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von Känel R. Stress-Induced Hypercoagulability: Insights from Epidemiological and Mechanistic Studies, and Clinical Integration. Semin Thromb Hemost 2024. [PMID: 38914118 DOI: 10.1055/s-0044-1787660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
By integrating findings from comprehensive reviews, meta-analyses, and cutting-edge genetic studies, this article illuminates the significance of stress-induced hypercoagulability in clinical medicine. In particular, the findings from numerous prospective cohort studies indicate that stress and hemostatic factors of a hypercoagulable state are associated with increased incident risk and poor prognosis for atherosclerotic cardiovascular disease and venous thromboembolism. Mendelian randomization studies suggest that these associations are partially causal. The review synthesizes extensive research on the link between acute and chronic stress and hypercoagulability, outlining a potential pathway from stress to thrombosis risk. Consistent with the allostatic load concept, acute stress-induced hypercoagulability, initially adaptive, can turn maladaptive under chronic stress or excessive acute stress, leading to arterial or venous thrombotic events. Individuals with predisposing factors, including atherosclerosis, thrombophilia, or immobilization, may exhibit an increased risk of thrombotic disease during stress. Contextual sociodemographic characteristics, the stress experience, and coping resources additionally modulate the extent of stress-induced hypercoagulability. Research into the neuroendocrine, cellular, and molecular bases reveals how stress influences platelet activation coagulation and fibrinolysis. The activation of the sympathetic nervous system and the hypothalamic-pituitary-adrenal axis, along with vagal withdrawal, and the effects of catecholamines, cortisol, and vasopressin, are the central mechanisms involved. Hemoconcentration, inflammation, endothelial dysfunction, and thrombopoiesis additionally contribute to stress-induced hypercoagulability. Further research is needed to prove a causal link between chronic stress and hypercoagulability. This includes exploring its implications for the prevention and management of thrombotic diseases in stressed individuals, with a focus on developing effective psychosocial and pharmacological interventions.
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Affiliation(s)
- Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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2
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Gamito P, Oliveira J, Silva J, Rosa J, Mendes MLR, Dias R, Dias F, Mansuklal SA, Cartaxo J, António H, Salvador Á. Stress Inoculation in Police Officers Using Virtual Reality: A Controlled Study. CYBERPSYCHOLOGY, BEHAVIOR AND SOCIAL NETWORKING 2024; 27:253-260. [PMID: 38377602 DOI: 10.1089/cyber.2023.0385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
Policing is a highly demanding and stressful profession. Virtual reality (VR) has emerged as a promising tool for enhancing stress management programs, including for police officers. The use of VR in combination with biosensors enables measurement of psychophysiological responses such as peripheral temperature (PT) and skin conductance level (SCL). This study investigated the psychophysiological responses of police officers exposed to a VR scenario simulating a car accident. The study included a total of 63 police officers from the Public Security Police. Participants were divided into three groups based on their police divisions: the Investigation Brigade of Traffic Accidents, the Traffic Surveillance Squad (TSS), and a control group from the Lisbon Metropolitan Command. The results indicated that the VR environment effectively induced psychophysiological arousal, particularly in less experienced officers (TSS), that is, there were significant group differences in mean SCL and PT, showing this group with higher SCL and lower PT during the VR exposure. These results support the potential of VR as a stress inoculation strategy for training police officers and highlight the complex nature of stress responses that are influenced by individual factors and psychopathology.
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Affiliation(s)
- Pedro Gamito
- HEI-Lab: Digital Human-Environment Interaction Labs, Lusófona University, Lisboa, Portugal
| | - Jorge Oliveira
- HEI-Lab: Digital Human-Environment Interaction Labs, Lusófona University, Lisboa, Portugal
| | | | - Joana Rosa
- HEI-Lab: Digital Human-Environment Interaction Labs, Lusófona University, Lisboa, Portugal
| | | | - Ricardo Dias
- HEI-Lab: Digital Human-Environment Interaction Labs, Lusófona University, Lisboa, Portugal
| | - Fábio Dias
- HEI-Lab: Digital Human-Environment Interaction Labs, Lusófona University, Lisboa, Portugal
| | - Shivani A Mansuklal
- HEI-Lab: Digital Human-Environment Interaction Labs, Lusófona University, Lisboa, Portugal
| | - Joana Cartaxo
- HEI-Lab: Digital Human-Environment Interaction Labs, Lusófona University, Lisboa, Portugal
| | | | - Ágata Salvador
- HEI-Lab: Digital Human-Environment Interaction Labs, Lusófona University, Lisboa, Portugal
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3
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Di Nota PM, Scott SC, Huhta JM, Gustafsberg H, Andersen JP. Physiological Responses to Organizational Stressors Among Police Managers. Appl Psychophysiol Biofeedback 2024; 49:85-102. [PMID: 38244109 PMCID: PMC10869394 DOI: 10.1007/s10484-023-09613-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2023] [Indexed: 01/22/2024]
Abstract
Police officers demonstrate increased risk of physical and mental health conditions due to repeated and prolonged exposure to stressful occupational conditions. Occupational stress is broken into two types: operational stress, related to the content of field duties (e.g., physical demands); and organizational stress, related to cultural and structural contexts (e.g., interpersonal relationships). Applied police research focuses on physiological activation in operational tasks as a mechanism explaining health risk and non-optimal performance outcomes. However, recent survey-based studies indicate numerous organizational stressors associated with self-reported mental health symptoms. The question of whether organizational stressors elicit significant physiological activity remains unknown. The current proof-of-concept field study tests the hypothesis that police managers will display significant physiological reactivity before, during, and after engaging in reality-based scenarios representative of stressful police management tasks developed from evidence-based pedagogical approaches. A sample of 25 training police managers (7 female, M = 16 +/- 5.3 years of experience) completed 5 reality-based scenarios, including resolving a heated conflict between colleagues, delivering negative feedback to a subordinate, and critical incident command. Significant increases in heart rate relative to rest were observed during all tasks, and in anticipation of several tasks. Greater increases in reactive heart rate were associated with longer recovery times. Sex differences and relationships between objective biological and subjective psychological measures of stress are discussed. The current findings demonstrate significant physiological responses to organizational stressors similar to levels observed during operational tasks, despite the absence of physical or aerobic exertion. Implications for police health and training are discussed.
