Imagine That! Findings in Hypothetical Trauma Exposure and Treatment Choices Amongst Law Enforcement Officers.

Imagine That! Findings in Hypothetical Trauma Exposure and Treatment Choices Amongst Law Enforcement Officers.

A review of:
Becker, C. B., Meyer, G., Price, J. S., Graham, M. M., Arsena, A., Armstrong, D.A., Ramon, E. (2009). Law enforcement preferences for PTSD treatment and crisis management alternatives. Behavior Research and Therapy, 47(3), 245-253.

by Sarah E. Barwick.

Evidence based treatments (EBT), particularly exposure techniques, may be underutilized in the treatment of PTSD due to several patient and therapist factors. For example, a therapist may feel nervous about their lack of training in EBT or may feel distressed over patient discomfort. Research to date has focused primarily on therapist factors that limit the use of EBT, whereas research on patient factors that limit EBT remains limited. Furthermore, previous studies have examined primarily collegiate samples, limiting the generalizibility of the findings.

In an attempt to expand on previous research, the current study focused on active and aspiring law enforcement officers, a population of particular interest when examining PTSD. Law enforcement officers are commonly exposed to trauma, and often experience significant symptomology related to this exposure. Participants (N= 379) included 156 active law enforcement officers, 108 police academy cadets, and 99 criminal justice students. Researchers aimed to expand on investigations conducted by Becker et al (2007), which examined PTSD treatment preferences in similar samples.

After giving informed consent, participants read a hypothetical traumatic scenario in which they were asked to imagine shooting a 15 year-old suspect in self-defense. The scenario then described an emergence of hypothetical PTSD symptoms following their alleged exposure that interfered with their professional and personal functioning. Following this, participants read through randomly ordered descriptions of treatment options, including Cognitive Processing Therapy (CPT), Eye Movement Desensitization and Reprocessing therapy (EMDR), Exposure therapy, medication treatment (Zoloft), Brief Eclectic Psychotherapy (BEP), and Psychodynamic therapy. Each participant then rated their projected credibility of each treatment, choosing their top and bottom two choices using a modified version of the Credibility Scale (CS; Addis & Carpenter, 1999). An additional evaluation of Critical Incident Stress Debriefing (CISD) followed treatment descriptions and ratings. Researchers hypothesized that CPT and exposure therapy would be chosen as most preferred of all treatments.

Results indicated that criminal justice students reported a higher incidence of traumatic exposure (61.0%) than did cadets (36.0%) or active duty officers (48%). Because rates of PTSD were the same among all groups, the data was collapsed for analysis. Regarding the most preferable treatment options, results indicated that the two most preferred treatments were CPT (36.9%) and exposure (25.9%) followed by psychodynamic therapy (13.2%), Zoloft (9.2%), BEP (9%), and EMDR (1.8%). CPT and exposure accounted for 87% of either first or second choice of treatment.

It should be noted that participants who met criteria for PTSD (n = 36) demonstrated a different trend when ranking proposed treatments. Although CPT was the most preferred treatment (38.9%), psychodynamic therapy was ranked second (25.0%) followed by BEP (13.9%), exposure therapy (11.1%), Zoloft (8.3%), and EMDR. Based on these results, it could be argued that the PTSD group yielded a more accurate list of treatment preference, as other participants were choosing under added projective conditions. Though much smaller in sample size, participants in the PTSD are far more representative of the study’s group of interest. These findings contradict the study’s hypothesis that CPT and exposure are the most preferred treatments among officers with PTSD.

This study has several limitations. The occurrence of PTSD may have been highly underreported among active law enforcement officers and cadets. Both groups reported lower incidences of Criterion A trauma than did criminal justice students. This finding may be the result of the “tough it out” mentality common among law enforcement officers. Reported PTSD symptomology may have also been underreported and, if so, the data should not have been collapsed. Furthermore, this study reports only projective data and therefore results are not indicative of actual treatment preference. To determine preference among actual treatment populations, future research should include during-treatment and post-treatment measurements.

To cite this review, please use this reference: Barwick, S. B. (2009). Imagine That! Findings in Hypothetical Trauma Exposure and Treatment Choices Amongst Law Enforcement Officers. Psychology Alert (3).