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OBJECTIVES: Firefighters are regularly exposed to potentially traumatic and injurious events and are at increased risk for developing posttraumatic stress disorder (PTSD) symptoms, pain, and pain-related disability. Mindfulness (i.e., present-oriented awareness and nonjudgmental acceptance of cognitions and bodily sensations) may influence PTSD-pain relations in firefighter populations and inform mutual maintenance models. The current cross-sectional study sought to examine the moderating role of mindfulness on the associations between PTSD symptom severity and pain-related disability and intensity among trauma-exposed firefighters. METHODS: Firefighters (N = 266; M(age) = 40.48, SD = 9.70; 92.5% male) were recruited from a large, southwestern metropolitan area and voluntarily completed an online, self-report survey advertised throughout the fire department. RESULTS: Accounting for covariates (i.e., age, years in the fire service, trauma load), a significant interactive effect of PTSD symptom severity and mindfulness on pain-related disability (ΔR(2) = 0.05, B = − 0.16, p < .001), but not pain intensity, emerged. Simple slope analyses revealed that PTSD symptom severity was associated with pain-related disability for those with low, but not high mindfulness. Post hoc analyses examining mindfulness facets revealed significant main effects of acting with awareness, non-judging of inner experience, and nonreactivity to inner experience on pain-related disability. Significant interactive effects of observing, describing, and nonreactivity to inner experience with PTSD symptom severity on pain-related disability emerged. CONCLUSIONS: Mindfulness moderates PTSD symptom severity and pain-related disability associations in trauma-exposed firefighters. Future work should further examine these associations among first responders, using experimental and/or longitudinal methodologies.

Firefighters experience heightened rates of posttraumatic stress disorder (PTSD) symptoms compared to the general population. Nascent literature has identified distress overtolerance (DO; i.e., the tendency to persist through extremely high levels of distress despite harmful consequences) as a construct of potential relevance to PTSD symptomatology, though empirical research is lacking. The present study examined incremental associations between DO subscales (Capacity for Harm: persevering through distress despite its effect on 1's wellbeing; Fear of Negative Evaluation: persisting through distress due to a fear of being negatively evaluated by others should they quit) and PTSD symptom severity and symptom cluster severity (i.e., intrusion, avoidance, negative alterations in cognitions and mood [NACM], arousal and reactivity) among firefighters.Participants included 282 trauma-exposed firefighters (91.8% male,Results indicated that Capacity for Harm was a significant incremental correlate of total PTSD symptom severity (ΔFurther work examining DO-PTSD relations is necessary to inform intervention and policy for the fire service. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Background Anxiety sensitivity (AS), defined as the fear of anxiety-related sensations, is associated with increased risk for suicide and related behavior. However, investigations of AS have centered on primarily non-Hispanic White men and women and with limited attention to clinically relevant underlying factors. Methods The purpose of this preliminary study was to examine the indirect effect of AS on suicide ideation and elevated suicide risk through mindfulness in a sample of 307 Black adults (79.2% female; Mage = 22.4, SD = 5.6). Participants completed an online questionnaire battery that included measures of AS, mindfulness, suicide ideation, and elevated suicide risk. Results After controlling for age and gender, results indicated that AS was directly and indirectly associated with suicide ideation and elevated suicide risk via lower levels of mindfulness. Limitations Limitations include using a cross-sectional methodological design and exclusive reliance on self-report measures. Conclusions These findings provide preliminary insight into novel risk and protective factors that influence suicide ideation and elevated suicide risk among Black Americans.

The comorbidity of post-traumatic stress disorder (PTSD) and alcohol use disorders (AUD) is prevalent, complex, and difficult to treat. Cue reactivity paradigms offer a clinically relevant scientific avenue to advance our understanding of PTSD/AUD comorbidity and ultimately inform evidence-based interventions. Cue reactivity paradigms evoke emotional, behavioral, and/or physiological responses by manipulating external (e.g. images, smells, scripts) cues. Through evaluation of how individuals with PTSD/AUD respond to trauma or alcohol cues (e.g. craving, distress, avoidance) in 'real' time, the theoretical framework for understanding functional associations between PTSD and AUD is refined. This brief narrative review of the recent literature (2015-present) will focus upon (1) summarizing the recently published cue reactivity studies relevant to PTSD/AUD, (2) explicating the limitations of the literature, and (3) discussing future empirical directions.