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Affiliation(s)
- Paula M Di Nota
- Department of Psychology, University of Toronto Mississauga, Mississauga, ON, Canada
| | - Sarah C Scott
- Department of Psychology, University of Toronto Mississauga, Mississauga, ON, Canada
| | - Juha-Matti Huhta
- Police University College of Finland, Tampere, Finland
- Faculty of Culture & Education, Tampere University, Tampere, Finland
| | | | - Judith P Andersen
- Department of Psychology, University of Toronto Mississauga, Mississauga, ON, Canada.
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4
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Voigt L, Hill Y, Frenkel MO. Testing the hormesis hypothesis on motor behavior under stress. APPLIED ERGONOMICS 2024; 115:104161. [PMID: 37935066 DOI: 10.1016/j.apergo.2023.104161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 10/24/2023] [Accepted: 10/27/2023] [Indexed: 11/09/2023]
Abstract
While much research has focused on the deleterious effects of stress on goal-directed behavior in recent decades, current views increasingly discuss growth under stress, often assuming dose-dependent effects of stress in a curvilinear association. This is based on the concept of hormesis, which postulates a strengthening effect of stress at low-to-moderate doses. Leveraging this approach, hormetic curves indicate under which stress dose an individual is able to maintain or even increase goal-directed behavior. The present study aimed to test the hormetic effect of low-to-moderate stress on tactical movement performance in the context of police operational scenarios in virtual reality. In teams of three to four, 37 riot police officers had to search a building for a potentially aggressive perpetrator in three scenarios with escalating stress potential (i.e., increasing weapon violence and number of civilians). Tactical movement performance as behavioral response was quantified by the sample entropy of each officer's velocity derived from positional data. To account for inter-individuality in response to the scenarios, we assessed self-reported stress, anxiety, mental effort, and vagally mediated heart rate variability. Specifically, we tested the quadratic associations between tactical movement performance and stress parameters, respectively. Random-intercept-random-slope regressions revealed neither significant linear nor quadratic associations between any of the stress parameters and performance. While we did not find evidence for hormesis in the present study, it stimulates theoretical discussions about the definition of "baseline" functioning and how the understanding of hormesis can move from psychological to behavioral adaptations to stressors.
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Affiliation(s)
- Laura Voigt
- Institute of Sports and Sports Sciences, Heidelberg University, Germany; Institute of Psychology, German Sport University, Cologne, Germany
| | - Yannick Hill
- Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, the Netherlands; Institute of Brain and Behaviour Amsterdam, Amsterdam, the Netherlands; Lyda Hill Institute for Human Resilience, Colorado Springs, USA.
| | - Marie Ottilie Frenkel
- Institute of Sports and Sports Sciences, Heidelberg University, Germany; Faculty of Health, Safety, Society, Furtwangen University, Germany
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5
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Cooper D, Fuller J, Wiggins MW, Wills JA. Negative Consequences of Pressure on Marksmanship May be Offset by Early Training Exposure to Contextually Relevant Threat Training: A Systematic Review and Meta-Analysis. HUMAN FACTORS 2024; 66:294-311. [PMID: 35387527 PMCID: PMC10756023 DOI: 10.1177/00187208211065907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE The purpose of this meta-analytic review is to examine the relationship between increased psychological pressure and Use of Force (UOF) behaviours, identifying current training methodologies and effectiveness of transfer of training interventions in high threat-simulated scenarios. BACKGROUND Data from UOF performance within Law Enforcement indicates a low transfer of marksmanship training into real-world UOF, resulting in unnecessary damage to property, personal injury and increased risk to loss of life. This meta-analysis examines both the impact of increased pressure and current training interventions. METHOD A meta-analysis was conducted across a wide range of published research to answer the primary research questions. RESULTS Increased levels of perceived pressure demonstrated an average decrease in marksmanship accuracy of 14.8%, together with a small increase in incorrect Decision Making (DM) and faster reaction Times (RT). Experience demonstrated a mitigating effect for pressure for marksmanship with a 1.1% increase for every one year of service but no effect on DM or RT. Training interventions utilizing a variety of early contextually relevant exposures to increased pressure improved performance over traditional training on average by 10.6%. CONCLUSION The outcomes illustrate the negative effect of pressure on marksmanship and UOF behaviours, and that early exposure to contextually relevant pressure may increase the transfer of training to real-world performance. APPLICATION Occupational experience is an important component in reducing the impact of pressure on UOF performance, and transfer of training may be enhanced through training methodologies that combine early exposure to contextually relevant pressure, that may replicate the benefits of experience.
