Protecting Against Stress & Trauma – Part 2: Research & Practice

HOWARD SPIVAK: That’s a nice lead-in, actually, to the next section, which is really better understanding the interface between research and practice. I think one of the things we struggle with at NIJ is how to facilitate that and how to get research into the practice setting. So I’d actually like to ask our two practitioners to start with. Where does science enter this? Is there an effort to understand science and bring it into practice? And if so, how is it happening at least currently? Wendy, why don’t you start?

WENDY STIVER: We’ve got the LEADS Program, obviously, which is a fantastic way of building on those researcher-practitioner partnerships. But I think this is a good time to also talk about, particularly in this subject, we’ve got research that tells us that there’s some techniques out there that may work, that may help us. But we’ve got cultural resistance to it. So building a bridge between research and resiliency, and things like mindfulness, and getting cops to do that.

If Gary Cordner’s in the room, I’d like to point out that yoga is one of those things that he loves to talk about. He’s a huge fan. But there’s this resistance to some of these things, and I think that’s kind of where having a good practitioner-researcher partnership can help to build a bridge, and make things like mindfulness be accepted as both tactical and practical. Because some of the research is telling us that these resiliency practices can actually help us perform better in the field. They can reduce errors in the kind of decision-making that happens in a use-of-force incident.

If we can get cops to understand and leadership to understand, that the things that make us healthier—mentally healthier in this job—can help us perform better, then it might be more acceptable to the entire field and it may benefit a large number police of officers both in terms of mental health and in surviving critical encounters. That’s a really difficult line to draw. So it’s going to take a lot of us who understand both the research and the practice of policing to make that real and tangible and practical for acceptance.

HOWARD SPIVAK:  Chris, part of the work you do now is trying to bring some of this work into police departments. What’s your experience been like in doing this?

CHRISTOPHER SCALLON: So here’s the deal. We’re not a complex animal as many would like to believe as a cop or fireman, or public safety. The best bridge that I see in most agencies is normally somebody who’s really gotten lost, and then has sought out professional help. And through research and through just therapy or whether it be in an in-patient setting, out--whatever it is, they come back. And they come back better. You start acquiring the champions of mental health in your agencies, that’s what bridges the gap. Foster those individuals, give them the opportunity.

When I was asked to create--well, I wasn’t asked to create, I said I got tired of being sick and tired. And I was like, “You know, I don’t ever want anybody to go to those dark places that I went to.” I know most agencies in the country are fully-manned. There’s no shortage of anybody like that. Imagine asking to create another unit within an agency that is already short-staffed. So I was given 10 minutes, and to the credit of the folks that I was dealing with, the assistant chiefs and the chiefs, they said, “You got 10 minutes.” I said, “Okay.” I did my research. Now we have a bomb squad in Norfolk and there’s a lot of money that goes into it annually for the budget. And I said, “Listen, in the past 20-plus years, how many live bombs have we had?” ”Well, we blew up some guy’s book bag who left it at the mall and we found a fake pipe bomb in the last 20 years,” So a little giggles all around. I said, “Do you know how many officers killed themselves in the last 20 years— from my agency? Well, it used be 12, now it’s 13.” We lost another one about a year or so ago. Well, they kind of were like, “We can’t not do it. So we kind of create the momentum.

The problem that we have with agencies is sustaining it. So the science is there. We trust who we trust. We trust the doctors that are working within this field, the science is there. Convincing us is not the issue. It’s creating an atmosphere to where we’re allowed to enter and kind of bring it in. The problem is with agencies is that when I was creating this peer support unit, someone said it. One of the clinical directors I was working with said, “Chris, you’re basically building a plane while you’re flying it.” And I was like, “You know what? You’re right.” Because I’m trying to get the parameters to get this thing going. But at the same time, I have an officer coming in. And it runs the spectrum of the officer that’s venting for two seconds, or the officer that’s in crisis who wants to kill themselves and their family.

