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NEW STUDY: 4-DAY THERAPY RETREAT DRAMATICALLY IMPROVES PTSD, INSOMNIA, AND NIGHTMARES IN FIREFIGHTERS
First-Ever Randomized Study of Culturally Adapted Mental Health Treatment Shows Major Results
ABOUT THIS STUDY
Who did it: Dr. Carmen McLean and research team from the National Center for PTSD, University of Arizona, and partner institutions
What they did: Tested 49 firefighters struggling with PTSD, insomnia, and nightmares in a new 4-day group therapy program designed specifically for fire service culture
What they found: Firefighters who completed the program showed huge improvements - 76.5% no longer met PTSD criteria, 58.8% no longer had insomnia disorder, and 61.8% no longer had nightmare disorder. Benefits lasted at least 3 months.
Published: January 19, 2026, Psychological Trauma: Theory, Research, Practice, and Policy
Full citation: McLean, C. P., Janke, S., Pruiksma, K. E., Taylor, D. J., Sloan, D. M., Dietch, J. R., Fredman, S. J., Sutherland, C., Hollerbach, B., Thompson, S. M., Tse, D., Nagy, S., Malek, N., & Haddock, C. K. (2026). A pilot feasibility randomized clinical trial of a culturally adapted accelerated group treatment for posttraumatic stress, insomnia, and nightmares in firefighters. Psychological Trauma: Theory, Research, Practice, and Policy. DOI: 10.1037/tra0002090
WHY THIS MATTERS
The firefighter mental health problem: Firefighters face high rates of PTSD (8-37%), insomnia (47-53%), and nightmares (19%) compared to the general population. These problems usually occur together and make each other worse. Beyond the suffering they cause, they lead to poor job performance, safety risks, disability claims, and suicide risk.
The treatment barrier: Treating PTSD, insomnia, and nightmares separately requires 4-7 months of weekly appointments. Firefighter shift schedules make this nearly impossible. Mental health stigma in the fire service keeps many from seeking help, and most firefighters won't use services provided by their own departments.
What this study tested: A completely different approach - compress all treatment into 4 consecutive days, deliver it in small groups (2-6 firefighters), recreate fire station culture by staying together in a house, and provide it away from participants' departments and communities. This is the first controlled study of a culturally adapted mental health treatment specifically designed for firefighters.
The Results - Nightmares:
Effect size: 0.72 (medium-large)
Before treatment: 69.4% met nightmare disorder criteria
After treatment: Only 38.2% still met criteria
Average nightmare score dropped from 7.5 to 3.9 (out of 28)
Other Findings:
Depression also improved significantly (even though not specifically targeted)
100% of firefighters who started the 4-day workshop completed it
All dropout happened before the workshop (due to travel/scheduling barriers)
Improvements maintained through 3-month follow-up
Participants continued getting better over time
High satisfaction ratings and willingness to recommend to others
WHAT THE STUDY FOUND
The Results - PTSD:
Effect size: 1.70 (considered "large" - huge improvement)
76.5% had major improvement (10+ point drop on standardized test)
Before treatment: 76.5% met full PTSD diagnostic criteria
After treatment: Only 14.7% still met criteria
Average PTSD score dropped from 40.0 to 22.3 (out of 80)
The Results - Insomnia:
Effect size: 1.47 (considered "large")
50% had significant improvement (6+ point drop)
Before treatment: 100% had insomnia disorder
After treatment: Only 41.2% still had it
Average insomnia score dropped from 18.5 to 12.4 (out of 28)
WHAT YOU CAN DO RIGHT NOW
KNOW THE WARNING SIGNS:
Participants in this study averaged 23 years in the fire service before getting help. Don't wait years.
Signs you might benefit:
Intrusive memories or flashbacks of traumatic calls
Avoiding things that remind you of traumatic events
Trouble falling asleep or staying asleep
Frequent nightmares about work or trauma
Feeling on edge, irritable, or hypervigilant
Depression or pulling away from family and friends
TALK TO YOUR DEPARTMENT:
Travel costs and scheduling were the biggest barriers to enrollment in this study. Advocate for:
Mental health benefits that cover intensive treatment
Time off policies that support 4-day treatment programs
Department culture where getting help is normalized
Share this research with leadership
IS THIS AVAILABLE NOW?:
This was a research study, so it's not available as a clinical service yet. Researchers are working on making it available, which requires training more therapists, identifying locations, and working with insurance companies.
