Treatment Development Report of an Intensive Group Treatment for Posttraumatic Stress, Insomnia, and Nightmares Adapted to Firefighter Culture

Insomnia, nightmares, and posttraumatic stress disorder (PTSD) are prevalent co-occurring problems among fire service members and associated with significant distress and dysfunction. This report describes an accelerated treatment program targeting symptoms of PTSD, insomnia, and nightmares by combining Written Exposure Therapy (WET) for PTSD, Cognitive Behavioral Therapy for Insomnia (CBTi), and Cognitive Behavioral Therapy for Nightmares (CBTn) and the iterative procedures used to develop the intervention.In Phase 1, we developed a treatment program outline and solicited feedback from stakeholders (firefighters, fire service leaders, and behavioral health specialists; N = 45). After integrating feedback, we conducted open pilot testing of the treatment protocol with two groups of fire service members with PTSD symptoms, insomnia, and nightmares (N = 5).The intervention includes an individual virtual preparatory session, a group workshop conducted over 4 consecutive days, and an individual virtual booster session. Open pilot evaluation suggests that participants experienced reductions in PTSD symptoms, insomnia, and nightmares, and were satisfied with the treatment program.WET, CBTi, and CBTn are compatible interventions that can be integrated into an accelerated group treatment format. Initial evaluation supports the feasibility and helpfulness of this model with firefighters. Additional controlled evaluation of the program is warranted.