Running head: VICARIOUS TRAUMA IN LAW ENFORCEMENT

The Effect of a Resiliency Training
on Vicarious Trauma in Law Enforcement
Summer Wolfe
Arizona State University

1

VICARIOUS TRAUMA IN LAW ENFORCEMENT

2

Abstract
Vicarious exposure to traumatic events is correlated with: mental health problems, a higher
prevalence of posttraumatic stress disorder, employee attrition, and higher mortality rates for
Law Enforcement Officers when compared to the general population. The purpose of this
evidence-based project was to determine if a resiliency training improved resiliency and
resiliency knowledge in law enforcement officers in a rural law enforcement agency in the
southwestern United States. Six participants completed a demographic survey, Response to
Stressful Experience Scale and a resiliency knowledge measure. A Wilcoxon signed-rank test
was conducted to compare pre- and post- training resiliency and resiliency knowledge scores.
The post-test overall resiliency scores (Mdn = 59.50) were not significantly higher than pre-test
overall resiliency scores (Mdn = 54.50), Z = -1.47, p = .141. Post-test resiliency knowledge
scores (Mdn = 9.00) were not significantly higher than pre-test resiliency knowledge scores (Mdn
= 8.00), Z = -1.63, p = .102. In this group of law enforcement officers, the resiliency training did
not have an effect on resiliency or resiliency knowledge. These outcomes could be potentially
explained by the limited sample size (N = 6), and possibly small effect size. Recommendations
for improving the current study include conducting the resiliency training with a larger sample
size of at least 30, and including additional relevant questions in the resiliency knowledge
measure.
Keywords: law enforcement officers, training, suicide, posttraumatic stress disorder,
PTSD, resilience, vicarious trauma

VICARIOUS TRAUMA IN LAW ENFORCEMENT

3

The Effect of a Resiliency Training on Vicarious Trauma in Law Enforcement
Law enforcement officers (LEOs) are frequently exposed to traumatic situations that
result in stressful life and death decisions. Dedication to public safety requires a commitment
that goes beyond the basic call to duty. Prolonged physiological stress from vicarious trauma
(VT) increases LEOs’ risk for depression, substance abuse, posttraumatic stress disorder (PTSD),
suicide, and burnout (Regehr & LeBlanc, 2017). Surviving emotional, physical, and mental
challenges associated with policing requires training to enhance individual resilience and protect
overall wellbeing (Regehr & LeBlance, 2017).
Problem Statement
The mental health welfare of LEOs is a significant issue throughout the United States. In
2017 the Law Enforcement Mental Health and Wellness Act was passed by Congress and signed
into law by the president (H.R.2228, 2018). Men and women who frequently put their lives on
the line to protect communities, or who, in the course of daily work life, witness traumatic
events, are vulnerable to the development of mental health conditions. Failure to treat mental
illness can prolong human suffering and result in suicide (Chopko, Palmieri, & Adams, 2015).
LEO suicide rates are four times higher than the national average (National Alliance on Mental
Illness [NAMI], 2019). Nationally, there was a 30% increase in the LEO suicide rate; with106
documented suicides in 2016 and 140 in 2017 (NAMI, 2019).
VT is defined as an occupational challenge in professions involving law enforcement,
victim services, emergency medical services, and fire services that is a consequence of chronic
exposure to victims of violence and trauma (Office of Justice Programs, 2019). LEOs have a
higher prevalence of PTSD associated with VT when compared to the general population
(Franczak, Barshter, Reich, Kent, & Zautra, 2016). Review of internal data collected from a rural

VICARIOUS TRAUMA IN LAW ENFORCEMENT

4

law enforcement agency from 2009 to 2017 reflects a 140% increase in service related calls
involving mental health emergencies and suicide-related crises. Consequently, local LEOs are in
a unique position to determine the course and possible outcome of the suicidal crises. They are at
greater risk of exposure to potentially traumatic situations, increasing the chance of developing
symptoms associated with PTSD and other mental health disorders.
Purpose and Rationale
The purpose of this paper is to increase awareness regarding the high prevalence of
PTSD, depression, and substance abuse among LEOs and to provide treatment through a
resiliency training (Stanley, Hom, & Joiner, 2016). Mental illness is treatable; however, without
treatment the cost to society and the individual are great (Trautmann, Rehm, & Wittchen, 2016).
One’s mental health can have adverse consequences on physical health, severely limiting LEOs
functioning and contributing to performance deficits, thereby jeopardizing the safety of the
community. Failure to adequately treat mental illness in LEOs leads to increased risk of suicide
(Trautmann et al, 2016). Trauma treatment guidelines recommend promoting resilience as
essential for the survival of LEOs in life and the workplace (McCraty & Atkinson, 2012; Molnar
et al., 2017).
Background and Significance
Cumulative exposure to potential harm is associated with: mental health problems, a
higher prevalence of PTSD, employee attrition, and higher mortality rates for LEOs when
compared to the general population (Marchand et al., 2015). Law enforcement agencies are
tasked with the responsibility of meeting diverse public needs, and LEOs are exposed to a variety
of mental and emotional challenges when responding to calls for service in the community
(Marchand et al., 2015). This is particularly true when calls for service involve individuals with

VICARIOUS TRAUMA IN LAW ENFORCEMENT

5

mental illness and suicidal ideation. These types of calls represent a growing concern for law
enforcement nationwide (International Association of Chiefs of Police, 2014). Advances in
practice and science emphasize the professional challenge associated with VT and the
importance of treating it in the work place (Molnar et al., 2017).
Internal Evidence
Locally, suicide rates have almost doubled in the community over the past two years.
LEOs responded to 177 calls for service involving suicidal persons in 2014 and 331 in 2017.
Increasing trends toward exposure to trauma and high attrition rates support the need for a
program designed to protect LEOs from developing mental illness. Trauma-focused resiliency
training is important for promoting adaptation skills during experiences involving trauma,
tragedy, and significant stress in order to minimize susceptibility to the development of
symptoms associated with PTSD (Joyce et al., 2017; Robertson, Cooper, Sarkar, & Curran,
2015). This discussion has led to the development of the following PICOT question: “In a group
of law enforcement officers (P), how does participation in a resiliency training (I) as compared to
pre- and post-training (C) affect scores on a measure of resiliency and on a measure of
knowledge of resiliency (O)?”
Search Strategy
A comprehensive search was performed in four databases – PubMed, PsycINFO,
EBSCOhost, and Cochrane Library. A combined search was conducted using the following key
terms to address the PICOT question: police, stress disorder, education, training, response to
stressful experiences, resilience, and response to stress. Inclusion criteria included adult subjects,
full text, peer-reviewed journals written in English, and published from 2013-2018. Articles

VICARIOUS TRAUMA IN LAW ENFORCEMENT

6

without statistically significant results, low level of evidence, high attrition rates, exploratory
research, and invalid measures were excluded.
Key search terms were combined using Boolean operators to refine results. An initial
search using keywords police and stress disorder without inclusion criteria yielded the following
results: 468 in PubMed, 941 in PsycINFO, 185 in EBSCOhost, and 65 in Cochrane Library. The
combined search terms police and stress disorder and education with inclusion criteria resulted
in 14 articles in PubMed, 21 in PsycINFO, 4 in EBSCOhost and 16 in Cochrane Library.
Incorporating key search terms used in the PICOT question police and resilience and training
with inclusion criteria yielded the following results 23 in PubMed, 22 in PsycINFO, three in
EBSCOhost, and seven in the Cochrane Library.
During the critical appraisal process articles and references of articles were evaluated for
strong methodology, accurate data, clinical relevance and statistical significance for answering
the PICOT question. The final results yielded 10 articles meeting criteria for higher levels of
evidence.
Synthesis of Evidence
A total of 10 articles were selected for review. Current studies include two mixed method
(MM) studies, six randomized control trials (RCTs), one systematic review (SR) and one metaanalysis (MA). The studies were organized hierarchically with RCTs, MA of RCTs, and SR of
RCTs ranked level one indicating the highest level of evidence; MM studies were ranked level
two indicating a lower level of evidence (Appendix B). Study limitations included an overrepresentation of male participants decreasing the ability to generalize findings to female LEOs
(Appendix B). Researchers speculated that males dominate first-responder professions and this
may have contributed to a smaller number of female participants (Tuckey & Scott, 2013).

VICARIOUS TRAUMA IN LAW ENFORCEMENT

7

Sample demographic data demonstrated a moderate degree of homogeneity (Appendix B).
Participants included LEOs, fire fighters, veterans, medics, and 911 dispatchers. The mean age of
participants ranged from 24 to 46 years. The duration of professional experience varied from less
than one year to over ten years (Appendix B). Samples included 12 to 900 participants.
Demographic data revealed ethnically diverse samples (Appendix B). Studies originated in the
US and Europe (Appendix B).
Dependent and independent variables were clearly defined (Appendix A). Multiple
interventions involving mindfulness-based resiliency training (MBRT) supported findings across
studies for a reduction in the number and severity of PTSD symptoms in participants (Appendix
B). Time frames for interventions varied from 90 minutes to eight weeks (Appendix B).
Statistically significant results included improvements in use of force decisions, situational
awareness, physiological and psychological responses to stress, quality of life, resilience, and
decreased alcohol consumption (Appendix B). Outcome measures were robust, valid, and
reliable (Appendix A).
The evidence suggests that in conjunction with social support, resilience training and
education fosters the development of a set of skills that help with better management of
emotional and physiological responses to traumatic situations (Iacoviello & Charney, 2014).
Prevention and treatment efforts can decrease the susceptibility to suicidal thoughts, or
behaviors, and mental illness. The increasing complexity of occupational stress and chronic
exposure to trauma faced by LEOs emphasizes the importance of resiliency interventions to help
them better manage physiological responses to stress (Boyd, Lanius, & McKinnon, 2018).
Although occupational stress has negative consequences, there is evidence to support the claim
that cumulative vicarious exposure to trauma results more frequently in PTSD and suicide

VICARIOUS TRAUMA IN LAW ENFORCEMENT

8

(Stanley et al., 2016). Because PTSD is characterized by the dysregulation of physiological
responses to trauma related stress, coping strategies that help with better management of this
type of stress would lead to a reduction in the number of cases of PTSD (Banks, Newman, &
Saleem, 2015; Liberzon & Abelson, 2016). Resiliency training has demonstrated a reduction in
the number of PTSD cases by promoting effective coping strategies that help LEOs better
regulate trauma related stress (Kaplan, Bergman, Christopher, Bowen, & Hunsinger, 2017).
Because suicidal thoughts, intentions, and behaviors are characterized by a feeling of
helplessness, interventions that promote emotional cohesion in the face of psychological
isolation and pain could lead to a reduction in the number of cases of suicide by LEOs (Banks et
al., 2015). In conjunction with social support, Resiliency Training leads to a reduction in the
number of cases of suicide by LEOs as a result of cumulative vicarious exposures to trauma
(Kaplan et al., 2017). Therefore, Resiliency Training is an effective prevention and treatment
approach for the deleterious consequences of vicarious exposure to trauma faced by LEOs.
Theoretical/Conceptual Framework
Homeostasis is a tendency of the body to maintain a relatively stable equilibrium between
interdependent elements (Sadock, Sadock, & Ruiz, 2015). Allostasis is a physiological
mechanism by which the body responds to stressors to maintain homeostasis (Sadock et al.,
2015). Key biological systems work in conjunction with brain function, social influences, and
genetics to promote resiliency by minimizing the allostatic load (Sadock et al., 2015). Hans
Seyle’s (1936) neuro-hormonal theory describes the biological responses to stress determining
that chronic exposure to adverse conditions contributed to negative physical changes.
Seyle’s General Adaptation Syndrome defines the “human stress response” through a
sequence of three stages including alarm, resistance, and exhaustion (Appendix C). The theory

VICARIOUS TRAUMA IN LAW ENFORCEMENT

9

underscores the project foundation by emphasizing the continuous cycle, stages and negative
outcomes associated with frequent exposure to stress. During the alarm stage the body prepares
for “fight” or “flight” in the presence of a “perceived threat” signaling the sympathetic nervous
system to release excessive amounts of cortisol and other stress hormones (Seyle, 1936). During
the resistance stage the body attempts to restore homeostasis by reducing sympathetic nervous
system activity and adrenal cortical activity. The alarm and resistance stage are continuous
throughout life (Seyle, 1936). When stressors are chronic, the increased intensity of the demand
leads to a reduction in the time it takes to reach the exhaustion stage (Seyle, 1978). Failure to
adapt to the stressors results in a failure to restore homeostasis, reducing the chances of survival,
resulting in death. Interventions that enhance one’s capacity to self-regulate negative arousal
during the stress response, described by Seyle, can maximize adaptation toward avoiding
exhaustion and thereby promote resilience (Boothroyd, Green, & Dougherty, 2018).
Evidenced Based Practice Model
The Academic Center for Evidence (ACE) Based Practice Star Model of Knowledge
Transformation (Appendix D) was selected as an evidence-based practice model to guide the
project using five phases to transform knowledge: discovery, summary of evidence, translation,
integration, and evaluation (Schaffer, Sandau, & Diedrick, 2012). Knowledge is transformed
through a sequential process using each point of the model building a scientific foundation to
support organizational change toward the adoption of professional development opportunities
that improve outcomes in LEOs (Schaffer et al., 2012). The discovery phase involved traditional
research methodologies to collect evidence in scholarly databases. The evidence was synthesized
in tables using a rigorous review process generating findings that support resiliency interventions
for promoting positive outcomes in LEOs exposed to VT. Translation involved implementing

VICARIOUS TRAUMA IN LAW ENFORCEMENT

10

evidence-based treatment guidelines to develop a Resiliency Training for LEOs exposed to VT.
The integration phase was used to promote change through the delivery of a Resiliency Training
in professional practice at both the individual and organizational level. The outcomes were
evaluated to inform practice to support the continued implementation of a Resiliency Training
for LEOs.
Methods
Ethical Considerations
Approval was obtained by the Institutional Review Board affiliated with Arizona State
University (Appendix E) in conjunction with site authorization (Appendix F) prior to the
implementation of the Resiliency Project. Patrol supervisors recruited potential participants
announcing the training with an agency memo. Informed consent (Appendix G) was obtained
prior to LEOs engagement in the training. To ensure confidentiality all instruments used to
collect the data were coded using a project identification numbers that included the last two
digits of participants Social Security Number, the last two digits of their birth year and the first
two digits of their birth month.
Setting and Participants
The project site was at a law enforcement agency located in a rural area in the
southwestern United States. LEOs voluntarily attended the training. They were not compensated
for their participation. Inclusion criteria included: LEOs employed by the site, English speaking,
over the age of 18; able to read, write and understand English.
Intervention
This project consisted of a pre-post design method. LEOs attended a 90-minute
Resiliency Training (Appendix H). A PowerPoint was used as an instructional visual aide.

