Crime Prevention

Research Review

No. 8

Effects of Stress Management 

Training on Physiological, 

Psychological and Behavioral 

Outcomes among Police 

Officers and Recruits

George T. Patterson

Irene W. Chung

Philip G. Swan

Silberman School of Social Work

Hunter College 

City University of New York
Suggested citation: 

Patterson, George T., Irene W. Chung, and Philip G. Swan. 2013. 

Effects of Stress Management Training on Physiological, Psychological, and 

Behavioral Outcomes among Police Officers and Recruits. No. 8 of Crime 

Prevention Research Review. Washington, D.C.: U.S. Department of 

Justice, Office of Community Oriented Policing Services. 

The opinions contained herein are those of the author(s) and do 

not necessarily represent the official position or policies of the 

U.S. Department of Justice. References to specific agencies, 

companies, products, or services should not be considered an 

endorsement by the author(s) or the U.S. Department of Justice. 

Rather, the references are illustrations to supplement discussion of 

the issues. 

The Internet references cited in this publication were valid as of the 

date of this publication. Given that URLs and websites are in constant 

flux, neither the author(s) nor the Office of Community Oriented 

Policing Services can vouch for their current validity. 

The Campbell Collaboration Crime and Justice Group 

(www.campbellcollaboration.org/ccjg) is an international 

network of researchers that prepares, updates, and rapidly 

disseminates systematic reviews of high-quality research 

conducted worldwide on effective methods to reduce 

crime and delinquency and improve the quality of justice.

ISBN: 978-1-932582-69-7 

January 2013

Cover: © arindambanerjee / Shutterstock.com
1

Contents

Acknowledgments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Summary of Systematic Review Methods. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Objectives. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Inclusion criteria. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Pilot study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Selection of studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Data Analysis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Results. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Description of eligible studies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Physiological outcomes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Psychological outcomes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Behavioral outcomes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Meta-analysis results. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Qualitative results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Conclusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Implications for policy and practice. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

Studies Included in the Review. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

Tables. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
2

Acknowledgments 

The authors would like to thank the National Policing Improvement Agency, Campbell 

Collaboration Crime and Justice Group, and George Mason University for funding this 

systematic review and David B. Wilson for his assistance with the meta-analysis. We also 

acknowledge the assistance of Daniel Schmidt with the study selection process and references 

and Professor Marvie Brooks, instruction librarian, John Jay College of Criminal Justice 

(CUNY) New York, New York, for assisting with the search strategy. 
Introduction

Law enforcement organizations provide many types of 

interventions to help both veteran police officers and 

recruits manage stress...
4

Introduction

Over a period of more than 35 years, John M. Violanti has conducted extensive research 

investigating the unique stressors experienced in law enforcement as well as strategies for 

coping with stress. Police officers perceive stressful work events differently based on rank, years 

of police experience, age, and race (Violanti and Aron 1995). Police recruits, because they 

are in academy training, experience less work stress even though the police academy training 

environment has been described as a source of stress (Violanti 1992). Examples of stressful 

events specific to police work include shift work (Violanti 1984), chronic organizational stress 

(Stinchcomb 2004), and traumatic incidents (Patterson 2001). 

Additional stress outcomes specific to police include suicide (Violanti 1996a), psychological 

distress (Violanti and Aron 1993), traumatic stress (Violanti 1996b), illegal drug use (Gorta 

2009), alcohol use (Violanti, Marshall, and Howe 1985), and symptoms that are physiological 

(headaches, stomachaches, backaches, ulcers, and heart attacks) or psychological (anxiety, 

depression, flashbacks, and panic attacks) (Stinchcomb 2004). 

A report from the National Institute of Mental Health (NIMH 2002) suggests that law 

enforcement officers, as first responders to traumatic incidents, disasters, and mass violence, 

require different training, knowledge, and skills from other trauma specialists due to the form 

of early intervention they provide. The report further suggests that training should be provided 

to law enforcement officers in order to help them recognize the mental health implications of 

providing early intervention to victims and survivors on their own psychological wellbeing. 

Moreover, Dunning (1988) asserts that training for emergency workers should include 

research findings focused on psychological injury because linking psychological injury with 

more commonly accepted forms of duty-related injury, such as back and knee injuries, 

increases the likelihood of follow-through by rescue workers. Dunning (1988, 289) further 

suggests that such training should also include techniques for rehabilitation and resolution 

of traumatic stress similar to the attention given to work-related physical injury; thus 

“psychological injury is...not singled out as something unusual or more serious but is seen as 

something that can normally happen in the course of performing one’s job.” 
5

Law enforcement officers also consider exposure to trauma as a normal part of their job and 

expect it, whereas other types of workers and victims of unexpected traumatic incidents 

do not anticipate the event, providing an additional reason why law enforcement officers 

need different training content from other types of workers and trauma victims (Beaton 

and Murphy 1995). Indeed, Westerink (1990) found that within one year after being hired, 

officers experienced a wide range of traumatic incidents. Situations involving the death or 

injury of children were reported as the most traumatic, followed by the removal of body 

parts. 

