Reducing emotional numbing symptoms among war paramedics: an action-research trial of a cognitive-behavioural and expressive-arts intervention in south Lebanon

Abstract

A participatory action-research design was employed with eight male paramedics (aged 18–30) from the Al-Risala Association for Health Emergency, Jabal Amel/Tyre Division, selected through purposive sampling from an initial screened pool of 92 paramedics (of whom 43 exceeded the clinical numbing threshold). Data was collected through individual and group interviews, guided behavioural observation, and a locally validated 62-item Emotional Reactivity and Numbing Scale (ERNS) spanning five domains (positive effect, sadness, general affect, anger, fear). A 12-session, 3-month intervention combining psychoeducation, cognitive restructuring (ABC model), mindfulness/grounding exercises, and expressive-arts techniques was delivered weekly. ERNS internal consistency was excellent (Cronbach's α = 0.956 total scale; subscale α = 0.738–0.955) and split-half reliability strong (Guttman = 0.877). All eight participants showed elevated baseline numbing (M = 3.44–4.53), with four classified as severe. Post-intervention scores decreased across all participants without exception, with improvement ranging from 4.4% to 37.3% (M reduction = 0.73 scale points). Six of eight participants shifted from a high/very high to a moderate numbing classification. A structured CBT-based intervention augmented with expressive-arts and mindfulness components produced consistent, measurable reductions in emotional numbing among war paramedics, despite considerable inter-individual variability in response magnitude. These findings support the institutional integration of systematic psychological support programmes within humanitarian ambulance organisations operating in conflict-affected regions.