Mindfulness-based interventions have demonstrated efficacy with regard to diverse psychological symptoms across populations. Few studies have evaluated the efficacy of mindfulness-based interventions for firefighters. This pilot randomized clinical trial (RCT) is designed to determine the preliminary efficacy, feasibility, and acceptability of a novel mindfulness-based workshop (entitled "Healthy Action Zone Mindful Attention Training" [HAZMAT]) developed for firefighters (Clinical Trials Identifier: NCT04909216). An anticipated sample size of 100 firefighters from a large fire department in the southern U.S. will be recruited. Firefighters will be randomized to: (1) HAZMAT workshop or (2) waitlist comparison condition. Outcomes will be assessed at baseline and five follow-up time-points: post-workshop, 1-week follow-up, 1-month follow-up, 3-month follow-up, and 6-month follow-up. First, we will evaluate the

Firefighters demonstrate high rates of posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD). Research has yet to compare how these diagnoses and their co-occurrence relate to firefighter mental health. This study evaluated trauma load, PTSD, alcohol use, depression, sleep, suicide risk, anger, and occupational stress across four discrete groups of firefighters ( N = 660): (1) trauma-exposed only ( n = 471), (2) probable PTSD-only ( n = 36), (3) probable AUD-only ( n = 125), and (4) probable PTSD-AUD ( n = 28). Firefighters completed an online survey. Firefighters with probable PTSD-AUD demonstrated higher scores on all criterion variables, except trauma load, compared to firefighters with probable AUD-only or trauma-only. Firefighters with probable PTSD-AUD and probable PTSD-only reported similar levels of all indices, except alcohol use severity and suicide risk, which were higher among the probable PTSD-AUD group. Results provide preliminary empirical evidence of the deleterious impact of PTSD-AUD comorbidity among firefighters.

Trauma exposure and posttraumatic stress disorder (PTSD) are significant concerns across psychiatric inpatient populations. Sleep disturbance is implicated in the etiology and maintenance of PTSD. Mindfulness facets, including observing, describing, acting with awareness, non-judging of inner experience, and non-reactivity to inner experience, may have clinical relevance to sleep disturbance and PTSD. No studies to date have examined associations among sleep disturbance, mindfulness facets, and PTSD symptom severity among psychiatric inpatients. Based upon the extant literature, greater sleep disturbance and lower acting with awareness, non-judging of inner experience, and non-reactivity to inner experience were expected to be associated with greater PTSD severity; sleep disturbance was expected to exert an indirect effect on PTSD severity through acting with awareness, non-reactivity to inner experience, and non-judging of inner experience. Covariates included trauma load and number of psychiatric diagnoses. Participants included 115 trauma-exposed psychiatric inpatients (40.0% female; Mage = 33.2, SD = 10.9). During an acute-care psychiatric inpatient hospitalization, participants were administered the Mini Mental Status Examination and completed a self-report packet, which included questionnaires used in the current investigation. Greater sleep disturbance and lower describing, acting with awareness, and non-judging of inner experience facets of mindfulness were each significantly associated with greater PTSD total symptom severity. Through non-judging of inner experience, sleep disturbance exerted an indirect effect on PTSD total symptom severity and the severity of PTSD symptom clusters, including intrusion, avoidance, negative cognitions and mood, and arousal and reactivity symptoms. Future research and clinical work may target the mindfulness facet of non-judging of inner experience in order to reduce the association between sleep disturbance and PTSD symptomatology among psychiatric inpatients.

Firefighters represent a unique population at high risk for trauma exposure, posttraumatic stress disorder (PTSD), and alcohol use. This study explored the main and interactive effects of PTSD symptom severity and impulsivity with regard to alcohol use severity. We hypothesized that higher levels of PTSD symptom severity and impulsivity would be related to greater alcohol use severity. Covariates included trauma load, depressive symptom severity, and romantic relationship status. The sample was comprised of 654 firefighters (Mage = 38.65, SD = 8.60) who endorsed exposure to potentially traumatic events and lifetime alcohol use. Firefighters completed an online questionnaire battery. A series of hierarchical regressions was conducted. PTSD symptom severity and impulsivity were significantly, incrementally associated with alcohol use severity, and a significant interactive effect was documented; firefighters with heightened PTSD symptom severity and impulsivity had the highest levels of alcohol use severity. This line of inquiry has great potential to inform prevention and intervention efforts for this vulnerable population. Clinical and research implications are discussed.

