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Table 4 Interventions for rehabilitation studies

From: Interventions for the prevention and management of occupational stress injury in first responders: a rapid overview of reviews

Intervention coding Intervention name Intervention duration/frequency Intervention description Study author (year) Study design Population
Drug therapy Carbemazepine and sodium valproate 500 mg 2× daily (sodium valproate) The patient first received carbemazepine added to the other medications, then withdrew due to side effects. The patient was re-admitted to the hospital and sodium valproate was commenced. After the symptoms improved, the patient was discharged and followed up as an outpatient. Ford, N (1996) [55] Case report Police
Prazosin 1 mg once/day for 1 week, then increase by 1 mg every 3-4 days thereafter, to up to 6 mg after 4 weeks Prazosin administered to the patient with increasing dosages. Coupland, NJ (2009) [56] Case report Firefighters
Psychotherapy Brief eclectic psychotherapy (BEP) 60-min sessions once/week for 16 weeks Combines cognitive-behavioral and psychodynamic approaches (including 5 essential elements: psycho-education, imaginary guidance, writing assignments and mementos, domain of meaning or integration, and a farewell ritual) over sessions of individual psychotherapy. Gersons, BPR (2000) [57] RCT Police
Brief eclectic psychotherapy (BEP) 16 weekly sessions Combines cognitive-behavioral and psychodynamic approaches (including 5 essential elements: psycho-education, imaginary guidance, writing assignments and mementos, domain of meaning or integration, and a farewell ritual) over sessions of individual psychotherapy. Plat, MCJ (2013) [58] Observational Police
Brief psychological intervention 1.5-h session A group intervention was given within 24 h after a critical incident. Briefly, participants described what they had done, expressed what they felt at the time of the incident, and talked about any symptoms. The therapist explained typical reactions and the normality of feeling anger, guilt, and having nightmares. Participants related past experience to the current incident. The therapist then summed up what the participants had expressed. Bohl, N (1991) [59] NRCT Police
Brief psychological intervention 1.5-h session A group intervention was given within 24 h after a critical incident. Briefly, participants described what they had done, expressed what they felt at the time of the incident, and talked about any symptoms. The therapist explained typical reactions and the normality of feeling anger, guilt, and having nightmares. Participants related past experience to the current incident. The therapist then summed up what the participants had expressed. Bohl, N (1995) [60] NRCT Firefighters
Cognitive-behavioral treatment 60-min sessions × 15 over 7 months The treatment included building rapport, development of alternate and adaptive mechanisms for coping, progressive muscle relaxation, introducing of assimilation and rational thinking as coping mechanisms, gradual exposure to the traumatic events with discussions of trauma, as well as relapse prevention and review of progress. Cornelius, TL (2007) [61] Case report Police
Individual wellness counseling sessions 60 min every other week × 5 (cognitive-behavioral personalized wellness counseling) 5 sessions every other week over 10 weeks (individual counseling) Cognitive-behavioral counseling personalized wellness sessions every other week. Referral to mental health services as required. Tanigoshi, H (2008) [62] RCT Police
Critical incident stress debriefing NR A peer counseling group procedure with psychoeducational components that provide information on various stress reactions following exposure to a critical incident. The strategy in this group meeting is to begin with materials that the participants are comfortable in discussing, leading to more emotionally intense exchanges, and concluding with a psychoeducational component intended to bring closure to the group. Strategy uses 7 stages: (a) introduction, (b) fact, (c) thought, (d) reaction, (e) symptoms, (f) teaching, and (g) reentry. Harris, MB (2002) [63] Observational/cohort Firefighters
Critical incident stress debriefing (CISD) Within 72-hr after a critical incident A peer counseling group procedure with psychoeducational components that provide information on various stress reactions following exposure to a critical incident. The strategy in this group meeting is to begin with materials that the participants are comfortable in discussing, leading to more emotionally intense exchanges, and concluding with a psychoeducational component intended to bring closure to the group. Strategy uses 7 stages: (a) introduction, (b) fact, (c) thought, (d) reaction, (e) symptoms, (f) teaching, and (g) reentry. Leonard, R (1999) [64] Observational Police