The research, which I’ve worked with a ton of folks —through IACP, through DOJ, and all that stuff. The research is there. The biggest push right now, for the resiliency and all that stuff—the resiliency works, we know this—is shifting that culture, making it okay. I feel redundant saying it, but it’s making it okay to do yoga because I got joked when we brought yoga into the police department. They’re like, “What are we going to have? Spin class?” That’s just cops like to complain. You give us $100, we complain it’s not in twenties. But it’s one of these things that we just need to shift it. It’s really promising that we’re having the newer officers that are coming in are—I think in my opinion in what I’ve seen—are more open to getting help. Or more open to talking about things, which is a really nice change. But then you have the salty veterans out there who will tell you, “Well, that stuff, you know, just suck it up.” Well, you know, you’re horrible. Your life is a mess, sucking it up hasn’t worked for you. So I’m going to try to something different. I’m going to try maybe not sucking it up and talking.

HOWARD SPIVAK: So let’s just carry on with that a little bit. What’s different about people coming into the profession now that there is a change in attitude going on? Why do you think that’s the case?

CHRISTOPHER SCALLON: I think it’s a different upbringing. I sat on the board for several years for new hires. I would ask a couple questions, but the one question I would always ask is, “Have you ever been in a fight?” Now listen, I grew up in Brooklyn and South America. And my nose didn’t get like this because… I’ve been in a couple scrapes in my time growing up by the military or otherwise. And resoundingly, no. I had one guy say, “Well, I got into a pushing match with my brother.” I don’t think their life experiences are the same that we experienced  growing up in in the ‘70s or ‘60s or ‘80s for that matter. So I think that we have a significant culture shift. Now it’s okay to be a little bit more emotional about it. When I first got on, they would test you to see how you would do. And if you showed any sign of weakness, you are isolated. You aren’t allowed to go to a unit, so you put on your best “I’m a grown-up” and you went to work. I think that’s changed, generationally-speaking.

HOWARD SPIVAK: Thank you. I want to turn to the researchers now. NIJ’s an applied research agency. So it’s important for us to be funding research in the field. We also know that research in the field isn’t easy and research in police departments has its challenges. Can you speak to that both in general, but also specifically around the issue of stress and trauma, and doing research. So Dan, why don’t you start?

DAN GRUPE: Yeah, so we’ve been working for about the past four years with the Madison, Wisconsin Police Department. It was really important to us when we started to do this work. We’re coming as outsiders. We’re from the university. We hadn’t worked in law enforcement before, just to come and be fully transparent about our motivations, about what we are hoping to get out of this, about the scientific knowledge we are hoping to gain, but also about the impact that we wanted to have for officers and for society more broadly. So we came in very openly, we spent a lot of time with that agency. We had a protracted period of time before we had funding to start doing this research. For scientists getting out of the office, getting out from your computer, getting in the field, going on a ride-along, going to in-services, going to have coffee with cops, it helps to build trust. The work that we’re doing is delivering mindfulness training and there is just kind of a cultural divide or some potential tension there. Those kinds of experiences allowed us as researchers, and also the teachers who are doing the work, to start to understand the culture, and the language, and to try different things out and see what works, and what doesn’t work.

HOWARD SPIVAK: I’d like you to speak a little bit about the research you’re doing now and what’s involved in it, and what your testing.

DAN GRUPE: Sure. I do think one of the big challenges generally is kind of this gatekeeper problem where you have a police agency that, for good reasons, may not want to engage with an outside organization if there is a lack of trust and if we’re collecting sensitive data. We’re asking officers, “Are you stressed? Are you depressed? Do you have relationship problems? Are you thinking about suicide?” These kinds of questions. So there is a lot of hesitancy on the part of officers and on the part of the agencies, and really a need for researchers to demonstrate that they’ve done their homework, that they really care about this issue, and that they are to be trusted.

So we have an agency that’s been super cooperative, Madison PD I think has been on the forefront of a lot of more progressive initiatives in policing over the past 30 or 40 years. And that really helps us get past what can be a real hurdle to getting into this work. When I look around at the, a lot of the researchers who do research in law enforcement—Dr. Violanti is an example—it’s a lot of people who have been inside of the agency. So for me, I don’t think I look like a cop. There might not be a lot of trust for the guy in tweed. So you really have to do that work to demonstrate, to build that trust. The work that we’re doing in Madison, I’ll just talk about quickly. We’ve been looking at a mindfulness-based training program to help officers work with stress and help combat some of these negative health outcomes that Dr. Violanti talked about.

