Trauma Management Therapy for First Responders

Introduction And Background

First responders risk their lives to protect the community and this profession is considered to be one of the most dangerous and stressful occupations in the United States (Del Ben, Scotti, Chen, & Fortson, 2006; U.S. Department of Labor, 2007). Society has long recognized the physical demands of first responders; however, what is less formally acknowledged are the negative psychological outcomes. The Oklahoma City Bombing and the September 11, 2001 terrorist attack on the World Trade Center (WTC) were the two earliest large-scale critical incidents that illuminated the numerous negative mental health consequences experienced by first responders (Corrigan et al., 2009; North et al., 2002). More recent studies have identified comparable mental health consequences to those of large-scale critical incidents among first responders with exposure to more routinely encountered potentially traumatic events (PTEs) (see Johnson, 2010; Paulus, Vujanovic, Schuhmann, Smith, & Tran, 2017; Stanley, Boffa, Hom, Kimbrel, & Joiner, 2017).

Most notable among these negative mental health consequences is posttraumatic stress disorder (PTSD). The hallmark of a PTSD diagnosis is that symptoms result from exposure to a traumatic event. Traumatic events are those that include exposure to actual or threatened death, serious injury, or sexual violence (American Psychiatric Association, 2013). First responders encounter these traumatic events repeatedly with high frequency as a function of their daily job requirements (Hartley, Violanti, Sarkisian, Andrew, & Burchfiel, 2013; Marmar et al., 2006). Documented prevalence rates for Posttraumatic Stress Disorder (PTSD) among United States police officers range from 6.2% to 15% (Hartley et al., 2013; Pietrzak et al., 2012), and from 6.3% to 22% (Bernard, Driscoll, Kitt, West, & Tak, 2006; DeLorme, 2014) among United States firefighters. Although varied, most studies observe PTSD rates in excess of the general population (6.8%, Kessler et al., 2005) and observe PTSD rates similar to the prevalence rate observed in OEF/OIF veterans (12%, Hoge, Riviere, Wilk, Herrell, & Weathers, 2014). It is estimated that there are at minimum 250,000 first responders in need of treatment for PTSD (Haugen, Evces, & Weiss, 2012); however, there is little scientific literature to guide clinicians in the selection of an effective treatment for PTSD in these patients.

Given the comparable rates of PTSD among first responders and OEF/OIF veterans, the treatment literature on PTSD and veterans may help guide clinicians’ clinical practice. Both intensive outpatient programs (IOP) and traditional outpatient programs (OP) have been effective in the treatment of PTSD for veterans (Beidel, Frueh, Neer, Bowers, et al., 2019; Beidel, Frueh, Neer, & Lejuez, 2017). Among veterans that participated in one IOP, the relapse (1%) and dropout (2%) rates for the program were lower than other PTSD treatments and RCTs. In addition to the improved relapse and dropout rates, treatment effects were large (d = 2.06). Of the 100 participants that completed treatment, 65.9% no longer met DSM-IV-TR criteria for PTSD, 72% experienced clinically significant symptom improvement, and 94.6% met the VA designated benchmark for symptom improvement. Among veterans that participated in the OP, the relapse (4.5%) and dropout (26%) rates for the exposure portion of the program were compatible with other PTSD treatments and RCTs. Treatment effects were large (d = 2.06). Of the 49 participants that completed treatment across groups, 65.9% no longer met DSM-IV-TR criteria for PTSD, 42% experienced clinically significant symptom improvement, and 94.6% met the VA designated benchmark for symptom improvement.