VICARIOUS TRAUMA IN LAW ENFORCEMENT

11

Written materials included a resiliency training test, Response to Stressful Experiences Scale
(RSES) and a demographic survey. Participants completed a resiliency test, RSES, and
Demographic Survey before the intervention. A resiliency test and RSES were completed post
intervention. The total time to complete the surveys was approximately 20 minutes.
Instruments/Outcome Measures
Response to Stressful Experience Scale. Resilience was measured using the RSES
(Appendix I) from the Veteran Affairs National Center for PTSD (Johnson et al., 2011).
Outcomes were evaluated by comparing pre and post training resilience scores. The RSES is a
22-item self-report measure. The RSES was selected because it has demonstrated good internal
consistency (𝛼 = .91 − .93) in addition to good test-retest reliability (r = .87) (Johnson et al.,
2011).
Resiliency knowledge measure and demographic survey. The resiliency pre-test and
post-test (Appendix J) consisted of 12 identical multiple-choice questions with three additional
questions on the post-test soliciting participant feedback regarding the project. Outcomes were
evaluated by comparing pre and post test scores A demographic survey (Appendix K) consisting
of 22 questions was developed to collect participant information regarding ethnicity, total
number of male and female participants, age range, years of professional experience, resiliency
training hours, and job-related trauma exposure.
Data Analysis
This project investigated the efficacy of resiliency training with a sample of rural law
enforcement officers. In other words, the increase in the law enforcement officers’ levels of
resilience, knowledge, and coping skills, was evaluated toward promoting their psychological
and physiological wellbeing. Six law enforcement officers volunteered and participated in the

VICARIOUS TRAUMA IN LAW ENFORCEMENT

12

training. Participants completed a pre/post intervention measure of resilience and a pre/post-test
measuring the knowledge of resilience. Participants also provided demographic information.
First, a description of demographic characteristics was reported, followed by descriptive
statistics for the RSES and resiliency knowledge measure both pre- and post-test. Finally, the
PICOT question was addressed using the non-parametric, Wilcoxon signed-rank test due to the
relatively small sample size (N = 6).
Before any analyses were conducted, data were screened, coded, and imputed into the
Statistical Package for the Social Sciences (SPSS) software. The RSES scores were calculated as
the sum of responses to each of the 22 items on the survey. All items were scored from a scale of
0 (“not at all like me”) to 4 (“exactly like me”). Scores on the RSES could range from 0-88.
According to the original scale convention, scores on the RSES ranging from 0-49 were
considered “low resilience”, 50 to 70 “moderate resilience”, and 71 to 88 “high resilience”
(Johnson et al., 2011). Items on the resilience knowledge test were coded as 1 = correct response,
0 = incorrect response. Total resilience knowledge scores were calculated as the sum of each
item’s response. For example, a participant with 12 correct responses would receive a resilience
knowledge score of 12.
First, frequencies and percentage summaries were used to summarize categorical data,
including demographic information. Then, descriptive statistics, including measures of central
tendency and measures of variability were calculated and reported for each of the pre- and posttest measures. Additionally, reliability for each pre- and post-test measure was calculated as
internal consistency using Cronbach’s Alpha. A value of .70 or greater is considered acceptable
for internal consistency (Melnyk & Fineout-Overholt, 2014). Finally, two separate aspects of the

VICARIOUS TRAUMA IN LAW ENFORCEMENT

13

PICOT questions were assessed: 1) participants’ level of resiliency pre- and post- training, and 2)
participants’ knowledge of resiliency pre- and post-training.
Budget
The preparation, implementation, and evaluation phases of the project were used as a
guide for developing a proposed budget (Appendix L). The total costs were estimated at
$2,717.00 USD. Participants were not compensated for their time. The project was not funded.
Interpretation of Results
Demographic Data
Sex, race, and education. Participants’ in the sample ranged in age from 27 years old to
45 years old, with an average age of 37 years old (SD = 6.10) (Appendix M). There were more
males (n = 5) than females (n = 1) in the sample. Most participants were married (n = 5). All
participants were white (n = 6). Half of the participants’ highest level of education was a
bachelor’s degree (n = 3) and half of the participants’ highest level of education was a high
school degree (n = 3).
Experience and injuries. Only one of the participants had any military experience, a
total of three years, and no combat experience, (Appendix M). All participants had at least five
years of experience in law enforcement, experience ranged from five to twenty years, with an
average of 14.83 years of experience (SD = 6.62). Most participants’ rank was that of a detective
(n = 4), and all participants’ primary assignment in law enforcement was criminal investigation.
Two participants were injured in the line of duty, one of whom reported that the injuries were
sustained from a physical assault or criminal action from another individual.
Job related activities. Participants were also asked to estimate the percentage of time on
the job spent doing various activities (Appendix N). The highest average percentage of time was

VICARIOUS TRAUMA IN LAW ENFORCEMENT

14

spent on administrative work (mean = 25%) and death-related duties (M = 18.33%). No
participants spent time on 1) service-related calls involving mentally ill, 2) suicidal subjects, 3)
nuisance calls, 4) vehicle or traffic, and 5) other.
Firearm use. Participants were also asked about their firearm usage in the line of duty.
All participants reported to having drawn their firearm. However, only one participant
discharged a firearm at an object, vehicle, and/or a person. Two participants reported to have
been fired at by another person. All participants reported to have engaged in the use of force
(Note. it was not possible to calculate the average or frequency of usage for these items
regarding firearms because some of the participants did not report the number of times, as
instructed in the directions, but rather checked or marked “Yes” or “No”).
Previous resiliency training. Finally, participants were also asked about the extent of
resiliency training they have received, whether they have sought physical or psychological
treatment, and about the support they have received following traumatic event(s). The
participants’ exposure to resiliency education ranged from it not being a part of their initial
training including the academy (n = 2) to between 7-8 hours (n = 1) over the course of their
career. Specifically, while as part of their initial training including the academy, the participants
had received 1-2 hours of resiliency education (n = 2), after the initial training they had received:
no resiliency education (n = 1), 1-2 hours (n = 1), 3-4 hours (n = 1), 5-6 hours (n = 1), or 7-8
hours (n = 2) of resiliency education.
Support and treatment. Regarding support and treatment for problems related to
exposure to a traumatic event or stress, most participants (n = 5) did not seek treatment for any
physical problems, and no participants (n = 6) sought treatment for psychological problems.
Furthermore, no participants needed additional time from work to recover from exposure to a

VICARIOUS TRAUMA IN LAW ENFORCEMENT

15

traumatic event at any point over the course of their career. However, most participants (n = 4)
felt there was adequate support to address exposure to traumatic events from their employer.
None of the participants were more likely to seek support from a peer-run support group than
from a group facilitated by a mental health professional.
Measurement Outcomes
Resiliency scores. The RSES was administered prior to and following the resiliency
training. All 22 items were scored in positive direction on a 5-point Likert scale (0–4), ranging
from 0 = “not at all like me” to 4 = “exactly like me.” The resiliency sum scores could range
from 0 to 88, where scores from 0-49 indicated low resilience, score from 50-70 indicated
moderate resilience, and scores from 71-88 indicated high resilience (Johnson et al., 2011).
Additionally, pre- and post-test responses on the RSES were assessed for internal
consistency using Cronbach’s Alpha. At pre-test Cronbach’s Alpha was .67. Cronbach’s Alpha
at post-test was .60 (Appendix O). Based on the conventional standard of .70 (Melnyk &
Fineout-Overholt, 2014), inter-item reliability was slightly less than satisfactory.
Scores ranged from a minimum of 49 to a maximum of 69 with a median score of 54.50
(Appendix O) where most participants’ scores (n = 5) fell within the “moderate resilience” score
range. At post-test, scores ranged from 51 to 68 with a median score of 59.50 (Appendix O)
where all participants’ scores (n = 6) fell within the “moderate resilience” score range. There was
no significant difference in the overall resiliency scores between post-test (Mdn = 59.50) and
pre-test (Mdn = 54.50), Z = -1.47, p = .141. Additionally, on average, participants’ resiliency
remained in the moderate range from pre-test to post-test.
Resiliency knowledge. In addition to the RSES as a measure of participants’ selfreported resiliency, a measure of resiliency knowledge was also administered prior to, and

VICARIOUS TRAUMA IN LAW ENFORCEMENT

16

following the training where their resiliency knowledge scores were converted to percentage of
correct answers. At pre-test, the median number of correct responses was 8.00. This corresponds
to approximately 60% correct. The minimum number of correct responses was 4 (33% correct),
and the maximum number of correct responses was 9 (75% correct). At post-test, the median
number of correct responses was 9.00. This corresponds to approximately 71% correct. The
minimum number of correct responses was 5 (42% correct), and the maximum number of correct
responses was 10 (83% correct). There was no significant difference in the resiliency knowledge
scores between post-test (Mdn = 9.00) and pre-test (Mdn = 8.00), Z = -1.63, p = .102. Although
on average, participants’ resiliency knowledge did not differ after receiving the resiliency
training, all participants reported post-training that they found the information presented to be
helpful and that they would likely recommend the training to their colleagues.
Impact of Project
Although LEOs did not demonstrate significant improvements in resiliency and resiliency
knowledge post intervention there was a sample-based increase in both resiliency and resiliency
knowledge. The Resiliency Training taught LEOs adaptive coping skills to better manage
emotional and physiological responses to traumatic events. Improving resiliency knowledge can
increase LEOs’ awareness of the negative impact associated with frequent exposure to workrelated trauma while emphasizing the importance of accessing mental health treatment early and
throughout their careers to promote health and well-being. Adaptive coping skills can potentially
enhance resilience toward improving safety of LEOs and of those around them at work and at
home. In the future, the Resiliency Training will be adopted and implemented throughout LEOs’
career within the organization. The goal is to continually provide staff development opportunities
that better equip LEOs to cope with work-related trauma and stress.

VICARIOUS TRAUMA IN LAW ENFORCEMENT

17

Supporting the health and wellness of LEOs is vital for promoting resilience and career
longevity. Preventative interventions can help organizations maximize cost savings by
decreasing recruitment and training costs due to high attrition rates. Increasing resilience and
promoting openness to seek psychological help before a mental health concern deteriorates into a
mental illness can help agencies and society avoid significant costs associated with the treatment
and management of a severe mental illness. Fostering an overall positive mental health culture
among LEOs can reduce attrition rates, burnout, health care costs, disability claims, accidents,
premature medical retirements, and mortality.
Discussion
Six rural law enforcement officers completed resiliency training. All participants listed
criminal investigation as their primary assignment. Most of the participants were white males,
with varying years of experience ranging from five to twenty years in law enforcement.
Participants completed two measures prior to the training: a measure of resiliency (RSES) and a
measure of resiliency knowledge. Participants then completed the same two measures following
the training session in order to analyze the impact of the resiliency training. There were no
significant differences observed in pre- and post-test scores on either of the measures.
Participants’ resiliency did not significantly increase following the training. Rather, participants
exhibited moderate resiliency - both pre- and post-test - indicating that participation in resiliency
training did not affect resiliency scores. Also, participants’ knowledge of resiliency did not
significantly increase from pre- to post-test indicating that participation in a resiliency training
did not affect the resiliency knowledge scores.
Conclusion

VICARIOUS TRAUMA IN LAW ENFORCEMENT

18

The outcomes could be explained by the limited sample size (N = 6), and a potentially
small effect size. It might be the case that in this sample the resiliency training leads to an
increase in participants’ resiliency and resiliency knowledge scores, but the sample size may be
too small for the test to detect it. A larger sample size, at least 30, is likely to increase the
probability of detecting this effect if it truly exists and lead to greater confidence in the
outcomes. Also, including additional relevant questions in the resiliency knowledge measure is
likely to lead to a greater effect size.

VICARIOUS TRAUMA IN LAW ENFORCEMENT

19

References
Andersen, J. P., Papazoglou, K., Koskelainen, M., Nyman, M., Gustafsberg, H., & Arnetz, B. B.
(2015). Applying resilience promotion training among Special Force police officers.
SAGE Open, 5(2), 1-8. doi:10.1177/2158244015590446
Andersen, J. P., & Gustafsberg, H. (2016). A training method to improve police use of force
decision making. SAGE Open, 6(2), 1-13. doi:10.1177/2158244016638708
Banks, K., Newman, E., & Saleem, J. (2015). An overview of the research on mindfulness-based
interventions for treating symptoms of posttraumatic stress disorder: A systematic
review. Journal of Clinical Psychology, 71(10), 935–963.doi:10.1002/jclp.2220
Boothroyd, R. A., Green, S., & Dougherty, A. (2018). Evaluation of operation restore: A brief
intervention for first responders exposed to traumatic events. Traumatology: An
International Journal. Advance online publication. doi:10.1037/trm0000168
Boyd, J. E., Lanius, R. A., & McKinnon, M. C. (2018). Mindfulness-based treatments for
posttraumatic stress disorder: A review of the treatment literature and neurobiological
evidence. Journal of Psychiatry & Neuroscience, 43(1), 7-25. doi:10.1503/jpn.170021
Burrows, V. L. (2015) The medicalization of stress: Hans Selye and the transformation of the
postwar medical marketplace (Doctoral dissertation). Retrieved from City University of
New York Academic Works Database. (Accession No.3703372)
Chopko, B., Palmieri, A., & Facemire, P. (2014). Prevalence and predictors of suicidal ideation
among U.S. law enforcement officers. Journal of Police and Criminal Psychology,
29(1), 1-9. doi:10.1007/s11896-013-9116-z

VICARIOUS TRAUMA IN LAW ENFORCEMENT

20

De La Rosa, G. M., Webb-Murphy, J. A., & Johnston, S. L. (2016). Development and validation
of a brief measure of psychological resilience: An adaptation of the response to stressful
experiences scale. Military Medicine, 181(3), 202-208. doi:10.7205/milmed-d-15-0003
Devilly, J., & Varker, T. (2013). The prevention of trauma reactions in police officers:
Decreasing reliance on drugs and alcohol. Monographs Series 47(1) Retrieved from
http://www.ndlerf.gov.au/publications/monographs/monograph-47
Franczak, M., Barshter, D., Reich, J. W., Kent, M., & Zautra, A. J. (2016). Enhancing resilience
and sustaining recovery. Evidence-Based Practices in Behavioral Health, 22(1), 409-438.
doi:10.1007/978-3-319-40537-7_17
Iacoviello, B. M., & Charney, D. S. (2014). Psychosocial facets of resilience: Implications for
preventing posttrauma psychopathology, treating trauma survivors, and enhancing
community resilience. European Journal of Psychotraumatology, 5(1), 23970.
doi:10.3402/ejpt.v5.23970
International Association of Chiefs of Police. (2014). National symposium on law enforcement
officer suicide and mental health: Breaking the silence on law enforcement suicides.
Washington, DC: Office of Community Oriented Policing Services
Johnson, D. C., Polusny, M. A., Erbes, C. R., King, D., King, L., Litz, B. T., Southwick, S. M.
(2011). Development and initial validation of the Response to Stressful Experiences
Scale. Military Medicine, 176(2), 161-169. doi:10.7205/milmed-d-10-00258
Joyce, S., Shand, F., Tighe, J., Laurent, S. J., Bryant, R. A., & Harvey, S. B. (2018). Road to
resilience: A systematic review and meta-analysis of resilience training programmes and
interventions. British Medical Journal Open, 8(6), e017858. doi:10.1136/bmjopen-2017017858