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Affiliation(s)
| | - Joel Fuller
- Macquarie University, Sydney, NSW, Australia
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Willemin-Petignat L, Anders R, Ogi S, Putois B. Validation and Psychometric Properties of the German Operational and Organizational Police Stress Questionnaires. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6831. [PMID: 37835101 PMCID: PMC10572357 DOI: 10.3390/ijerph20196831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/13/2023] [Accepted: 09/22/2023] [Indexed: 10/15/2023]
Abstract
CONTEXT Working in the police force is an operationally and organizationally stressful job. Suitable psychometric tools are needed to detect and study the psychosocial risks of these professionals. The original version contains 40 items, which may be too long for clinical use or as a research control measure. The main aim of this study is to validate the Police Stress Questionnaire (PSQ) in German. The secondary objective is to validate a shorter version. METHOD After translation and counter translation of the PSQ-G by a committee of experts, 10 participants pre-tested the comprehension of an intermediate version, allowing the development of a final version that was submitted to a psychometric validation plan with 2314 German-speaking officers. Structure, reliability, and convergent, divergent, and discriminant validities were tested for each sample. RESULTS The German version of the PSQ performed well psychometrically. We have created a short version of 14 items with good psychometric properties, 7 items for each subscale: operational stressors and organizational stressors. CONCLUSION This study validated a German version of the PSQ and provides a reliable measure of stress processes in the police force. A short version is now available.
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Affiliation(s)
- Lauriane Willemin-Petignat
- Faculty of Psychology, UniDistance Suisse, 3900 Brig, Switzerland
- Psychological Service, Bern Police Department, 3001 Bern, Switzerland
| | - Royce Anders
- Department of Psychology, Epsylon Laboratory UR4556, University Paul Valéry Montpellier 3, 34000 Montpellier, France
| | - Sabrina Ogi
- Faculty of Applied Faculty, University of Applied Sciences and Arts Northwestern Switzerland, 4600 Olten, Switzerland
| | - Benjamin Putois
- Faculty of Psychology, UniDistance Suisse, 3900 Brig, Switzerland
- Lyon Neuroscience Research Center, National Centre for Scientific Research UMR 5292—National Institute of Health and Medical Research U1028, 69675 Bron, France
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7
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Farkas I, Végh J, Ivaskevics K, Szabó EM, Haller J. The effects of expected and unexpected stress on inappropriate aggression in simulated police interventions. Heliyon 2023; 9:e17871. [PMID: 37483715 PMCID: PMC10362074 DOI: 10.1016/j.heliyon.2023.e17871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 06/12/2023] [Accepted: 06/29/2023] [Indexed: 07/25/2023] Open
Abstract
Here we performed a before-after ABA-design study in police cadets (N = 82) to compare the effects of unexpected (event-triggered) and expected (anticipatory) stressors on aggression. On the first day of the study, participants filled in the Buss-Perry Aggression Questionnaire (BPAQ) and the Barratt Impulsiveness Scale (BIS) and were fitted with heart rate (HR) monitors, which remained attached till the end of the study. On day 2, they were instructed to perform a police intervention in a realistic training environment. The intervention was preceded either by a warning or by a reassuring audio recording that forecasted violent or routine interventions, respectively. Both groups encountered hostile suspects at the intervention site, the behavior of which, however, did not justify the use of force e.g., aggression. The warning resulted in a gradually developing anticipatory stress as shown by HRs. Cadets exposed to the reassuring audio recording showed minimal anticipatory stress but responded to the hostile suspects by an abrupt increase in HRs, which was missing in the warned group. The magnitude of HR responses was similar in the two groups, only their temporal evolution differed. Although aggression showed some associations with BPAQ and BIS scores, the main predictors of behavior were HR changes according to a Multiple Regression analysis. The gradually developing anticipatory stress was associated with low, whereas the abrupt increase in HRs was associated with high aggression. Our findings suggest that the anticipation of a stressful event improves behavioral control whereas an unexpected stress strongly promotes aggression.
