F.I.R.E.- Fighters With Focus, Intention, Regulation and Engagement

F.I.R.E.- Fighters With Focus, Intention, Regulation and Engagement: Development and Feasibility Study of a Psychological Intervention Aiming to Promote Firefighters' Well-being and Mental Health

Firefighters are routinely exposed to potentially traumatic events, making them vulnerable to debilitating mental health problems. Consequently, promoting well-being and the ability to respond effectively and safely to work demands are vital. The FIRE is an innovative mindfulness, Acceptance and Commitment Therapy, and compassion-based manualized intervention encompassing eight weekly group sessions delivered at Fire Stations. A preliminary version of this program will be refined based on qualitative inputs from structured interviews with firefighters and emergency/civil protection sector stakeholders. The FIRE feasibility dimensions of adaptation, acceptability, implementation, practicality, integration, and limited efficacy will be evaluated in a two-arm, 1:1, non-blinded randomised controlled trial. The extent to which the FIRE contributes to the promotion of well-being and the decrease of psychopathological symptoms, and the causal theory underlying FIRE, will be explored through an examination of potential mechanisms of change.

Study Overview

• Status: Not yet recruiting
• Conditions: Firefighters' Mental Health
• Intervention / Treatment: Behavioral: FIRE

Detailed Description

The FIRE is an innovative mindfulness, Acceptance and Commitment Therapy, and compassion-based manualised intervention, encompassing 8-weekly group sessions delivered at Fire Stations. The FIRE implementation will occur outside the Charlie phase (fire critical season, from May to October), controlling for the potential seasonality impact on results. Two clinical psychologists with mindfulness, ACT, and compassion training will facilitate the FIRE sessions. Weekly gentle reminders will be sent to motivate participants to practice the between-sessions exercises.

The current project aims to conduct a feasibility study, including the dimensions of adaptation, acceptability, implementation, practicality, integration, and limited efficacy. Regarding limited efficacy, it is hypothesised that participants in the experimental group (EG-FIRE) will reveal significant decreases in firefighters' psychopathological symptoms (depression, anxiety, PTSD) and will present higher levels of well-being, feelings of belonging, acceptance, and feelings of warmth from colleagues, and attention when compared to participants in the waiting-list control group (CG-WL). It is also hypothesised that these improvements will persist over a 3-month follow-up period.

The ANEPC will invite Fire Stations in the centre region of Portugal to participate. The FIRE will be presented at each Fire Station enrolled in the study during an informative session, and a leaflet will also be distributed. Interested firefighters will be asked to register, assess eligibility, and give informed consent. Consenting participants will be randomly allocated to: a) experimental group-EG-FIRE receiving the intervention; b) wait-list control group-WL-CG.

All ethical requirements for research with humans will be guaranteed. Participants will complete online standardised self-report measures at pre-intervention (M0), post-intervention (M1), and 3-month follow-up (M2). At M1, the EG-FIRE will complete a feasibility criteria questionnaire. Limited efficacy will be assessed using Intention-to-Treat and per-protocol analyses. Two-way mixed ANOVAs and MANOVAs will be computed on the study outcomes, with Group (EG-FIRE, WL-CG) as the between-subject variable and Time (M0, M1) as the within-subject factor. Repeated ANOVAs and MANOVAS with Time (M1, M2) as the within-subject factor will be computed to investigate changes in outcomes from M1 to M2 and at the 3-month follow-up in the EG-FIRE. Effect sizes will be analysed.

To limit attrition rates, risks, and barriers to the FIRE implementation (interference with firefighters' assignments), it will be proposed that sessions be scheduled to avoid conflicts with participants' work shifts, held at the Fire Station (to avoid participants' burden). It will be negotiated to include the FIRE sessions in the national training hours plan for EG-FIRE participants. To ensure the program's rigorous implementation, weekly meetings will be held with the project supervisors.

The FIRE is expected to be a feasible program that will advance, disseminate, and facilitate knowledge transfer, providing scientific evidence to inform mental health practices for the emergency and civil protection sectors. It is expected to promote well-being, feelings of connectedness, belonging, warmth, acceptance, and attention, and decrease firefighters' psychopathological symptoms. Mental health benefits are expected to result from improvements in mindfulness, psychological flexibility, and compassion skills, and from decreases in rumination, and to be sustained over a 3-month follow-up. Two self-report measures adapted to the firefighters' setting will be available, contributing to further investigate psychological aspects in this population.

• Study Type: Interventional
• Enrollment (Estimated): 53
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Soraia Moniz; Phone Number: +351912155586; Email: soraia-moniz@live.com.pt

Study Locations

• Portugal
  • Coimbra, Portugal, 3000-115
    • Faculty of Psychology and Education Sciences, University of Coimbra
    • Contact: Soraia Moniz; Phone Number: +351912155586; Email: soraia-moniz@live.com.pt
    • Principal Investigator: Soraia Moniz, MSc
    • Principal Investigator: Ana Galhardo, PhD
    • Principal Investigator: Cláudia Ferreira, PhD

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Age 18-65
• Being a volunteer firefighter

Exclusion Criteria:

• Currently undergoing any form of psychiatric/psychological intervention (self-reported)

