The International Performance, Resilience and Efficiency Program Protocol for the Application of HRV Biofeedback in Applied Law Enforcement Settings.

Law enforcement officers are routinely exposed to high-threat encounters that elicit physiological stress responses that impact health, performance, and safety. Therefore, self-regulation using evidence-based approaches is a priority in police research and practice. This paper describes a five-module heart rate variability biofeedback (HRVB) protocol that is part of a larger resilience program (the International Performance Resilience and Efficiency Program - iPREP) established in 2014. Supported by 10 years of user-informed research and development, our methods are tailored to address occupational stressors and the practical realities of training and resource availability in operational settings. Building on existing clinical methods that comprise five to six weekly sessions and up to 40-min of daily practice, our iPREP HRVB protocol is typically delivered in a condensed format across 2-3 days and is seamlessly integrated with reality-based training scenarios commonly employed in policing. By combining best practices in clinical HRVB with police-specific pedagogical frameworks, officers receive accelerated and job-relevant training to adaptively modulate autonomic responses to acute and chronic stress. Efficacy of the iPREP HRVB protocol is supported by several research studies of various methodological designs (i.e., randomized control trial, longitudinal cohort) that demonstrate immediate and sustained improvements in police performance and physiological health outcomes. We conclude with a critical appraisal of the available empirical evidence contrasting common and emerging breathing techniques proposed for use in operational policing contexts. The critical appraisal guide is intended to serve as a resource for law enforcement agencies, governing bodies, and operators when choosing appropriate and effective self-regulation training approaches.

Physiological Responses to Organizational Stressors Among Police Managers.

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.

Psychological interventions for post-traumatic stress injuries among public safety personnel: a systematic review and meta-analysis.

BACKGROUND: Public safety personnel (PSP) are exposed to potentially psychologically traumatic events (PPTE) far more often than the general public, which increases the risk for various post-traumatic stress injuries (PTSIs). While there are many evidence-based psychological interventions for PTSI, the effectiveness of each intervention for PSP remains unclear. OBJECTIVES: The current study assessed the effectiveness and acceptability of psychological interventions for PTSI among PSPs. METHODS: A systematic review and random-effects meta-analysis were performed on the effectiveness and acceptability of psychotherapies for PTSIs (i.e., symptoms of depression, anxiety, post-traumatic stress disorder) among PSP. The review adhered to the PRISMA reporting guidelines and used standardized mean differences (Cohen's d), rate ratios (RR), and their 95% confidence intervals (95% CI) to measure pooled effect sizes across studies; negative d values and RR values less than one indicated a reduction in symptoms compared to baseline or control groups. In addition, heterogeneity was quantified using I2, and publication bias was evaluated using Egger's test. RESULTS: The analyses included data from eight randomized controlled trials representing 402 PSP (79.4% male, 35.3 years). Psychological interventions included narrative exposure therapy (n = 1), cognitive behavioral therapy (n = 2), eclectic psychotherapy (n = 2), eye-movement desensitization and reprocessing (n = 1), supportive counseling (n = 2), and group critical incident stress debriefing (n = 1). The interventions were associated with statistically significant reductions in symptoms associated with PTSD (d = - 1.23; 95% CI - 1.81, - 0.65; 7 studies; I2 = 81%), anxiety (- 0.76; 95% CI - 1.28, - 0.24; 3 studies; I2 = 47%), and depression (d = - 1.10; 95% CI - 1.62, - 0.58; 5 studies; I2 = 64%). There were smaller but statistically significant improvements at follow-up for symptoms of PTSD (d = - 1.29 [- 2.31, - 0.27]), anxiety (d = - 0.82 [- 1.20, - 0.44]), and depression (d = - 0.46 [- 0.77, - 0.14]). There were no statistically significant differences in dropout rates (RR = 1.00 [0.96, 1.05]), suggesting high acceptability across interventions. CONCLUSIONS: There is preliminary evidence that psychotherapies help treat PTSIs in PSP; however, the shortage of high-quality studies on PSP indicates a need for additional research into treating PTSI among PSP. SYSTEMATIC REVIEW REGISTRATION: PROSPERO: CRD42019133534.