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Affiliation(s)
| | - József Végh
- International Training Centre, Budapest, Hungary
| | - Krisztián Ivaskevics
- University of Public Service, Department of Criminal Psychology, Budapest, Hungary
| | | | - József Haller
- University of Public Service, Department of Criminal Psychology, Budapest, Hungary
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8
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Kasperski R, Yariv E. Gut reaction or rational problem-solving? Teachers’ considerations when coping with classroom disruptions. EMOTIONAL AND BEHAVIOURAL DIFFICULTIES 2022. [DOI: 10.1080/13632752.2022.2125210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Ronen Kasperski
- Department of Special Education, Gordon College of Education, Haifa, Israel
- Department of Special Education, Shaanan Academic Religious Teachers’ College, Haifa, Israel
| | - Eliezer Yariv
- Head of the M.Ed. program for Inclusive Education, Givat Washington Academic College of Education, Israel
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9
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Chan JF, Di Nota PM, Planche K, Borthakur D, Andersen JP. Associations between police lethal force errors, measures of diurnal and reactive cortisol, and mental health. Psychoneuroendocrinology 2022; 142:105789. [PMID: 35525124 DOI: 10.1016/j.psyneuen.2022.105789] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 04/25/2022] [Accepted: 04/27/2022] [Indexed: 11/13/2022]
Abstract
Errors in lethal force by police are met with significant demand for explanations as to why they occur, stimulating a growing body of multidisciplinary research. Acutely stressful occupational conditions result in decrements to police performance, including lethal force decision-making. Further, although it is known that repeated and prolonged exposure to potentially traumatic work-related encounters is linked to higher rates of mental health symptoms, it is unclear if psychological symptoms are related to police performance, and lethal force errors specifically. The present study tested the relationships between biological stress and psychological symptoms on lethal force errors among a combined sample of non-clinical, active-duty frontline (n = 57) and tactical (n = 44) police officers. Specifically, biological measures included: diurnal (cortisol awakening response - CAR), and reactive cortisol (prior to and in response to realistic critical incident (CI) simulations). Psychological self-reported symptoms included: pre-CI stress, depression, anxiety, PTSD, and occupational stress. Tactical officers displayed higher CAR compared to frontline officers, consistent with prior research. When including outliers, CAR significantly predicted lethal force decision-making errors; however, the effect does not remain once removing the influence of outlier CAR observations. The current findings suggest that biological measures of reactive cortisol may be too nonspecific to predict lethal force errors during acutely stressful police operations and measures of diurnal cortisol are heavily influenced by outlier values. Non-clinical levels of psychological symptoms (as measured in this study) do not appear to interfere with lethal force decision-making. It remains to be tested if clinically diagnosed disorders would interfere with police performance. Implications for future applied health research are discussed.
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Affiliation(s)
- Jennifer F Chan
- University of Toronto Mississauga, Department of Psychology, Canada
| | - Paula M Di Nota
- University of Toronto Mississauga, Department of Psychology, Canada
| | - Kyle Planche
- University of Guelph, Industrial Organizational Psychology, Canada
| | | | - Judith P Andersen
- University of Toronto Mississauga, Department of Psychology, Canada.
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10
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Pistol Shooting Performance Correlates with Respiratory Muscle Strength and Pulmonary Function in Police Cadets. SUSTAINABILITY 2022. [DOI: 10.3390/su14127515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Breathing patterns play a crucial role in shooting performance; however, little is known about the respiratory muscle strength and pulmonary capacities that control these patterns. The present study aimed to examine the relationship between shooting performance, respiratory muscle strength, and pulmonary function and to determine differences in respiratory capacities according to the shooting performance categories in police cadets. One hundred sixty-seven police cadets were recruited to assess respiratory muscle strength, pulmonary function, and shooting performance in a well-controlled environment. Measurements included maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), slow vital capacity (SVC), maximal voluntary ventilation (MVV), and pistol shooting scores. The shooting score had a moderate positive correlation with MIP (ρ = 0.33) and MEP (ρ = 0.45). FVC (ρ = 0.25), FEV1 (ρ = 0.26), SVC (ρ = 0.26) (p < 0.001) and MVV (ρ = 0.21) (p < 0.05) were slightly correlated with shooting score. There were differences between shooting performance categories in MIP, MEP, FVC, FEV1, SVC, and MVV (p < 0.001, p < 0.05). The results imply that both strong respiratory muscles and optimal pulmonary function may be one of the necessary prerequisites for superior shooting performance in police.
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11
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Bennell C, Jenkins B, Blaskovits B, Semple T, Khanizadeh AJ, Brown AS, Jones NJ. Knowledge, Skills, and Abilities for Managing Potentially Volatile Police–Public Interactions: A Narrative Review. Front Psychol 2022; 13:818009. [PMID: 35330722 PMCID: PMC8940200 DOI: 10.3389/fpsyg.2022.818009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 02/03/2022] [Indexed: 11/13/2022] Open
Abstract
We conducted a narrative review of existing literature to identify the knowledge, skills, and abilities (KSAs) necessary for officers who police in democratic societies to successfully manage potentially volatile police–public interactions. This review revealed 10 such KSAs that are frequently discussed in the literature. These KSAs include: (1) knowledge of policies and laws; (2) an understanding of mental health-related issues; (3) an ability to interact effectively with, and show respect for, individuals from diverse community groups; (4) awareness and management of stress effects; (5) communication skills; (6) decision-making and problem-solving skills; (7) perceptual skills; (8) motor skills related to use-of-force; (9) emotion and behavior regulation; and (10) an ability to treat people in a procedurally just manner. Following our review, we conducted semi-structured interviews (N = 7) with researchers who specialize in police training and adult education, interactions with individuals in crisis, and racialized policing, as well as two police trainers with expertise in de-escalation and use-of-force training. These interviews confirmed the importance of the 10 KSAs and highlighted two additional KSAs that are likely to be critical: understanding the role of policing in a free and democratic society and tactical knowledge and skills. To ensure that police–public interactions are managed effectively, police trainers may want to focus on the development and evaluation of these KSAs—something that is not always done currently.
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Moses TEH, Javanbakht A. How Should Clinicians Determine a Traumatized Patient's Readiness to Return to Work? AMA J Ethics 2022; 24:E111-119. [PMID: 35324097 PMCID: PMC8958981 DOI: 10.1001/amajethics.2022.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
A clinician's standard primary role is to treat and monitor their patients' health and to be their ally. Clinicians with obligations to patients and to organizations, however, must also assess patients for nontherapeutic purposes (eg, readiness to resume work). These 2 obligations can conflict, and, when they do, clinicians must balance their duties to patients and to society. We propose criteria clinicians should consider when determining a patient's readiness to return to work and offer recommendations for interpreting factors that influence this decision.