In addition to work stress, law enforcement personnel also experience stressful life events 

such as dealing with the death or health problems of a relative or close friend (Patterson 

2002). These events also have the potential to affect officers’ physiological, psychological, 

and behavioral wellbeing as well as their job performance. 

Researchers have used different approaches to investigate the physiological, psychological, and 

behavioral stress outcomes that police officers and recruits experience. Using heart rate data 

and observations of physical activity during police officers’ shifts as outcomes to distinguish 

between physical and psychosocial stress, Anderson, Litzenberger, and Plecas (2002) found 

that officers experienced both types of stress while at work; however, they experienced more 

stress before and during responding to traumatic incidents. Wirth et al. (2011) used cortisol 

responses after waking to assess the relationship between waking cortisol responses and 

shiftwork among police officers. 

Gershon et al. (2009) investigated symptoms of physical and behavioral stress among police 

officers. The authors found physical symptoms of stress were chronic lower back pain, foot 

problems, migraine headaches, and chronic insomnia, in that order. Behavioral symptoms 

included drinking alcohol, smoking tobacco, and aggressive and physical behavior with pets, 

other officers, spouses or significant others, and children. Psychological symptoms included 

burnout, depression, somatization, lack of energy, self-blame, and lack of interest in things. 

LeBlanc et al. (2008) utilized biological and psychological stress outcomes to examine 

the relationship between coping strategies and job performance in response to a stressful 

scenario among police recruits, whereas Yoo, Eisenmann, and Franke (2009) used measures 

of self-reported physical activity, perceived stress, and metabolic syndrome factors (body 

mass index, blood pressure, and blood profile) to assess the affects of stress and physical 

activity/inactivity on metabolic syndrome factors. 
6

Numerous interventions have been described to help police officers and recruits cope with 

stressful events. For example, Berking, Meier, and Wupperman (2010) suggested that the 

use of emotion-regulation training and skills as a component of interventions designed to 

help officers regulate their emotional responses to their work was beneficial. 

Although officers’ use of stress management programs as prevention or treatment 

approaches have been underutilized as a result of confidentiality and other aspects of police 

culture (Waters and Ussery 2007), law enforcement organizations provide many types 

of interventions to help both veteran police officers and recruits manage stress, the most 

common of which is training designed to help recognize signs of stress along with ways of 

coping (Finn 2000; Sewell 1999). 

Examples of stress management interventions used in law enforcement include the use of 

spot checking and scanning, positive self-talk, deep breathing, anchoring, cognitive rehearsal 

and desensitization, progressive muscle relaxation, meditation, imagery and biofeedback, 

goal setting, stress debriefing, time management, financial planning, visual-motor behavior 

rehearsal (VMBR), critical incident stress management (CISM), physical fitness, progressive 

relaxation, biofeedback, social support, and eye movement desensitization and reprocessing 

(EMDR) (Addis and Stephens 2008; Anderson, Swenson, and Clay 1995; Brandt 1993; 

Carlier et al. 1998; Chapin et al. 2008; Ellison and Genz 1983; Everly, Flannery, and 

Mitchell 2000; Shipley and Baranski 2002; Webb and Smith 1980; Wilson et al. 2001). 
Summary of Systematic 

Review Methods

What are the effects of officer stress management 

interventions on stress outcomes?
8

Summary of Systematic Review Methods

Objectives

The objectives of this systematic review were to identify, retrieve, evaluate, and synthesize 

the existing evidence investigating stress management intervention outcomes provided to 

veteran police officers and recruits. The review question is: What are the effects of officer stress 

management interventions on stress outcomes?

Inclusion criteria

Including studies in this systematic review required that several criteria be met regarding 

population characteristics, sampling strategies, interventions, study methods and designs, data 

analysis, and outcome results. The criteria included: 

1.A population consisting of veteran police officers, police recruits, and/or civilian 

(non-sworn) police personnel; however, other populations (such as firefighters) could 

be included if data collected from police officers and recruits were able to be analyzed 

separately 

2.A randomized controlled trial (RCT), random assignment to conditions, or quasiexperimental design that included a control group; this methodological criterion is based 

on what Lipsey and Wilson (2001, 9) refer to as “best evidence” 

3.Any type of stress management intervention with physical or psychosocial components 

4.Quantitative outcome data; however, studies that utilized qualitative methods (focus 

groups and interviews) were included in the review if these data were part of a mixed 

methods study that met the inclusion criteria 

5. Published or non-published studies conducted in any geographic location 
9

Pilot study 

Prior to beginning data collection from retrieved studies, a pilot study was completed to 

test the coding protocols (coding form and codebook). The pilot study also assisted the two 

reviewers with testing procedures to resolve disagreements regarding study relevance decisions. 

