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

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: Enrolling by invitation
• Conditions: Wellbeing
• Intervention / Treatment: Behavioral: Attention Bias Modification

• Study Type: Interventional
• Enrollment (Estimated): 80
• Phase: Not Applicable

Contacts and Locations

Study Locations

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

Participation Criteria

Eligibility Criteria

• 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

How is the study designed?

Design Details

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

Number of Arms

4

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
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

Outcome Measure	Measure Description	Time Frame
Client Satisfaction Questionnaire	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

Outcome Measure	Measure Description	Time Frame
Stress Reduction (visual analogue scale)	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	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	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	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	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

Outcome Measure	Measure Description	Time Frame
Qualitative Evaluation of Acceptability.	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

• Sponsor: Palo Alto University

Study record dates

Study Major Dates

• Study Start (Actual): November 15, 2025
• Primary Completion (Estimated): September 1, 2026
• Study Completion (Estimated): December 1, 2026

Study Registration Dates

• First Submitted: November 19, 2025
• First Submitted That Met QC Criteria: November 19, 2025
• First Posted (Estimated): November 25, 2025

Study Record Updates

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

More Information

Terms related to this study

• Other Study ID 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