Mindfulness-based resilience training to reduce health risk, stress reactivity, and aggression among law enforcement officers: A feasibility and preliminary efficacy trial

Psychological intervention programme for developing resilience in the military personnel. A randomized controlled trial

Military gendarmes are frequently exposed to events with traumatic impact, with negative effects on emotional and physical health. The present research aims to analyse the effectiveness of Military Resilience Training (MRTR), a psychological intervention programme developed to reduce perceived stress, increase the perception of adaptive resources and strengthen resilience. Ninety-eight participants who met the inclusion criteria were enroled in a single-blind randomized controlled trial. The psychological training programme was implemented in the intervention group (n = 48) for a duration of 5 months. The participants in the control group (n = 50) were scheduled to start the training later. The levels of perceived stress, adaptive resources and resilience were measured in all participants, from the intervention and the control group, before and after the intervention, and at a 3-month follow-up. The effects of the intervention (Cohen's d) were very high for adaptive resources (d = 0.99), self-schemes (d = 1.33), family support (d = 0.70), and partner support (d = 0.66), average for resilience (d = 0.53) and stress (d = 0.49), with very high effects on military task demands (d = 1.19) and averages for friction with authority (d = 0.51). The effects were obtained only in the intervention group, and all gains were maintained at follow-up. This study provides evidence of the effectiveness of MRTR, a psychological intervention implemented in the military gendarmerie population. In the short and long term, MRTR has significant effects in reducing perceived stress, increasing the perception of adaptive resources and strengthening the resilience of military gendarmes.

The role of mindfulness and resilience in Navy SEAL training

Mindfulness and resilience are thought to be essential qualities of the military's special operations community. Both are tested daily in Special Operations Forces (SOF) assessment and selection efforts to prepare candidates to persist through grueling training and complex combat situations; but these qualities are rarely measured. While military leadership places value on the concepts of mindfulness and resilience, there is minimal empirical research examining the role that they play in the completion of training. This longitudinal study followed three classes of SEAL candidates at Basic Underwater Demolition/SEAL (BUD/S) training over their six-month selection program. We estimated logit models predicting successful completion of BUD/S and specific types of failure in that training environment with indexes of mindfulness and resilience at the start of the program as predictors of completion. The results indicate that (1) mindfulness is unrelated to completion, while (2) resilience is positively related to completion, and (3) The results indicate that mindfulness is generally unrelated to completion, while resilience generally predicts completion.

A multisite feasibility randomized clinical trial of mindfulness-based resilience training for aggression, stress, and health in law enforcement officers

BACKGROUND

Law enforcement officers (LEOs) are exposed to significant stressors that can impact their mental health, increasing risk of posttraumatic stress disorder, burnout, at-risk alcohol use, depression, and suicidality. Compromised LEO health can subsequently lead to aggression and excessive use of force. Mindfulness training is a promising approach for high-stress populations and has been shown to be effective in increasing resilience and improving mental health issues common among LEOs.

METHODS

This multi-site, randomized, single-blind clinical feasibility trial was intended to establish optimal protocols and procedures for a future full-scale, multi-site trial assessing effects of mindfulness-based resilience training (MBRT) versus an attention control (stress management education [SME]) and a no-intervention control, on physiological, attentional, and psychological indices of stress and mental health. The current study was designed to enhance efficiency of recruitment, engagement and retention; optimize assessment, intervention training and outcome measures; and ensure fidelity to intervention protocols. Responsiveness to change over time was examined to identify the most responsive potential proximate and longer-term assessments of targeted outcomes.

RESULTS

We observed high feasibility of recruitment and retention, acceptability of MBRT, fidelity to assessment and intervention protocols, and responsiveness to change for a variety of putative physiological and self-report mechanism and outcome measures.

CONCLUSIONS

Results of this multi-site feasibility trial set the stage for a full-scale, multi-site trial testing the efficacy of MBRT on increasing LEO health and resilience, and on decreasing more distal outcomes of aggression and excessive use of force that would have significant downstream benefits for communities they serve.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT03784846 . Registered on December 24th, 2018.

Psychometric properties of the Buss-Perry Aggression Questionnaire-short form among law enforcement officers

Repeatedly capturing national headlines, excessive law enforcement officer (LEO) use of force in critical incident encounters is one of the most divisive human rights issues in the United States. Valid and reliable measures of potential precursors to LEO excessive use of force, such as aggression, are needed. The Buss-Perry Aggression Questionnaire-short form (BPAQ-SF) is a validated measure of aggression across various populations; however, evaluation of this easily administered measure in high-stress, frontline populations such as LEOs is limited. The primary goal of this study was to evaluate the validity, reliability, and sensitivity to change the BPAQ-SF in a sample of LEOs. A confirmatory factor analysis suggested that the hierarchical solution provides a mixed fit to the data: SBχ²(25.84)  = 62.50, p = .0001; comparative fit index = .94, non-normed fit index = .92, root mean square error of approximation = .19 (90% confidence interval = .17-.21), standardized root mean squared residual = .08. The BPAQ-SF demonstrated good internal consistency (α = .84) and test-retest reliability (r = .86), correlations in the expected direction with predictors of and buffers against aggression, and sensitivity to change among LEOs who participated in an intervention targeting aggression. Results support and extend previous findings suggesting that the BPAQ-SF is a valid and reliable measure of aggression among LEOs.

Web-Based Mindfulness Meditation as an Adjunct to Internet-Delivered Cognitive Behavioral Therapy for Public Safety Personnel: Mixed Methods Feasibility Evaluation Study

BACKGROUND

Public safety personnel (PSP) are individuals who work to ensure the safety and security of communities (eg, correctional workers, firefighters, paramedics, and police officers). PSP have a high risk of developing mental disorders and face unique barriers to traditional mental health treatments. The PSP Wellbeing Course is a transdiagnostic, internet-delivered cognitive behavioral therapy (iCBT) course tailored to assist PSP with symptoms of depression, anxiety, and posttraumatic stress disorder (PTSD). The initial course outcomes are promising, but some clients report some challenges with learning skills and recommend adding additional resources. Mindfulness meditations, which help people to experience the world and their reactions to the world in open and nonjudgmental ways, may complement the existing PSP Wellbeing Course.

OBJECTIVE

This study aims to examine the feasibility of mindfulness meditations in iCBT tailored for PSP. Information was gathered to evaluate engagement and client experiences with mindfulness meditations, symptom change, and the relationship between mindfulness meditation use and symptom change.

METHODS

A mixed methods study was conducted on PSP enrolled in the PSP Wellbeing Course who were offered 5 mindfulness meditations during the program (ie, 1/lesson). Clients completed questionnaires on depression, anxiety, PTSD, anger, insomnia, resilience, and mindfulness at pretreatment and at 8 weeks; an 8-week treatment satisfaction questionnaire; and brief weekly measures of mindfulness meditation engagement. We used paired sample t tests (2-tailed) to assess changes in outcomes over time and partial correlations to assess whether mindfulness meditation use predicted outcomes at posttreatment. A total of 12 clients were interviewed about their perceptions of the mindfulness meditations, and interviews were analyzed using directed content analysis.

RESULTS

Among the 40 clients enrolled, 27 (68%) reported using the mindfulness meditations, practicing for an average of 4.8 (SD 8.1) minutes each week. Most interviewees described the mindfulness meditations as beneficial but also reported challenges, such as discomfort while sitting with their feelings. Clients provided suggestions for better integration of mindfulness into iCBT. Overall, clients who completed the PSP Wellbeing Course with mindfulness meditations experienced statistically significant improvements in symptoms of anxiety (P=.001), depression (P=.001), PTSD (P=.001), and anger (P=.001) but not insomnia (P=.02). Clients also experienced improvements in resilience (P=.01) and mindfulness (P=.001). Self-reported time spent meditating was not associated with changes in symptoms over time.

CONCLUSIONS

This study provides new insight into the integration of mindfulness meditations with iCBT for PSP. It demonstrates the partial feasibility of adding mindfulness meditations to iCBT, revealing that some, but not all, PSP engaged with the meditations and reported benefits. PSP reported using the mindfulness meditations inconsistently and described challenges with the meditations. Improvements can be made to better integrate mindfulness meditation into iCBT, including offering mindfulness meditation as an optional resource, providing more psychoeducation on managing challenges, and offering shorter meditations.