VICARIOUS TRAUMA IN LAW ENFORCEMENT

21

Kaplan, J. B., Bergman, A. L., Christopher, M., Bowen, S., & Hunsinger, M. (2017). Role of
resilience in mindfulness training for first responders. Mindfulness, 8(5), 1373-1380.
doi:10.1007/s12671-017-0713-2
Law Enforcement Mental Health and Wellness Act, H.R.2228, 115th Cong. (2018)
Leppin, A. L., Bora, P. R., Tilburt, J. C., Gionfriddo, M. R., Zeballos-Palacios, C., Dulohery, M.
M., & Montori, V. M. (2014). The efficacy of resiliency training programs: A systematic
review and meta-analysis of randomized trials. Public Library of Science One, 9(10),
e111420. doi:10.1371/journal.pone.0111420
Liberzon, I., & Abelson, J. (2016). Context processing and the neurobiology of post-traumatic
stress disorder. Neuron, 92(1), 14-30. doi:10.1016/j.neuron.2016.09.039
Marchand, A., Nadeau, C., Beaulieu-Prévost, D., Boyer, R., & Martin, M. (2015). Predictors of
posttraumatic stress disorder among police officers: A prospective study. Psychological
Trauma: Theory, Research, Practice, and Policy, 7(3), 212-221. doi:10.1037/a0038780
McCraty, R., & Atkinson, M. (2012). Resilience training program reduces physiological and
psychological stress in police officers. Global Advances in Health and Medicine, 1(5),
44-66. doi:10.7453/gahmj.2012.1.5.013
Melnyk, B. M., & Fineout-Overholt, E. (2014). Evidence-based practice in nursing and
healthcare: A guide to best practice (3rd ed.). PA: Wolters Kluwer
Molnar, B. E., Sprang, G., Killian, K. D., Gottfried, R., Emery, V., & Bride, B. E. (2017).
Advancing science and practice for vicarious traumatization/secondary traumatic stress:
A research agenda. Traumatology, 23(2), 129-142. doi:10.1037/trm0000122

VICARIOUS TRAUMA IN LAW ENFORCEMENT

22

National Alliance on Mental Illness. (2019). Law enforcement officers. Retrieved from
https://www.nami.org/Law-Enforcement-and-Mental-Health/Strengthening-OfficerResilience
Office of Justice Programs. (2019). Vicarious trauma toolkit: What is vicarious trauma?
Retrieved from https://vtt.ovc.ojp.gov/what-is-vicarious-trauma
Patterson, G. T., Chung, I. W., & Swan, P. W. (2014). Stress management interventions for
police officers and recruits: A meta-analysis. Journal of Experimental Criminology,
10(4), 487-513. doi:10.1007/s11292-014-9214-7
Possemato, K., Bergen-Cico, D., Treatman, S., Allen, C., Wade, M., & Pigeon, W. (2015). A
randomized clinical trial of primary care brief mindfulness training for veterans with
PTSD. Journal of Clinical Psychology, 72(3), 179-193. doi:10.1002/jclp.22241
Ramey, S., Perkhounkova, Y., Hein, M., Chung, S., Franke, W., & Anderson, A. (2016).
Building resilience in an urban police department. Journal of Occupational and
Environmental Medicine, 58(8), 796-804.doi: 10.1097/jom.0000000000000791
Regehr, C., & LeBlanc, V.R. (2017). PTSD, acute stress, performance and decision-making in
emergency service workers. Journal of the American Academy of Psychiatry and the
Law, 45(2), 184-192. doi:10.1037/t12199-000
Robertson, I. T., Cooper, C. L., Sarkar, M., & Curran, T. (2015). Resilience training in the
workplace from 2003 to 2014: A systematic review. Journal of Occupational and
Organizational Psychology, 88(3), 533-562. doi:10.1111/joop.12120
Sadock, B., Sadock, V. & Ruiz, P. (2015). Kaplan and Sadock's synopsis of psychiatry:
Behavioral sciences/clinical psychiatry. Philadelphia, PA: Lippincott, Williams &
Wilkins

VICARIOUS TRAUMA IN LAW ENFORCEMENT

23

Schaffer, M. A., Sandau, K. E., & Diedrick, L. (2012). Evidence-based practice models for
organizational change: Overview and practical applications. Journal of Advanced
Nursing, 69(5), 1197-1209. doi:10.1111/j.1365-2648.2012.06122.x
Selye, H. (1936). A syndrome produced by diverse nocuous agents. Nature, 138, 32
Selye, H. (1978). The stress of life. New York: McGraw-Hill
Shand, F., Joyce, S., Lal, T. J., Mott, B., Bryant, R. A., & Harvey, S. B. (2019).
Resilience@work mindfulness program: Results from a cluster randomized controlled
trial with first responders. Journal of Medical Internet Research, 21(2), e12894.
doi:10.2196/1289
Stanley, I. H., Hom, M. A., & Joiner, T. E. (2016). A systematic review of suicidal thoughts and
behaviors among police officers, firefighters, EMTs, and paramedics. Clinical
Psychology Review, 44(1), 25-44. doi:10.1016/j.cpr.2015.12.002
Stevens, K. R. (2012). Star Model of EBP: Knowledge Transformation. Academic Center for
Evidence-based Practice. Retrieved from http://nursing.uthscsa.edu/onrs/starmodel/starmodel.asp
Stewart, H. (2017). Mental illness stigma expressed by police to police. The Israel journal of
Science and related Science, 15(1), 18-23
Trautmann, S., Rehm, J., & Wittchen, H. (2016). The economic costs of mental disorders. EMBO
reports, 17(9), 1245-1249. doi:10.15252/embr.20164295
Tuckey, M. R., & Scott, J. E. (2013). Group critical incident stress debriefing with emergency
services personnel: A randomized controlled trial. Anxiety, Stress, & Coping, 27(1), 3854. doi:10.1080/1061580

VICARIOUS TRAUMA IN LAW ENFORCEMENT

24
Appendix A
Evaluation Table

Table A.1
Citation

Anderson et
al., (2016).
A training
method to
improve
police use of
force
decisionmaking: A
randomized
controlled
trial.
Funding:
No financial
support.

Conceptual
Framework
Neurobiology
and Learning
Theory

Design/Method

Sample/Setting

Design:
RCT

N=12
n TRT = 6
n CNTL = 6

Purpose:
Improved use of
force decisions
during critical
incidents.

Setting:
Police
University
College of
Finland campus
Sample
Demographics:
12 Caucasian
m, M age of
31.5, M police
service 4.68
years, M SRT
2.8 years

Major
Variables &
Definitions
IV1: 3 days of
“iPREP
training”
IV2: “TAU”
DV1: SA (DH
& WH)
DV2:Use of
force decisions
DV3:
Physiological
arousal (HR)
DV4: SRS

Measurement

Analysis

Maximum HR,
BP,
10-point scale
appropriate of
decision
making, and
self-reported
surveys.

Shapiro–
Wilk test,
independent
samples t
tests, Mann–
Whitney U
tests,
Fisher’s
exact chisquare tests,
t-tests, and
Cohen’s d.
two expert
raters
coding,
Statistical
analysis
conducted
using PASW
V 20.

Findings

DV1: TRT
performed
significantly
better than
CNTL
(DH)
t (10) = 4.838
p = .001
d = 2.79
(WH)
t(10) = 5.406
p = < .000
d = 3.12

Decision for Use

LOE: I
Strengths: SRT trainers were
blinded to study questions,
random assignment to reduce
small n failure, reliable
instruments and outcome
variables measured during
multiple scenarios.
Weaknesses: Small sample
size, self-report measures,
and incomplete data.

Conclusions: Resilience
DV2: TRT
education with use of force
performed
training improved SA,
Definitions:
significantly
performance, and a greater
Bias:
“iPREP
None
better than
number of correct use of
training”
a) education
CNTL
force decisions.
Inclusion
about the
t (10) = 4.025
Country:
Criteria:
Key: AC – academic settings; AfAm – African American; ALT – altered; ANOVA – analysis of variance; AR – autonomic response; BMT – brief mindfulness training; BP–
blood pressure; α – Chronbach’s alpha; CBT – Cognitive Behavioral Therapy; CC – correlation coefficient; CI – confidence interval; CNTL – control group; CTSA –
clinical and translational science award; CV – cardiovascular; CVD –cardiovascular disease; DASP – data analytic software package; DH – drug house; DQ – descriptive
qualitative; DS – descriptive statistics; DV – dependent variable; EMDR – Eye Movement Desensitization and Reprocessing; ES – effect size; CISD– crisis intervention stress
debriefing; EXP – experience; FB – fairly bad; FBI –Federal Bureau of Investigations; FG – fairly good; FL – Florida; FR - First Responder; HBA1C – glycated hemoglobin
HCL – Hypercholesterolemia; HR – heat rate; HRV –heart rate variability; HTN – high blood pressure; iPREP – international performance resilience and efficiency
program; I – independently; IV – independent variable; K score – interater reliability; LOE – level of evidence; M – mean; MA – meta-analysis; MBRT – MindfulnessBased Resilience Training; MM – mixed method; MPD – Milwaukee Police Department; n – group sample size studies; N – total number of participants; NCATS – National
Center for Translational Science ; NRNCT – non-randomized control trials; OES – open ended survey questionnaire; OR – Operation Restore; P – p value; PA – police
academy; PASW– predictive analytics software; PCL – posttraumatic checklist; PHQ-9– patient health questionnaire; PHYS – physiological; PR – performance ratings; PS
– parasympathetic ; PSYCH – psychological; PT – physical training; pt. – patient; PTGI – Posttraumatic Growth Inventory; PTSD – Posttraumatic Stress Disorder; Q –
question; RCT – randomized control trials; RS – random sample; RTI – resilience training interventions; SA – situational awareness; SE – standard error; SQ – sleep quality;
SR – systematic review; SRS – self reported stress; SRT - Special Response Team; TAU – training as usual; TM – telementor; TRT– treatment group; USA – United States
of America; V – version; VG – very good; W – white; WH – warehouse; WI – Wisconsin; WKS – week

VICARIOUS TRAUMA IN LAW ENFORCEMENT
Citation

Conceptual
Framework

Design/Method

Finland

Sample/Setting

Gender, close in
age, SRT ~ 2
years EXP,
prior training
exposure,
Attrition: 1
(17%)

Citation

Conceptual
Framework

Design/Method

Sample/Setting

25
Major
Variables &
Definitions
physiology of
the stress
response (b)
SA in
performance
and nonperformance
settings; (c)
instruction and
use of
biofeedback to
practice
engaging in
controlled
breathing
exercises
stress
“TAU”
shooting
targets, active
PT, and
undercover
pursuit of
criminals
Major
Variables &
Definitions

Measurement

Analysis

Findings

p < .01
d = 2.32
DV3: TRT
HR were
lower than
CNTL

Decision for Use

Feasibility/ Applicability to
pt. population:
Recommended for use in FRs
due to effectiveness in
improving SA, performance,
and psychophysiological
control.

t = - 4.30
p < .003
d = - 2.72
DV4: M
scores ranged
from 5.33 –
8.33 on 10
point scale,
CNTL
reported
higher levels
of confidence
than TRT
p < .05
Measurement

Analysis

Findings

Decision for Use

Key: AC – academic settings; AfAm – African American; ALT – altered; ANOVA – analysis of variance; AR – autonomic response; BMT – brief mindfulness training; BP–
blood pressure; α – Chronbach’s alpha; CBT – Cognitive Behavioral Therapy; CC – correlation coefficient; CI – confidence interval; CNTL – control group; CTSA –
clinical and translational science award; CV – cardiovascular; CVD –cardiovascular disease; DASP – data analytic software package; DH – drug house; DQ – descriptive
qualitative; DS – descriptive statistics; DV – dependent variable; EMDR – Eye Movement Desensitization and Reprocessing; ES – effect size; CISD– crisis intervention stress
debriefing; EXP – experience; FB – fairly bad; FBI –Federal Bureau of Investigations; FG – fairly good; FL – Florida; FR - First Responder; HBA1C – glycated hemoglobin
HCL – Hypercholesterolemia; HR – heat rate; HRV –heart rate variability; HTN – high blood pressure; iPREP – international performance resilience and efficiency
program; I – independently; IV – independent variable; K score – interater reliability; LOE – level of evidence; M – mean; MA – meta-analysis; MBRT – MindfulnessBased Resilience Training; MM – mixed method; MPD – Milwaukee Police Department; n – group sample size studies; N – total number of participants; NCATS – National
Center for Translational Science ; NRNCT – non-randomized control trials; OES – open ended survey questionnaire; OR – Operation Restore; P – p value; PA – police
academy; PASW– predictive analytics software; PCL – posttraumatic checklist; PHQ-9– patient health questionnaire; PHYS – physiological; PR – performance ratings; PS
– parasympathetic ; PSYCH – psychological; PT – physical training; pt. – patient; PTGI – Posttraumatic Growth Inventory; PTSD – Posttraumatic Stress Disorder; Q –
question; RCT – randomized control trials; RS – random sample; RTI – resilience training interventions; SA – situational awareness; SE – standard error; SQ – sleep quality;
SR – systematic review; SRS – self reported stress; SRT - Special Response Team; TAU – training as usual; TM – telementor; TRT– treatment group; USA – United States
of America; V – version; VG – very good; W – white; WH – warehouse; WI – Wisconsin; WKS – week

VICARIOUS TRAUMA IN LAW ENFORCEMENT
Citation

Banks et al.,
(2015). An
overview of
the research
on
mindfulnessbased
interventions
for treating
symptoms of
posttraumatic
stress
disorder:
A systematic
review.

Funding:
Falkirk
Community
Hospital
Bias:
Cultural Bias
Country:

Conceptual
Framework
CognitiveBehavioral

Design/Method

Sample/Setting

Design:
SR

N=12

Purpose:
Evaluate
mindfulness
interventions to
treat PTSD

DS: Search
conducted on
10/14
EMBASE
(1980-2014),
OVID (19462014), MedLine
(1946-2014),
Psycinfo (18062014),
CINAHL
(1871-2014), &
PILOTS (18712014)
Inclusion
Criteria:
Intervention is
mindfulnessbased, over age
18, reliable &
validated
outcome
measure of
PTSD pre/post,
published in
English.

26
Major
Variables &
Definitions
IV:
Mindfulness
Based
Interventions
DV: PTSD
symptoms
Definition:
“MindfulnessBased
Intervention”
CBT,
meditation,
experiential
exercises,
breathing, &
movement.

Measurement

Analysis

Findings

Clinician
Administered
PTSD Scale,
Posttraumatic
Symptoms
Scale, Emotion
Regulation
Questionnaire,
& Assessment
of PTSD.

Studies were
reviewed
according to
Downs and
Black
Quality
Criteria
Checklist, a
second rater
a qualified
consultant
clinical
psychologist
, rated
three papers,
selected to
represent
different
degrees of
quality, to
measure
inter-rater
reliability.
Studies were
fully
anonymized
so that the
second rater

DV:
A majority of
the results
demonstrated
improvement
in PTSD
symptoms
postintervention
with
sustained
long-term
outcomes.

Decision for Use

LOE: I
Strengths: Specifically
focused on mindful-based
intervention outcomes for
PTSD, findings were
consistent in studies, quality
index was specified as good,
outcome measures were
robust, validated, & reliable
with inter-rater validity.
Weaknesses:
Trauma populations varied in
severity of PTSD symptoms
& diagnosis.
Conclusion:
Mindful-based interventions
improved PTSD symptoms.

Feasibility/Applicability to
pt population
Mindfulness based
interventions are effective for
decreasing PTSD symptoms
in adults.

