Posted 04.01.2019 | by AMRA

First responders such as firefighters, police, and EMTs are regularly exposed to stressful and traumatic experiences. These experiences put them at increased risk for depression, anxiety disorders, PTSD, and alcoholism. There is a considerable interest in developing workplace programs that can increase first responders’ resilience to and recovery from stressful experiences.

Joyce et al. [Journal of Medical internet Research] tested the efficacy of an online Resilience-at-Work (RAW) Mindfulness Program on firefighter resilience and wellbeing.

The researchers randomly selected 12 Australian fire stations as workplaces where firefighters could receive RAW training and 12 additional stations as attention-matched controls. A total of 143 firefighters (96% male, average age = 42) volunteered to participate, 79 of whom were available for post-treatment assessment, and 69 for a 6-month follow-up. Controls had a higher 6-week drop-out rate (54%) than RAW participants (32%).

RAW training consisted of six self-paced 20-25 minute iPad lessons that were to be completed over a period of up to 6 weeks. The lessons included aspects of Mindfulness-Based Cognitive Therapy and Acceptance and Commitment Therapy with additional training in self-compassion. The control condition completed six 20-minute Healthy Living lessons covering a range of topics such as skin health, maintaining a healthy home, and using cell phones wisely.

Self-reports were completed at baseline, post-intervention, and 6-month follow-up on measures of resilience (adaptation to stressful life events), bounce-back resilience, and other psychological measures.

RAW participants completed an average of 3.5 of the six trainings with only 37% completing the entire program. RAW participants increased their resilience scores more than controls. This difference approached significance at immediate post-testing and reached significance by the 6-month follow-up (a moderate-to-large effect). There were no group differences in bounce-back resilience.

In secondary analyses, positive changes in resilience were significantly greater for those who completed the greatest number of sessions. Change scores on a 10-point resilience scale ranged from -1.78 points for controls to +2.6 for RAW participants who completed the program. RAW participants were significantly more optimistic at post-testing, and significantly more likely to seek advice and emotional support from others. These differences were no longer significant at 6 months.

At the 6-month follow-up, RAW participants had higher levels of active coping than controls. RAW participants who completed 5-6 lessons were significantly more mindful than controls at both 6 weeks and 6 months, whereas participants who completed 4 or fewer sessions were not.

The study demonstrates that a targeted mindfulness training program increases some aspects of firefighter resilience (distress tolerance, positive adjustment, and perseverance), but not bounce-back resilience. The more lessons firefighters completed, the greater their improvements in both mindfulness and resilience.

RAW is a promising, inexpensive workplace program that can potentially improve first responder resilience. The study’s weaknesses include its high dropout rate, low level of compliance with the intervention, and reliance on only self-report measures.


Joyce, S., Shand, F., Lal, T. J., Mott, B., Bryant, R. A., & Harvey, S. B. (2019). Resilience@ work mindfulness program: Results from a cluster randomized controlled trial with first responders. Journal of Medical Internet Research, 21(2), e12894.

[Link to study]