pediatric Residents. Bursch, B., Lloyd, J., Mogil, C., et al.[2022]

The pilot study demonstrated that the STAIR program, delivered via video teleconferencing, is feasible and well-accepted by women veterans in rural areas who have experienced military sexual trauma, with high participant satisfaction reported.

Participants showed significant improvements in various areas, including social functioning and symptoms of PTSD, depression, and emotion regulation, indicating the initial efficacy of the STAIR program with effect sizes ranging from Hedge's g = 1.41 to 2.35.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Telemental Health Delivery of Skills Training in Affective and Interpersonal Regulation (STAIR) for Rural Women Veterans Who Have Experienced Military Sexual Trauma. Weiss, BJ., Azevedo, K., Webb, K., et al.[2019]

A study involving 58 women with PTSD from childhood abuse showed that a two-phase cognitive-behavioral treatment significantly improved their emotional regulation, interpersonal skills, and PTSD symptoms compared to a waitlist group.

The success of the treatment was linked to the strength of the therapeutic alliance and the development of negative mood regulation skills during the initial phase, highlighting the importance of these factors before engaging in exposure therapy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Skills training in affective and interpersonal regulation followed by exposure: a phase-based treatment for PTSD related to childhood abuse. Cloitre, M., Koenen, KC., Cohen, LR., et al.[2022]

Citations

1. England pubmed.ncbi.nlm.nih.gov

Predictors of Dropout in Cognitive Processing Therapy for PTSD: An Examination of Trauma Narrative Content. [2021]

2. England pubmed.ncbi.nlm.nih.gov

The problem of dropout from "gold standard" PTSD therapies. [2020]

3. England pubmed.ncbi.nlm.nih.gov

Predictors of dropout in cognitive processing therapy for PTSD: An examination of in-session treatment processes. [2023]

4. United States pubmed.ncbi.nlm.nih.gov

Changes in implementation of two evidence-based psychotherapies for PTSD in VA residential treatment programs: a national investigation. [2022]

5. England pubmed.ncbi.nlm.nih.gov

Predictors of attendance and dropout in three randomized controlled trials of PTSD treatment for active duty service members. [2020]

6. United States pubmed.ncbi.nlm.nih.gov

A systematic review of biopsychosocial training programs for the self-management of emotional stress: potential applications for the military. [2021]

7. United States pubmed.ncbi.nlm.nih.gov

Adaptation and Evaluation of Military Resilience Skills Training for Pediatric Residents. [2022]

8. United States pubmed.ncbi.nlm.nih.gov

Telemental Health Delivery of Skills Training in Affective and Interpersonal Regulation (STAIR) for Rural Women Veterans Who Have Experienced Military Sexual Trauma. [2019]

9. United States pubmed.ncbi.nlm.nih.gov

Skills training in affective and interpersonal regulation followed by exposure: a phase-based treatment for PTSD related to childhood abuse. [2022]