Key: AC – academic settings; AfAm – African American; ALT – altered; ANOVA – analysis of variance; AR – autonomic response; BMT – brief mindfulness training; BP–
blood pressure; α – Chronbach’s alpha; CBT – Cognitive Behavioral Therapy; CC – correlation coefficient; CI – confidence interval; CNTL – control group; CTSA –
clinical and translational science award; CV – cardiovascular; CVD –cardiovascular disease; DASP – data analytic software package; DH – drug house; DQ – descriptive
qualitative; DS – descriptive statistics; DV – dependent variable; EMDR – Eye Movement Desensitization and Reprocessing; ES – effect size; CISD– crisis intervention stress
debriefing; EXP – experience; FB – fairly bad; FBI –Federal Bureau of Investigations; FG – fairly good; FL – Florida; FR - First Responder; HBA1C – glycated hemoglobin
HCL – Hypercholesterolemia; HR – heat rate; HRV –heart rate variability; HTN – high blood pressure; iPREP – international performance resilience and efficiency
program; I – independently; IV – independent variable; K score – interater reliability; LOE – level of evidence; M – mean; MA – meta-analysis; MBRT – MindfulnessBased Resilience Training; MM – mixed method; MPD – Milwaukee Police Department; n – group sample size studies; N – total number of participants; NCATS – National
Center for Translational Science ; NRNCT – non-randomized control trials; OES – open ended survey questionnaire; OR – Operation Restore; P – p value; PA – police
academy; PASW– predictive analytics software; PCL – posttraumatic checklist; PHQ-9– patient health questionnaire; PHYS – physiological; PR – performance ratings; PS
– parasympathetic ; PSYCH – psychological; PT – physical training; pt. – patient; PTGI – Posttraumatic Growth Inventory; PTSD – Posttraumatic Stress Disorder; Q –
question; RCT – randomized control trials; RS – random sample; RTI – resilience training interventions; SA – situational awareness; SE – standard error; SQ – sleep quality;
SR – systematic review; SRS – self reported stress; SRT - Special Response Team; TAU – training as usual; TM – telementor; TRT– treatment group; USA – United States
of America; V – version; VG – very good; W – white; WH – warehouse; WI – Wisconsin; WKS – week

VICARIOUS TRAUMA IN LAW ENFORCEMENT
Citation

Conceptual
Framework

Design/Method

USA, North
America, &
Europe

Sample/Setting

27
Major
Variables &
Definitions

Measurement

Citation

Conceptual
Framework

Design/Method

Boothroyd et
al., (2018).
Evaluation of
operation

Critical
Incident Stress
Management
Model

Design: MM –
(NRNCT) &
(pre/posttest) &

N=207
Setting:
Franciscan

Findings

Decision for Use

Findings

Decision for Use

was blind to
the
publication
authors
and journal
to reduce
any potential
bias.
Cohen’s
kappa (κ)
indicated a
substantial
level of
agreement
between the
raters (κ=
0.79).

Exclusion
Criteria:
Mixed
intervention
studies, specific
types of
meditation:
(transcendental,
loving kindness,
&
mantrumbased)
qualitative
analysis only,
lack of reliable
& validated
outcome
measure of
PTSD pre/post
Attrition:
4%-49%
Sample/Setting

Analysis

Major
Variables &
Definitions
IV: OR retreat
“a brief PTSD
intervention”.

Measurement

NRNCT:
Modified
PTGI
(α =.92)

Analysis

NRNCT:
Independent
t-tests, oneway

NRNCT:
Post
treatment

LOE: II
Strengths: A paired t-test
was used to compare PTGI

Key: AC – academic settings; AfAm – African American; ALT – altered; ANOVA – analysis of variance; AR – autonomic response; BMT – brief mindfulness training; BP–
blood pressure; α – Chronbach’s alpha; CBT – Cognitive Behavioral Therapy; CC – correlation coefficient; CI – confidence interval; CNTL – control group; CTSA –
clinical and translational science award; CV – cardiovascular; CVD –cardiovascular disease; DASP – data analytic software package; DH – drug house; DQ – descriptive
qualitative; DS – descriptive statistics; DV – dependent variable; EMDR – Eye Movement Desensitization and Reprocessing; ES – effect size; CISD– crisis intervention stress
debriefing; EXP – experience; FB – fairly bad; FBI –Federal Bureau of Investigations; FG – fairly good; FL – Florida; FR - First Responder; HBA1C – glycated hemoglobin
HCL – Hypercholesterolemia; HR – heat rate; HRV –heart rate variability; HTN – high blood pressure; iPREP – international performance resilience and efficiency
program; I – independently; IV – independent variable; K score – interater reliability; LOE – level of evidence; M – mean; MA – meta-analysis; MBRT – MindfulnessBased Resilience Training; MM – mixed method; MPD – Milwaukee Police Department; n – group sample size studies; N – total number of participants; NCATS – National
Center for Translational Science ; NRNCT – non-randomized control trials; OES – open ended survey questionnaire; OR – Operation Restore; P – p value; PA – police
academy; PASW– predictive analytics software; PCL – posttraumatic checklist; PHQ-9– patient health questionnaire; PHYS – physiological; PR – performance ratings; PS
– parasympathetic ; PSYCH – psychological; PT – physical training; pt. – patient; PTGI – Posttraumatic Growth Inventory; PTSD – Posttraumatic Stress Disorder; Q –
question; RCT – randomized control trials; RS – random sample; RTI – resilience training interventions; SA – situational awareness; SE – standard error; SQ – sleep quality;
SR – systematic review; SRS – self reported stress; SRT - Special Response Team; TAU – training as usual; TM – telementor; TRT– treatment group; USA – United States
of America; V – version; VG – very good; W – white; WH – warehouse; WI – Wisconsin; WKS – week

VICARIOUS TRAUMA IN LAW ENFORCEMENT
Citation

restore: A
brief
intervention
for first
responders
exposed to
traumatic
events.
Funding:
Franciscan
Center of
Tampa Bay,
FL.
Bias:
Selection Bias
Country:
USA

Conceptual
Framework

Design/Method

Sample/Setting

DQ (OES
questionnaire)

Center, Tampa
Bay, FL.

Purpose: To
assess PTGI
scores in FRs
after OR, a brief
PTSD
intervention in
Tampa Bay, FL

Sample
Demographics:
33.3% f, 66.7%
m) 24 to 61
years with a M
age of 42.35,
Caucasian =
77.8%, AfAm =
13%, Hispanic
= 8.7%.
27.5% selfidentified as
veterans.
Occupations:
72% police
officers, 16%
firefighters, 6%
EMS, 1.9% 911
operators, 1.9%
dispatchers, and
1.4% FBI.
Inclusion
Criteria: FRs
exposed to

28
Major
Variables &
Definitions
DV1: PrePTGI Scores
DV2: PostPTGI Scores
Q1: What
were FRs
perception of
OR?
Definition:
“Brief PTSD
Crisis
Intervention”
Stress
Debriefing is
used over 3-4
days with FRs
exposed to
traumatic
events to
lessen the
impact.

Measurement

DQ:
OES
questionnaire
(K = .67)

Analysis

ANOVA,
Pearson
Product
Moment
Correlation,
Multiple
Linear
Regression,
Cohen’s d
DQ:
OES theme
content was
analyzed
using
Dedoose a
DASP.
A RS of
three OES
transcripts
were I coded
by two
evaluators.

Findings

PTGI scores
were higher
(p < .001).
DV1:
M=2.74
p < .001
DV2:
M=3.43
t(206) =93,
p < .01
ES: 1.45
DQ:
Theme 1:
Lessons
learned
Theme 2:
Retreat
evaluation
Theme 3:
PTSD

Decision for Use

scores pre/post showed a
statistically significant
increase in scores. Cohen’s d
scores pre/post represented a
large effect. Qualitative data
and quantitative data were
appropriately analyzed.
Weaknesses: Self- selection,
lack of a CNTL, and a
modified version of PTGI.
Conclusions: The result
showed that FRs had a
positive increase in PTGI
scores from pre/post
intervention. DQ results
indicate relief of PTSD
symptoms through increased
emotional regulation.
Feasibility/ Applicability to
pt. population:
The intervention described is
feasible and recommended
for use in practice with FRs
due to positive gains
maintained in treating PTSD.

Key: AC – academic settings; AfAm – African American; ALT – altered; ANOVA – analysis of variance; AR – autonomic response; BMT – brief mindfulness training; BP–
blood pressure; α – Chronbach’s alpha; CBT – Cognitive Behavioral Therapy; CC – correlation coefficient; CI – confidence interval; CNTL – control group; CTSA –
clinical and translational science award; CV – cardiovascular; CVD –cardiovascular disease; DASP – data analytic software package; DH – drug house; DQ – descriptive
qualitative; DS – descriptive statistics; DV – dependent variable; EMDR – Eye Movement Desensitization and Reprocessing; ES – effect size; CISD– crisis intervention stress
debriefing; EXP – experience; FB – fairly bad; FBI –Federal Bureau of Investigations; FG – fairly good; FL – Florida; FR - First Responder; HBA1C – glycated hemoglobin
HCL – Hypercholesterolemia; HR – heat rate; HRV –heart rate variability; HTN – high blood pressure; iPREP – international performance resilience and efficiency
program; I – independently; IV – independent variable; K score – interater reliability; LOE – level of evidence; M – mean; MA – meta-analysis; MBRT – MindfulnessBased Resilience Training; MM – mixed method; MPD – Milwaukee Police Department; n – group sample size studies; N – total number of participants; NCATS – National
Center for Translational Science ; NRNCT – non-randomized control trials; OES – open ended survey questionnaire; OR – Operation Restore; P – p value; PA – police
academy; PASW– predictive analytics software; PCL – posttraumatic checklist; PHQ-9– patient health questionnaire; PHYS – physiological; PR – performance ratings; PS
– parasympathetic ; PSYCH – psychological; PT – physical training; pt. – patient; PTGI – Posttraumatic Growth Inventory; PTSD – Posttraumatic Stress Disorder; Q –
question; RCT – randomized control trials; RS – random sample; RTI – resilience training interventions; SA – situational awareness; SE – standard error; SQ – sleep quality;
SR – systematic review; SRS – self reported stress; SRT - Special Response Team; TAU – training as usual; TM – telementor; TRT– treatment group; USA – United States
of America; V – version; VG – very good; W – white; WH – warehouse; WI – Wisconsin; WKS – week

VICARIOUS TRAUMA IN LAW ENFORCEMENT
Citation

Conceptual
Framework

Design/Method

Sample/Setting

29
Major
Variables &
Definitions

Measurement

Analysis

Findings

Decision for Use

Major
Variables &
IV:
MindfulnessBased
Resilience
Training
(MBRT)

Measurement

Analysis

Findings

Decision for Use

NRNCT:
Brief
Resilience
Scale
pre-MBRT α
=.87; postMBRT α = .90
Oldenburg
Burnout
Inventory
pre-MBRT α
=.85; postMBRT α = .88

NRNCT:
Nonparamet
ric biascorrected
bootstrappin
g with
10,000
resamples
testing
indirect
effect and
statistical
significance,
adhoc power
analysis,
mediation
model tested

Changes in
resilience
partially
mediated the
relationship
between
mindfulness
& burnout &
increased
mindfulness
was related to
increased
resilience
pre/post in
both fire
fighters &
police

traumatic
events that
participated in
one OR more
retreats between
2013-2018.

Citation
Kaplan et al.,
(2017). Role
of resilience
in mindfulness
training for
first
responders.
Funding:
Pacific
University
Bias:
Response bias
Country:
USA

Conceptual
Framework
Inferred to be
CognitiveBehavioral

Design/Method
Design:
MM – (NRNCT)
& (pre/posttest)
&
DQ
(Mindfulness
questionnaire)
Purpose:
Examine the
effect of
MBRT on
resilience,
mindfulness, and
burn out

Attrition:
2 (1%)
Sample/Setting
N=69
n fire-fighter =
22
n police = 47
Setting:
Pacific
University
Wellness
Center
Sample
Demographics:
Police n=47,
57% m, M age
43.53, 81%
Euro-American,

DV1:
(pre/post)
Resilience
DV2:
(pre/post)
Burnout
Q1: Does
resilience
mediate the

DQ:

LOE: II
Strengths:
Outcomes consistent with
other findings for resilience
as key mechanism of change
for stress and burnout.
Weaknesses:
Small sample size impacts
power & generalizability, no
control group, causality
cannot be made.
Conclusions:

Key: AC – academic settings; AfAm – African American; ALT – altered; ANOVA – analysis of variance; AR – autonomic response; BMT – brief mindfulness training; BP–
blood pressure; α – Chronbach’s alpha; CBT – Cognitive Behavioral Therapy; CC – correlation coefficient; CI – confidence interval; CNTL – control group; CTSA –
clinical and translational science award; CV – cardiovascular; CVD –cardiovascular disease; DASP – data analytic software package; DH – drug house; DQ – descriptive
qualitative; DS – descriptive statistics; DV – dependent variable; EMDR – Eye Movement Desensitization and Reprocessing; ES – effect size; CISD– crisis intervention stress
debriefing; EXP – experience; FB – fairly bad; FBI –Federal Bureau of Investigations; FG – fairly good; FL – Florida; FR - First Responder; HBA1C – glycated hemoglobin
HCL – Hypercholesterolemia; HR – heat rate; HRV –heart rate variability; HTN – high blood pressure; iPREP – international performance resilience and efficiency
program; I – independently; IV – independent variable; K score – interater reliability; LOE – level of evidence; M – mean; MA – meta-analysis; MBRT – MindfulnessBased Resilience Training; MM – mixed method; MPD – Milwaukee Police Department; n – group sample size studies; N – total number of participants; NCATS – National
Center for Translational Science ; NRNCT – non-randomized control trials; OES – open ended survey questionnaire; OR – Operation Restore; P – p value; PA – police
academy; PASW– predictive analytics software; PCL – posttraumatic checklist; PHQ-9– patient health questionnaire; PHYS – physiological; PR – performance ratings; PS
– parasympathetic ; PSYCH – psychological; PT – physical training; pt. – patient; PTGI – Posttraumatic Growth Inventory; PTSD – Posttraumatic Stress Disorder; Q –
question; RCT – randomized control trials; RS – random sample; RTI – resilience training interventions; SA – situational awareness; SE – standard error; SQ – sleep quality;
SR – systematic review; SRS – self reported stress; SRT - Special Response Team; TAU – training as usual; TM – telementor; TRT– treatment group; USA – United States
of America; V – version; VG – very good; W – white; WH – warehouse; WI – Wisconsin; WKS – week

VICARIOUS TRAUMA IN LAW ENFORCEMENT
Citation

Conceptual
Framework

Design/Method

Sample/Setting

13% Latino, 6%
other, yrs on the
force 13.28
Fire Fighters
n=22, 73% m,
years on the
force 13.67,
90% EuroAmerican, 4%
multiracial, 4%
Asian, 2%
AfAmer
Inclusion
Criteria:
Human subjects
approved
through the
Pacific
University IRB,
police and fire
fighters in the
Pacific
Northwest

30
Major
Variables &
Definitions
relationship
between
increases in
specific facets
of mindfulness
and decreased
burnout?

Definition:
“MBRT”
8-WK 2 hour
course with
experiential,
didactic
exercises;
including body
scan, sitting,
walking
meditations, &
mindful
movement.