Experience-Dependent Effects to Situational Awareness in Police Officers: An Eye Tracking Study.

Police work requires making suitable observations which form the basis of situational awareness (SA) of the encounter in progress. Incomplete early-stage SA (i.e., perception) can lead to errors in subsequent judgement and decision-making that can have severe consequences for performance, learning, and occupational health. SA in police contexts is still relatively understudied and requires closer examination using objective measures. The current preliminary study aimed to measure the gaze and fixation patterns among novice and expert police officers to understand early-stage SA at different levels of professional experience. Participants included 23 novices (10 early, 13 intermediate) and 11 experienced officers and instructors in tactics and use of force. Visit duration and fixation order were measured while participants viewed various static images of staged encounters. Results showed that all participants fixated longer on targets compared to the periphery, and fixated earlier on suspects' faces compared to hands, bodies, or the environment. Further, experts fixated earlier on hands and spent less time scanning the environment than early novices. The current findings reveal eye movement patterns while officers engaged in typical police encounters. Future research can inform evidence-based police training to achieve optimal SA and minimize negative outcomes in training and operational field settings.

Associations between police lethal force errors, measures of diurnal and reactive cortisol, and mental health.

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.

Coping among public safety personnel: A systematic review and meta-analysis.

Public safety personnel (PSP) are routinely exposed to potentially psychologically traumatic events (PPTEs) that, in turn, can result in posttraumatic stress injuries (PTSI), including burnout and increased symptoms of depression and anxiety. However, the longitudinal impact of PPTEs on PSP coping remains unclear. Coping can be operationalized as various strategies (i.e., behaviours, skills, thought and emotion regulation) for dealing with stressors, which are broadly categorized as either approach (adaptive, positive, social support) or avoidant coping strategies (maladaptive withdrawal, avoidance, substance use). This systematic review and meta-analysis aims to evaluate longitudinal coping outcomes among PSP. Thirteen eligible repeated-measures studies explicitly evaluated coping in 1854 police officers, firefighters, and rescue and recovery workers. Study designs included randomized-control trials, within-subject interventions and observational studies. Effect sizes (Cohen's d) at follow-up were described in 11 studies. Separate meta-analyses reveal small (d < 0.2) but non-significant improvements in approach and avoidant coping. Studies were of moderate quality and low risk of publication bias. Heterogeneity in outcome measures, follow-up durations, and study types precluded subgroup analyses. The current findings can inform the development and evaluation of organizational training programs that effectively promote sustained adaptive coping for PSP and mitigate PTSIs.

Considering Objective and Subjective Measures for Police Use of Force Evaluation.

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).

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).

Critical Review of Visual Models for Police Use of Force Decision-Making.

Recent calls for widespread police reform include re-examination of existing training and practice surrounding the use of force (UOF, e.g., verbal and non-verbal communication, physical tactics, firearms). Visual models representing police UOF decision-making are used for both police training and public communication. However, most models have not been empirically developed or assessed in either the applied police or vision science literatures, representing significant gaps in knowledge. The purpose of the current review is to provide a novel, relevant, and practical analysis of the visual components of three common police UOF decision-making model types (circular, cyclical, staircase). We begin with a critical evaluation of the visual features specific to each model type (i.e., shape), followed by critical reviews of common visual features, including colour, implied motion, text, and clarity. The insights provided by the current work afford scientists from visual disciplines a unique opportunity to contribute meaningfully to the improvement of existing police UOF practices, with the goal of promoting public and occupational safety. To this end, we conclude with evidence-based recommendations for designing visual models that effectively promote training of police and communication of police UOF decision-making to the public.

Peer Support and Crisis-Focused Psychological Interventions Designed to Mitigate Post-Traumatic Stress Injuries among Public Safety and Frontline Healthcare Personnel: A Systematic Review.

