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.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
49
WET is a trauma-focused intervention in which individuals write about their worst traumatic experience following scripted instruction from the therapist.
CBTi focuses on stimulus control, eliminating maladaptive coping habits, reducing arousal, and challenging maladaptive thoughts about sleep in an effort to reduce time to fall asleep and time awake during the night.
CBTn involves writing about a distressing or frequent nightmare, rewriting the narrative of the nightmare to target trauma-related themes, and reading the rescripted nightmare narrative.
Waitlist for delayed intervention.
NDRI_USA
Kansas City, Missouri, United States
Clinician Administered PTSD Scale (CAPS-5)
The CAPS-5 is a structured clinical interview that assesses the presence and severity of PTSD symptoms.
Time frame: Change from baseline to post treatment (~4 weeks post baseline)
Structured Clinical Interview for DSM-5 Sleep Disorders- Revised (SCISD-R)
The SCISD-R is a semi-structured interview designed to obtain a sleep history and screen for certain sleep disorders and diagnose others, including insomnia, hypersomnia, circadian rhythm sleep-wake disorders, sleep-disordered breathing, and parasomnias.
Time frame: Change from baseline to post treatment (~4 weeks post baseline)
Insomnia Severity Index (ISI)
The ISI assesses perceived severity of insomnia.
Time frame: Change from baseline through 3 months post treatment
Nightmare Disorders Index
The NDI is a self-report assessment of nightmare disorder.
Time frame: Change from baseline through 3 months post treatment
Posttraumatic Stress Disorder Checklist (PCL-5)
Self-report measure update of the PCL designed to assess PTSD symptoms as defined by the DSM-5.
Time frame: Change from baseline through 3 months post treatment
Trauma-Related Nightmare Survey (TRNS)
The TRNS assesses nightmare frequency, disturbance, and characteristics.
Time frame: Change from baseline through 3 months post treatment
Self-Assessment of Sleep (SASS)
The SASS is a brief assessment of self-reported sleep quantity and sleep quality.
Time frame: Change from baseline through 3 months post treatment
Sleep Diary and Nightmare Log
The Sleep Diary and Nightmare Log assess daily subjective sleep patterns and to inform treatment recommendations.
Time frame: Change from baseline through post treatment (~4 weeks post baseline)
Patient Health Questionnaire-9 (PHQ-9)
The PHQ-9 the severity of affective and somatic symptoms related to depression; items correspond to the diagnostic criteria for major depression disorder.
Time frame: Change from baseline through 3 months post treatment
Depressive Symptoms Index-Suicidality Subscale (DSI-SS)
The DSI-SS is a self-report measure of suicidal ideation, plans, perceived control over ideation, and impulses for suicide.
Time frame: Change from baseline through 3 months post treatment
Net Prompter Score
The Net Prompter Score is a single item measures of treatment acceptability that asks respondents to rate the likelihood that they would recommend the efficient treatment to a friend or colleague on a scale from 0-10.
Time frame: Post treatment (~4 weeks post baseline)
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