Measurement

Analysis

Five Faucet
Mindfulness
Questionnaire
pre-MBRT α
=.82; postMBRT α = .88

with process
macro for
SPSS
version 22
DQ:
Exploratory
mediation
analysis

Findings

DV1:
(b=.41, SE
=.11, p < .01)
which in turn
related to a
decrease in
burnout
DV2: b= .25, SE=.12,
p = .03

Decision for Use

Increasing mindfulness can
improve resilience and
decrease burnout.
Feasibility/Applicability to
pt population:
MBRT is a recommended
intervention for first
responders to mitigate
negative impact of negative
stressors.

Theme 1:
Nonreactivity
Theme 2:
Non-judging
Theme 3:
Acting with
Awareness

Attrition:
0%
Key: AC – academic settings; AfAm – African American; ALT – altered; ANOVA – analysis of variance; AR – autonomic response; BMT – brief mindfulness training; BP–
blood pressure; α – Chronbach’s alpha; CBT – Cognitive Behavioral Therapy; CC – correlation coefficient; CI – confidence interval; CNTL – control group; CTSA –
clinical and translational science award; CV – cardiovascular; CVD –cardiovascular disease; DASP – data analytic software package; DH – drug house; DQ – descriptive
qualitative; DS – descriptive statistics; DV – dependent variable; EMDR – Eye Movement Desensitization and Reprocessing; ES – effect size; CISD– crisis intervention stress
debriefing; EXP – experience; FB – fairly bad; FBI –Federal Bureau of Investigations; FG – fairly good; FL – Florida; FR - First Responder; HBA1C – glycated hemoglobin
HCL – Hypercholesterolemia; HR – heat rate; HRV –heart rate variability; HTN – high blood pressure; iPREP – international performance resilience and efficiency
program; I – independently; IV – independent variable; K score – interater reliability; LOE – level of evidence; M – mean; MA – meta-analysis; MBRT – MindfulnessBased Resilience Training; MM – mixed method; MPD – Milwaukee Police Department; n – group sample size studies; N – total number of participants; NCATS – National
Center for Translational Science ; NRNCT – non-randomized control trials; OES – open ended survey questionnaire; OR – Operation Restore; P – p value; PA – police
academy; PASW– predictive analytics software; PCL – posttraumatic checklist; PHQ-9– patient health questionnaire; PHYS – physiological; PR – performance ratings; PS
– parasympathetic ; PSYCH – psychological; PT – physical training; pt. – patient; PTGI – Posttraumatic Growth Inventory; PTSD – Posttraumatic Stress Disorder; Q –
question; RCT – randomized control trials; RS – random sample; RTI – resilience training interventions; SA – situational awareness; SE – standard error; SQ – sleep quality;
SR – systematic review; SRS – self reported stress; SRT - Special Response Team; TAU – training as usual; TM – telementor; TRT– treatment group; USA – United States
of America; V – version; VG – very good; W – white; WH – warehouse; WI – Wisconsin; WKS – week

VICARIOUS TRAUMA IN LAW ENFORCEMENT
Citation

Conceptual
Framework

Design/Method

Sample/Setting

Citation

Conceptual
Framework
Inferred to be
CognitiveBehavioral

Design/Method

Sample/Setting

Design:
RCT

N=281
n TRT =141
n CNTL = 140

Devilly et al.,
(2013). The
prevention of
trauma
reactions in
police
officers:
Decreasing
reliance on
drugs and
alcohol.

Purpose:
Develop and
evaluate a
resiliency
training program
designed
specifically to
help new recruit
police officers
mitigate stress
reactions.

Setting:
Victoria Police
academy

Bias:
Attrition &
Publication
Bias

Sample
Demographics
n TRT = 68 m,
73 f, M age 28,
19-50 years old
n CNTL = 76
m, 64 f, M age
28.8, 19-60
years old
Inclusion
Criteria:
Male & female
recruits for the
Victoria Police
Department

Country:

Attrition:
10%

Funding:
National Drug
Law
Enforcement
Research
Fund

31
Major
Variables &
Definitions
Major
Variables &
IV: Resilience
training
program
DV1: Health
and Wellbeing
DV2:
Affective
Distress
DV3: Trauma
Exposure/Sym
ptomology
Definition:
“Resiliency
training”
8 WKS
thought
challenging
questions,
activating
event, Belief,
consequence
worksheet,

Measurement

Analysis

Findings

Decision for Use

Measurement

Analysis

Findings

Decision for Use

Depression
Stress, &
Anxiety Scale
- 21 item
α pre/post =
.94, .87,
Distress
Endorsement
Validation
Scale (α =
0.84),
Credibility /
Expectancy
Questionnaire
(α = 0.84 0.85)

Analyses
were
conducted
using
Statistical
version 6.1
and Clinical
Tools
Version 4,
repeated
ANOVA,
effect size,
Hedges g,
Spearman
rank
correlations

At 6 months

LOE: I

DV1:
Resilience
training
demonstrated
a significant
increase in
health over
time in the
TRT group.
(F(1,
278)=4.63,
p<0.04), and
this
represented a
small effect
size (Hedges’
ĝ=0.14, 95%
CI: -0.30, 0.03).

Strengths:
There is a strong positive
relationship between
stressors and symptoms for
the control condition, this
was greatly reduced or
eradicated for the resilience
condition.

When
compared to
the CNTL
group the

Weaknesses: Follow-up at 6
months may not have
accurately depicted sustained
results, a larger sample size
may have detected very small
effects, & test-retest liability
was low.
Conclusions:
There is a relationship
between trauma symptoms &
substance involvement.
Resilience training can
decrease trauma symptoms.

Key: AC – academic settings; AfAm – African American; ALT – altered; ANOVA – analysis of variance; AR – autonomic response; BMT – brief mindfulness training; BP–
blood pressure; α – Chronbach’s alpha; CBT – Cognitive Behavioral Therapy; CC – correlation coefficient; CI – confidence interval; CNTL – control group; CTSA –
clinical and translational science award; CV – cardiovascular; CVD –cardiovascular disease; DASP – data analytic software package; DH – drug house; DQ – descriptive
qualitative; DS – descriptive statistics; DV – dependent variable; EMDR – Eye Movement Desensitization and Reprocessing; ES – effect size; CISD– crisis intervention stress
debriefing; EXP – experience; FB – fairly bad; FBI –Federal Bureau of Investigations; FG – fairly good; FL – Florida; FR - First Responder; HBA1C – glycated hemoglobin
HCL – Hypercholesterolemia; HR – heat rate; HRV –heart rate variability; HTN – high blood pressure; iPREP – international performance resilience and efficiency
program; I – independently; IV – independent variable; K score – interater reliability; LOE – level of evidence; M – mean; MA – meta-analysis; MBRT – MindfulnessBased Resilience Training; MM – mixed method; MPD – Milwaukee Police Department; n – group sample size studies; N – total number of participants; NCATS – National
Center for Translational Science ; NRNCT – non-randomized control trials; OES – open ended survey questionnaire; OR – Operation Restore; P – p value; PA – police
academy; PASW– predictive analytics software; PCL – posttraumatic checklist; PHQ-9– patient health questionnaire; PHYS – physiological; PR – performance ratings; PS
– parasympathetic ; PSYCH – psychological; PT – physical training; pt. – patient; PTGI – Posttraumatic Growth Inventory; PTSD – Posttraumatic Stress Disorder; Q –
question; RCT – randomized control trials; RS – random sample; RTI – resilience training interventions; SA – situational awareness; SE – standard error; SQ – sleep quality;
SR – systematic review; SRS – self reported stress; SRT - Special Response Team; TAU – training as usual; TM – telementor; TRT– treatment group; USA – United States
of America; V – version; VG – very good; W – white; WH – warehouse; WI – Wisconsin; WKS – week

VICARIOUS TRAUMA IN LAW ENFORCEMENT
Citation

Australia

Conceptual
Framework

Design/Method

Sample/Setting

32
Major
Variables &
Definitions
guided self
dialogue, calm
breathing
exercises,
muscle
relaxation,
how to
recognize
problem
drinking
worksheet

Measurement

Analysis

Findings

TRT group
demonstrated
a decrease in
effective
distress.

Decision for Use

Feasibility/Applicability to
pt population:
Resiliency training can
mitigate the negative effects
of trauma in FRs.

DV2: M
decrease of
affective
distress =1.15
DV3:
Resilience
training may
have had an
effect on the
relationship
between
trauma
exposure and
trauma
expression,
with exposure
having less of
an effect on
trauma
symptomatol
ogy than for

Key: AC – academic settings; AfAm – African American; ALT – altered; ANOVA – analysis of variance; AR – autonomic response; BMT – brief mindfulness training; BP–
blood pressure; α – Chronbach’s alpha; CBT – Cognitive Behavioral Therapy; CC – correlation coefficient; CI – confidence interval; CNTL – control group; CTSA –
clinical and translational science award; CV – cardiovascular; CVD –cardiovascular disease; DASP – data analytic software package; DH – drug house; DQ – descriptive
qualitative; DS – descriptive statistics; DV – dependent variable; EMDR – Eye Movement Desensitization and Reprocessing; ES – effect size; CISD– crisis intervention stress
debriefing; EXP – experience; FB – fairly bad; FBI –Federal Bureau of Investigations; FG – fairly good; FL – Florida; FR - First Responder; HBA1C – glycated hemoglobin
HCL – Hypercholesterolemia; HR – heat rate; HRV –heart rate variability; HTN – high blood pressure; iPREP – international performance resilience and efficiency
program; I – independently; IV – independent variable; K score – interater reliability; LOE – level of evidence; M – mean; MA – meta-analysis; MBRT – MindfulnessBased Resilience Training; MM – mixed method; MPD – Milwaukee Police Department; n – group sample size studies; N – total number of participants; NCATS – National
Center for Translational Science ; NRNCT – non-randomized control trials; OES – open ended survey questionnaire; OR – Operation Restore; P – p value; PA – police
academy; PASW– predictive analytics software; PCL – posttraumatic checklist; PHQ-9– patient health questionnaire; PHYS – physiological; PR – performance ratings; PS
– parasympathetic ; PSYCH – psychological; PT – physical training; pt. – patient; PTGI – Posttraumatic Growth Inventory; PTSD – Posttraumatic Stress Disorder; Q –
question; RCT – randomized control trials; RS – random sample; RTI – resilience training interventions; SA – situational awareness; SE – standard error; SQ – sleep quality;
SR – systematic review; SRS – self reported stress; SRT - Special Response Team; TAU – training as usual; TM – telementor; TRT– treatment group; USA – United States
of America; V – version; VG – very good; W – white; WH – warehouse; WI – Wisconsin; WKS – week

VICARIOUS TRAUMA IN LAW ENFORCEMENT
Citation

Conceptual
Framework

Design/Method

Sample/Setting

33
Major
Variables &
Definitions

Measurement

Analysis

Findings

Decision for Use

the control
group.
nCNTL;R(s)
=0.24,
N=111,
p=0.01

Citation

Patterson et
al., (2014).
Stress
management
interventions
for police
officers and
recruits:
A metaanalysis.

Conceptual
Framework
Inferred to be
CognitiveBehavioral

Design/Method

Sample/Setting

Design:
MA

N=12 studies
n=906
participants

Purpose:
Examine the
effects of stress
management
interventions in
police and
recruits.

Sample
Demographics:
M age 34.48,
10.77 years of
police
experience.
DS: Specific
names of DS

Major
Variables &
Definitions
IV:
Stress
Management
Interventions
DV1:
Physiological
DV2:
Psychological
DV3:
Behavioral

Measurement

Analysis

Police Stress
Survey (α not
reported),
Police Daily
Hassles(α =.77
-.93), Police
Daily Uplifts
(α =.52 - .92),
Operational
Police Stress
Questionnaire
(α =.90),

MA was
performed
using
Comprehens
ive MA
Version
2.2.050,
effect sizes
were
separated
out by
outcome
type,

nTRT;;
R(s)=0.11,
N=118,
p=0.25 R
Findings

DV1: Hedges
g=0.196,
p>.05, 95 %
CI=−0.187,
0.578
DV2:
(Hedges
g=0.038,
p>.05, 95 %
CI=−0.155,
0.230)Over

Decision for Use

LOE: I
Strengths: Nine of the
studies reviewed represent
high quality regarding
internal validity.
Heterogeneity was observed
in physiological results
across three studies and
psychological results
contributing to a larger
common effect.

Key: AC – academic settings; AfAm – African American; ALT – altered; ANOVA – analysis of variance; AR – autonomic response; BMT – brief mindfulness training; BP–
blood pressure; α – Chronbach’s alpha; CBT – Cognitive Behavioral Therapy; CC – correlation coefficient; CI – confidence interval; CNTL – control group; CTSA –
clinical and translational science award; CV – cardiovascular; CVD –cardiovascular disease; DASP – data analytic software package; DH – drug house; DQ – descriptive
qualitative; DS – descriptive statistics; DV – dependent variable; EMDR – Eye Movement Desensitization and Reprocessing; ES – effect size; CISD– crisis intervention stress
debriefing; EXP – experience; FB – fairly bad; FBI –Federal Bureau of Investigations; FG – fairly good; FL – Florida; FR - First Responder; HBA1C – glycated hemoglobin
HCL – Hypercholesterolemia; HR – heat rate; HRV –heart rate variability; HTN – high blood pressure; iPREP – international performance resilience and efficiency
program; I – independently; IV – independent variable; K score – interater reliability; LOE – level of evidence; M – mean; MA – meta-analysis; MBRT – MindfulnessBased Resilience Training; MM – mixed method; MPD – Milwaukee Police Department; n – group sample size studies; N – total number of participants; NCATS – National
Center for Translational Science ; NRNCT – non-randomized control trials; OES – open ended survey questionnaire; OR – Operation Restore; P – p value; PA – police
academy; PASW– predictive analytics software; PCL – posttraumatic checklist; PHQ-9– patient health questionnaire; PHYS – physiological; PR – performance ratings; PS
– parasympathetic ; PSYCH – psychological; PT – physical training; pt. – patient; PTGI – Posttraumatic Growth Inventory; PTSD – Posttraumatic Stress Disorder; Q –
question; RCT – randomized control trials; RS – random sample; RTI – resilience training interventions; SA – situational awareness; SE – standard error; SQ – sleep quality;
SR – systematic review; SRS – self reported stress; SRT - Special Response Team; TAU – training as usual; TM – telementor; TRT– treatment group; USA – United States
of America; V – version; VG – very good; W – white; WH – warehouse; WI – Wisconsin; WKS – week

VICARIOUS TRAUMA IN LAW ENFORCEMENT
Citation

Funding:
National
Policing
Improvement
Agency,
Campbell
Collaboration
Crime, Justice
Group, &
George Mason
University
Bias:
None
recognized
Country:
USA,
Netherlands,
Canada,
Australia

Conceptual
Framework

Design/Method

Sample/Setting

were not
mentioned. 35
databases were
hand searched
involving
journals, books,
conferences,
websites,
organizations,
& relevant
citations was
conducted
ranging from
8/1/09-5/31/10.
Inclusion
Criteria:
Veteran police
officers, police
recruits, and/or
civilian (nonsworn) police
personnel) or
quasiexperimental
designs that
included a
control group, a

34
Major
Variables &
Definitions
Duration of
Stress
Management
interventions
were 10.95
hours, range
30 minutes to
24 hours

Measurement

Analysis

Findings

Decision for Use

Organizational
Police Stress
Questionnaire
(α =.90).

multiple
outcomes
were
averaged.
effect sizes
were not
averaged
across
different
outcome
types, effect
sizes were
calculated
using
reported
means,
standard
deviations &
sample
sizes. Some
effect sizes
were
calculated
using
Hedges g,
Cohen’s d
and t-test
results.

all M effect =
.038

Weaknesses:
The interventions varied with
the outcomes and
inconsistencies were noted
in measurement approaches.