Effectiveness of stress management interventions to change cortisol levels: a systematic review and meta-analysis

Stress has a damaging impact on our mental and physical health, and as a result, there is an on-going demand for effective stress management interventions. However, there are no reviews or meta-analyses synthesising the evidence base of randomised controlled trials testing the effectiveness of psychological interventions on changing cortisol levels (the stress hormone) in non-patient groups. Therefore, the primary aim of this systematic review and meta-analysis was to address this gap. Six databases (Medline, PsychInfo, Embase, CINAHL, Cochrane and Web of Science) were searched (1171 studies identified) with 58 studies (combined N = 3508) included in the meta-analysis. The interventions were coded into one of four categories; mind body therapies, mindfulness, relaxation or talking therapies. A random effects meta-analysis on cortisol as measured in blood, saliva or hair found that stress management interventions outperformed pooled control conditions with a medium positive effect size (g = 0.282). The studies that utilised cortisol awakening measures (g = 0.644) revealed larger effects of stress management interventions than those that measured diurnal cortisol (g = 0.255). Mindfulness and meditation (g = 0. 345) and relaxation (g = 0. 347) interventions were most effective at changing cortisol levels, while mind body therapies (g = 0. 129) and talking therapies (g = 0.107) were shown to have smaller and non-significant effect sizes. Additionally, studies that utilised an active control group (g = 0. 477) over passive control group (g = 0.129) were found to have stronger effects. Length of the intervention, study quality, risk of bias, age and gender did not influence the effectiveness of interventions and there was no evidence of publication bias. Overall, the current findings confirm that stress management interventions can positively influence cortisol levels. Future research should investigate the longer term implications for health and health outcomes.

Relative Impact of Mindfulness, Self-Compassion, and Psychological Resilience on Mental Health Outcomes in Racially Minoritized Adults

Racially minoritized adults lack equal representation in research and experience disparities in healthcare. Little is known about which trait-level factors may help mitigate negative and promote positive psychological health among adults from these communities. The aim of this study was to assess the differential impact of dispositional mindfulness, self-compassion, and resilience in predicting depression, anxiety, stress, and life satisfaction in a sample of racially minoritized adults. This study is a cross-sectional analysis of 169 participants (37.3% female and 62.7% male) between the ages of 18 and 64 (M = 37.05; SD = 11.94). Separate hierarchical multiple regression models examined the relative influence of mindfulness facets (acting with awareness (AA); nonjudging of inner experience (NJ), and nonreactivity of inner experience (NR)), self-compassion, and resilience in predicting depression, anxiety, stress, and life satisfaction. Self-compassion, resilience, AA, and NR predicted depression; self-compassion, resilience, and NR predicted anxiety; self-compassion, resilience, and NR predicted stress; and self-compassion predicted satisfaction with life. Self-compassion, resilience, AA, NJ, and NR differentially predicted depression, anxiety, stress, and life satisfaction; however, only self-compassion consistently predicted all outcomes. Future research may incorporate an intersectional methodology and account for differences among different racially minoritized groups.

Resilience is associated with cortical gray matter of the antinociceptive pathway in people with chronic pain

Resilience is an important personal characteristic that influences health and recovery. Previous studies of chronic pain suggest that highly resilient people may be more effective at modulating their pain. Since brain gray matter in the antinociceptive pathway has also been shown to be abnormal in people with chronic pain, we examined whether resilience is related to gray matter in regions of interest (ROIs) of the antinociceptive pathway (rostral and subgenual anterior cingulate cortex (rACC, sgACC), anterior insula (aINS), dorsolateral prefrontal cortex (dlPFC)) normally and in people who are experiencing chronic pain. We extracted gray matter volume (GMV) and cortical thickness (CT) from 3T MRIs of 88 people with chronic pain (half males/females) and 86 healthy controls (HCs), who completed The Resilience Scale and Brief Pain Inventory. We found that resilience scores were significantly lower in people with chronic pain compared to HCs, whereas ROI GMV and CT were not different between groups. Resilience negatively correlated with average pain scores and positively correlated with GMV in the bilateral rACC, sgACC, and left dlPFC of people with chronic pain. Mediation analyses revealed that GMV in the right rACC and left sgACC partially co-mediated the relationship between resilience and average pain in people with chronic pain. The resilience-pain and some resilience-GMV relationships were sex-dependent. These findings suggest that the antinociceptive pathway may play a role in the impact of resilience on one's ability to modulate chronic pain. A better understanding of the brain-resilience relationship may help advance evidence-based approaches to pain management.

Effectiveness of psychological skills training for police personnel: a meta-analysis

There has been an increasing interest in primary prevention programmes developed to improve police officers' mental health. This meta-analysis synthesised the existing findings on psychological skills training for police personnel including resilience training and mindfulness-based training. Particularly, this study systematically assessed the effectiveness of training programmes on mental health outcomes including resilience, depression, anxiety and perceived stress. A comprehensive search of EBSCO, ProQuest and Web of Science was conducted for studies written in English from 1999 to 2022. Two independent researchers screened 5604 studies. Eligible studies are intervention studies with controlled trials that involved training programmes to improve participants' mental health and reported at least one of the following outcomes: resilience, depression, anxiety and perceived stress. The meta-analysis estimated standardised mean differences (SMDs) for each of the four outcomes. A total of 12 studies, involving 2298 police personnel from 8 countries, met the criteria for inclusion and quality assessment. The training programmes of the eligible studies varied in training approaches, duration, total sessions and follow-up periods. The results suggest that training programmes have a statistically significant moderate effect on depression (SMD=-0.47, 95% CI=-0.73 to -0.22) and anxiety (SMD=-0.40, 95% CI=-0.73 to -0.06), while the effects on resilience (SMD=1.03, 95% CI=-0.36 to 2.41) and perceived stress (SMD=-1.03, 95% CI=-2.15 to 0.08) are not statistically significant. This study highlights the role of primary prevention approaches in supporting officers' mental health by showing that training programmes are effective in mitigating the risk of depression and anxiety.

Individual participant data systematic review and meta-analysis of randomised controlled trials assessing adult mindfulness-based programmes for mental health promotion in non-clinical settings

Introduction

Mindfulness-based programmes (MBPs) are widely used to prevent mental ill-health that is becoming the leading global cause of morbidity. Evidence suggests beneficial average effects but wide variability. We aimed to confirm the effect of MBPs on psychological distress, and to understand whether and how baseline distress, gender, age, education, and dispositional mindfulness modify the effect of MBPs on distress among adults in non-clinical settings.

Methods

We conducted a pre-registered systematic review and individual participant data (IPD) meta-analysis (PROSPERO CRD42020200117). Thirteen databases were searched in December 2020 for randomised controlled trials satisfying a quality threshold and comparing in-person, expert-defined MBPs in non-clinical settings with passive control groups. Two researchers independently selected, extracted, and appraised trials using the revised Cochrane Risk-of-Bias Tool (RoB2). Anonymised IPD of eligible trials were sought from collaborating authors. The primary outcome was psychological distress (unpleasant mental or emotional experiences including anxiety and depression) at 1 to 6 months after programme completion. Data were checked and imputed if missing. Pairwise, random-effects, two-stage IPD meta-analyses were conducted. Effect modification analyses followed a within-studies approach. Public and professional stakeholders were involved in the planning, conduct and dissemination of this study.

Results

Fifteen trials were eligible, 13 trialists shared IPD (2,371 participants representing 8 countries, median age 34 years-old, 71% women, moderately distressed on average, 20% missing outcome data). In comparison with passive control groups, MBPs reduced average distress between one- and six-months post-intervention with a small to moderate effect size (standardised mean difference (SMD) -0.32; 95% confidence interval (CI) -0.41 to -0.24; p-value < 0.001; 95% prediction interval (PI) -0.41 to -0.24 (no heterogeneity)). Results were robust to sensitivity analyses, and similar for the other psychological distress time point ranges. Confidence in the primary outcome result is high. We found no clear indication that this effect is modified by baseline psychological distress, gender, age, education level, or dispositional mindfulness.

Conclusions

Group-based teacher-led MBPs generally reduce psychological distress among community adults who volunteer to receive this type of intervention. More research is needed to identify sources of variability in outcomes at an individual level.

Mindfulness-Based and Mindfulness-Informed Interventions at the Workplace: A Systematic Review and Meta-Regression Analysis of RCTs

Objectives

Positive effects of mindfulness-based interventions (MBIs) on occupational health have been demonstrated by several systematic review studies during the last two decades. So far, existing reviews excluded mindfulness-informed interventions (MIIs) that build on informal approaches or mixed techniques aiming at improving mindfulness indirectly. To address this research gap, the present comprehensive meta-analysis synthesizes the results of RCTs of MBIs and MIIs conducted in various workplace settings.

