RESILIENT - An Online Multidimensional Treatment to Promote Resilience After a Disaster: Randomized Controlled Trial Protocol
Condition: Post Traumatic Stress Disorder; Insomnia; Depression
MeSH terms: Stress Disorders, Traumatic; Stress Disorders, Post-Traumatic
Study type: Interventional

Summary: 
      Background. The wildfires on May 1, 2016 in Fort McMurray, Alberta (Canada), destroyed
      approximately 2,400 homes and buildings and led to massive displacement of approximately
      88,000 people. Many individuals faced direct or potential threat to their life or health, or
      significant losses, and many months later, families were still living through ongoing
      adversity and uncertainty as they adapted to new or temporary homes, schools and workplaces.
      Alberta Health Services estimated in August 2016 that mental health staff in the city had
      received 20,000 referrals since May, compared to 1,200 referrals each year.

      Objectives. The overarching aim of this project is to understand the needs of the Fort
      McMurray population in terms of mental health and to widely disseminate evidence-based tools
      to promote resilience. More specifically, we will assess the efficacy of an online self-help
      intervention targeting post-traumatic resilience on specific symptoms (post-traumatic stress
      disorder [PTSD], insomnia, depression).

      Method. 1,510 phone surveys have been conducted in May-July 2017 to assess the prevalence of
      PTSD, insomnia and depression in the evacuees from the Fort McMurray wildfires (T0). After
      the survey, 697 participants expressed interest to participate in the longitudinal arm of the
      study, which will include four in-depth assessments with online questionnaires (T1 to T4) and
      a diagnostic interview (T1 only). A period of six months will separate all four times of
      assessment. Participants with post-traumatic stress symptoms (expected n = 150) will be
      randomised either to the treatment condition (n = 75) or to a waitlist control condition (n =
      75) after completion of T2.

      Data Analyses. Primary outcomes will be post-traumatic, depressive and insomnia symptom
      severity, measured with validated self-report questionnaires. Secondary outcomes will include
      cognitive, behavioural and social indicators, as well as general mental health and
      post-traumatic growth. Several probable moderators of treatment will be examined, including
      sociodemographic characteristics, level of exposure, and continuing stressors.

      Foreseen Impacts. If found effective in reducing symptoms, the results of this study have the
      potential to impact positively the Fort McMurray community. Indeed, a direct and concrete
      deliverable of this research project will be to provide an extended (at least two years) and
      free access to the online intervention specifically tailored to this population's needs.
    


Intervention name(s): Treatment
Intervention type(s): Behavioral
Intervention description(s): The treatment is a therapist-assisted self-help online cognitive-behaviour therapy focusing on post-traumatic stress, sleep and mood. It includes 12 sessions of evidence-based psychotherapeutic components, such as psychoeducation about PTSD, sleep and depression; prolonged exposure to avoided situations and memories; sleep management strategies (restriction of time in bed, stimulus control, sleep hygiene education); behavioural activation; relaxation and mindfulness exercises; problem-solving strategies; and cognitive restructuring. A small portion of material was unlocked each week, and access to one module was accessible after the completion of a previous one. Supervised graduate psychology students provided brief regular weekly contacts for 12 weeks by video chat or phone, according to the participant's preference. Access to the online material was unlimited in time.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: mental health; post-traumatic stress disorder; psychological distress; sleep