Article

Evaluation of a trauma therapy programme within emergency service organizations

Authors:
  • Noreen Tehrani Associates
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Abstract

Background: Occupational health practitioners working in emergency services, where employees are exposed to a higher level of physical or psychological trauma, need to be able to access trauma therapy programmes which are economically viable and effective in reducing post-traumatic stress disorder and associated symptoms of anxiety and depression. Aims: The aim of this review is to provide evidence on benefits of a short-term organizational programme of trauma therapy using NICE (2018) [1] recommended interventions. Methods: The review examined the pre- and post-therapy clinical scores from 429 emergency service professionals (ESPs) who were employed in five police forces, two fire and two ambulance services. The ESPs in higher risk roles were in a psychological surveillance programme, with those found to be experiencing clinically significant levels of trauma-related symptoms being referred to a psychologist for an assessment which identified the ESPs requiring trauma therapy. At the end of the therapy, the symptoms of the ESPs were re-assessed, and the scores before and after the therapy were compared. Results: The results showed a significant improvement in the level of symptoms, with 81% of ESPs no longer exhibiting clinically significant trauma symptoms and 6% showing an increase in symptoms. In addition, the clinical results also showed improvements in ESPs' perceived work capacity and quality of social relationships. Conclusions: The findings indicate that there are clinical and personal benefits to using an organizationally based short-term model of trauma therapy in an emergency service setting.

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... The Trauma Therapy Program [57] is an intervention comprising 6 sessions of 90 min to reduce work-related distress in health practitioners working in emergency services. The intervention aims to reduce symptoms of anxiety, depression, and PTSD. ...
... The intervention is delivered by therapists trained in TF-CBT or EMDR. The program was tested in an uncontrolled pre-post-test study in N = 429 emergency service professionals from the UK [57]. The intervention effectively reduced anxiety, depression, and PTSD symptoms post-treatment compared to pre-treatment. ...
... Most of these interventions can also be applied to other types of stressors, such as disasters or pandemics. Overall, the results of five studies showed that the interventions EFT, exposure-based CBT, EMDR, MBSR, CBT-PD, and the Trauma Therapy Program were successful in reducing psychological distress and/or subclinical symptoms [49,52,56,57,60]. One RCT on the Preventive Resilience Training for Unaccompanied Refugee Minors reported no reduction in anxiety, PTSD, and depressive symptoms at a seven-week follow-up, although well-being significantly increased [53]. ...
Article
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A substantial number of survivors of disasters, pandemics, and other severe stressors develop persistent distress that impairs mental health and well-being. However, only a few brief psychological interventions target distress or subclinical symptoms. This systematic review aimed to identify and describe brief psychological interventions to reduce distress or subclinical symptoms in survivors of disasters, pandemics, and other severe stressors. Based on a systematic literature search (MEDLINE, PsycINFO, PSYNDEX, PTSDpubs, and Web of Science), we reviewed published studies and study protocols on self-help, psychosocial support, or brief psychotherapeutic interventions to reduce distress and/or subclinical symptoms following natural hazards and man-made disasters, pandemics, or other traumatic events. We included 27 published studies or study protocols (n = 15 RCTs, n = 3 controlled pre–post studies, and n = 9 uncontrolled pre–post studies) describing 22 interventions. We found evidence for reducing psychological distress and/or subclinical symptoms in 9 out of 15 RCTs, 2 out of 3 controlled pre–post studies, and 9 out of 9 uncontrolled pre–post studies. One RCT provided evidence of increasing well-being. Innovative brief interventions have been developed to reduce distress and/or subclinical symptoms that have an emerging evidence base.
... The officers had consented to the data to be used to provide management information to monitor and audit the effectiveness of the service and to identify opportunities to improve the well-being of the officers and staff. Following the screening, officers or staff members found to have clinical symptoms to have exceeded the cutoff levels for a referral to an OH professional or to a psychologist were provided with a follow-up assessment and where appropriate a referral for general counselling or trauma therapy (Tehrani, 2019) bv. ...
... Suggestion: Introduce easy access to trauma therapy programmes (Tehrani, 2019). ...
Article
Police officers play an important role in protecting the community. During the COVID-19 pandemic, their role has posed a serious threat to their physical and psychological health and well-being. This study was designed to assess the prevalence of anxiety, depression, PTSD and compassion fatigue in police officers and to identify the factors that predict COVID-19-related physical and mental well-being. As part of a regular health surveillance programme, 3863 police officers recorded their physical exposure to COVID-19 and the extent to which COVID-19 had affected their psychological well-being. The study provides suggestions on developing evidence-based well-being interventions for policing.
