Testing a Novel Attention Based Training Prevention Strategy for First Responders: FirstFocus a Mobile App

December 1, 2025 updated by: Mikael Rubin, Palo Alto University

Testing a Novel Attention Based Training Prevention Strategy for First Responders: FirstFocus a Mobile Appt

First responders are frequently exposed to high-stress and traumatic events, putting them at increased risk for mental health challenges such as posttraumatic stress disorder, anxiety, and depression. Access to traditional mental health services is often hindered by stigma, time constraints, and a lack of tailored resources. Mobile app-based interventions offer a promising solution due to their accessibility and potential to address mental health proactively and in a time sensitive way. Attention training has emerged as a simple way to prevent distress and the emergence of future mental health concerns. The proposed research will test a mobile app: FirstFocus which will leverage targeted attention training to prevent stress/distress during shifts and enhance the wellbeing of rural first responders. The specific aims are to (1) test the feasibility and acceptability of FirstFocus as an intervention for rural first responders; (2) to test the short-term preventative efficacy of attention training on state stress/distress and its longer-term efficacy for improving professional quality of life and reducing symptoms of anxiety and depression.

Study Overview

Status

Status

Indicates the current recruitment status or the expanded access status.
Enrolling by invitation

Conditions

Conditions

The disease, disorder, syndrome, illness, or injury that is being studied. On ClinicalTrials.gov, conditions may also include other health-related issues, such as lifespan, quality of life, and health risks.

Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.

Study Type

Study Type

Describes the nature of a clinical study. Study types include interventional studies (also called clinical trials), observational studies (including patient registries), and expanded access.
Interventional

Enrollment (Estimated)

Enrollment

The number of participants in a clinical study. The "anticipated" enrollment is the target number of participants that the researchers need for the study.
80

Phase

Phase

The stage of a clinical trial studying a drug or biological product, based on definitions developed by the U.S. Food and Drug Administration (FDA). The phase is based on the study's objective, the number of participants, and other characteristics. There are five phases: Early Phase 1 (formerly listed as Phase 0), Phase 1, Phase 2, Phase 3, and Phase 4. Not Applicable is used to describe trials without FDA-defined phases, including trials of devices or behavioral interventions.
  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • United States
    • California
      • Palo Alto, California, United States, 94304
        • Palo Alto University

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Eligibility Criteria

The key requirements that people who want to participate in a clinical study must meet or the characteristics they must have. Eligibility criteria consist of both inclusion criteria (which are required for a person to participate in the study) and exclusion criteria (which prevent a person from participating). Types of eligibility criteria include whether a study accepts healthy volunteers, has age or age group requirements, or is limited by sex.

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

Yes

Description

Inclusion Criteria:

  • Age 18 or older
  • Employed as an Active First Responder
  • iPhone mobile device
  • Located in a rural part of the US

Exclusion Criteria:

- Works less than 20 hours/week on average

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm

Participant Group / Arm

A group or subgroup of participants in a clinical trial that receives a specific intervention/treatment, or no intervention, according to the trial's protocol.
Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.
Experimental: Attention Training Baseline Start
Participants in this arm will begin ABM at the start of the study.
Behavioral: Attention Bias Modification
Attention training involves 80 training trials. The task uses words developed specifically for this study with fear words such as "crash" and "car" and neutral words such as "couch" and "can" that are balanced for length and frequency. Additionally, on every trial the location of the probe is the same as the location of the fear word. Participants press the button corresponding to the direction of the probe. The training takes approximately 5 minutes to complete.
Experimental: Attention Training Week 1 Start
Participants in this arm will begin ABM 1 week after the start of the study.
Behavioral: Attention Bias Modification
Attention training involves 80 training trials. The task uses words developed specifically for this study with fear words such as "crash" and "car" and neutral words such as "couch" and "can" that are balanced for length and frequency. Additionally, on every trial the location of the probe is the same as the location of the fear word. Participants press the button corresponding to the direction of the probe. The training takes approximately 5 minutes to complete.
Experimental: Attention Training Week 2 Start
Participants in this arm will begin ABM 2 weeks after the start of the study.
Behavioral: Attention Bias Modification
Attention training involves 80 training trials. The task uses words developed specifically for this study with fear words such as "crash" and "car" and neutral words such as "couch" and "can" that are balanced for length and frequency. Additionally, on every trial the location of the probe is the same as the location of the fear word. Participants press the button corresponding to the direction of the probe. The training takes approximately 5 minutes to complete.
Experimental: Attention Training Week 3 Start
Participants in this arm will begin ABM 3 weeks after the start of the study.
Behavioral: Attention Bias Modification
Attention training involves 80 training trials. The task uses words developed specifically for this study with fear words such as "crash" and "car" and neutral words such as "couch" and "can" that are balanced for length and frequency. Additionally, on every trial the location of the probe is the same as the location of the fear word. Participants press the button corresponding to the direction of the probe. The training takes approximately 5 minutes to complete.