Contact for updates: Dr. Carmen McLean
National Center for PTSD
carmen.mclean4@va.gov
What you can do while waiting:
Seek evidence-based PTSD treatment (Prolonged Exposure, Cognitive Processing Therapy, Written Exposure Therapy)
Ask providers about CBT for Insomnia and CBT for Nightmares
Consider intensive outpatient programs if available in your area
Use confidential resources: Fire/EMS Helpline 1-888-731-FIRE (3473)
COMMON QUESTIONS
"How is this different from regular therapy?"
Regular therapy: PTSD (8-15 weeks) + insomnia (4-8 weeks) + nightmares (4-6 weeks) = 16-29 weeks total if done separately. This program: 4 days total. Same evidence-based treatments, same effectiveness, compressed timeline. Why accelerated works: No time between sessions to avoid, full focus without distractions, builds momentum, less dropout. Research shows accelerated PTSD treatment works as well as weekly treatment.
"Why group therapy instead of individual?"
Research shows group PTSD therapy works just as well as individual therapy. For firefighters, group may be better because: you're used to working in teams, reduces isolation ("I'm not the only one"), peer support from people who understand the job, matches fire service culture. What participants said: "Being in a group with others who were similar, who had gone through similar things, was wonderful. It was a comfortable space."
"Will people from my department be in my group?"
No. The study specifically avoided putting firefighters from the same department together to protect privacy and allow people to speak freely without department politics.
"What if my trauma happened at work?"
79.6% of traumas in this study were job-related: transportation accidents (35%), sudden violent death (24%), sudden accidental death (22%), physical assault, fires, other on-duty incidents. The treatment is designed for occupational trauma.
"I have sleep apnea too. Will this still work?"
39-46% of participants had possible sleep apnea. The treatment still worked. You may need additional treatment for sleep apnea (like CPAP), but this program can still help with insomnia and nightmares. Other sleep problems participants had: shift work sleep disorders (19-35%), restless legs syndrome (4-12%), sleepwalking, REM sleep behavior disorder. Treatment worked despite these complications.
"Do I have to talk about my trauma in front of everyone?"
No. You write about your trauma privately (30 minutes, five times over the 4 days). You're in the same room as others who are also writing, but what you write is private - you don't share it with the group. The therapist gives you individual feedback. Instructions and brief check-in happen as a group, but detailed trauma content stays between you and the therapist.
"What if my trauma is really severe?"
The study included firefighters with moderate to severe PTSD (average scores 30-40 out of 80). 76.5% met full diagnostic criteria for PTSD. Average 23 years in the fire service with years of accumulated trauma. The treatment worked for them. You're not "too bad" for this treatment.
RETURN ON INVESTMENT:
Compare potential treatment costs to: one disability retirement ($500K-$2M), one mental health claim ($50K-$200K), recruiting/training replacement ($100K-$150K). Plus: healthier firefighters = better performance, safety, retention, recruitment, and morale.
TALKING POINTS FOR GOVERNING BODIES:
"This is evidence-based medicine for an occupational health problem. First controlled study of mental health treatment for firefighters. Large effect sizes prove it works. 100% completion shows firefighters will use it when it fits their needs. The current approach (weekly therapy) isn't working due to schedules and stigma. This approach was designed specifically for firefighters. The return on investment is clear - preventing one disability retirement pays for many treatments."