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Experimental FIRE Group; Participants in the experimental group will receive the FIRE programme delivered at Fire Stations. Participants will complete online standardised self-report measures, pre-(M0), post-intervention (M1) and 3-months follow-up (M2). At M1, the experimental FIRE group will complete a feasibility criteria questionnaire.	Behavioral: FIRE; The FIRE will include 8-weekly group sessions (10-15 participants per group; 90-minutes duration) delivered at Fire Stations. The FIRE implementation will occur outside the charlie phase (fire critical season, from May to October), controlling for the potential seasonality impact on results. Two clinical psychologists with mindfulness, ACT and compassion training will facilitate the FIRE sessions. Weekly gentle reminders will be sent to motivating participants to practice the between-sessions exercises.
No Intervention: Wait-list Control Group; Participants in the wait-list control group will complete online standardised self-report measures, pre-(M0), post-intervention (M1) and 3-months follow-up (M2). The wait-list control group participants will be offered the opportunity to receive the FIRE programme after the study.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Well-being	Measured by the World Health Organization Well-Being Index 5 (WHO-5). The total raw score, ranging from 0 to 25, is multiplied by 4 to give the final score, with 0 representing the worst imaginable well-being and 100 representing the best imaginable well-being.	Baseline, 8 weeks and 3-month follow-up

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Depression	Measured with the depression subscale of the Patient Health Questionnaire 4 (PHQ-4). The subscale scores range between 0 and 6. Scores equal or higher than 3 are a reasonable cut-off point for detecting possible cases of depression.	Baseline, 8 weeks and 3-month follow-up
Anxiety	Measured with the anxiety subscale of the Patient Health Questionnaire-4 (PHQ-4). The subscale scores range between 0 and 6. Scores equal to or higher than 3 are a reasonable cut-off point for detecting possible cases of anxiety.	Baseline, 8 weeks and 3-month follow-up
PTSD	Measured with the PTSD Checklist-5. The total score ranges from 0 to 80, with higher scores indicating greater severity of post-traumatic stress disorder symptoms.	Baseline, 8 weeks and 3-month follow-up
Attention	Measured with the Toulose Piéron Cancellation Test. Performance is assessed based on the number of correctly cancelled stimuli, errors of omission and commission, and indices of attention and concentration, with higher scores indicating better attentional performance.	Baseline and 8 weeks
Mindfulness	Measured with the Five-Facet Mindfulness Questionnaire (FFMQ; 18-item version). The total score for this scale ranges from 18 to 90, with higher scores indicating greater mindfulness skills.	Baseline, 8 weeks and 3-month follow-up
Compassion	Measured with the Self-Compassion Scale - short form (SCS-SF). The total score for this scale ranges from 12 to 60, with higher scores indicating greater self-compassion.	Baseline, 8 weeks and 3-month follow-up
Psychological Flexibility	Measured with the Psy-Flex. The total score for this scale ranges from 5 to 30, with higher scores indicating greater psychological flexibility.	Baseline, 8 weeks and 3-month follow-up
Social Safeness	Measured with the Social Safeness and Pleasure Scale - Firefighters (SSPS-F). The total score ranges from 11 to 55, with higher scores indicating greater perceived social safeness and pleasure.	Baseline, 8 weeks and 3-month follow-up

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Feasibility criteria questionnaire - Acceptability	Measured through the feasibility criteria questionnaire (to be developed by the researchers). It will comprise questions addressing overall FIRE satisfaction, perceived usefulness of each session and experiential exercises and willingness to recommend the FIRE to peers.	8 weeks
Feasibility criteria questionnaire - Demand	Measured through the feasibility criteria questionnaire (to be developed by the researchers). This dimension will focus on program adherence (e.g., number of participants, percentage of sessions completed).	8 weeks
Feasibility criteria questionnaire - Implementation	Measured through the feasibility criteria questionnaire (to be developed by the researchers). Barriers and facilitators of engagement will be examined.	8 weeks
Feasibility criteria questionnaire - Practicality	Measured through the feasibility criteria questionnaire (to be developed by the researchers). This dimension will assess the practicality of delivering the intervention within fire stations, including the availability of required resources (e.g., space, materials).	8 weeks
Feasibility criteria questionnaire - Adaptation	Measured through the feasibility criteria questionnaire (to be developed by the researchers). This dimension will assess the need for, and type of adaptations required to deliver the intervention in fire stations (e.g., modifications to content, format, duration, or delivery procedures to fit the operational context).	8 weeks
Feasibility criteria questionnaire - Integration	Measured through the feasibility criteria questionnaire (to be developed by the researchers). The integration dimension will be defined as how participant firefighters use the FIRE skills in everyday life and their willingness to continue to do so in the future.	8 weeks
Feasibility criteria questionnaire - Expansion	Measured through the feasibility criteria questionnaire (to be developed by the researchers). This dimension will assess the potential for expanding the intervention.	8 weeks
Limited Efficacy	Measured through standardised self-report measures previously mentioned. Limited efficacy will correspond to the effect size estimations of changes in primary and secondary self-reported outcomes in the FIRE Group vs the Wait-list Control Group.	8 weeks

Collaborators and Investigators

• Sponsor: University of Coimbra

Study record dates

Study Major Dates

• Study Start (Estimated): August 1, 2026
• Primary Completion (Estimated): February 1, 2028
• Study Completion (Estimated): May 1, 2028

Study Registration Dates

• First Submitted: January 19, 2026
• First Submitted That Met QC Criteria: March 16, 2026
• First Posted (Actual): March 20, 2026

Study Record Updates

• Last Update Posted (Actual): March 20, 2026
• Last Update Submitted That Met QC Criteria: March 16, 2026
• Last Verified: March 1, 2026

More Information

Terms related to this study

• Keywords: Acceptance and Commitment Therapy; Mindfulness; Psychological Intervention; Feasibility study; Compassion; Firefighters
• Additional Relevant MeSH Terms: Environment and Public Health; Environment; Fires
• Other Study ID Numbers: FIRE.2024; 2024.05940.BD (Other Grant/Funding Number: Foundation for Science and Technology, Portugal)

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