Emotional Resilience Training for Post-Traumatic Stress Disorder

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of Regina

Disqualifiers: Suicide risk, Psychosis, Mania, Addictions, others

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

Approved in 1 Jurisdiction This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 3

192 Participants Needed

Trial Summary

Do I need to stop my current medications to join the trial?

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your doctor.

What data supports the effectiveness of the treatment Emotional Resilience Skills Training (ERST) for Post-Traumatic Stress Disorder?

Research shows that preparing patients with emotion regulation skills before cognitive behavior therapy (CBT) can enhance treatment outcomes for PTSD, suggesting that similar skills training like ERST might also be beneficial. ^{1 2 3 4 5}

Is Emotional Resilience Training safe for humans?

The studies reviewed do not provide specific safety data for Emotional Resilience Training or its variants. However, similar web-based cognitive and affective interventions for PTSD have been implemented without reported safety concerns, suggesting they are generally safe for human use. ^{2 6 7 8 9}

How is the Emotional Resilience Skills Training (ERST) treatment different from other PTSD treatments?

Emotional Resilience Skills Training (ERST) is unique because it focuses on building resilience through skills training, similar to programs used in military settings, which integrate cognitive-behavioral and mindfulness techniques to improve stress regulation and emotional control. Unlike traditional PTSD treatments like prolonged exposure or cognitive processing therapy, ERST emphasizes teaching individuals how to enhance their coping mechanisms and emotional resilience. ^{7 10 11 12 13}

What is the purpose of this trial?

This trial aims to help public safety personnel, like firefighters and police officers, manage stress and prevent trauma-related injuries through a special training program. The program teaches skills to handle emotions and stress, with periodic assessments to track progress. The goal is to improve mental health and resilience for these workers.

Research Team

R. Nicholas Carleton, PhD

Principal Investigator

University of Regina

Eligibility Criteria

This trial is for Canadian public safety personnel like firefighters, police officers, paramedics, and communicators who've been in service for at least 3 years. They must be fluent in English or French and have internet access. Those with performance issues, psychosis, mania, high suicide risk or recent attempts, drug/alcohol addiction or against mental health care cannot join.

Inclusion Criteria

Currently serving PSP firefighters, municipal police officers, paramedics, and public safety communicators

Potential participants must be Canadian citizens or permanent residents

Access to a computer with internet service

Exclusion Criteria

Currently experiencing psychosis or mania

High risk of suicide or previous suicide attempt/hospitalization within the prior year

Currently experiencing impairing drug or alcohol addictions

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Pre-training Assessment

Participants undergo pre-training assessments including clinical interviews and self-report surveys

1 week

1 visit (in-person)

Training

Participants receive the Emotional Resilience Skills Training (ERST) over 13 weeks

13 weeks

Weekly sessions (in-person)

Post-training Assessment

Participants are assessed post-training to evaluate changes in mental health symptoms

1 week

1 visit (in-person)

Follow-up

Participants are monitored for sustained changes in mental health at a 1-year follow-up

52 weeks

1 visit (in-person)

Treatment Details

Interventions

• Emotional Resilience Skills Training (ERST)

Trial Overview The study tests Emotional Resilience Skills Training (ERST), a program based on the Unified Protocol for emotional disorders but tailored for public safety workers to prevent stress injuries including PTSD.

Participant Groups

Group I: Emotional Resilience Skills Training (ERST) 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.

Emotional Resilience Skills Training (ERST) is already approved in Canada for the following indications:

Approved in Canada as Emotional Resilience Skills Training for:

• Posttraumatic Stress Injuries (PTSI) prevention and management

Who Is Running the Clinical Trial?