DV3:
(Hedges
g=−0.176,
p>.05, 95 %
CI=−0.719,
0.367)

Conclusions:
A specific intervention needs
to address specific types of
stress. Agencies need to
evaluate stress interventions
and outcomes.
Feasibility/Applicability to
pt population:
Specific organizational
stressors may not be feasible
to address involving
workload, shift work, and
excessive paperwork.
Targeting specific stressors
using interventions to achieve
desired outcomes for
reducing stress is
recommended in FRs.

Key: AC – academic settings; AfAm – African American; ALT – altered; ANOVA – analysis of variance; AR – autonomic response; BMT – brief mindfulness training; BP–
blood pressure; α – Chronbach’s alpha; CBT – Cognitive Behavioral Therapy; CC – correlation coefficient; CI – confidence interval; CNTL – control group; CTSA –
clinical and translational science award; CV – cardiovascular; CVD –cardiovascular disease; DASP – data analytic software package; DH – drug house; DQ – descriptive
qualitative; DS – descriptive statistics; DV – dependent variable; EMDR – Eye Movement Desensitization and Reprocessing; ES – effect size; CISD– crisis intervention stress
debriefing; EXP – experience; FB – fairly bad; FBI –Federal Bureau of Investigations; FG – fairly good; FL – Florida; FR - First Responder; HBA1C – glycated hemoglobin
HCL – Hypercholesterolemia; HR – heat rate; HRV –heart rate variability; HTN – high blood pressure; iPREP – international performance resilience and efficiency
program; I – independently; IV – independent variable; K score – interater reliability; LOE – level of evidence; M – mean; MA – meta-analysis; MBRT – MindfulnessBased Resilience Training; MM – mixed method; MPD – Milwaukee Police Department; n – group sample size studies; N – total number of participants; NCATS – National
Center for Translational Science ; NRNCT – non-randomized control trials; OES – open ended survey questionnaire; OR – Operation Restore; P – p value; PA – police
academy; PASW– predictive analytics software; PCL – posttraumatic checklist; PHQ-9– patient health questionnaire; PHYS – physiological; PR – performance ratings; PS
– parasympathetic ; PSYCH – psychological; PT – physical training; pt. – patient; PTGI – Posttraumatic Growth Inventory; PTSD – Posttraumatic Stress Disorder; Q –
question; RCT – randomized control trials; RS – random sample; RTI – resilience training interventions; SA – situational awareness; SE – standard error; SQ – sleep quality;
SR – systematic review; SRS – self reported stress; SRT - Special Response Team; TAU – training as usual; TM – telementor; TRT– treatment group; USA – United States
of America; V – version; VG – very good; W – white; WH – warehouse; WI – Wisconsin; WKS – week

VICARIOUS TRAUMA IN LAW ENFORCEMENT
Citation

Conceptual
Framework

Design/Method

Sample/Setting

35
Major
Variables &
Definitions

Measurement

Analysis

Findings

Decision for Use

psychosocial or
other type of
stress
management
intervention,
quantitative
outcomes
although studies
that utilized
qualitative
methods (focus
groups,
interviews)
were included
as long as these
studies focus on
the
interventions
examined in the
RCT studies, &
published and
non-published
studies
conducted in
any geographic
location.
Attrition:
Key: AC – academic settings; AfAm – African American; ALT – altered; ANOVA – analysis of variance; AR – autonomic response; BMT – brief mindfulness training; BP–
blood pressure; α – Chronbach’s alpha; CBT – Cognitive Behavioral Therapy; CC – correlation coefficient; CI – confidence interval; CNTL – control group; CTSA –
clinical and translational science award; CV – cardiovascular; CVD –cardiovascular disease; DASP – data analytic software package; DH – drug house; DQ – descriptive
qualitative; DS – descriptive statistics; DV – dependent variable; EMDR – Eye Movement Desensitization and Reprocessing; ES – effect size; CISD– crisis intervention stress
debriefing; EXP – experience; FB – fairly bad; FBI –Federal Bureau of Investigations; FG – fairly good; FL – Florida; FR - First Responder; HBA1C – glycated hemoglobin
HCL – Hypercholesterolemia; HR – heat rate; HRV –heart rate variability; HTN – high blood pressure; iPREP – international performance resilience and efficiency
program; I – independently; IV – independent variable; K score – interater reliability; LOE – level of evidence; M – mean; MA – meta-analysis; MBRT – MindfulnessBased Resilience Training; MM – mixed method; MPD – Milwaukee Police Department; n – group sample size studies; N – total number of participants; NCATS – National
Center for Translational Science ; NRNCT – non-randomized control trials; OES – open ended survey questionnaire; OR – Operation Restore; P – p value; PA – police
academy; PASW– predictive analytics software; PCL – posttraumatic checklist; PHQ-9– patient health questionnaire; PHYS – physiological; PR – performance ratings; PS
– parasympathetic ; PSYCH – psychological; PT – physical training; pt. – patient; PTGI – Posttraumatic Growth Inventory; PTSD – Posttraumatic Stress Disorder; Q –
question; RCT – randomized control trials; RS – random sample; RTI – resilience training interventions; SA – situational awareness; SE – standard error; SQ – sleep quality;
SR – systematic review; SRS – self reported stress; SRT - Special Response Team; TAU – training as usual; TM – telementor; TRT– treatment group; USA – United States
of America; V – version; VG – very good; W – white; WH – warehouse; WI – Wisconsin; WKS – week

VICARIOUS TRAUMA IN LAW ENFORCEMENT
Citation

Conceptual
Framework

Design/Method

Sample/Setting

36
Major
Variables &
Definitions

Measurement

Analysis

Findings

Decision for Use

Major
Variables &
Definitions

Measurement

Analysis

Findings

Decision for Use

HRV
analyzed
with Kubios
HRV
software,
Cohen’s d,
Pearson’s
CC,
ANOVA,
two-sided ttest

DV1:(r= .66, p < .001,
n = 26)

Not discussed.
Citation

Ramey et al.,
(2016).
Building
resilience in
an urban
police
department.
Funding:
Pilot A funded
by the
National
Institute of
Occupational
Safety and
Health. Pilot
B funded by
USA
Department of
Justice.
Bias:

Conceptual
Framework

Specific
operational
stress control

Design/Method

Sample/Setting

Design:
RCT

N=38
n TRT=20
(Pilot A)
n CNTL=18
(Pilot B)

Purpose:
Examine RTI
impacts on AR
to stress and
improve CV
risk, psych, &
phys outcomes

Sample
Demographics:
TRT=
M age – 24.4
m/f– 82.4%/0
AfAm – 29.4%
W – 58.8%
Exercise –
100%
HTN – 17.7%
HCL – 5.9%
SQ:
VG – 11.8%
FG – 82.4%
FB – 5.9%

IV1: 2 hr
“education
class”+“mentoring
component” +
additional
session for alt.
breathing/HR

Perceived
Stress Scale
(α = 0.75)

IV2: 2 hr
education class

Impact Events
Scale
(α = 0.87)

DV1:
HbA1c

Maastricht
Questionnaire
9-item Form B
(α = 0 .83)

DV2:
Self-reported
stress

Personal and
Organizational
Quality
Assessment
α = (0.76-0.92)

DV3:
HRV

Response to
Stressful

DV2: (r= .44, p= .03,
n=24)
DV3: M PS
component
increased by
2.5 on work
days (p= .03,
d= 0.43), off
workdays by
2.6 days
p=.03,
d=.43).

LOE: I
Strengths:
RCT design, reliable
instruments, and n=10
participants in education
class to promote
participation.
Weaknesses:
Retention of participants in
Pilot A was higher, high
variability in outcomes, and
small number of participants.
Conclusions: Resiliency
education can improve CVD
risk factors by improving
HRV.
Feasibility/ Applicability to
pt. population:

Key: AC – academic settings; AfAm – African American; ALT – altered; ANOVA – analysis of variance; AR – autonomic response; BMT – brief mindfulness training; BP–
blood pressure; α – Chronbach’s alpha; CBT – Cognitive Behavioral Therapy; CC – correlation coefficient; CI – confidence interval; CNTL – control group; CTSA –
clinical and translational science award; CV – cardiovascular; CVD –cardiovascular disease; DASP – data analytic software package; DH – drug house; DQ – descriptive
qualitative; DS – descriptive statistics; DV – dependent variable; EMDR – Eye Movement Desensitization and Reprocessing; ES – effect size; CISD– crisis intervention stress
debriefing; EXP – experience; FB – fairly bad; FBI –Federal Bureau of Investigations; FG – fairly good; FL – Florida; FR - First Responder; HBA1C – glycated hemoglobin
HCL – Hypercholesterolemia; HR – heat rate; HRV –heart rate variability; HTN – high blood pressure; iPREP – international performance resilience and efficiency
program; I – independently; IV – independent variable; K score – interater reliability; LOE – level of evidence; M – mean; MA – meta-analysis; MBRT – MindfulnessBased Resilience Training; MM – mixed method; MPD – Milwaukee Police Department; n – group sample size studies; N – total number of participants; NCATS – National
Center for Translational Science ; NRNCT – non-randomized control trials; OES – open ended survey questionnaire; OR – Operation Restore; P – p value; PA – police
academy; PASW– predictive analytics software; PCL – posttraumatic checklist; PHQ-9– patient health questionnaire; PHYS – physiological; PR – performance ratings; PS
– parasympathetic ; PSYCH – psychological; PT – physical training; pt. – patient; PTGI – Posttraumatic Growth Inventory; PTSD – Posttraumatic Stress Disorder; Q –
question; RCT – randomized control trials; RS – random sample; RTI – resilience training interventions; SA – situational awareness; SE – standard error; SQ – sleep quality;
SR – systematic review; SRS – self reported stress; SRT - Special Response Team; TAU – training as usual; TM – telementor; TRT– treatment group; USA – United States
of America; V – version; VG – very good; W – white; WH – warehouse; WI – Wisconsin; WKS – week

VICARIOUS TRAUMA IN LAW ENFORCEMENT
Citation

Attrition Bias
in Pilot B
Country:
USA

Conceptual
Framework

Design/Method

Sample/Setting

CNTL=
M age – 27
m/f – 82.4%/0
AfAm – 5.9%
W – 88.2%
Exercise –
100%
HTN – 35.3%
HCL – 23.5%
SQ:
VG – 17.7%
FG – 52.9%
FB – 29.4%
Setting:
PA for MPD
located in
Milwaukee, WI

37
Major
Variables &
Definitions
Definition:
“Education
class”
Resiliency
education
includes:
triggers of
stress/
awareness,
modifying AR,
& focusing on
the positive.

Measurement

Experiences
Scale
α = (0.91-0.93)

Analysis

Findings

Decision for Use

Recommended for use in
practice with FRs due to
effectiveness of intervention.

HR monitors
A non-fasting
blood sample
Health/Lifestyl
e questionnaire

“Mentoring
component”
4 tm sessions,
every 2-3 wks

Inclusion
Criteria:
PA recruits for
MPD.
Attrition:
2 (5%)

Key: AC – academic settings; AfAm – African American; ALT – altered; ANOVA – analysis of variance; AR – autonomic response; BMT – brief mindfulness training; BP–
blood pressure; α – Chronbach’s alpha; CBT – Cognitive Behavioral Therapy; CC – correlation coefficient; CI – confidence interval; CNTL – control group; CTSA –
clinical and translational science award; CV – cardiovascular; CVD –cardiovascular disease; DASP – data analytic software package; DH – drug house; DQ – descriptive
qualitative; DS – descriptive statistics; DV – dependent variable; EMDR – Eye Movement Desensitization and Reprocessing; ES – effect size; CISD– crisis intervention stress
debriefing; EXP – experience; FB – fairly bad; FBI –Federal Bureau of Investigations; FG – fairly good; FL – Florida; FR - First Responder; HBA1C – glycated hemoglobin
HCL – Hypercholesterolemia; HR – heat rate; HRV –heart rate variability; HTN – high blood pressure; iPREP – international performance resilience and efficiency
program; I – independently; IV – independent variable; K score – interater reliability; LOE – level of evidence; M – mean; MA – meta-analysis; MBRT – MindfulnessBased Resilience Training; MM – mixed method; MPD – Milwaukee Police Department; n – group sample size studies; N – total number of participants; NCATS – National
Center for Translational Science ; NRNCT – non-randomized control trials; OES – open ended survey questionnaire; OR – Operation Restore; P – p value; PA – police
academy; PASW– predictive analytics software; PCL – posttraumatic checklist; PHQ-9– patient health questionnaire; PHYS – physiological; PR – performance ratings; PS
– parasympathetic ; PSYCH – psychological; PT – physical training; pt. – patient; PTGI – Posttraumatic Growth Inventory; PTSD – Posttraumatic Stress Disorder; Q –
question; RCT – randomized control trials; RS – random sample; RTI – resilience training interventions; SA – situational awareness; SE – standard error; SQ – sleep quality;
SR – systematic review; SRS – self reported stress; SRT - Special Response Team; TAU – training as usual; TM – telementor; TRT– treatment group; USA – United States
of America; V – version; VG – very good; W – white; WH – warehouse; WI – Wisconsin; WKS – week

VICARIOUS TRAUMA IN LAW ENFORCEMENT
Citation

Conceptual
Framework

Design/Method

Sample/Setting

Citation

Conceptual
Framework

Design/Method

Sample/Setting

Possemato et
al., (2017). A
randomized
control trial of
primary care
brief
mindfulness
training for
veterans with
PTSD.

Inferred to be
Cognitive
Behavioral

Design: RCT

N=62
nTRT= 36
nCNTL= 26

Funding:
Syracuse VA
Medical
Center
Bias:
Attrition bias
in TRT group.
Country:
USA

Purpose: Test
if BMT can
decrease the
severity of
PTSD symptoms
and depression

Setting:
Syracuse NY
VA Medical
Center
Sample
Demographics:
87.1% m,
12.9% f, M age
46, W=82.3%
H=3.2%
Diagnostic level
PTSD=48%
Sub-threshold
PTSD=52%
Inclusion
Criteria:
Enrolled in VA
for services,
adults, at least a

38
Major
Variables &
Definitions
Major
Variables &
Definitions

Measurement

Analysis

Findings

Decision for Use

Measurement

Analysis

Findings

Decision for Use

ANOVA
using SPSS
version 22,
bootstrap
sample used
to replace
original
TRT sample
calculating
the indirect
effect 5000
times,
Cohen’s d,
intent to
treat
analysis,
Rosenthal’s
formula,
estimation
maximizatio
n algorithm.