HOWARD SPIVAK: Can you actually explain what mindfulness is?

DAN GRUPE: Yes. Absolutely. Because it gets bandied about a lot and I think everybody probably has heard the word and maybe has some different sense of what it means. Really at its core, the definition of mindfulness that Jon Kabat-Zinn who really popularized this and brought it to the West and kind of secularized some of these practices, mindfulness is paying attention on purpose, in the present moment, and without judgment. So it’s not thinking about the past. It’s not worrying about the future. If you have experienced difficultly, if you’ve experienced trauma, it’s not being ashamed of that. It’s not thinking, “I’m not supposed to feel this way. This is not the way that police officers are supposed to behave.” It’s looking at those feelings, or responses, or emotions, or whatever they are without judgment.

So that’s mindfulness kind of as a trait and this is something that we believe we can train. So, we have an eight-week training program, and I should take a step back and say there’s work that’s going on in Oregon for about the past seven or eight years. Mike Christopher is a researcher out there. Rich Goerling is a lieutenant in the Hillsboro, Oregon Police Department. They really pioneered a lot of this work. We’re following up on it now and kind of taking our own approach to it. So we have an eight-week training program where we are giving officers different very practical, grounded, embodied skills and practices that they can use to try to cultivate better present moment awareness, grounding yourself in the present. Breathing exercises, movement practices, things like yoga, related to tai chi.

We’ve been doing this work for the past two or three years. We’ve demonstrated our initial pilot study. A lot of the issues that we’ve already talked about. Officers report they’re sleeping better. Officers report they’re less anxious, they’re less stressed, less feelings of burnout. We recently showed that symptoms of post-traumatic stress go down after eight weeks of this training in police officers. In particular, one of the symptoms of PTSD that’s most prevalent and kind of relevant for law enforcement populations is hypervigilance or the sense of kind of always being on edge, always being on guard and it’s this tendency that’s really adaptive. If you’re going on the kinds of calls that we’ve talked about where threat is real and you need to be prepared for it, but it’s not an adaptive trait, you go home and you’re hanging out with your wife and kids. Through this kind of training in mindful awareness of the present moment, we think that we can maybe allow people to recognize whether the way that you’re responding in a particular situation, the way that you’re holding your body, the way that you’re breathing, kind of the thoughts that you’re having, are those adaptive given the current threat situation, and it seems like that’s something that we may be able to shift with this kind of training.

We’re currently doing work funded by the NIJ. We’re in the middle of a two-year randomized controlled trial where we’re following up on some of these early improvements that we’ve seen and now we’re starting to look at some more objective biological and physiological outcomes. So Dr. Violanti’s done a lot of work on post-traumatic stress, cortisol responses in police officers. One of the things that we’re looking at is the potential impact of this training in mindfulness on cortisol reactivity, and we’re looking at inflammatory markers, which are a risk factor for cardiovascular disease. We’re looking at sleep objectively using wearable devices where we can track the actual amount of sleep time, really trying to dig into some of those more biological, physiological outcomes to show this is all part of the same situation. It’s not like your mind and your body are two totally different things. So through this kind of training, we think we can affect some of these biological, physiological outcomes that are more proximal indicators of long-term disease in police officers.

HOWARD SPIVAK: John, can you speak to some of your experience trying to do research and I think particularly around post-traumatic stress disorder which, as common as it is, carries such a huge stigma that it’s an uncomfortable diagnosis for people to have. So, what’s been your experience in doing this work?

JOHN VIOLANTI: Well, I totally agree on the stigma. Again, we’re talking about the police culture here and how one should never appear to be weak. One should never ask for help because we don’t need the help. And developing PTSD, I think, is a shock to most police officers because they don’t expect to feel emotion and when they do, they don’t know what to do with it so they stuff it. And when they stuff it, it starts affecting physiologically as well. We did find some interesting things with PTSD which I mentioned before on the effect on health. Also we found that resiliency moderated PTSD in relationship with depression. So, making your people more resilient to PTSD, I think, is important. A lot of the sociological research tells us that it’s not that the resiliency—it’s not only in fact a personality factor, but it’s also social factor. What I mean by that is the organization essentially is a psychological safety net, if you will, to have that group of cohesive individuals who trust each other, that can help alleviate a lot of the problems with PTSD.

