Protecting Against Stress & Trauma - Part 1: Defining the Problem

DAVID MUHLHAUSEN: Good morning and welcome to the National Institute of Justice. I’m very pleased to see so many people here today to learn about the important research and educational work we conduct at the National Institute of Justice. The researchers you will hear from today are pioneers in the field of the Evidence-Based Policing Movement. They are leading scholars and LEADS scholars. For those of you not familiar with the LEADS Scholarship Program, LEADS stands for Law Enforcement Advancing Data and Science.

One of our LEADS scholars here today, Sgt. Obed Magny is from the Sacramento Police Department where they just lost an officer. In fact, Obed flew here to DC from California directly from the fallen officer’s funeral. All of us here at NIJ and OJP are saddened to hear about the loss of Officer Tara O’Sullivan from the Sacramento Police Department. She was 26 years old and had been on the force for only six months. Our hearts go out to Sgt. Magny and to all his colleagues at the Sacramento Police Department and Officer O’Sullivan’s friends, family, and loved ones.

NIJ has long recognized that police and corrections work are among the most stressful and dangerous of professions. The safety, health, and wellness concerns that draw us together today are not new. And this work is not becoming any less stressful, not any time soon. Over 20 years ago, NIJ started funding research into fatigue and its impact on officer health, safety, and performance. In 2005, we funded research examining the connection between shift work, exhaustion, sleep disorders, and officer health and wellness. Although we have invested significant resources into many factors affecting the health of police officers and corrections officers, there remains a need for further research into factors affecting officer safety, health, and wellness. In 2016, NIJ began a concentrated effort to address these issues. We integrated science and evidence-based tools into our safety, health, and wellness strategic plan. This strategic plan focuses on stress, PTSD, and suicide in law enforcement, as well as the broader criminal justice community. Sadly, NIJ’s initiatives come at urgent time when suicides and PTSD are a rising concern. NIJ will focus our efforts and never let up until these tragedies are a thing of the past.

Some of the sources of stress in law enforcement are known or have been known to generations of officers. These include consistent exposure to people in distress and pain, the responsibility of protecting the lives of citizens, threats to officer life, and an officer having to control emotions at all times even when provoked, and the unpredictable pace of the daily job. Situations can arise quickly in an officer’s line of work. To be blunt, these and related issues have not always been given the focus they deserve. Importantly, the corrections community is sometimes neglected. This is even though the stresses and dangers of working in prison conditions are as great, if not greater, than those faced by police officers working in the general population. NIJ’s strategic plan includes studies of the unique safety concerns present, indeed omnipresent in correctional settings. We fund this research now and will continue to do so. Our research delves into agency policies and their effects on officer stress. For example, overtime work has long been rewarded, even required during short staffing. There is reverse incentive to earn more money and show loyalty and commitment by working overtime. But there is often a price in health, safety, and wellness.

As DOJ’s research and evaluation agency, NIJ has a commitment to evidence-based practices. We demand rigorous evaluations to determine what works and what doesn’t work. One way we determine the most effective practices is by supporting our LEADS scholars in the field. Today, we have among us several practitioners who are LEADS scholars. They are developing science-based interventions that can be applied in many settings including with their own agencies. Many of them are working on health and wellness-related projects. LEADS scholars please rise, stand up.  I asked you to rise because I want to recognize all the hard work you put in both in the execution of your official duties and for the additional research you take on your own time, so thank you very much.

NIJ began this Research for the Real World series back in 2009. We want to feature research that is changing our thinking about criminal justice policies and practices. We seek to hear from both practitioners doing research and researchers striving to impact practice. Panels like the one today are critically important because they allow us to discuss our work and share it with people it directly affects. Our panelists today include researchers who are subject matter experts in the field of stress and trauma, as well as two practitioners with experience in treating officer stress and trauma. NIJ works shoulder to shoulder with these practitioners. I look forward to hearing our speakers discuss the work they do and how it will support officers in their varied work environments every day. It is now my pleasure to welcome Principal Deputy Assistant Attorney General of the Office of Justice Programs, Katie Sullivan who will kick off our discussion.

DAVID MUHLHAUSEN: Before joining the Department of Justice, Katie was a Colorado State Trial Court judge for 11 years. She has heard over 45,000 cases during her years on the bench including domestic violence cases, sexual assaults, cases involving drugs and alcohol. Before I give Katie the floor, I want to say that NIJ is very excited to have Katie here. She’s a dynamic leader and she just exudes enthusiasm, and NIJ, I believe, is operating, I would say, in fifth gear. Now that Katie’s here, we have to find our fifth gear because we’re just going to have to push even harder and do more. So Katie, you have the floor.

