A pilot feasibility randomized clinical trial of a culturally adapted accelerated group treatment for posttraumatic...

Firefighters experience frequent traumatic events and occupational stressors, increasing risk for posttraumatic stress disorder (PTSD), insomnia, and nightmares, which are frequently comorbid and interrelated. However, firefighter schedules and mental health stigma limit engagement in weekly therapy. The present study was a randomized pilot feasibility trial of an integrated, accelerated, culturally adapted treatment for firefighters with clinically significant PTSD, insomnia, and nightmare symptoms.

Participants (N = 49) were randomized to immediate or delayed treatment. Treatment integrated written exposure therapy for PTSD and cognitive behavioral therapies for insomnia and nightmares and was delivered in a 4-day group therapy "workshop" with one individual session before and after the workshop. Participants completed diagnostic interviews at baseline and 1-month posttreatment and self-report surveys through 3-month posttreatment.

Most indices of program feasibility were positive despite logistical challenges impacting enrollment and treatment uptake. In addition, there were large group by time interaction effects for reductions in symptoms of PTSD (g = 1.70) and insomnia (g = 1.47) and a medium effect for nightmares (g = 0.72). Improvements in symptoms of all three targeted disorders and depressive symptoms were maintained through 3-month posttreatment.

This study supports the efficacy of accelerated, integrated PTSD and sleep disorder treatment. To our knowledge, this is the first controlled study of a culturally adapted mental health intervention for firefighters. (PsycInfo Database Record (c) 2026 APA, all rights reserved).