Public safety personnel (PSP) and frontline healthcare professionals (FHP) are frequently exposed to potentially psychologically traumatic events (PPTEs), and report increased rates of post-traumatic stress injuries (PTSIs). Despite widespread implementation and repeated calls for research, effectiveness evidence for organizational post-exposure PTSI mitigation services remains lacking. The current systematic review synthesized and appraised recent (2008-December 2019) empirical research from 22 electronic databases following a population-intervention-comparison-outcome framework. Eligible studies investigated the effectiveness of organizational peer support and crisis-focused psychological interventions designed to mitigate PTSIs among PSP, FHP, and other PPTE-exposed workers. The review included 14 eligible studies (n = 18,849 participants) that were synthesized with qualitative narrative analyses. The absence of pre-post-evaluations and the use of inconsistent outcome measures precluded quantitative meta-analysis. Thematic services included diverse programming for critical incident stress debriefing, critical incident stress management, peer support, psychological first aid, and trauma risk management. Designs included randomized control trials, retrospective cohort studies, and cross-sectional studies. Outcome measures included PPTE impacts, absenteeism, substance use, suicide rates, psychiatric symptoms, risk assessments, stigma, and global assessments of functioning. Quality assessment indicated limited strength of evidence and failures to control for pre-existing PTSIs, which would significantly bias program effectiveness evaluations for reducing PTSIs post-PPTE.

Expert Event Segmentation of Dance Is Genre-Specific and Primes Verbal Memory.

By chunking continuous streams of action into ordered, discrete, and meaningful units, event segmentation facilitates motor learning. While expertise in the observed repertoire reduces the frequency of event borders, generalization of this effect to unfamiliar genres of dance and among other sensorimotor experts (musicians, athletes) remains unknown, and was the first aim of this study. Due to significant overlap in visuomotor, language, and memory processing brain networks, the second aim of this study was to investigate whether visually priming expert motor schemas improves memory for words related to one's expertise. A total of 112 participants in six groups (ballet, Bharatanatyam, and "other" dancers, athletes, musicians, and non-experts) segmented a ballet dance, a Bharatanatyam dance, and a non-dance control sequence. To test verbal memory, participants performed a retrieval-induced forgetting task between segmentation blocks. Dance, instrument, and sport word categories were included to probe the second study aim. Results of the event segmentation paradigm clarify that previously-established expert segmentation effects are specific to familiar genres of dance, and do not transfer between different types of experts or to non-dance sequences. Greater recall of dance category words among ballet and Bharatanatyam dancers provides novel evidence for improved verbal memory primed by activating familiar sensorimotor representations.

Complex Motor Learning and Police Training: Applied, Cognitive, and Clinical Perspectives.

The practices surrounding police training of complex motor skills, including the use of force, varies greatly around the world, and even over the course of an officer's career. As the nature of policing changes with society and the advancement of science and technology, so should the training practices that officers undertake at both central (i.e., police academy basic recruit training) and local (i.e., individual agency or precinct) levels. The following review is intended to bridge the gap between scientific knowledge and applied practice to inform best practices for training complex motor skills that are unique and critical to law enforcement, including the use of lethal force. We begin by providing a basic understanding of the fundamental cognitive processes underlying motor learning, from novel skill acquisition to complex behaviors including situational awareness, and decision-making that precede and inform action. Motor learning, memory, and perception are then discussed within the context of occupationally relevant stress, with a review of evidence-based training practices that promote officer performance and physiological responses to stress during high-stakes encounters. A lack of applied research identifying the neurophysiological mechanisms underlying motor learning in police is inferred from a review of evidence from various clinical populations suffering from disorders of cognitive and motor systems, including Alzheimer's and Parkinson's disease and stroke. We conclude this review by identifying practical, organizational, and systemic challenges to implementing evidence-based practices in policing and provide recommendations for best practices that will promote training effectiveness and occupational safety of end-users (i.e., police trainers and officers).

Diurnal Cortisol Variation According to High-Risk Occupational Specialty Within Police: Comparisons Between Frontline, Tactical Officers, and the General Population.