Critical incident debriefs NR Group-based debriefing sessions. Ruck, S (2013) [65] NRCT Correctional
Critical incident stress debriefing (CISD) ~ 90 min, within 72-h after a critical incident A peer counseling group procedure with psychoeducational components that provide information on various stress reactions following exposure to a critical incident. The strategy in this group meeting is to begin with materials that the participants are comfortable in discussing, leading to more emotionally intense exchanges, and concluding with a psychoeducational component intended to bring closure to the group. Strategy uses 7 stages: (a) introduction, (b) fact, (c) thought, (d) reaction, (e) symptoms, (f) teaching, and (g) reentry. Tuckey, MR (2014) [66] RCT Firefighters
Individual debriefing 3 sessions in total at 24-h, 1 month, 3 months The debriefer applies a seven-stage, semi-structured procedure, comprising of: an introduction, facts, thoughts and impressions, emotional reactions, normalization and traumatic stress education, planning for the future, and disengagement. Carlier, IVE (2000) [67] NRCT Police
Eclectic group counseling 1.5–2-h sessions once/week for 3 months Counseling included the interactive model of cognitive-behavioral therapy, religious interventions, mandala drawing, and reality therapy. Chongruksa, D (2012) [68] RCT Police
Crisis debriefing groups 1 single session A single session for relieving the distress of emergency service workers encountering traumatic events in the line of duty. Regehr, C (2001) [69] Observational Firefighters
Exposure-based therapy and cognitive restructuring NR Psychotherapy (i.e., exposure-based therapy and cognitive restructuring, or ETCR) for police officers with partial post-traumatic stress disorder (pPTSD). Peres, JFP (2011) [70] NRCT Police
Trauma risk management (TRiM) NR Peer support intervention using trained, non-medical personnel to conduct a psychological risk assessment for those exposed to potentially traumatic events. TRiM interviews can be delivered to individuals (a 1:1 intervention) or within small groups; the police service currently uses mostly 1:1 interventions. Hunt, E (2013) [71] Cohort study Police
Trauma risk management (TRiM) NR NR Watson (2014) [72]* NR NR
Other therapies Exposure therapy 90-min weekly sessions × 5 Therapy sessions involving imaginal exposure (e.g., deliberately recounting the trauma) and in vivo exposure (e.g., exposure to stimuli that remind the patient of past trauma). Tolin, DF (1999) [73] Case report Police
Eye movement desensitization and reprocessing (EMDR) 5–6 sessions Psychological treatment for post-traumatic stress disorder (PTSD). Kitchiner, NJ (2004) [74] Case report Firefighters
Eye movement desensitization and reprocessing (EMDR) 2–3-h sessions conducted 3–4 weeks apart Psychological treatment for PTSD. Subjects were taught coping and “containment” techniques, how to identify and develop support networks, and how to log their trauma-related memories—a necessary precondition for eye movement desensitization and reprocessing (EMDR). The first (pre-EMDR) brain SPECT scans were collected before EMDR took place. This procedure gave bilateral stimulation in the subjects’ palms and fingers, thus allowing them to re-experience traumatic scenes. This was followed by a “reconciliation phase” of treatment, focusing on the re-scripting of relational patterns that might not have been corrected once subjects became detraumatized. Lansing, K (2005) [75] Observational Police
Eye movement desensitization and reprocessing (EMDR) 2-h EMDR sessions × 3 Psychological treatment for PTSD. The EMDR sessions took place off-site at the office of the therapist assigned to the officer. The stressors identified in the clinical interview served as the focus of the EMDR sessions. Wilson, SA (2001) [76] RCT Police
Writing intervention 15-min writing once/day for 4 consecutive shifts Emotional disclosure in writing as a coping method for police officers; they received instructions to write about their strong emotions, positive or negative, related to work or not, and about what they plan to do, if anything, as a result of the emotions. Ireland, M (2007) [77] RCT Police
  1. BEP brief eclectic psychotherapy, CISD critical incident stress debriefing, EMDR eye movement desensitization and reprocessing, PTSD post-traumatic stress disorder, NR not reported, NRCT non-randomized controlled trial, RCT randomized controlled trial, TRiM trauma risk management
  2. *Watson (2014) was an unpublished thesis; information was extracted from the review only