The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders Delivered to Firefighters via Videoconferencing: Pilot Outcomes Highlighting Improvements in Alcohol Use Disorder and Posttraumatic Stress Disorder Symptoms

Firefighters protect the public despite significant risk to their health and well-being stemming from frequent trauma exposure and other occupational stressors. A minority of firefighters develop posttraumatic stress disorder (PTSD), alcohol use disorder (AUD), or related mental health problems, such as depression or anxiety. These problems frequently co-occur and are linked with high neuroticism and difficulties with emotion regulation. Thus, efficient treatment for this population should be transdiagnostic and target neuroticism. Moreover, logistical challenges and stigma represent barriers to care in firefighters. We addressed these challenges by culturally adapting the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders and delivering it to 61 firefighters via videoconferencing, of whom 49 completed treatment. The adaptation process is described, and two case vignettes are presented. In the total sample, large effect size improvements were observed in symptoms of PTSD, depression, and psychological aspects of quality of life at posttreatment and 1-month follow-up. For anxiety, improvements were medium at posttreatment and large at follow-up. Medium effects were observed on reductions in AUD symptoms and in the other aspects of quality of life (physical health, social relationships, and environmental) at posttreatment and follow-up. Reductions in suicide risk were small in the total sample and moderate among those who screened positive for being at suicide risk at pretreatment. Similarly promising results were observed in the subsamples of participants who screened positive for PTSD, AUD, and co-occurring PTSD–AUD at pretreatment, with large improvements in AUD symptoms observed in those who screened positive for AUD at pretreatment. This is the first study to report on the unified protocol delivered via telehealth. The treatment completion rate was high (80.3%). The current study contributes to the emerging literature on the unified protocol for PTSD and AUD. The current findings support the utility of this treatment for PTSD and AUD, consistent with the underlying approach of targeting neuroticism across diagnostic categories.

Duke Scholars

Author Nathan Andrew Kimbrel Psychiatry & Behavioral Sciences, Behavioral Medicine & Neur ...