Police Psychology | An Ounce of Prevention is Worth a Pound of Cure

Robert John Zagar PhD MPH and Brandon Northern

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.  It is an occupational hazard built into the job.

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’s important to distinguish between acute and chronic trauma.

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.  I 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.

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.

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.  Loved ones help mediate this trauma. This is part of the “zone of proximal development” which is consistent with an individual’s capability of functioning on their own.  However, the traumatized can do better with a “teacher” (anyone who guides the person by offering responses that are emotionally validating or developmentally challenging). This provides a developmental grounding for understanding the “natural” therapeutic efforts of others and for the “programmatic” 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.

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.

What can you do if you suspect PTSD?   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.

First, research on Prolonged Exposure (PE) has a 1.91 effect size — 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’s emphasized that it’s a gradual, controlled manner until the person can understand they can return to normal life.

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’s not clear how EMDR works, for that reason; it’s somewhat controversial, though the therapy is research-supported.

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’re incompetent because they’ve “let” a terrible event happen.

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.  

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 “never let them see you cry” sensibilities. Even when their department offers mental health services, officers may be reluctant, fearing lack of confidentiality or the perception of weakness.

The first step toward breaking down the emotional and cultural barriers is to address the issue during training. To reinforce understanding of mental health issues within the profession, there should be in-service training for all emergency responders. There still is the stigma of seeking help and a belief of being weak. But training family and friends seems to be a help. Early intervention is the key to successfully treating PTSD. More focus in the academy on how to stay mentally healthy would help—except that these officers tend to be younger and less likely to see how they might be negatively affected. To avoid the stigma associated with psychological services, there are websites and chat rooms that provide an anonymous forum for officers to share their experiences and provide support in a non-judgmental way. Another confidential source of support for officers is Safe Call Now, established by former officer Sean Riley. At this site, officers can speak confidentially to peers who understand their pain.  Then of course there is the very site you are on at this moment, Inside Police Psychology, that brings psychological information into the forefront of policing.

A number of similar hotlines and forums exist to provide support. As valuable as these outlets are for helping combat the stigma surrounding mental health in law enforcement, they don’t replace the need for formal support systems. It’s imperative that departments offer employee assistance programs, whether developed in-house or outsourced. Although most can never understand the horrors of the job—perpetually wondering when the last moments of life will be—there are ways in which families can help. For families who know their loved ones have been through a traumatic event, getting them to talk or deal with it is probably the wrong thing to do. Just being there and being patient and supportive in a quiet way is enough. 

Sometimes the experience of “the straw that broke the camel’s back” leads to a call for help. It’s important to make a list of all the traumatic events over the years because many of these events never get processed to the extent necessary to provide insight. The first responder culture is characteristically resistant to discussing mental health or seeking treatment for it. When traumatic experiences are encountered on the job, first responders are encouraged to get over them quickly because they have duties.

Officers worry they might be skipped over for promotion if word gets out they have sought counseling. There is an element of secrecy and insulation in police culture that serves as a barrier to seeking help. Part of that insulation stems from the distrust that sometimes seems to exist between police officers, the public, and the media. If an officer encounters an armed suspect and doesn’t react quickly, they may die. If the officer shoots, the media may portray them as unnecessarily brutal. It makes sense that officers sometimes believe that society doesn’t truly understand what they go through.

There is a push to pay more attention to mental health issues among officers because administrators have come to see that neglecting mental health care ends up being more costly in the long run. The department spends a lot of money training officers over many years. If an officer retires early or quits, the agency has to spend more money to train new officers. The growing awareness may also come from the officers themselves, who tend to be better educated than past years, including on the topic of mental health.

When thinking about PTSD, one needs to realize that people react to the same situation in different ways. Some police officers may be deeply affected by what they experience, while others won’t.

As a result, mental-health service providers have increased their outreach efforts to engage officers. Despite poor utilization of services, the majority of officers reported having a primary health-care provider whom they see for routine health evaluations. Because this health-care contact occurs outside the department, under patient-provider confidentiality, it may provide an ideal opportunity to address psychological distress.

 

Site Editor:  Gary S. Aumiller, Ph.D. ABPP

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