The two reviewers met frequently to discuss and resolve coding differences and modify the 

coding form. The coding form was developed to record publication, sampling, population, 

intervention, measurement, design, and outcome data characteristics. In some instances, these 

characteristics were specific to law enforcement, such as officers’ rank. The protocol titled Stress 

Management Training and Development Programs for Police Officers and Recruits (see Patterson 

and Chung 2010) is available at The Campbell Library website (www.campbellcollaboration.org/lib/download/703/). 

Selection of studies 

Several search methods were used to identify studies, including (1) searching electronic 

databases and Internet websites; (2) hand searching journals, books, and conference 

proceedings; (3) visually scanning reference lists from relevant studies; (4) contacting 

organizations and authors of relevant studies; and (5) searching citations. The search was 

conducted over a 10 month period between August 1, 2009 and May 31, 2012.

Data Analysis

Mixed methods studies using qualitative methods 

[were included] to provide contextual information 

to the quantitative data.
12

Data Analysis

The meta-analysis was performed using the computer software program Comprehensive 

Meta-Analysis Version 2.2.050 (Borenstein et al. 2009). Multiple outcomes and time points 

reported in the retrieved studies were not treated as independent, and multiple outcomes 

were averaged. However, effect sizes were not averaged across different outcome types. 

Effect sizes were calculated and analyzed separately based on outcome type (physiological, 

psychological, and behavioral). The majority of studies included data that were used to 

calculate effect sizes from reported means, standard deviations, and sample sizes, although a 

few studies reported Cohen’s d- and t-test results that were used to calculate effect sizes. 

Mixed methods studies using qualitative methods (focus groups and interviews) that 

met the inclusion criteria were included in this systematic review to provide contextual 

information to the quantitative data. The themes that emerged from these data were 

summarized. Two studies met this criterion as shown in Table 1 on pages 36–39.
Results

Officers perceived a lack of trust toward the law 

enforcement organization’s involvement in their 

health issues...
14

Results

Description of eligible studies

The total number of titles and/or abstracts identified from the search strategy and screened was 

678. Of these titles and abstracts, 25 studies were retrieved. Upon closer examination, 13 of 

the 25 studies were excluded due to the lack of either pre- or post-test data or the absence of 

separate outcome data for police officers. 

Table 1 on pages 36–39 provides a description of the 12 primary studies included in the 

systematic review that were published between 1984 and 2008. Combined, these studies 

comprised a total sample size of 906 participants. Seven studies contained samples comprising 

only police officers; two studies reported samples of police officers and civilian personnel; one 

study reported a sample of police officers and recruits; one study included a sample of police 

officers and significant others; and one study included a sample of police recruits. Ten studies 

reported the participants’ gender—401 were male and 91 were female. Eleven studies reported 

the participants’ age—the average age was 34.48 (SD = 3.57). 

The years of experience police officers reported was described in seven of the 12 studies—the 

average years of police experience was 10.77 (SD = 4.00) (years of police experience were 

calculated only for veteran police officers). Among the samples, the rank police officers’ 

held was described in three studies and included (1) below the rank of sergeant; (2) police 

officer, detective, and administrative officers; and (3) deputy chiefs, commanders, lieutenants, 

sergeants, and police officers. 

As indicated in Table 1, the types of interventions provided to police officers and recruits 

were quite varied. Among the 12 primary studies, 11 provided a citation for the prior work 

establishing the basis for the intervention, and 10 specific interventions were identified: 

1. Stress management program

2. Stress reduction program

3. Stress inoculation

4. Brief interventions

5. Counseling
15

6. Nutrition and physical conditioning

7. Circuit weight training

8. Eye movement desensitization and reprocessing (EMDR)

9. Visual-motor behavior rehearsal (VMBR)

10. Writing intervention

One study (Gersons et al. 2000) investigated an intervention as treatment for police 

officers diagnosed with posttraumatic stress disorder (PTSD) and required that police 

officers participating in the treatment have previous exposure to a PTSD event, meet the 

Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R) criteria for PTSD, not 

have comorbid disorders, and not have taken any psychotropic medication 4 weeks prior to 

participating in the study. The remaining 11 studies investigated interventions intended to 

either reduce stress outcomes or assess outcomes. As such, it was difficult to assess whether the 

interventions were intended as preventative or treatment interventions. 