At 8 WKS
the TRT
group
demonstrated
significant
improvement
when
compared to
the CNTL
DV1:
F(2,39)=2.1,
p = .16
d = .45
DV2:
F (1,40) = 4.1
p =.03
d= .99

IV1: BMT
IV2: TAU

PCL-5
α = (0.90-0.95)

DV1: PTSD
DV2:
Depression

PHQ-9
α = (0.87-0.90)

Definition:
“BMT” is 4,
90 minute
sessions sitting
medication,
body scan,
moving
meditation,
gentle yoga &
group
discussions.
“TAU” is a
PTSD psycho
educational
class

LOE: I
Strengths: RCT and reliable
instruments. Describing
internal experiences were
thought to contribute to a
decrease in PTSD symptoms
that are consistent findings
with previous research and
theoretical evidence.
Weaknesses: Low
participant engagement in
BMT due to poor
understanding of purpose and
contents. Significant for
working with populations
with trauma history to
promote buy-in. F results not
discussed.
Low n resulting in
diminished statistical power.
Conclusions: BMT
decreased depression and

Key: AC – academic settings; AfAm – African American; ALT – altered; ANOVA – analysis of variance; AR – autonomic response; BMT – brief mindfulness training; BP–
blood pressure; α – Chronbach’s alpha; CBT – Cognitive Behavioral Therapy; CC – correlation coefficient; CI – confidence interval; CNTL – control group; CTSA –
clinical and translational science award; CV – cardiovascular; CVD –cardiovascular disease; DASP – data analytic software package; DH – drug house; DQ – descriptive
qualitative; DS – descriptive statistics; DV – dependent variable; EMDR – Eye Movement Desensitization and Reprocessing; ES – effect size; CISD– crisis intervention stress
debriefing; EXP – experience; FB – fairly bad; FBI –Federal Bureau of Investigations; FG – fairly good; FL – Florida; FR - First Responder; HBA1C – glycated hemoglobin
HCL – Hypercholesterolemia; HR – heat rate; HRV –heart rate variability; HTN – high blood pressure; iPREP – international performance resilience and efficiency
program; I – independently; IV – independent variable; K score – interater reliability; LOE – level of evidence; M – mean; MA – meta-analysis; MBRT – MindfulnessBased Resilience Training; MM – mixed method; MPD – Milwaukee Police Department; n – group sample size studies; N – total number of participants; NCATS – National
Center for Translational Science ; NRNCT – non-randomized control trials; OES – open ended survey questionnaire; OR – Operation Restore; P – p value; PA – police
academy; PASW– predictive analytics software; PCL – posttraumatic checklist; PHQ-9– patient health questionnaire; PHYS – physiological; PR – performance ratings; PS
– parasympathetic ; PSYCH – psychological; PT – physical training; pt. – patient; PTGI – Posttraumatic Growth Inventory; PTSD – Posttraumatic Stress Disorder; Q –
question; RCT – randomized control trials; RS – random sample; RTI – resilience training interventions; SA – situational awareness; SE – standard error; SQ – sleep quality;
SR – systematic review; SRS – self reported stress; SRT - Special Response Team; TAU – training as usual; TM – telementor; TRT– treatment group; USA – United States
of America; V – version; VG – very good; W – white; WH – warehouse; WI – Wisconsin; WKS – week

VICARIOUS TRAUMA IN LAW ENFORCEMENT
Citation

Conceptual
Framework

Design/Method

Sample/Setting

39
Major
Variables &
Definitions

Measurement

Analysis

Findings

score of 31 on
PCL-5, and
DSM-V
qualifying
criterion A for a
traumatic event.

Citation

Conceptual
Framework

Shand et al.,
(2019).
Resilience@w
ork
mindfulness
program:
Results from a
cluster
randomized
controlled trial

Inferred to be
CognitiveBehavioral

Design/Method

Design:
RCT
Purpose:
Examine if a
mindfulness
resilience
training program
delivered via
internet can

Attrition:
May have failed
to achieve
statistical
significance
consequent to
attrition.
Sample/Setting

N=544
n TRT= 268
n CNTL= 272
Setting:
Fire and Rescue
Station in New
South Wales
Sample
Demographics:

Decision for Use

anxiety from pre to post
intervention. Outcomes were
maintained at 8WKS.
Feasibility/ Applicability to
pt. population:
Described as feasible and
recommended in practice due
to effectiveness for treating
pts with PTSD.

Major
Variables &
Definitions
IV:
Mindfulness
Resilience
Training
DV:
Resilience
Definition:
“Resiliency@
Work”

Measurement

ConnorDavidson
Resilience
Scale
α = .81-.88
Brief
Resilience
Scale
α= .86-.90

Analysis

Intent to
treat, mixed
method
repeated
measures,
group by
time
interaction,
priori
planned per
protocol

Findings

Decision for Use

At 6 months

LOE: I

DV:
n TRT
compared to
n CNTL
group (p =
.002)

Strengths:
Strong statistical methods,
results consistent with other
studies.

resilience
scores

Weaknesses:
High prevalence of males
resulting in lack of
generalizability

Key: AC – academic settings; AfAm – African American; ALT – altered; ANOVA – analysis of variance; AR – autonomic response; BMT – brief mindfulness training; BP–
blood pressure; α – Chronbach’s alpha; CBT – Cognitive Behavioral Therapy; CC – correlation coefficient; CI – confidence interval; CNTL – control group; CTSA –
clinical and translational science award; CV – cardiovascular; CVD –cardiovascular disease; DASP – data analytic software package; DH – drug house; DQ – descriptive
qualitative; DS – descriptive statistics; DV – dependent variable; EMDR – Eye Movement Desensitization and Reprocessing; ES – effect size; CISD– crisis intervention stress
debriefing; EXP – experience; FB – fairly bad; FBI –Federal Bureau of Investigations; FG – fairly good; FL – Florida; FR - First Responder; HBA1C – glycated hemoglobin
HCL – Hypercholesterolemia; HR – heat rate; HRV –heart rate variability; HTN – high blood pressure; iPREP – international performance resilience and efficiency
program; I – independently; IV – independent variable; K score – interater reliability; LOE – level of evidence; M – mean; MA – meta-analysis; MBRT – MindfulnessBased Resilience Training; MM – mixed method; MPD – Milwaukee Police Department; n – group sample size studies; N – total number of participants; NCATS – National
Center for Translational Science ; NRNCT – non-randomized control trials; OES – open ended survey questionnaire; OR – Operation Restore; P – p value; PA – police
academy; PASW– predictive analytics software; PCL – posttraumatic checklist; PHQ-9– patient health questionnaire; PHYS – physiological; PR – performance ratings; PS
– parasympathetic ; PSYCH – psychological; PT – physical training; pt. – patient; PTGI – Posttraumatic Growth Inventory; PTSD – Posttraumatic Stress Disorder; Q –
question; RCT – randomized control trials; RS – random sample; RTI – resilience training interventions; SA – situational awareness; SE – standard error; SQ – sleep quality;
SR – systematic review; SRS – self reported stress; SRT - Special Response Team; TAU – training as usual; TM – telementor; TRT– treatment group; USA – United States
of America; V – version; VG – very good; W – white; WH – warehouse; WI – Wisconsin; WKS – week

VICARIOUS TRAUMA IN LAW ENFORCEMENT
Citation

with first
responders.
Funding:
Australian
Government
Research
Training
Program
Scholarship &
University
New South
Wales Brain
Sciences PhD
Grant
Bias:
Attrition bias
Country:
Australia

Conceptual
Framework

Design/Method

Sample/Setting

enhance
resilience among
high-risk
workers.

nTRT= 93% m,
7%f, M age
43.9,
Years of service
as a fire fighter
1-5; 8%
6-10; 22%
11-15; 18%
16-20; 10%
20+; 42%
nCNTL= 81%
m, 2%f, M age
41.1,
Years of service
as a fire fighter
1-5; 11%
6-10; 33%
11-15; 29%
16-20; 7%
20+; 20%

40
Major
Variables &
Definitions
teaches selfcompassion
and acceptance
skills, 6 online
training
sessions, 25
minutes each

Measurement

Analysis

analysis,
two sided
alpha level,
analyses
completed
on SPSS
version
24

Findings

increased
1.3=
moderate-tolarge effect
size with n
CNTL group
of .73(CI:
.38-1.06)

Decision for Use

Conclusions: Resilience
scores improved from pre to
post follow-up with
mindfulness training.

Feasibility/ Applicability to
pt. population:
The resiliency based on-line
intervention
Resiliency@Work is
recommended due to the
effectiveness for improving
resilience in FRs.

Inclusion
Criteria:
24 Fire and
Rescue
Departments at
New South
Wales
Key: AC – academic settings; AfAm – African American; ALT – altered; ANOVA – analysis of variance; AR – autonomic response; BMT – brief mindfulness training; BP–
blood pressure; α – Chronbach’s alpha; CBT – Cognitive Behavioral Therapy; CC – correlation coefficient; CI – confidence interval; CNTL – control group; CTSA –
clinical and translational science award; CV – cardiovascular; CVD –cardiovascular disease; DASP – data analytic software package; DH – drug house; DQ – descriptive
qualitative; DS – descriptive statistics; DV – dependent variable; EMDR – Eye Movement Desensitization and Reprocessing; ES – effect size; CISD– crisis intervention stress
debriefing; EXP – experience; FB – fairly bad; FBI –Federal Bureau of Investigations; FG – fairly good; FL – Florida; FR - First Responder; HBA1C – glycated hemoglobin
HCL – Hypercholesterolemia; HR – heat rate; HRV –heart rate variability; HTN – high blood pressure; iPREP – international performance resilience and efficiency
program; I – independently; IV – independent variable; K score – interater reliability; LOE – level of evidence; M – mean; MA – meta-analysis; MBRT – MindfulnessBased Resilience Training; MM – mixed method; MPD – Milwaukee Police Department; n – group sample size studies; N – total number of participants; NCATS – National
Center for Translational Science ; NRNCT – non-randomized control trials; OES – open ended survey questionnaire; OR – Operation Restore; P – p value; PA – police
academy; PASW– predictive analytics software; PCL – posttraumatic checklist; PHQ-9– patient health questionnaire; PHYS – physiological; PR – performance ratings; PS
– parasympathetic ; PSYCH – psychological; PT – physical training; pt. – patient; PTGI – Posttraumatic Growth Inventory; PTSD – Posttraumatic Stress Disorder; Q –
question; RCT – randomized control trials; RS – random sample; RTI – resilience training interventions; SA – situational awareness; SE – standard error; SQ – sleep quality;
SR – systematic review; SRS – self reported stress; SRT - Special Response Team; TAU – training as usual; TM – telementor; TRT– treatment group; USA – United States
of America; V – version; VG – very good; W – white; WH – warehouse; WI – Wisconsin; WKS – week

VICARIOUS TRAUMA IN LAW ENFORCEMENT
Citation

Conceptual
Framework

Design/Method

Sample/Setting

41
Major
Variables &
Definitions

Measurement

Analysis

Findings

Impact of
Events Scale
Kessler 10,
Quality of Life
Enjoyment &
Satisfaction
QuestionnaireShort Form,
Alcohol
Consumption

One-way
ANOVA,
randomizati
on, t-test,
multileving
software, &
DS

DV1: PTSD
scores
pre/post were
low in all
three groups,
ranging from
0 - 8.75 at
baseline and
0 - 5.21 at
follow-up

Decision for Use

Attrition:
Decreased
engagement
during followup.

Tuckey et al.,
(2013). Group
critical
incident
debriefing
with
emergency
service
personnel: A
randomized
control trial.

Funding:
Work &
Stress
Research
Group, Centre
for Applied

Critical
Incident Stress
Management
Model

Design:
RCT
Purpose:

N=67
n= 6-20
participants
randomly
assigned to 3
groups.
nTRT= CISD
nTRT = Stress
MGT Education
nCNTL=Screeni
ng
Setting:
Australian Fire
-Fighter
Brigade
Sample
Demographics:

IV1: CISD
IV2: Stress
Management
Education
IV3:
Screening
DV1: PTSD
DV2:
Nonspecific
Psychological
Distress
DV3: Quality
of Life
DV4: Alcohol
Consumption
Definition:

DV2:
Nonspecific
Psychological
Distress
Scores
pre/post; 016, 0-18

LOE: I
Strengths:
Took place in a real world
setting contributing to good
external validity
Weaknesses:
Varied alcohol use among
participants, self report data,
lacking a standard alcohol
screening tool, overrepresentation of men in
sample, female results not
reported.
Conclusions:
Education phase increased
group processing improving
peer and social resources.

Key: AC – academic settings; AfAm – African American; ALT – altered; ANOVA – analysis of variance; AR – autonomic response; BMT – brief mindfulness training; BP–
blood pressure; α – Chronbach’s alpha; CBT – Cognitive Behavioral Therapy; CC – correlation coefficient; CI – confidence interval; CNTL – control group; CTSA –
clinical and translational science award; CV – cardiovascular; CVD –cardiovascular disease; DASP – data analytic software package; DH – drug house; DQ – descriptive
qualitative; DS – descriptive statistics; DV – dependent variable; EMDR – Eye Movement Desensitization and Reprocessing; ES – effect size; CISD– crisis intervention stress
debriefing; EXP – experience; FB – fairly bad; FBI –Federal Bureau of Investigations; FG – fairly good; FL – Florida; FR - First Responder; HBA1C – glycated hemoglobin
HCL – Hypercholesterolemia; HR – heat rate; HRV –heart rate variability; HTN – high blood pressure; iPREP – international performance resilience and efficiency
program; I – independently; IV – independent variable; K score – interater reliability; LOE – level of evidence; M – mean; MA – meta-analysis; MBRT – MindfulnessBased Resilience Training; MM – mixed method; MPD – Milwaukee Police Department; n – group sample size studies; N – total number of participants; NCATS – National
Center for Translational Science ; NRNCT – non-randomized control trials; OES – open ended survey questionnaire; OR – Operation Restore; P – p value; PA – police
academy; PASW– predictive analytics software; PCL – posttraumatic checklist; PHQ-9– patient health questionnaire; PHYS – physiological; PR – performance ratings; PS
– parasympathetic ; PSYCH – psychological; PT – physical training; pt. – patient; PTGI – Posttraumatic Growth Inventory; PTSD – Posttraumatic Stress Disorder; Q –
question; RCT – randomized control trials; RS – random sample; RTI – resilience training interventions; SA – situational awareness; SE – standard error; SQ – sleep quality;
SR – systematic review; SRS – self reported stress; SRT - Special Response Team; TAU – training as usual; TM – telementor; TRT– treatment group; USA – United States
of America; V – version; VG – very good; W – white; WH – warehouse; WI – Wisconsin; WKS – week

VICARIOUS TRAUMA IN LAW ENFORCEMENT
Citation

Psychological
Research
Bias:
Attrition Bias
Country:
Australia

Conceptual
Framework

Design/Method

Sample/Setting

91% m, average
time on the job
13 years
Inclusion
Criteria:
Fire-fighters
with secondary
exposure to
traumatic event
from 9/07 -2/09

Attrition:
Information
attrition post
intervention
surveys not
returned

42
Major
Variables &
Definitions
“Stress
Management
Education”
90 minute
workshop
teaching
recognizing
stress, self
care, PTSD
symptoms,
treatment,
& comorbidity
of trauma.