Method

A systematic literature search was conducted in five electronic databases complemented by manual search. Random-effects models were used to synthesize standardized mean differences (SMDs) for 25 outcomes and seven overarching categories of outcomes, and to detect various temporal effects. Meta-regressions were run to elucidate average SMDs between mindfulness intervention types and intervention and population characteristics, with the goal of detecting sources of heterogeneity and help guide the selection of the most appropriate mindfulness intervention type.

Results

Based on 91 eligible studies (from 92 publications), including 4927 participants and 4448 controls, the synthesis shows that MBIs and MIIs significantly improve mindfulness (SMD = 0.43; 95%-CI [0.33;0.52]), well-being (SMD = 0.63; 95%-CI [0.34;0.93]), mental health (SMD = 0.67; 95%-CI [0.48;0.86]), stress (SMD = 0.72; 95%-CI [0.54;0.90]), resilience (SMD = 1.06; 95%-CI [-0.22;2.34]), physical health (SMD = 0.45; 95%-CI [0.32;0.59]), and work-related factors (SMD = 0.62; 95%-CI [0.14;1.10]). Sensitivity analyses demonstrate a tendency towards smaller effect sizes due to extreme outliers. Effect sizes are stable in short-term follow-up assessments (1-12 weeks) for most outcomes, but not for long-term follow-up assessments (13-52 weeks). Meta-regressions suggest that observable intervention characteristics (e.g., online delivery) and population characteristics (e.g., age of participants), as well as study quality, do not explain the prevalence of heterogeneity in effect sizes.

Conclusions

Generally effective, mindfulness interventions are a useful tool to enhance aspects of employee health. However, because of heterogeneity and risk of bias, studies aiming at high-quality data collection and thorough reporting are necessary to draw firm conclusions.

Preregistration

A protocol of this systematic review was registered with PROSPERO (Registration-No. CRD42020159927).

Supplementary Information

The online version contains supplementary material available at 10.1007/s12671-023-02130-7.

Effects of Resilience Training on Resilient Functioning in Chronic Stress Situations among Cadets of the Swiss Armed Forces

Research on resilient functioning has gained increasing interest, and some recent studies interpreted resilience in the sense of resilient functioning to stress. In the present study, we investigated the associations between resilient functioning and coping strategies, stress reactivity, self-efficacy, and well-being, and we examined whether resilient functioning could be improved through a training intervention. The participants were 110 male cadets from two infantry officers' schools of the Swiss Armed Forces. The schools were divided into an intervention and control group. The participants in the intervention group took part in the resilience training intervention, whereas the participants in the control group performed military training as usual. Data were assessed before and after the intervention period. Results showed that resilient functioning was positively associated with task-oriented coping and well-being and negatively associated with emotion-oriented coping and stress reactivity. Furthermore, resilient functioning significantly improved in the intervention group from pre- to post-intervention. The results suggested that specific interventions have the power to increase resilient functioning.

Only Small Effects of Mindfulness-Based Interventions on Biomarker Levels of Inflammation and Stress: A Preregistered Systematic Review and Two Three-Level Meta-Analyses

Mindfulness-based interventions (MBIs) have a positive effect on biomarkers of inflammation and stress in patients with psychiatric disorders and physical illnesses. Regarding subclinical populations, results are less clear. The present meta-analysis addressed the effects of MBIs on biomarkers in psychiatric populations and among healthy, stressed, and at-risk populations. All available biomarker data were investigated with a comprehensive approach, using two three-level meta-analyses. Pre-post changes in biomarker levels within treatment groups (k = 40 studies, total N = 1441) and treatment effects compared to control group effects, using only RCT data (k = 32, total N = 2880), were of similar magnitude, Hedges g = -0.15 (95% CI = [-0.23, -0.06], p < 0.001) and g = -0.11 (95% CI = [-0.23, 0.001], p = 0.053). Effects increased in magnitude when including available follow-up data but did not differ between type of sample, MBI, biomarker, and control group or duration of the MBI. This suggests that MBIs may ameliorate biomarker levels in both psychiatric and subclinical populations to a small extent. However, low study quality and evidence of publication bias may have impacted on the results. More large and preregistered studies are still needed in this field of research.

The Effectiveness of Mindfulness-Based Interventions for Police Officers' Stress Reduction: a Systematic Review

The profession of a police officer is associated with high levels of stress, which can have harmful consequences for officers' personal lives, the police organisation, and society. This systematic review aims to synthesise recent literature on the effectiveness of mindfulness-based intervention related to stress reduction (MBIs) in a sample of police officers. The search of relevant articles was applied in four databases (SpringerLink, Web of Science, Academic Search Ultimate (EBSCO), and PubMed), using the following inclusion criteria: (1) study involved police officers; (2) study used (quasi)experimental research design; (3) mindfulness-based stress reduction intervention was applied as the main intervention; and (4) study presented pre- and post-intervention measures and quantitative results of stress. The systematic review of eight articles included in the analysis revealed that MBIs were effective in reducing police officers' stress and other stress-related outcomes (sleep problems, post-traumatic stress disorder (PTSD), negative affect, burnout).

Mental Health Stigma and Help-Seeking Intentions in Police Employees

Mental health problems among police employees are exacerbated by negative attitudes and beliefs around mental health help-seeking that are perpetuated by police culture. We collected anonymous survey data from 259 civilian and commissioned police employees in a mid-sized, Midwestern U.S. city to test hypothesized relationships among help-seeking stigma, help-seeking attitudes, and intended help-seeking behavior. Results demonstrated that mental help-seeking stigma was negatively associated with help-seeking attitudes, and in turn with reduced mental health help-seeking intentions. Structural equation modeling provided support for a model linking help-seeking stigma, help-seeking attitudes, and intentions to seek help. This path model was moderated by psychological distress and previous participation in mindfulness training, which had opposing effects on help-seeking stigma and (indirectly) on intended help-seeking. Results provide insight into policies, practices, and interventions that police agencies may enact to combat stigma, positively influence mental health help-seeking, and improve the mental health and well-being of police employees and the broader community.

The Relationships Between Tendency to Aggression, Self-control, Mindfulness, and Happiness in Students of the Faculty of Health Sciences

Objectives: Previous studies focus on variables that reduce violence such as mindfulness, self-control, and happiness, but do not cover these relationships in a single study, creating a gap in the literature. The aim of this cross-sectional study was to investigate the relationships between aggression and these 3 variables in health science undergraduate students at a state university in Turkey. Methods: Students completed the aggression questionnaire, the Oxford happiness questionnaire short version, the brief self-control scale, and the mindful attention awareness scale. Results: In correlational analysis, only verbal aggression and happiness did not show a relationship. The result of hierarchical multiple regression analyses indicated that the most significant predictors that explained total aggression and aggression subscales were mindfulness and self-control, respectively. However, happiness did not have a significant link to either total aggression or subscales of aggression (except for hostility). Conclusions: The results emphasize that mindfulness and self-control may play important roles in reducing aggression. This study reveals the need for further analysis of the relationships between happiness and aggression and its subscales. Other implications are discussed.

Resilience mediates parenting style associated school bullying victimization in Chinese children and adolescents

BACKGROUND

Existing evidence has shown that negative parenting style elevates the risk of school bullying victimization in children and adolescents. Resilience may play as a mediating factor in this association. However, this hypothesis has not been investigated.

METHODS

In this cross-sectional study, a total of 4582 Chinese children and adolescents had been surveyed by self-administered questionnaire. The Chinese version of Egna Minnen av. Barndoms Uppfostra (s-EMBU-C), the Olweus Bully/Victim Questionnaire (OBVQ) and the Resilience Scale for Chinese Adolescents (RSCA) were used to collect relevant information. Univariate and multiple logistic regression models were used to estimate the crude and adjusted associations between parenting style, resilience, and bullying victimization. Path analysis was used to estimate the mediation via resilience in the association between parenting style and bullying victimization.

RESULTS

After adjustment for possible covariates, the results of multivariate binary logistic regression model suggested that among all dimensions of parenting style, mother's and father's rejection were significantly associated with school bullying victimization. Path analysis revealed a statistically significant mediation of resilience in the association between parental rejection and bullying victimization, and among the five dimensions of resilience, emotion regulation, family support and interpersonal assistance accounted for the highest proportions of mediation.

CONCLUSIONS

For children and adolescents who suffered from parental rejection, building up resilience, especially those measures aiming at improving emotion regulation ability and consolidating family and peer support, might be effective in reducing risk of school bullying victimization.

