Abstract

Emergency medical service clinicians face significant mental health risk. This randomized controlled pilot trial examined (a) feasibility, acceptability, and adoptability of Self-Reflection Resilience-Recovery Activity Promotion Training (SRR-RAPT); (b) SRR-RAPT’s effect on hypothesized mechanisms of action (HMAs: meaning made from stressors, adaptive self-reflection, recovery activities, recovery experiences); and (c) SRR-RAPT’s impact on mental health outcomes (MHOs: posttraumatic stress disorder, anxiety, depression symptoms). Participants were ≥18 years with ≥1 shift scheduled within 8 days.

Overall, 83/126 workers were eligible and randomized to intervention (n = 37) or control (n = 46). Most were White (89%) and male (51%). Both groups completed eight daily assessments monitoring HMAs/MHOs. Intervention participants received 10 additional reflection questions on stressors, lessons learned, and recovery strategies. We recruited >80% of respondents within 3 weeks; 70/83 submitted ≥1 complete assessment (M = 6.07, SD = 2.20); SRR-RAPT was rated helpful, useful, and acceptable.

The intervention group reported more meaning made across assessments (b = 1.46, 95% CI [0.17, 2.75], p = .027) and higher levels on each subsequent assessment (b = 0.35, 95% CI [0.16, 0.53], p < .001). Higher adherence predicted more meaning made across assessments (b = 1.53, 95% CI [0.03, 1.02], p = .039) and higher levels on each subsequent assessment (b = 0.13, 95% CI [0.06, 0.20], p < .001). No significant differences were detected on other HMAs or MHOs.

Results support the intervention’s feasibility and acceptability, but refinement is necessary to detect expected differences on all HMAs/MHOs before definitive trials.