... A precedent for tailored support exists in England: NHS Practitioner Health provides effective mental health and addiction care specifically for HCPs [35,36]. An OH-based trauma therapy for emergency service professionals, including those with personal or secondary DA experience has also shown promise [37]. ...
Article
Background Healthcare professionals (HCPs) are expected to identify and respond to domestic abuse (DA) among their patients. Although research suggests that a high proportion of HCPs are affected by DA, the impact of their experiences has been under-researched. Aims To assess UK HCPs’ experiences of DA and develop a broad understanding of its impact on work and HCPs’ support needs. Methods An online cross-sectional survey was promoted via multiple professional channels (October to December 2022). We adopted convenience sampling and analysed data descriptively. Results Among the 192 HCP survivors who responded, all abuse subtypes—psychological, sexual, economic and physical—were common. Ninety per cent of abusers were male (ex)partners. Eighty-five per cent reported abusers directly interfered with their work and 92% reported their work and career were affected. Almost all reported physical and mental health consequences. Eighty-nine per cent reported their own experiences shaped their responses to patient survivors. On average, per year, HCP survivors reported they had 13 sick days, 5 days’ leave, 10 days’ lateness and 6 days’ early departure due to DA. Only 20% reported their workplace had a staff DA policy, and over 50% were unsure what workplace support mechanisms were available. Just over half disclosed at work; concerns that others would question their fitness to practice were common. Twenty-two per cent reported aspects of work, for example, long hours, stopped them from seeking support outside work. Conclusions HCPs face unique barriers to DA disclosure and support-seeking and may benefit from tailored support from specialists who understand both DA and the healthcare context.
... 대상 논문의 중재 효과 경찰 및 소방공무원 대상 중재 효과는 PTSD 등을 포함한 심리사회 적 변수가 주를 이루었다. 결과 변수를 세부적으로 살펴보면, PTSD 변 수 16편(1, 3, 6-8, 10-12, 14, 15, 18-20, 23-25), 우울 변수 14편(1, 3, 6, 7, 12-16, 19-22, 25), 사건충격, 주요사건 관련 변수 12편(2-5, 9, 11, 13, 17, 18, 21, 22, 26), 불안 변수 9편(1,3,7,(12)(13)(14)(19)(20)(21), 스트레스 변수 8편(3,14,15,18,20,22,23,25), 삶의 질, 삶의 조절, 웰빙(well-being) 관련 변수 일관성 변수 2편(13, 21), 수면의 질, 불면 관련 변수 2편(14, 18), 업무 제 한, 열의, 태도 관련 변수 2편(18, 20), 정동 관련 변수 2편(18, 24)으로 확 인되었으며, 그외 적대감, 심박동 변이, 해리경험, 외상 후 인지, 체성감 각증폭척도, 자살충동, 공포, 소진, 신체화 증상, 반추 변수가 결과 변 수로 사용되었다. 매년 고도화되는 중대범죄와 사건사고에 지속적으로 노출되는 경 찰 및 소방공무원은 일상 직무 안에서 외상 후 PTSD를 겪기 쉬운 환 경에 노출되어 있다[1,2]. ...
Article
Objectives: This study aimed to determine the current state of Post-traumatic stress disorder (PTSD) interventions for police officers and firefighter and their effectiveness by using an integrative review. There has been a significant increase in mental health issues among police and firefighters due to exposure to traumatic life events, and an integrative review of the research evidence underpinning these programs is timely. Methods: Previous intervention studies were identified through PubMed, Web of science, Embase, PsycINFO, CINAHL, DBpia, RISS, and KISS database. Eligible studies included articles published between 2006 and 2023 in English and Korean. We excluded articles that did not include police and firefighters and did not focus on PTSD interventions. We also excluded simple systematic reviews, protocols, and editorials. Results: A total of 26 studies were selected for this an integrative review. The intervention elements of extracted 26 studies were categorized into 3 themes. The intervention elements were divided into the themes of psychosocial centered interventions to reduce PTSD symptoms, target population-oriented specific PTSD interventions, and applying individual, group and integrated interventions. Conclusions: The results show that several PTSD interventions can be effective methods to improve PTSD symptoms of police officers and firefighters suffered from PTSD. The findings emphasize the importance of implementing programs to provide coping strategies and regulate physical, emotional, and mental reactions to address crisis situations faced by police officers and firefighters. Therefore, those findings will serve as a foundation for the development of PTSD intervention for police officers and firefighters in South Korea.