University of Regina

Lead Sponsor

Trials

59

Recruited

9,100+

Saskatchewan Association of Chiefs of Police

Collaborator

Trials

1

Recruited

190+

Saskatchewan Health Authority - Regina Area

Collaborator

Trials

29

Recruited

5,400+

Association of Public Safety Communication Officials

Collaborator

Trials

1

Recruited

190+

Canadian Institutes of Health Research (CIHR)

Collaborator

Trials

1,417

Recruited

26,550,000+

Canadian Institute for Public Safety Research and Treatment

Collaborator

Trials

3

Recruited

2,100+

Frontenac Paramedic Services

Collaborator

Trials

1

Recruited

190+

Ottawa Paramedic Service

Collaborator

Trials

2

Recruited

600+

Paramedic Services Chiefs of Saskatchewan

Collaborator

Trials

1

Recruited

190+

Peterborough County-City Paramedics

Collaborator

Trials

1

Recruited

190+

Findings from Research

A single session of Emotional Freedom Techniques (EFT) combined with Eye Movement Desensitization and Reprocessing (EMDR) led to significant improvements in PTSD symptoms for a survivor of the Twin Towers collapse, as measured by the Trauma Symptom Inventory (TSI) and Personality Assessment Inventory (PAI).

The participant experienced nearly complete symptom relief and was able to return to work after years of disability, highlighting the potential efficacy of combining these therapeutic approaches for treating complex PTSD.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

World Trade Center: A longitudinal case study for treating Post Traumatic Stress Disorder with Emotional Freedom Technique and Eye Movement Desensitization and Reprocessing. Nicosia, GJ., Minewiser, L., Freger, A.[2019]

A randomized clinical trial involving 135 patients will compare the online efficacy of trial-based cognitive therapy (TBCT), mindfulness-based health promotion (MBHP), and positive psychotherapy (PPT) in reducing PTSD symptoms during the COVID-19 pandemic.

The study aims to show that all three therapies can effectively reduce PTSD symptoms, anxiety, and depression, with no significant differences expected among them, highlighting the potential for flexible online treatment options for PTSD.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Randomized Clinical Trial to Assess the Efficacy of Online-Treatment with Trial-Based Cognitive Therapy, Mindfulness-Based Health Promotion and Positive Psychotherapy for Post-Traumatic Stress Disorder during the COVID-19 Pandemic: A Study Protocol. Duran, ÉP., Hemanny, C., Vieira, R., et al.[2022]

A training workshop on prolonged exposure (PE) therapy for PTSD significantly improved the self-efficacy and outcome expectations of 45 psychologists, leading to increased use of PE techniques in their practice.

The study highlights the importance of combining training with intensive consultation to enhance the delivery of evidence-based PTSD treatments, suggesting that such approaches could help more emergency service patients receive effective care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Training plus intensive consultation improves uptake and outcome expectations of prolonged exposure therapy among practitioners treating emergency service personnel with post-traumatic stress disorder. Wade, D., Terhaag, S., Putica, A., et al.[2021]

In a study involving 164 participants with acute and chronic PTSD, cognitive and affective computerized training showed significant improvement in identifying fearful faces and a trend towards reducing PTSD symptoms, particularly in re-experiencing symptoms.

The training was more effective for individuals with better cognitive performance at baseline, suggesting that cognitive capacity may influence the effectiveness of such interventions in treating PTSD.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Internet-delivered computerized cognitive & affective remediation training for the treatment of acute and chronic posttraumatic stress disorder: Two randomized clinical trials. Fonzo, GA., Fine, NB., Wright, RN., et al.[2020]

The study outlines a design for a web-based cognitive remediation training aimed at enhancing neurocognitive functions that may help prevent the development of PTSD in trauma survivors.

By focusing on early intervention shortly after trauma exposure, the study aims to address the challenges of administering targeted training to improve emotional reactivity and regulation, potentially reducing PTSD symptoms.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Evaluating web-based cognitive-affective remediation in recent trauma survivors: study rationale and protocol. Fine, NB., Achituv, M., Etkin, A., et al.[2020]

A randomized controlled trial is being conducted to compare the efficacy of a web-based version of Prolonged Exposure therapy (Web-PE) with in-person Present-Centered Therapy (PCT) for treating PTSD in 120 active duty military personnel and veterans over 8 weeks.

