Symposia
Disaster Mental Health
Kathryn Trottier, Ph.D.
University Health Network
Toronto, Ontario, Canada
Susan E Abbey, MD
Psychiatrist-in-chief
University Health Network
Toronto, Ontario, Canada
Candice M. Monson, Ph.D.
Professor
Ryerson University
Toronto, Ontario, Canada
Debra Kaysen, ABPP, Ph.D.
Professor
Stanford University
Palo Alto, California
Anne C Wagner, PhD
Psychologist
Remedy
Toronto, Ontario, Canada
Rachel Liebman, PhD
Psychologist
University Health Network
Toronto, Ontario, Canada
Many healthcare workers on the frontlines of the COVID-19 pandemic are experiencing clinical levels of mental health symptoms. Effective interventions to address these symptoms are urgently needed. RESTORE is an online guided transdiagnostic intervention adapted from evidence-based cognitive behavioral therapies for anxiety, depression, and posttraumatic stress disorder (PTSD). It was designed to address the range of mental health symptoms associated with COVID-19-related traumatic and extreme stressors, and to overcome barriers to accessing psychotherapy. RESTORE addresses three potential causal and maintaining mechanisms: (1) social isolation and withdrawal from positive activities, (2) avoidance of thoughts, feelings, and situations related to extremely stressful events, and (3) negative cognitions about the cause, meaning, and implications of the events. In an initial study, we assessed the feasibility, acceptability, and initial efficacy of RESTORE in healthcare workers. Twenty-one individuals exposed to COVID-19-related traumatic or extremely stressful experiences in the context of their work and who screened positive for clinical levels of anxiety, depression, and/or PTSD symptoms were enrolled. Co-primary outcomes included the Generalized Anxiety Disorder-7, Patient Health Questionnaire-9, and PTSD Checklist-5 administered at baseline, mid-intervention, end-of-intervention (EoI), and 1-month follow-up. An intent-to-intervene approach to data collection was utilized. Changes in the three primary outcomes were tested using multilevel growth models estimated with restricted maximum likelihood and a Kenward-Roger correction for small samples. RESTORE was found to be feasible and safe, and there were statistically significant improvements from baseline to EoI of large magnitude on anxiety (g = 1.05), depression (g = 0.89), and PTSD symptoms (g = 1.23), and additional improvements over 1-month follow-up (gs = 1.34-1.84). There were also moderate to large improvements in grief, guilt, perceived health, work functioning, and quality of life (gs = .57-1.20 at EoI and gs = .40-1.45 at follow-up). Participant satisfaction ratings were high (20.7 out of 24). We will also present findings from program evaluation in healthcare workers, as well as methodology from a randomized controlled trial evaluating RESTORE. RESTORE has the potential to become a widely disseminable evidence-based intervention to address mental health symptoms associated with mass traumas such as those experienced in the COVID-19 pandemic.