Firefighters are chronically exposed to potentially traumatic events, augmenting their risk of developing posttraumatic stress disorder (PTSD). The current study aimed to examine the incremental associations of lower-order dimensions of anxiety sensitivity (AS), examined concurrently, and PTSD symptom severity among a sample of trauma-exposed firefighters. We hypothesized that AS physical and cognitive concerns would be strongly associated with all PTSD symptom clusters and overall symptom severity, after controlling for theoretically relevant covariates (trauma load; years in fire service; alcohol use severity; depressive symptom severity). Participants were comprised of firefighters ( N = 657) who completed an online questionnaire battery and endorsed PTSD Criterion A trauma exposure. Results revealed that the AS cognitive concerns, but not AS physical concerns, was significantly and robustly associated with overall PTSD symptom severity, intrusion symptoms, and negative alterations in cognitions and mood ( ∆R2’s = .028–.042; p’s 2 = .03, p

The present investigation evaluated the preliminary impact of COVID-19 exposure on first responder mental health. Data were collected between June and August 2020. The sample was comprised of 189 first responders (Mage = 47.58, SD = 10.93; 21% female), recruited nationally, who completed an online survey. Results indicated that COVID-19-exposed first responders were more likely to be emergency medical services [EMS] personnel (vs. non-EMS) in career (vs. volunteer) roles. COVID-19-exposed first responders reported higher alcohol use severity; no other between-group differences were noted. COVID-19-related worry and medical vulnerability were incrementally associated with more severe symptoms of anxiety and depression; only COVID-19-related worry was associated with alcohol use severity. Among the subset of first responders (n = 122) who reported COVID-19 exposure, COVID-19-related worry was significantly associated with PTSD symptom severity. Covariates included gender, trauma load, years as a first responder, and COVID-19 exposure. Clinical and policy implications as well as future directions will be discussed.

Firefighters represent a distinct group of first responders that are at heightened risk of developing posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD). Assessing the role of transdiagnostic factors that underlie PTSD-AUD associations can inform specialized interventions among this population. This study included urban firefighters (

Objective: Persons in psychiatric inpatient hospitals represent a unique population with high rates of suicidal ideation and behavior as well as childhood maltreatment. Lower levels of perceived distress tolerance (DT) are associated with a history of childhood maltreatment and suicidal ideation and behavior in adulthood. Our study examined the association of childhood maltreatment severity with self-report and behavioral indices of suicide through perceived DT in a sample of adults in an acute-care psychiatric inpatient unit. We hypothesized that lower levels of perceived DT would account for the association between (a) childhood maltreatment severity and suicidal ideation severity and (b) childhood maltreatment severity and prehospitalization suicidality. Method: The sample was composed of 94 trauma-exposed adults (60% men; Mage = 33.43; SD = 12.06) admitted to a psychiatric acute-care inpatient hospital in a large metropolitan area in the southern United States. Approximately 55% of the sample were hospitalized due to suicidality, with an average number of 1.28 (SD = 2.42) prior suicide attempts; 3% of patients exhibited suicidality during their hospitalization. All patients reported experiencing at least one type of childhood maltreatment, with varying degrees of exposure. We conducted indirect effects analyses using PROCESS Macro for SPSS. Results: Childhood maltreatment severity was indirectly associated with both suicidal ideation severity and prehospitalization suicidality through DT. Conclusions: Findings advance our understanding of the association between childhood maltreatment and increased risk for suicidal ideation and behavior in adulthood, specifically among the psychiatric inpatient population. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Developing research suggests that the co-occurrence of posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) is a significant clinical concern across first responder populations. This comorbidity is difficult to treat and marked by a more costly, complex, and chronic clinical course when compared to either disorder alone. Significant associations between PTSD/AUD comorbidity and various psychological, behavioral, and physical health outcomes among first responder samples have been documented. This chapter provides a theoretical framework and empirical review of the literature relevant to PTSD/AUD in the context of firefighter, police, and other first responder populations (e.g., emergency medical technicians). Future directions, utilizing varied methodologies and assessment tools, and focusing upon varied first responder populations are enumerated to build upon this preliminary, yet clinically meaningful, empirical foundation. This research domain has great potential to inform specialized, evidence-based clinical care for first responders.

