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A Training Method to Improve Police Use of Force Decision Making: A Randomized Controlled Trial

A Training Method to Improve Police Use of Force Decision Making: A Randomized Controlled Trial Police safety and use of force decisions during critical incidents are an ongoing source of concern for both police practitioners and the public. Prior research in the area of police performance reveals that psychological and physiological stress responses during critical incidents can shape the outcome of the incident, either positively or negatively. The goal of this study was to test a training method to improve use of force decision making among police. This randomized controlled pilot study consisted of training officers to apply techniques to enhance psychological and physiological control during stressful critical incidents. Of a pool of 80 police officers, potential participants were invited based on equivalent age, years of experience, physiological characteristics (i.e., body mass index [BMI] and cardiovascular reactivity), and expertise. Results revealed that the intervention group displayed significantly better physiological control, situational awareness, and overall performance, and made a greater number of correct use of force decisions than officers in the control group (all ps < .01). The relevant improvements in use of force decision-making found in this pilot study indicate that this training method warrants further investigation. Improved use of force decision making directly translates into potential lifesaving decisions for police and the civilians they are working with. Keywords police special forces, resilience, critical incidents, physiological reactivity, use of force, situational awareness, SWAT There is no other job like a police officer’s, that requires North America include arming police officers and training someone to deliberately go out and actively search for dangerous them to make appropriate use of force decisions (Statistics situations where their life or someone else’s life may be Canada, 2013; U.S. Department of Justice Fiscal Year, 2014). threatened. It remains to be examined why questionable use of force decisions continue to be made despite significant resources Artwohl and Christensen (1997, p. 36) directed toward police training. Foundational research in the area of police performance reveals that psychological and physiological stress responses Police safety and use of force decisions during critical inci- during critical incidents shape the outcome of the incident, dents are an ongoing source of concern for both police prac- either for good or for bad (Arnetz, Arble, Backman, Lynch, titioners and the public. This concern is evidenced by & Lublin, 2013; Arnetz, Nevedal, Lumley, Backman, & extensive media coverage of this issue. A recent news article Lublin, 2009). Maladaptive stress responses during a critical in the Wall Street Journal (WSJ) highlights both the sky rock- incident put the officer and members of the public at risk of eting cost of police-misconduct cases and the growing public injury or death. Furthermore, maladaptive stress responses distrust of the use of force decisions made by police officers. can negatively affect an officer’s health and performance The authors of the WSJ article used data gathered from pub- over time (Covey, Shucard, Violanti, Lee, & Shucard, 2013; lic records and report that among the U.S. cities with the 10 largest police forces, there has been a 48% increase in costs of police-misconduct cases since 2010 (Elinson & Frosch, University of Toronto, Mississauga, Ontario, Canada 2015). The authors further reported, “Those cities collec- Police University College in Finland, Tampere tively, paid out $1.02 billion over those 5 years (2010-2015) Corresponding Author: in such cases, which include alleged beatings, shootings and Judith P. Andersen, University of Toronto Mississauga, Deer Field Hall, wrongful imprisonment” (Elinson & Frosch, 2015). A sig- 4032, Mississauga, Ontario L5L 1C6, Canada. nificant portion of the billions of dollars spent on policing in Email: judith.andersen@utoronto.ca Creative Commons CC-BY: This article is distributed under the terms of the Creative Commons Attribution 3.0 License (http://www.creativecommons.org/licenses/by/3.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). 2 SAGE Open Violanti, 2010). The objective of the current study was to All non-essential bodily functions, such as digestion and design and test a training method to improve police officers’ muscle repair, are stopped (Everly & Lating, 2013). The stress responses and use of force decision making during Hypothalamic–Pituitary–Adrenal (HPA) axis is also acti- critical incidents. The training method was designed to be vated during fight or flight. The HPA axis produces a cascade brief and integrated into existing use of force training pro- of hormones that act to maintain the fight or flight response, grams at police organizations. and importantly, to shut it off when the threat has been resolved. A key regulating hormone in the HPA cascade is cortisol, which is responsible for suppressing immune func- How Stress Affects Critical Incident tion and shutting down the fight or flight response (Johnson, Outcomes 2008). It is important to note that while fight or flight is a When an individual encounters a potential threat, the body purely physiological process, psychological processes, such engages in a series of automatic physiological processes in as threat perception, anxiety, and anticipation stress, can response to the threat. During a physiological stress response, stimulate, maintain, or inhibit the shut off of the fight or the sympathetic nervous system (SNS) is activated, and the flight response. Cortisol is excreted in a dose-response man- parasympathetic nervous system (PNS), responsible for calm- ner to the level of threat the individual perceives (Lovallo, ing and stabilizing the body, is withdrawn. The degree of a 2016). Aspects of the fight or flight response, including per- SNS response is determined by one’s cognitive perception of ceptual distortions, reduced motor dexterity, and impaired how threatening the stimulus is (Kalisch, Müller, & Tüscher, cognitive function, can be detrimental to use of force deci- 2015). Furthermore, the physiological responses during stress sion making during critical incidents (Johnson, 2008). can be enhanced or diminished by psychological factors, such as perceived control over the situation. A moderate amount of Perceptual Distortions SNS arousal is beneficial for performing optimally during critical incidents. The benefits of moderate arousal include During fight or flight, perceptual distortions in sensory infor- alertness, focused attention, and improved cognitive perfor- mation can occur. Sensory distortions include changes in mance (Jameson, Mendes, Blackstock, & Schmader, 2010). vision, sense of time (i.e., slowing down or speeding up), and Moderate arousal facilitates memory formation and memory a narrowing of auditory information (Klinger, 2006; Klinger retrieval (Cahill & Alkire, 2013). During moderate SNS & Brunson, 2009). Vision is compromised in three ways: arousal, sensory perceptions including visual, auditory, and reduced peripheral vision, distance-only eyesight, and forced olfactory senses are enhanced. Improved sensory awareness binocular vision (Olson, 1998). Reduced peripheral vision, increases an individual’s ability to successfully address a also known as “tunnel vision,” is caused by restricted blood threat (Kalisch et al., 2015). flow to the eyes and eye muscle contractions. The eye lens Police work, however, is an inherently a high-risk occupa- tends to flatten, thus reducing depth perception. The eyes tion. Officers routinely face unpredictable, unexpected, and focus on the source of a threat, with heightened attention to uncontrollable events, all of which are factors that increase visual detail, while ignoring near objects (Olson, 1998). the threatening nature of an encounter (Sapolsky, 2004). Officers may focus on one single threat, missing other poten- Furthermore, officers are often required to face these threats tially life-threatening cues around them. under the least ideal conditions, including darkness, unfamil- Even trained officers are at risk of having a fight or flight iar territory, and other distractions such as unexpected noise response and experiencing the associated perceptual distor- or erratic bystanders. When a stimulus is perceived as very tions. For example, Westmoreland and Haddock (1989) con- threatening, such as in the case of potential injury or death, ducted a study that entailed putting officers through 98 an individual experiences a greater degree of SNS arousal. A shooting scenarios involving both non-stressful and stressful severe SNS response is colloquially known as the fight or situations. Findings from this study showed overwhelmingly flight response (Lovallo, 2016). Fight or flight is an instinc- that even trained officers focused on the immediate threat tual survival response comprised of significant neurological, when confronted with life-threatening situations, at the behavioral, and neuroendocrine changes, and is accompa- expense of peripheral awareness. Studies show that during a nied by negative emotions such as anxiety, fear, and anger fight or flight response, an officer’s vision may be compro- (Lipton, 2008; Lovallo, 2016). During a fight or flight mised by up to 70%, resulting in the failure to detect subtle response, rapid release of epinephrine from the adrenal gland movements due to loss of peripheral vision (tunnel vision). stimulates an increase in respiration, heart rate, and blood Olson (1998) reported that it can take up to 440% longer to pressure (BP). A heart rate of 100 or above is an indication react when peripheral vision is decreased by 70%. The pupil that the stress response has been activated (Johnson, 2008). dilation caused by SNS arousal impairs vision for close Oxygen-rich blood is directed to the major muscle groups in objects (4-feet range). SNS arousal disrupts monocular the legs, torso, and arms to support necessary fighting or vision and results in the loss of control of the dominant eye fleeing action (Lundberg, 2011). Epinephrine signals the (used for precision shooting, that is, monocular vision) inhib- liver to release glucose to power the fight or flight response. iting the ability to focus on a gun sight (Klinger & Brunson, Andersen and Gustafsberg 3 2009; Siddle & Breedlove, 1995). Visual distortions have is that when a person is inhaling rapidly, they are increasing implications for using weapons accurately when targets are SNS arousal without allowing for the calming effect of the at close range (Johnson, 2008). The perceptual distortions parasympathetic system, which can act as a “brake” to regu- that occur during fight or flight affect an officer’s ability to late SNS arousal. see and hear potential threats within their immediate envi- In summary, there are both psychological and physiologi- ronment. These perceptual distortions combined with a cal aspects of the stress response. Psychological aspects slowed reaction time may directly affect the safety of the include the degree to which a person evaluates a situation or officer and the public. stimulus as a threat. Based on the degree of the threat per- ceived, the body automatically activates SNS arousal, a physiological response, to meet the level of the perceived Motor Deficits threat. Understanding the psychological and physiological During fight or flight, heart-rate and respiration increase, and mechanisms that underlie stress responses can inform the an individual is more likely to hyperventilate or hold one’s creation of an intervention to improve police performance breath, impairing the brain areas affecting fine motor skills during critical incidents. For example, although the fight or (Johnson, 2008). The rapid increase in BP and blood flow to flight response is an automatic instinctual reaction to a per- the large muscle groups enhances strength and gross motor ceived threat, police officers know that they will routinely be skills such as punching, kicking, and running, the very exposed to threatening situations. Therefore, controlling actions needed to fight or flee (Everly & Lating, 2013). one’s respiration before, during, and after a critical incident However, in regard to fine motor skills, the vasoconstriction is a way to avoid excessive SNS arousal and the associated of minor blood vessels in the extremities results in the loss of cognitive, sensory, and motor deficits. Controlled respiration dexterity, cold hands, and muscle tremors (Johnson, 2008). can be learned and practiced as one of a number of psycho- The loss of fine motor skills may compromise an officer’s physiological techniques to improve use of force decision hand/eye coordination and precision movements necessary making during critical incidents (Johnson, 2008). to operate weapons optimally. Improving Police Performance and Cognitive Deficits Safety A fight or flight response is an instinctual response and hap- Prior research in the area of police stress has not focused pens automatically, without a person deciding whether or not specifically on improving use of force decision making. to have one. Vascular processes directed by adrenal hormones However, several foundational studies address the psycho- (e.g., epinephrine and cortisol) stimulate automatic reactions logical and physiological components of the stress response, in the area of the brain called the hindbrain. Automatic which are, in turn, related to use of force decisions. McCraty instinctual processes are significantly faster than information and colleagues (McCraty, Atkinson, Tomasino, & Bradley, processed in the pre-frontal cortex, an area of the brain 2009; McCraty & Atkinson, 2012) designed and tested a required for memory, decision making, and logical thought stress reduction program for police and correction officers. (Arnsten & Goldman-Rakic, 1998; Goldstein, Rasmusson, The program is based on premise that improving self-regula- Bunney, & Roth, 1996; Takamatsu et al., 2003). During a tion skills (i.e., emotion regulation and energy levels) and fight or flight response, adrenal stress hormones constrict reducing physiological reactivity to stress (i.e., cardiovascu- blood vessels, reducing oxygen levels in the pre-frontal cor- lar and respiratory activation) would improve officer health tex, further decreasing an individual’s ability to access and performance outcomes (McCraty & Atkinson, 2012; stored memories and learned information (Lipton, 2008; McCraty et al., 2009). The authors conducted a 16-week Westmoreland & Haddock, 1989). The ramifications of expe- study in which they taught officers to practice self-regulation riencing a severe fight or flight response include difficulty skills and controlled respiration (5-second inhale and a remembering stored information and implementing learned 5-second exhale). McCraty and Atkinson (2012) reported behaviors, all of which may translate into an officer making that officers in the training group self-reported improve- less than ideal tactical maneuvers and use of force decisions ments in their communication skills at work, and with fam- during critical incidents. ily, increased positive emotion, vitality, reduced negative Excessive respiration during a fight or flight response emotion and depressive symptoms, and improved self-regu- may also lead to cognitive deficits. Rapid breathing and lation in response to stress. The authors did not find any sig- hyperventilation lead to dizziness, and even a mental state nificant differences between the trained and non-trained called “depersonalization” in which the individual feels that officers on use of force and decision-making skills during they are disconnected from their body (Brown & Gerbarg, critical incident scenarios (McCraty & Atkinson, 2012). 