When individual things are intrinsically connected, is it better to break them into their individual parts and address them or approach them as an entire unit? That’s a complicated question, and one firefighter wellness researchers are taking on.
Consider this: your internal combustion engine needs a battery, a starter and a fuel pump to start. If it won’t start when you flip the switch, you isolate the problem to one of those three. Fixing, say, a faulty battery should do the trick.
Humans are more complex. That nagging shoulder injury you’ve ignored for a year, or so, is now causing neck and back pain. Fixing the shoulder is just a start — you are a system, not a collection of components. And the mind is even more complicated. Which, of course, is where our researchers turned their attention.
Often, firefighters experience insomnia, nightmares and PTSD together — like a system. Yet, these conditions are for the most part treated as components. Think isolating the temperamental starter and hoping that solves the wonky fuel injector.
“To our knowledge, no prior research has tested the effects of accelerated treatment for PTSD, insomnia, and nightmares in firefighters or any other population,” the authors wrote in their paper published by the American Psychological Association.
Accelerated therapy is a key term here. Previous researchers found that the longer firefighters had to stay in a therapy program, the greater the chances they would drop out before completion. In this study, everyone who started the program finished it.
Here’s how the study shook out. Researchers did outreach efforts to find firefighters who suffered from all three disorders. The qualified firefighters spent four days at a therapy retreat in small groups. They stayed in a rented house and lived much like they would in a career firehouse. They cooked and ate together. They unwound together with cards or whatever — alcohol, however, was forbidden. And they trained together in the form of group therapy exercises.
They had an individual tele-therapy session before arriving on site, as well as a follow up session one week after. The in-person therapy consisted of Written Exposure Therapy for trauma with Cognitive Behavioral Therapy for insomnia and nightmares. Participants completed five structured trauma-writing sessions, following the WET protocol — writing about their worst experiences in detail.
Again, despite the limitations and it being a maiden voyage, the results were pretty damn good.
PTSD symptoms showed large improvements, with more than 75% no longer meeting diagnostic criteria one month later. Insomnia severity dropped sharply. Nightmare frequency fell by nearly half. Depressive symptoms improved, too.
Researchers checked with the participants one and three months after their sessions to see if the results stuck. Even three months out, the gains held.
“We are so excited about these results,” says Sara Jahnke, one of the researchers on the project and head of Science to the Station. “But keep in mind, this is a start, not a finish. We have so much more to do and to learn. This study showed us what we need to do to improve future research and improve this accelerated therapy. And the positive results we got from this study tell us we absolutely have to push forward on both these fronts.”
Some of the early lessons learned were making it easier for participants to get to the workshops. Four days doesn’t seem like a lot, but tack on travel and it became a burden to some. Of the 49 qualified participants, only 34 could make it to the in-person workshops. Again, those who showed up all finished.
“This suggests that enrollment and retention might be higher if the program were available in more geographic locations and participants could select the group dates that fit their schedule,” the research team wrote. “An individual treatment format would have fewer logistical challenges but may have lower acceptability.”
Being away from home, researchers said, likely limited the distractions and helped the firefighters focus on the program.
The study also found that group size mattered. When the group size was as small as two or three, or so large that the group was split into two living quarters, the firefighters reported less satisfaction. The researchers said a minimum of four participants would be ideal.
Researchers also recommend relying less on self-reporting tools like sleep diaries and engaging more technology — such as wearables that monitor sleep quantity and quality.
“The best part about this was that we saw not only what worked well, but what can work better,” Jahnke says. “We just can’t wait to start applying what we learned here to help more firefighters.”
