There is a dearth of research on primary prevention interventions to prepare professionals in occupations at high risk for repeated trauma exposures to respond adaptively to these exposures. Such interventions are needed to protect people, such as police officers, from developing work-induced post-trauma adjustment disorders. Empirically-supported prevention programs have the potential to increase resilience, promote successful adjustment, improve occupational performance, and reduce the health, social and financial costs of traumatic events. However, primary prevention programs must first be developed and found to be feasible, acceptable, and transferable within the police community. The overall objective of this R34 application is to adapt an innovative imagery training program, which we developed and found to be effective in attenuating trauma- and stress-related disorders in Swedish police, to the realities of police work in a major urban American city, Detroit, which has high rates of potentially traumatic exposures for officers. We will adapt this intervention program to U.S. conditions and determine the acceptability and feasibility among Detroit police. Furthermore, pilot testing is expected to demonstrate program effectiveness in improving trauma-related self efficacy and appraisal and decrease catastrophic thinking - mechanisms believed to be involved in adjustment disorders.
The specific aims will be accomplished in four phases. First, we will adapt and modify our original Swedish manual and intervention protocol, in collaboration with the Detroit police, to create a protocol that is relevant to the current, U.S. urban context. Second, we will conduct initial qualitative evaluation and refinement of the intervention protocol using a small group of rookie police officers, one experienced police trainer, and a mental health therapist. Third, we will execute an uncontrolled clinical trial of the imagery-based intervention on 48 police officer participants, and follow them 6 months after the intervention. This phase will allow us to evaluate the feasibility and acceptability of the intervention and to evaluate our assessment strategy and tools, specifically targeting the sensitivity of instruments used to identify adjustment disorders among police (compared to formal, structured clinical interviews), and the feasibility of obtaining objective performance data. We also will obtain information on attrition, adherence, therapist training and supervision, intervention fidelity, and on post-treatment outcomes in order to estimate effect sizes. Finally, in the fourth phase, we will analyze the data and prepare an R01 grant application to seek funding to conduct a large-scale randomized clinical trial of the intervention. The long-term goal of this research is to develop an evidence-based prevention program to enhance mental health and professional performance in police and other high-risk personnel. The relevance of this project is that it will inform the development and conduct of future controlled intervention research on the primary prevention in professions of high risk for trauma exposure. The project, if successful, will have public health implications by offering a U.S. police-culture-appropriate primary prevention model that can be evaluated in subsequent clinical trials for its cost-effectiveness by involving police departments that are eager to implement innovative training and increase their employees'psychological resilience and long-term well- being. This intervention also holds great promise for reducing the incidence of trauma-induced mental disorders among high-risk professionals. Police are exposed to a number of job stressors that dramatically increase their risk of developing trauma-related disorders, work difficulties, and other behavioral and emotional problems. Although interventions have been developed that attempt to prevent trauma-related problems from emerging after police are exposed to stress, or to treat existing trauma disorders, these approaches are of limited efficacy, underutilized, or stigmatized. There is a great need for research on feasible, acceptable, and efficacious prevention methods that help prepare officers to respond more adaptively when they encounter stressful experiences in their work. This proposed research seeks to adapt an innovative imagery-based training prevention program, which we have shown to be effective in attenuating trauma-related mental health consequences among Swedish police, to the harsh realities facing Detroit police officers. The project will: adapt the program to urban United States conditions and police personnel, systematically assess the program's feasibility and acceptability among new officers, pilot test key measures of trauma and health, and estimate the intervention's effect size in an uncontrolled trial. This developmental research is a necessary step prior to a formal efficacy testing in a large-scale randomized clinical trial. The proposed research has important public health significance because-if the current adaptation of the program and a subsequent clinical trial are successful-it offers a valid and feasible primary prevention program for trauma-related disorders among police officers via enhancement of stress resilience.
Police are exposed to a number of job stressors that dramatically increase their risk of developing trauma-related disorders, work difficulties, and other behavioral and emotional problems. Although interventions have been developed that attempt to prevent trauma-related problems from emerging after police are exposed to stress, or to treat existing trauma disorders, these approaches are of limited efficacy, underutilized, or stigmatized. There is a great need for research on feasible, acceptable, and efficacious prevention methods that help prepare officers to respond more adaptively when they encounter stressful experiences in their work. This proposed research seeks to adapt an innovative imagery-based training prevention program, which we have shown to be effective in attenuating trauma-related mental health consequences among Swedish police, to the harsh realities facing Detroit police officers. The project will: adapt the program to urban United States conditions and police personnel, systematically assess the program's feasibility and acceptability among new officers, pilot test key measures of trauma and health, and estimate the intervention's effect size in an uncontrolled trial. This developmental research is a necessary step prior to a formal efficacy testing in a large-scale randomized clinical trial. The proposed research has important public health significance because-if the current adaptation of the program and a subsequent clinical trial are successful-it offers a valid and feasible primary prevention program for trauma-related disorders among police officers via enhancement of stress resilience.
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