2009). When a person inhales, his or her SNS is dominant. Backman, Arnetz, Levin, and Lublin (1997), and Arnetz and When a person exhales, the parasympathetic nervous system colleagues (2009; Arnetz et al., 2013) developed a program is dominant (Cacioppo & Tassinary, 1998). What this means to improve police resilience and tested this program via a 4 SAGE Open randomized controlled trial. Their 10-session program (90 motor, and cognitive deficits associated with fight or flight min per session) was based on the premise that giving offi- (Cahill & Alkire, 2013; Johnson, 2008; Lovallo, 2016). cers the opportunity to practice stress reduction techniques Furthermore, the iPREP methodology utilizes techniques (i.e., relaxation) while listening, via audiotape, to repeated frequently implemented by elite athletes used to reduce critical incident scenarios and visualizing optimal perfor- threat and enhance knowledge acquisition and skill retention. mance would enhance the perception of predictability and Techniques include visualization, mental rehearsal, focused control when facing such events in the real world. The attention, and controlled respiration. Ryan and Simons authors reported clinically significant improvements in offi- (1982) found that, although mental rehearsal and visualiza- cer performance and reduced psychological distress when tion alone did not substitute for actual physical practice to tested on a critical incident scenario 1 year following their enhance motor skills among police, these techniques help training. Andersen and colleagues (2015) conducted the solidify the learning process in regard to situational aware- Arnetz et al. (2009) program with special forces police offi- ness and sensory perception during police critical incidents. cers. The authors reported that officers displayed reduced These techniques have been successfully applied among SNS arousal while listening to the critical incident scenarios police officers and associated with better performance over 1 week of training. However, officers requested more (Arnetz et al., 2009). Unique to iPREP is the addition of a intensive, scenario-based resilience training, better tailored mental coaching technique to enhance sensory perception. to the high-stress use of force decision making in their real- Heightened sensory perceptions, including visual, auditory, world encounters (Andersen et al., 2015). tactile, and olfactory senses, are critical components of Based on prior research, the current training method was police situational awareness. Biofeedback is used to train the developed specifically to improve police use of force deci- officer how to rapidly attain the optimal state of sensory sion making during critical incidents. This training method is awareness and physiological control. Situational awareness called the “international performance resilience and effi- is defined as the ability to perceive and process all potential ciency program” (iPREP). The iPREP method is based on threats in the environment. This is accomplished by using the empirical research detailing the psychological and physio- full array of sensory input (i.e., visual, auditory, olfactory, logical factors that are theorized to most strongly influence tactile) to recognize and prioritize the order in which threats use of force outcomes. Specifically, the psychological per- should be addressed. Situational awareness is just as impor- ception and anticipation of threat, and the associated physi- tant as knowledge of weapons and tactical maneuvers. It ological SNS arousal that, if left unchecked, would result in forms the basic foundational skills necessary for a police sensory, motor, and cognitive deficits during critical inci- officer to keep the public and themselves safe and make the dents (Johnson, 2008; Kalisch et al., 2015). Of equal impor- most appropriate use of force decisions. tance is the way in which the iPREP training method is administered. Driskell and Johnston (1998) conducted semi- The Current Study nal research comparing methods of training police and mili- tary personnel to perform during life-threatening situations. A randomized controlled trial was conducted to test the iPREP The authors outline the necessary components for training methodology. A baseline skills test (i.e., pre-test) was admin- delivery that maximize skill acquisition, retention, and appli- istered, after which officers were randomized into interven- cation (Driskell & Johnston, 1998). The authors report that tion and control conditions. Following the training week, a optimal training must include dynamic processes beginning final test (post-test) was held to determine if the intervention with exposure to the knowledge to be learned in a non-stress group displayed enhanced performance in comparison with environment; training the necessary skills in an increasingly the control group. We hypothesized the following: stressful and realistic environment; and providing opportuni- ties for increasing one’s confidence in his or her ability to Hypothesis 1: Officers in the intervention group would perform during stress (Driskell & Johnston, 1998). display significantly better situational awareness and Dynamic police training is not a new concept (Olson, overall performance than officers in the control group, as 1998). However, to our knowledge, no one to date has com- rated by senior use of force police trainers (SRT_Trainers) bined dynamic police training with empirically based meth- who were blinded to study conditions. ods to reduce psychological threat perception and improve Hypothesis 2: At post-test, officers in the intervention physiological control, as we have done with the iPREP group would make correct use of force decisions more method. Advances in neurobiology and learning theory sup- often (shoot/no shoot) than officers in the control group. port the iPREP methodology (Cahill & Alkire, 2013; Driskell Hypothesis 3: Officers in the intervention group would & Johnston, 1998). Namely that reducing threat perceptions display lower SNS arousal during critical incident sce- while systematically increasing situational and cognitive narios at post-test as compared with officers in the control challenges will enable an individual to capitalize on the ben- group. SNS arousal was operationalized as maximum efits of epinephrine, for memory formation and retrieval dur- heart rate during the incident (HR_Max), heart-rate recov- ing moderate SNS arousal, without experiencing the sensory, ery (HR_Recovery), which was the time (in seconds) to Andersen and Gustafsberg 5 return to resting heart rate following the incident, and BP pre-test assessing officer skills and abilities was conducted. (systolic and diastolic). Following the pre-test, officers were randomized into the Hypothesis 4: At post-test, officers in the intervention intervention and control groups. The intervention group group would self-report lower stress and greater confi- accompanied the researchers to the Police University College dence in their skills to manage critical incidents, com- of Finland campus for 3 days of iPREP training. The control pared with officers in the control group. group engaged in training-as-usual activities (e.g., shooting targets, active physical training, undercover pursuit of crimi- nals, etc.) at their base in Helsinki, Finland. Five days fol- Method lowing the pre-test and training, a post-test assessing officer Of a pool of approximately 80 officers serving on the Finnish performance during stressful scenarios was conducted on the Federal Special Response Police Teams (SRTs), select offi- 6th day. During all assessment and training scenarios, offi- cers (n = 16) were invited to participate in the study. The cers wore full police gear. All scenarios were conducted in selected group (n = 16) was chosen because they had compa- realistic field settings (e.g., abandoned school, apartments, rable years of service on the special unit (~2 years). The abandoned warehouse, etc.), using real weapons with simu- majority of officers invited agreed to participate (n = 12). nition (i.e., chalk bullets that leave a colored mark, which can be used to assess shooting accuracy). In addition, trained actors, low light exposures, and loud noises were used for the Sample Size Considerations purpose of enhancing the stress level and realism of the sce- Despite the randomized controlled design of this study, narios. See below for further explanation: empirical studies with few participants are at risk of “small sample failure of random assignment” (Strube, 1991). This Pre-test. At the beginning of the pre-test, officers were fitted occurs when, by chance, individuals with qualities that are with chest bands which recorded their SNS arousal (i.e., confounded with outcome variables happen to be random- heart rate, respiration, movement). Critical incident scenar- ized to one group, thus inflating or deflating intervention ios for assessing tactical skills and decision making were effects incorrectly. While in the case of larger sample sizes, designed by senior training officers of the Finnish National randomization is the process that solves the problem of indi- Police. Training officers were independent of the research vidual differences accounting for treatment effects. As rec- study and were not involved in study design or implementa- ommended by clinical researchers and statisticians tion to avoid bias. Trained actors (experienced police offi- specializing in intervention research with random assign- cers) conducted the scenarios so as to enhance the reality of ment, this study applied the recommended steps to reduce the incidents. Officers waited together but were called inde- the likelihood that “small sample failure of random assign- pendently to engage in each pre-test scenario as follows: (a) ment” accounts for study findings (Hsu, 1989; Strube, 1991). Car robbery in progress: Officer is called to the scene of a First, participants were matched on gender, years of service robbery. A man holding a knife was searching an empty car. as a police officer on the SRT, prior training exposure (i.e., As the officer approaches, the man runs behind the car, drops all received training from the same organization), and close the knife, and then runs toward the officer, ignoring any in age. Importantly, all participants were tested on skills and commands to stop. (b) Potential hostage situation: Officer is abilities immediately prior to the randomization. A pre-test called to the scene of an abandoned building with a potential ensures that potential individual-difference confounds (i.e., hostage situation in progress. Officer enters an empty room, police tactical skills and decision-making abilities) were hears movement in a second room. In the second room, a equal across both groups. In addition to controlling for tacti- criminal holds a gun to the head of another individual. (c) cal skills and abilities, physical variables potentially related Domestic dispute: Officer is given information that loud to SNS arousal were assessed. Specifically, body mass index noises are coming from an apartment, potentially a domestic (BMI) and baseline cardiovascular function were assessed dispute in progress. When the officer approaches the resi- and determined to be equal at baseline. dence, screaming can be heard coming from the back of the This study was approved by the University of Toronto apartment. Upon entry of the apartment, the officer encoun- Research Ethics Board as well as the Research Ethics ters two men, one angry and yelling, the other standing sta- Committee of the Police University College of Finland. All tionary in the corner. Upon entering the room where the participants signed the ethics-approved consent form before screaming is coming from, the officer encounters a man and participating. woman struggling; the man is holding a knife. (d) School shooting in progress: Officer enters an empty hallway lead- ing to a classroom where the hostage situation is happening. Procedure A hysterical person runs out of the classroom and passes the Two weeks before the study began, officers were mailed officer. Upon entering the classroom, the officer encounters a consent form and demographic surveys to their home in a a gunman facing them and a gunman holding two individuals confidential envelope. Prior to initiating the intervention, a hostage in classroom seats on the other side of the room. 6 SAGE Open Randomization. At the end of the pre-test day, the trainer’s Post-test. Participants were fitted with the chest bands at the scores revealed that there were no differences in tactical abil- beginning of the post-test day. To avoid bias, federal SRT ities among officers. Officers were then randomized via a senior trainers, who were blinded to study conditions, pre- coin flip into the intervention and control groups. Following pared the post-test scenarios without consulting with the a 24-hr break, officers in the intervention group began the researchers. Scenarios were designed to test the officer’s iPREP training at the Police University College of Finland, situational awareness, decision making, and action skills while the control group returned to their base in Helsinki, (i.e., shoot/no shoot), as well as overall performance. Analo- Finland to engage in training-as-usual activities. gous to the pre-test, trained police actors carried out the two post-test scenarios to enhance the reality of the scenarios. Training Intervention (iPREP). Core components of the training Participants completed a brief survey before and after each included (a) education about the physiology of the stress critical incident, assessing their confidence in their skill to response system, energy management, and fueling for peak manage the critical incident and the stressfulness of the inci- performance; (b) group instruction on how to use mental focus dent. To reduce the chance that officers would warn others and visualization to enhance sensory perception and situa- about the upcoming scenarios, officers waited alone in iso- tional awareness in performance and non-performance set- lated rooms and were called out at random to complete the tings; (c) instruction and use of biofeedback to practice post-test scenarios independently as follows: (a) Officers engaging in controlled breathing exercises that have been were informed that a potentially armed suspect was seen shown to enhance SNS control during stress (McCraty et al., entering a known drug house where a loud noise was 2012). Controlled breathing is not a relaxation exercise; rather, reported. Upon entering the abandoned building that had it balances the activity of the sympathetic and parasympathetic been transitioned into a drug house, officers witnessed an nervous system during stress, facilitating states of moderate armed man kill another man and run into a room down a arousal and blocking panic reactions and hyperventilation hallway. In the room where the suspect ran, five men were in responses that lead to maladaptive sensory responses such as various positions around the room (two men were standing in tunnel vision and auditory exclusion (Johnson, 2008); (d) corners with their hands in their pockets, one man was sitting dynamic police training during realistic critical incident sce- on a seat holding a gun pointed at the floor, and the armed narios. Following the principles of dynamic training, instruc- suspect was holding another man hostage at knifepoint). (b) tion begins with three to four consecutive, brief, slow-motion Officers were informed that a disturbance was reported from critical incident scenarios. An important component of this a known gang club in an old warehouse. Prior to entering the stage of training is helping the officer to recognize their SNS building, officers were required to perform 20 squats in full arousal in order to enhance situational awareness and decision gear to stimulate physiological arousal that would normally making. Once an officer was aware of their physiological be elevated due to the effort to arrive at the call out. The arousal state, they were instructed to apply the psychological warehouse scenario consisted of four separate incidents in and physiological control techniques during subsequent sce- which the officer had to make shoot/no shoot decisions. The narios. A central benefit of dynamic training is that the use of first was two men fist fighting at the end of a darkened hall- force trainer has objective evidence to determine if the officer