Cognitive Resilience Training Reduces MDD and PTSD Risk in Paramedic Recruits
Key Clinical Summary
- Internet-delivered cognitive resilience training (iCT-R) significantly lowered PTSD and major depressive disorder (MDD) diagnoses at 12-month follow-up in paramedic trainees compared with psychoeducation and standard practice.
- Randomized trial of 570 recruits showed ~80% reduced odds of meeting PTSD/MDD criteria with resilience training.
- Number needed to treat (NNT) ~18–24 to prevent 1 PTSD/MDD case over 1 year.
A multicenter randomized clinical trial published in JAMA Network Open evaluated whether internet-delivered cognitive resilience training (iCT-R) could prevent posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) among early career paramedic recruits in England.
The study found that, compared to online psychoeducation and standard training practice, iCT-R significantly lowered PTSD and MDD diagnoses at 1-year follow-up.
Study Findings
The trial enrolled 570 student paramedics across 15 UK universities between October 2017 and October 2022, with follow-up through 12 months. Participants (mean age 23.7 years; 65.3% female) were randomized to 1 of 3 arms: internet-delivered cognitive resilience training (n = 195), internet-delivered psychoeducation (n = 197), or standard practice (n = 178). iCT-R consisted of 6 weekly online modules targeting modifiable cognitive risk factors identified in paramedics, such as rumination and maladaptive resilience beliefs, plus 6 monthly top-up emails. Psychoeducation offered 6 weekly online sessions on general mental health topics with identical booster emails. Standard practice involved usual university training and support services without added online intervention.
At 1-year follow-up, iCT-R participants had significantly lower odds of meeting diagnostic criteria for PTSD or MDD compared with both psychoeducation (odds ratio [OR], 0.20; 95% CI, 0.05-0.73) and standard practice (OR, 0.25; 95% CI, 0.07-0.97). The effect represented roughly an 80% reduction in odds versus psychoeducation and 75% reduction versus standard care. Secondary symptom measures—such as clinician-rated PTSD and depression scales—also showed greater improvements in the iCT-R group at later follow-ups. Providing iCT-R to 18 to 24 paramedic trainees would prevent one case of PTSD or MDD over 12 months (NNT).
Clinical Implications
Paramedics are routinely exposed to traumatic stressors, irregular schedules, and high-pressure decision making, contributing to elevated risks for PTSD and major depressive disorder compared with the general population. Traditional pre-trauma psychoeducation has shown limited effectiveness in preventing psychiatric disorders, particularly when it fails to target cognitive processes that predispose individuals to psychopathology. The iCT-R program’s focus on modifiable predictors—such as rumination and resilience appraisals—offers a proactive, scalable strategy to reduce disorder incidence in a high-risk occupational group.
Delivering CBT-informed resilience training online has practical advantages, including broad reach across training institutions and flexibility for trainees. If adopted more widely in paramedic education, iCT-R could support mental health preparedness and potentially reduce future healthcare burden associated with chronic PTSD or MDD among first responders. However, the majority of participants were White, limiting broad generalizability; future research should include more diverse cohorts and evaluate longer-term outcomes beyond 12 months.
Expert Commentary
“Unlike psychoeducation-focused approaches, iCT-R offered an active, experiential intervention, teaching evidence-based tools through interactive exercises and videos,” said Jennifer Wild, DClinPsy, Department of Experimental Psychology, University of Oxford, and co-authors in the study discussion. “Participants had opportunities to apply and test strategies across modules, with the goal of targeting modifiable risk factors for PTSD and depression.”
Conclusion
Internet-delivered cognitive resilience training substantially reduced the likelihood of PTSD and MDD diagnoses at 12 months among UK paramedic recruits compared with psychoeducation and standard practice. These findings support integrating targeted resilience training into paramedic education to enhance mental health outcomes and occupational readiness.
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