KATHARINE T. SULLIVAN: Thank you, Dave.

KATHARINE T. SULLIVAN: Thank you. Hey, this is so great. Thank you so much. It’s a real privilege. I want to tell all of you I started last Monday in leading the Office of Justice Programs, longtime friend of Dave Muhlhausen’s and know how deep his commitment is to the work that’s being done here at the National Institute of Justice. So when he asked me to come and just deliver a couple of quick welcoming remarks, the answer is “absolutely yes.” particularly for this series. The Research for the Real World is something I think is vital. I understand this program has been going on for many, many years and I know that David and Howard work very hard to make sure that this series in particular is relevant, and helpful, and have figured out ways to make it more dynamic and useful to all of you. So I really appreciate so much the work that Dave and Howard are doing and this is going to be a great panel. Thank you to the panelists. You guys have gone out of your way to come and be here today. We so appreciate your expertise and so thank you very much. I know this is going to be a great discussion.

I do want to talk just briefly about trauma and policing. So I was never a police officer, I was a prosecutor and then presided over a rural trial court for 11 years in Colorado. When you’re a rural court judge, you have to do everything, right? So you’re listening to a motions hearing for a DUI stop and then you got to take a break because someone comes in with a temporary protection order or an eviction. You really wear so many hats as a rural court judge and you really get to see a very, very big picture. I have always so deeply appreciated law enforcement and the job that you all do. And I always looked at being a prosecutor as partnering with law enforcement—that the way a prosecutor’s office works very effectively is to create partnerships and collaboration, and really good strong communication.

When I was kind of a brand new district attorney, the domestic violence laws—so this would’ve been in 2000—in the state of Colorado changed and we went to the mandatory arrest. Some of you are too young to know that it wasn’t always a mandatory arrest situation, but in 2000 in reaction to the Violence Against Women Act, many states adopted this law instructing police officers that if there was probable cause, they must arrest in a domestic violence situation. Our officers were having a difficult time. It really marked a very big change in the way that they approached these cases. They weren’t completely sure how to handle it. All of them did not have a great attitude about it.

So I started as a district attorney in this rural part of Colorado and so I said that every domestic violence case, I would go ahead and go out with them, just to call me and pick me up, and I would go to the scene with them while we were figuring all of this out. So very shortly after that about 11:00 at night, I got a phone call, got in the car, the guys took me out and it’s pitch black in the middle of nowhere on a ranch in Colorado. A woman is hysterical. She’s with the victim’s advocate and she keeps talking about how he has a gun, he has a gun, he has a gun. She says he ran that way into the pitch black. The officers start trying to look for him. And didn’t find him that day but he did turn himself in the next morning. She was put in a safe shelter. This was 19 years ago and I remember every single detail of that event. Every detail. That was one time that I went out with these officers. Forevermore that experience has reminded me that you guys do that every day, multiple times a day. You’re going into those situations that when you roll up on something, you have absolutely no idea what might happen.

I have to tell you first of all thank you. Thank you for what you do. Thank you for protecting us. Thank you for protecting your communities. But I also want to say that just from that one event, I think about how you have to create skills in order to be able to get up out of bed every morning to go roll up on the next call. There are certain things that you do internally and emotionally and all these brilliant people are going to talk about it in order to keep doing your jobs especially in this culture. Right now, we just have a lot of tension around law enforcement and communities. That doesn’t help in any way, shape, or form. So I think this idea of trauma and secondary trauma is a vital discussion and I’m so appreciative that Dave has brought this and used this as a topic for this panel.

I also want to talk about the suicide rates among law enforcement which Dave mentioned. Suicide is the worst outcome of the mental health challenges faced by law enforcement. But police also have higher than average rates of depression and PTSD. Just very quick anecdote, I ran a drug court and a DUI court. Our teams would all come to Colorado, to Denver, and we’d have a big conference. In one year, they focused on secondary trauma. We took the test. I was like, “Oh my God. I have a docket that is so busy, I love to work. I got to go sit here and listen to this stuff about secondary trauma. This has nothing to do with me. I sit up on the bench.” All this stuff. Now I start taking the little tests. Turns out I’m sort of in the high yellow zone moving into a red zone. I mean, it was stunning to me. I really had a prism change and I know that it isn’t always in the criminal justice world. We don’t always talk about the emotional health of the people in the criminal justice world. But I think we’re starting to and I know that NIJ is committed to this and this panel is committed to it.