way, the second entailed the officer opening a door to has indeed learned the skills based on their performance in the encounter a man holding a tool (wrench) facing the officer, scenarios and does not need to rely on the officer’s self-reports. the third was a hostage situation with one man holding a gun Officers are often required to make split-second UOF deci- to another man’s head in a darkened locker room, and finally, sions. During fight or flight, an individual reverts to the auto- immediately following the hostage situation, a man matic actions they have been trained to perform. The approached the officer from the side with a radio in his hand, slow- motion scenarios are purposly low-stress exercises in asking “What happened here?” order to provide the officer with the opportunity to aquire opti- mal motor movements that will be automatically performed Measures during high stress encounters. Training continues in blocks of moderate and then high speed action, with increasing levels of Relevant demographic information was assessed prior to the stress during the scenarios. Use of force instructors provide onset of the study (i.e., age, height, weight, marital status, positive feedback to the officers whenever possible to enhance years as a police officer, and years as a special forces police their confidence and mastery of skills. Importantly, in between officer). each use of force learning block, officers review their perfor- mance through visualizing both what happened and mentally Heart rate. The chest-band monitors (i.e., Zephyr Bioharness) rehearsing the optimal performance, as instructed by the use of were non-invasive devices fitted next to the skin of the partici- force trainer according to the “best practices” of the organiza- pant under their uniform. Monitors recorded the participant’s tion. By the end of the use of force instructional period, offi- physiological reactivity (moment by moment) in real time. In cers were able to transition to an optimal mental and this study, two components of cardiovascular physiology were physiological state within seconds. recorded: (a) Heart Rate Max (HR_Max), the highest heart Andersen and Gustafsberg 7 rate attained during the critical incident scenario and (b) Heart- Rate Recovery Time (HR_Recovery) which indicates the time, in seconds, for the officer’s heart rate to return to their average baseline resting HR measured over the course of 5 min at the beginning of the post-test day while sitting. Blood Pressure. Omnisense ambulatory BP wrist cuffs were used to measure the participant’s systolic and diastolic BP before and after exposure to the critical incident scenarios. Performance ratings. The senior SRT trainers, blinded to study conditions, rated the officers on situational awareness, deci- sion making (shoot/no shoot), and overall performance. In the Figure 1. Pre- and post-training: Daily overall performance. drug house scenario, there were six different potential threats Note. The pre-training day included four scenarios. Each scenario was in the environment. Officers were rated on how many threats rated on a 10-point scale, which resulted in a maximum possible score of they recognized and managed. Overall performance in the 40 (four pre-training scenarios × 10 maximum points). During the post- training day, there were two scenarios; each scenario rated from 1 to 10, drug house was rated on a 10-point scale, including the appro- resulting in a maximum possible score of 20 (two post-training scenarios priateness of decision making and actions relevant to the × 10 maximum points). threats at hand. In the warehouse scenario, there were five **p < .01. potential threats in the environment and four shoot/no shoot decisions to be made. Identical to the drug house scenario, officers were rated on how many threats they were aware of diastolic), situational awareness, trainer’s rating, partici- and managed and their decision-making skills and actions. pants’ subjective self-report, shoot/no shoot decision mak- ing. Independent samples t tests were used to compare mean Self-reported stress, skills, and ability to manage the scenarios. Self- differences between the intervention and control groups on reported surveys were administered directly before and after continuous variables with a normal distribution. If the each scenario. All questions were rated on a 10-point Likert- assumption of normality was not met, Mann–Whitney U type scale (1 = lowest and 10 = highest score). The pre-incident tests were used to compare mean differences between the survey included ratings of anticipation stress (“How stressful do intervention and control groups (Whitney, 1997). Fisher’s you anticipate the upcoming scenario to be?”), self-confidence Exact chi-square tests were used to examine categorical vari- in decision making (“How confident do you feel that you will be ables (participant perceived accuracy of shoot/no shoot able to make the appropriate decisions during the scenario?”), actions). Cohen’s d (using absolute values) was calculated to self-confidence in situational awareness (“How confident are examine if results comprised of meaningful differences. you that you will be able to maintain situational awareness dur- According to Cohen (1992), a small effect is .2, a medium ing the scenario?”), self-confidence in carrying out correct effect is .5, and a large effect is .8 or above. All analyses were actions (“How confident are you that you will be able to carry conducted using PASW Statistics version 20. out the correct actions during the scenario?”). Similarly, the post-incident self-report survey queried the stress level of the Results scenario (“How stressful was this scenario?”), decision making (“Were you able to make the appropriate decisions during the Sample and Descriptive Statistics scenario?”), situational awareness (“Were you able to maintain situational awareness during the scenario?”), self-confidence in All participants (n = 12) were White male police officers having carried out the correct actions (“Were you able to carry (M = 31.50; Range_age = 7). All officers had completed a _age out the correct actions during the scenario?”), overall perfor- similar number of years of police service prior to entering the mance (“Rate your overall performance during the scenario”), SRT (M_police service = 4.68). All participants were within ability to de-stress (“Ability to return to a non-stressed state in their second year of SRT service (M_SRT = 2.08; Range_ your body after the scenario finished?”), time to de-stress (“How SRT = 2.75; SD_SRT = 0.76). An independent samples t test long did it take you to return to a non-stressed state in your body did not reveal any difference in BMI between the interven- after the scenario finished?”). tion (M = 25.21, SD = 0.669) and control groups (M = 24.98, SD = 1.078), t(10) = 0.451, p = .662. Independent samples t tests did not reveal any significant differences in pre-test Analytic Methods baseline skills, including the SRT trainer’s ratings of situa- The Shapiro–Wilk test was used to assess normality of the tional awareness, decision making (shoot/no shoot), and following continuous variables: Heart Rate Max (HR_Max), overall performance (Figure 1), or participant’s self-reported Heart-Rate Recovery Time (HR_Recovery), BP (systolic and stress levels, confidence and perceived skills (ps > .05). 8 SAGE Open Table 1. Manipulation Check: Stress Responses to the Critical Incident Simulations (N = 12, Unless Otherwise Noted). Scenario 1: Scenario 2: Drug house Warehouse Effect size Effect size Measure M (SD) (d) t p M (SD) (d) t p Heart rate (BPM) Baseline 79.41 (10.07) During (HR_Max) 153.60 (15.38) −6.41 −20.26 <.001 169.50 (8.42) −12.91 −40.81 <.001 Self-reported stress PreQ1 6.25 (1.71) 6.50 (1.83) PostQ1 5.83 (1.80) 0.30 1.05 .32 6.42 (1.88) 0.08 0.266 .80 Note. BPM = beats per minute. Due to an equipment malfunction, HR_Max during the scenario was not measured for 10 participants instead of 12. Similarly, no significant differences in physiology, includ- ing, HR_Max, HR_Recovery, and BP (both systolic and dia- stolic), were noted (ps > .05). As a manipulation check to test if the post-test scenarios were realistically stressful, changes in HR and self-reported stress levels were exam- ined (Table 1). Paired samples t tests revealed a significant increase in heart-rate response from resting to scenario per- formance (ps < .05). Although self-reported stress levels did not change significantly from pre- to post-scenario, all sce- narios were rated above the median on a 10-point scale, indi- cating moderate to high stress. Hypothesis 1: At post-test, officers in the intervention group displayed significantly better situational awareness and overall performance compared with officers in the Figure 2. Post-training scenarios: Scenario-based situational control group. awareness. Note. In the “drug house” scenario, the participants were supposed to recognize six different “potential threats” in the environment. In the Mann–Whitney U tests were performed to examine differ- “warehouse” scenario, the participants were supposed to recognize five ences in situational awareness and overall performance different “potential threats” in the environment. between groups. Results revealed significant differences in **p < .01. ***p < .001. SRT_Trainer’s ratings of the intervention and control groups at post-test. Specifically, officers in the intervention group were significantly more situationally aware than officers in p = .001; Cohen’s d = 2.79. Similarly, in Scenario 2 (ware- the control group (Figure 2). For Scenario 1 (drug house), house) officers in the intervention group were rated as per- officers in the intervention group noticed more of the six forming significantly better (M = 8.17, SD = 1.4720) than threats in the environment (M = 5.67, SD = 0.5164) than the officers in the control group (M = 3.17, SD = 1.7224), t(10) = control group (M = 2.5, SD = 1.0488; U = .000, p < .01), 5.406, p < .000; Cohen’s d = 3.12 (Figure 3). Cohen’s d = 3.83. Similarly, a Mann–Whitney U test revealed significant differences between groups for Scenario 2 (ware- Hypothesis 2: At post-test, officers in the intervention house). Specifically, officers in the intervention group group would make correct use of force decisions more noticed more of the five threats in the environment (M = 4.5, often (shoot/no shoot) than officers in the control group. SD = 0.8367) than the control group (M = 2.17, SD = 1.1691; U = 2.000, p < .000), Cohen’s d = 2.29. An independent samples t test revealed that, out of four use Independent samples t tests conducted to assess overall of force decisions embedded within Scenario 2 (ware- performance revealed significant differences between groups. house), officers in the intervention group made signifi- Specifically, for Scenario 1 (drug house), officers in the inter- cantly more correct shoot/no shoot decisions (M = 3.83, vention group were rated as performing significantly better SD = 0.4083) compared with officers in the control group on a scale of 1 to 10 (M = 7.5, SD = 1.0488) than officers in (M = 2.33, SD = 0.8165), t(10) = 4.025, p < .01; Cohen’s d = the control group (M = 3.67, SD = 1.6330), t(10) = 4.838, 2.32 (Figure 4). Andersen and Gustafsberg 9 Figure 4. Warehouse shoot/no shoot decisions. Figure 3. Post-training scenarios: Scenario-based overall Note. In the “warehouse” scenario, there were four shoot/no shoot performance. decisions (maximum score: 4 points − minimum score: 0 points). These Note. In both post-test scenarios (“drug house” and “warehouse”), the included the following: participants were rated on a 10-point scale (1-10), where Score 1 was 1. A slow moving fight between two drunk men is in progress (no rated as a “very low” performance and 10 was rated as an “outstanding” weapons)—Correct decision: No shoot (Score: 1 point). performance. 2. Upon opening a closed door, a man walks toward the officer holding a ***p ≤ .001. wrench tool—Correct decision: No shoot (Score: 1 point). 3. An offender holds another man with gun to head—Correct decision: Shoot (Score: 1 point). Hypothesis 3: Officers in the intervention group would 4. A man holds a radio in his hand and he approaches the office asking, display lower physiological arousal during critical inci- “What is happening here?”—Correct decision: No shoot (Score: 1 point). dent scenarios at post-test as compared with officers in the **p < .01. control group (HR_Max, HR_Recovery, and BP). 8.83 on a 10-point scale (ps > .05). However, Mann–Whitney At post-test, an independent samples t test revealed that there U tests revealed significant differences between the interven- were significant differences in HR_Max and change in HR from tion and control group’s pre-scenario ratings of their confi- baseline on Scenario 1 (drug house) between the intervention dence to carry out the correct actions during the upcoming group and the control group (ps < .05; Table 2). Although the scenario. Specifically, in Scenario 1 (drug house) the control intervention group displayed lower HR_Max for Scenario 2 group reported higher levels of confidence than the interven- (warehouse), the differences between the intervention group tion group (p < .05). Similarly, in Scenario 2 (warehouse) the and control group did not reach statistical significance (Table 2). control group reported higher levels of confidence than the An independent samples t test revealed that, although the intervention group (p < .05; Table 3). Independent samples t intervention group did recover in a shorter time than the con- tests did not reveal any significant differences between the trol group, the differences in HR_Recovery for both Scenario intervention and control group on the following self-reported 1 (drug house) and Scenario 2 (warehouse) were not statisti- questions rated after each of the scenarios at post-test: How cally significant (Table 2). stressful was the scenario, ability to maintain situational Independent t tests revealed that systolic and diastolic BP awareness, overall performance, and ability to return to a values, both before and after each critical incident scenario non-stressed physical state, and time, in minutes, to return to during the post-test, were not significantly different between a non-stressed physical state. All ratings were above average groups (ps > .05; Table 2). with means ranging from 5.50 to 8.20 on a 10-point scale (ps > .05). Fisher’s Exact chi-square tests revealed no differ- Hypothesis 4: At post-test, officers in the intervention ences between groups in perceived ability to carry out the group would self-report lower stress and greater confi- correct shoot/no shoot actions during both Scenario 1 (drug dence in their skills to manage critical incidents, com- house) and Scenario 2 (warehouse; Table 3). pared with officers in the control group. At post-test, independent samples t tests and Mann– Discussion Whitney U tests revealed no significant differences between In this experiment, we tested if a novel resilience program, groups on self-reported ratings before the scenarios on the integrated directly into use of force training, would improve following variables: How stressful the scenario was antici- police performance and safety during highly realistic critical pated to be, the ability to make appropriate decisions in the incident scenarios. In support of our hypotheses, officers in upcoming scenario, and situational awareness (Table 3). All the intervention group displayed significantly enhanced ratings were above average, with means ranging from 5.33 to 10 SAGE Open Table 2. Comparing Physiological Arousal Between Groups at Post-Test. Scenario 1 Scenario 2 intervention Control intervention Control Effect size Effect size Measure M (SD) M (SD) (d) Test statistic p M (SD) M (SD) (d) Test statistic p Blood pressure (n = 6) (n = 6) (n = 6) (n = 6) Baseline systolic 131.33 (16.48) 132.33 (11.04) T = −0.12 .90 Baseline diastolic 89.50 (15.14) 87.50 (4.04) T = 0.31 .77 Pre-scenario systolic 133.50 (12.15) 133.33 (12.79) T = 0.02 .98 137.83 (11.96) 139.00 (6.45) T = −0.21 .84 Pre-scenario diastolic 84.00 (11.78) 84.33 (7.53) T = −0.058 .96 88.33 (12.08) 91.17 (4.79) T = −0.53 .61 Post-scenario systolic 140.50 (14.38) 