What is the study measuring?

Primary Outcome Measures

Primary Outcome Measures

In a clinical study's protocol, the planned outcome measure that is the most important for evaluating the effect of an intervention/treatment. Most clinical studies have one primary outcome measure, but some have more than one.
Outcome Measure
Measure Description
Time Frame
Client Satisfaction Questionnaire
Time Frame: From enrollment to the end of treatment at 8 weeks.
The Client Satisfaction Questionnaire - 8 item version (CSQ-8; Nguyen et al., 1983) will assess participant satisfaction with the FirstFocus app at the 60-day assessment. The CSQ-8 yields a total score ranging from 8 to 32, with higher scores indicating greater satisfaction.
From enrollment to the end of treatment at 8 weeks.

Secondary Outcome Measures

Secondary Outcome Measures

In a clinical study's protocol, a planned outcome measure that is not as important as the primary outcome measure for evaluating the effect of an intervention but is still of interest. Most clinical studies have more than one secondary outcome measure.
Outcome Measure
Measure Description
Time Frame
Stress Reduction (visual analogue scale)
Time Frame: From enrollment to the end of treatment at 8 weeks.
Current stress will be assessed using a Visual Analogue Scale for Stress, administered daily before and after each shift. Participants rate their stress on a 0-100 scale, where 0 = no stress and 100 = extreme stress. Higher scores indicate greater stress.
From enrollment to the end of treatment at 8 weeks.
Professional Quality of Life
Time Frame: From enrollment to the end of treatment at 8 weeks
The Professional Quality of Life Scale, Version 5 (ProQOL-5) assesses compassion satisfaction, burnout, and secondary traumatic stress. Each subscale yields a score from 10 to 50, with higher Compassion Satisfaction scores reflecting better outcomes, and higher Burnout or Secondary Traumatic Stress scores reflecting worse outcomes. Administered weekly on login.
From enrollment to the end of treatment at 8 weeks
Symptoms of depression
Time Frame: From enrollment to the end of treatment at 8 weeks
The Patient Health Questionnaire-9 (PHQ-9; Kroenke et al., 2001) assesses depressive symptoms over the past week. Total scores range from 0 to 27, with higher scores indicating more severe depressive symptoms. Administered monthly on login.
From enrollment to the end of treatment at 8 weeks
Symptoms of anxiety
Time Frame: From enrollment to the end of treatment at 8 weeks
The Generalized Anxiety Disorder-7 (GAD-7; Spitzer et al., 2006) assesses anxiety symptoms over the past week. Total scores range from 0 to 21, with higher scores indicating more severe anxiety. Administered monthly on login.
From enrollment to the end of treatment at 8 weeks
Stress
Time Frame: From enrollment to the end of treatment at 8 weeks
The Perceived Stress Scale - 10 item version (PSS-10; Cohen et al., 1983) assesses perceived stress over the past week. Total scores range from 0 to 40, with higher scores indicating higher perceived stress levels. Administered monthly on login.
From enrollment to the end of treatment at 8 weeks

