Predictors of Outcome and Residual Symptoms Following Trauma‐Focused Psychotherapy in Police Officers With Posttraumatic Stress Disorder

Abstract

Police officers exposed to potentially traumatic events (PTE) are at a heightened risk of developing posttraumatic stress disorder (PTSD). Little is known about trauma‐focused psychotherapy outcomes in the police. In this naturalistic study, we evaluated whether PTE exposure and baseline clinical characteristics predicted PTSD symptom reduction during treatment and residual PTSD symptoms posttreatment. In consecutive referrals to a specialized mental health service for police officers (N = 665), PTSD was measured pre‐ and posttreatment using structured clinical interviews. Treatment consisted of brief eclectic psychotherapy for PTSD. We grouped PTE as follows: injury/maltreatment, loss (colleague or private), other job‐related, other private traumatic events. Data were analyzed multivariably using structural equation modeling and logistic regression. Treatment effect size was large, d = 3.6, 95% CI [3.4, 3.8]. Police officers who reported more injury/maltreatment or private traumatic had more baseline PTSD symptoms as well as larger symptom reduction during treatment; police officers who reported more losses of loved ones showed smaller PTSD symptom reduction. Concentration problems persisted in 17.7% of police officers posttreatment, and these were predicted by baseline PTSD symptoms and loss of loved ones. Proportions of variance explained by the multivariable models ranged from 0.08 to 0.14. Our findings increase insight into the type of PTE and clinical characteristics of police officers with PTSD who benefit most from trauma‐focused treatment. Because loss of loved ones can be presumed to have a profound impact on social and interpersonal functioning, a more specific treatment focus on grief processes may further enhance efficacy.

Ritual in Therapy for Prolonged Grief: A Scoping Review of Ritual Elements in Evidence-Informed Grief Interventions

“…Although three studies did not show significant treatment effects (47)(48)(49), 19 studies revealed significant treatment effects on symptom reduction. It is important to note that, with the exception of Smid et al (50), the reported effects concerned the entire treatment and not only the ritual element(s). This means that the studies reported here measured effects in terms of reductions in grief or other symptoms after completion of the full treatment, not only the ritual element.…”

“…As can be seen in Appendix 1, 8 studies were categorized level 2 of evidence (RCT with significant symptom reduction), 11 studies were categorized as level 3 evidence (non-randomized controlled cohort/follow-up study) and three studies were categorized as level 4 due to no significant result of the treatment [one RCT with no significant effect; (47), two pre/post-tests with no significant result due to small sample; (48,49)]. All measured effects were reported for the entire treatment, with the exception of one observational study that measured a significant separate effect on the ritual element (farewell ritual) (50).…”

The UK National Homicide Therapeutic Service: A Retrospective Naturalistic Study Among 929 Bereaved Individuals

“…Hence, no model fit indices for the model are given. This model fits prior research using a comparable sample and design (46). For the calculation of Cohen's d (47), we used the mean and standard deviation of the change in symptoms during treatment and the correlation between pre-and posttreatment symptoms for all measures (48).…”

Inevitable Loss and Prolonged Grief in Police Work: An Unexplored Topic

“…Of all mental health conditions experienced by police officers, PTSD has received the most clinical and research attention (Gersons et al, 2000;Difede et al, 2007). In addition, PTSD and prolonged grief are often comorbid as shown by a growing body of research (e.g., Wenzel, 2002;Gibson, 2008;Nakajima et al, 2012); however, it appears that PTSD symptom reduction may be more challenging in the treatment context when such comorbidity exists (Smid et al, 2018). Despite the treatment challenge when PTSD and prolonged grief are comorbid, PTSD evidence-based treatment (e.g., Cognitive-Behavioral Therapy, Exposure Therapy) has been shown to be significantly efficacious in PTSD symptom improvement among first responders who suffer from PTSD (Gersons et al, 2000;Difede et al, 2007).…”

“…Most police officers may not ultimately be diagnosed with PTSD, however, most officers experience loss at some point during their law enforcement careers. Nevertheless, especially in the context of specialized police mental health services with a focus on PTSD, specific attention should be emphasized to the mental health effects of losses of loved ones on police officers' mental health and well-being (Smid et al, 2018).…”