... When clients are not adequately informed about what to expect from their treatment, for example about a possible initial worsening of symptoms, drop-out increases significantly (Barawi et al., 2020). It is therefore important to offer ample information on what to expect from trauma-focused treatment, and to engage in shared-decision making where clients can indicate which type of treatment they prefer (Lewis-Schroeder et al., 2018;Tehrani, 2019). Specifically for police officers, the treatment outcome is positively influenced when clinicians are familiar with the operational context and the organisational culture (Smid et al., 2018), which can be achieved by integrating this in clinician training. ...
Article
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Background: Police officers are frequently exposed to a wide variety of potentially traumatic events (PTE) and are therefore at a considerable risk of developing posttraumatic stress disorder (PTSD). Previous research estimated the point prevalence of PTSD in Belgian police officers at 7.4%, significantly higher than in the general population. An effective organisational strategy to manage posttraumatic stress is essential. Objective: We aimed to develop a novel organisational approach regarding traumatic stress for Belgian police, combining evidence-based strategies for the prevention and treatment of posttraumatic stress in a stepped care intervention model. Method: In a broad development process, we combined scientific literature, case studies of best practices from other police organisations with insights gathered from a number of expert panels, thematic working groups and feedback groups. Results: A comprehensive stepped care intervention model was developed, consisting of evidence-based interventions for the prevention and treatment of posttraumatic stress. Conclusions: The intervention model is a promising organisational strategy for the management of posttraumatic stress in police organisations based on evidence-based interventions. Its effectiveness will be studied in the coming years.
... We used clinical data to evaluate the effectiveness of a service providing brief trauma-focused interventions to police officers with PTSD and CPTSD. A recent evaluation of the service programme shows benefits in emergency service workers with PTSD [19]; however, effectiveness for CPTSD has not yet been investigated. ...
Article
Full-text available
Background Police are frequently exposed to occupational trauma, making them vulnerable to post-traumatic stress disorder (PTSD) and other mental health conditions. Through personal and occupational trauma police are also at risk of developing Complex PTSD (CPTSD), associated with prolonged and repetitive trauma. Police Occupational Health Services require effective interventions to treat officers experiencing mental health conditions, including CPTSD. However, there is a lack of guidance for the treatment of occupational trauma. Aims To explore differences in demographics and trauma exposure between police with CPTSD and PTSD and compare the effectiveness of brief trauma-focused therapy between these diagnostic groups. Methods Observational cohort study using clinical data from the Trauma Support Service, providing brief trauma-focused therapy for PTSD (cognitive behavioural therapy/eye movement desensitization and reprocessing) to UK police officers. Demographics, trauma exposure, baseline symptom severity and treatment effectiveness were compared between police with PTSD and CPTSD. Changes in PTSD, depression and anxiety symptoms were used to measure treatment effectiveness. Results Brief trauma therapy reduced symptoms of PTSD, depression and anxiety. Treatment effectiveness did not differ between CPTSD and PTSD groups. Police with CPTSD exposed to both primary and secondary occupational trauma had poorer treatment outcomes than those exposed to a single occupational trauma type. Conclusions Brief trauma-focused interventions are potentially effective in reducing symptoms of PTSD, depression and anxiety in police with CPTSD and PTSD. Further research is needed to establish whether additional CPTSD symptoms (affect dysregulation, self-perception and relational difficulties) are also reduced.
... OH practitioners would be encouraged by the good outcomes reported in the use of short-term trauma therapy within an occupational health framework for emergency service organizations; the study supports the development of a practitioner-led business case for a trauma intervention involving objective and perceptual factors (in support of SOM's value proposition) [8]. Indeed, while studies in this issue (including from Brazil, Australia and The Netherlands) focus on negative impact of the uniformed occupations, the majority of their study populations remained healthy; resilience, after all, usually develops from exposure to adversity. ...
... Following traumatic exposure, many workers experience upset and distress that may reduce their productivity, cause absence, and increase accidents and errors (McNally et al., 2003). In a group of traumatized emergency service workers, the perceived capability to perform at work was estimated to be 37% of their normal level of performance (Tehrani, 2020). For most, the psychological impact will reduce over the next few days and weeks. ...
