A Biological Approach to Building Resilience and Wellness Capacity Among Police Exposed to Posttraumatic Stress Injuries: Protocol for a Randomized Controlled Trial.

BACKGROUND: Law enforcement officers are routinely exposed to hazardous, disturbing events that can impose severe stress and long-term psychological trauma. As a result, police and other public safety personnel (PSP) are at increased risk of developing posttraumatic stress injuries (PTSIs) and disruptions to the autonomic nervous system (ANS). ANS functioning can be objectively and noninvasively measured by heart rate (HR), heart rate variability (HRV), and respiratory sinus arrhythmia (RSA). Traditional interventions aimed at building resilience among PSP have not adequately addressed the physiological ANS dysregulations that lead to mental and physical health conditions, as well as burnout and fatigue following potential psychological trauma. OBJECTIVE: In this study, we will investigate the efficacy of a web-based Autonomic Modulation Training (AMT) intervention on the following outcomes: (1) reducing self-reported symptoms of PTSI, (2) strengthening ANS physiological resilience and wellness capacity, and (3) exploring how sex and gender are related to baseline differences in psychological and biological PTSI symptoms and response to the AMT intervention. METHODS: The study is comprised of 2 phases. Phase 1 involves the development of the web-based AMT intervention, which includes 1 session of baseline survey measures, 6 weekly sessions that integrate HRV biofeedback (HRVBF) training with meta-cognitive skill practice, and 1 session of follow-up survey measures. Phase 2 will use a cluster randomized control design to test the effectiveness of AMT on the following prepost outcomes: (1) self-report symptoms of PTSI and other wellness measures; (2) physiological indicators of health and resilience including resting HR, HRV, and RSA; and (3) the influence of sex and gender on other outcomes. Participants will be recruited for an 8-week study across Canada in rolling cohorts. RESULTS: The study received grant funding in March 2020 and ethics approval in February 2021. Due to delays related to COVID-19, phase 1 was completed in December 2022, and phase 2 pilot testing began in February 2023. Cohorts of 10 participants in the experimental (AMT) and control (prepost assessment only) groups will continue until a total of 250 participants are tested. Data collection from all phases is expected to conclude in December 2025 but may be extended until the intended sample size is reached. Quantitative analyses of psychological and physiological data will be conducted in conjunction with expert coinvestigators. CONCLUSIONS: There is an urgent need to provide police and PSP with effective training that improves physical and psychological functioning. Given that help-seeking for PTSI is reduced among these occupational groups, AMT is a promising intervention that can be completed in the privacy of one's home. Importantly, AMT is a novel program that uniquely addresses the underlying physiological mechanisms that support resilience and wellness promotion and is tailored to the occupational demands of PSP. TRIAL REGISTRATION: ClinicalTrials.gov NCT05521360; https://clinicaltrials.gov/ct2/show/NCT05521360. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/33492.

Testing the Efficacy of a 1-Day Police Decision-Making and Autonomic Modulation Intervention: A Quasi-Random Pragmatic Controlled Trial.

Contemporary discourse has identified several urgent priorities concerning police training and education, including: (a) empirically testing and validating the effectiveness of current programming in reducing lethal force decision-making errors; (b) integrating evidence-based content and pedagogical approaches into police curriculum; and (c) understanding the breadth and length of programming necessary to ensure learning and transfer of skills to operational field settings. Widespread calls to identify effective and actionable training programs have been met with numerous research studies, systematic reviews, and policy recommendations that reveal the need to train officers' internal physiological awareness, which is foundational in shaping cognitive decision-making, emotion regulation, and behavior under stressful conditions. Several investigations have shown improvements to both lethal force errors and physiological recovery following a multi-day autonomic modulation (AM) intervention. Immediate and sustained training gains are observed following repeated practice with clinically validated protocols integrated into training scenarios. Despite evidence-based support for AM in addressing the aforementioned priorities, police organizations are faced with limited time and funding for training and education. The goal of the current quasi-random pragmatic controlled trial was to evaluate the effectiveness of a modified 1-day version of an established AM intervention. A sample of active-duty police officers were quasi-randomly assigned to an AM intervention (n = 82) or waitlist control group (n = 105). Lethal force errors and objective measures of autonomic arousal and recovery were measured during reality-based scenarios pre- and post-training and at 12-month follow-up. In contrast to previous investigations of longer AM intervention protocols, no significant training-related improvements to behavioral or physiological outcomes were found immediately post-intervention or at follow-up. The current results suggest that single-day training is insufficient to learn the physiological awareness and regulation skills necessary to perform effectively during lethal force encounters, as demonstrated by a lack of immediate or sustained training effects. Practical considerations, such as resource allocation, that may undermine the effectiveness of implementing evidence-based police training are discussed.

Reducing Lethal Force Errors by Modulating Police Physiology.

OBJECTIVES: The aim of this study was to test an intervention modifying officer physiology to reduce lethal force errors and improve health. METHODS: A longitudinal, within-subjects intervention study was conducted with urban front-line police officers (n = 57). The physiological intervention applied an empirically validated method of enhancing parasympathetic engagement (ie, heart rate variability biofeedback) during stressful training that required lethal force decision-making. RESULTS: Significant post-intervention reductions in lethal force errors, and in the extent and duration of autonomic arousal, were maintained across 12 months. Results at 18 months begin to return to pre-intervention levels. CONCLUSION: We provide objective evidence for a physiologically focused intervention in reducing errors in lethal force decision-making, improving health and safety for both police and the public. Results provide a timeline of skill retention, suggesting annual retraining to maintain health and safety gains.