A Digital Resilience Intervention for Emergency Medical Service Workers

Self-Reflective Resilience-Recovery Activity Promotion Training for Emergency Medical Service Personnel

Emergency medical service (EMS) workers (i.e., ambulance service providers) experience triple the risk for anxiety, depression, and posttraumatic stress disorder (PTSD) compared to the general U.S. population. These mental disorders impact health and well-being across the life course. Thus, there is a critical need for interventions targeting key risk factors that can reduce EMS workers' mental health risk. Chronic stress represents such a risk factor and is a routine feature of the EMS profession due to the demands of providing emergency medical care. Self-Reflective Resilience-Recovery Activity Promotion Training (SRR-RAPT) promotes finding positive meaning in stressors by building self-awareness of the coping and regulatory responses used to manage them; evaluating those responses; adapting them based upon their perceived effectiveness; and developing a plan for managing similar stressors in the future based on what can be learned from the current situation. In addition to prompting self-monitoring and active reflection on stressors and coping responses, SRR-RAPT encourages practicing recovery activities that permit a person's stressor induced strain level to return to baseline. The primary objective of the current study is to evaluate the feasibility, acceptability, and adoptability of SRR-RAPT among EMS personnel. A secondary objective was to examine the intervention's effect on hypothesized mechanisms of action predicted to vary in response to the intervention, as well as consider the intervention's ability to reduce mental health symptoms. It is hypothesized that the intervention will be associated with more positive meaning made, adaptive self-reflection, recovery activities, and recovery experiences, as well as lower levels of mental health symptoms.

Study Overview

• Status: Completed
• Conditions: Depression; Feasibility; Anxiety; Acceptability; Post Traumatic Stress Disorder PTSD; Adoptability; Meaning Made; Adaptive Self-reflection; Recovery Activities; Recovery Experiences
• Intervention / Treatment: Behavioral: Self-Reflective Resilience-Recovery Activity Promotion Training

• Study Type: Interventional
• Enrollment (Actual): 83
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • New York
    • Syracuse, New York, United States, 13244
      • Syracuse University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Full-time or part-time employee at an emergency medical service agency
• ≥ 18 years of age
• ≥ 1 emergency medical service shift scheduled in the next 8 days from recruitment date.

Exclusion Criteria:

• Not a full-time or part-time employee at an emergency medical service agency
• < 18 years of age
• < 1 emergency medical service shift scheduled in the next 8 days from recruitment date.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Crossover Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Self-Reflective Resilience-Recovery Activity Promotion Training (SRR-RAPT); Receives Self-Reflective Resilience-Recovery Activity Promotion Training (SRR-RAPT)	Behavioral: Self-Reflective Resilience-Recovery Activity Promotion Training; Self-Reflective Resilience-Recovery Activity Promotion Training (SRR-RAPT) promotes finding positive meaning in stressors by building self-awareness of the coping and regulatory responses used to manage them; evaluating those responses; adapting them based upon their perceived effectiveness; and developing a plan for managing similar stressors in the future based on what can be learned from the current situation. In addition to prompting self-monitoring and active reflection on stressors and coping responses, SRR-RAPT encourages practicing recovery activities that permit a person's stressor induced strain level to return to baseline. SRR-RAPT is administered daily for 8 consecutive days.
No Intervention: Usual Care; Does not receive SRR-RAPT.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Time period required to achieve target sample size	The number of months it takes to recruit the number of participants necessary to reach the target sample size.	From study initiation until at least 80 participants are recruited, up to 12 months
Number of participants recruited and randomized each week of the study	A count of the number of participants who are recruited and randomized each week that the study is taking place.	From study initiation until at least 80 participants are recruited, up to 12 months
Acceptability	Assessed with 3 items asking about respondents' perceptions that the intervention was helpful ("I found that answering the questions about managing stressful experiences and practicing recovery behaviors was helpful"); useful ("I found that answering the questions about managing stressful experiences and practicing recovery behaviors was useful"); and not burdensome ("I found that answering the questions about managing stressful experiences and practicing recovery behaviors was not too burdensome"). Respondents rated each item on a scale ranging from 1 ("Strongly Disagree") to 5 ("Strongly Agree"). Ratings are summed to yield a total daily score.	Day 8 of the intervention
Adoptability	Assessed with 3 items asking about respondents intention to use what they had learned from the intervention in the future ("I will keep using these questions to help manage stressful experiences and practice recovery activities in the future." "I will try to use these questions in the future when managing stressful experiences and trying to practice recovery activities." "I plan to use some of the approaches that I came up with in my responses to the questions about managing stressful experiences and practicing recovery behaviors in the future"). Respondents rate each item on a scale ranging from 1 ("Strongly Disagree") to 5 ("Strongly Agree"). Ratings are summed to yield a total daily score.	Day 8 of the intervention