FOR DEPARTMENT LEADERSHIP: POLICY & IMPLEMENTATION GUIDE
This is the first controlled study proving culturally adapted mental health treatment works for firefighters. Here's what it means for your department:
THE PROBLEM:
8-37% of your firefighters have PTSD, 47-53% have insomnia, 19% have nightmares
These are often job-related occupational injuries
Weekly therapy doesn't fit shift schedules (4-7 months doesn't work)
Mental health stigma and fear of career consequences prevent firefighters from using department services
Untreated mental health = poor performance, safety risks, disability claims ($50K-$200K each), disability retirements ($500K-$2M lifetime), suicide risk
WHAT THIS STUDY PROVED:
4-day intensive format fits firefighter schedules
Group therapy leverages team culture firefighters are used to
Away from department reduces stigma
100% completion rate among those who started
Huge improvements: 76.5% no longer met PTSD criteria, 58.8% no longer had insomnia disorder
Benefits lasted at least 3 months
High satisfaction - participants called it "life changing"
WHAT YOU CAN DO NOW:
Provide information:
Share this research with your personnel
Include mental health resources in orientation and training
Post treatment information in stations
Support time off:
Treat mental health treatment like medical care (not vacation days)
Be flexible with scheduling for intensive programs
Have coverage plans that make treatment accessible
Remove barriers:
Consider covering treatment costs as employee benefits
Support outside providers (not department-provided services to reduce stigma)
Protect confidentiality - never ask who's in treatment
Make clear getting help won't affect careers
Create supportive culture:
Chiefs and officers talk openly about mental health
Include mental health in safety briefings
Normalize getting help (like getting surgery)
Lead from the front - when leaders get help, it gives others permission
NEW STUDY IDENTIFIES KEY PREDICTORS OF PFAS LEVELS IN U.S. CAREER FIREFIGHTERS
Fire Firefighter Cancer Study (FFCCS) Tests 2,056 Firefighters to Determine What Raises and Lowers Exposure
ABOUT THIS STUDY
Who did it: University of Arizona researchers (lead author: Reagan Conner, MPH; principal investigator: Dr. Jefferey Burgess)
What they did: Tested blood samples from 2,056 career firefighters in 7 states (Arizona, California, Idaho, Massachusetts, Oregon, Virginia, Washington) between July 2023 and October 2024
What they found: Both your personal choices AND your department's policies directly affect how much PFAS is in your blood
Published: January 19, 2026, Journal of Occupational and Environmental Medicine
Full citation: Conner, R., Hollister, J., Lutrick, K., Burgess, J.L., et al. (2026). Predictors of serum per- and polyfluoroalkyl substances (PFAS) levels among U.S. career firefighters. Journal of Occupational and Environmental Medicine, University of Arizona. DOI: 10.1097/JOM.0000000000003670
WHY THIS MATTERS
What is PFAS? "Forever chemicals" used in firefighting foam, gear, and thousands of products. They don't break down and they build up in your body.
The health risks:
PFOA = causes cancer (Group 1 carcinogen)
PFOS = probably causes cancer (Group 2B carcinogen)
Both linked to heart disease, thyroid problems, and immune issues
Stays in your body for 3-5 years (half-life)
The firefighter problem:
100% of firefighters tested had PFAS in their blood
Firefighters have higher levels than regular people
Comes from foam, burning materials, contaminated dust, and water
The good news: This study found specific things you can do - and your department can do - to lower your levels
Things that LOWERED PFAS levels:
Donating plasma (17-40% lower)
Donating blood (6-15% lower)
Drinking bottled water (8-11% lower)
Using reverse osmosis water filters
Washing gear after fires with soap/brush/rinse (9-11% lower)
Department gear bag policy
Department policy requiring gear washing before storage
Weekly dusting in stations
Weekly hood cleaning programs
WHAT THE STUDY FOUND
Things that RAISED PFAS levels:
Drinking well water (19-24% higher)
Using AFFF foam (11% higher PFOA)
Military service history (8-21% higher)
Carpet in station living areas
More years on the job
Being older (true for everyone, not just firefighters)
WHAT YOU CAN DO RIGHT NOW
1. DONATE PLASMA OR BLOOD
What the study showed: Plasma donation had the biggest effect - up to 40% lower PFAS. Blood donation also worked - 6-15% lower.
Why it works: PFAS sticks to proteins in your blood. When you donate, the PFAS leaves your body with the blood or plasma.
