Combining internet-delivered cognitive behavioural therapy and attention bias modification for reducing depressive symptoms in firefighters: a randomized controlled trial

Abstract Background: Firefighters are frequently exposed to traumatic events and stressful environments and are at particularly high risk of depressive symptoms. Aims: The present study aimed to examine the impact of a combined internet-delivered cognitive behavioral therapy (iCBT) and attention bias modification (ABM) intervention to reduce depressive symptoms in firefighters. Method: The study was a randomized controlled trial carried out in Kunming, China, and involved the recruitment of 138 active firefighters as participants. The intervention lasted for an 8-week duration, during which participants participated in ABM exercises on alternating days and concurrently underwent eight modules of iCBT courses delivered through a smartphone application. Baseline and post-intervention assessments were conducted to evaluate the effects of the intervention. Results and Discussion: Results indicated that the combined iCBT and ABM intervention was significantly effective in reducing symptoms of depression compared with the no intervention control group ( U =1644, p <0.001, Wilcoxon r =0.280). No significant change was observed in attention bias post-intervention ( U =2460, p =0.737, Wilcoxon r =0.039), while a significant increase was observed in attention-bias variability ( U =3172, p <0.001, Wilcoxon r =–0.287). This study provides evidence for the effectiveness of the combined iCBT and ABM intervention in reducing depressive symptoms among firefighters. This study provides conceptual support and preliminary evidence for the effectiveness of the combined iCBT and ABM intervention in reducing depressive symptoms among firefighters.