Are mindful people less aggressive? The role of emotion regulation in the relations between mindfulness and aggression

Inducing mindfulness has shown a promising effect on reducing aggression in both clinical and nonclinical populations, possibly because mindfulness can improve emotion regulation. The present study examined the association between mindfulness and aggression through potential mediating effects of several emotion regulation strategies. University and community samples of U.S. adults completed questionnaires on mindfulness, emotion regulation strategies, and trait aggression. Results indicate that mindfulness was associated with rumination and expressive suppression, which mediated the mindfulness-aggression relationship. Most facets of mindfulness were unrelated to the use of reflection and cognitive reappraisal. The nonjudging of experience facet of mindfulness was negatively related to hostility through rumination and expressive suppression. In contrast, the observing mindfulness facet was positively related to verbal aggression and hostility; these relations were mediated by rumination and expressive suppression.

Working hours, sleep, and fatigue in the public safety sector: A scoping review of the research

BACKGROUND

The public safety sector includes law enforcement officers (LEO), corrections officers (CO), firefighter service (FF), wildland firefighting (WFF), and emergency medical services (EMS), as defined in the National Occupational Research Agenda (NORA) of the National Institute for Occupational Safety and Health (NIOSH). Across these occupations, shiftwork, long-duration shifts, and excessive overtime are common. Our objective was to identify research gaps related to working hours, sleep, and fatigue among these workers.

METHODS

We used a scoping review study design that included searches of MEDLINE, Embase, CAB Abstracts, Global Health, PsychInfo, CINAHL, Scopus, Academic Search Complete, Agricultural and Environmental Science Collection, ProQuest Central, Cochrane Library, Safety Lit, Homeland Security Digital Library, and Sociological Abstracts using a range of occupational search terms and terms related to working hours, sleep, and fatigue.

RESULTS

Out of 3415 articles returned from our database search, 202 met all inclusion criteria. Six common outcomes related to working hours, sleep, and fatigue emerged: sleep, fatigue, work performance, injury, psychosocial stress, and chronic disease. Nearly two-thirds (59%, n = 120) of the studies were observational, of which 64% (n = 77) were cross sectional and 9% were (n = 11) longitudinal; 14% (n = 30) of the studies were reviews; and 19% (n = 39) were experimental or quasi-experimental studies. Only 25 of the 202 articles described mitigation strategies or interventions. FFs, LEOs, EMS, and WFFs were the most studied, followed by COs.

CONCLUSIONS

In general, more longitudinal and experimental studies are needed to enrich the knowledge base on the consequences of long working hours, poor sleep, and fatigue in the public safety sector. Few experimental studies have tested novel approaches to fatigue mitigation in diverse sectors of public safety. This gap in research limits the decisions that may be made by employers to address fatigue as a threat to public-safety worker health and safety.

The role of resilience in diabetes stigma among young and middle-aged patients with type 2 diabetes

AIM

To explore the prevalence and related factors influencing diabetes stigma among Chinese young and middle-aged patients with type 2 diabetes.

DESIGN

A cross-sectional, quantitative study was conducted through questionnaires.

METHODS

A total of 453 young and middle-aged patients with type 2 diabetes were recruited. Questionnaire survey was conducted with convenience sampling from September 2019 to December 2020. This included demographic questionnaire, Type 2 Diabetes Stigma Assessment Scale (DSAS-2) and Connor-Davidson Resilience Scale (CD-RISC). The STROBE checklist was applied as the reporting guideline for this study.

RESULTS

The scores of diabetes stigma and resilience of patients were 48.18 ± 14.52 and 66.02 ± 7.18, respectively. Diabetes stigma was negatively correlated with resilience, the correlation coefficient was -0.581. The results showed that the complications, diabetes year, monthly income and insulin treatment are important factors affecting stigma. In addition, it is resilience that was a protective factor of diabetes stigma, explaining 27.2% of the variance in diabetes stigma.

The effectiveness of psychological interventions for reducing PTSD and psychological distress in first responders: A systematic review and meta-analysis

Background

First responders are faced with stressful and traumatic events in their work that may affect their psychological health. The current review examined the effectiveness of psychological interventions to treat posttraumatic stress disorder (PTSD), anxiety, depression, stress and burnout in first responders.

Methods

Four databases were searched to identify controlled studies that examined the efficacy of psychological interventions to reduce PTSD symptoms (primary outcome) in first responders (including firefighters, police/law enforcement officers, search and rescue personnel, emergency and paramedics teams). Secondary outcomes were anxiety, depression, burnout, and stress.

Results

15 studies were identified, including 10 studies that measured PTSD, 7 studies for anxiety, 10 studies for depression, 7 studies for stress and 1 for burnout. Interventions were associated with a significant reduction in PTSD (SDM = -0.86; 95% CI = -1.34 –- 0.39), depression (SDM = -0.63; 95% CI = -0.94 –-0.32), and anxiety (SDM = -0.38; 95% CI = -0.71 –-0.05) but not stress (SDM = -0.13; 95% CI = -0.51–0.25). CBT-based and clinician-delivered interventions were associated with significantly greater reductions in PTSD than other types of interventions and non-clinician interventions, but no differences were found for depression. There was evidence of moderate to high risk of bias across all studies.

Conclusions

Psychological interventions are effective in reducing PTSD, depression and anxiety symptoms but not stress in first responders. Further research is needed using high quality randomised designs over longer periods of follow-up.

Burnout among Professionals Working in Corrections: A Two Stage Review

Burnout is a state of emotional, physical, and mental exhaustion often caused by excessive and prolonged stress. Given the emotionally and often physically demanding nature of the work of correctional professionals, they are at substantial risk of suffering the adverse consequences of burnout. We systematically reviewed (Stage 1) the influence of burnout amongst forensic psychologists, psychiatrists, case workers, nurses, and correction officers. Interventions were then reviewed (Stage 2) at the individual and collective level to examine the effectiveness or efficacy of treatments for burnout among professionals working in corrections.

A Qualitative Analysis of the Mental Health Training and Educational Needs of Firefighters, Paramedics, and Public Safety Communicators in Canada

Background—Public safety personnel (PSP) are at heightened risk of developing mental health challenges due to exposures to diverse stressors including potentially psychologically traumatic experiences. An increased focus on protecting PSP mental health has prompted demand for interventions designed to enhance resilience. While hundreds of available interventions are aimed to improve resilience and protect PSPs’ mental health, research evidence regarding intervention effectiveness remains sparse. Methods—Focus groups with PSP elicited a discussion of psychoeducational program content, preferred modes of program delivery, when such training should occur, and to whom it ought to be targeted. Results—The results of thematic analyses suggest that PSP participants feel that contemporary approaches to improving mental health and resilience are lacking. While welcomed, the provision of sporadic one-off mental health and resilience programs by organizations was seen as insufficient, and the available organizational mental health supports were perceived as being questionable. The available programs also left participants feeling insufficiently prepared to deal with personal mental health problems and in discussing mental health concerns with co-workers. Conclusions—Participants reported needing more engaging methods for delivering information, career-long mental health knowledge acquisition, and a systems approach to improve the workplace culture, particularly regarding mental health.

Resilience Interventions Conducted in Western and Eastern Countries-A Systematic Review

Previous research has demonstrated the efficacy of psychological interventions to foster resilience. However, little is known about whether the cultural context in which resilience interventions are implemented affects their efficacy on mental health. Studies performed in Western (k = 175) and Eastern countries (k = 46) regarding different aspects of interventions (setting, mode of delivery, target population, underlying theoretical approach, duration, control group design) and their efficacy on resilience, anxiety, depressive symptoms, quality of life, perceived stress, and social support were compared. Interventions in Eastern countries were longer in duration and tended to be more often conducted in group settings with a focus on family caregivers. We found evidence for larger effect sizes of resilience interventions in Eastern countries for improving resilience (standardized mean difference [SMD] = 0.48, 95% confidence interval [CI] 0.28 to 0.67; p < 0.0001; 43 studies; 6248 participants; I2 = 97.4%). Intercultural differences should receive more attention in resilience intervention research. Future studies could directly compare interventions in different cultural contexts to explain possible underlying causes for differences in their efficacy on mental health outcomes.

