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TRAUMATIC REENACTMENT


October 7, 2014
By Lindsy Richardson

We all now know that having to seriously injure or kill someone in the line of duty is significantly related to post traumatic stress disorder (PTSD) symptoms and depression. A huge mental health problem, PTSD impacts officers, their families and work.

Naturally, work in our field exposes us to traumatic situations like responding to child sexual assaults, attending gruesome motor vehicle collisions or being openly humiliated in the media after a Police Service Act charge.

Police culture is a very macho environment that has created a stigma around seeking mental health help. Asking employees after a stressful incident if they need counselling will result in a flat no and probably even a smirk. Posters on walls or even bathroom stalls will be ignored. I recommend that police services be more proactive and offer services that officers relate to. We are not nursery school providers or librarians.

When we think psychological treatment we think Prozac and long deep conversations with a shrink. From my experience the typical police officer will likely not want to go through this or even believe it is necessary. However, years down the road symptoms such as sleep disturbances, reckless behaviour, increased aggression or diminished interests might surface and by then it will be difficult to determine their cause.

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Police agencies are equipped to help their own people. Canadian police services have the resources and equipment to provide effective treatment for officers with PTSD symptoms. As an alternative to the usual employee assistance program I recommend scenario-based exposure training for officers involved in incidents where a civilian was seriously injured or killed.

There is research demonstrating how re-exposure to previous traumatic events will reduce post traumatic stress symptoms. For example, researchers <Foa, Rothbaum, Riggs and Murdock (1991)> conducted a study comparing exposure training to counselling. Victims of rape were asked to participate in seven sessions reliving the entire incident through their own imagination. Patients were instructed to imagine the sexual assault and describe it out loud. They were recorded and asked to listen to the audio recording every day as homework. The researchers found that this approach led to a decrease of PTSD symptoms.

A meta-analysis of 20 randomized controlled trials, involving 1,308 participants, by demonstrated that exposure was just as effective as cognitive behavioural therapy. A 2011 study by compared virtual-reality exposure therapy to the standard treatment for post traumatic stress. All 20 participants were active duty service members who served in Operation Iraqi Freedom or Operation Enduring Freedom (Afghanistan) and had been diagnosed with PTSD by a health professional.

The researchers found that 70 per cent of participants who received the virtual reality exposure demonstrated a clinically significant decrease in PTSD symptoms after a 10 week treatment program. A segment of this treatment program also included training on techniques such as relaxation and attention control.

Another study by found that prolonged exposure therapy was superior to treatment as usual (TAU) for short- and long-term effects of PTSD and depression symptoms. The study included 30 patients who suffered PTSD symptoms from combat and terror related incidents.

This is where police services can make an important difference for those who need help the most. Many large services have training divisions and use scenario-based training for recruit and annual mandatory training. By incorporating the same resources police agencies can help officers involved in traumatic life threatening incidents use systematic desensitization techniques to expose them to a replication of the same stimuli that caused the initial trauma. An example of an exposure-based program (exposure therapy should not be conducted without the supervision of a licensed therapist) could be:

Session A – Police officer meets with police service training team and a therapist to provide a detailed description of the exact traumatic event.

Session B – Training team and therapist provides officer with relaxation, breathing and coping exercises to be used throughout the scenarios.

Session C – Training team and therapist gradually introduces the officer to the traumatic stimuli.

Session D – Training team and therapist continue to gradually introduce the officer to the traumatic stimuli.

Session E – Training team and therapist expose officer to a full replication of the traumatic event.

Session D – Training team and therapist expose officer again to the full replication of the traumatic event.

Session E – Training team and therapist replicate the entire traumatic event, if feasible, at the exact location and time of the initial event.

Ottawa based PTSD specialist Dr. Brenda Saxe believes the facilitator must have a secure relationship with the participant for exposure training to be effective. A therapist would not walk into a therapy session yelling or criticizing their patient, nor should your training team. Officers with PTSD are individuals with significant mental health concerns who deserve patience, respect and a positive exposure experience. The process of healing requires a safe and caring approach, which is almost a polar opposite of the stereotypical approach of a defensive tactics instructor.

{References}

Foa, E. B., Rothbaum, B. O., Riggs, D. S., & Murdock, T. B. (1991). Treatment of posttraumatic stress disorder in rape victims: a comparison between cognitive-behavioral procedures and counseling. 59(5), 715. doi: 10.1037/0022-006X.59.5.715

McLay, R. N., Wood, D. P., Webb-Murphy, J. A., Spira, J. L., Wiederhold, M. D., Pyne, J. M., & Wiederhold, B. K. (2011). A randomized, controlled trial of virtual reality-graded exposure therapy for post-traumatic stress disorder in active duty service members with combat-related post-traumatic stress disorder. <Cyberpsychology, Behavior and Social Networking,> 14(4), 223-229. doi: 10.1089/cyber.2011.0003.

Nacasch, N., Foa, E. B., Huppert, J. D., Tzur, D., Fostick, L., Dinstein, Y., & Zohar, J. (2011). Prolonged exposure therapy for combat-and terror-related posttraumatic stress disorder: a randomized control comparison with treatment as usual. 72(9), 1174-1180. doi: 10.4088/JCP.09m05682blu

Ougrin, D. (2011). Efficacy of exposure versus cognitive therapy in anxiety disorders: Systematic review and meta-analysis. 11(1), 200. doi: 10.1186/1471-244X-11-200

BIO

Dr. Lindsy Richardson has a doctorate in organizational psychology and is an Ottawa police officer. This article does not reflect the opinion of the Ottawa Police Service. Contact him at lindsyrichardson@yahoo.ca to learn more about the program.

*Exposure therapy should not be conducted without the supervision of a licensed therapist.