How to do it:
Whole blood: Every 56 days (8 weeks)
Plasma: Up to twice a week at paid donation centers
Find a place: redcrossblood.org or search "plasma donation near me"
Bottom line: This showed the strongest results in the study. An Australian study already tested this and proved it works. A U.S. trial is happening now to find the best donation schedule.
2. CHECK YOUR DRINKING WATER
What the study showed:
Well water drinkers: 19-24% higher PFAS
Bottled water drinkers: 8-11% lower PFAS
Reverse osmosis filters: Lower PFAS
At home:
Figure out where your water comes from (well, city, or bottled)
If you have well water → Get it tested for PFAS
Call your state health department or hire a private lab
EPA water info: epa.gov/ground-water-and-drinking-water
If it's contaminated → Install a reverse osmosis filter OR switch to bottled water
At your fire station:
Ask your chief to test the station water
Push for reverse osmosis filters or bottled water at all stations
Even cheap pitcher filters (like Brita) showed some benefit
Why well water is worse: 13% of Americans use well water. It's not regulated like city water, and most people don't test it. If it's contaminated, you don't know unless you check.
3. WASH YOUR GEAR AFTER EVERY FIRE
What the study showed: Firefighters who did soap/brush/rinse decon had 9-11% lower PFOA.
The right way to do it:
Take off your SCBA and gloves
Wet down your turnout gear
Apply soap and scrub with a stiff brush
Rinse everything thoroughly
Wipe your exposed skin (face, neck, hands) with wipes
Why it works: When smoke cools down, it settles as dust and crud on your gear. That stuff soaks into your body through your skin. Washing it off at the scene stops that from happening.
What your department needs:
Soap, brushes, water, and skin wipes on every apparatus
A standard procedure that everyone follows
Training on the right technique
Bonus: This also reduces PAHs (another cancer-causing chemical from fires).
OTHER THINGS THAT HELP
Use a gear bag - Departments that gave everyone a bag had firefighters with lower PFAS
Don't bring dirty gear home - Keep contamination at the station
Push for weekly dusting - Stations that dusted weekly had lower PFAS
Support hood swap programs - Weekly hood cleaning = lower PFAS
COMMON QUESTIONS
"I've been on the job for 20+ years. Is it too late?" No. Research suggests that actions taken now may still be meaningful, regardless of how long someone has been exposed. Some studies indicate that plasma donation may help reduce PFAS levels in the blood, though results can vary and are not guaranteed.
"What's the single most important thing I can do?" Donate plasma. It showed the biggest reduction - up to 40% lower for some PFAS types.
"How often should I donate blood?" Whole blood: every 56 days. Plasma: up to twice a week. A research trial is happening now to figure out the best schedule for PFAS reduction.
"Do Brita-style filters work?" They help a little. The study found lower PFAS with "other" water sources including pitcher filters. But reverse osmosis works better.
"Does my turnout gear have PFAS in it?" Probably yes. Research has found fluorine in gear materials. But we don't know yet if that's a major source compared to smoke, foam, and water.
"Should we stop using two sets of gear?" Don't change anything yet. The study found higher PFAS with a second set, but researchers don't understand why. It might be because people with two sets have longer careers or other factors. Wait for more research.
"What about my family?" If you have well water at home, get it tested - your whole family drinks it. Never bring contaminated gear into your house or car. Always use a gear bag.
"Is AFFF banned now?" Not everywhere. The study found current AFFF use = 11% higher PFOA. Push your department to switch to fluorine-free foam.
"We already follow NFPA 1851. Isn't that enough?" The study found that just meeting NFPA minimum standards wasn't linked to lower PFAS. You need specific policies like requiring gear washing BEFORE storage, not just twice a year advanced cleaning.
"What about food in paper containers?" Weirdly, people who ate more pizza and fast food had LOWER PFAS in this study. Researchers can't explain it. Don't change your diet based on this finding.
FOR DEPARTMENT LEADERSHIP: POLICY & IMPLEMENTATION GUIDE
This study proves that your policies directly impact your firefighters' cancer risk. Here's how to use these findings:
STEP 1: ASSESS YOUR CURRENT SITUATION
Water Assessment:
Where does drinking water come from at each station? (City/municipal, well, bottled)
When was it last tested for PFAS?