Does Training Motivation Influence Resilience Training Outcome on Chronic Stress? Results from an Interventional Study

Resilience is understood as an acquired skill which aids in coping with acute and chronic stress. Accordingly, the present study aimed to determine the effect of resilience training on mental health problems during chronic stress. To this end, we conducted a quasi-experimental study with 127 male cadets (mean age: 21 years) of the Swiss Armed Forces officers' school. Whereas the intervention group (IG) received resilience training in addition to the standard officer's education program, the control group (CG) completed the officers' school as usual. Data assessment included pre- and post- measurement of chronic stress, symptoms of depression, and vital exhaustion in both groups. Motivation for training was collected before the first training session. Those who received the resilience training reported no change in chronic stress, whereas participants in the CG showed a significant increase in chronic stress over time (η_p² = 0.025). Furthermore, significant differences between IG and CG were only found for symptoms of depression: Participants in the IG reported significantly decreased symptoms of depression, while this was not the case for participants in the CG. Within the IG, participants' training motivation strongly influenced the effectiveness of the resilience training. More specifically, motivated individuals were more likely to benefit from the resilience training than unmotivated ones. Outcome data suggest that resilience training appeared to favorably affect chronic stress and related mental health symptoms; however, the motivation for the training seemed to be an essential prerequisite.

A Mini-Review of Work Stress and Mindfulness: A Neuropsychological Point of View

Work stress is consistently linked with the deterioration of cognitive and mental health, limitations in everyday workplace performance, and an increased risk of developing diseases. A common thread binding these consequences appears to be stress-associated alterations in neuropsychological functions and affective domains, especially those reliant on hippocampal, prefrontal, and amygdala brain area. Although research broadly supports the claim that the practice of mindfulness meditation for the reduction of the consequences of stress and the promotion of health exert positive effects on workplaces, the precise neuropsychological benefits of Mindfulness-based interventions (MBIs) in the context of organizations remain elusive. In this review, we will analyze the impairments imposed by stress on the brain areas and functions and the benefits of MBIs from a neuropsychological point of view. This is significant since there is a centrality of cognitive functions in core processes necessary for work achievements, such as emotion regulation, problem-solving, and learning. The promotion of wellbeing is a responsibility shared between workers and organizations. Developing healthy environments allows workers to exercise greater control over their work, face work challenges, work productively and develop their talent.

A Confirmatory Factor Analysis of the PROMIS Sleep Disturbance Among Law Enforcement Officers

Law enforcement officers (LEOs) are at increased risk for sleep disorders relative to the general population. Common LEO occupational stressors, including critical incidents and shift work, predict sleep disturbance, which in turn negatively impacts health, performance, and community safety. The Patient-Reported Outcomes Measurement Information System-Sleep Disturbance 4-item (PROMIS SD4) was developed to assess self-reported sleep quality, satisfaction, and difficulties falling asleep. Previous studies suggest PROMIS-SD short-forms (4-, 6-, and 8-item) have good psychometric properties; however, evaluation of this easily-administered measure in high-stress, frontline populations is limited. The primary goal of this study was to evaluate the validity and reliability of the PROMIS-SD4 in a sample of LEOs (N = 111). A confirmatory factor analysis suggests that the original one-factor solution, with a correlated error-term, provides an excellent fit to the data, SBχ²(2) = 1.62, p = .23, CFI = .99, RMSEA = .12, SRMR = .01. The PROMIS SD4 demonstrated good reliability (α = .85) and evidence of convergent validity correlations in the expected direction with domains of psychological distress, positive health outcomes, reactivity, and body experience (all p's < .05). Results suggest that the PROMIS-SD4 is a valid and reliable measure of sleep disturbance among LEOs.

Indirect Associations Between Posttraumatic Stress Symptoms and Other Psychiatric Symptoms, Alcohol Use, and Well-being via Psychological Flexibility Among Police Officers

Police officers experience a high number of potentially traumatic events (PTEs) often associated with elevated posttraumatic stress symptoms (PTSS). In addition, PTSS are related to co-occurring psychiatric symptoms (e.g., anxiety, depression), alcohol misuse, and low perceived well-being. Yet, behavioral processes that may account for the associations between PTSS and unfavorable outcomes remain unspecified. Psychological flexibility, or one's response to private experiences (e.g., PTE-related memories) with an open, aware, and active approach, may be one such process. The present study aimed to evaluate psychological flexibility as both a mediator and moderator of PTSS and commonly co-occurring psychiatric symptoms, alcohol use, and general well-being, using cross-sectional data provided by a sample of police officers (N = 459) recruited from three regionally distributed U.S. police agencies. Structural equation modeling indicated a well-fitting model wherein psychological flexibility indirectly accounted for associations among PTSS and endogenous outcomes, χ² (107, N = 457) = 225.33, p < .001, CFI = .99, TLI = .98, RMSEA = .05, 90% CI [.04, .06], SRMR = .03. Psychological flexibility also moderated associations between PTSS and psychiatric symptoms, B = 1.58 (SE = 0.22), p < .001; and well-being, B = -3.84 (SE = 0.46), p < .001. Although additional research is needed, these preliminary results suggest psychological flexibility may be a behavioral process that accounts for negative outcomes associated with PTSS and a productive intervention target in the context of PTSS and generalized distress. Further research regarding the role of psychological flexibility in PTSS-related outcomes for police officers appears warranted.

Impact of Mindfulness Training on Spanish Police Officers' Mental and Emotional Health: a Non-Randomized Pilot Study

Objectives

The purpose of this exploratory non-randomized controlled study was to determine the acceptance and effectiveness of an 8-week mindfulness-based intervention (MBI) co-designed by a police officer.

Methods

A pretest-posttest control group design was followed. Participants (MBI group = 20; control group = 18) answered baseline and post-training self-reported measures. In addition, the weekly emotional state of the MBI group was collected. Paired-samples t-test and analysis of covariance were performed for pre-post within-group and between-group differences, respectively, as well as linear mixed effects analysis of repeated measures for week-by-week data.

Results

High acceptance and attendance rates, as well as significant pre-post within-group differences in the MBI group in mindfulness (η² = 0.43), self-compassion (η² = 0.43), depression (η² = 0.54), anxiety (η² = 0.46), stress (η² = 0.51), difficulties in emotion regulation, sleep quality (η² = 0.57), and burnout (η² = 0.31–0.47), were identified. Moreover, police officers who underwent the MBI experienced a week by week decrease of anger, disgust, anxiety, sadness, and desire. Finally, after adjusting for pre-test scores, significant between-group differences were found in the way of attending to internal and external experiences (observing mindfulness facet; η_p² = 0.21), depression symptoms (η_p² = 0.23), general distress (η_p² = 0.24), and the degree of physical and psychological exhaustion (personal burnout; η_p² = 0.20).

Conclusions

The preliminary effectiveness of this MBI on psychopathology and quality of life outcomes in Spanish police officers was discussed. Previous evidence regarding the promising use of MBIs in this population was supported.

Acceptability of a real-time notification of stress and access to self-help therapies among law enforcement officers

BACKGROUND

Law enforcement officers (LEOs) are exposed to chronic stress throughout the course of their shift, which increases the risk of adverse events. Although there have been studies targeting LEO safety through enhanced training or expanded equipment provisions, there has been little attempt to leverage personal technology in the field to provide real-time notification of LEO stress. This study tests the acceptability of implementing of a brief, smart watch intervention to alleviate stress among LEOs.

METHODS

We assigned smart watches to 22 patrol LEOs across two police departments: one suburban department and one large, urban department. At baseline, we measured participants' resting heart rates (RHR), activated their watches, and educated them on brief wellness interventions in the field. LEOs were instructed to wear the watch during the entirety of their shift for 30 calendar days. When LEO's heart rate or stress continuum reached the predetermined threshold for more than 10 min, the watch notified LEOs, in real time, of two stress reduction interventions: [1] a 1-min, guided breathing exercise; and [2] A Calm app, which provided a mix of guided meditations and mindfulness exercises for LEOs needing a longer decompression period. After the study period, participants were invited for semi-structured interviews to elucidate intervention components. Qualitative data were analyzed using an immersion-crystallization approach.

RESULTS

LEOs reported three particularly useful intervention components: 1) a vibration notification when hearts rates remained high, although receipt of a notification was highly variable; 2) visualization of their heart rate and stress continuum in real time; and, 3) breathing exercises. The most frequently reported type of call for service when the watch vibrated was when a weapon was involved or when a LEO was in pursuit of a murder suspect/hostage. LEOs also recollected that their watch vibrated while reading dispatch notes or while on their way to work.

CONCLUSIONS

A smart watch can deliver access to brief wellness interventions in the field in a manner that is both feasible and acceptable to LEOs.