Other Outcome Measures

Other Outcome Measures

For clinical trials, a planned measurement described in the protocol that is used to determine the effect of an intervention/treatment on participants. For observational studies, a measurement or observation that is used to describe patterns of diseases or traits, or associations with exposures, risk factors, or treatment. Types of outcome measures include primary outcome measure and secondary outcome measure.
Outcome Measure
Measure Description
Time Frame
Qualitative Evaluation of Acceptability.
Time Frame: From enrollment to the end of treatment at 8 weeks
Qualitative feedback will be collected via a single open-ended item each week, along with multiple open-ended acceptability questions at the 60-day assessment. As a qualitative measure, no numerical scale or score range applies. This approach allows for detailed feedback on usability, acceptability, and alignment with first responder needs.
From enrollment to the end of treatment at 8 weeks

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sponsor

The organization or person who initiates the study and who has authority and control over the study.
Palo Alto University

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

Study Start

The actual date on which the first participant was enrolled in a clinical study. The "anticipated" study start date is the date that the researchers think will be the study start date.
November 15, 2025

Primary Completion (Estimated)

Primary Completion

The date on which the last participant in a clinical study was examined or received an intervention to collect final data for the primary outcome measure. Whether the clinical study ended according to the protocol or was terminated does not affect this date. For clinical studies with more than one primary outcome measure with different completion dates, this term refers to the date on which data collection is completed for all the primary outcome measures. The "anticipated" primary completion date is the date that the researchers think will be the primary completion date for the study.
September 1, 2026

Study Completion (Estimated)

Study Completion

The date on which the last participant in a clinical study was examined or received an intervention/treatment to collect final data for the primary outcome measures, secondary outcome measures, and adverse events (that is, the last participant's last visit). The "anticipated" study completion date is the date that the researchers think will be the study completion date.
December 1, 2026

Study Registration Dates

First Submitted

First Submitted

The date on which the study sponsor or investigator first submitted a study record to ClinicalTrials.gov. There is typically a delay of a few days between the first submitted date and the record's availability on ClinicalTrials.gov (the first posted date).
November 19, 2025

First Submitted That Met QC Criteria

First Submitted That Met QC Criteria

The date on which the study sponsor or investigator first submits a study record that is consistent with National Library of Medicine (NLM) quality control (QC) review criteria. The sponsor or investigator may need to revise and submit a study record one or more times before NLM's QC review criteria are met. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
November 19, 2025

First Posted (Estimated)

First Posted

The date on which the study record was first available on ClinicalTrials.gov after National Library of Medicine (NLM) quality control (QC) review has concluded. There is typically a delay of a few days between the date the study sponsor or investigator submitted the study record and the first posted date.
November 25, 2025

Study Record Updates

Last Update Posted (Actual)

Last Update Posted

The most recent date on which changes to a study record were made available on ClinicalTrials.gov. There may be a delay between when the changes were submitted to ClinicalTrials.gov by the study's sponsor or investigator (the last update submitted date) and the last update posted date.
December 5, 2025

Last Update Submitted That Met QC Criteria

Last Update Submitted That Met QC Criteria

The most recent date on which the study sponsor or investigator submitted changes to a study record that are consistent with National Library of Medicine (NLM) quality control (QC) review criteria. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
December 1, 2025

Last Verified

Last Verified

The most recent date on which the study sponsor or investigator confirmed the information about a clinical study on ClinicalTrials.gov as accurate and current. If a study with a recruitment status of recruiting; not yet recruiting; or active, not recruiting has not been confirmed within the past 2 years, the study's recruitment status is shown as unknown.
December 1, 2025

More Information

Terms related to this study

Other Study ID Numbers

Other Study ID Numbers

Identifiers or ID numbers other than the NCT number that are assigned to a clinical study by the study's sponsor, funders, or others. These numbers may include unique identifiers from other trial registries and National Institutes of Health grant numbers.
  • 2025-024-PAU

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

YES

IPD Plan Description

All deidentified outcomes will be shared at the time of publication.

IPD Sharing Time Frame

IPD and supporting information will be available at the time of publication of related findings/outcomes.

IPD Sharing Supporting Information Type

  • STUDY_PROTOCOL
  • SAP
  • ANALYTIC_CODE

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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