The duration of the interventions was relatively brief, ranging from 35 minutes to 24 hours. 

These time frames were spread over a 1- to 16-week period. The average length of the 

interventions was 10.95 hours (SD = 7.33). 

Physiological outcomes

The number of outcomes reported among the 12 primary studies ranged from one to 20, with 

an average of eight outcomes per study. Two studies (McCraty et al. 1999; Short et al. 1984) 

reported physiological outcomes such as heart rate variability, blood pressure increase, strength 

improvement, physical fitness measures (height, weight, waist size, biceps diameter, and 

chest size), and weight gain/loss. Among these two studies, data were not reported for all the 

physiological outcomes that were discussed. 
16

Psychological outcomes

All of the studies measured psychological outcomes even though data were not reported for 

each outcome discussed in many of the studies. The following examples illustrate the wide 

range and diversity of standardized instruments used in the studies to measure an array of 

psychological outcomes such as anxiety, depression, and perceived levels of stress: a police 

officers questionnaire, the Coulson Police Job Stress Discussionaire (CPJSD), a police 

stress inventory (PSI), the Profile of Mood States (POMS), the Tennessee Self-Concept 

Scale (TSCS), the State-Trait Anger Expression Inventory (STAXI), the Posttraumatic 

Stress Diagnostic Scale (PTDS), the Personal and Organizational Quality Assessment 

(POQA), the Hopkins Symptom Checklist, the Perceived Stress Scale, a health and fitness 

questionnaire, the Maslach Burnout Inventory, and the Depression Anxiety Stress Scales.

Behavioral outcomes

Four studies described behavioral outcomes (see Table 1). However, data were not provided 

in all four of those studies. A single study reported the number of alcoholic drinks 

consumed as behavioral outcomes (Richmond et al. 1999), whereas the remaining studies 

reported behavioral outcomes that were work-related. Therefore, drinking behavior was 

eliminated from the analysis, resulting in three studies (McCraty et al. 1999; Norvell and 

Belles 1993; Shipley and Baranski 2002) reporting behavioral outcomes that were used 

in the analysis. Examples of behavioral outcomes include the number of sick hours and 

vacation hours used, number of complaints filed and disciplinary actions employed, number 

of accidents, times tardy, number of injuries, behaviors observed during a live-fire scenario, 

and self-ratings of work performance.
17

Meta-analysis results

Although stressful events have the potential to affect physiological, psychological, and 

behavioral wellbeing negatively, all 12 primary studies examined psychological stress 

outcomes, whereas only three studies examined behavioral outcomes, and two examined 

physiological outcomes. 

Near null effects were found among the physiological, psychological, and behavioral 

outcomes. Given that effect sizes range from -1 (a very strong negative effect size) to +1 

(a very strong positive effect size), the overall effect was near zero for each outcome. For 

instance, as Table 2 on page 40 shows, among the physiological outcomes the column labeled 

Hedge’s g shows effect sizes of 0.030 and 0.324. The overall effect is 0.196, representing a 

very small effect. Among the psychological outcomes shown in Table 3 on page 40, 12 effect 

sizes were calculated, representing each of the 12 studies. These effect sizes range from -0.485 

to 0.975. The overall effect is 0.038, representing a near zero effect. Finally, Table 4 on page 

41 shows the effect sizes for behavioral outcomes. These were -0.695, 0.041, and 0.194. The 

overall effect was -0.176, representing a very small negative effect. 

The meta-analysis results suggest that stress management interventions had no significant 

effect on physiological, psychological, and behavioral outcomes. Effect sizes were also 

calculated for several officer subgroups, and one study characteristic (attrition) theorized 

to influence intervention outcomes. These moderator variables were (1) duration of the 

stress management intervention, (2) type of stress management intervention (physical 

exercise or psychosocial intervention), (3) study population (recruit, veteran police officer, 

and civilian), (4) gender, (5) years of police experience, and (6) attrition. Too few studies 

reported officers’ rank to include it as a moderator variable. The moderator analyses results 

contained too few studies to show any significant differences across the studies. 

In sum, these results do not provide evidence to support the efficacy of stress management 

interventions for police officers or recruits. The weakness of the research designs and 

the low number of studies included in the meta-analysis should be considered when 

interpreting these results.
18

Qualitative results 

Wilson et al. (2001) conducted clinical interviews and structured exit interviews with police 

officers and their significant others. In their study, the results of the clinical interviews 

included descriptions of stressful work and life events that became the focus of the stress 

management interventions. The structured exit interviews elicited responses in the following 

areas that were not examined using the standardized instruments: 

Have you been in therapy after the stress management program, did you 

refrain from discussing your experience in the study with others, have you 

noticed any differences in yourself as a result of this stress program, have others 

noticed any changes, how do you rate the program in terms of organization, 

convenience, friendliness of staff, and recommendations for doing things 

differently. (Wilson et al. 2001, 188) 

The following themes emerged from these questions: officers’ significant others observed 

positive changes in their officer spouses following participation in EMDR, officers who 

participated in the EMDR stress management intervention referred their friends to the 

treatment, and spouses expressed an interest in participating in EMDR themselves. 

