Reducing Psychological Distress in Fire Fighters with an Asynchronous App-based Meditation Intervention

摘要 美国100多万消防员在海地提供危急紧急医疗服务 他们服务的社区，一直在医疗保健提供的第一线，包括在整个 新冠肺炎大流行。由于暴露在职业压力之下，很高比例的消防员 经历相当大的压力相关疾病负担，包括慢性疼痛、心理困扰(即， 焦虑和抑郁)和创伤后应激障碍。尽管干预措施已经发展到 解决这一迫切需要减少职业应激暴露的影响，以提高消防员的工作水平- 尽管如此(例如，认知行为疗法、复原力训练)，并不是所有这些方式都能吸引所有人 如果没有直接的面对面接触，他们也不容易实施。一种模式已经显示出 减少不同人群痛苦的承诺是冥想，包括通过智能手机提供的冥想 应用程序。就我们所知，没有基于智能手机的冥想干预旨在同时培养两者 与他人的社会联系的专注力和感觉已经在消防员身上进行了测试。这项研究将 因此，在N=192个职业中测试为期10天的基于智能手机的冥想应用干预的有效性 消防员。这款应用程序是由Health Minds Innovation(威斯康星州麦迪逊HMI)开发的，旨在 增强正念(意识)和与他人的社交联系，以减少焦虑。我们的团队 最近，Pilot测试了这款应用程序，发现消防员表现出的焦虑程度有所降低(这是 心理困扰)和精疲力竭，以及压力荷尔蒙皮质醇功能的改善 到使用该应用程序后。尽管这些令人鼓舞的结果表明，基于智能手机的低成本、可扩展 冥想APP可能有效改善消防员幸福感，我们的初步研究缺乏注意力控制 需要进行比较才能确定干预效果。因此，与3个大都会消防局合作 在美国各部门，我们将测试HMI冥想应用程序的功效，以减少心理 与严格的主动注意力控制(即，基于我们之前的健康教育应用程序)相比， 工作)(目标1)。我们还将确定HMI冥想应用程序对心理健康的影响 苦恼是通过正念和感知的社会联系来调节的(目标2)。拟议的研究将 为基于智能手机的冥想应用干预的有效性提供重要证据，很可能 高影响力，培养正念和社会联系，以减少心理 消防一线工作人员遇险。这项研究支持NIOSH的战略目标7/活动 目标7.14.1(制定将保护免受与工作有关的健康危害与 促进预防以增进工人福祉)和Nora目标6(促进健康工作 设计和福祉)。

ABSTRACT More than one million firefighters in the United States provide critical emergency medical services in communities they serve and have been on the front lines of healthcare delivery, including throughout the COVID-19 pandemic. As a result of exposure to occupational stressors, a high proportion of firefighters experience considerable stress-related illness burden, including chronic pain, psychological distress (i.e., anxiety and depression), and posttraumatic stress disorder. Although interventions have been developed to address this high need of reducing effects of occupational stress exposure in order to improve firefighter well- being (e.g., cognitive-behavioral therapy, resilience training), not all of these modalities appeal to all firefighters, nor are they easily implemented without direct, in-person contact. One modality that has shown promise to reduce distress in various populations is meditation, including meditation delivered by smartphone apps. To the best of our knowledge, no smartphone-based meditation interventions designed to cultivate both mindfulness and feelings of social connection to others have been tested with firefighters. This study will therefore test the efficacy of a 10-day, smartphone-based meditation app intervention among N=192 career firefighters. The app was developed by Health Minds Innovations (HMI, Madison, WI) and is designed to enhance both mindfulness (awareness) and social connection to others in order to reduce anxiety. Our group recently piloted tested this app and found that firefighters exhibited reduced anxiety (a key component of psychological distress) and burnout, as well as improved function of the stress hormone, cortisol, from before to after use of the app. Although these encouraging results suggest a low-cost, scalable smartphone-based meditation app may be effective to improve firefighter well-being, our pilot study lacked an attention control comparison needed to establish intervention efficacy. Therefore, in collaboration with 3 metropolitan fire departments in the United States, we will test the efficacy of the HMI meditation app to reduce psychological distress compared to a rigorous active attention control (i.e., a Health Education app, based on our prior work)(Aim 1). We will also determine whether the effect of the HMI meditation app of psychological distress is mediated by mindfulness and perceived social connection (Aim 2). The proposed research will provide important evidence of efficacy about a smartphone-based meditation app intervention, with likely high impact, that cultivates both mindfulness and social connection in order to reduce psychological distress in frontline workers in the fire service. This research supports NIOSH's Strategic Goal 7 / Activity Goal 7.14.1 (to develop interventions that integrate protection from work-related health hazards with promotion of prevention to advance worker well-being) and NORA Objective 6 (promote healthy work design and well-being).