Article
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Background In some organizations, traumatic events via direct or indirect exposure are routine experiences. The National Institute for Health and Care Excellence reviews (2005; 2018) of post-traumatic stress disorder management in primary and secondary care did not address early interventions for trauma within emergency response organizations. Aims This scoping review was designed to identify research which evaluates the use of early interventions in emergency and other high-risk organizations following exposure to primary or secondary trauma and to report on the effectiveness of the early intervention models in common use. Methods A scoping review was conducted to examine early interventions for workers exposed to trauma, including emergency response, military, and humanitarian aid. Relevant data were extracted from the included studies and the outcomes were assessed using meta-ethnography. Results Fifty studies of mixed quality met the inclusion criteria for this review. A synthesis of study outcomes found that early interventions help emergency responders to manage post-incident trauma when they are delivered in a manner that (a) respects distinct organizational culture, (b) is supported by organizations and senior management, and (c) harnesses existing social cohesion and peer support systems within teams. Conclusion This review demonstrates that early interventions support emergency responders following exposure to trauma when these are tailored to the needs of the population, are supported by the host organization, and harness existing social cohesion and peer support processes within a team or unit. A number of recommendations for the delivery and evaluation of early interventions for psychological trauma in emergency response organizations were made.
Article
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Objective Workplace mental health is relevant to public safety organizations due to the exposure that many public safety personnel (PSP) have to psychological trauma in the course of their daily work. While the importance of attending to PSP mental health has been established, the implementation of workplace mental health interventions is not as well understood. This scoping review describes workplace mental health interventions and their implementation in public safety organizations. Methods English published primary studies with any publication date up to July 3, 2020 were considered. JBI methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews was followed. Results 89 citations met inclusion criteria out of the 62,299 found. Articles and reports found were largely published within the last decade, most frequently from Western nations, and most often applied to police, followed by firefighters. The focus of interventions was commonly stress management and resilience, and a frequent implementation strategy was multi-session group training. Comprehensive quality improvement initiatives, a focus on supervisors and managers, and interventions across primary, secondary, and tertiary prevention, were infrequent. Conclusion Public safety organizations are frequently reporting on stress management and resilience interventions for police and firefighters, implemented through multi-session group training. A focus across a range of PSP, including paramedics, corrections officers, and emergency dispatchers, using implementation strategies beyond group training, is suggested. This area of research is currently expanding, with many studies published within the past decade; ongoing evaluation of the quality of interventions and implementation strategies is recommended.
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Objectives: The purpose of this study is to provide basic data for the development of effective post-traumatic stress disorder (PTSD) intervention programs for firefighters.Methods: Four domestic and four abroad databases were used, and 7 domestic and 4 abroad studies that met the criteria of this study were selected for systematic review and meta-analysis.Results: The overall effect size of the PTSD intervention program was 0.40 (95% confidence interval, CI: 0.17-0.64, p<0.05) in domestic and 0.37 (95% CI: 0.02-0.71, p<0.05) in abroad.Conclusions: Various domestic and abroad intervention methods for PTSD of firefighters have low effects. Therefore, based on the results of this study, it is necessary to develop and apply a post-traumatic stress disorder intervention program for firefighters.
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Background: Prior to COVID-19 there had been a renewed policy focus in the National Health Service on the health and well-being of the healthcare workforce, with the ambulance sector identified as a priority area. This focus is more important than ever as the sector deals with the acute and longer-term consequences of a pandemic. Aim: To systematically identify, summarise and map the evidence regarding mental health, well-being and support interventions for United Kingdom ambulance services staff and to identify evidence gaps. Method: Evidence mapping methodology of published and grey original research published in English from 1 January 2000 to 23 May 2020 describing the health risk, mental health and/or well-being of UK ambulance services staff including retired staff, volunteers and students. MEDLINE, EMBASE, PsychINFO, CINAHL and AMED databases, plus EThOS, Zetoc, OpenGrey and Google, were searched, alongside hand-searching of grey literature and bibliographies. Information was extracted on study aims, sample, design and methodology, funding source, country and key findings. Included studies were categorised into seven a priori theme areas. Results: Of 1862 identified articles, 45 peer-reviewed studies are included as well as 24 grey literature documents. Peer-reviewed research was largely observational and focused on prevalence studies, post-traumatic stress disorder or organisational and individual social factors related to health and well-being. Most grey literature reported the development and testing of interventions. Across all study types, underpinning theory was often not cited. Conclusion: To date, intervention research has largely been funded by charities and published in the grey literature. Few studies were identified on self-harm, bullying, sleep and fatigue or alcohol and substance use. Theoretically informed intervention development and testing, including adaptation of innovations from other countries and 24-hour workforces, is needed. This evidence map provides important context for planning of staff well-being provision and research as the sector responds to and recovers from the pandemic. Prospero registration number: CRD42018104659.
