Emotional Resilience Training for PTSD

Overseen by Nicholas Carleton

Age: 18 - 65

Sex: Any

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Academic

Recruiting

Sponsor: University of Regina

Disqualifiers: Non-cadets

No Placebo Group

Trial Summary

What is the purpose of this trial?

This trial aims to improve the mental health of RCMP cadets by providing enhanced training that includes skills to manage stress and trauma. The goal is to reduce posttraumatic stress injuries among cadets.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

What data supports the effectiveness of the treatment Emotional Resilience Skills Training (ERST) for PTSD?

The research highlights that treatments like Cognitive Processing Therapy (CPT), which focus on cognitive emotional processing, can reduce dropout rates in PTSD therapy. This suggests that components of Emotional Resilience Skills Training (ERST) that enhance emotional processing may also improve treatment engagement and effectiveness. ^{1 2 3 4 5}

How does Emotional Resilience Training for PTSD differ from other treatments?

Emotional Resilience Training for PTSD is unique because it focuses on building emotional resilience through multimodal biopsychosocial training, incorporating techniques like mindfulness and stress management, which are not typically emphasized in standard PTSD treatments. This approach aims to preemptively reduce stress responses and improve self-management of emotional stress, making it particularly suitable for military personnel and their families. ^{3 6 7 8 9}

Research Team

Nicholas Carleton

Principal Investigator

University of Regina

Eligibility Criteria

This trial is specifically for cadets beginning the RCMP Cadet Training Program. It aims to study mental health risk and resilience factors related to traumatic stress. Only these cadets can participate, excluding anyone else not starting this program.

Inclusion Criteria

Cadets starting the RCMP Cadet Training Program

Exclusion Criteria

Anyone other than cadets starting the RCMP Cadet Training Program

Trial Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Pre-training

Participants undergo pre-training assessments to establish baseline mental health metrics

1 week

1 visit (in-person)

Training

Participants receive either the Standard Training Condition (STC) or the Augmented Training Condition (ATC) over a 26-week period

26 weeks

Weekly assessments (virtual)

Post-training

Participants are assessed for changes in mental health symptoms following the training period

1 week

1 visit (in-person)

Follow-up

Participants are monitored annually for 5 years to assess long-term mental health outcomes

5 years

Annual assessments (in-person and virtual)

Treatment Details

Interventions

• Active Monitoring (Behavioral Intervention)
• Emotional Resilience Skills Training (ERST) (Behavioral Intervention)

Trial Overview The trial tests Emotional Resilience Skills Training (ERST) against Active Monitoring in new RCMP cadets. They'll be assessed before and after training, then annually for five years, plus with monthly and daily surveys to measure mental health outcomes.

Participant Groups

Group I: Augmented Training Condition (ATC) Experimental Treatment 1 Intervention

The Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders (UP) is an evidence-based cognitive-behavioral intervention designed to cultivate constructive approach-oriented emotional engagement. The 13-week Emotional Resilience Training (ERST) is an adaptation of the UP designed for use as a proactive training course. The ERST frames emotional experiences as natural responses to threat, rather than pathological occurrences to avoid; as such, the ERST is well-suited for mitigating health challenges and the skills may also help PSP to support persons in distress, including other PSP and the community members they all serve. The ERST training materials include an instructor guide, didactic PowerPoints, and a trainee workbook. The ERST was designed for seamless integration with the Cadet Training Program, effective June 2022, which is what creates the augmented training arm (i.e., the ATC).

Group II: Standard Training Condition (STC) Active Control 1 Intervention

The STC has received the "standard" RCMP Depot Division ("Depot") Cadet Training Program as has been provided to cadets prior to June 2022. The STC and the ATC will complete the same standardized self-report assessments, clinical interview assessments, and biometric assessments, and receive the same feedback and reporting based on those assessments.

Who Is Running the Clinical Trial?

University of Regina

Lead Sponsor

Trials

59

Recruited

9,100+

Dr. Jeff Keshen

University of Regina

Chief Executive Officer since 2021

PhD in Political Science from the University of Toronto

Dr. Cathy Rocke

University of Regina

Chief Medical Officer since 2020

PhD in Social Work from the University of Manitoba

Royal Canadian Mounted Police

Collaborator

Trials

1

Recruited

960+

Government of Canada

Collaborator

Trials

13

Recruited

2,400+

Ministry of Public Safety and Emergency Preparedness

Collaborator

Trials

1

Recruited

960+

Canadian Institute for Public Safety Research and Treatment

Collaborator

Trials

3

Recruited

2,100+

Findings from Research

In a study of 51 adults with PTSD undergoing cognitive processing therapy (CPT), dropout rates were significantly higher in CPT (39.7%) compared to written exposure therapy (WET) (6.4%), indicating a need for improved engagement strategies in CPT.