142.83 (8.84) T = −0.34 .74 Post-scenario diastolic 96.17 (13.33) 90.50 (10.31) T = 0.82 .43 Change systolic 3.40 (5.68) 10.50 (8.69) U = 7.00 .14 Change diastolic 6.67 (9.29) 3.00 (10.49) T = 0.64 .54 Heart rate (BPM) (n = 5) (n = 5) (n = 5) (n = 5) Baseline 79.99 (7.86) 78.82 (12.87) T = 0.173 .87 HR_Max 145.00 (14.07) 162.20 (12.22) T = −2.06 .07 164.50 (5.80) 170.80 (7.86) T = −1.33 .22 Change 65.01 (8.25) 83.38 (4.79) −2.72 T = −4.30 .003 (<.01) 88.21 (7.52) 91.98 (6.65) T = −0.84 .43 HR_Recovery (s) 471.40 (115.05) 565.60 (152.70) T = −1.10 .30 630.20 (239.92) 967.60 (648.92) T = −1.09 .33 situational awareness, overall performance, and made a control group. Based on observational data gathered at spe- greater number of correct use of force decisions (shoot/no cialized law enforcement trainings, Siddle (1995) provided shoot) than officers in the control group. Specifically, offi- general heart-rate ranges, in beats per minute (BPM), that cers in the intervention group saw more of the potential indicate moderate, potentially maladaptive, and extreme threats in the environment, allowing them to more accurately arousal states, and their associated implications for situa- decide what was actually happening in the situation and per- tional awareness. On average, a range between 115 and form actions in line with police “best practice” policies for 145/150 BPM indicates an optimal state of arousal and sen- use of force. Improved performance directly translates into sory awareness, after which there is a potential decline in potential lifesaving decisions for police and the civilians abilities and skills. When the heart rate reaches 170 and they are working with. above BPM, perceptual distortions, freezing, and possible As Olson (1998) reviewed, inappropriate use of force irrational behavior can occur. An officer with a heart rate of decisions during critical incidents are frequently associated 200 or more is at risk of freezing or complete lack of aware- with poor situational awareness arising from extreme physi- ness. Officers in our intervention group were more likely to ological arousal; an officer may even look in the direction of remain in or near the optimal heart-rate range in both sce- the threat but not actually see or encode what is going on or narios compared with the control group. It is also important “may repeatedly pull the trigger of an empty weapon, mis- to note that officers in the intervention group recovered identify innocuous items as weapons, or not see or hear inno- approximately 2 minutes faster following Scenario 1 and cent bystanders in the line of fire” (Olson, 1998). It follows over 6 minutes faster following Scenario 2 than officers in then that the core component of improving use of force deci- the control group. Although this finding did not reach statis- sion making is to improve an officer’s ability to maintain an tical significance, it is relevant given that officers may rou- optimal state of sensory awareness (e.g., visual, auditory, tinely encounter instances in which they need to face multiple tactile, olfactory) associated with moderate arousal during threats in a short period of time, in which rapid recovery is critical incidents (Kalisch et al., 2015). Controlling ones’ advantageous for both safety and subsequent performance. heart rate within a moderate range is of key importance in Although we did not find significant differences in BP, this maintaining physiological control, cognitive acuity, and the may be associated with the data collection method. Although ability to perform under pressure (McCraty & Atkinson, BP was measured before and after each scenario, there was a 2012; McCraty et al., 2009). To examine if that goal was several minute delay in placing the wrist cuff BP monitor on achieved by our intervention, the first step was to make sure the officer to attain the reading, during which time BP likely that the testing scenarios induced significant physiological returned to normal. stress arousal. As demonstrated by the manipulation check Ratings of officers’ self-perceptions of stress, situational (Table 1), large effects indicate that officers did experience awareness, and the ability to make the best decisions and per- the scenarios as highly realistic and stressful, as shown by form the correct actions during the scenarios were gathered both self-reports and a significant increase in heart rate from from participants both before and after each scenario. There baseline to scenario performance. In line with our hypothe- were no significant differences between groups on any of the ses, the data showed that the intervention group displayed pre- or post-ratings, except on their rating of confidence in lower heart rate max during the scenarios and a quicker time taking the correct action (shoot/no shoot) during the situa- to recovery following the scenarios than individuals in the tion. The control group perceived greater confidence before Andersen and Gustafsberg 11 Table 3. Comparing Self-Reported Stress and Performance Between Groups at Post-Test. Scenario 2: Scenario 1: Intervention Intervention Control Control (n = 6) (n = 6) (n = 6) (n = 6) Effect Test Effect Test Measure M (SD) M (SD) size (d) statistic p M (SD) M (SD) size (d) statistic p Pre-scenario Stress 5.33 (1.86) 7.17 (0.98) T = −2.13 .06 5.83 (2.23) 7.17 (1.17) U = 10.50 .20 Decision making 7.33 (1.63) 7.50 (1.76) U = 15.50 .60 7.33 (1.63) 7.83 (0.75) U = 17.50 .92 Situational awareness 7.33 (1.63) 7.00 (0.89) U = 32.00 .21 7.00 (2.00) 6.83 (0.75) U = 10.50 .20 Correct action 7.17 (2.04) 8.83 (0.75) −1.08 U = 5.00 .02* 7.17 (2.04) 8.50 (0.55) −0.89 U = 7.50 .04* Post-scenario Stress 5.50 (2.17) 6.17 (1.47) T = −0.62 .55 5.50 (2.07) 7.33 (1.21) T = −1.87 .091 Decision making 7.33 (1.75) 6.67 (2.42) U = 37.50 .81 7.67 (1.51) 6.00 (2.90) T = 1.25 .24 Situational awareness 7.33 (1.21) 5.67 (2.16) T = 1.65 .13 7.67 (1.51) 5.67 (2.42) T = 1.72 .12 Correct action 1 no, 5 yes 0 no, 6 yes X = 1.091 1.000 6 yes 6 yes — Overall performance 7.17 (1.60) 5.67 (1.75) T = 1.55 .15 7.83 (1.60) 6.67 (2.07) T = 1.09 .30 Ability to de-stress 8.17 (0.41) 8.50 (0.55) U = 12.00 .24 8.20 (0.84) 7.40 (2.07) U = 10.50 .66 Time to de-stress 4.33 (3.20) 2.50 (1.38) T = 2.41 .23 5.75 (6.50) 5.00 (3.46) T = 0.20 .85 Note. Only 10 people completed response to S2PostQ6 (ability to de-stress); five people from each group. Only eight people completed response to S2PostQ7 (ability to de-stress); four people from each group. *p < .05. the scenario in their ability to take correct actions in the self-report measures, the key study variables were measured upcoming event, and all participants in the control group without the risk of biases that are inherent to self-reported were confident that they had completed the correct actions information, such as social desirability (Podsakoff & Organ, after the scenario had ended. This finding is of particular 1986). Fourth, key outcome variables were measured during interest given that the self-reports of control group officers multiple scenarios, using realistic, ecologically valid critical were in stark contrast with the objective ratings of perfor- incident simulations. The latter method further enhances the mance and actions given by expert raters blind to study con- reliability and generalizability of the data. dition. This finding highlights an important issue—officers may be inaccurately confident in their tactical skills to cor- Implications and Applications rectly manage a life or death situation, and rightly so; all par- ticipants in this study were shown to have high levels of Enhancing resilience among officers is an increasingly popu- equivalent tactical skills at baseline in low stress scenarios. lar idea among scholars and police organizations looking to However, when faced with a highly threatening realistic sce- support the well-being of their officers. To this end, large-scale nario, an individual may not account for the perceptual dete- resilience building programs originally developed for military rioration associated with high stress arousal, which negatively personnel are now being applied in police organizations across affects their ability to perform tactical maneuvers. These North America, via classroom instruction. Programs such as findings highlight the benefit of advancing police tactical the Road to Mental Readiness in Canada (Pedersen, 2013) training by incorporating principles of psychological and and Comprehensive Soldier Fitness (Cornum, Matthews, & physiological control during stress. Seligman, 2011) in the United States aim to improve the health A limitation of this study is the small sample size. and performance of first responders through general resilience However, a number of factors enhance confidence in the building techniques. Randomized controlled trials testing the study findings. First, our results are aligned with findings efficacy of these programs to improve use of force outcomes from prior randomized controlled trials in this field and are not available. It may be misleading to assume that resil- extend the applicability by integrating our training into the ience programs delivered in classroom environments will gen- existing use of force programming (Arnetz et al., 2009). eralize to use of force and behavioral performance outcomes Second, we successfully reduced the potential for small sam- in the real world. Patterson, Chung, and Swan (2012) con- ple failure of random assignment, as discussed in the Method ducted a meta-analysis on exactly this topic. These authors section (Coalition for Evidence-Based Policy, 2014; Hsu, assessed the impact of police-specific stress management 1989; Strube, 1991). Third, the results are based on multiple interventions that aimed to improve psychological, physiolog- objective outcomes, including both biological data and ical, and behavioral outcomes among police. The meta-analy- expert raters. Of note, there were two expert raters coding sis revealed overwhelmingly non-significant physiological or participant behavior and actions from various angles to fur- behavioral outcomes in the programs they reviewed (Patterson ther enhance coding accuracy. Although we included et al., 2012). Researchers have the highest confidence that a 12 SAGE Open program is effective when the following standards are met: (a) Funding the intervention must be designed to address the specific out- The author(s) received no financial support for the research and/or comes it claims to change and (b) the intervention must be authorship of this article. tested using a randomized controlled trial, the scientific gold standard for determining program effectiveness (Patterson References et al., 2012). Andersen, J. P., Papazoglou, K., Koskelainen, M., Nyman, M., The iPREP intervention was developed to address identi- Gustafsberg, H., & Arnetz, B. B. (2015). Applying resil- fied outcomes that are known to enhance use of force deci- ience promotion training among special forces police sions (e.g., situational awareness). Officers were then trained officers. Journal of Police Emergency Response, 5, 1-8. on these specific targets by directly addressing the mecha- doi:10.1177/2158244015590446 nisms hypothesized to improve performance, namely psycho- Arnetz, B. B., Arble, E., Backman, L., Lynch, A., & Lublin, A. (2013). Assessment of a prevention program for work-related physiological control. Importantly, the iPREP intervention stress among urban police officers. International Archives was integrated directly into realistic use of force training of Occupational and Environmental Health, 86, 79-88. rather than delivered in the classroom setting. Further research doi:10.1007/s00420-012-0748-6. is needed to determine the most efficacious manner of reduc- Arnetz, B. B., Nevedal, D. C., Lumley, M. A., Backman, L., & ing use of force mistakes and enhancing police safety and Lublin, A. (2009). Trauma resilience training for police: well-being in real-world settings. However, taken together, Psychophysiological and performance effects. Journal of the findings from the current study provide preliminary evi- Police and Criminal Psychology, 24, 1-9. doi:10.1007/s11896- dence that the iPREP intervention warrants future investiga- 008-9030-y tion into whether it can improve situational awareness and Arnsten, A. F. T., & Goldman-Rakic, P. S. (1998). Noise stress use of force decisions among larger, more varied samples impairs prefrontal cortical cognitive function in monkeys: (e.g., recruits, patrol officers) and in real-world settings. Evidence for a hyperdop-aminergic mechanism. Archives of General Psychiatry, 55, 362-368. Former assistant U.S. attorney, Kami Chavis Simmons, Artwohl, A., & Christensen, L. (1997). Deadly force encounters. who now directs the criminal-justice program at Wake Forest Boulder, CO: Paladin Press. University School of Law, is quoted in the WSJ stating, “The Backman, L., Arnetz, B. B., Levin, D., & Lublin, A. (1997). 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Nursing, 24, 12. McCraty, R., & Atkinson, M. (2012). Resilience training pro- gram reduces physiological and psychological stress in police Author Biographies officers. Global Advances in Health and Medicine, 1, 44-66. Judith P. Andersen is a health psychologist with expertise in the doi:10.7453/gahmj.2012.1.5.013 physical and mental health outcomes associated with stressful and McCraty, R., Atkinson, M., Tomasino, D., & Bradley, R. T. (2009). traumatic experiences. Prof. Andersen specializes in the psycho- The coherent heart: Heart-brain interactions, psychophysi- physiology of performance during high stress encounters. Her on- ological coherence, and the emergence of system-wide order. going research is focused on incorporating evidence-based physio- Integral Review, 5, 10-115. logical resilience training into police use of force and de-escalation Olson, D. T. (1998). Deadly force decision making. FBI Law instruction. Enforce Bulletin, 67, 1-9. Patterson, G. T., Chung, I. W., & Swan, P. G. (2012). The effects Harri Gustafsberg is a former Chief Inspector of the Finnish of stress management interventions among police officers and National Police. He is a 23 year veteran of Finnish Federal Special recruits. Campbell Systematic Reviews, 7, 1-53. Intervention Police unit. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png SAGE Open SAGE

A Training Method to Improve Police Use of Force Decision Making: A Randomized Controlled Trial

SAGE Open , Volume 6 (2): 1 – Apr 7, 2016

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Abstract