Introduction Firefighters are vulnerable to developing posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD). Anxiety sensitivity (AS) is a cognitive-affective mechanism with clinical relevance to both PTSD and AUD. The current study examined the potential role of AS in the association of PTSD symptomatology with alcohol use severity and alcohol use motives among a large sample of firefighters. Heightened PTSD and high AS were expected to be associated with alcohol use severity and coping-oriented alcohol use motives. Heightened PTSD symptomatology was expected to be indirectly associated with alcohol use severity and coping motives through high AS. Covariates included number of years in the fire service and the number of traumatic event types endorsed. Methods Participants included 652 urban firefighters (93.3% male; Mage = 38.7, SD = 8.57). Firefighters completed an online questionnaire battery. Results PTSD symptomatology was positively associated with alcohol use and coping motives. AS was positively associated with alcohol use coping motives but not alcohol use severity. AS partially explained the association between PTSD symptomatology and coping, conformity, and social motives, but did not significantly account for the relationship between PTSD symptom severity and enhancement motives or alcohol use severity. Conclusions Among firefighters, the association between PTSD and alcohol use coping, conformity, and social motives is partially accounted for by AS. Clinical and research implications are discussed.

Mental contamination (MC), feeling dirty in the absence of a physical contaminant, has been linked to the basic emotion of disgust. Both MC and disgust have been associated with posttraumatic stress (PTS) and obsessive-compulsive (OC) symptoms occurring separately as well as together. However, there is no consensus on the specific ways in which these constructs interact with each other, PTS, or OC symptoms. Thus, this study sought to specify the associations between self-reported MC, disgust constructs, and OC symptoms amongst 250 undergraduates endorsing lifetime traumatic events. Results showed MC to significantly predict OC symptom severity above and beyond the effects of disgust propensity (DP) and disgust sensitivity (DS), controlling for gender, general negative affect, and PTS symptom severity, in both the large trauma-exposed sample and a subgroup (n = 49) endorsing PTS symptoms approximating DSM-5 criteria. Further, DS significantly moderated the strength of the association between DP and MC, controlling for gender, negative affect, PTS symptoms, and OC symptoms, such that higher levels of DS strengthened the conditional effects of DP on MC. These findings suggest that MC predicts OC symptom severity amongst trauma-exposed individuals, and that the interaction of disgust constructs contributes to MC in this population.

BACKGROUND: Schizophrenia is associated with visual-processing abnormalities, including impairments in visual acuity, low-contrast stimulus detection, and perceptual organization (i.e., perceiving visual information in an organized “perceptual whole”). These visual impairments are clinically significant, with research indicating that specific visual-processing alterations are significantly related to poorer performance on higher-level cognitive tasks, impaired facial emotion recognition, impaired reading ability, and worse functional outcomes. Despite such findings, very few studies have evaluated the therapeutic potential of interventions that are specifically designed to improve visual processing (“visual remediation”) in schizophrenia. METHODS: Therefore, we conducted a small pilot randomized controlled trial to evaluate the efficacy of a computerized visual perceptual training program to improve visual, cognitive, and emotion-recognition functions in outpatients with schizophrenia who were attending a partial hospital treatment program. Eighteen participants with a mean age of 39.1 (SD=10.1) who met DSM-5 diagnostic criteria for schizophrenia or schizoaffective disorder as confirmed with the SCID-5 were randomized to either: 1) attend a visual training group 3 times a week over a period of 12–14 weeks (for a total of 30–35 sessions); or 2) receive treatment as usual. Visual training was provided in a small group setting, and involved participants completing approximately 40 minutes of computerized training using programs that targeted low- and mid-level visual processes. All participants were assessed at baseline, midpoint, and post-training on measures of visual acuity, contrast sensitivity, contour integration, and symptom severity, as well as with the MATRICS Consensus Cognitive Battery (MCCB). RESULTS: Seventeen participants completed the study through the midpoint whereas 12 were retained through post-training assessments. The visual training sessions were well-tolerated by the participants in the training group. Preliminary analyses indicate significant treatment-related gains in low-contrast letter acuity (p=.030, Cohen’s d effect size=2.04, n=12), and a non-significant treatment-related improvement of strong effect in contour integration (p=.181, effect size=1.10, n=10). There were no significant treatment effects or any indication of greater improvement in the visual training group on facial emotion recognition or discrimination. Analyses of potential treatment effects on contrast sensitivity, cognitive performance as assessed by the MCCB, and clinical symptom severity as assessed by the Brief Psychiatric Rating Scale are currently underway. DISCUSSION: The results from this initial pilot trial provide preliminary support for the efficacy of this visual remediation intervention to drive gains in low- and mid-level visual processes. In-progress analyses will address whether such an intervention can lead to improvements in higher-order cognitive functions that depend on visual processes, such as visual working memory and visual learning. The results from this study will be used to inform the design of additional, larger-scale investigations of visual remediation for individuals with schizophrenia and thus has the potential to inform the development and delivery of more targeted and effective treatments for this condition.