The qualitative data collected in the study conducted by Richmond et al. (1999) suggests 

that officers perceived a lack of trust toward the law enforcement organization’s involvement 

in their health issues and that drinking alcohol was a private matter unless it interfered with 

job performance. Police officers described police work stress as promoting alcohol use as a 

coping and bonding strategy among officers. Officers were pleased by the interest expressed 

from the organization regarding their health and use of alcohol; however, they expressed a 

lack of trust concerning why the organization was interested in their health and alcohol use. 

Officers believed that health-related issues should be managed by officers themselves rather 

than the organization, and interventions that focused on alcohol use were not viewed 

positively unless other health issues where simultaneously addressed. Officers also recognized 

the impact of promotions, traumatic events, and the repetition involved in their work 

on perceptions of stress. Use of alcohol was viewed as supported by police occupational 

culture; officers felt pressure to drink excessively, and drinking alcohol was not viewed as a 

maladaptive coping strategy.
Conclusion

It is imperative to determine which components of stress 

management interventions are effective.
20

Conclusion

Numerous studies describe the sources of stress that police officers and recruits experience, 

coping strategies, and approaches to investigating physiological, psychological, and behavioral 

stress outcomes. Most of this literature consists of descriptive cross-sectional studies and asserts 

the need for stress management interventions to help officers cope with stress. However, few 

rigorous outcome studies have been conducted that are designed to investigate the efficacy of stress 

management interventions given to police officers and recruits. 

Law enforcement organizations provide a wide variety of stress management interventions 

developed to help police officers and recruits manage stress, yet evaluation methods seldom utilize 

randomized controlled trials, which are the best methods for demonstrating program effectiveness. 

Consequently, the need exists to conduct a review of the available evidence. 

The purpose of this systematic review was to examine the research question: What are the effects 

of officer stress management interventions on stress outcomes? Because police officers experience 

numerous stressful work and life events, this is an important question that warrants examination. 

Twelve studies were found that met the inclusion criteria. Richardson and Rothstein (2008) 

observed that when a specific population is the focus of stress management intervention outcomes, 

reviews are likely to include a small number of studies. The primary studies included in this 

systematic review provided a great deal of information regarding the components of the 10 

interventions that were quite varied. Most of the interventions do not appear to be a part of an 

ongoing training program or program evaluation effort by the law enforcement organizations 

participating in the studies and thus appear to be a part of a one-time study. 

The wide variety of intervention components made it difficult to code the components and 

consequently to disentangle which components of the stress management interventions were 

likely to be effective. It was also unclear among the primary studies which types of stress were 

the focus of the interventions. Giga, Cooper, and Faragher (2003) noted that stress management 

interventions have a wide range of objectives, methods, and structures and are provided to 

different populations of workers. Some interventions focus on organizational factors (policies and 

the physical work environment), whereas others focus on individual factors (workers’ attitudes 

and behaviors). 
21

In order to guide organizations in implementing interventions and contribute to the 

literature describing the effectiveness of stress management interventions, it is imperative to 

determine which components of stress management interventions are effective (van der Hek 

and Plomp 1997). Among the studies included in the review, it was also difficult to assess 

whether the interventions were primary, secondary, or tertiary interventions. The treatment 

provided to officers experiencing PTSD (Gersons et al. 2000) was the only tertiary 

intervention found among the primary studies. 

Our results indicate that stress management interventions had no significant effect on 

physiological, psychological, or behavioral outcomes. Although stress can contribute to 

psychological, behavioral, and physiological outcomes, all of the primary studies examined 

psychological stress outcomes, whereas only three studies examined behavioral outcomes, 

and two examined physiological outcomes. Near null effects were found for psychological, 

behavioral, and physiological outcomes. Moderator analyses also did not to find any 

differences across the studies in terms of subgroups or study characteristics. 

Given the weakness of the research designs, we cannot conclude that the stress management 

interventions are effective or ineffective. There are several possible explanations regarding 

these findings, such as (1) the low quality of the primary studies, (2) the varied aims of the 

interventions, (3) methodological issues including the diversity in standardized instruments 

used to measure outcomes, and (4) the small sample size among the primary studies. 