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Affiliation(s)
- Tabitha E. H. Moses
- Translational Neuroscience Program at Wayne State University School of Medicine in Detroit, Michigan
| | - Arash Javanbakht
- Stress, Trauma, and Anxiety Research Clinic at Wayne State University School of Medicine in Detroit, Michigan
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13
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Baldwin S, Bennell C, Blaskovits B, Brown A, Jenkins B, Lawrence C, McGale H, Semple T, Andersen JP. A Reasonable Officer: Examining the Relationships Among Stress, Training, and Performance in a Highly Realistic Lethal Force Scenario. Front Psychol 2022; 12:759132. [PMID: 35111100 PMCID: PMC8803048 DOI: 10.3389/fpsyg.2021.759132] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 11/09/2021] [Indexed: 12/13/2022] Open
Abstract
Under conditions of physiological stress, officers are sometimes required to make split-second life-or-death decisions, where deficits in performance can have tragic outcomes, including serious injury or death and strained police-community relations. The current study assessed the performance of 122 active-duty police officers during a realistic lethal force scenario to examine whether performance was affected by the officer's level of operational skills training, years of police service, and stress reactivity. Results demonstrated that the scenario produced elevated heart rates (i.e., 150 beats per minute), as well as perceptual and cognitive distortions, such as tunnel vision, commensurate with those observed in naturalistic use of force encounters. The average performance rating from the scenario was 59%, with 27% of participants making at least one lethal force error. Elevated stress reactivity was a predictor of poorer performance and increased lethal force errors. Level of training and years of police service had differential and complex effects on both performance and lethal force errors. Our results illustrate the need to critically reflect on police training practices and continue to make evidence-based improvements to training. The findings also highlight that while training may significantly improve outcomes, flawless performance is likely not probable, given the limits of human performance under stress. Implications for the objective reasonableness standard, which is used to assess the appropriateness of force in courts of law, are discussed.
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Affiliation(s)
- Simon Baldwin
- Department of Psychology, Carleton University, Ottawa, ON, Canada
- Royal Canadian Mounted Police, Ottawa, ON, Canada
| | - Craig Bennell
- Department of Psychology, Carleton University, Ottawa, ON, Canada
| | | | - Andrew Brown
- Department of Psychology, Carleton University, Ottawa, ON, Canada
| | - Bryce Jenkins
- Department of Psychology, Carleton University, Ottawa, ON, Canada
| | - Chris Lawrence
- Police Research Lab, Carleton University, Ottawa, ON, Canada
| | - Heather McGale
- Department of Psychology, Carleton University, Ottawa, ON, Canada
| | - Tori Semple
- Department of Psychology, Carleton University, Ottawa, ON, Canada
| | - Judith P. Andersen
- Department of Psychology, University of Toronto Mississauga, Mississauga, ON, Canada
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14
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Adler AB, Gutierrez IA. Acute Stress Reaction in Combat: Emerging Evidence and Peer-Based Interventions. Curr Psychiatry Rep 2022; 24:277-284. [PMID: 35353322 PMCID: PMC8965216 DOI: 10.1007/s11920-022-01335-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/02/2022] [Indexed: 12/04/2022]
Abstract
PURPOSE OF REVIEW This paper highlights the topic of combat-related acute stress reactions (ASRs) in service members. Specifically, we contrast ASRs with related psychiatric conditions, report the estimated prevalence of ASRs for soldiers deployed to combat, and discuss how team members can effectively respond to these reactions. RECENT FINDINGS Although not regarded as a clinical disorder, ASRs can have a significant impact on high-risk occupations like the military in which impaired functioning can imperil team members and others. Based on self-report, 17.2% of soldiers who have deployed to combat report having experienced a possible ASR. To our knowledge, this is the first such prevalence estimate. The prevalence of ASRs underscores the need for improved prevention, management, and recovery strategies. Peer-based intervention protocols such as iCOVER may provide a useful starting point to address ASRs in team members.
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Affiliation(s)
- Amy B. Adler
- Walter Reed Army Institute of Research, 503 Robert Grant Ave, Silver Spring, MD 20910 USA
| | - Ian A. Gutierrez
- Walter Reed Army Institute of Research, 503 Robert Grant Ave, Silver Spring, MD 20910 USA
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15
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Anticoagulants and the Hemostatic System: A Primer for Occupational Stress Researchers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010626. [PMID: 34682370 PMCID: PMC8535451 DOI: 10.3390/ijerph182010626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/27/2021] [Accepted: 10/05/2021] [Indexed: 12/02/2022]
Abstract
Anticoagulation, the body’s mechanism to prevent blood clotting, is an internal biomarker of an individual’s response to stress. Research has indicated that understanding the causes, processes, and consequences of anticoagulation can provide important insight into the experience of individuals facing emotional and occupational strain. Unfortunately, despite their importance, the mechanisms and implications of anticoagulation are unfamiliar to many researchers and practitioners working with trauma-exposed professionals. This paper provides an accessible primer on the topic of anticoagulation, including an overview of the biological process, the research connecting these processes with emotional and occupational functioning, as well as some potential methods for assessment.