Police safety and use of force decisions during critical incidents are an ongoing source of concern for both police practitioners and the public. Prior research in the area of police performance reveals that psychological and physiological stress responses during critical incidents can shape the outcome of the incident, either positively or negatively. The goal of this study was to test a training method to improve use of force decision making among police. This randomized controlled pilot study consisted of training officers to apply techniques to enhance psychological and physiological control during stressful critical incidents. Of a pool of 80 police officers, potential participants were invited based on equivalent age, years of experience, physiological characteristics (i.e., body mass index [BMI] and cardiovascular reactivity), and expertise. Results revealed that the intervention group displayed significantly better physiological control, situational awareness, and overall performance, and made a greater number of correct use of force decisions than officers in the control group (all ps < .01). The relevant improvements in use of force decision-making found in this pilot study indicate that this training method warrants further investigation. Improved use of force decision making directly translates into potential lifesaving decisions for police and the civilians they are working with. Keywords police special forces, resilience, critical incidents, physiological reactivity, use of force, situational awareness, SWAT There is no other job like a police officer’s, that requires North America include arming police officers and training someone to deliberately go out and actively search for dangerous them to make appropriate use of force decisions (Statistics situations where their life or someone else’s life may be Canada, 2013; U.S. Department of Justice Fiscal Year, 2014). threatened. It remains to be examined why questionable use of force decisions continue to be made despite significant resources Artwohl and Christensen (1997, p. 36) directed toward police training. Foundational research in the area of police performance reveals that psychological and physiological stress responses Police safety and use of force decisions during critical inci- during critical incidents shape the outcome of the incident, dents are an ongoing source of concern for both police prac- either for good or for bad (Arnetz, Arble, Backman, Lynch, titioners and the public. This concern is evidenced by & Lublin, 2013; Arnetz, Nevedal, Lumley, Backman, & extensive media coverage of this issue. A recent news article Lublin, 2009). Maladaptive stress responses during a critical in the Wall Street Journal (WSJ) highlights both the sky rock- incident put the officer and members of the public at risk of eting cost of police-misconduct cases and the growing public injury or death. Furthermore, maladaptive stress responses distrust of the use of force decisions made by police officers. can negatively affect an officer’s health and performance The authors of the WSJ article used data gathered from pub- over time (Covey, Shucard, Violanti, Lee, & Shucard, 2013; lic records and report that among the U.S. cities with the 10 largest police forces, there has been a 48% increase in costs of police-misconduct cases since 2010 (Elinson & Frosch, University of Toronto, Mississauga, Ontario, Canada 2015). The authors further reported, “Those cities collec- Police University College in Finland, Tampere tively, paid out $1.02 billion over those 5 years (2010-2015) Corresponding Author: in such cases, which include alleged beatings, shootings and Judith P. Andersen, University of Toronto Mississauga, Deer Field Hall, wrongful imprisonment” (Elinson & Frosch, 2015). A sig- 4032, Mississauga, Ontario L5L 1C6, Canada. nificant portion of the billions of dollars spent on policing in Email: judith.andersen@utoronto.ca Creative Commons CC-BY: This article is distributed under the terms of the Creative Commons Attribution 3.0 License (http://www.creativecommons.org/licenses/by/3.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). 2 SAGE Open Violanti, 2010). The objective of the current study was to All non-essential bodily functions, such as digestion and design and test a training method to improve police officers’ muscle repair, are stopped (Everly & Lating, 2013). The stress responses and use of force decision making during Hypothalamic–Pituitary–Adrenal (HPA) axis is also acti- critical incidents. The training method was designed to be vated during fight or flight. The HPA axis produces a cascade brief and integrated into existing use of force training pro- of hormones that act to maintain the fight or flight response, grams at police organizations. and importantly, to shut it off when the threat has been resolved. A key regulating hormone in the HPA cascade is cortisol, which is responsible for suppressing immune func- How Stress Affects Critical Incident tion and shutting down the fight or flight response (Johnson, Outcomes 2008). It is important to note that while fight or flight is a When an individual encounters a potential threat, the body purely physiological process, psychological processes, such engages in a series of automatic physiological processes in as threat perception, anxiety, and anticipation stress, can response to the threat. During a physiological stress response, stimulate, maintain, or inhibit the shut off of the fight or the sympathetic nervous system (SNS) is activated, and the flight response. Cortisol is excreted in a dose-response man- parasympathetic nervous system (PNS), responsible for calm- ner to the level of threat the individual perceives (Lovallo, ing and stabilizing the body, is withdrawn. The degree of a 2016). Aspects of the fight or flight response, including per- SNS response is determined by one’s cognitive perception of ceptual distortions, reduced motor dexterity, and impaired how threatening the stimulus is (Kalisch, Müller, & Tüscher, cognitive function, can be detrimental to use of force deci- 2015). Furthermore, the physiological responses during stress sion making during critical incidents (Johnson, 2008). can be enhanced or diminished by psychological factors, such as perceived control over the situation. A moderate amount of Perceptual Distortions SNS arousal is beneficial for performing optimally during critical incidents. The benefits of moderate arousal include During fight or flight, perceptual distortions in sensory infor- alertness, focused attention, and improved cognitive perfor- mation can occur. Sensory distortions include changes in mance (Jameson, Mendes, Blackstock, & Schmader, 2010). vision, sense of time (i.e., slowing down or speeding up), and Moderate arousal facilitates memory formation and memory a narrowing of auditory information (Klinger, 2006; Klinger retrieval (Cahill & Alkire, 2013). During moderate SNS & Brunson, 2009). Vision is compromised in three ways: arousal, sensory perceptions including visual, auditory, and reduced peripheral vision, distance-only eyesight, and forced olfactory senses are enhanced. Improved sensory awareness binocular vision (Olson, 1998). Reduced peripheral vision, increases an individual’s ability to successfully address a also known as “tunnel vision,” is caused by restricted blood threat (Kalisch et al., 2015). flow to the eyes and eye muscle contractions. The eye lens Police work, however, is an inherently a high-risk occupa- tends to flatten, thus reducing depth perception. The eyes tion. Officers routinely face unpredictable, unexpected, and focus on the source of a threat, with heightened attention to uncontrollable events, all of which are factors that increase visual detail, while ignoring near objects (Olson, 1998). the threatening nature of an encounter (Sapolsky, 2004). Officers may focus on one single threat, missing other poten- Furthermore, officers are often required to face these threats tially life-threatening cues around them. under the least ideal conditions, including darkness, unfamil- Even trained officers are at risk of having a fight or flight iar territory, and other distractions such as unexpected noise response and experiencing the associated perceptual distor- or erratic bystanders. When a stimulus is perceived as very tions. For example, Westmoreland and Haddock (1989) con- threatening, such as in the case of potential injury or death, ducted a study that entailed putting officers through 98 an individual experiences a greater degree of SNS arousal. A shooting scenarios involving both non-stressful and stressful severe SNS response is colloquially known as the fight or situations. Findings from this study showed overwhelmingly flight response (Lovallo, 2016). Fight or flight is an instinc- that even trained officers focused on the immediate threat tual survival response comprised of significant neurological, when confronted with life-threatening situations, at the behavioral, and neuroendocrine changes, and is accompa- expense of peripheral awareness. Studies show that during a nied by negative emotions such as anxiety, fear, and anger fight or flight response, an officer’s vision may be compro- (Lipton, 2008; Lovallo, 2016). During a fight or flight mised by up to 70%, resulting in the failure to detect subtle response, rapid release of epinephrine from the adrenal gland movements due to loss of peripheral vision (tunnel vision). stimulates an increase in respiration, heart rate, and blood Olson (1998) reported that it can take up to 440% longer to pressure (BP). A heart rate of 100 or above is an indication react when peripheral vision is decreased by 70%. The pupil that the stress response has been activated (Johnson, 2008). dilation caused by SNS arousal impairs vision for close Oxygen-rich blood is directed to the major muscle groups in objects (4-feet range). SNS arousal disrupts monocular the legs, torso, and arms to support necessary fighting or vision and results in the loss of control of the dominant eye fleeing action (Lundberg, 2011). Epinephrine signals the (used for precision shooting, that is, monocular vision) inhib- liver to release glucose to power the fight or flight response. iting the ability to focus on a gun sight (Klinger & Brunson, Andersen and Gustafsberg 3 2009; Siddle & Breedlove, 1995). Visual distortions have is that when a person is inhaling rapidly, they are increasing implications for using weapons accurately when targets are SNS arousal without allowing for the calming effect of the at close range (Johnson, 2008). The perceptual distortions parasympathetic system, which can act as a “brake” to regu- that occur during fight or flight affect an officer’s ability to late SNS arousal. see and hear potential threats within their immediate envi- In summary, there are both psychological and physiologi- ronment. These perceptual distortions combined with a cal aspects of the stress response. Psychological aspects slowed reaction time may directly affect the safety of the include the degree to which a person evaluates a situation or officer and the public. stimulus as a threat. Based on the degree of the threat per- ceived, the body automatically activates SNS arousal, a physiological response, to meet the level of the perceived Motor Deficits threat. Understanding the psychological and physiological During fight or flight, heart-rate and respiration increase, and mechanisms that underlie stress responses can inform the an individual is more likely to hyperventilate or hold one’s creation of an intervention to improve police performance breath, impairing the brain areas affecting fine motor skills during critical incidents. For example, although the fight or (Johnson, 2008). The rapid increase in BP and blood flow to flight response is an automatic instinctual reaction to a per- the large muscle groups enhances strength and gross motor ceived threat, police officers know that they will routinely be skills such as punching, kicking, and running, the very exposed to threatening situations. Therefore, controlling actions needed to fight or flee (Everly & Lating, 2013). one’s respiration before, during, and after a critical incident However, in regard to fine motor skills, the vasoconstriction is a way to avoid excessive SNS arousal and the associated of minor blood vessels in the extremities results in the loss of cognitive, sensory, and motor deficits. Controlled respiration dexterity, cold hands, and muscle tremors (Johnson, 2008). can be learned and practiced as one of a number of psycho- The loss of fine motor skills may compromise an officer’s physiological techniques to improve use of force decision hand/eye coordination and precision movements necessary making during critical incidents (Johnson, 2008). to operate weapons optimally. Improving Police Performance and Cognitive Deficits Safety A fight or flight response is an instinctual response and hap- Prior research in the area of police stress has not focused pens automatically, without a person deciding whether or not specifically on improving use of force decision making. to have one. Vascular processes directed by adrenal hormones However, several foundational studies address the psycho- (e.g., epinephrine and cortisol) stimulate automatic reactions logical and physiological components of the stress response, in the area of the brain called the hindbrain. Automatic which are, in turn, related to use of force decisions. McCraty instinctual processes are significantly faster than information and colleagues (McCraty, Atkinson, Tomasino, & Bradley, processed in the pre-frontal cortex, an area of the brain 2009; McCraty & Atkinson, 2012) designed and tested a required for memory, decision making, and logical thought stress reduction program for police and correction officers. (Arnsten & Goldman-Rakic, 1998; Goldstein, Rasmusson, The program is based on premise that improving self-regula- Bunney, & Roth, 1996; Takamatsu et al., 2003). During a tion skills (i.e., emotion regulation and energy levels) and fight or flight response, adrenal stress hormones constrict reducing physiological reactivity to stress (i.e., cardiovascu- blood vessels, reducing oxygen levels in the pre-frontal cor- lar and respiratory activation) would improve officer health tex, further decreasing an individual’s ability to access and performance outcomes (McCraty & Atkinson, 2012; stored memories and learned information (Lipton, 2008; McCraty et al., 2009). The authors conducted a 16-week Westmoreland & Haddock, 1989). The ramifications of expe- study in which they taught officers to practice self-regulation riencing a severe fight or flight response include difficulty skills and controlled respiration (5-second inhale and a remembering stored information and implementing learned 5-second exhale). McCraty and Atkinson (2012) reported behaviors, all of which may translate into an officer making that officers in the training group self-reported improve- less than ideal tactical maneuvers and use of force decisions ments in their communication skills at work, and with fam- during critical incidents. ily, increased positive emotion, vitality, reduced negative Excessive respiration during a fight or flight response emotion and depressive symptoms, and improved self-regu- may also lead to cognitive deficits. Rapid breathing and lation in response to stress. The authors did not find any sig- hyperventilation lead to dizziness, and even a mental state nificant differences between the trained and non-trained called “depersonalization” in which the individual feels that officers on use of force and decision-making skills during they are disconnected from their body (Brown & Gerbarg, critical incident scenarios (McCraty & Atkinson, 2012). 