Our review included three of 10 studies (Norvell and Belles 1993; Shipley and Baranski 

2002; Short et al. 1984) identified in a prior systematic review investigating the affects of 

stress management interventions for police personnel (see Peñalba, McGuire, and Leite 

2009). The authors did not conduct a meta-analysis, stating that the diversity among study 

participants, intervention types, and outcomes made it impossible to conduct the analysis. 

Taken together, our findings and the findings reported by Peñalba, McGuire, and Leite 

(2009) highlight the low quality of retrieved studies and the diversity among participants, 

interventions, and outcomes. Giga, Cooper, and Faragner (2003) asserted that such diversity 

among studies may contribute to conflicting findings reported in the literature. Indeed, 

multiple classifications of coping, measurement strategies, and methods used to investigate 

work stress and interventions have been reported (Dewe and Cooper 2007). 
22

Implications for policy and practice

The meta-analysis results alone do not offer implications for law enforcement policy and 

practice relative to stress management interventions. However, the characteristics and 

methodological quality of the retrieved studies included in the systematic review, as well 

as excluded studies, do offer a number of implications for law enforcement policies and 

practices: 

•	 More systematic evaluations of stress management interventions provided to police 

officers and recruits are necessary that examine predisposing factors and specify the 

aims of the interventions, types of stress addressed, and whether the interventions are 

intended as primary, secondary, and tertiary interventions. 

•	 Stress management interventions for police officers and recruits should focus on 

specific types of stress (organizational and life stressors), and the type of stress that is 

the focus of the intervention should be described in studies. 

•	 Stress management program content should be developed based on a thorough 

literature review and ideas obtained from officers similar to the approach used by 

Wilson et al. (2001) and the law enforcement administration. 

•	 Increase collaboration between law enforcement, mental health experts, and 

researchers when developing, implementing, and evaluating stress management 

interventions. 

•	 Increase research funding to conduct rigorous multi-site program evaluations with 

the aim of developing best practice approaches for stress management interventions 

provided to law enforcement personnel. 
23

•	 Improve law enforcement organizational support for randomized controlled trial 

(RCT) studies that can rule out extraneous factors and provide greater evidence of 

intervention effectiveness. This requires organizations to abandon current evaluation 

methods that assess participant satisfaction with program content, instructors, 

and materials. Although RCTs are not always feasible in law enforcement settings, 

particularly during recruit academy training, an alternative intervention can be 

provided to the control group. 

•	 More qualitative data are needed to contextualize participants’ experiences with 

the intervention through mixed methods studies. The results of such studies can 

add to the body of knowledge on participants’ perceptions and experiences with 

interventions that are not measured using standardized instruments. These data can 

help guide the implementation, monitoring, and evaluation of interventions. 

•	 Change law enforcement cultural views of excessive use of alcohol and other forms of 

maladaptive coping toward a view that encourages adaptive forms of coping. 

Studies Included in 

the Review
26

Studies Included in the Review

Ackerley, D.G. 1986. “The Effects of a Stress Management Program on Police Personnel.” 

Ph.D. dissertation, University of Missouri—Columbia. ProQuest (ID 303496319).

Coulson, J.E. 1987. The Effectiveness of a Stress Reduction Program for Police Officers. Ph.D. 

dissertation, University of North Texas. ProQuest (ID 303591680).

Digliani, J.A. 1994. “Stress Inoculation Training: The Police.” Dissertation Abstracts 

International 56 (04B).

Gersons, B.P.R., I.V.E. Carlier, R.D. Lamberts, and B.A. van der Kolk. 2000. “Randomized 

Clinical Trial of Brief Eclectic Psychotherapy for Police Officers with Posttraumatic 

Stress Disorder.” International Society for Traumatic Stress Studies 13 (2): 333–347. 

doi:10.1023/A:1007793803627.

Ireland, M., J.M. Malouff, and B. Byrne. 2007. “The Efficacy of Written Emotional 

Expression in the Reduction of Psychological Distress in Police Officers.” International 

Journal of Police Science & Management 9 (4): 303–311. doi:10.1350/ijps.2007.9.4.303.

McCraty, R., D. Tomasino, M. Atkinson, and J. Sundram. 1999. Impact of the HeartMath 

Self-Management Skills Program on Physiological and Psychological Stress in Police Officers, 

no. 99–075. Boulder Creek, CA: HeartMath Research Center, Institute of HeartMath. 

Norvell, N., and D. Belles. 1993. “Psychological and Physical Benefits of Circuit Weight 

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“Quantitative and Qualitative Evaluations of Brief Interventions to Change Excessive 

Drinking, Smoking and Stress in the Police Force.” Addiction 94 (10): 1509–1521. 

