{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T13:06:59Z","timestamp":1770728819745,"version":"3.49.0"},"reference-count":34,"publisher":"American Medical Association (AMA)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Rates of posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) are high among paramedics.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To evaluate the efficacy of a cognitive resilience training program for reducing the development of PTSD and MDD among early career paramedics compared with psychoeducation and standard practice.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This randomized clinical trial of paramedics training at 15 universities across England was conducted between October 2017 to October 2022 with 12-month follow-up. Data were analyzed from December 2023 to July 2025.<\/jats:p>\n <\/jats:sec>\n \n Intervention<\/jats:title>\n Participants were randomized to receive internet-delivered cognitive training in resilience (iCT-R), psychoeducation, or standard practice. iCT-R, a guided online intervention that utilizes cognitive therapy tools to target predictors of PTSD and MDD identified in prospective research with paramedics, consisted of 6 modules delivered over 6 weeks with 6-monthly top-up sessions delivered by email. Internet-delivered psychoeducation, a supported online psychoeducation intervention, consisted of 6 topics (1 topic per week) with 6-monthly top-up sessions delivered by email. Standard practice was training as usual.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n \n The primary outcome was rate of PTSD and MDD at 1-year follow-up, assessed by independent assessors blinded to intervention using the Structured Clinical Interview for the\n Diagnostic and Statistical Manual of Mental Disorders<\/jats:italic>\n (\n Fifth Edition<\/jats:italic>\n ). Secondary outcomes included measures of PTSD and depression symptom severity, resilience, rumination, anxiety, psychological distress, and well-being. Intent-to-treat analyses were conducted, with the primary outcome analyzed using mixed-effects logistic regression.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Of 570 student paramedics enrolled (372 female [65.3%]; mean [SD] age, 23.67 [6.88] years), 195 were randomized to iCT-R, 197 to psychoeducation, and 178 to standard practice. For participants randomized to iCT-R, the odds of meeting criteria for PTSD or MDD at 12 months were significantly lower compared with psychoeducation (odds ratio [OR], 0.20; 95% CI, 0.05-0.73) and standard practice (OR, 0.25; 95% CI, 0.07-0.97). Providing iCT-R training to 18 to 24 paramedic trainees (number needed to treat) would prevent 1 case of PTSD or MDD.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this randomized clinical trial, participants receiving iCT-R were approximately 5 times less likely to develop PTSD or MDD at 1-year follow-up compared with psychoeducation and 4 times less likely when compared with standard practice. These findings suggest that iCT-R appears to decrease the likelihood of developing PTSD and MDD in early career paramedics.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n isrctn.org Identifier:\n ISRCTN16493616<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.57241","type":"journal-article","created":{"date-parts":[[2026,2,9]],"date-time":"2026-02-09T16:30:36Z","timestamp":1770654636000},"page":"e2557241","source":"Crossref","is-referenced-by-count":0,"title":["Cognitive Resilience Training to Prevent PTSD and Major Depressive Disorder in Paramedic Recruits"],"prefix":"10.1001","volume":"9","author":[{"given":"Jennifer","family":"Wild","sequence":"first","affiliation":[{"name":"Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom"},{"name":"Oxford Health National Health Service Foundation Trust, Littlemore, Oxford, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gabriella","family":"Tyson","sequence":"additional","affiliation":[{"name":"Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Graham","family":"Thew","sequence":"additional","affiliation":[{"name":"Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom"},{"name":"Oxford Health National Health Service Foundation Trust, Littlemore, Oxford, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abbie","family":"Wilkins","sequence":"additional","affiliation":[{"name":"Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Esther","family":"Beierl","sequence":"additional","affiliation":[{"name":"Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shama","family":"El-Salahi","sequence":"additional","affiliation":[{"name":"Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hj\u00f6rdis","family":"Lorenz","sequence":"additional","affiliation":[{"name":"Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ceri","family":"Storch","sequence":"additional","affiliation":[{"name":"Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Haddi","family":"Browne","sequence":"additional","affiliation":[{"name":"Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Morris","sequence":"additional","affiliation":[{"name":"Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ed","family":"Watkins","sequence":"additional","affiliation":[{"name":"Sir Henry Wellcome Building for Mood Disorders Research, School of Psychology, Faculty of Health and Life Sciences, University of Exeter, Exeter, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anke","family":"Ehlers","sequence":"additional","affiliation":[{"name":"Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom"},{"name":"Oxford Health National Health Service Foundation Trust, Littlemore, Oxford, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10","published-online":{"date-parts":[[2026,2,9]]},"reference":[{"key":"zoi251525r1","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2023.1151248","article-title":"Work-related posttraumatic stress disorder in paramedics in comparison to data from the general population of working age. 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