Rachel Rogers AFBPsS Police Care UK – Lead Clinical Therapist PhD Police Mental Health 2017-
Trauma Impact Prevention Techniques (TIPT) is an evidence based, peer reviewed set of strategies designed to aid healthy cognitive processing of difficult life events. It has been designed specifically for (and with) the Police, given the high levels of trauma exposure on the job. Research shows that as well as over 90% of officers being trauma exposed, prevalence of Post-Traumatic Stress Disorder (PTSD) within the police is around 20%. Many more (55%) feel like they don’t have opportunity to properly process their work experiences, which is a significant precursor to trauma potential (Miller et al, 2018., Brewin et al, 2019).
In light of this, TIPT was created as a proactive intervention aimed at upskilling healthy officers and staff in managing their own reflective processes in a structured way. If individuals can become accustomed to dealing with their ‘abnormal’ exposures and experiences appropriately, then this can safeguard against later illness. TIPT is a proactive prevention and is a shift away from a somewhat typical ‘no time to think’, ‘put it in a box’ approach commonly seen in policing. There are no other existing strategies for sustaining this avoidant technique and wellbeing interventions are usually reactive to either clinical need or significant event only.
Police Care UK, drawing on expertise within neuro and clinical psychology, trauma specialists and Police leaders (including the National Wellbeing Lead and Acting Chief Medical Officer), aimed to address this issue and looked to design a tool to enhance the health of healthy, functioning Officers and staff [see Trauma Impact Prevention Techniques (TIPT) – Police Care UK for further details/ information]. TIPT is recognised as a safe coping strategy that enhances brain function in specific areas that are key to trauma resilience, specifically, the hippocampus (Miller, 2016., Miller et al, 2017a., Miller et al, 2017b). This small region is vital in the successful integration of difficult memories. Ironically, chronic stress over a policing career can cause it to deteriorate. Maintaining hippocampal flexibility is therefore essential for this population. Fortunately, this area of the brain is
trainable. TIPT provides that bespoke brain training and therefore compliments other established healthy lifestyle and wellbeing options available to those in policing and beyond.
Importantly, TIPT is not a clinical or reactive intervention for individuals already exhibiting signs of PTSD/CPTSD. It does not replicate TRIM either. The techniques draw on maps and timelines and this is in line with existing police processes (such as interviewing witnesses, case construction, etc); adopting methods that are already familiar to them. Similarly, maps and other visual aids are commonplace within many other learning practices. For TIPT, they directly activate the hippocampus, (enhancing spatial and episodic memory function, i.e. our ability to make sense of what happened where and when). Maps and timelines have also long been used within psychological and trauma-focused therapies (for example, when taking a history or revisiting an experience). The significant difference with their use in therapy is that they are used on symptomatic individuals by an appropriately trained clinician in line with an identified treatment plan. This is distinctly different to the TIPT target audience and model, which is about healthy cognitive processing for all.
As a clinician myself, I can see the divergences in the application and utility of the techniques for therapy and for prevention- but it is imperative that they are managed appropriately for the setting (ie in clinic vs in training). Put briefly, trauma therapy would look to ameliorate difficulties; presenting as broadly a) reexperiencing symptoms, (b) avoidance symptoms, (c) negative disturbances in mood and cognitions, and (c) arousal symptoms and therefore diagnosable as a disorder; (C-)PTSD. These techniques would identify “hotspots” within the unfiled or fragmented memory, readdress faulty cognitions and aid the integration of the whole memory – so that the event can be seen in a balanced, historic manner. This forms part of a recognised treatment approach.
TIPT, on the other hand, is delivered by individuals who have completed the TIPT training and is for those wishing to enhance their ability to process challenging life events in their role in the police. TIPT is designed for healthy participants. Recipients should be asymptomatic and not meet the diagnostic criteria for a PTSD disorder. Whilst the exercise requires trainees to identify a difficult event to practice the techniques with, it is made clear in joining instructions and throughout the training that this training scenario should be something manageable and not something that is intensely distressing. [Any individual who experiences difficulties because they have chosen distressing examples will be advised to choose a different scenario and signposted to the appropriate Occupational Health channels].