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Purpose The purpose of this paper is to examine the role that psychological screening and surveillance can take in improving the delivery of psychological support to emergency service responders (ESRs) at a time of increasing demands and complexity. Design/methodology/approach The study aims to present and discuss the use of psychological screening and surveillance of trauma exposed emergency service workers. Findings The evidence supports the use of psychological screening and surveillance using appropriate validated questionnaires and surveys. Research limitations/implications The findings suggest that emergency services should be using psychological screening and surveillance of ESRs in roles where there is high exposure to traumatic stress. Originality/value These findings will help emergency service organisations to recognise how psychological screening and surveillance can be used as part of a wider programme of well-being support. This approach can also help them meet their legal health and safety obligations to protect the psychological health and well-being of their ESRs.
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Abstract Although single-session individual debriefing is contraindicated, the efficacy of group psychological debriefing remains unresolved. We conducted the first randomized controlled trial of critical incident stress debriefing (CISD) with emergency workers (67 volunteer fire-fighters) following shared exposure to an occupational potentially traumatic event (PTE). The goals of group CISD are to prevent post-traumatic stress and promote return to normal functioning following a PTE. To assess both goals we measured four outcomes, before and after the intervention: post-traumatic stress, psychological distress, quality of life, and alcohol use. Fire brigades were randomly assigned to one of three treatment conditions: (1) CISD, (2) Screening (i.e., no-treatment), or (3) stress management Education. Controlling for pre-intervention scores, CISD was associated with significantly less alcohol use post-intervention relative to Screening, and significantly greater post-intervention quality of life relative to Education. There were no significant effects on post-traumatic stress or psychological distress. Overall, CISD may benefit broader functioning following exposure to work-related PTEs. Future research should focus on individual, group, and organizational factors and processes that can promote recovery from operational stressors. Ultimately, an occupational health (rather than victim-based) approach will provide the best framework for understanding and combating potential threats to the health and well-being of workers at high risk for PTE exposure.
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Psychological Screening and Surveillance in the Workplace Noreen Tehrani Health surveillance and screening are a familiar part of an occupational health advisor’s role involving a systematic approach to the identification of early signs of work-related ill-health or injury. The Management of Health and Safety at Work (1999) legislation provides the framework with a specific reference to the need for surveillance “Every employer shall ensure that his employees are provided with such health surveillance as is appropriate having regard to the risks to their health and safety which are identified by the assessment.” Surveillance falls within the wider Risk Control and Management Cycle in which organisations are required to undertake key five activities: 1. Identify the risks in the workplace: What hazards exist and how could these hazards affect the health and wellbeing of employees? 2. Find out who might be harmed and how this might occur: Who might be exposed? Which groups are particularly vulnerable? How could they become exposed? Which roles or tasks are particularly hazardous? 3. Analyse and evaluate the level of risk: What is the likelihood of an injury occurring? What could be the magnitude of harm caused? How can the risk be measured? 4. Establish ways to reduce the risks: What are the control measures? Are they proportionate? How should they be implemented? Who would be responsible? 5. Record, monitor, review and improve: How is the surveillance programme working? How do we compare with other organisations? What can we do to improve? Whilst occupational surveillance shares some of the features and tools of clinical research it is not designed to generate or create new scientific knowledge but rather it uses existing knowledge and research to prevent disease or injury, enhance resilience and increase wellbeing in employees who may become exposed to an identified health hazard (Otto et al. 2014). A review of the risks inherent in organisations (European Agency for Safety and Health at Work, 2011) identified a number of hazards inherent in emergency services these included physical exposures including: musculoskeletal hazards, radioactive substances, chemical substances, biological substances; however in addition to these physical hazards the agency also identified psychological hazards including exposure to disasters, dealing with multiple deaths, body recovery, transport accidents, terrorism, fires, shootings and other threats to life. The HSE has also identified a number of psychosocial workplace hazards that are less extreme including bullying, harassment and workplace stress (Rick et al. 2001). This article is concerned with the need for OH providers to engage in undertaking surveillance in relationship to known psychosocial workplace hazards which have been shown to cause harm to workers. The surveillance of psychosocial hazards should be treated with the same importance and urgency as physical surveillance in order to support organisations to meet their duty of care to their workforce (ACAS, 2012).