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Tables
36

Table 1. Characteristics of Included Studies

Author Sample size and 

description Methods Intervention components

Ackerley (1986) Total: 49

Police officers and civilian 

personnel 

Random block 

design and focus 

groups 

The stress process, physical education, relaxation training, dietary 

programming, cognitive restructuring, sleep and biological cycles, 

communication skills, coping, and exercise program 

Coulson (1987) Total: 63

Police officers and 

recruits

Quasi-experimental Stress inoculation, cognitive-behavioral approach, stress awareness, and 

stress control

Digliani (1994) Total: 51

Police officers

Quasi-experimental Conceptualization, skills acquisition and rehearsal, and application and 

follow-through

Gersons, Carlier, 

Lamberts, and 

van der Kolk 

(2000)

Total: 42

Police officers

Random Psychoeducation, imaginary guidance, writing assignments and 

mementos, domain of meaning or integration, and farewell ritual

Ireland, Malouff, 

and Byrne (2007) 

Total: 67

Police officers

Random Writing intervention 

McCraty, 

Tomasino, 

Atkinson, and 

Sundram (1999)

Total: 59

Police officers and civilian 

personnel

Random HeartMath stress and emotional self-management techniques (freezeframe technique, coherent communication, and heart lock-in), and 

scenarios (building search, high-speed pursuit, and domestic violence)
37

Study outcomes Length of 

intervention 

Intervention 

type Age Country

Psychological: social stress, burnout (emotional 

exhaustion, depersonalization, and personal 

accomplishment), job satisfaction, quality of family life, 

coping, and internal-external locus of control

Behavioral: indicators of job performance (sick hours taken, 

number of vacation hours taken, complaints filed against, 

complaints filed, number of disciplinary actions taken, 

number of accidents, times tardy, and number of injuries) 

24 hours Stress management 

program

32 United States

Psychological: mood disturbance (tension-anxiety, 

depression-dejection, anger-hostility, vigor-activity, 

fatigue-inertia, and confusion-bewilderment)

10 hours Stress reduction 

program

32 United States

Psychological: trait anxiety, personal stress, self-efficacy, 

and trait anger 

10 hours Stress inoculation 

training 

37.6 United States

Psychological: phobic anxiety, anxiety, depression, 

somatization, obsessive compulsive, interpersonal 

sensitivity, hostility, sleeping problems, psychoticism (SCL90 scales), and co-morbid disorder as per DSM-III-R

Behavioral: return to work

16 weekly sessions, 

60 minutes 

per session

Brief Eclectic 

Psychotherapy 

(BEP), a 

combination 

of cognitivebehavioral and 

psycho-dynamic 

approaches

35 Netherlands 

Psychological: stress, anxiety, and depression (Depression 

Anxiety Stress Scale DASS, Lovibond and Lovibond 1995)

4 work days, 

15 minutes 

each day

Total: 1 hour

Writing 

intervention 

35.85 (SD 

= 8.95) for 

TG; 38.83 

for entire 

sample

Australia 

Psychological: coping skills, family relationships, work 

performance, interpersonal skills, stress, emotional 

wellbeing, and physical stress symptoms

Physiological: heart rate variability and blood pressure 

Behavioral: training officer ratings and self-ratings of work 

performance

4–6 hours 

(5 hours average)

HeartMath stress 

and emotional 

self-management 

techniques

39 United States
38

Table 1. Characteristics of Included Studies (con’t)

Author Sample size and 

description Methods Intervention components

Norvell and 

Belles (1993)

Total: 29

Police officers 

Random Initial circuit weight training, no individualized training following initial 

instruction, and circuit machines 

Richmond, 

Kehoe, Hailstone, 

Wodak, and 

Uebel-Yan (1999)

Total: 355

Police officers

Quasi-experimental Health assessment, alcohol intervention, brief advice, and self-help 

materials 

Short, DiCarlo, 

Steffee, and 

Pavlou (1984)

Total: 45

Police officers

Random Physical fitness instruction and conditioning 

Shipley and 

Baranski (2002)

Total: 54

Police recruits

Random Progressive relaxation (breathing exercise and systematic relaxation of 

major muscle groups), imagery/mental rehearsal (energizing cue words, 

positive self-statements, and imagery), and scenario (live fire)

Tanigoshi, 

Kontos, and 

Remley (2008)

Total: 51

Police officers

Random Indivisible self model, wellness plans, and prevention plans 

Wilson, Tinker, 

Becker, and 

Logan (2001)

