Early-career paramedics who completed an online cognitive resilience training program were significantly less likely to develop posttraumatic stress disorder or major depressive disorder over the following year than peers receiving psychoeducation or standard training alone, in a large randomized clinical trial. The study was led by Jennifer Wild, DClinPsy, of the University of Oxford, and colleagues.
The study enrolled 570 student paramedics across 15 universities in England and evaluated whether a targeted, internet-delivered cognitive training intervention could prevent common psychiatric disorders associated with early paramedic work. Participants were randomized to one of three groups: internet-delivered cognitive training in resilience, online psychoeducation, or standard practice.
At 12 months, participants assigned to internet-delivered cognitive training in resilience (iCT-R) were approximately 5 times less likely to meet diagnostic criteria for posttraumatic stress disorder (PTSD) or major depressive disorder (MDD) than those receiving psychoeducation – and 4 times less likely than those receiving standard practice. The number needed to treat ranged from 18 to 24 trainees to prevent one case of PTSD or MDD.
Unlike traditional resilience or psychoeducation programs, iCT-R was designed to target modifiable cognitive risk factors identified in prior prospective studies of paramedics, including rumination and maladaptive resilience appraisals. The six-module program incorporated cognitive therapy tools delivered through interactive exercises, with brief email support and automated reminders. Both online programs were delivered over 6 weeks, with follow-up practice prompts for 6 months.
By contrast, the psychoeducation intervention did not significantly reduce rates of PTSD or MDD compared with standard practice. This aligns with earlier evidence suggesting that information-based approaches alone offer limited protection against trauma-related psychopathology.
Secondary outcomes showed that iCT-R participants also had lower symptom severity for PTSD and depression at follow-up, although mediation analyses did not confirm that symptom reductions were directly driven by changes in measured rumination or resilience scores. The authors note that floor effects and the nonclinical baseline status of participants may have limited sensitivity to detect mediating mechanisms.
In their discussion, the authors note that paramedic training and early service are associated with substantial psychological burden, and that few effective pre-incident interventions currently exist for first responders. They also argue that targeting disorder-specific cognitive processes – rather than providing general stress education – may be key to preventing mental health disorders in high-risk occupational groups.
While the study was conducted in student paramedics in the UK, the authors suggest that scalable, low-intensity digital interventions like iCT-R could be adapted for other emergency and frontline professions. Ongoing analyses will assess whether the protective effects persist at 2 years and whether similar approaches benefit other first-responder populations.
Source: JAMA Network Open