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The following values have no corresponding Zotero field: ID - 47
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Employers are becoming increasingly aware of the risks to employee wellbeing associated with the traumatic incidents that occur in the workplace. Despite this increased organizational awareness of the need to protect employees from the damaging effects of traumatic events, there has been little provision to help organizations to evaluate their management systems and post trauma interventions. This problem of a lack of evaluation has become more important as a growing body of evidence has provided evidence that suggests that trauma debriefing, the widely used approach to traumatic stress may be ineffective or damaging. The problem for an organization is to have a means of assessing the impact of a traumatic incident on exposed employees soon after the event and at regular intervals as a way of tracking the effectiveness of the treatment and rehabilitation programme. This paper examines the development and validation of a traumatic stress questionnaire designed to be used by trained practitioners working with traumatized employees. The extended impact of events scale (IES-E), took the 15 items from the impact of events scale (IES) and added eight new items which had been chosen on the basis of existing theory and clinical experience to represent the traumatic stress symptom of hyperarousal. Two studies are reported which examine the structure and reliability, and then the discriminant validity of the extended scale when used with a working population. The first study involved a factor analysis of the IES-E items using data collected from 105 subjects who had formally reported exposure to stressful work events to their employing organization. The second study then used the IES-E to compare employees self-reporting of the impact of either a major positive or a major negative life event. The results of the first study confirmed the presence of the re-experience and avoidance symptoms as a response to a traumatic event (as in the IES) but, in addition, identified a new factor, arousal and a new measurement model based on a single general factor. The reliability coefficients for all three scales and the general factor were found to be good. The second study showed that IES-E scores on re-experience, avoidance, arousal and the general factor could be used to discriminate between the subjects reporting major positive and negative life events. Two measurement models can therefore describe the impact of stressful events, the first based on three orthogonal factors, and the second based on a single general factor. The theoretical implications of these findings are explored.
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We review recent evidence regarding risk factors for childhood posttraumatic stress disorder (PTSD) and treatment outcome studies from 2010 to 2012 including dissemination studies, early intervention studies and studies involving preschool children. Recent large-scale epidemiological surveys confirm that PTSD occurs in a minority of children and young people exposed to trauma. Detailed follow-up studies of trauma-exposed young people have investigated factors that distinguish those who develop a chronic PTSD from those who do not, with recent studies highlighting the importance of cognitive (thoughts, beliefs and memories) and social factors. Such findings are informative in developing treatments for young people with PTSD. Recent randomized controlled trials (RCTs) confirm that trauma-focused cognitive behaviour therapy (TF-CBT) is a highly efficacious treatment for PTSD, although questions remain about effective treatment components. A small number of dissemination studies indicate that TF-CBT can be effective when delivered in school and community settings. One recent RCT shows that TF-CBT is feasible and highly beneficial for very young preschool children. Studies of early intervention show mixed findings. Various forms of theory-based TF-CBT are highly effective in the treatment of children and adolescents with PTSD. Further work is needed to replicate and extend initial promising outcomes of TF-CBT for very young children. Dissemination studies and early intervention studies show mixed findings and further work is needed.