Do you have any filtration systems?
Gear Policies Assessment:
Do you require gear to be washed before storing it?
Does everyone have a department-issued gear bag?
Do you have a hood swap or weekly hood cleaning program?
How many sets of gear does each firefighter have?
Decontamination Assessment:
Is on-scene decon a formal requirement or just a suggestion?
Does every apparatus have soap, brushes, water, and wipes?
Are people trained on the soap/brush/rinse method?
Do you have SOPs written for on-scene decon?
Station Environment Assessment:
How often are living quarters dusted?
Is there carpet in living areas (sleeping, eating)?
Do you clean apparatus interiors after fires?
Do gear storage rooms have automatic closing doors?
STEP 2: PRIORITY ACTIONS (START HERE)
Based on the study, these four things had the clearest impact:
PRIORITY #1: WATER
The finding: Reverse osmosis filters and bottled water = significantly lower PFAS
What to do:
Test water at ALL stations (even city water can be contaminated)
Get test results and compare to EPA advisory levels
Choose your solution:
Option A: Install reverse osmosis systems (better long-term, higher upfront cost)
Option B: Provide bottled water (cheaper short-term, ongoing cost)
Option C: Combination (RO for cooking/drinking, bottled as backup)
Budget:
RO systems: $1,500-$5,000 per station (installation) + $200-$500/year (filters)
Bottled water: ~$50-$150/month per station
Testing: $300-$600 per water source
Timeline:
Testing: 2-4 weeks
RO installation: 1-3 months
Bottled water: Immediate
PRIORITY #2: GEAR MANAGEMENT POLICIES
The findings:
Policy requiring gear washing before storage = lower PFOA
Department-issued gear bags = lower PFOA
Hood swap/weekly cleaning = lower PFOA
What to do:
A. Write or update your gear washing policy:
Require all gear to be washed after fire responses before being stored
Specify WHERE it gets washed (station extractor, sent out, etc.)
Specify WHEN (within 24 hours, before next shift, etc.)
Make it enforceable with accountability
Sample policy language: "All structural firefighting protective equipment exposed to fire products of combustion shall be cleaned using an approved extractor and appropriate detergent within 24 hours of exposure and prior to being returned to storage."
B. Gear bag program:
If you don't supply gear bags, budget for them
Require use for transporting contaminated gear
Make it clear: contaminated gear does NOT go in personal vehicles or homes
Budget: $75-$150 per gear bag × number of personnel
C. Hood swap/cleaning program:
Buy extra hoods (2-3 per firefighter)
Set up a weekly rotation/cleaning schedule
Assign someone to manage it
Track compliance
Budget: $50-$100 per hood × number needed
PRIORITY #3: ON-SCENE DECONTAMINATION
The finding: Soap/brush/rinse method = 9-11% lower PFOA
What to do:
A. Write or update your on-scene decon SOP:
Make it mandatory after every working fire
Specify the soap/brush/rinse method (study shows this works best)
Include skin decon (face, neck, hands)
Specify who's responsible for ensuring it happens
Sample SOP excerpt: "Following fire suppression and prior to returning to quarters, all personnel who operated in the hazard zone shall perform on-scene decontamination using the following procedure: [steps 1-5]. Company officers are responsible for ensuring compliance."
B. Stock every apparatus:
Appropriate cleaning solution (safe for turnout gear)
Stiff brushes
Water source or adequate water supply
Personal hygiene wipes
Bags for contaminated gear if needed
Budget: $100-$200 per apparatus (initial stock) + ongoing supplies
C. Train everyone:
How to do it right
Why it matters (cancer prevention, not just cleanliness)
When to do it (every fire, not just "big ones")
PRIORITY #4: STATION HOUSEKEEPING
The findings:
Weekly dusting = lower PFOA
Carpet in living quarters = higher PFHpS
Apparatus interior cleaning = lower PFHpS
What to do:
A. Update cleaning procedures:
Require dusting of living quarters at least once per week (not monthly)
Specify what gets dusted (surfaces, blinds, vents, electronics)
Add apparatus interior cleaning to post-fire procedures
B. Evaluate carpet:
Identify which stations have carpet in living areas
Prioritize removal in sleeping and eating areas
Budget for replacement flooring (sealed concrete, VCT, etc.)