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16
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Considering Objective and Subjective Measures for Police Use of Force Evaluation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18105351. [PMID: 34069786 PMCID: PMC8157287 DOI: 10.3390/ijerph18105351] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/14/2021] [Accepted: 05/16/2021] [Indexed: 11/28/2022]
Abstract
In spite of significant interest in the application of police use of force (UOF) from organisations, researchers, and the general public, there remains no industry standard for how police UOF is trained, and by extension, evaluated. While certain UOF behaviours can be objectively measured (e.g., correct shoot/no shoot decision making (DM), shot accuracy), the subjective evaluation of many UOF skills (e.g., situation awareness, SA) falls to the discretion of individual instructors. The aim of the current brief communication is to consider the operationalisation of essential UOF behaviours as objective and subjective measures, respectively. Using longitudinal data from a sample of Canadian police officers (n = 57) evaluated during UOF training scenarios, we discuss how objective and subjective measures reflect changes in officer performance over time. Objective lethal force DM was measured as a binary ‘correct–incorrect’ outcome and subjective SA was measured on a 5-point Likert scale ranging from ‘unacceptable’ to ‘exceptional’. Subjective evaluation of SA demonstrated significant changes over time, while DM remained relatively high and stable. Given the practical and professional implications of UOF, we recommend that a combination of objective and subjective measures is systematically implemented at all stages of police UOF training and evaluation (i.e., basic, advanced, in-service).
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17
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Huey L, Andersen J, Bennell C, Ann Campbell M, Koziarski J, Vaughan AD. Caught in the currents: evaluating the evidence for common downstream police response interventions in calls involving persons with mental illness. Facets (Ott) 2021. [DOI: 10.1139/facets-2021-0055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The origins of this report, and of the Mental Health and Policing Working Group, can be traced to the unique situation Canadians have faced as a result of the COVID-19 pandemic. The unique circumstances of this global outbreak, which have for many Canadians resulted in serious illness and death, intensified economic uncertainties, altered family and lifestyle dynamics, and generated or exacerbated feelings of loneliness and social dislocation, rightly led the Royal Society of Canada’s COVID-19 Taskforce to consider the strains and other negative impacts on individual, group, and community mental health. With the central role that police too often play in the lives of individuals in mental and (or) emotional crisis, we were tasked with exploring what can be reasonably said about the state of our current knowledge of police responses to persons with mental illness.
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Affiliation(s)
- Laura Huey
- University of Western Ontario, London, ON, Canada
| | | | | | | | | | - Adam D. Vaughan
- Texas State University, School of Criminal Justice and Criminology, San Marcos, TX USA
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18
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Giessing L, Oudejans RRD, Hutter V, Plessner H, Strahler J, Frenkel MO. Acute and Chronic Stress in Daily Police Service: A Three-Week N-of-1 Study. Psychoneuroendocrinology 2020; 122:104865. [PMID: 32961407 DOI: 10.1016/j.psyneuen.2020.104865] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 08/27/2020] [Accepted: 08/27/2020] [Indexed: 01/14/2023]
Abstract
On duty, police officers are exposed to a variety of acute, threatening stress situations and organizational demands. In line with the allostatic load model, the resulting acute and chronic stress might have tremendous consequences for police officers' work performance and psychological and physical health. To date, limited research has been conducted into the underlying biological, dynamic mechanisms of stress in police service. Therefore, this ecological momentary assessment study examined the associations of stress, mood and biological stress markers of a 28-year-old male police officer in a N-of-1 study over three weeks (90 data points). Four times a day (directly after waking up, 30 minutes later, 6 hours later, before going to bed), he answered questions about the perceived stress and mood using a smartphone application. With each data entry, he collected saliva samples for the later assessment of salivary cortisol (sCort) and alpha-amylase (sAA). In addition, data was collected after six police incidents during duty. sCort and sAA were not related to perceived stress in daily life and did not increase in police incidents. Regarding mood measures, deterioration of calmness, but not valence and energy was associated with perceived stress. The results suggest continued police service to constitute a major chronic stressor resulting in an inability to mount a proper response to further acute stress. As an indicator of allostatic load, psychological and biological hyporesponsivity in moments of stress may have negative consequences for police officers' health and behavior in critical situations that require optimal performance. Prospectively, this research design may also become relevant when evaluating the efficacy of individualized stress management interventions in police training.
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Affiliation(s)
- Laura Giessing
- Institute for Sport and Sport Sciences, Heidelberg University, Germany.