Article
Recent research efforts in emergency medical services (EMS) has identified variability in the ability of EMS personnel to recognize their level of stress-related impairment. Developing a better understanding of how workplace stress may affect EMS personnel is a key step in the process of increasing awareness of the impact of work-related stress and stress-related impairment. This paper demonstrates that for those in EMS, exposure to several types of workplace stressors is linked to stress reactions. Stress reactions such as posttraumatic stress symptomatology (PTSS) have the potential to negatively influence the health of EMS providers. This research demonstrates that two different types of work-related stress and alcohol use influence the development of PTSS. A probability sample of nationally registered emergency medical technician (EMT)-Basics and EMT-Paramedics (n = 1,633) completed an Internet-based survey. Respondents reported their levels of operational and organizational types of chronic stress, critical incident stress, alcohol use, and PTSS. Ordinary least squares regression illustrated that when demographic factors were controlled, organizational and operational forms of chronic stress, critical incident stress, and alcohol use were all significant predictors of PTSS (p < 0.01). Inclusion of an interaction effect between operational stress and critical incident stress (p < 0.01) as well as between operational stress and alcohol use (p < 0.01) created a robust final model with an R(2) of 0.343. These findings indicate that exposure to both chronic and critical incident stressors increases the risk of EMS providers' developing a posttraumatic stress reaction. Higher levels of chronic stress, critical incident stress, and alcohol use significantly related to an increased level of PTSS. Further, for those reporting high levels of alcohol use or critical incident stress, interactions with high levels of chronic operational stress were associated with higher rates of PTSS. For those interested in the impact of work-related stress in EMS, these findings indicate that attention must be paid to levels of stress associated with both critical incident exposure as well as the chronic stress providers experience on a day-to-day basis.
Article
To examine the relationships between exposure to the air disaster in Amsterdam and multiple physical symptoms among firefighters and police officers, and to explore the role of post-traumatic stress symptoms (PTSS) herein. Historic cohort study. On average 8.5 years post-disaster, exposed professional firefighters (N=334) and police officers (N=834) and their nonexposed colleagues (N=194 and N=634, respectively) completed questionnaires on disaster exposure and current symptoms. Logistic regression with adjustment for background characteristics was used to compare exposed and nonexposed workers. PTSS were added to these models, as was the interaction between exposure and PTSS, to explore potential mediating and modifying effects, respectively. Exposed workers reported multiple physical symptoms significantly more often. Multiple physical symptoms seemed to have particularly affected the exposed firefighters who rescued people, and the exposed police officers who supported injured victims and workers, who were involved in the identification of or search for victims and human remains, who witnessed the immediate disaster scene or had a close one affected by the disaster. These exposure effects were essentially independent of PTSS, and no significant interactions between exposure and PTSS were found. In conclusion, the excess in post-disaster multiple physical symptoms in exposed workers could not be attributed to PTSS.
A resilience building toolbox
  • N Tehrani
Tehrani N. A resilience building toolbox. In: Tehrani N, ed. Managing Trauma in the Workplace: Supporting Workers and Organisations. London: Routledge, 2011; 251-266.
Research or practice?
  • J L Otto
  • M Holodnly
  • R F Defraites
Otto JL, Holodnly M, DeFraites RF. Research or practice? Am J Pub Health 2014;104:596-602.
Rehabilitation: maintaining a healthy workforce.
  • Tehrani
Rehabilitation: maintaining a healthy workforce
  • N Tehrani
  • B Macintyre
  • S Maddock
  • R Shaw
  • R Illingworth
Tehrani N, MacIntyre B, Maddock S, Shaw R, Illingworth R. Rehabilitation: maintaining a healthy workforce. In: Scott M, Jonathan H, eds. Health Psychology-European Perspectives on Research, Education and Practice. Vol. 7. Castelo da Maia: SerSilito-Maia ISMAI, 2007; 143-168.
Guidelines for Standards of Ethical Approval in Psychological Research
British Psychological Society. Guidelines for Standards of Ethical Approval in Psychological Research. Leicester, UK: British Psychological Society, 2004.
Teaching Recovery Techniques
  • War Children
  • Foundation
Children and War Foundation. Teaching Recovery Techniques. http://www.childrenandwar.org/resources/teaching-recoverytechniques-trt/ (3 February 2019, date last accessed).
Management of Health and Safety at Work Regulations 1999, Approved Code of Practice and Guidance
  • Safety Health
  • Executive
Health and Safety Executive (HSE). Management of Health and Safety at Work Regulations 1999, Approved Code of Practice and Guidance, L21. 2nd ed. Sudbury, UK: HSE Books, 2000.
The Improving Access to Psychological Therapies Manual
National Collaborating Center for Mental Health. The Improving Access to Psychological Therapies Manual. National Health Service, 2019; 65. https://www.england.nhs. uk/wp-content/uploads/2019/02/improving-access-topsychological-therapies-manual.pdf (25 May 2019, date last accessed).
The International Trauma Questionnaire: development of a self-report measure of ICD-11 PTSD and complex PTSD
  • M Cloitre
  • M Shevlin
  • CR Brewin