Mental Durability in NSW Police Officers

The overarching aim of this study is to conduct a pilot feasibility (pre-post design including short-term follow-up) targeting hyperarousal symptoms to assist NSW Police Officers seeking help from the RECON units in NSW for PTSD, anxiety and/or other stress –related disorders, as well as for distress (including depressive symptoms) due to chronic pain. For the purposes of this project, a new de-arousal therapy manual has recently been developed by psychologists at the RECON unit. The treatment components have been informed by methods that have been found to be beneficial in reducing hyperarousal symptoms including relaxation, exercise and mindfulness strategies. In particular the specific modules of the program include: Coping strategies including cognitive, defusion and behavioural methods, physical activity, breathing and relaxation exercises, sensory grounding skills, mindfulness exercises, self-compassion and gratitude activities, healthy lifestyle education and practice including sleeping patterns, engaging in meaningful activities and hobbies. The program will be delivered on an individual (one-on-one) format in-person. Each therapy session is expected to take 1 hour per week. The therapy modules include interactive activities, including home exercises supplemented by video clips and handouts. Home exercises are expected to take about 5-10 minutes per activity. Participants will be encouraged to practice activities at least several (minimum 2 to 3 times per week and even more regularly as they progress through the program). Home exercises will include such activities as breathing exercises, muscle relaxation practice, and practicing using various coping strategies (including defusion exercises and self-soothing talk). Adherence to the therapy modules and home practice recommendations will be monitored on a weekly basis via an online survey to be completed separately by the participant and therapist. The specific aim of this study is to test the feasibility and pilot the efficacy of adding this de-arousal program with the traditional therapies currently offered to officers at RECON who present with PTSD, anxiety and/or other stress –related disorders, as well as for chronic pain. These traditional therapies include CBT, Cognitive Processing Therapy, EMDR and physiotherapy. That is, eligible officers will be provided with this new 12 session de-arousal program in combination with any other aforementioned traditional therapies the treating therapist deems suitable for the officer during this 12-week period. Hence, all eligible officers who consent to take part in this study will be offered the de-arousal therapy strategies and encouraged to use these strategies on a weekly basis for 12-weeks whilst they are concurrently receiving any additional evidence-based therapy at the RECON unit. Although the focus of the 12 therapy sessions will be for participants’ primary problem at referral, sessions may also be tailored to address any crises issues that may arise. As this is a feasibility study, we will also aim is to monitor (via online self-report measures) the weekly hyperarousal and stress symptoms of officers in conjunction with the specific hyperarousal strategies used as well as any other therapy components administered to determine whether specific hyperarousal strategies are associated with more rapid and /or better treatment gains by the end of the 12 week program. Given officers will not be precluded from also being offered traditional, evidence-based (cognitive and behavioural based) therapies provided at the RECON clinics, the participating officers’ therapists will also document the type of therapy components received during the course of the 12-week de-arousal program. This data will be taken into account when evaluating and interpreting the study results. For example, we will be able to test whether officers offered CBT components for stress management in conjunction with the de-arousal program report even greater or comparable reductions in symptoms by 12-weeks. It is noteworthy to highlight that this new de-arousal program is being tested in a real-world clinic context administered by trained clinicians (psychologists and allied mental health experts). • Summary of Clinician Decision Tree – Ratio of de-arousal strategies covered in each session contingent on primary problem/ at time of referral: As part of the clinician decision tree, the following ratio of time will be committed to the de-arousal program for each therapy session across the 12 weeks, relative to the traditional, typically CBT-based intervention. Ratio of de-arousal program and traditional/ CBT (or EMDR) per therapy session • Anxiety: 60% de-arousal, 40% CBT • PTSD: 20% de-arousal. 80% EMDR • Pain: 30% de-arousal, 70% CBT. • Sleep: 40% de-arousal. 60% CBT