Police encounter trauma almost daily and yet many are not affected by their events; at any one time 4 out of 5 are likely to be psychologically healthy after trauma exposure. Not every incident will trigger a PTSD, but no individual is immune to the effect of incidents later down the line. If all police and staff can learn strategies to boost their resilience to potentially traumatic events then this can be prophylactic. Mapping and time-lining can be used put any memory into better perspective, and the use of safety cues can teach individuals how to self soothe after stress and appraise the occurrence accurately in its entirety; together, these activities provide a prevention technique. To put this simply, TIPT is akin to stretching after exercise, easily taught to keep the brain supple, active and therefore healthy. Trauma-focused therapies are akin to physiotherapy; in response to disorder, identifiable symptoms with trigger events, requiring bespoke, targeted treatment of the affected areas.
Given that PTSD can be underreported and unidentified, it may be that individuals attending TIPT disclose clinically significant information. This is not ‘caused’ by TIPT but the psycho-educational material can result in an unexpected, personal realisation or insight into an experience. Such insight may well have occurred in other wellbeing interventions, such as ‘shared experience talks’. It may be that those engaging with TIPT who are high risk for trauma exposure may benefit from some pre-screening or education. That individuals can flag concerns about underlying experiences and can engage with relevant support in a timely way and in a protected setting is no doubt going to be beneficial for individuals, when handled appropriately by the force.
TIPT is newer than some other applications, it is also unique in its purpose. It has, however, undergone a Randomised Controlled Trial, peer review and further controlled in-group testing over a period of 5 years; many other interventions are not subjected to such rigour. Control data demonstrates that TIPT does no harm, is effective in reducing unease with difficult incidents and that objectivity and recall can improve. What is more, rich qualitative feedback has been overwhelmingly positive since day one for TIPT delivery and this raw honesty from those on the front line who have gone through the process and go on to share the techniques of their own accord contributes much to its evaluation. TIPT is a practical intervention based on neuro- and clinical psychology, many activities (therapeutic or otherwise) are based on similar areas of expertise and so sit amicably together, enhancing real tangible change for those who engage in them. Examples of similar work within hippocampal health and trauma prevention within emergency and armed services personnel include Butler et al (2020) and Lyadurai et al (2017) which you may wish to consider. These studies also advocate the benefits of visuospatial tasks for positive hippocampal outcomes and the prevention of future intrusive memories/flashbacks and PTSD. Trauma is multi-faceted, therefore remedial actions (whether pro- or re-active) should be similarly diverse to accommodate individual differences, need and preference. Paramount is the sustained health of Police Officers/Staff and Police Care UK see that all available trauma interventions sit together, each with its own application in assisting those that do a job like no other in the healthiest possible way.
Rachel Rogers AFBPsS Police Care UK – Lead Clinical Therapist PhD Police Mental Health 2017-
Brewin, C.B., Miller, J.K., Soffia, M., Peart, A., Burchell, B. (2019). Posttraumatic Stress Disorder and Complex Posttraumatic Stress Disorder in U.K. Police Officers. Journal of Consulting and Clinical Psychology
Butler O, Herr K, Willmund G, Gallinat J, Kühn S, Zimmermann P. Trauma, treatment and Tetris: video gaming increases hippocampal volume in male patients with combat-related posttraumatic stress disorder. J Psychiatry Neurosci. 2020 Jul 1;45(4):279-287. doi: 10.1503/jpn.190027. PMID: 32293830;
Lyadurai L, Blackwell SE, Meiser-Stedman R, Watson PC, Bonsall MB, Geddes JR, Nobre AC, Holmes
EA. Preventing intrusive memories after trauma via a brief intervention involving Tetris computer
game play in the emergency department: a proof-of-concept randomized controlled trial. Mol Psychiatry. 2018 Mar;23(3):674-682. doi: 10.1038/mp.2017.23. Epub 2017 Mar 28. PMID: 28348380; PMCID: PMC5822451.
Miller, J., Soffia, M., Brewin, C., & Burchell, B. (2018) POLICING: THE JOB & THE LIFE SURVEY 2018 [online] Available at: PoliceCareUK_TJTL-Report-.pdf.
Miller J (2016) Navigating trauma: How PTSD affects spatial processing, Police Professional 532: 12– 17.
Miller JK, McDougall S, Thomas S, et al. (2017a) The impact of the brain-derived neurotrophic factor gene on trauma and spatial processing. Journal of Clinical Medicine 6: 108.
Miller JK, McDougall S, Thomas S, et al. (2017b) Impairment in active navigation from trauma and post-traumatic stress disorder. Neurobiology of Learning and Memory 140: 114–123