2009). When a person inhales, his or her SNS is dominant. Backman, Arnetz, Levin, and Lublin (1997), and Arnetz and When a person exhales, the parasympathetic nervous system colleagues (2009; Arnetz et al., 2013) developed a program is dominant (Cacioppo & Tassinary, 1998). What this means to improve police resilience and tested this program via a 4 SAGE Open randomized controlled trial. Their 10-session program (90 motor, and cognitive deficits associated with fight or flight min per session) was based on the premise that giving offi- (Cahill & Alkire, 2013; Johnson, 2008; Lovallo, 2016). cers the opportunity to practice stress reduction techniques Furthermore, the iPREP methodology utilizes techniques (i.e., relaxation) while listening, via audiotape, to repeated frequently implemented by elite athletes used to reduce critical incident scenarios and visualizing optimal perfor- threat and enhance knowledge acquisition and skill retention. mance would enhance the perception of predictability and Techniques include visualization, mental rehearsal, focused control when facing such events in the real world. The attention, and controlled respiration. Ryan and Simons authors reported clinically significant improvements in offi- (1982) found that, although mental rehearsal and visualiza- cer performance and reduced psychological distress when tion alone did not substitute for actual physical practice to tested on a critical incident scenario 1 year following their enhance motor skills among police, these techniques help training. Andersen and colleagues (2015) conducted the solidify the learning process in regard to situational aware- Arnetz et al. (2009) program with special forces police offi- ness and sensory perception during police critical incidents. cers. The authors reported that officers displayed reduced These techniques have been successfully applied among SNS arousal while listening to the critical incident scenarios police officers and associated with better performance over 1 week of training. However, officers requested more (Arnetz et al., 2009). Unique to iPREP is the addition of a intensive, scenario-based resilience training, better tailored mental coaching technique to enhance sensory perception. to the high-stress use of force decision making in their real- Heightened sensory perceptions, including visual, auditory, world encounters (Andersen et al., 2015). tactile, and olfactory senses, are critical components of Based on prior research, the current training method was police situational awareness. Biofeedback is used to train the developed specifically to improve police use of force deci- officer how to rapidly attain the optimal state of sensory sion making during critical incidents. This training method is awareness and physiological control. Situational awareness called the “international performance resilience and effi- is defined as the ability to perceive and process all potential ciency program” (iPREP). The iPREP method is based on threats in the environment. This is accomplished by using the empirical research detailing the psychological and physio- full array of sensory input (i.e., visual, auditory, olfactory, logical factors that are theorized to most strongly influence tactile) to recognize and prioritize the order in which threats use of force outcomes. Specifically, the psychological per- should be addressed. Situational awareness is just as impor- ception and anticipation of threat, and the associated physi- tant as knowledge of weapons and tactical maneuvers. It ological SNS arousal that, if left unchecked, would result in forms the basic foundational skills necessary for a police sensory, motor, and cognitive deficits during critical inci- officer to keep the public and themselves safe and make the dents (Johnson, 2008; Kalisch et al., 2015). Of equal impor- most appropriate use of force decisions. tance is the way in which the iPREP training method is administered. Driskell and Johnston (1998) conducted semi- The Current Study nal research comparing methods of training police and mili- tary personnel to perform during life-threatening situations. A randomized controlled trial was conducted to test the iPREP The authors outline the necessary components for training methodology. A baseline skills test (i.e., pre-test) was admin- delivery that maximize skill acquisition, retention, and appli- istered, after which officers were randomized into interven- cation (Driskell & Johnston, 1998). The authors report that tion and control conditions. Following the training week, a optimal training must include dynamic processes beginning final test (post-test) was held to determine if the intervention with exposure to the knowledge to be learned in a non-stress group displayed enhanced performance in comparison with environment; training the necessary skills in an increasingly the control group. We hypothesized the following: stressful and realistic environment; and providing opportuni- ties for increasing one’s confidence in his or her ability to Hypothesis 1: Officers in the intervention group would perform during stress (Driskell & Johnston, 1998). display significantly better situational awareness and Dynamic police training is not a new concept (Olson, overall performance than officers in the control group, as 1998). However, to our knowledge, no one to date has com- rated by senior use of force police trainers (SRT_Trainers) bined dynamic police training with empirically based meth- who were blinded to study conditions. ods to reduce psychological threat perception and improve Hypothesis 2: At post-test, officers in the intervention physiological control, as we have done with the iPREP group would make correct use of force decisions more method. Advances in neurobiology and learning theory sup- often (shoot/no shoot) than officers in the control group. port the iPREP methodology (Cahill & Alkire, 2013; Driskell Hypothesis 3: Officers in the intervention group would & Johnston, 1998). Namely that reducing threat perceptions display lower SNS arousal during critical incident sce- while systematically increasing situational and cognitive narios at post-test as compared with officers in the control challenges will enable an individual to capitalize on the ben- group. SNS arousal was operationalized as maximum efits of epinephrine, for memory formation and retrieval dur- heart rate during the incident (HR_Max), heart-rate recov- ing moderate SNS arousal, without experiencing the sensory, ery (HR_Recovery), which was the time (in seconds) to Andersen and Gustafsberg 5 return to resting heart rate following the incident, and BP pre-test assessing officer skills and abilities was conducted. (systolic and diastolic). Following the pre-test, officers were randomized into the Hypothesis 4: At post-test, officers in the intervention intervention and control groups. The intervention group group would self-report lower stress and greater confi- accompanied the researchers to the Police University College dence in their skills to manage critical incidents, com- of Finland campus for 3 days of iPREP training. The control pared with officers in the control group. group engaged in training-as-usual activities (e.g., shooting targets, active physical training, undercover pursuit of crimi- nals, etc.) at their base in Helsinki, Finland. Five days fol- Method lowing the pre-test and training, a post-test assessing officer Of a pool of approximately 80 officers serving on the Finnish performance during stressful scenarios was conducted on the Federal Special Response Police Teams (SRTs), select offi- 6th day. During all assessment and training scenarios, offi- cers (n = 16) were invited to participate in the study. The cers wore full police gear. All scenarios were conducted in selected group (n = 16) was chosen because they had compa- realistic field settings (e.g., abandoned school, apartments, rable years of service on the special unit (~2 years). The abandoned warehouse, etc.), using real weapons with simu- majority of officers invited agreed to participate (n = 12). nition (i.e., chalk bullets that leave a colored mark, which can be used to assess shooting accuracy). In addition, trained actors, low light exposures, and loud noises were used for the Sample Size Considerations purpose of enhancing the stress level and realism of the sce- Despite the randomized controlled design of this study, narios. See below for further explanation: empirical studies with few participants are at risk of “small sample failure of random assignment” (Strube, 1991). This Pre-test. At the beginning of the pre-test, officers were fitted occurs when, by chance, individuals with qualities that are with chest bands which recorded their SNS arousal (i.e., confounded with outcome variables happen to be random- heart rate, respiration, movement). Critical incident scenar- ized to one group, thus inflating or deflating intervention ios for assessing tactical skills and decision making were effects incorrectly. While in the case of larger sample sizes, designed by senior training officers of the Finnish National randomization is the process that solves the problem of indi- Police. Training officers were independent of the research vidual differences accounting for treatment effects. As rec- study and were not involved in study design or implementa- ommended by clinical researchers and statisticians tion to avoid bias. Trained actors (experienced police offi- specializing in intervention research with random assign- cers) conducted the scenarios so as to enhance the reality of ment, this study applied the recommended steps to reduce the incidents. Officers waited together but were called inde- the likelihood that “small sample failure of random assign- pendently to engage in each pre-test scenario as follows: (a) ment” accounts for study findings (Hsu, 1989; Strube, 1991). Car robbery in progress: Officer is called to the scene of a First, participants were matched on gender, years of service robbery. A man holding a knife was searching an empty car. as a police officer on the SRT, prior training exposure (i.e., As the officer approaches, the man runs behind the car, drops all received training from the same organization), and close the knife, and then runs toward the officer, ignoring any in age. Importantly, all participants were tested on skills and commands to stop. (b) Potential hostage situation: Officer is abilities immediately prior to the randomization. A pre-test called to the scene of an abandoned building with a potential ensures that potential individual-difference confounds (i.e., hostage situation in progress. Officer enters an empty room, police tactical skills and decision-making abilities) were hears movement in a second room. In the second room, a equal across both groups. In addition to controlling for tacti- criminal holds a gun to the head of another individual. (c) cal skills and abilities, physical variables potentially related Domestic dispute: Officer is given information that loud to SNS arousal were assessed. Specifically, body mass index noises are coming from an apartment, potentially a domestic (BMI) and baseline cardiovascular function were assessed dispute in progress. When the officer approaches the resi- and determined to be equal at baseline. dence, screaming can be heard coming from the back of the This study was approved by the University of Toronto apartment. Upon entry of the apartment, the officer encoun- Research Ethics Board as well as the Research Ethics ters two men, one angry and yelling, the other standing sta- Committee of the Police University College of Finland. All tionary in the corner. Upon entering the room where the participants signed the ethics-approved consent form before screaming is coming from, the officer encounters a man and participating. woman struggling; the man is holding a knife. (d) School shooting in progress: Officer enters an empty hallway lead- ing to a classroom where the hostage situation is happening. Procedure A hysterical person runs out of the classroom and passes the Two weeks before the study began, officers were mailed officer. Upon entering the classroom, the officer encounters a consent form and demographic surveys to their home in a a gunman facing them and a gunman holding two individuals confidential envelope. Prior to initiating the intervention, a hostage in classroom seats on the other side of the room. 6 SAGE Open Randomization. At the end of the pre-test day, the trainer’s Post-test. Participants were fitted with the chest bands at the scores revealed that there were no differences in tactical abil- beginning of the post-test day. To avoid bias, federal SRT ities among officers. Officers were then randomized via a senior trainers, who were blinded to study conditions, pre- coin flip into the intervention and control groups. Following pared the post-test scenarios without consulting with the a 24-hr break, officers in the intervention group began the researchers. Scenarios were designed to test the officer’s iPREP training at the Police University College of Finland, situational awareness, decision making, and action skills while the control group returned to their base in Helsinki, (i.e., shoot/no shoot), as well as overall performance. Analo- Finland to engage in training-as-usual activities. gous to the pre-test, trained police actors carried out the two post-test scenarios to enhance the reality of the scenarios. Training Intervention (iPREP). Core components of the training Participants completed a brief survey before and after each included (a) education about the physiology of the stress critical incident, assessing their confidence in their skill to response system, energy management, and fueling for peak manage the critical incident and the stressfulness of the inci- performance; (b) group instruction on how to use mental focus dent. To reduce the chance that officers would warn others and visualization to enhance sensory perception and situa- about the upcoming scenarios, officers waited alone in iso- tional awareness in performance and non-performance set- lated rooms and were called out at random to complete the tings; (c) instruction and use of biofeedback to practice post-test scenarios independently as follows: (a) Officers engaging in controlled breathing exercises that have been were informed that a potentially armed suspect was seen shown to enhance SNS control during stress (McCraty et al., entering a known drug house where a loud noise was 2012). Controlled breathing is not a relaxation exercise; rather, reported. Upon entering the abandoned building that had it balances the activity of the sympathetic and parasympathetic been transitioned into a drug house, officers witnessed an nervous system during stress, facilitating states of moderate armed man kill another man and run into a room down a arousal and blocking panic reactions and hyperventilation hallway. In the room where the suspect ran, five men were in responses that lead to maladaptive sensory responses such as various positions around the room (two men were standing in tunnel vision and auditory exclusion (Johnson, 2008); (d) corners with their hands in their pockets, one man was sitting dynamic police training during realistic critical incident sce- on a seat holding a gun pointed at the floor, and the armed narios. Following the principles of dynamic training, instruc- suspect was holding another man hostage at knifepoint). (b) tion begins with three to four consecutive, brief, slow-motion Officers were informed that a disturbance was reported from critical incident scenarios. An important component of this a known gang club in an old warehouse. Prior to entering the stage of training is helping the officer to recognize their SNS building, officers were required to perform 20 squats in full arousal in order to enhance situational awareness and decision gear to stimulate physiological arousal that would normally making. Once an officer was aware of their physiological be elevated due to the effort to arrive at the call out. The arousal state, they were instructed to apply the psychological warehouse scenario consisted of four separate incidents in and physiological control techniques during subsequent sce- which the officer had to make shoot/no shoot decisions. The narios. A central benefit of dynamic training is that the use of first was two men fist fighting at the end of a darkened hall- force trainer has objective evidence to determine if the officer way, the second entailed the officer opening a door to has indeed learned the skills based on their performance in the encounter a man holding a tool (wrench) facing the officer, scenarios and does not need to rely on the officer’s self-reports. the third was a hostage situation with one man holding a gun Officers are often required to make split-second UOF deci- to another man’s head in a darkened locker room, and finally, sions. During fight or flight, an individual reverts to the auto- immediately following the hostage situation, a man matic actions they have been trained to perform. The approached the officer from the side with a radio in his hand, slow- motion scenarios are purposly low-stress exercises in asking “What happened here?” order to provide the officer with the opportunity to aquire opti- mal motor movements that will be automatically performed Measures during high stress encounters. Training continues in blocks of moderate and then high speed action, with increasing levels of Relevant demographic information was assessed prior to the stress during the scenarios. Use of force instructors provide onset of the study (i.e., age, height, weight, marital status, positive feedback to the officers whenever possible to enhance years as a police officer, and years as a special forces police their confidence and mastery of skills. Importantly, in between officer). each use of force learning block, officers review their perfor- mance through visualizing both what happened and mentally Heart rate. The chest-band monitors (i.e., Zephyr Bioharness) rehearsing the optimal performance, as instructed by the use of were non-invasive devices fitted next to the skin of the partici- force trainer according to the “best practices” of the organiza- pant under their uniform. Monitors recorded the participant’s tion. By the end of the use of force instructional period, offi- physiological reactivity (moment by moment) in real time. In