An Integrative Review on the Research Progress of Mindfulness and Its Implications at the Workplace

Mindfulness has rapidly become a significant subject area in many disciplines. Most of the work on mindfulness has focused on the perspective of health and healthcare professionals, but relatively less research is focused on the organizational outcomes at the workplace. This review presents a theoretical and practical trajectory of mindfulness by sequential integration of recent fragmented scholarly work on mindfulness at the workplace. The review showcases that most contemporary practical challenges in organizations, such as anxiety, stress, depression, creativity, motivation, leadership, relationships, teamwork, burnout, engagement, performance, well-being, and physical and psychological health, could be addressed successfully with the budding concept of mindfulness. The causative processes due to higher mindfulness that generate positive cognitive, emotional, physiological, and behavioral outcomes include focused attention, present moment awareness, non-judgmental acceptance, self-regulatory functions, lower mind wandering, lower habit automaticity, and self-determination. Employee mindfulness could be developed through various mindfulness interventions in order to improve different organizational requirements, such as psychological capital, emotional intelligence, prosocial behavior, in-role and extra-role performance, financial and economic performance, green performance, and well-being. Accordingly, this review would be beneficial to inspire academia and practitioners on the transformative potential of mindfulness in organizations for higher performance, well-being, and sustainability. Future research opportunities and directions to be addressed are also discussed.

Pre-deployment programmes for building resilience in military and frontline emergency service personnel

BACKGROUND

Military personnel and frontline emergency workers may be exposed to events that have the potential to precipitate negative mental health outcomes such as depression, symptoms of post-traumatic stress and even post-traumatic stress disorder (PTSD). Programmes have been designed to build psychological resilience before staff are deployed into the field. This review presents a synthesis of the literature on these "pre-deployment resilience-building programmes".

OBJECTIVES

The objective of this review was to assess the effectiveness of programmes that seek to build resilience to potentially traumatic events among military and frontline emergency service personnel prior to their deployment. These resilience programmes were compared to other interventions, treatment as usual or no intervention.

SEARCH METHODS

Studies were identified through searches of electronic databases including Ovid MEDLINE, Embase, PsycINFO, Web of Science and Google Scholar. The initial search took place in January 2019, with an updated search completed at the end of September 2020.

SELECTION CRITERIA

Only studies that used a randomised controlled trial (RCT)/cluster-RCT methodology were included. The programmes being evaluated must have sought to build resilience prior to exposure to trauma. Study participants must have been 18 years or older and be military personnel or frontline emergency workers.

DATA COLLECTION AND ANALYSIS

Studies that met the inclusion criteria were assembled. Data extracted included methods, participants' details, intervention details, comparator details, and information on outcomes. The primary outcomes of interest were resilience, symptoms of post-traumatic stress and PTSD. Secondary outcomes of interest included acute stress disorder, depression, social support, coping skills, emotional flexibility, self-efficacy, social functioning, subjective levels of aggression, quality of sleep, quality of life and stress. Assessment of risk of bias was also completed. A total of 28 studies were included in a narrative synthesis of results.

MAIN RESULTS

All 28 included studies compared an experimental resilience building intervention versus a control or no intervention. There was a wide range of therapeutic modalities used, including cognitive behavioural therapy (CBT) informed programmes, biofeedback based programmes, stress-management programmes, mindfulness and relaxation programmes, neuropsychological-based programmes, and psychoeducational-informed programmes. The main outcomes are specified here, secondary outcomes such as depression, social support, coping skills, self-efficacy, subjective levels of aggression and stress are reported in text. No studies reported on the following pre-specified outcomes; acute stress disorder, emotional flexibility, social functioning, quality of sleep and quality of life. Resilience Eight studies reported resilience as an outcome. We narratively synthesised the data from these studies and our findings show that five of these interventions had success in building resilience in their respective samples. Two of the studies that reported significant results utilised a CBT approach to build resilience, while the other three successful programmes were mindfulness-based interventions. Symptoms of post-traumatic stress Our narrative synthesis of results included eight studies. Two of the eight studies produced significant reductions in symptoms of post traumatic stress compared to controls. These interventions used neuropsychological and biofeedback intervention models respectively. PTSD caseness Four studies reported PTSD caseness as an outcome. Our narrative synthesis of results suggests that evidence is mixed as to the effectiveness of these interventions in reducing clinical diagnosis of PTSD. One study of a neuropsychology-orientated Attention Bias Modification Training (AMBT) programme had success in reducing both symptoms of post-traumatic stress and numbers of participants receiving a diagnosis of PTSD. A stress-management programme reported that, when baseline differences in rates of pre-deployment mental health issues were controlled for, participants in the control condition were at 6.9 times the risk of a diagnosis of PTSD when compared to the intervention group. Given the diversity of intervention designs and theoretical orientations used (which included stress-management, neuropsychological and psychoeducational programmes), a definitive statement on the efficacy of pre-deployment programmes at reducing symptoms of post-traumatic stress and PTSD cannot be confidently offered.

AUTHORS' CONCLUSIONS

While a number of evaluations of relevant programmes have been published, the quality of these evaluations limits our ability to determine if resilience-building programmes 'work' in terms of preventing negative outcomes such as depression, symptoms of post-traumatic stress and diagnoses of PTSD. Based on our findings we recommend that future research should: a) report pre-/post-means and standard deviation scores for scales used within respective studies, b) take the form of large, RCTs with protocols published in advance, and c) seek to measure defined psychological facets such as resilience, PTSD and stress, and measure these concepts using established psychometric tools. This will provide more certainty in future assessments of the evidence base. From a clinical implications point of view, overall there is mixed evidence that the interventions included in this review are effective at safe guarding military personnel or frontline emergency workers from experiencing negative mental health outcomes, including PTSD, following exposure to potentially traumatic events. Based on this, practitioners seeking to build resilience in their personnel need to be aware of the limitations of the evidence base. Practitioners should have modest expectations in relation to the efficacy of resilience-building programmes as a prophylactic approach to employment-related critical incident traumas.

Resilience Training Programs in Organizational Contexts: A Scoping Review

The importance of resilience for employees' well-being and performance at work has grown steadily in recent years. This development has become even more pronounced through the recent COVID-19 pandemic and its consequences, including major changes in occupational settings. Although there is increasing interest in resilience in general and a growing number of publications focusing on the development of resilience in particular, many questions remain about resilience training, especially in organizational contexts. The purpose of this scoping review is to uncover what is known about resilience training in organizational contexts. A systematic search of four databases for articles published through 2021 was conducted. A total of 48 studies focusing on resilience training programs in organizational contexts were included in this review. The review provides relevant insights into resilience training programs by focusing on program characteristics, target group, study design, and outcomes. Based on the results, the main aspects that concern the development of resilience training programs for organizational settings and requirements for the study design for empirical investigation were summarized. The results of the review highlight possible directions for future research and offer useful insights for resilience-enhancing training programs in organizations.

A review of workplace mental health interventions and their implementation in public safety organizations

OBJECTIVE

Workplace mental health is relevant to public safety organizations due to the exposure that many public safety personnel (PSP) have to psychological trauma in the course of their daily work. While the importance of attending to PSP mental health has been established, the implementation of workplace mental health interventions is not as well understood. This scoping review describes workplace mental health interventions and their implementation in public safety organizations.

METHODS

English published primary studies with any publication date up to July 3, 2020 were considered. JBI methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews was followed.

RESULTS

89 citations met inclusion criteria out of the 62,299 found. Articles and reports found were largely published within the last decade, most frequently from Western nations, and most often applied to police, followed by firefighters. The focus of interventions was commonly stress management and resilience, and a frequent implementation strategy was multi-session group training. Comprehensive quality improvement initiatives, a focus on supervisors and managers, and interventions across primary, secondary, and tertiary prevention, were infrequent.

CONCLUSION

Public safety organizations are frequently reporting on stress management and resilience interventions for police and firefighters, implemented through multi-session group training. A focus across a range of PSP, including paramedics, corrections officers, and emergency dispatchers, using implementation strategies beyond group training, is suggested. This area of research is currently expanding, with many studies published within the past decade; ongoing evaluation of the quality of interventions and implementation strategies is recommended.