This study aims to not only assess the effectiveness of Web-PE but also to explore the biological mechanisms that may underlie its therapeutic effects, addressing the urgent need for accessible PTSD treatments in the military.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Design of a randomized controlled trial examining the efficacy and biological mechanisms of web-prolonged exposure and present-centered therapy for PTSD among active-duty military personnel and veterans. McLean, CP., Rauch, SAM., Foa, EB., et al.[2019]

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]

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 U.S. Army Master Resilience Trainer (MRT) course is a 10-day program designed to equip sergeants with resilience training skills, which they can then teach to their soldiers, promoting mental toughness and well-being.

The curriculum is based on evidence from the Penn Resilience Program and positive psychology, ensuring that the training is grounded in scientifically validated methods.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Master resilience training in the U.S. Army. Reivich, KJ., Seligman, ME., McBride, S.[2011]

Mental resilience training (MRT) is a mindfulness-based program developed for the British Army that combines cognitive behavioral techniques to enhance stress regulation and emotional control among military personnel.

Initial trials conducted between 2014 and 2016 at the Infantry Training Centre showed that MRT significantly improved infantry recruits' application of psychological skills in real-life training situations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Mental resilience training. Precious, D., Lindsay, A.[2019]

A formative evaluation of 38 VA residential treatment programs for PTSD revealed that a significant number of providers received training in evidence-based treatments (EBTs) for PTSD, with 37.4% trained in prolonged exposure (PE) and 64.2% in cognitive processing therapy (CPT).

The adoption of these EBTs varied widely among programs, indicating a need for strategies to enhance implementation, such as simplifying treatment manuals to focus on essential elements.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A formative evaluation of two evidence-based psychotherapies for PTSD in VA residential treatment programs. Cook, JM., O'Donnell, C., Dinnen, S., et al.[2021]

References

1. Netherlands pubmed.ncbi.nlm.nih.gov

World Trade Center: A longitudinal case study for treating Post Traumatic Stress Disorder with Emotional Freedom Technique and Eye Movement Desensitization and Reprocessing. [2019]

2. Ireland pubmed.ncbi.nlm.nih.gov

Treatment of post-traumatic stress disorder with eye movement desensitization and reprocessing: outcome is stable in 35-month follow-up. [2019]

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

Augmenting cognitive behaviour therapy for post-traumatic stress disorder with emotion tolerance training: a randomized controlled trial. [2018]

4. Switzerland pubmed.ncbi.nlm.nih.gov

A Randomized Clinical Trial to Assess the Efficacy of Online-Treatment with Trial-Based Cognitive Therapy, Mindfulness-Based Health Promotion and Positive Psychotherapy for Post-Traumatic Stress Disorder during the COVID-19 Pandemic: A Study Protocol. [2022]

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

Training plus intensive consultation improves uptake and outcome expectations of prolonged exposure therapy among practitioners treating emergency service personnel with post-traumatic stress disorder. [2021]

6. England pubmed.ncbi.nlm.nih.gov

Internet-delivered computerized cognitive & affective remediation training for the treatment of acute and chronic posttraumatic stress disorder: Two randomized clinical trials. [2020]

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

Evaluating web-based cognitive-affective remediation in recent trauma survivors: study rationale and protocol. [2020]

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

Design of a randomized controlled trial examining the efficacy and biological mechanisms of web-prolonged exposure and present-centered therapy for PTSD among active-duty military personnel and veterans. [2019]

9. England pubmed.ncbi.nlm.nih.gov

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

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

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

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

Master resilience training in the U.S. Army. [2011]

12. England pubmed.ncbi.nlm.nih.gov

Mental resilience training. [2019]

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

A formative evaluation of two evidence-based psychotherapies for PTSD in VA residential treatment programs. [2021]