So with an open mind, I think that you guys are going to learn a lot and hopefully a lot about yourselves in ways that you can help not only yourselves but the other people that you work with, so thank you very much. Thank you to everyone on Webex. This is a very popular series. I’m absolutely thrilled to be here and so appreciate all of you. Thank you.

HOWARD SPIVAK: Good morning, everybody. I’m Howard Spivak. I’m the Principal Deputy Director of NIJ and we’ll be moderating the panel. This session is going to be different from many of the other Research in the Real World sessions in that we’re not going to have four talking heads standing up here giving presentations but we’re going to have a facilitated discussion about this issue of stress and trauma and how we deal with it, which I think will allow for some exchange and some interesting conversation. We will eventually open things up for questions and comments from the audience as well.

As David mentioned, NIJ over the last three or four years has increased its efforts in the area of safety and wellness for people working in the criminal justice system. But actually one of the surprises for me when I first came to NIJ was the fact that NIJ had in fact funded some of the early research on sleep deprivation and its impact on functioning at work. That was particularly relevant to me because I’m trained as a physician. I spent two years during my training working 36 hours on, 12 hours off with all of 28 days off for vacation during those two years. So not only was I being asked to make life and death decisions with 30 or more hours of being awake, but I literally fall asleep driving home and pass my house. It was incredibly dangerous and in fact, some of the research that NIJ has funded contributed to the change in the medical training system that has stopped that from happening. I wish it had happened before I started training but at least it’s happening now.

So on that note, I think I’d like to get started and I’d like to introduce the panelists. To my far right is Chris Scallon who is a retired sergeant from the Norfolk Police Department and is currently director of Public Safety Support for Chateau Recovery. He has 24 years of experience mentoring law enforcement officers who experienced critical incidents. To my right is John Violanti who’s a researcher professor at the University of Buffalo and is an expert in the field of police stress, health, and suicide. To my immediate left is Wendy Stiver who’s a major in the Dayton Ohio Police Department, is also a LEADS Scholar. Did you stand when David asked? You didn’t? Okay. And is also currently a practitioner in residence at NIJ, so she’s spending a lot of time here doing work. And among other things, she’s done work in addressing the issue of officer stress and trauma through my mindfulness training. Then to my far left is Dan Grupe who is an assistant researcher at the University of Wisconsin in Madison and his background is in studying resiliency to stress and trauma. I’d just like to get things started and I think a nice way to do this is to start with Wendy and have her talk a bit about some of her own personal experiences as well as what she’s seen with some of her colleagues on the job with respect to stress and exposure to trauma and implications of that. So Wendy.

WENDY STIVER: Thank you, Howard. I just celebrated I guess my 20th anniversary. I don’t know if celebrated is the right word because the only thing I really remember about the academy is every single senior police officer that talked to us said “Enjoy it because it’s going to go really fast.” It feels like it did and at the time, the idea of my career just zipping away before my eyes was sad. So I’m glad I made it to 20 years but I’m a little wistful that the fun part of it might be behind me.

But I started in ‘99 in Dayton, Ohio. I spent five years in the military before that. I started in ‘99 in Dayton, Ohio and in 2000, one of my friends was shot. She was shot in the collarbone. The bullet skipped across her spine and left her paralyzed from the neck down. She survived another two years and succumbed to her injuries. At the same time she was in the ICU, my dad was in the ICU having a triple bypass. So I actually was bouncing back and forth between visiting my friend, Mary, and visiting my dad. Less than a year later, I was involved in a critical incident and was very fortunate to survive that. My partner and I responded to a burglary alarm and it appeared like a couple of guys wrapping up at a construction site on a Friday night. When we asked them for their identification, one of them ran to his truck, got in his truck, and it looked like he was about to drive away. My partner ran up to the driver side and was pulling on the door handle which the door was locked, so he couldn’t get in. So I thought “Oh, no. You’re not getting away that easy.” So I went to run around to the passenger side of the truck and before I could clear the back end of the truck, the driver threw it in reverse and dragged me probably about 40 feet through this construction site. My partner shot and killed him. So that’s the only reason I’m really here today to talk about it.

