Robert John Zagar PhD MPH and Brandon Northern<\/span><\/p>\n Current ways of finding challenges like trauma and stress miss 61% of at-risk. Conventional approaches of interviews, background checks, and short paper and pencil tests are less than chance accurate and comparable to a coin toss. This costs billions of U.S. dollars in work productivity. This is money that can be used for education, and making communities, workplaces, and the armed forces safer. Finding trauma and post-traumatic stress are crucial to treating it, given that many estimates suggest one in five police officers and even more corrections officers suffer chronically from these two issues.\u00a0 It is an occupational hazard built into the job.<\/span><\/p>\n Post-traumatic stress (PTSD) is experienced at many points of life, in any setting. Understanding that it can be diagnosed accurately and treated is crucial to keeping police officers healthy and functioning at peak levels. Understanding PTSD requires comprehending trauma. To do that it\u2019s important to distinguish between acute and chronic trauma. <\/span><\/p>\n Psychiatrist Lenore Terr of Columbia University labeled acute as type I and chronic as type II. Acute refers to a single event that has not been preceded by other events. Chronic refers to longstanding exposure to events, something most officers experience daily. \u00a0I would add a Type III as a more extreme trauma, resulting from multiple, pervasive violent events beginning early in life during childhood and continuing for years.<\/span><\/p>\n The long term effects of acute trauma are full-detailed memory and PTSD symptoms. For chronic trauma, add poor self-esteem\/self-concept, interpersonal distrust, and shame. For type III trauma there was foreshortened sense of future, rage, and impulsivity. Type III trauma sufferers are often not identified as victims due to poor memory resulting in dissociation.<\/span><\/p>\n Chronic danger and experiences of violence impose a requirement of developmental adjustment. Sometimes the person cannot assimilate trauma into existing conceptual frameworks. Officers adopt a negative view of the world.\u00a0 Loved ones help mediate this trauma. This is part of the \u201czone of proximal development\u201d which is consistent with an individual\u2019s capability of functioning on their own. \u00a0However, the traumatized can do better with a \u201cteacher\u201d (anyone who guides the person by offering responses that are emotionally validating or developmentally challenging). This provides a developmental grounding for understanding the \u201cnatural\u201d therapeutic efforts of others and for the \u201cprogrammatic\u201d efforts of professionals. It is why having one person who is psychologically available can go a long way toward helping officers heal from chronic trauma.<\/span><\/p>\n Chronic trauma, according to Bruce Perry, is over-stimulation of more primitive parts of the brain at the expense of sophisticated regions that process higher reasoning. This over-stimulation can produce an over-development of the amygdala that processes emotions, particularly anger and fear. PTSD can result in inability to manage arousal and gives meaning to frightening experiences. One develops an inability to effectively handle the physiological stress responses in threatening situations and come face-to-face with human vulnerability and evil in the natural world.<\/span><\/p>\n What can you do if you suspect PTSD?\u00a0\u00a0 Use internet tests such as the MMPI-2 and the Standard Predictor. If the officer is reluctant, ask them to see their private physician and therapist. All have coverage under insurance. Next, try one of 4 evidence-based approaches: prolonged exposure, eye movement desensitization, cognitive processing, and anti-depressants.<\/span><\/p>\n First, research on Prolonged Exposure (PE) has a 1.91 effect size \u2014 a large effect. In this treatment, a therapist guides the client to recall traumatic memories in a controlled fashion to eventually regain mastery of feelings around the incident. While exposing people to the very events that caused trauma may seem counter-intuitive, it\u2019s emphasized that it\u2019s a gradual, controlled manner until the person can understand they can return to normal life.<\/span><\/p>\n Second, the research says Eye Movement Desensitization and Reprocessing (EMDR) has a large 1.89 effect. In this intervention the therapist guides clients to make eye movements or follow hand taps as they recall traumatic events. It\u2019s not clear how EMDR works, for that reason; it\u2019s somewhat controversial, though the therapy is research-supported.<\/span><\/p>\n Third, Cognitive Processing Therapy (CPT) has a 1.81 large effect. This diversion from PTSD includes an exposure component, but places greater emphasis on altering erroneous thinking. Practitioners alter false beliefs that they\u2019re incompetent because they\u2019ve \u201clet\u201d a terrible event happen.<\/span><\/p>\n Finally fourth, Selective Serotonin Reuptake Inhibitors (SSRIs), or antidepressants have a 1.64 large effect. Specifically these have been approved by the Federal Drug Administration. Probably two or more of these approaches will result in a greater lowering of PTSD symptoms. \u00a0<\/span><\/p>\n Perhaps the largest barrier to finding effective treatments is the culture that exists within law enforcement. The profession requires officers to rein in their own emotions to take control of complex situations. Flipping that emotional switch can be difficult for those engaged in a profession steeped in \u201cnever let them see you cry\u201d sensibilities. Even when their department offers mental health services, officers may be reluctant, fearing lack of confidentiality or the perception of weakness.<\/span><\/p>\n