ORIGINAL RESEARCH article
Front. Health Serv.
Sec. Mental Health Services
Volume 5 - 2025 | doi: 10.3389/frhs.2025.1452976
This article is part of the Research TopicMental Health Services for Occupational Trauma: Decreasing Stigma and Increasing Access, Volume 2View all 7 articles
Pilot outcomes and exploration of treatment mechanisms using a culturally adapted version of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders to improve mental health symptoms, alcohol misuse, functional outcomes, and sleep quality in emergency responders
Provisionally accepted
- 1University of Pittsburgh, Pittsburgh, United States
- 2Carlow University, Pittsburgh, Pennsylvania, United States
- 3Baylor Scott & White Research Institute (BSWRI), Dallas, Texas, United States
- 4University of Arizona, Tucson, Arizona, United States
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Emergency responders encounter frequent trauma and myriad occupational hazards, contributing to concerning rates of posttraumatic stress disorder (PTSD) and related mental health symptoms. These symptoms are each strongly linked with neuroticism/negative emotionality/neuroticism (NNE). Thus, an emotion-focused, transdiagnostic, skills-based treatment approach seems to be a strong match for this population. We sought to address barriers to mental health treatment for emergency responders, including stigma, logistical barriers, and lack of provider knowledge regarding emergency response culture by delivering treatment via telehealth by providers trained in emergency response culture. In an uncontrolled pilot trial, we delivered the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders to 30 emergency medical service, police, and fire service personnel, of whom 80.0% completed treatment. Working Alliance Inventory scores were high. Large improvements occurred at post-treatment and one-month follow-up in PTSD symptom severity (Hedges' g = 1.1 at post-treatment; g = 1.3 at follow-up), depression (g = 1.3; 1.3), anxiety (g = 1.1; 1.0), functional impairment (g = 1.2; 1.1), and quality of life (g = .89; .81). Small-to-medium sized improvements occurred in sleep quality (g = .42; .69) and engagement in values-consistent behavior (g = .34; .77). There were large, theory-consistent improvements during treatment in NNE (g = 1.1), difficulties in emotion regulation (g = .94), and experiential avoidance (g = 1.1), and large associations between changes in these mechanistic variables and improved treatment outcomes. We summarize our cultural adaptation process aimed at maximizing fit of the UP with emergency responders.
Keywords: paramedic, Fire fighter, Police, First responder, Trauma, Quality of Life, functional impairment, alcohol
Received: 21 Jun 2024; Accepted: 28 May 2025.
Copyright: © 2025 Meyer, Roth, Coe, Taylor and Gulliver. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Eric Meyer, University of Pittsburgh, Pittsburgh, United States
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