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Meaning Made	Assessed using 3 items with the highest factor loadings on the positive reframing, acceptance, and religion subscales of the Brief COPE plus one additional item representing growth ("I identified lessons that I can learn from the challenge"). Respondents rate how much they performed the strategy described in response to any stressful or challenging experiences they encountered today. Ratings are made on a scale ranging from 1 ("Not at all") to 4 ("I did this a lot"). Ratings are summed to yield a total daily score.	Days 1 to 8 of the intervention
Adaptive Self-Reflection	Derived from 3 items used in prior research. Each day respondents rate how much they agree with the following statements describing how they reacted to challenging and stressful events they encountered today: "I noticed the strategies that I used to cope with today's stress experiences", "I considered how I approach stressful experiences in my life", and "After attempting to deal with any of today's stressful experiences, I thought about how well my approach worked." Ratings are made on a scale ranging from 1 ("Strongly Disagree") to 5 ("Strongly Agree"). Ratings are summed to yield a total daily score.	Days 1 to 8 of the intervention
Recovery Activities	Pittsburgh Enjoyable Activities Test. For each item, respondents indicate whether they did the activity described today when they were not working ("Yes" vs "No"). Endorsed items are summed to yield a total daily count.	Days 1 to 8 of the intervention
Recovery Experiences	Derived from 8 items with the highest factor loadings from the detachment, relaxation, mastery, and control subscales of the Recovery Experiences Questionnaire. Respondents report how much they agree with each statement describing what they did during their off-job time today on a scale ranging from 1 ("Totally Disagree") to 5 ("Totally Agree"). Ratings are summed to yield a total daily score.	Days 1 to 8 of the intervention
PTSD Symptom Severity	Short -form of the PTSD Checklist for DSM-5. Each day respondents rate how bothered they are by PTSD symptoms on a scale ranging from 0 ("Not at all") to 4 ("Extremely"). Ratings are summed to yield a total daily score.	Days 1 to 8 of the intervention
Depression Symptom Severity	PROMIS-dep-4a questionnaire. Each day respondents rate the extent they experienced depression symptoms on a scale ranging from 1 ("Not at all") to 5 ("All of the time"). Ratings are summed to yield a total daily score.	Days 1 to 8 of the intervention
Anxiety Symptom Severity	PROMIS-anx-4a questionnaire. Each day respondents rate the extent they experienced anxiety symptoms on a scale ranging from 1 ("Not at all") to 5 ("All of the time"). Ratings are summed to yield a total daily score.	Days 1 to 8 of the intervention

Collaborators and Investigators

• Sponsor: Syracuse University

Publications and helpful links

General Publications

• Carver CS. You want to measure coping but your protocol's too long: consider the brief COPE. Int J Behav Med. 1997;4(1):92-100. doi: 10.1207/s15327558ijbm0401_6.
• Pressman SD, Matthews KA, Cohen S, Martire LM, Scheier M, Baum A, Schulz R. Association of enjoyable leisure activities with psychological and physical well-being. Psychosom Med. 2009 Sep;71(7):725-32. doi: 10.1097/PSY.0b013e3181ad7978. Epub 2009 Jul 10.
• Sonnentag S, Fritz C. The Recovery Experience Questionnaire: development and validation of a measure for assessing recuperation and unwinding from work. J Occup Health Psychol. 2007 Jul;12(3):204-21. doi: 10.1037/1076-8998.12.3.204.
• Cella D, Choi SW, Condon DM, Schalet B, Hays RD, Rothrock NE, Yount S, Cook KF, Gershon RC, Amtmann D, DeWalt DA, Pilkonis PA, Stone AA, Weinfurt K, Reeve BB. PROMIS(R) Adult Health Profiles: Efficient Short-Form Measures of Seven Health Domains. Value Health. 2019 May;22(5):537-544. doi: 10.1016/j.jval.2019.02.004.
• Zuromski KL, Ustun B, Hwang I, Keane TM, Marx BP, Stein MB, Ursano RJ, Kessler RC. Developing an optimal short-form of the PTSD Checklist for DSM-5 (PCL-5). Depress Anxiety. 2019 Sep;36(9):790-800. doi: 10.1002/da.22942. Epub 2019 Jul 29.
• Cooper C, Katona C, Livingston G. Validity and reliability of the brief COPE in carers of people with dementia: the LASER-AD Study. J Nerv Ment Dis. 2008 Nov;196(11):838-43. doi: 10.1097/NMD.0b013e31818b504c.

Study record dates

Study Major Dates

• Study Start (Actual): June 28, 2023
• Primary Completion (Actual): December 20, 2023
• Study Completion (Actual): December 20, 2023

Study Registration Dates

• First Submitted: February 24, 2025
• First Submitted That Met QC Criteria: February 28, 2025
• First Posted (Actual): March 25, 2025

Study Record Updates

• Last Update Posted (Actual): March 25, 2025
• Last Update Submitted That Met QC Criteria: March 5, 2025
• Last Verified: March 1, 2025

More Information

Terms related to this study

• Keywords: Psychological Resilience; Emergency Medical Service Personnel
• Additional Relevant MeSH Terms: Trauma and Stressor Related Disorders; Mental Disorders; Pathologic Processes; Disease Attributes; Emergencies; Stress Disorders, Traumatic; Stress Disorders, Post-Traumatic
• Other Study ID Numbers: 11-3278-2022

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No