Total: 62

Police officers and 

significant others

Random, clinical 

interviews, and 

structured exit 

interviews

Eye movement desensitization and reprocessing (EMDR)
39

Study outcomes Length of 

intervention 

Intervention 

type Age Country

Psychological: psychological symptom patterns 

(somatization, obsessive-compulsiveness, interpersonal 

sensitivity, depression, anxiety, hostility, phobic anxiety, 

paranoid ideation, and psychotism), distress (global 

severity, positive symptom distress, and positive symptom 

total), perceived stress, satisfaction with nature of work, 

pay, promotional opportunities, and characteristics of 

supervision and co-workers

Physiological: common physical symptoms, cardiovascular 

fitness (discontinuous step test), strength improvement 

(one-repetition maximum-strength measure), physical 

fitness measures (height, weight, waist size, biceps 

diameter, and chest size), and grip strength 

16 hours Circuit weight 

training 

32.84 United States

Behavioral: alcohol consumption and cigarette smoking

Psychological: stress

Physiological: exercise and weight gain/loss

35 minutes Brief interventions 33.2 Australia 

Psychological: self-concept (physical self, personal self, 

social self, identity, self-satisfaction, behavior, and 

self-criticism)

12 hours Nutrition 

and physical 

conditioning 

program

Not reported 

(age range: 

29–52)

United States

Psychological: cognitive state anxiety, somatic state 

anxiety, and self-confidence

Behavioral: job performance self-rated and facilitator-rated

30 minutes Visuo-motor 

behavior rehearsal 

(VMBR)

27 Canada 

Psychological: wellness (essential self, social self, physical 

self, creative self, and coping self), willingness to change

5 hours Individual wellness 

counseling

35 United States

Psychological: personal and job stress (subjective 

disturbance, stress, state-trait anger, and coping), marital 

adjustment, PTSD, and general psychological functioning

6 hours EMDR stress 

management 

program

36.8 United States
Table 2. Physiological Outcomes

Studyname Outcome Time point Statistics for each study Hedges’s g and 95% Cl

Hedges’s g Standard 

error Variance Lower 

limit

Upper 

limit Z-Value p-Value

McCraty et al. Combined Combined 0.324 0.260 0.068 -0.185 0.833 1.247 0.213

Short et al. Combined Combined 0.030 0.295 0.087 -0.549 0.609 0.102 0.919

0.196 0.195 0.038 -0.187 0.578 1.003 0.316

–2.00 –1.00 0.00 1.00 2.00

Table 3. Psychological Outcomes

Study name Outcome Time point Statistics for each study Hedges’s g and 95% Cl

Hedges ’s g Standard 

error Variance Lower limit

Upper 

limit Z-Value p-Value

Short et al. Combined Combined -0.022 0.295 0.087 -0.599 0.556 -0.073 0.942

Tanigoshi et al. Combined Combined 0.095 0.278 0.077 -0.450 0.640 0.342 0.732

Ackerley Combined Combined -0.110 0.282 0.080 -0.663 0.443 -0.390 0.696

Coulson Combined Combined -0.341 0.305 0.093 -0.939 0.257 -1.117 0.264

Digliani Combined Combined -0.170 0.279 0.078 -0.717 0.377 -0.608 0.543

Gersons et al. Combined Combined -0.485 0.312 0.097 -1.097 0.126 -1.556 0.120

Ireland et al. Combined Combined 0.018 0.176 0.031 -0.327 0.363 0.102 0.919

McCraty et al. Combined Combined 0.054 0.259 0.067 -0.453 0.561 0.209 0.834

Norvell et al. Combined Combined -0.317 0.370 0.137 -1.043 0.409 -0.855 0.392

Richmond et al. Psy stress Combined 0.028 0.107 0.011 -0.182 0.238 0.258 0.796

Wilson et al. Combined Posttest 0.975 0.268 0.072 0.449 1.500 3.636 0.000

Shipley et al. Psy anxiety Posttest 0.462 0.272 0.074 -0.072 0.995 1.697 0.090

0.038 0.098 0.010 -0.155 0.230 0.384 0.701

–2.00 –1.00 0.00 1.00 2.00

40
Table 4. Behavioral Outcomes

Study name Outcome Time point Statistics for each study Hedges’s g and 95% Cl

Hedges’s g Standard 

error Variance Lower limit Upper limit Z-Value p-Value

McCraty et al. Combined Combined 0.041 0.258 0.067 -0.465 0.546 0.158 0.875

Norvell et al. Combined Combined 0.194 0.368 0.135 -0.526 0.915 0.528 0.597

Shipley et al. Combined Posttest -0.695 0.277 0.077 -1.238 -0.153 -2.512 0.012

-0.176 0.277 0.077 -0.719 0.367 -0.635 0.525

–2.00 –1.00 0.00 1.00 2.00

Favors A Favors B

41
U.S. Department of Justice

Office of Community Oriented Policing Services

145 N Street, N.E.

Washington, DC 20530

To obtain details on COPS programs, 

call the COPS Office Response Center at 800.421.6770.

Visit COPS Online at www.cops.usdoj.gov.

January 2013

e081225702

ISBN: 978-1-932582-69-7