That actually wasn’t the scariest thing that happened to us that week because a couple days before we got sent to a domestic violence call and we approached this house and we’re listening at the side of the house and we hear what sounds like somebody racking a shotgun. So we look at each other and we’re like “Oh, crap, we got to go.” So he goes to the back and I go to the front. I knocked on the front door and this guy comes to the front door. And the next thing I know, there’s a--the barrel of the gun that big in my face. It looked that big at the time. About the same time I realized I had a gun in my face, this guy realized he was pointing a BB gun at a cop. Fortunately, that little bit of delay and that little bit of recognition allowed him to drop it and me not to shoot him because I had that tunnel vision we hear about. What I didn’t see was the pregnant woman and the small child standing behind him. The reason that that actually was the scariest thing that happened to us is because all of our colleagues showed up and chastised us for not shooting this guy. So often, it’s not necessarily the critical incident that causes the most stress in what we do. It’s the way we get treated and the way we interact with our colleagues and sometimes the way our organizations respond to these things.

To quote one of my favorite LEADS scholars, Jason Potts, it was a time in my career where I just run around with my hair on fire, trying to get into as much excitement as I could. All of these things just kind of built up. The organizational response wasn’t that great. Then I moved into a phase in my career where I just started working all the time and I went the entire year of 2007, I didn’t sleep more than three hours consecutively. I just lived on three-hour naps. As we talked about that sleep deprivation just made things worse and worse and worse and I ended up in the hospital. So I’ve always had kind of an interest in how we can do this better and how we can maybe leverage some of the research and some of these ideas that are out there into taking care of our folks a little bit better so we don’t lose them halfway through their careers. Because at this time, I actually had realized that I had had about enough and I was looking at going to culinary school. Some of you have eaten food that I’ve prepared and you can vouch for the fact that that probably wasn’t a great idea. I haven’t really been very good at a lot of the other things I’ve tried. I also tried recently craft brewing at home and my neighbors will vouch for that probably it wasn’t a good career move either. So, I’m here and I’ve got this wonderful opportunity to really spend some time digging into some of the research and looking at ways that we can improve not only the way we respond to these issues but the way we prepare for them. Because I think Dan and John are going to tell us that the way that we prepare ourselves to survive and navigate these careers is probably going to have a much bigger effect on how we respond to them afterwards.

HOWARD SPIVAK: Thank you. Actually, following up on that, John, let’s bring some science to this. Now, we know that these kind of experiences have considerable effects on both neurological and biological function which both affects the immediate responses but also has long-term consequences. So, can you speak to some of the physiological issues that connect with all of these experiences and what the potential impact of that is?

JOHN VIOLANTI: Sure, doctor. Thank you. I was a police officer as well. I was a New York State trooper for about 23 years. Many of the things that you talk about, we’ve all been there with a gun in the face and the horrible things we see. I think most of our research in the past 14 years has involved the effect of post-traumatic stress disorder or stress on the physiological and disease aspect of police officers. We’re finding some amazing things. We’re looking at this over time and we’re seeing that, for example, people who have high rates of post-traumatic stress disorder are three times more likely to have the metabolic syndrome, which is a sort of a list of components that lead to heart disease. So we’re finding them at higher risk for cardiovascular health disease simply because of the trauma they experience in this work.

Additionally, sleep deprivation is an important thing we’ve looked at. Many officers are surviving on three hours sleep. They’re working 10- to 12-hour shifts. Some are doubling back because of the shortage of personnel out there. They go to court after work. They go home. They work their second job. They take care of their family. And the next night, they go back to work again. Some officers have admitted falling asleep at the wheel. Other officers cannot handle that deprivation aspect. We see sleep deprivation leading to increased risk for cardiovascular disease, diabetes.

We see the diet of people who work shift work is absolutely terrible. There’s no place to eat for one thing. And in general, it’s food that is not good for health. There is a lot of different aspects of post-traumatic stress disorder. I’m quite interested in that aspect. I think one of our most recent studies had to do with the effect of PTSD on the ability of police officers to make decisions on the street which is scary. We found, for example, in our brain imaging studies that post-traumatic people who have had high levels of post-traumatic stress symptomatology had more difficulty in making decisions which we measured in the lab by the way. But still, the parts of the brain that are required to make good decisions are essentially blocked off by post-traumatic stress disorder. So it’s a scary thing. We need to find interventions to help people deal with that.