Analysis of trauma narratives revealed that more negative emotions and ruminative processing were associated with lower dropout rates, while overgeneralized beliefs increased dropout risk, suggesting that monitoring these narrative elements could help clinicians identify at-risk patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Predictors of Dropout in Cognitive Processing Therapy for PTSD: An Examination of Trauma Narrative Content. Alpert, E., Hayes, AM., Barnes, JB., et al.[2021]

Prolonged Exposure and Cognitive Processing Therapy are recognized as gold-standard treatments for PTSD, showing positive outcomes in randomized controlled trials (RCTs) with reasonable patient retention.

However, real-world studies reveal a significant dropout rate among patients undergoing these therapies, highlighting the need for further research on retention strategies to ensure effective treatment delivery outside of controlled environments.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The problem of dropout from "gold standard" PTSD therapies. Najavits, LM.[2020]

In a study of 53 adults with PTSD undergoing cognitive processing therapy (CPT), dropout rates were significantly higher (39.7%) compared to written exposure therapy (6.4%), indicating a need to address factors influencing treatment retention.

The research identified that higher levels of physiological distress and cognitive emotional processing were associated with lower dropout rates, while avoidance behaviors predicted higher dropout, suggesting that targeting these factors early in treatment could improve engagement and outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Predictors of dropout in cognitive processing therapy for PTSD: An examination of in-session treatment processes. Shayani, DR., Canale, CA., Sloan, DM., et al.[2023]

Multimodal biopsychosocial training programs, which include techniques like mindfulness and cognitive behavioral stress management, can effectively reduce stress-related symptoms in combat-exposed troops and their families.

The systematic review highlights the feasibility of implementing these self-management techniques within military training cycles, suggesting they can help preempt or lessen posttraumatic stress responses.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A systematic review of biopsychosocial training programs for the self-management of emotional stress: potential applications for the military. Crawford, C., Wallerstedt, DB., Khorsan, R., et al.[2021]

The pilot-tested resilience skills training program for pediatric residents resulted in 76% of participants rating the skills as important and 60% expressing satisfaction with the training.

Post-training, 82% of residents reported a change in their response to patient-related grief and trauma, indicating increased awareness of stress signs and improved coping strategies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Adaptation and Evaluation of Military Resilience Skills Training for Pediatric Residents. Bursch, B., Lloyd, J., Mogil, C., et al.[2022]

A study involving 58 women with PTSD from childhood abuse showed that a two-phase cognitive-behavioral treatment significantly improved their emotional regulation, interpersonal skills, and PTSD symptoms compared to a waitlist group.

The success of the treatment was linked to the strength of the therapeutic alliance and the development of negative mood regulation skills during the initial phase, highlighting the importance of these factors before engaging in exposure therapy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Skills training in affective and interpersonal regulation followed by exposure: a phase-based treatment for PTSD related to childhood abuse. Cloitre, M., Koenen, KC., Cohen, LR., et al.[2022]

References

1. England pubmed.ncbi.nlm.nih.gov

Predictors of Dropout in Cognitive Processing Therapy for PTSD: An Examination of Trauma Narrative Content. [2021]

2. England pubmed.ncbi.nlm.nih.gov

The problem of dropout from "gold standard" PTSD therapies. [2020]

3. England pubmed.ncbi.nlm.nih.gov

Predictors of dropout in cognitive processing therapy for PTSD: An examination of in-session treatment processes. [2023]

4. United States pubmed.ncbi.nlm.nih.gov

Changes in implementation of two evidence-based psychotherapies for PTSD in VA residential treatment programs: a national investigation. [2022]

5. England pubmed.ncbi.nlm.nih.gov

Predictors of attendance and dropout in three randomized controlled trials of PTSD treatment for active duty service members. [2020]

6. United States pubmed.ncbi.nlm.nih.gov

A systematic review of biopsychosocial training programs for the self-management of emotional stress: potential applications for the military. [2021]

7. United States pubmed.ncbi.nlm.nih.gov

Adaptation and Evaluation of Military Resilience Skills Training for Pediatric Residents. [2022]

8. United States pubmed.ncbi.nlm.nih.gov

Telemental Health Delivery of Skills Training in Affective and Interpersonal Regulation (STAIR) for Rural Women Veterans Who Have Experienced Military Sexual Trauma. [2019]

9. United States pubmed.ncbi.nlm.nih.gov

Skills training in affective and interpersonal regulation followed by exposure: a phase-based treatment for PTSD related to childhood abuse. [2022]