Post-traumatic stress disorder, again, I think Dan talked about cortisol, which is known as the stress hormone. Every time you’re under stress, cortisol is secreted through the, what we call the HPA Axis, which is sort of a system in your body. There’s a normal pattern in cortisol. It kind of it looks like a bell-shaped curve. When you wake up in the morning, it peaks during midday then it goes back down. But when you’re under stress, it sort of knocks the heck out of that pattern. What happens after a while if you have PTSD, what happens to cortisol is it loses the normal pattern and it becomes dysregulated. Now we’ve seen officers out there with, instead of a bell-shaped curve, they have a flat liner curve in cortisol. They have cortisol that goes down instead of staying up. It’s this regulation of cortisol, the stress hormone, which can open the body up for disease and that’s what happens. So, that’s why when we look at PTSD and we look at cardiovascular disease and inflammatory markers from blood samples and so forth, we see an increased risk for cardiovascular disease. We look at things like artery health. We can measure this by the way with ultrasound. We look at the carotid artery, which are your arteries in your neck, which when they get plugged up, you can have a stroke. All of these various artery factors are affected by post-traumatic stress disorder and chronic stress, and it all comes back to cortisol and it all comes back to dysregulation of all systems in the body.

I think mindfulness is a great find and I love the idea of mindfulness. I think it’s finally going to help police officers to get out of that mode of being hypervigilant all the time, to always thinking about the horrible things they’ve seen, which is hard to do. It’s really hard to do, to get them in the present moment, to get their minds out of what’s going to happen tomorrow and to give them a chance to finally relax in their own time. That’s a good intervention and education’s a good intervention. The thing that worries me about PTSD is that we do not know how many officers have PTSD. We do not know. We cannot go out there and diagnose 950,000 police officers in this country to find out if they have PTSD. The small studies that are accumulated tell us about 15 percent, but who knows? I think this is something we have to figure out.

Secondly, we don’t know how many officers out there commit suicide or die by suicide. We guess. We estimate. We think this. We think that, but we don’t know. That’s another very disturbing factor for me. How are we going to find this out? We need a central reporting system, some kind of reporting system like the FBI has, to log suicides. What’s the scope of the problem? I don’t know, nobody knows. It’s scary. Post-traumatic stress and suicide are related. We know that from the big studies in the military. Now studies of like five million veterans found veterans that had PTSD had like almost a 3.1 fold risk of suicide. These are all statistics and they’re statistics. So I guess then my view is, well, we need to look further into this to get a nationwide view of what’s going on here. We just don’t know.

HOWARD SPIVAK: Thank you. So Wendy, there’s clearly a growing understanding of the interplay between environment and experience and our bodies and our biology and our neurological function. How well do you think cops understand or know this and how can we better enhance that understanding?

WENDY STIVER: So I think it’s a good time to talk about leadership. We’ve been talking a lot in policing about trauma-informed policing, and having a better awareness of the trauma that our victims and our witnesses are dealing with when we deal with them. I think it’s time to start talking about trauma-informed leadership, and recognizing that it’s the role of leadership to understand some of these things and push them out to our agencies because it’s not just about caring for the organizational spirit. It’s about caring for our communities because how we treat our police officers is going to be reflected in how they treat our communities and so it’s good for business. If we can do a better job of managing these things through leadership and push those things out to our cops, our cops will do a better job of taking care of the people in the communities. Coming from the military, I was raised in the military. I spent five years in the Army and I had the privilege to work for some pretty cool generals. The one thing that I was taught during that experience was that if you take care of the people, they will take care of the mission.

So it’s important not just for our folks but to make sure that they’re doing a good job at their jobs. That they’re able to go out there and perform better in the field, to survive when critical incidents happen and deliver better services to citizens because if we’re more presently aware of what’s going on around us, we have better situational awareness. We can do a better job of what we do, because a lot of what we do is about remembering things. We listen to stories, we write them down, and we testify about them in court, right? So, a lot of this job really depends on sharpening those skill sets and applying them to the real world.