The Impact of Mindfulness Training on Police Officer Stress, Mental Health, and Salivary Cortisol Levels

Unaddressed occupational stress and trauma contribute to elevated rates of mental illness and suicide in policing, and to violent and aggressive behavior that disproportionately impacts communities of color. Emerging evidence suggests mindfulness training with police may reduce stress and aggression and improve mental health, but there is limited evidence for changes in biological outcomes or the lasting benefits of mindfulness training. We conducted a randomized controlled trial (RCT) of 114 police officers from three Midwestern U.S. law enforcement agencies. We assessed stress-related physical and mental health symptoms, blood-based inflammatory markers, and hair and salivary cortisol. Participants were then randomized to an 8-week mindfulness intervention or waitlist control (WLC), and the same assessments were repeated post-intervention and at 3-month follow-up. Relative to waitlist control, the mindfulness group had greater improvements in psychological distress, mental health symptoms, and sleep quality post-training, gains that were maintained at 3-month follow-up. Intervention participants also had a significantly lower cortisol awakening response (CAR) at 3-month follow-up relative to waitlist control. Contrary to hypotheses, there were no intervention effects on hair cortisol, diurnal cortisol slope, or inflammatory markers. In summary, an 8-week mindfulness intervention for police officers led to self-reported improvements in distress, mental health, and sleep, and a lower CAR. These benefits persisted (or emerged) at 3-month follow-up, suggesting that this training may buffer against the long-term consequences of chronic stress. Future research should assess the persistence of these benefits over a longer period while expanding the scope of outcomes to consider the broader community of mindfulness training for police.

Clinical Trial Registration: ClinicalTrials.gov#NCT03488875.

The Relationships Between Reduced Alcohol Use and Decreased Burnout Following Mindfulness-Based Resilience Training in Law Enforcement Officers

Objective: This study is a secondary analysis of data collected in an earlier clinical trial of mindfulness-based resilience training (MBRT) (ClinicalTrials.gov registration number 02521454), where the MBRT condition demonstrated a significant reduction in self-reported burnout and trend-level reductions in alcohol use in law enforcement officers (LEOs). Given that MBRT is not designed to be a substance use intervention and does not contain explicit substance-related content, this study sought to clarify these findings by exploring whether improved burnout mediates reduced alcohol use. Method: Participants (n = 61) were sworn LEOs (89% male, 85% White, 8% Hispanic/Latinx) recruited from departments in a large urban metro area of the northwestern United States, and were randomized to either MBRT (n = 31) or no intervention control group (n = 30) during the trial. Results: MBRT group assignment predicted reduced burnout (b = 0.43, standard error [SE] = 0.14, p = 0.004), which subsequently predicted reduced alcohol use (b = 1.69, SE = 0.81, p = 0.045). Results suggest that reduced alcohol use was indirectly related to a reduction in burnout post-MBRT. Conclusion: Given that MBRT does not explicitly address substance use, these findings were interpreted to suggest that officers in the training acquired a new set of coping skills to deal with the operational and organizational stressors of police work.

The impact of a mindfulness-based intervention on the quality of life of Spanish national police officers

PURPOSE

Police officers belong to a profession with a high risk of stress, burnout and compassion fatigue. Incorporating mindfulness practices into the health and occupational-risk prevention programs run by the national police forces in Spain could provide a new approach to reducing stress and enhancing the psychological and emotional balance of these officers.

METHODS

A 7-week mindfulness-based intervention (MBI) was conducted in a group of 20 national police officers in Mallorca (Spain). Mindfulness, self-compassion, burnout, compassion fatigue, compassion satisfaction and perceived stress were measured and compared before and after the intervention.

RESULTS

We identified significant differences in mindfulness (F(5, 14) = 7.441, p = 0.001, η²  = 0.727), compassion satisfaction (F(1, 19) = 5.929, p = 0.025, η²  = 0.238) and perceived stress levels (t(18) = 2.863, p = 0.010, d = 0.611) after the intervention; non-significant improvements were observed for the remaining variables assessed.

CONCLUSIONS

MBIs could be an effective way of reducing stress levels among police officers in Spain.

Trait Mindfulness Moderates the Association Between Stressor Exposure and Perceived Stress in Law Enforcement Officers

Objectives

To test the magnitude of the relationship between self-reported stressor exposure and perceived stress in police officers using a novel measure of daily work events, and whether dispositional mindfulness and resilience moderate this relationship.

Methods

A total of 114 law enforcement officers from a mid-sized Midwestern US city completed daily logs of job stressors and associated perceived stress, as well as additional self-report measures of perceived stress, trait mindfulness and resilience, and demographics and work information. Principal component analysis (PCA) was used to cluster job stressors into a smaller number of components in a data-driven manner. Linear mixed-effects models were used to test the relationship between stressor exposure and perceived stress for each component, and the moderation of this relationship by trait mindfulness and resilience.

Results

The PCA categorized stressor exposure into three components: (1) acute or traumatic line-of-duty stressors, (2) routine daily stressors, and (3) interpersonal stressors. Results of mixed models showed robust positive relationships between self-reported stressor exposure and corresponding perceived stress across all 3 components. Dispositional mindfulness (but not resilience) moderated the association between stressor exposure and perceived stress for routine stressors, such that individuals with higher dispositional mindfulness showed a relatively attenuated relationship between exposure to routine daily stressors and resulting perceived stress.

Conclusions

Police officers high in dispositional mindfulness may experience daily routine stressors as less stressful, which can reduce the accumulation of general stress in the long term and which could help buffer against negative health outcomes associated with perceived stress.

Trial registration

Clinicaltrials.gov/ct2/show/NCT03488875

Supplementary Information

The online version contains supplementary material available at 10.1007/s12671-021-01707-4.

Individual Resilience Interventions: A Systematic Review in Adult Population Samples over the Last Decade

Resilience interventions have been gaining importance among researchers due to their potential to provide well-being and reduce the prevalence of mental disorders that are becoming an increasing concern, especially in Western countries, because of the costs associated. The purpose of this systematic review is to identify the intervention studies carried out in the last decade in adult population samples, evaluate their methodological quality and highlight the trends of these types of interventions. This review was performed using systematic literature searches in the following electronic databases: B-on, PubMed, PsycNet and Science Direct. The application of eligibility criteria resulted in the inclusion of 38 articles, of which 33 were randomized controlled trials and the other five were nonrandomized controlled studies. Although most studies showed statistical significance for their results, these were constrained by the great heterogeneity of the studies, the lack of power of the samples and their fair methodological quality. Therefore, it is important to consolidate the theoretical basis and standardize certain methodologies so that the effects of the interventions can be compared through a meta-analysis.

Meditation and mindfulness reduce perceived stress in women with recurrent pregnancy loss: a randomized controlled trial

RESEARCH QUESTION

Can participating in a tailored 7-week meditation and mindfulness programme with additional standard supportive care versus standard supportive care only reduce perceived stress for women with recurrent pregnancy loss (RPL)?

DESIGN

A two-armed randomized controlled trial (RCT) with 12-month follow-up. In total 76 patients were enrolled and randomly assigned to either standard supportive care or to a 7-week meditation and mindfulness programme led by an instructor in addition to standard supportive care.

RESULTS

At intervention completion (after 7 weeks), perceived stress decreased significantly both in the intervention group (P = 0.001) and in the control group (P = 0.006). The decrease in perceived stress in the intervention group was significantly larger (P = 0.027) compared with the control group. At the 12-month follow-up perceived stress was still significantly decreased in both groups compared with baseline (P < 0.0001 in the intervention group and P = 0.002 in the control group).

CONCLUSION

This first RCT of a tailored meditation and mindfulness intervention for women with RPL documents that a 7-week daily at-home meditation and mindfulness programme combined with group sessions reduced perceived stress significantly more than a standard supportive care programme. Future studies should address the most effective format and the 'dose' needed for an impact on perceived stress levels.

Proactive psychological programs designed to mitigate posttraumatic stress injuries among at-risk workers: a systematic review and meta-analysis

BACKGROUND

Public safety personnel and frontline healthcare professionals are at increased risk of exposure to potentially psychologically traumatic events (PPTE) and developing posttraumatic stress injuries (PTSI, e.g., depression, anxiety) by the nature of their work. PTSI are also linked to increased absenteeism, suicidality, and performance decrements, which compromise occupational and public health and safety in trauma-exposed workers. Evidence is lacking regarding the effectiveness of "prevention" programs designed to mitigate PTSI proactively. The purpose of this review is to measure the effectiveness of proactive PTSI mitigation programs among occupational groups exposed to PPTE on measures of PTSI symptoms, absenteeism, and psychological wellness.

METHODS

Five electronic databases were searched per PRISMA guidelines for English or French peer-reviewed studies from 2008 to 2019 evaluating PTSI and psychological wellness in adults exposed to occupational PPTE. The risk of bias was assessed using the Newcastle-Ottawa Scale.