It’s my view that we should be proactive about this, that at the academy level, people should start to be made aware of the trauma they’re going to experience for the next 20 years. A lot of young people coming in the police work today have never seen the horrible things that police officers see. They’ve never seen a dead body. They’ve never seen abused kids, horrible traffic accidents, terrible assaults, bodies in the bathtub, all severed. This is quite a shock. This is reality shock. And after the first year on the job, we see developing aspects of chronic stress and post-traumatic stress disorder. So, I say proactively start at the beginning. Inoculate them, get them ready for what they’re about to experience. Otherwise, we have to go into a reactive mode which is not the best mode to go into.

Disease is prevalent in police officers. Heart attacks, cardiovascular disease are one of the most common types of death. We just looked at a study on that and found that 48 percent of the officers who had job-related illness died on the job of a heart attack. This is very scary. We’ve also seen that the rate of heart disease is increasing. We looked at the heart attacks over 21 years in a sample and found that there’s a significant increase in cardiovascular deaths in police officers over a period of 21 years. Much of this is related to stress. You know, lifestyle certainly has a lot to do with it. But stress has a lot to do with affecting our cardiovascular system. I think it’s essential that we address wellness to bring that back into policing. It’s starting to come out. I applaud the young leaders of today who have good ideas about mental health and want to help.

I think it’s important to understand that leadership is very important here. Many officers that I talked to say that with the support of the organization, with the support of leadership, I always do much better. We need to integrate that. We need to integrate leadership. And that officer that goes out on the street where the rubber hits the road is very important. If the top person on the top of the organization cares, everybody else cares. I saw this recently in New York City at the NYPD. We had a seminar on police suicide. Three hundred people from all over the world were there. And Commissioner O’Neill started this, supported this, said in his speech that, “Hey, I care. I care about you people, you know. I care.” You don’t think that made a big impact. It did.

Moving over to suicide which I’ve been studying suicide for 20 years now and I still have not found an answer. But I can tell you in my opinion, police suicide is part of police work. It’s part of the job. And you might say, “Well, maybe it’s relationship problems, maybe it’s finance problems, maybe it’s things on the outside of the job.” But think about how much the job affects those outside things, quite a bit, quite a bit. It’s part of the equation. I believe that. Some people don’t. I do.

When we look at suicide rates, we see that we are as an occupation at an increased risk for suicide. We’re not the only occupation. Physicians certainly of late have been subject to burn out and suicide as well. But we are one of the leading occupations in suicide. We could stop this. We could stop this with the support of the organization. I think it’s essential that leadership be trained in suicide, at middle management, and at the top to deal with this very serious problem we have. We’ve seen clusters lately and this is very disturbing, Chicago, New York City. We need to take action on this.

HOWARD SPIVAK: Thank you. Chris, we also know this isn’t a one size fits all and that people have different reactions and different responses to sometimes the same experiences. So how do we better understand that? How do we understand who’s most at risk? How do we understand the variations and how to deal with that and create strategies that accommodate those variations?

CHRISTOPHER SCALLON: Thank you. It’s really an honor to be here. Not unlike the Major, I’m here as a result of being what this was all about. I was diagnosed with post-traumatic stress disorder, acute depression with suicidal ideations. I attempted suicide three times as a police officer. So I get it. This job can be overwhelming. I’m in agreement with the doc, that it kind of bleeds over into everything. So, the big thing is—and especially in running peer support units is that we look for the big things, right? Early on in my career, I was working in narcotics and I had a guy talk to me. He’s like, “You’re missing a lot of stuff when you’re doing your searches.” And I said, “Well, because I’m searching for a gun.” He goes, “No. Search for a razorblade.” So when we start focusing our searches and start identifying these little things, we’re going to find more stuff, as opposed to just addressing the big things.

Again, it’s interesting that we have the stuff about how this job is stressful. This job is very stressful and it puts us in some very bad places. But we’re not born in a vacuum. We bring with us our culture, our upbringing and it’s interesting to me because 20 years, 24 years goes like that. I see these folks coming in and there’s no life experience there, for the most part. But then I also see at the same time veterans coming in. So, if you have a combat veteran coming in or you have somebody that’s still living with mom going through the academy, those are two very specific individuals. So how do we address that? I think we address it by creating a context or an atmosphere in which it is, A, okay to ask for help. It’s okay to say that you’re struggling with something and not have it being met with, like, the Major was talking about, “Why didn’t you shoot the guy?” “You weren’t here, so, you know.” Everybody has their own opinions.

