Trauma Management Therapy for First Responders

Trauma Management Therapy for First Responders

Madeline Marks (University of Central Florida, USA), Annelise Cunningham (University of Central Florida, USA), Clint Bowers (University of Central Florida, USA) and Deborah C. Beidel (University of Central Florida, USA)
DOI: 10.4018/978-1-5225-9803-9.ch013
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Mental health professionals are only recently beginning to understand the risks for stress-related disorders experienced by first responders. For example, it is clear that first responders are at increased risk for Post-Traumatic Stress Disorder. Unfortunately, clinicians currently have a limited repertoire with which to treat these disorders. Treatments for PTSD have been developed for use with military patients, for the most part. It is not clear that these treatments are appropriate, and effective, for first responders. In this chapter, the authors describe a pilot study designed to evaluate whether one specific treatment approach creates similar clinical outcomes for first responders as have been observed for a military sample. The results indicate that clinical outcomes for first responders were nearly identical as those obtained with military personnel. The results are discussed in terms of future directions for research in this area.
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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.

Key Terms in this Chapter

Intensive Outpatient Program (IOP): Treatment schedule consisting of increase frequency of attendance in comparison to traditional outpatient services. Schedule includes 29 sessions over a three-week period. Incorporates individual, group, and in vivo sessions.

Imaginal Exposure Scene: Unique account of the patient’s index trauma that includes attention to the sights, sounds, and smells that were present during the traumatic event as well as attention to how the patient was behaving, thinking, and feeling.

Posttraumatic Stress Disorder: Clinical diagnosis identified by the DSM-5, consisting of intrusion symptoms, avoidance, negative alterations in mood and cognitions, changes in arousal and reactivity following a traumatic event. Traumatic event can be directly experienced, witnessed, or learned about.

Exposure Therapy: Behavioral treatment modality that consists of confronting an individual’s core fear to elicit anxiety.

First Responder: Occupation related to individuals trained in emergency response.

Psychoeducation: Information provided to patients about the causes, symptoms, and treatments of mental health conditions.

Trauma Management Therapy: A multi-component behavioral treatment program to address the primary symptoms of PTSD.

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