RESULTS

We identified 42 studies evaluating 3182 public safety and frontline healthcare professionals, PPTE-exposed educational staff, and miners. Significant overlap was found across program themes that included mindfulness, psychoeducation, resilience promotion, and stress management strategies. Post-program effect sizes were small (SMD < 0.5) to moderate (SMD < 0.8) for reductions in PTSI symptoms and for promoting measures of well-being as indicated by a meta-analysis on 36 studies. There was no evidence for significant reductions in substance use, absenteeism, or biomarkers of distress except for heart rate. Subgroup analyses indicated that multimodal programs effectively improved general psychological health, while resilience programs improved measures of depression, burnout, coping, and resilience. Effect sizes for resilience, depression, and general psychological health improvements were greatest immediately or 1-month post-training, while improvements in PTSD symptoms and coping were larger at longer follow-up. Studies were of moderate quality and risk of bias.

CONCLUSIONS

The current results showcase modest evidence for time-limited reductions in PTSI following participation in holistic programs that promote resilience, stress, and emotion regulation among at-risk workers. Implications for organizational implementation of proactive PTSI mitigation programs and areas of future research are discussed.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO (CRD42019133534).

The mindful shield: The effects of mindfulness training on resilience and leadership in military leaders

OBJECTIVES

The purpose of this study was to address military leader perceptions of their resilience, transformational leadership behaviors, and leadership effectiveness before and after experiencing Mindfulness-Based Attention Training (MBAT).

METHODS

Participants were formal and informal leaders in the Kansas Air National Guard. The study used a mixed-methods sequential exploratory design. Phase I involved analyzing pretest and posttest results obtained from a Jha Lab study for three self-report assessments in an intervention group (n = 36) vs a control group (n = 37). The qualitative data in phase II was obtained from individual interviews of participants (n = 12) following the Jha Lab study.

RESULTS

The phase I quantitative results confirmed the null hypotheses-no significant differences found-for all research questions. Phase II resulted in eight thematic codes, six of which were central to the experiences described by participants (Halting, Sensing, Being, Shielding, Considering, and Engaging) and two that were not (Obstructing, and Escaping).

CONCLUSIONS

The key finding was that the descriptions of mindful thoughts and behaviors were consistent across participants indicating that MBAT accurately presents mindfulness during the course and the training had positive effects on participant mindfulness, primarily in the areas of being present to self, shielding the self through reperceiving, and then consciously altering behavior based on the new perspective. Results should direct future resiliency course development, leadership course curricula, and aid understanding of how leaders mentally conceptualize stress, incorporate resilient behaviors and then apply that knowledge to their own leadership behaviors.

Mindfulness training reduces PTSD symptoms and improves stress-related health outcomes in police officers

Law enforcement officers are regularly exposed directly and indirectly to a wide variety of traumatic stressors, which take place against a backdrop of high levels of organizational stressors. Consequently, this group is at elevated risk for posttraumatic stress disorder (PTSD) and other negative physical and mental health outcomes, yet there are few empirically supported interventions to proactively mitigate the effects of occupational stress for this population. Recent studies suggest that training in mindfulness meditation may reduce perceived stress and improve related physical and mental health outcomes in this group. We sought to demonstrate feasibility, acceptability, and adherence for an 8-week mindfulness training program in 30 officers from a mid-sized, Midwestern U.S. police department, replicate findings of improved stress-related health outcomes, and provide novel evidence for reduced PTSD symptoms. All 30 officers completed the training, with high rates of class attendance, substantial out-of-class practice time, and good acceptability of the training and teachers. We replicated findings of reduced post-training perceived stress, sleep disturbances, anxiety, and burnout. We also identified novel evidence for reduced PTSD symptoms that persisted at a 5-month follow-up assessment. These results indicate key targets for future investigation in larger, mechanistic, randomized controlled trials of mindfulness training in police officers.

Mindful Nonreactivity Moderates the Relationship between Chronic Stress and Pain Interference in Law Enforcement Officers

INTRODUCTION

With high levels of both chronic stress and chronic pain, law enforcement provides a unique population in which to study the potential mitigating impact of cognitive and affective reactivity on the stress-pain link. The primary aim of the present study was to examine the moderating role of mindful nonreactivity in the relationship between chronic stress and pain interference in law enforcement officers (n = 60).

METHODS

A regression analysis was conducted to determine if chronic stress predicted pain interference, and subsequently, to compute an estimate of the interaction effect of the chronic stress and mindful nonreactivity on pain interference.

RESULTS

Results demonstrated the overall model was significant, F (3,55) = 5.29, p =.003, R2 = .47. When controlling for mindful nonreactivity, chronic stress significantly predicted pain interference, b = .76, t (55) = 3.40, p = .001, such that every one unit increase in chronic stress was associated with a .76 unit increase in pain interference. Results also demonstrated a significant interaction effect of mindful nonreactivity and chronic stress on pain interference, b = -.04, t (55) = -2.86, p = .006. The Johnson-Neyman technique was conducted and revealed among individuals with low levels of mindful nonreactivity, chronic stress significantly predicted pain interference. However, for individuals with greater levels of mindful nonreactivity, chronic stress no longer predicted pain interference.

CONCLUSIONS

Findings contribute to a growing understanding of how mindfulness can mitigate harmful effects of stress.

Mindfulness Training Improves Quality of Life and Reduces Depression and Anxiety Symptoms Among Police Officers: Results From the POLICE Study-A Multicenter Randomized Controlled Trial

Background: Police officers' high-stress levels and its deleterious consequences are raising awareness to an epidemic of mental health problems and quality of life (QoL) impairment. There is a growing evidence that mindfulness-based interventions are efficacious to promote mental health and well-being among high-stress occupations. Methods: The POLICE study is a multicenter randomized controlled trial (RCT) with three assessment points (baseline, post-intervention, and 6-month follow-up) where police officers were randomized to mindfulness-based health promotion (MBHP) (n = 88) or a waiting list (n = 82). This article focuses on QoL, depression and anxiety symptoms, and religiosity outcomes. Mechanisms of change and MBHP feasibility were evaluated. Results: Significant group × time interaction was found for QoL, depression and anxiety symptoms, and non-organizational religiosity. Between-group analysis showed that MBHP group exhibited greater improvements in QoL, and depression and anxiety symptoms at both post-intervention (QoL d = 0.69 to 1.01; depression d = 0.97; anxiety d = 0.73) and 6-month follow-up (QoL d = 0.41 to 0.74; depression d = 0.60; anxiety d = 0.51), in addition to increasing non-organizational religiosity at post-intervention (d = 0.31). Changes on self-compassion mediated the relationship between group and pre-to-post changes for all QoL domains and facets. Group effect on QoL overall health facet at post-intervention was moderated by mindfulness trait and spirituality changes. Conclusion: MBHP is feasible and efficacious to improve QoL, and depression and anxiety symptoms among Brazilian officers. Results were maintained after 6 months. MBHP increased non-organizational religiosity, although the effect was not sustained 6 months later. To our knowledge, this is the first mindfulness-based intervention RCT to empirically demonstrate these effects among police officers. Self-compassion, mindfulness trait, and spirituality mechanisms of change are examined. Clinical Trial Registration: www.ClinicalTrials.gov. identifier: NCT03114605.

An Evaluation of a Suicide Prevention E-Learning Program for Police Officers (COPS): Improvement in Knowledge and Competence

Background: Police officers are at high risk for mental and physical health problems and suicidal ideation. The specific risk factors are numerous and concern stressful missions and administrative aspects of the police profession. So far, the police get only little training on specific missions as well as on coping with stress and suicidal ideation in the police profession. In this study we test the efficacy of the online training COPS (Coping with Suicide) for police officers. Methods: A total of 142 police officers from Germany and Switzerland participated in the study; complete data (baseline and post) are available from 102 participants. The training consisted of three modules covering the topics of delivering death notifications, dealing with individuals with suicidal ideation and dealing with one's own distress and suicidal ideation in the police profession. The primary outcomes are perceived knowledge and self-rated competence regarding the contents of the program, actual knowledge as well as symptoms of depression and anxiety (PHQ-9), and attitudes toward suicide (ATTS). The data are collected at baseline and after completing the training. Results: We found a significant increase in knowledge as well as in perceived competence after completing the training. Mental health and attitudes toward suicide did not change significantly. Years on the job had no moderating effect on the effectiveness of the training. Discussion: The results suggest that a short e-learning program significantly improves knowledge and self-rated competence in delivering death notifications, in suicide prevention and stress management. It can be easily integrated into the daily routine of police-officers, and participants could participate at their own pace and from any location. One limitation of this study is the lack of a control-group. Further advantages and limitations of this study are discussed. Clinical Trial Registration: https://www.drks.de/drks_web/, identifier: DRKS00023882.