Budget: Varies widely - $2-$10 per square foot for flooring replacement
C. Update station cleaning checklists:
Add specific tasks and frequencies
Assign responsibility
Track completion
STEP 3: SECONDARY ACTIONS (GOOD TO HAVE)
These showed some benefit or are worth considering:
Gear Storage:
Automatic closing doors for gear rooms (showed lower PFOA)
Separate ventilation for gear storage areas
Apparatus Interior Decon:
Formal policy for cleaning cabs after fires
Supplies and procedures for doing it
Contamination Zones:
Mark red/yellow/green zones (though study showed mixed results on this)
STEP 4: WHAT DIDN'T WORK (DON'T WASTE MONEY HERE)
The study found NO significant effect from:
Just meeting NFPA 1851 minimum standards (you need to do MORE than the minimum)
Where extractors are located (centralized vs. at each station)
How gear is dried (turnout dryer vs. air dry)
HEPA filters in stations
Having decon kits on apparatus (if people don't USE them)
Weird finding: Having a second set of gear was linked to HIGHER PFAS. Researchers don't know why yet. Don't change your gear policies based on this until more research explains it.
STEP 5: BUILD YOUR BUDGET JUSTIFICATION
Use this study to justify costs:
The case for leadership/city council:
This is peer-reviewed science from a major university
2,056 firefighters across 7 states prove these interventions work
PFAS causes cancer - officially classified by international health agencies
Every firefighter tested had PFAS in their blood
These policies will reduce cancer risk and future costs
Sample budget memo language:
"A January 2026 peer-reviewed study of 2,056 firefighters published in the Journal of Occupational and Environmental Medicine identified specific department policies associated with significantly lower PFAS levels. PFAS are 'forever chemicals' classified as carcinogens that were detected in 100% of firefighters tested. The study found that [specific policy] was associated with [X%] lower PFAS levels. Implementation cost is estimated at $[amount], which will reduce long-term cancer risk, workers' compensation costs, and recruiting/retention challenges."
Costs vs. Benefits:
Upfront costs: RO systems, gear bags, extra hoods, flooring = $[your estimate]
Ongoing costs: Water, cleaning supplies, maintenance = $[your estimate]/year
Savings: Reduced cancer cases, lower workers' comp, fewer disability retirements, better retention
Intangible benefits: Healthier firefighters, improved morale, competitive advantage in hiring
STEP 6: COMMUNICATE WITH YOUR PEOPLE
After reading this study, you need to:
Tell your firefighters:
What PFAS is and why it matters
What the study found
What the department is going to do about it
What they can do personally (donate plasma, check home water, etc.)
Timeline for changes
Ways to communicate:
Shift briefings
Department-wide email/memo
Post this website link in stations
Include in safety training
Discuss at union meetings
Be transparent:
If budget is tight, say so and explain the timeline
If testing found contaminated water, share results
If you're making changes, explain why
Ask for input on implementation
STEP 7: TRACK AND MEASURE
How to know if it's working:
Process measures (Are people doing it?):
Gear washing logs
Decon compliance observations
Hood rotation tracking
Cleaning checklists completed
Outcome measures (Is it making a difference?):
Encourage firefighters to join the ongoing research study
Some occupational health programs offer PFAS testing
Track cancer diagnoses (though this takes years to show change)
Annual review:
Are policies being followed?
Do procedures need updating?
What's working and what's not?
What does new research say?
STEP 8: STAY INFORMED
This research is ongoing:
The Fire Fighter Cancer Cohort Study is a 30-year project
More findings will come out about what works
New interventions will be tested
Technology and products will improve
How to stay updated:
Check science2station.org/breaking for new studies
Follow University of Arizona firefighter research
Attend fire service conferences with research tracks
Subscribe to occupational health publications
Connect with other departments implementing these changes