| | - Raôul R D Oudejans
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Institute for Brain and Behaviour Amsterdam, the Netherlands; Faculty of Sports and Nutrition, Amsterdam University of Applied Sciences, the Netherlands
| | - Vana Hutter
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Institute for Brain and Behaviour Amsterdam, the Netherlands
| | - Henning Plessner
- Institute for Sport and Sport Sciences, Heidelberg University, Germany
| | - Jana Strahler
- Faculty of Psychology and Sport Science, Justus-Liebig University, Gießen, Germany
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19
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Active Shooter Training Drill Increases Blood and Salivary Markers of Stress. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17145042. [PMID: 32668818 PMCID: PMC7400181 DOI: 10.3390/ijerph17145042] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/02/2020] [Accepted: 07/10/2020] [Indexed: 11/17/2022]
Abstract
Police officers are frequently engaged in a variety of high-stress scenarios, such as high-speed chases and other suspect conflicts, that cause significant increases in a variety of physiological and psychological stress markers. The purpose of this study was to investigate salivary and blood markers of stress in response to an active shooter training drill (ASD). Thirty-one participants (n = 31; males = 15, females = 16; Age: 21 ± 3.5 years) participated in an ASD involving professional actors playing the role of one active gunman, as well as four victims. The ASD lasted approximately 50 s. Blood samples were collected 15 min prior as well as after the ASD and analyzed for epinephrine (EPI) and norepinephrine (NE) levels. Saliva samples were collected 30 and 5 min prior to the ASD and 5 and 30 min after the ASD, were analyzed for cortisol, α-amylase, and secretory immunoglobulin-A (SigA). The ASD resulted in significant (p < 0.05) increases in EPI, α-amylase, and SigA levels. The increase in NE from pre to post ASD approached significance (p = 0.06). These results demonstrate that a short duration (~50 s) ASD results in significant increases in both blood and salivary markers of stress. These data may provide meaningful implications for those engaged in high-stress tactical occupations, especially law enforcement and military personnel, as chronic exposure to such occupational stressors can contribute to cardiometabolic disease.
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20
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Anderson GS, Di Nota PM, Metz GAS, Andersen JP. The Impact of Acute Stress Physiology on Skilled Motor Performance: Implications for Policing. Front Psychol 2019; 10:2501. [PMID: 31781001 PMCID: PMC6856650 DOI: 10.3389/fpsyg.2019.02501] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 10/22/2019] [Indexed: 12/26/2022] Open
Abstract
Investigations of police performance during acutely stressful situations have primarily focused on higher-order cognitive processes like attention, affect or emotion and decision-making, and the behavioral outcomes of these processes, such as errors in lethal force. However, behavioral outcomes in policing must be understood as a combination of both higher-order processes and the physical execution of motor skills. What is missing from extant police literature is an understanding of how physiological responses to acute stress contribute to observed decrements in skilled motor performance at the neuromuscular level. The purpose of the current paper is to fill this knowledge gap in the following ways: (1) review scientific evidence for the physiological (i.e., autonomic, endocrine, and musculoskeletal) responses to acutely stressful exposures and their influence on skilled motor performance in both human and animal models, (2) review applied evidence on occupationally relevant stress physiology and observed motor decrements in performance among police, and (3) discuss the implications of stress physiology for police training and identify future directions for applied researchers. Evidence is compelling that skill decay is inevitable under high levels of acute stress; however, robust evidence-informed training practices can help mitigate this decay and contribute to officer safety.
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Affiliation(s)
- G S Anderson
- Office of Applied Research and Graduate Studies, Justice Institute of British Columbia, New Westminster, BC, Canada
| | - P M Di Nota
- Office of Applied Research and Graduate Studies, Justice Institute of British Columbia, New Westminster, BC, Canada.,Department of Psychology, University of Toronto Mississauga, Mississauga, ON, Canada
| | - G A S Metz
- Department of Neuroscience, University of Lethbridge, Lethbridge, AB, Canada
| | - J P Andersen
- Department of Psychology, University of Toronto Mississauga, Mississauga, ON, Canada
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21
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Baldwin S, Bennell C, Andersen JP, Semple T, Jenkins B. Stress-Activity Mapping: Physiological Responses During General Duty Police Encounters. Front Psychol 2019; 10:2216. [PMID: 31636582 PMCID: PMC6788355 DOI: 10.3389/fpsyg.2019.02216] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 09/17/2019] [Indexed: 01/31/2023] Open
Abstract
Policing is a highly stressful and dangerous profession that involves a complex set of environmental, psychosocial, and health risks. The current study examined autonomic stress responses experienced by 64 police officers, during general duty calls for service (CFS) and interactions with the public. Advancing previous research, this study utilized GPS and detailed operational police records as objective evidence of specific activities throughout a CFS. These data were then used to map officers' heart rate to both the phase of a call (e.g., dispatch, enroute) and incident factors (e.g., call priority, use-of-force). Furthermore, physical movement (i.e., location and inertia) was tracked and assisted in differentiating whether cardiovascular reactivity was due to physical or psychological stress. Officer characteristics, including years of service and training profiles, were examined to conduct a preliminary exploration of whether experience and relevant operational skills training impacted cardiovascular reactivity. Study results provide foundational evidence that CFS factors, specifically the phase of the call (i.e., arrival on scene, encountering a subject) and incident factors (i.e., call priority, weapons, arrest, use-of-force), influence physiological stress responses, which may be associated with short-term performance impairments and long-term health outcomes. Implications of research findings for operational policing, police training, and health research are discussed.