OBJECTIVE: The aim of this study was to compare diurnal salivary cortisol among high-risk occupational police specialties and the general population (n = 18,698). METHODS: Tactical and frontline officers provided salivary cortisol samples for 2 days (four times: wake, 30 minutes, 11 hours, and 17 hours post-awakening) and were compared with a general population sample of group field studies utilizing similar methodology. Samples were analyzed for free cortisol concentrations (nmol/L) using chemiluminescence immunoassay. RESULTS: Repeated-measures mixed-model analysis of variance (ANOVA) revealed significantly greater salivary diurnal cortisol among tactical than frontline officers. Furthermore, both tactical and frontline officers had higher cortisol levels on average at all time points than the general population sample. CONCLUSION: Results suggest that diurnal cortisol response may be associated with level of risk exposure in hazardous occupational subspecialties within policing compared with the general population.

Experience-dependent modulation of alpha and beta during action observation and motor imagery.

BACKGROUND: EEG studies investigating the neural networks that facilitate action observation (AO) and kinaesthetic motor imagery (KMI) have shown reduced, or desynchronized, power in the alpha (8-12 Hz) and beta (13-30 Hz) frequency bands relative to rest, reflecting efficient activation of task-relevant areas. Functional modulation of these networks through expertise in dance has been established using fMRI, with greater activation among experts during AO. While there is evidence for experience-dependent plasticity of alpha power during AO of dance, the influence of familiarity on beta power during AO, and alpha and beta activity during KMI, remain unclear. The purpose of the present study was to measure the impact of familiarity on confidence ratings and EEG activity during (1) AO of a brief ballet sequence, (2) KMI of this same sequence, and (3) KMI of non-dance movements among ballet dancers, dancers from other genres, and non-dancers. RESULTS: Ballet dancers highly familiar with the genre of the experimental stimulus demonstrated higher individual alpha peak frequency (iAPF), greater alpha desynchronization, and greater task-related beta power during AO, as well as faster iAPF during KMI of non-dance movements. While no between-group differences in alpha or beta power were observed during KMI of dance or non-dance movements, all participants showed significant desynchronization relative to baseline, and further desynchronization during dance KMI relative to non-dance KMI indicative of greater cognitive load. CONCLUSIONS: These findings confirm and extend evidence for experience-dependent plasticity of alpha and beta activity during AO of dance and KMI. We also provide novel evidence for modulation of iAPF that is faster when tuned to the specific motor repertoire of the observer. By considering the multiple functional roles of these frequency bands during the same task (AO), we have disentangled the compounded contribution of familiarity and expertise to alpha desynchronization for mediating task engagement among familiar ballet dancers and reflecting task difficulty among unfamiliar non-dance subjects, respectively. That KMI of a complex dance sequence relative to everyday, non-dance movements recruits greater cognitive resources suggests it may be a more powerful tool in driving neural plasticity of action networks, especially among the elderly and those with movement disorders.

Lateral occipitotemporal cortex (LOTC) activity is greatest while viewing dance compared to visualization and movement: learning and expertise effects.

The lateral occipitotemporal cortex (LOTC) is comprised of subregions selectively activated by images of human bodies (extrastriate body area, EBA), objects (lateral occipital complex, LO), and motion (MT+). However, their role in motor imagery and movement processing is unclear, as are the influences of learning and expertise on its recruitment. The purpose of our study was to examine putative changes in LOTC activation during action processing following motor learning of novel choreography in professional ballet dancers. Subjects were scanned with functional magnetic resonance imaging up to four times over 34 weeks and performed four tasks: viewing and visualizing a newly learned ballet dance, visualizing a dance that was not being learned, and movement of the foot. EBA, LO, and MT+ were activated most while viewing dance compared to visualization and movement. Significant increases in activation were observed over time in left LO only during visualization of the unlearned dance, and all subregions were activated bilaterally during the viewing task after 34 weeks of performance, suggesting learning-induced plasticity. Finally, we provide novel evidence for modulation of EBA with dance experience during the motor task, with significant activation elicited in a comparison group of novice dancers only. These results provide a composite of LOTC activation during action processing of newly learned ballet choreography and movement of the foot. The role of these areas is confirmed as primarily subserving observation of complex sequences of whole-body movement, with new evidence for modification by experience and over the course of real world ballet learning.