But it needs to be top down. If the people on top and executive-level management aren’t supporting this, now let’s be honest, really supporting it, not checking a box because I have to do this because it’s police suicide, click, yeah. We got somebody you can talk to. That bothers me a lot, and we’re seeing that. So, if we get the upper echelon on board. A while ago, I was speaking with a chief of an agency and he said, “Chris, change comes from the bottom up.” And I was like that’s a coup. That’s like we’re revolting against you. Why don’t you drive the ship and tell us which way to go? Recently, there was a police chief in Northern Virginia that came out and spoke about how he was struggling with post-traumatic stress disorder. What it did for that agency, it made it okay. And that’s ultimately what we need. We need to make it okay because the trauma, the stress, the anxiety, PTSD, it exists on a spectrum. There’s high functioning and low functioning. Unfortunately, I got to the very low functioning phase but I could’ve gotten tagged at any single time along my journey, but I didn’t.  Anybody ever been to a call where you get back and you’re done, you’re like, “You know, guys, I was very emotionally charged?” No, No. We make jokes and stuff like that. We need to start switching it around and start making it okay. You can have all the best people in the world working in these agencies, it cannot happen unless the head of that agency recognizes it as an importance. The problem is a lot of people don’t want to recognize it for a simple fact. And this kills me every time. —

I was speaking at a Midwest agency and I was talking about trauma and I tell my story of suicide or attempted suicide, and PTSD, and shootings and all this stuff. A couple folks came up to me afterwards and they’re like, “I’m listening to me on the stage.” I’m like, “Yeah, I get it.” Because it’s funny. I equate it to this old music video from Blind Melon with this little girl walking around in a bee costume and she’s like this outcast. And then she comes across all these other people dressed as bees. Well that’s what it’s like when you talk about trauma openly. I’m no more embarrassed of my diagnosis that I would be if I broke my leg.  So when people see that, they’re drawn to it. So fortunately two of the individuals I spoke to left the agency and got help. They needed it. I got a phone call from somebody that was working with that agency that said, “You know, hey, this is what happened.” I’m like, “That’s great. They got help.” Unfortunately, the head of that agency was upset that now they are two people shy of a full complement. If manpower is the issue, then we’re not doing anything. It’s the people that matter. The most important thing that an agency and the most powerful thing that an agency can have is healthy individuals within it that aren’t afraid to talk.

HOWARD SPIVAK: Thank you. Dan, you’ve done a lot of work around resiliency, how do you develop resiliency? How do you teach it? How do you reinforce it? How do you prepare people in ways that allow them to moderate some of these effects or deal with some of these experiences?

DAN GRUPE: Yeah, that’s a big question. There are—just to pick up on some of what Wendy and Chris said—some definite risk factors that we know, people who are not resilient exhibit. So one thing is the experiences, the lifetime experiences that you’ve had. Early life adversity, exposure to adverse childhood events is a huge risk factor. We talked about exposure to trauma and something that both Wendy and Chris kind of mentioned. The exposure to traumatic events is something that to some extent is expected when people go into policing, and there’s multiple studies that have shown that the impact of traumatic events is actually less predictive of the development of PTSD than people’s perception of the day in, day out stress associated with the work, and especially the organizational stress.

So, when we’re thinking about resilience and developing resilience, part of it is about building skills within the individual. We can talk about ways that we’ve been looking at doing that in Madison. But part of it is really about the organization and having an organization that supports resilience. I think not just paying lip service to this in saying we want our officers to be healthy and well. We’re not providing them with tools and resources to do that, but actually modeling it from the top. One other thing, and Chris spoke to this as well, that determines who’s resilient and who’s not in the face of trauma and adversity, is the way in which you relate to that traumatic event, the way in which you identify with it, the way in which you’re able to kind of integrate that event into your life, or the way that you distance yourself from it. There are studies showing that people who experience traumatic events but have what’s called a dissociative response, kind of like an out-of-body nonintegrated experience with that event, those people are at higher risk of developing PTSD. So I think individuals who are resilient are able to acknowledge the fact that they’ve experienced some of the worst human suffering that people can bear witness to and give themselves permission to express emotion, to not avoid the experience of emotion. I don’t know if we want to talk now, or if it’s in the next part of the panel about ways in which we’re trying to actually cultivate resilience and train some of these things, but we do believe in the work that we’re doing that this is not just something that you’re born with or not, it’s not the case. But if you experience some of these adverse events, you’re on a trajectory and there’s no way to get off of it. We think that this is something that we can train. We think that there are skills that we can help people build.