Improving Officer Resiliency to Stress and Associated Health Outcomes
Introduction
Developing training tools to help police officers sustain resilience and maintain mental and emotional composure should be a primary concern for the policing profession. Indeed, the importance of officer safety and wellness was a priority for the recent President’s Task Force on 21st Century Policing. Action item 6.1.3 of the task force report specifically states, “The Federal Government should support the continuing research into the efficacy of an annual mental health check for officers, as well as fitness, resilience, and nutrition.”1 Resilience is defined as the capacity to prepare for, recover from, and adapt in the face of stress, adversity, trauma, or challenge.2 To specifically support building officers’ resilience, interventions should equip officers with the tools to maintain composure and self-regulate their levels of stress in challenging situations and should further provide techniques that teach officers to quickly regain psychological and physiological balance afterwards.3
Project synopsis
Exposure to stress in police work is often unavoidable but affects performance and health. Recently, the authors of this article and research partners conducted a pilot study in the Milwaukee (Wisconsin) Police Department to examine the feasibility of a stress-resilience training intervention for modifying psychological stress and the extent to which it affects autonomic responses to stress and cardiovascular disease (CVD) risk factors in police officers. A group of 20 Milwaukee police officers between the ages of 21 and 65 volunteered for the study, were trained to use techniques to manage emotional and physical responses to stress, and practiced self-regulation of responses using biofeedback techniques including regulated breathing exercises. To assess outcomes, researchers used standard measures of psychological stress as well as standard biological variables such as blood pressure and heart rate variability (HRV). These measures were taken prior to the training intention (i.e., at baseline) as well as at three and six months following the training.
The importance of heart rate variability
The value of HRV as an indicator of an individual capacity to response to stress has been recognized for decades, but it has only recently been used in military and law enforcement settings to assess individual capacity to deal with and recover from stress. HRV is a measure of beat-to-beat changes in heart rate that occur naturally. Although a detailed discussion of the clinical significance of HRV is beyond the scope of this article, it is important to recognize that a level of variability in an individual’s heart rate is a desirable trait because it is indicative of an individual’s resilience. While HRV varies naturally among individuals and generally diminishes
with age, it is also important to realize that individuals can be trained to use biofeedback techniques and exercises to self-regulate breathing to improve their HRV.
Findings
The stress reduction intervention training in Milwaukee proved feasible, cost effective, and acceptable to officers. In this study, officers wore a FirstBeat heart rate monitor by HeartMath Institute, a small device that uses two electrodes placed on the chest to record data similar to that obtained by an electrocardiogram (EKG), which captures and records the electrical activity of the heart including reading of HRV over time. Overall police officers found this technology to be noninvasive and not disruptive to their normal routines.
Readers should be aware that technologies for measuring HRV are becoming more popular, and monitors compatible with Android and iPhone apps are now available at relatively low costs. Caution should be used, however, in employing some of the new monitoring devices being marketed, some of which are placed on a finger or an earlobe, because the accuracy and scope of measurement may not be comparable to devices designed to be placed on the chest. The company that produced the equipment used in this study, HeartMath, has developed an application for use with iPhone and iPad making it possible to eliminate the use of a separate monitor (“em Wave 2 device”), which has resulted in reduced cost of the equipment.
While the officers in this study were satisfied with the training they received and found the monitoring device to be acceptable and noninvasive, the officers as a group also benefited in several physiological outcomes. Specially, officers showed reductions in average diastolic blood pressure, which on average was a seven-point decrease (M = -6.8, SD= 9.3, p = .02) in the bottom number for blood pressure, as well as robust trends for associations between increased coherence (an HRV measure of resiliency to stress) and improved critical incident stress responses. The research team concluded that officers in this study had improved physical and psychological responses to job stress following a stress-resilience intervention.
Why this really matters
There are a number of reasons why this study matters. Foremost, this study confirms findings from a limited but growing number of studies in law enforcement and military settings that illustrate the value of HRV-based training protocols for reducing officer stress and improving health. While there may be few opportunities to change the dangers and stress inherent in the policing profession, meaningful steps can be taken to help officers self-regulate their responses and improve their resiliency to stress.
In addition, however, studies like this matter because in an environment of reduced budgets, in a period when the policing profession is under intense scrutiny and media attention, and at a time when increased numbers of officers are retiring, attention must to be given to those remaining in the workforce. Indeed, police executives have an obligation to avail themselves of all opportunities to enhance officer safety and wellness. They should consider officer safety and wellness not just to retain and promote the well-being of the officers they have but also because it can help ensure that their department is a viable career choice for potential recruits.
