Policing is exciting, challenging and often dangerous work. It involves adjusting to everyday exposure to incidents and situations that, for more people, might only happen once in a lifetime. As one of the toughest jobs an individual can do – organisational stress, critical incident trauma, shift work, relationship problems and alcohol abuse are five prominent risk factors commonly associated with policing.
In addition to usual life stressors we all face, an officer could see 400-600 traumatic events during an average career, contrasted with the 3-4 serious events typically thought to be experienced by civilians. This accumulation of stress and trauma can take its toll, causing a dripping tap effect of individual experiences resulting in catastrophic cumulative impact, with comparable levels of traumatic illness to the military (Irizar et al., 2021).
What is PTSD?
Post traumatic stress disorder (PTSD) is a mental health condition caused by experiencing very stressful, frightening or distressing events. Whilst trauma impact is a natural response to any exposure in the first 4-6 weeks, PTSD causes a physical and emotional response to traumatic events that can persist long after the trauma occurred.
The Amygdala, part of the brain, is the bodies ‘alarm bell’ that will be triggered when something isn’t right. It is responsible for our fight or flight response, blood pressure, digestion, hyper-arousal and vigilance. It is, in essence, our response system to stress, fear and trauma.
The hippocampus is the part of the brain that contextualises information and commits trauma to memory. This is the part of the brain that turns the current into the past and manages the recall process.
Whilst some people are pre-disposed to problems in these areas of the brain, the challenge for those in policing is that, due to it’s nature, policing leads to the Amygdala being in a constant state of arousal, which can mean the brain has difficulty contextualising stress and turning it into memories.
We can be exposed to PTSD in different ways:
- Direct exposure to the event.
- Witnessing the trauma.
- Learning that a relative, or close friend, was exposed to a trauma.
- Indirect exposure to aversive details of a trauma, often in the course of professional duties, such as emergency services, therapists and first responders. This is sometimes called secondary or vicarious trauma.
Primary trauma is the direct exposure to traumatic events involving death, injury, attacks, accidents, etc, A misconception is that this only applies to major incidents – it doesn’t. Every day incidents can result in primary trauma.
Secondary trauma relates to indirect exposure from victims, offenders, materials, testimony, images etc. It is the immersion in an incident that often results in secondary trauma as the individual begins to re-live it from the victim’s perspective.
Burnout is the normal consequence of working in a high pressure an demanding role with scarce resources, high public expectations and limited capacity. It is compounded by an inability to reflect, rationalise, and retain (rather than re-live) incidents, and over time reduces an individual’s levels of resilience.
What is Complex PTSD (CPTSD)
A diagnosis of CPTSD is made when the criteria for PTSD are met plus 3 further set of symptoms which are called disturbances in self-organisation (ICD 11).
Difficulty regulating emotions
Negative self-concept (such as feeling of guilt, shame and loneliness)
Interpersonal problems which impact on building and maintaining relationships, including disassociation and avoidance.
CPTSD can also include physical symptoms, such as headaches, dizziness, chest pains and stomach aches.
Signs and symptoms of PTSD
Someone with PTSD often relives the traumatic event/events and experiences at least one of the following:
- Unwanted upsetting memories
- Nightmares
- Flashbacks
- Emotional distress after exposure to traumatic reminders
- Physical reactivity (increased heart rate, sweating) after exposure to traumatic reminders
They can also experience avoidance of trauma-related thoughts or feelings and try to block them out, as well as trauma-related external reminders, such as avoiding people, avoiding certain places and any reminders of events.
Negative thoughts or feelings may also begin or worsen after the trauma, in the following way(s):
- Inability to recall key features of the trauma
- Overly negative thoughts and assumptions about oneself or the world
- Exaggerated blame of self or others for causing the trauma
- Negative emotions
- Decreased interest in activities
- Feeling isolated
- Difficulty experiencing positive emotions
People will also experience a change in their bodily reactions/sensations:
- Irritability or aggression
- Risky or destructive behaviour (increased alcohol intake, drugs, gambling, etc)
- Hypervigilance
- Heightened startle reaction
- Difficulty concentrating
- Difficulty sleeping
Treatment for PTSD/CPTSD
Treatments for PTSD/CPTSD according to the NICE guidance are trauma-focused therapies such as trauma-focused cognitive behavioural therapy (tfCBT), prolonged exposure (PE) or eye movement desensitisation and reprocessing (EMDR).
Eye Movement Desensitisation Reprocessing (EMDR)
Eye movement desensitisation reprocessing is a structured therapy that encourages the patient to focus briefly on the trauma memory while simultaneously experiencing bilateral stimulation (typically eye movements), which is associated with a reduction in the vividness and emotion associated with the trauma memories. Eye Movement Desensitization and Reprocessing (EMDR) therapy is an extensively researched, effective psychotherapy method proven to help people recover from trauma and PTSD symptoms (EMDRIA)
Cognitive Behavioural Therapy (CBT)
Cognitive behavioural therapy (CBT) is a type of talking therapy that aims to help you manage problems by changing how you think and act.
Trauma-focused CBT uses a range of psychological techniques to help you come to terms with the traumatic event.
For example, your therapist may ask you to face your traumatic memories by describing aspects of your experience in detail.
During this process, your therapist helps you cope with any distress you feel while identifying any beliefs you have about the experience that may be unhelpful.
Your therapist can help you gain control of your fear and distress by reviewing with you any conclusions you have drawn about your experience (for example, feeling you’re to blame for what happened, or fear that it may happen again).
You may also be encouraged to gradually restart any activities you have avoided since your experience, such as driving a car if you had an accident.
Prolonged Exposure (PE)
Prolonged exposure teaches individuals to gradually approach their trauma-related memories, feelings and situations. They learn that trauma-related memories and cues are not dangerous and do not need to be avoided.
Self care
Living with PTSD can be difficult for those directly affected, and their loved ones. For those exposed to trauma who may be struggling with PTSD there are some things you can do to help, although it is important to seek professional help.
- Get to know your triggers
- Safety cues and ‘standing down’ – let yourself know that you are safe.
- Sharing experiences and talking to others, such as colleagues, peer supporters or line managers.
- Breathing exercises and breathwork
- Self-Support Techniques
Where to get help
- Occupational Health, wellbeing teams, Federation /Staff Association reps,
- TRiM practitioners within your force
- Employee Assistance Programmes and services
- GP/NHS
- Qualified clinicial physician or psychiatrist.
- Police Care UK