cers were able to transition to an optimal mental and this study, two components of cardiovascular physiology were physiological state within seconds. recorded: (a) Heart Rate Max (HR_Max), the highest heart Andersen and Gustafsberg 7 rate attained during the critical incident scenario and (b) Heart- Rate Recovery Time (HR_Recovery) which indicates the time, in seconds, for the officer’s heart rate to return to their average baseline resting HR measured over the course of 5 min at the beginning of the post-test day while sitting. Blood Pressure. Omnisense ambulatory BP wrist cuffs were used to measure the participant’s systolic and diastolic BP before and after exposure to the critical incident scenarios. Performance ratings. The senior SRT trainers, blinded to study conditions, rated the officers on situational awareness, deci- sion making (shoot/no shoot), and overall performance. In the Figure 1. Pre- and post-training: Daily overall performance. drug house scenario, there were six different potential threats Note. The pre-training day included four scenarios. Each scenario was in the environment. Officers were rated on how many threats rated on a 10-point scale, which resulted in a maximum possible score of they recognized and managed. Overall performance in the 40 (four pre-training scenarios × 10 maximum points). During the post- training day, there were two scenarios; each scenario rated from 1 to 10, drug house was rated on a 10-point scale, including the appro- resulting in a maximum possible score of 20 (two post-training scenarios priateness of decision making and actions relevant to the × 10 maximum points). threats at hand. In the warehouse scenario, there were five **p < .01. potential threats in the environment and four shoot/no shoot decisions to be made. Identical to the drug house scenario, officers were rated on how many threats they were aware of diastolic), situational awareness, trainer’s rating, partici- and managed and their decision-making skills and actions. pants’ subjective self-report, shoot/no shoot decision mak- ing. Independent samples t tests were used to compare mean Self-reported stress, skills, and ability to manage the scenarios. Self- differences between the intervention and control groups on reported surveys were administered directly before and after continuous variables with a normal distribution. If the each scenario. All questions were rated on a 10-point Likert- assumption of normality was not met, Mann–Whitney U type scale (1 = lowest and 10 = highest score). The pre-incident tests were used to compare mean differences between the survey included ratings of anticipation stress (“How stressful do intervention and control groups (Whitney, 1997). Fisher’s you anticipate the upcoming scenario to be?”), self-confidence Exact chi-square tests were used to examine categorical vari- in decision making (“How confident do you feel that you will be ables (participant perceived accuracy of shoot/no shoot able to make the appropriate decisions during the scenario?”), actions). Cohen’s d (using absolute values) was calculated to self-confidence in situational awareness (“How confident are examine if results comprised of meaningful differences. you that you will be able to maintain situational awareness dur- According to Cohen (1992), a small effect is .2, a medium ing the scenario?”), self-confidence in carrying out correct effect is .5, and a large effect is .8 or above. All analyses were actions (“How confident are you that you will be able to carry conducted using PASW Statistics version 20. out the correct actions during the scenario?”). Similarly, the post-incident self-report survey queried the stress level of the Results scenario (“How stressful was this scenario?”), decision making (“Were you able to make the appropriate decisions during the Sample and Descriptive Statistics scenario?”), situational awareness (“Were you able to maintain situational awareness during the scenario?”), self-confidence in All participants (n = 12) were White male police officers having carried out the correct actions (“Were you able to carry (M = 31.50; Range_age = 7). All officers had completed a _age out the correct actions during the scenario?”), overall perfor- similar number of years of police service prior to entering the mance (“Rate your overall performance during the scenario”), SRT (M_police service = 4.68). All participants were within ability to de-stress (“Ability to return to a non-stressed state in their second year of SRT service (M_SRT = 2.08; Range_ your body after the scenario finished?”), time to de-stress (“How SRT = 2.75; SD_SRT = 0.76). An independent samples t test long did it take you to return to a non-stressed state in your body did not reveal any difference in BMI between the interven- after the scenario finished?”). tion (M = 25.21, SD = 0.669) and control groups (M = 24.98, SD = 1.078), t(10) = 0.451, p = .662. Independent samples t tests did not reveal any significant differences in pre-test Analytic Methods baseline skills, including the SRT trainer’s ratings of situa- The Shapiro–Wilk test was used to assess normality of the tional awareness, decision making (shoot/no shoot), and following continuous variables: Heart Rate Max (HR_Max), overall performance (Figure 1), or participant’s self-reported Heart-Rate Recovery Time (HR_Recovery), BP (systolic and stress levels, confidence and perceived skills (ps > .05). 8 SAGE Open Table 1. Manipulation Check: Stress Responses to the Critical Incident Simulations (N = 12, Unless Otherwise Noted). Scenario 1: Scenario 2: Drug house Warehouse Effect size Effect size Measure M (SD) (d) t p M (SD) (d) t p Heart rate (BPM) Baseline 79.41 (10.07) During (HR_Max) 153.60 (15.38) −6.41 −20.26 <.001 169.50 (8.42) −12.91 −40.81 <.001 Self-reported stress PreQ1 6.25 (1.71) 6.50 (1.83) PostQ1 5.83 (1.80) 0.30 1.05 .32 6.42 (1.88) 0.08 0.266 .80 Note. BPM = beats per minute. Due to an equipment malfunction, HR_Max during the scenario was not measured for 10 participants instead of 12. Similarly, no significant differences in physiology, includ- ing, HR_Max, HR_Recovery, and BP (both systolic and dia- stolic), were noted (ps > .05). As a manipulation check to test if the post-test scenarios were realistically stressful, changes in HR and self-reported stress levels were exam- ined (Table 1). Paired samples t tests revealed a significant increase in heart-rate response from resting to scenario per- formance (ps < .05). Although self-reported stress levels did not change significantly from pre- to post-scenario, all sce- narios were rated above the median on a 10-point scale, indi- cating moderate to high stress. Hypothesis 1: At post-test, officers in the intervention group displayed significantly better situational awareness and overall performance compared with officers in the Figure 2. Post-training scenarios: Scenario-based situational control group. awareness. Note. In the “drug house” scenario, the participants were supposed to recognize six different “potential threats” in the environment. In the Mann–Whitney U tests were performed to examine differ- “warehouse” scenario, the participants were supposed to recognize five ences in situational awareness and overall performance different “potential threats” in the environment. between groups. Results revealed significant differences in **p < .01. ***p < .001. SRT_Trainer’s ratings of the intervention and control groups at post-test. Specifically, officers in the intervention group were significantly more situationally aware than officers in p = .001; Cohen’s d = 2.79. Similarly, in Scenario 2 (ware- the control group (Figure 2). For Scenario 1 (drug house), house) officers in the intervention group were rated as per- officers in the intervention group noticed more of the six forming significantly better (M = 8.17, SD = 1.4720) than threats in the environment (M = 5.67, SD = 0.5164) than the officers in the control group (M = 3.17, SD = 1.7224), t(10) = control group (M = 2.5, SD = 1.0488; U = .000, p < .01), 5.406, p < .000; Cohen’s d = 3.12 (Figure 3). Cohen’s d = 3.83. Similarly, a Mann–Whitney U test revealed significant differences between groups for Scenario 2 (ware- Hypothesis 2: At post-test, officers in the intervention house). Specifically, officers in the intervention group group would make correct use of force decisions more noticed more of the five threats in the environment (M = 4.5, often (shoot/no shoot) than officers in the control group. SD = 0.8367) than the control group (M = 2.17, SD = 1.1691; U = 2.000, p < .000), Cohen’s d = 2.29. An independent samples t test revealed that, out of four use Independent samples t tests conducted to assess overall of force decisions embedded within Scenario 2 (ware- performance revealed significant differences between groups. house), officers in the intervention group made signifi- Specifically, for Scenario 1 (drug house), officers in the inter- cantly more correct shoot/no shoot decisions (M = 3.83, vention group were rated as performing significantly better SD = 0.4083) compared with officers in the control group on a scale of 1 to 10 (M = 7.5, SD = 1.0488) than officers in (M = 2.33, SD = 0.8165), t(10) = 4.025, p < .01; Cohen’s d = the control group (M = 3.67, SD = 1.6330), t(10) = 4.838, 2.32 (Figure 4). Andersen and Gustafsberg 9 Figure 4. Warehouse shoot/no shoot decisions. Figure 3. Post-training scenarios: Scenario-based overall Note. In the “warehouse” scenario, there were four shoot/no shoot performance. decisions (maximum score: 4 points − minimum score: 0 points). These Note. In both post-test scenarios (“drug house” and “warehouse”), the included the following: participants were rated on a 10-point scale (1-10), where Score 1 was 1. A slow moving fight between two drunk men is in progress (no rated as a “very low” performance and 10 was rated as an “outstanding” weapons)—Correct decision: No shoot (Score: 1 point). performance. 2. Upon opening a closed door, a man walks toward the officer holding a ***p ≤ .001. wrench tool—Correct decision: No shoot (Score: 1 point). 3. An offender holds another man with gun to head—Correct decision: Shoot (Score: 1 point). Hypothesis 3: Officers in the intervention group would 4. A man holds a radio in his hand and he approaches the office asking, display lower physiological arousal during critical inci- “What is happening here?”—Correct decision: No shoot (Score: 1 point). dent scenarios at post-test as compared with officers in the **p < .01. control group (HR_Max, HR_Recovery, and BP). 8.83 on a 10-point scale (ps > .05). However, Mann–Whitney At post-test, an independent samples t test revealed that there U tests revealed significant differences between the interven- were significant differences in HR_Max and change in HR from tion and control group’s pre-scenario ratings of their confi- baseline on Scenario 1 (drug house) between the intervention dence to carry out the correct actions during the upcoming group and the control group (ps < .05; Table 2). Although the scenario. Specifically, in Scenario 1 (drug house) the control intervention group displayed lower HR_Max for Scenario 2 group reported higher levels of confidence than the interven- (warehouse), the differences between the intervention group tion group (p < .05). Similarly, in Scenario 2 (warehouse) the and control group did not reach statistical significance (Table 2). control group reported higher levels of confidence than the An independent samples t test revealed that, although the intervention group (p < .05; Table 3). Independent samples t intervention group did recover in a shorter time than the con- tests did not reveal any significant differences between the trol group, the differences in HR_Recovery for both Scenario intervention and control group on the following self-reported 1 (drug house) and Scenario 2 (warehouse) were not statisti- questions rated after each of the scenarios at post-test: How cally significant (Table 2). stressful was the scenario, ability to maintain situational Independent t tests revealed that systolic and diastolic BP awareness, overall performance, and ability to return to a values, both before and after each critical incident scenario non-stressed physical state, and time, in minutes, to return to during the post-test, were not significantly different between a non-stressed physical state. All ratings were above average groups (ps > .05; Table 2). with means ranging from 5.50 to 8.20 on a 10-point scale (ps > .05). Fisher’s Exact chi-square tests revealed no differ- Hypothesis 4: At post-test, officers in the intervention ences between groups in perceived ability to carry out the group would self-report lower stress and greater confi- correct shoot/no shoot actions during both Scenario 1 (drug dence in their skills to manage critical incidents, com- house) and Scenario 2 (warehouse; Table 3). pared with officers in the control group. At post-test, independent samples t tests and Mann– Discussion Whitney U tests revealed no significant differences between In this experiment, we tested if a novel resilience program, groups on self-reported ratings before the scenarios on the integrated directly into use of force training, would improve following variables: How stressful the scenario was antici- police performance and safety during highly realistic critical pated to be, the ability to make appropriate decisions in the incident scenarios. In support of our hypotheses, officers in upcoming scenario, and situational awareness (Table 3). All the intervention group displayed significantly enhanced ratings were above average, with means ranging from 5.33 to 10 SAGE Open Table 2. Comparing Physiological Arousal Between Groups at Post-Test. Scenario 1 Scenario 2 intervention Control intervention Control Effect size Effect size Measure M (SD) M (SD) (d) Test statistic p M (SD) M (SD) (d) Test statistic p Blood pressure (n = 6) (n = 6) (n = 6) (n = 6) Baseline systolic 131.33 (16.48) 132.33 (11.04) T = −0.12 .90 Baseline diastolic 89.50 (15.14) 87.50 (4.04) T = 0.31 .77 Pre-scenario systolic 133.50 (12.15) 133.33 (12.79) T = 0.02 .98 137.83 (11.96) 139.00 (6.45) T = −0.21 .84 Pre-scenario diastolic 84.00 (11.78) 84.33 (7.53) T = −0.058 .96 88.33 (12.08) 91.17 (4.79) T = −0.53 .61 Post-scenario systolic 140.50 (14.38) 142.83 (8.84) T = −0.34 .74 Post-scenario diastolic 96.17 (13.33) 90.50 (10.31) T = 0.82 .43 Change systolic 3.40 (5.68) 10.50 (8.69) U = 7.00 .14 Change diastolic 6.67 (9.29) 3.00 (10.49) T = 0.64 .54 Heart rate (BPM) (n = 5) (n = 5) (n = 5) (n = 5) Baseline 79.99 (7.86) 78.82 (12.87) T = 0.173 .87 HR_Max 145.00 (14.07) 162.20 (12.22) T = −2.06 .07 164.50 (5.80) 170.80 (7.86) T = −1.33 .22 Change 65.01 (8.25) 83.38 (4.79) −2.72 T = −4.30 .003 (<.01) 88.21 (7.52) 91.98 (6.65) T = −0.84 .43 HR_Recovery (s) 471.40 (115.05) 565.60 (152.70) T = −1.10 .30 630.20 (239.92) 967.60 (648.92) T = −1.09 .33 situational awareness, overall performance, and made a control group. Based on observational data gathered at spe- greater number of correct use of force decisions (shoot/no cialized law enforcement trainings, Siddle (1995) provided shoot) than officers in the control group. Specifically, offi- general heart-rate ranges, in beats per minute (BPM), that cers in the intervention group saw more of the potential indicate moderate, potentially maladaptive, and extreme threats in the environment, allowing them to more accurately arousal states, and their associated implications for situa- decide what was actually happening in the situation and per- tional awareness. On average, a range between 115 and form actions in line with police “best practice” policies for 145/150 BPM indicates an optimal state of arousal and sen- use of force. Improved performance directly translates into sory awareness, after which there is a potential decline in potential lifesaving decisions for police and the civilians abilities and skills. When the heart rate reaches 170 and they are working with. above BPM, perceptual distortions, freezing, and possible As Olson (1998) reviewed, inappropriate use of force irrational behavior can occur. An officer with a heart rate of decisions during critical incidents are frequently associated 200 or more is at risk of