Exposure to acute and chronic stressors increases officers’ risks for developing adverse health outcomes.4 Compared to the general population, police officers tend to have poorer metabolic profiles and a higher prevalence of CVD risk factors.5 Because stress appears to be virtually unavoidable in the law enforcement profession, it is critical that officers develop the ability to recover from recurrent stressors if physiological and psychological well-being are to be maintained.6 Perhaps most important, research is beginning to show that while stress may contribute to poor decision making there is hope that developing stress resilience in officers can mitigate the negative effects of stress on decision making.7
Lessons learned
The majority of the officers in the study voiced positive feedback on all aspects of the study. Officers’ comments indicated they were more consciously aware of their stress levels and that the monitoring device allowed them the ability to take a mental step back and relax. Some officers remarked feeling calmer after using the device, and one officer reported experiencing more uninterrupted sleep when the device and self-stress reduction exercise technique were used prior to bedtime. Others commented on the effectiveness of the protocol beyond the job and into their personal life. Only one officer returned his practice device, stating, “This is just not for me.”
In retrospect, the most important thing missing from this pilot study as well as from other studies that address resilience is the building of both individual willingness and organizational support capacity to sustain the stress monitoring and self-regulation exercises after the researcher or trainer is gone from the law enforcement agency. Without a method to train mentors within agencies about how to execute the training and reinforce and build on the training, this intervention—like many other training endeavors in law enforcement—will be only temporary and will not likely be sustained or enhanced over time. Therefore, without organizational commitment and capacity to support and sustain this type of training protocol, the effects will be short term for projects like this. In future studies, it is important to have a plan to build organizational capacity to continue the work after the researcher and the funding are withdrawn from the agency.
Consideration might be given to bundling resiliency monitoring with other efforts to reduce stress and promote general well-being. As stated by the President’s Task Force, officer safety and overall well-being is a priority, and future research interventions should focus on promoting officer fitness, resilience, and nutrition.
The study presented here found clear value and benefit in the training and self-regulation methods for the period during which researchers were engaged with study participants, but the intervention was an isolated pilot study not broadly integrated into the department’s operations. Police executives should consider further adoption and experimentation in implementing HRV-based stress-regulation training and protocols. They should also seek to partner with researchers to assess these implementations. Integrating these protocols into general fitness and well-being programs, for instance, might well result in sustained benefits for officers—particularly those who are already committed to a fitness regime. More widespread benefits could also accrue if such a training protocol were introduced to new recruits during academy training, perhaps again as a part of a more integrated health and wellness plan. A potential benefit of such training in the academy would be establishing both individual and organizational commitment to a multifaceted approach to fitness, well-being, and stress management among police officers early in their careers.
Sandra Ramey
Assistant Professor
The University of Iowa College of Nursing and Public Health
John Markovic
Senior Social Science Analyst
The COPS Office
References
1 President’s Task Force on 21st Century Policing, Final Report of the President’s Task Force on 21st Century Policing (Washington, DC: Office of Community Oriented Policing Services, 2015), http://www.cops.usdoj.gov/pdf/taskforce/TaskForce_FinalReport.pdf.
2 Rollin McCraty and Mike Atkinson, “Resilience Training Program Reduces Physiological and Psychological Stress in Police Officers,” Global Advances in Health and Medicine 21, no. 5 (2012), 42–64,http://www.gahmj.com/doi/full/10.7453/gahmj.2012.1.5.013.
3Ibid.
4 Bengt Arnetz et al., “Assessment of Prevention Program for Work-Related Stress among Urban Police Officers,” International Archives of Occupational and Environmental Health 86, no. 1 (2013), doi: 10.1007/s00420-012-0748-6.
5 Tara A. Hartley et al., “Health Disparities in Police Officers: Comparisons to the U.S. General Population,” International Journal of Emergency Mental Health 13, no. 3 (2011), 211–220, http://www.omicsonline.com/open-access/health-disparities-in-police-officers-comparisons-to-the-us-general-populations.pdf; Sandra L. Ramey, Nancy R. Downing, and Warren D. Franke, “Milwaukee Police Department Retirees: Cardiovascular Disease Risk and Morbidity among Aging Law Enforcement Officers,” American Association Occupational Health Nurses Journal, 57, no. 11 (2009), 448–453, http://whs.sagepub.com/content/57/11/448.full.pdf; Bruce R. Wright, Celestina Barbosa-Leiker, and Trynke Hoekstra, “Law Enforcement Officer Versus Non–Law Enforcement Officer Status as a Longitudinal Predictor of Traditional and Emerging Cardiovascular Risk Factors,” Journal of Occupational and Environmental Medicine. 53, no. 7 (2011), 730–734, doi: 10.1097/JOM.0b013e318220c2da.
6 Douglas C. Johnson et al. “Modifying Resilience Mechanisms in At-Risk Individuals: A Controlled Study of Mindfulness Training in Marines Preparing for Deployment,” American Journal of Psychiatry. 171, no. 8 (2014), 844–853, doi: 10.1176/appi.ajp.2014.14040501.
7 velyn-Rose Saus et al., “The Effect of Brief Situational Awareness Training in a Police Shooting Simulator: An Experimental Study,” Military Psychology 18, Supplement (2006), S3–S21, http://psycnet.apa.org/journals/mil/18/S/S3.pdf&productCode=pa .
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