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Affiliation(s)
- Simon Baldwin
- Department of Psychology, Carleton University, Ottawa, ON, Canada
- Royal Canadian Mounted Police, Ottawa, ON, Canada
| | - Craig Bennell
- Department of Psychology, Carleton University, Ottawa, ON, Canada
| | - Judith P. Andersen
- Department of Psychology, University of Toronto Mississauga, Mississauga, ON, Canada
| | - Tori Semple
- Department of Psychology, Carleton University, Ottawa, ON, Canada
| | - Bryce Jenkins
- Department of Psychology, Carleton University, Ottawa, ON, Canada
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22
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Kelley DC, Siegel E, Wormwood JB. Understanding Police Performance Under Stress: Insights From the Biopsychosocial Model of Challenge and Threat. Front Psychol 2019; 10:1800. [PMID: 31447738 PMCID: PMC6696903 DOI: 10.3389/fpsyg.2019.01800] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 07/19/2019] [Indexed: 12/04/2022] Open
Abstract
We examine when and how police officers may avoid costly errors under stress by leveraging theoretical and empirical work on the biopsychosocial (BPS) model of challenge and threat. According to the BPS model, in motivated performance contexts (e.g., test taking, athletics), the evaluation of situational and task demands in relation to one's perceived resources available to cope with those demands engenders distinct patterns of peripheral physiological responding. Individuals experience more challenge-like states in which blood circulates more efficiently in the periphery when they evaluate their coping resources as meeting or exceeding the task demands. Conversely, individuals experience more threat-like states in which blood circulates less efficiently in the periphery when they view the situation or task demands as exceeding their coping resources. Patterns of response consistent with challenge and threat states have been shown to predict important performance and decision-making outcomes in stressful contexts, and repeated experiences of threat-like patterns of physiological activity are thought to have detrimental effects on long-term cardiovascular health. To date, however, research has not used the biopsychosocial model to understand police decision-making under stress. Here, we review relevant empirical work from the perspective of the BPS model concerning how minority status and power can shape challenge and threat responding and contribute to decision-making under stress. We then detail a research agenda aimed at improving the translational value of research being conducted within the BPS model for understanding complex performance and decision-making in the real world, including among law enforcement personnel.
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Affiliation(s)
- Donovan C. Kelley
- Department of Psychology, University of New Hampshire, Durham, NH, United States
| | - Erika Siegel
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States
| | - Jolie B. Wormwood
- Department of Psychology, University of New Hampshire, Durham, NH, United States
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23
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Giessing L, Frenkel MO, Zinner C, Rummel J, Nieuwenhuys A, Kasperk C, Brune M, Engel FA, Plessner H. Effects of Coping-Related Traits and Psychophysiological Stress Responses on Police Recruits' Shooting Behavior in Reality-Based Scenarios. Front Psychol 2019; 10:1523. [PMID: 31333547 PMCID: PMC6617500 DOI: 10.3389/fpsyg.2019.01523] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 06/17/2019] [Indexed: 12/20/2022] Open
Abstract
Police officers are often required to perform under high-stress circumstances, in which optimal task performance is crucial for their and the bystanders' physical integrity. However, stress responses, particularly anxiety and increased cortisol levels, shift attention from goal-directed to stimulus-driven control, leaving police officers with poor shooting performance under stress. Cardiac vagal activity and coping-related traits (i.e., self-control, sensation seeking) might help individuals to maintain performance under stress. So far, only few studies have integrated coping-related traits, psychophysiological stress markers and occupationally meaningful measures of behavior to investigate police officers' work performance under stress. Therefore, the present study investigated 19 police recruits (M age = 22.84, SD = 3.30) undergoing a reality-based shooting scenario in two experimental conditions in a within-design: low stress (LS) against a non-threatening mannequin, and high stress (HS), involving physical threat by an opponent. Psychological (i.e., anxiety, mental effort) and physiological stress responses (i.e., salivary cortisol, alpha-amylase, cardiac vagal activity) as well as shooting accuracy were repeatedly assessed. It was hypothesized that under stress, police recruits would demonstrate elevated psychophysiological stress responses and impaired shooting performance. Elevated psychophysiological stress responses would negatively influence shooting performance, whereas self-control, sensation seeking and cardiac vagal activity would positively influence shooting performance. While recruits reported significantly higher anxiety and mental effort in the HS scenario, both scenarios elicited comparable physiological responses. Overall, shooting accuracy was low and did not significantly decrease in the HS scenario. Shooting performance was predicted by self-control in the LS scenario and by post-task cardiac vagal activity in the HS scenario. While increased anxiety hints at a successful stress manipulation, physiological responses suggest similar stress levels for both scenarios, diminishing potential behavioral differences between the scenarios. Performance efficiency decreased under stress, as indicated by increasing mental effort. Findings on self-control suggest that suppressing negative stress responses might lead to impaired goal-directed attention, resulting in performance decrements. For police research and training, high-realism scenarios afford an opportunity to investigate and experience psychophysiological stress responses.
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Affiliation(s)
- Laura Giessing
- Institute of Sports and Sports Sciences, Heidelberg University, Heidelberg, Germany
| | | | - Christoph Zinner
- Department of Sport, University of Applied Sciences for Police and Administration of Hesse, Wiesbaden, Germany
| | - Jan Rummel
- Psychological Institute, Heidelberg University, Heidelberg, Germany
| | - Arne Nieuwenhuys
- Department of Exercise Sciences, University of Auckland, Auckland, New Zealand
| | - Christian Kasperk
- Department of Internal Medicine I and Clinical Chemistry, Steroid Laboratory, Heidelberg University Hospital, Heidelberg, Germany
| | - Maik Brune
- Department of Internal Medicine I and Clinical Chemistry, Central Laboratory, Heidelberg University Hospital, Heidelberg, Germany
| | - Florian Azad Engel
- Institute of Sports and Sports Sciences, Heidelberg University, Heidelberg, Germany
| | - Henning Plessner
- Institute of Sports and Sports Sciences, Heidelberg University, Heidelberg, Germany
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