freezing or complete lack of aware- with poor situational awareness arising from extreme physi- ness. Officers in our intervention group were more likely to ological arousal; an officer may even look in the direction of remain in or near the optimal heart-rate range in both sce- the threat but not actually see or encode what is going on or narios compared with the control group. It is also important “may repeatedly pull the trigger of an empty weapon, mis- to note that officers in the intervention group recovered identify innocuous items as weapons, or not see or hear inno- approximately 2 minutes faster following Scenario 1 and cent bystanders in the line of fire” (Olson, 1998). It follows over 6 minutes faster following Scenario 2 than officers in then that the core component of improving use of force deci- the control group. Although this finding did not reach statis- sion making is to improve an officer’s ability to maintain an tical significance, it is relevant given that officers may rou- optimal state of sensory awareness (e.g., visual, auditory, tinely encounter instances in which they need to face multiple tactile, olfactory) associated with moderate arousal during threats in a short period of time, in which rapid recovery is critical incidents (Kalisch et al., 2015). Controlling ones’ advantageous for both safety and subsequent performance. heart rate within a moderate range is of key importance in Although we did not find significant differences in BP, this maintaining physiological control, cognitive acuity, and the may be associated with the data collection method. Although ability to perform under pressure (McCraty & Atkinson, BP was measured before and after each scenario, there was a 2012; McCraty et al., 2009). To examine if that goal was several minute delay in placing the wrist cuff BP monitor on achieved by our intervention, the first step was to make sure the officer to attain the reading, during which time BP likely that the testing scenarios induced significant physiological returned to normal. stress arousal. As demonstrated by the manipulation check Ratings of officers’ self-perceptions of stress, situational (Table 1), large effects indicate that officers did experience awareness, and the ability to make the best decisions and per- the scenarios as highly realistic and stressful, as shown by form the correct actions during the scenarios were gathered both self-reports and a significant increase in heart rate from from participants both before and after each scenario. There baseline to scenario performance. In line with our hypothe- were no significant differences between groups on any of the ses, the data showed that the intervention group displayed pre- or post-ratings, except on their rating of confidence in lower heart rate max during the scenarios and a quicker time taking the correct action (shoot/no shoot) during the situa- to recovery following the scenarios than individuals in the tion. The control group perceived greater confidence before Andersen and Gustafsberg 11 Table 3. Comparing Self-Reported Stress and Performance Between Groups at Post-Test. Scenario 2: Scenario 1: Intervention Intervention Control Control (n = 6) (n = 6) (n = 6) (n = 6) Effect Test Effect Test Measure M (SD) M (SD) size (d) statistic p M (SD) M (SD) size (d) statistic p Pre-scenario Stress 5.33 (1.86) 7.17 (0.98) T = −2.13 .06 5.83 (2.23) 7.17 (1.17) U = 10.50 .20 Decision making 7.33 (1.63) 7.50 (1.76) U = 15.50 .60 7.33 (1.63) 7.83 (0.75) U = 17.50 .92 Situational awareness 7.33 (1.63) 7.00 (0.89) U = 32.00 .21 7.00 (2.00) 6.83 (0.75) U = 10.50 .20 Correct action 7.17 (2.04) 8.83 (0.75) −1.08 U = 5.00 .02* 7.17 (2.04) 8.50 (0.55) −0.89 U = 7.50 .04* Post-scenario Stress 5.50 (2.17) 6.17 (1.47) T = −0.62 .55 5.50 (2.07) 7.33 (1.21) T = −1.87 .091 Decision making 7.33 (1.75) 6.67 (2.42) U = 37.50 .81 7.67 (1.51) 6.00 (2.90) T = 1.25 .24 Situational awareness 7.33 (1.21) 5.67 (2.16) T = 1.65 .13 7.67 (1.51) 5.67 (2.42) T = 1.72 .12 Correct action 1 no, 5 yes 0 no, 6 yes X = 1.091 1.000 6 yes 6 yes — Overall performance 7.17 (1.60) 5.67 (1.75) T = 1.55 .15 7.83 (1.60) 6.67 (2.07) T = 1.09 .30 Ability to de-stress 8.17 (0.41) 8.50 (0.55) U = 12.00 .24 8.20 (0.84) 7.40 (2.07) U = 10.50 .66 Time to de-stress 4.33 (3.20) 2.50 (1.38) T = 2.41 .23 5.75 (6.50) 5.00 (3.46) T = 0.20 .85 Note. Only 10 people completed response to S2PostQ6 (ability to de-stress); five people from each group. Only eight people completed response to S2PostQ7 (ability to de-stress); four people from each group. *p < .05. the scenario in their ability to take correct actions in the self-report measures, the key study variables were measured upcoming event, and all participants in the control group without the risk of biases that are inherent to self-reported were confident that they had completed the correct actions information, such as social desirability (Podsakoff & Organ, after the scenario had ended. This finding is of particular 1986). Fourth, key outcome variables were measured during interest given that the self-reports of control group officers multiple scenarios, using realistic, ecologically valid critical were in stark contrast with the objective ratings of perfor- incident simulations. The latter method further enhances the mance and actions given by expert raters blind to study con- reliability and generalizability of the data. dition. This finding highlights an important issue—officers may be inaccurately confident in their tactical skills to cor- Implications and Applications rectly manage a life or death situation, and rightly so; all par- ticipants in this study were shown to have high levels of Enhancing resilience among officers is an increasingly popu- equivalent tactical skills at baseline in low stress scenarios. lar idea among scholars and police organizations looking to However, when faced with a highly threatening realistic sce- support the well-being of their officers. To this end, large-scale nario, an individual may not account for the perceptual dete- resilience building programs originally developed for military rioration associated with high stress arousal, which negatively personnel are now being applied in police organizations across affects their ability to perform tactical maneuvers. These North America, via classroom instruction. Programs such as findings highlight the benefit of advancing police tactical the Road to Mental Readiness in Canada (Pedersen, 2013) training by incorporating principles of psychological and and Comprehensive Soldier Fitness (Cornum, Matthews, & physiological control during stress. Seligman, 2011) in the United States aim to improve the health A limitation of this study is the small sample size. and performance of first responders through general resilience However, a number of factors enhance confidence in the building techniques. Randomized controlled trials testing the study findings. First, our results are aligned with findings efficacy of these programs to improve use of force outcomes from prior randomized controlled trials in this field and are not available. It may be misleading to assume that resil- extend the applicability by integrating our training into the ience programs delivered in classroom environments will gen- existing use of force programming (Arnetz et al., 2009). eralize to use of force and behavioral performance outcomes Second, we successfully reduced the potential for small sam- in the real world. Patterson, Chung, and Swan (2012) con- ple failure of random assignment, as discussed in the Method ducted a meta-analysis on exactly this topic. These authors section (Coalition for Evidence-Based Policy, 2014; Hsu, assessed the impact of police-specific stress management 1989; Strube, 1991). Third, the results are based on multiple interventions that aimed to improve psychological, physiolog- objective outcomes, including both biological data and ical, and behavioral outcomes among police. The meta-analy- expert raters. Of note, there were two expert raters coding sis revealed overwhelmingly non-significant physiological or participant behavior and actions from various angles to fur- behavioral outcomes in the programs they reviewed (Patterson ther enhance coding accuracy. Although we included et al., 2012). Researchers have the highest confidence that a 12 SAGE Open program is effective when the following standards are met: (a) Funding the intervention must be designed to address the specific out- The author(s) received no financial support for the research and/or comes it claims to change and (b) the intervention must be authorship of this article. tested using a randomized controlled trial, the scientific gold standard for determining program effectiveness (Patterson References et al., 2012). Andersen, J. P., Papazoglou, K., Koskelainen, M., Nyman, M., The iPREP intervention was developed to address identi- Gustafsberg, H., & Arnetz, B. B. (2015). Applying resil- fied outcomes that are known to enhance use of force deci- ience promotion training among special forces police sions (e.g., situational awareness). Officers were then trained officers. Journal of Police Emergency Response, 5, 1-8. on these specific targets by directly addressing the mecha- doi:10.1177/2158244015590446 nisms hypothesized to improve performance, namely psycho- Arnetz, B. B., Arble, E., Backman, L., Lynch, A., & Lublin, A. (2013). Assessment of a prevention program for work-related physiological control. Importantly, the iPREP intervention stress among urban police officers. International Archives was integrated directly into realistic use of force training of Occupational and Environmental Health, 86, 79-88. rather than delivered in the classroom setting. Further research doi:10.1007/s00420-012-0748-6. is needed to determine the most efficacious manner of reduc- Arnetz, B. B., Nevedal, D. C., Lumley, M. A., Backman, L., & ing use of force mistakes and enhancing police safety and Lublin, A. (2009). Trauma resilience training for police: well-being in real-world settings. However, taken together, Psychophysiological and performance effects. Journal of the findings from the current study provide preliminary evi- Police and Criminal Psychology, 24, 1-9. doi:10.1007/s11896- dence that the iPREP intervention warrants future investiga- 008-9030-y tion into whether it can improve situational awareness and Arnsten, A. F. T., & Goldman-Rakic, P. S. (1998). Noise stress use of force decisions among larger, more varied samples impairs prefrontal cortical cognitive function in monkeys: (e.g., recruits, patrol officers) and in real-world settings. Evidence for a hyperdop-aminergic mechanism. Archives of General Psychiatry, 55, 362-368. Former assistant U.S. attorney, Kami Chavis Simmons, Artwohl, A., & Christensen, L. (1997). Deadly force encounters. who now directs the criminal-justice program at Wake Forest Boulder, CO: Paladin Press. University School of Law, is quoted in the WSJ stating, “The Backman, L., Arnetz, B. B., Levin, D., & Lublin, A. (1997). [use of force litigation] numbers are staggering, and they Psychophysiological effects of mental imaging training for have huge consequences for taxpayers.” Professor Simmons police trainees. Stress & Health, 13, 43-48. urges politicians and police organizations to address use of Brown, R. P., & Gerbarg, P. L. (2009). Yoga breathing, meditation, force litigation from a different perspective: “Municipalities and longevity. Annals of the New York Academy of Science, should take a hard look at the culture of police organizations 1172, 54-62. and any structural reforms that might help alleviate the pos- Cacioppo, J. T., & Tassinary, L. G. (1998). Principles of neurology sibility of some of these huge civil suits” (Elinson & Frosch, (6th ed.). New York, NY: McGraw-Hill. 2015). We posit that many police organizations are looking Cahill, L., & Alkire, M. T. (2013). Epinephrine enhancement of human memory consolidation: Interaction with arousal at for solutions to growing concerns about use of force decision encoding. Neurobiology of Learning and Memory, 79, 194-198. making but are facing shrinking training budgets. Given Coalition for Evidence-Based Policy. (2014). Which study designs these realities, organizations may benefit from investing in are capable of producing valid evidence about a program’s resilience programming, such as iPREP, which is integrated effectiveness. Retrieved from http://coalition4evidence.org/ directly into the existing use of force training. Integrated wp-content/uploads/2014/10/Which-Study-Designs-are- training is not only cost-effective but it also enhances the Capable-of-Producing-Valid-Evidence-of-Effectiveness.pdf ecological validity of the method and potential generalizabil- Cohen, J. (1992). A power primer. Psychological Bulletin, 112, ity to real-world settings. 155-159. doi:10.1037/0033-2909.112.1.155 Cornum, R., Matthews, M. D., & Seligman, M. E. P. (2011). Acknowledgments Comprehensive soldier fitness. Building resilience in a chal- lenging institutional context. American Psychologist, 66, 4-9. A special thank you to the following individuals: Mr. Kimmo doi:10.1037/a0021420 Himberg, the director of the Police University College of Finland Covey, T. J., Shucard, J. L., Violanti, J. M., Lee, J., & Shucard, for the opportunity to conduct this research in collaboration with the D. W. (2013). The effects of exposure to traumatic stressors University; and Konstantinos Papazoglou, MA, a graduate student on inhibitory control in police officers: A dense electrode at the University of Toronto; Marian Pitel, BSc, and Markku array study using a Go/NoGo continuous performance task. Nyman, MA, for their assistance with the study’s implementation. International Journal of Psychophysiology, 87, 363-375. A special thank you to all the members of the Karhu Special Driskell, J. E., & Johnston, J. H. (1998). Stress exposure training. In Response Team who participated in this research study. J. A. Cannon-Bowers & E. Salas (Eds.), Making decisions under stress: Implications for individual and team training (pp. 191- Declaration of Conflicting Interests 217). Washington, DC: American Psychological Association. The author(s) declared no potential conflicts of interest with respect Elinson, Z., & Frosch, D. (2015, July 15). Cost of police-miscon- to the research, authorship, and/or publication of this article. duct cases soars in big U.S. cities. The Wall Street Journal. Andersen and Gustafsberg 13 Retrieved from http://www.wsj.com/articles/cost-of-police- Pedersen, Z. (2013). Armed and ready—To tackle mental health. misconduct-cases-soars-in-big-u-s-cities-1437013834 Canadian HR Reporter, 26, 12-14. Everly, G. S., & Lating, J. M. 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Nursing, 24, 12. McCraty, R., & Atkinson, M. (2012). Resilience training pro- gram reduces physiological and psychological stress in police Author Biographies officers. Global Advances in Health and Medicine, 1, 44-66. Judith P. Andersen is a health psychologist with expertise in the doi:10.7453/gahmj.2012.1.5.013 physical and mental health outcomes associated with stressful and McCraty, R., Atkinson, M., Tomasino, D., & Bradley, R. T. (2009). traumatic experiences. Prof. Andersen specializes in the psycho- The coherent heart: Heart-brain interactions, psychophysi- physiology of performance during high stress encounters. Her on- ological coherence, and the emergence of system-wide order. going research is focused on incorporating evidence-based physio- Integral Review, 5, 10-115. logical resilience training into police use of force and de-escalation Olson, D. T. (1998). Deadly force decision making. FBI Law instruction. Enforce Bulletin, 67, 1-9. Patterson, G. T., Chung, I. W., & Swan, P. G. (2012). The effects Harri Gustafsberg is a former Chief Inspector of the Finnish of stress management interventions among police officers and National Police. He is a 23 year veteran of Finnish Federal Special recruits. Campbell Systematic Reviews, 7, 1-53. Intervention Police unit.

Journal

SAGE OpenSAGE

Published: Apr 7, 2016

Keywords: police special forces; resilience; critical incidents; physiological reactivity; use of force; situational awareness; SWAT

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