Measurement

Analysis

Findings

DV3: Quality
of Life
pre/post;
rated
(satisfying/
satisfying).
DV4:
Fire fighters
in the CISD
group
reported
significant
lower alcohol
consumption
when
compared to
the other
groups.
Alcohol
Consumption
pre/post;
F(2,52)=
3.48, p<.05,
F(2,52)= 4.78
& p <.05

Decision for Use

CISD was effective for
decreasing alcohol
consumption.
Feasibility/ Applicability to
pt. population:
CISD is an effective
intervention for decreasing
alcohol consumption and
improving quality of life.

Key: AC – academic settings; AfAm – African American; ALT – altered; ANOVA – analysis of variance; AR – autonomic response; BMT – brief mindfulness training; BP–
blood pressure; α – Chronbach’s alpha; CBT – Cognitive Behavioral Therapy; CC – correlation coefficient; CI – confidence interval; CNTL – control group; CTSA –
clinical and translational science award; CV – cardiovascular; CVD –cardiovascular disease; DASP – data analytic software package; DH – drug house; DQ – descriptive
qualitative; DS – descriptive statistics; DV – dependent variable; EMDR – Eye Movement Desensitization and Reprocessing; ES – effect size; CISD– crisis intervention stress
debriefing; EXP – experience; FB – fairly bad; FBI –Federal Bureau of Investigations; FG – fairly good; FL – Florida; FR - First Responder; HBA1C – glycated hemoglobin
HCL – Hypercholesterolemia; HR – heat rate; HRV –heart rate variability; HTN – high blood pressure; iPREP – international performance resilience and efficiency
program; I – independently; IV – independent variable; K score – interater reliability; LOE – level of evidence; M – mean; MA – meta-analysis; MBRT – MindfulnessBased Resilience Training; MM – mixed method; MPD – Milwaukee Police Department; n – group sample size studies; N – total number of participants; NCATS – National
Center for Translational Science ; NRNCT – non-randomized control trials; OES – open ended survey questionnaire; OR – Operation Restore; P – p value; PA – police
academy; PASW– predictive analytics software; PCL – posttraumatic checklist; PHQ-9– patient health questionnaire; PHYS – physiological; PR – performance ratings; PS
– parasympathetic ; PSYCH – psychological; PT – physical training; pt. – patient; PTGI – Posttraumatic Growth Inventory; PTSD – Posttraumatic Stress Disorder; Q –
question; RCT – randomized control trials; RS – random sample; RTI – resilience training interventions; SA – situational awareness; SE – standard error; SQ – sleep quality;
SR – systematic review; SRS – self reported stress; SRT - Special Response Team; TAU – training as usual; TM – telementor; TRT– treatment group; USA – United States
of America; V – version; VG – very good; W – white; WH – warehouse; WI – Wisconsin; WKS – week

VICARIOUS TRAUMA IN LAW ENFORCEMENT

43
Appendix B
Synthesis Table

Table B.1
Author
Year
Design/Level of
Evidence:
N=

Anderson et
al.
2016
RCT/I

Banks et al.
2015
SR/I

Boothroyd
et al.
2018
MM/II

12

12 studies

207

Demographics
M age

31.5

NR

42.35

M years police service

4.68

M years FF service
Males (%)

66.7

Females (%)
Caucasian

33.3
77.8

Kaplan et
al.
2017
MM/II

Devilly et
al.
2013
RCT/I

Patterson et al.

Ramey et al.

2014
MA/I

2016
RCT/I

Possemato
et al.
2017
RCT/I

906
12 studies

38

62

544 FF

28

34.48

24.4

46

43.9

New
Recruits

10.77

New Recruits

69
281
22 FF
47 police
Study Characteristics
43.5 –
police
NR FF
13.28
13.6
57- police
73 - FF
NR
81- police
90 - FF

Shand et
al.
2019
RCT/I

Tuckey et al.
2013
RCT/I
67 FF

68

82.4

87.1

93

13
91

73

NR
58.8

12.9
82.3

7

NR

AfAm (%)
13
2 - FF
29.4
Asian (%)
4 - FF
Hispanic (%)
8.7
6 - police
3.2
Multiracial (%)
4 - FF
Police (%)
72
FF (%)
6
Key: AfAm – African American; BP – blood pressure; BRS – brief resilience scale; CA – clinician administered; CBT – cognitive behavioral therapy; DEVCEQ –
distress endorsement validation credibility/expectancy questionnaire DX – diagnosis; ERQ – emotion regulation; questionnaire EXP – exposure; FF – fire fighter; FFMQ –
five faucet mindfulness questionnaire; HLQ –health/lifestyle questionnaire; HR – heart rate; IES – impact events scale; iPREP – international performance resilience and
efficiency program; M – mean; MA – meta-analysis; MBRT – Mindfulness-Based Resilience Training; MM – mixed method; N –total number of participants; NR – not
reported; OBI –Oldenburg burnout inventory; OPPS – operational police stress questionnaire; PCL – posttraumatic checklist; PHQ-9 – patient health questionnaire; POQA –
personal organizational quality assessment; PHYS – physiological; PSS – posttraumatic symptoms scale; PSYCH – psychological; PTSD – posttraumatic stress disorder;
PTGI – Posttraumatic Growth Inventory; RSES – response to stressful experiences scale; RCT – randomized control trial; SR – systematic review; ST – sub-threshold; USA –
United States of America

VICARIOUS TRAUMA IN LAW ENFORCEMENT
Medic (%)
911 Operator (%)
Veterans (%)
PTSD Dx (%)
ST PTSD Dx (%)
Exp to Secondary
Trauma (%)
Setting
USA
Finland
North America
Europe
Canada
Australia
Netherlands
Measurement Tools

Duration of
Intervention

Interventions
iPREP training
Stress Debriefing
MBRT

44

1.9
1.9
27.5

68
48
52
67

X

X

X

X

X

X

X
X
X
X
X
HR, BP, &
10-point
scale
appropriate
of decision
making, and
self-reported
surveys

CA PTSD
Scale, PSS,
ERQ,
Assessment
of PTSD.

3 days

PTGI

BRS, OBI,
FFMQ

Depression
Stress, &
Anxiety
Scale - 21
item,
DEVCEQ

3-4 days

8 weeks/ 2
hours a day

8 weeks

X

X

X
PSS Police
Stress Survey,
Police Daily
Hassles, Police
Daily Uplifts,
OPPS,
Organizational
Police Stress
Questionnaire

10.9 hours

Perceived
Stress Scale,
Maastricht
Questionnaire
9-item Form
B,
IES, POQA,
RSES, HR, a
non-fasting
blood
sample,
HLQ
2 hours

X

X

PCL-5
PHQ-9

ConnorDavidson
Resilience
Scale,
BRS

IES
Kessler 10,
Quality of Life
Enjoyment &
Satisfaction
QuestionnaireShort Form,
Alcohol
Consumption

4 sessions;
90
minutes
each

6 sessions;
24
minutes
each

90 minutes

X

X

X
X
X

X
X

Key: AfAm – African American; BP – blood pressure; BRS – brief resilience scale; CA – clinician administered; CBT – cognitive behavioral therapy; DEVCEQ –
distress endorsement validation credibility/expectancy questionnaire DX – diagnosis; ERQ – emotion regulation; questionnaire EXP – exposure; FF – fire fighter; FFMQ –
five faucet mindfulness questionnaire; HLQ –health/lifestyle questionnaire; HR – heart rate; IES – impact events scale; iPREP – international performance resilience and
efficiency program; M – mean; MA – meta-analysis; MBRT – Mindfulness-Based Resilience Training; MM – mixed method; N –total number of participants; NR – not
reported; OBI –Oldenburg burnout inventory; OPPS – operational police stress questionnaire; PCL – posttraumatic checklist; PHQ-9 – patient health questionnaire; POQA –
personal organizational quality assessment; PHYS – physiological; PSS – posttraumatic symptoms scale; PSYCH – psychological; PTSD – posttraumatic stress disorder;
PTGI – Posttraumatic Growth Inventory; RSES – response to stressful experiences scale; RCT – randomized control trial; SR – systematic review; ST – sub-threshold; USA –
United States of America

VICARIOUS TRAUMA IN LAW ENFORCEMENT
Stress Management
Training
Dependent Variables
Situational Awareness
Use of Force Decision
Making
PTSD Symptoms
Burn Out
Phys & psych responses
to stress
Resiliency
Quality of Life
Alcohol Consumption
Blood Pressure
Maximum HR
Findings/Outcomes
Improved Situational
Awareness
Improved Use of Force
Decision Making
Relief of PTSD
Symptoms
Decrease Burn Out
Decrease in negative
phys & psych responses
to stress
Improve resiliency
Improved Quality of Life
Decrease alcohol
consumption
Decreased Blood
Pressure
Decreased Maximum HR

45
X

X

X
X
X

X

X

X

X
X

X
X
X
X

X
X
X
X
X

X

X

X

X
X

X

X
X
X
X
X

Key: AfAm – African American; BP – blood pressure; BRS – brief resilience scale; CA – clinician administered; CBT – cognitive behavioral therapy; DEVCEQ –
distress endorsement validation credibility/expectancy questionnaire DX – diagnosis; ERQ – emotion regulation; questionnaire EXP – exposure; FF – fire fighter; FFMQ –
five faucet mindfulness questionnaire; HLQ –health/lifestyle questionnaire; HR – heart rate; IES – impact events scale; iPREP – international performance resilience and
efficiency program; M – mean; MA – meta-analysis; MBRT – Mindfulness-Based Resilience Training; MM – mixed method; N –total number of participants; NR – not
reported; OBI –Oldenburg burnout inventory; OPPS – operational police stress questionnaire; PCL – posttraumatic checklist; PHQ-9 – patient health questionnaire; POQA –
personal organizational quality assessment; PHYS – physiological; PSS – posttraumatic symptoms scale; PSYCH – psychological; PTSD – posttraumatic stress disorder;
PTGI – Posttraumatic Growth Inventory; RSES – response to stressful experiences scale; RCT – randomized control trial; SR – systematic review; ST – sub-threshold; USA –
United States of America

VICARIOUS TRAUMA IN LAW ENFORCEMENT

46
Appendix C
General Adaptation Syndrome

Figure C.1

Figure C.1. General Adaptation Syndrome. Reprinted from The Stress if Life (p.87), by V.L. Burrows, 2015, New York, NY: McGraw Hill. Copy
right 1956 by McGraw-Hill.

VICARIOUS TRAUMA IN LAW ENFORCEMENT

47
Appendix D

The Start Model of Knowledge Transformation
Figure D.1

Figure D.1. The Star Model of Knowledge Transformation. Reprinted from School of Nursing UT Health and Science Center, by K.R. Stevens,
2012, Retrieved from http://nursing.uthscsa.edu/onrs/starmodel/star-model.asp. Copy right 2012 by The University of Texas Health Science Center at
San Antonio.

VICARIOUS TRAUMA IN LAW ENFORCEMENT
Appendix E
Institutional Review Board Approval

48

VICARIOUS TRAUMA IN LAW ENFORCEMENT

49

VICARIOUS TRAUMA IN LAW ENFORCEMENT
Appendix F
Site Authorization Letter

50

VICARIOUS TRAUMA IN LAW ENFORCEMENT
Appendix G
Informed Consent

51

VICARIOUS TRAUMA IN LAW ENFORCEMENT

Appendix H
Resiliency Training Outline

52

VICARIOUS TRAUMA IN LAW ENFORCEMENT
Appendix I
Response to Stressful Experiences Measure

53

VICARIOUS TRAUMA IN LAW ENFORCEMENT
Appendix J
Resiliency Test

54

VICARIOUS TRAUMA IN LAW ENFORCEMENT

55

VICARIOUS TRAUMA IN LAW ENFORCEMENT
.

56

VICARIOUS TRAUMA IN LAW ENFORCEMENT
Appendix K
Demographic Survey

57

VICARIOUS TRAUMA IN LAW ENFORCEMENT

58

VICARIOUS TRAUMA IN LAW ENFORCEMENT

59

VICARIOUS TRAUMA IN LAW ENFORCEMENT

60

VICARIOUS TRAUMA IN LAW ENFORCEMENT

61

Appendix L
Budget
Table L.1
Phase
Preparation

Activities
Direct Costs
Developing Resiliency
Training Intervention
DNP Student Hours @
$25/hr
Professional Consultant
$150/hr
Travel Expenses
Round trip from Flagstaff,
Arizona to Mesa, Arizona
Create Pre/Post Education
Materials and
Questionnaires

Expenses
40 hours
$1,000.00

4 hours
$ 600.00
320 miles
$ 65.00

DNP Student Hours @
$25/hr
DNP Mentor Guidance

10 hours
$ 250.00
4 hours@$38
$152.00

6 Deputies @ $28/hr
training

2 hours
$336.00

DNP Student hours
$25/hour training data
collection

2.5 hours
$62.50

Computer
Overhead Projector

1/$0

Coding and analyzing data
DNP Student hours $25/hr
training

4 hours
$100.00

ASU Bio-Stat Clinical
Professor $38/hr

4 hours
$152.00

SPSS Software

1/$0

Resiliency Measurement
Tool

Public Domain/$0

Implementation

Evaluation

Expense Totals: $2,717.00
DNP Student Total:$1,477.50

VICARIOUS TRAUMA IN LAW ENFORCEMENT

62

Appendix M
Demographic Characteristics and Experiences
Table M.1
Demographic Characteristics
Ethnicity
White
Gender
Male
Female
Rank
Detective
Lieutenant
Sergeant
Highest Level of Education
High School
Bachelor’s Degree
Military Service
Yes
No
Primary Assignment
Criminal Investigation
Injured in the line of duty
Yes
No

N

%

6

100.0

5
1

83.3
16.7

4
1
1

66.6
16.7
16.7

3
3

50.0
50.0

1
5

16.7
83.3

6

100.0

2
4

33.3
66.7

VICARIOUS TRAUMA IN LAW ENFORCEMENT

63

Appendix N
Amount of Time (%) Spent Job-Related Activities
Table N.1

Percentage of Time spent:

Mean

Standard
Deviation

Range

On service-related calls involving mentally ill
subjects

0.0

0.0

0%

Service-related calls involving suicidal subjects

0.0

0.0

0%

Completed Suicides

4.67

2.58

0% – 8%

Crimes against children

6.67

7.53

0% – 20%

Nuisance Calls

0.0

0.0

0%

Domestic Violence

7.33

6.98

0% – 20%

Juvenile Crime

2.00

2.45

0% – 5%

Property Crime

7.50

6.89

0% – 20%

Sex Crime

13.0

14.97

0% – 40%

Drugs/Narcotics

0.17

0.41

0% – 1%

Vehicle/Traffic

0.0

0.0

0%

Homicide

6.33

6.98

0% – 20%

Dead Bodies

18.33

22.95

0% – 60%

Administrative Work

25.00

32.86

0% – 80%

Other (Specify)

0.0

0.0

0%

VICARIOUS TRAUMA IN LAW ENFORCEMENT

64

Appendix O
Descriptive and Reliability Statistics for the Response to Stressful Experience Scale
Table O.1

Response to Stressful Experience Scale
Pre-test
Post-test

Median

Range

54.5
59.5

49 – 69
51 - 68

Inter-item
reliability
.67
.60