Mindfulness-Based Resilience Training for Aggression, Health, and Stress Among Law Enforcement Officers

Study Overview
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Brief Summary
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Law enforcement officers (LEOs) are exposed to significant stressors, elevating their risk for aggression and excessive use of force, as well as mental health consequences, including post-traumatic stress disorder, burnout, alcohol misuse, depression, and suicide. The proposed study will identify, optimize and refine best clinical and research practices across two sites to ensure success in a future multisite efficacy trial assessing preventative effects of Mindfulness-Based Resilience Training on physiological, behavioral, and psychological outcomes.

Detailed Description
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Law enforcement officers (LEOs) are exposed to significant stressors, elevating their risk for aggression and excessive use of force. Such dysfunctional stress reactivity can lead to devastating consequences for their community, including unjustified shootings, severe beatings, and fatal chokings. It can also lead to serious consequences for the LEOs, including elevated incidence of post-traumatic stress disorder, burnout, alcohol misuse, depression, and suicide. A recent meta-analysis of LEO stress reduction programs found little evidence to demonstrate that such approaches are effective, highlighting the urgent need for preventive interventions targeting the stress inherent to policing. Mindfulness training is a promising approach with high-stress populations that has been shown effective in reducing stress and increasing resilience. In a recent pilot feasibility study (R21AT008854), the study team established initial feasibility, acceptability, and adherence to procedures in a single-site RCT assessing Mindfulness-Based Resilience Training (MBRT), a preventive intervention designed to improve LEO mental health and resilience, and reduce aggression and excessive use of force. The R21 data suggest physiological mechanisms and potential clinical benefit in a sample of LEOs. Relative to waitlist control, MBRT participants showed improvements in stress reactivity, aggression, burnout, occupational stress, sleep disturbance, and psychological flexibility. Implemented at two sites, the proposed study is designed to establish optimal protocols and procedures for a future full-scale, multi-site trial assessing effects of MBRT versus an attention control (Stress Management Education) and a no-intervention control, on physiological, behavioral, and psychological outcomes. To prepare for this future clinical trial, this study will: a) enhance efficiency of recruitment, engagement and retention; b) optimize lab, assessment, and data management procedures; c) optimize intervention training and ensure fidelity to intervention protocols; and d) assess participant experience and optimize outcome measures across sites. The long-term objective of this line of research is to develop an intervention that will reduce violence and increase resilience among LEOs, as well as yield significant benefits for communities and residents they serve.

Official Title
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Mindfulness-Based Resilience Training for Aggression, Health, and Stress Among Law Enforcement Officers

Conditions
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Stress, Psychological, Aggression

Intervention / Treatment
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* Behavioral: Mindfulness-Based Resilience Training
* Behavioral: Stress Management Education


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: be 21-65 years old (age limitations for both police departments), demonstrate English fluency, be a sworn, full-time, active status law enforcement officer, agree to random assignment to condition, and be willing to complete assessments at multiple time points and attend intervention groups Exclusion Criteria: previous participation in MBSR, MBRT or a similar mindfulness course, score in the severe range on brief screening measures of depression, suicidal ideation, alcohol use, or PTSD, or unable or unwilling to give written informed consent.

Ages Eligible for Study
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Minimum Age: 21 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Individually-Randomized Group Treatment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Mindfulness-Based Resilience Training<br>MBRT is an 8-week program combining training in standardized mindfulness practices targeting factors that facilitate resilience, cognitive behavioral therapy (CBT), and psychoeducation. It contains experiential and didactic exercises including body scan, sitting and walking meditation, mindful movement and discussions. | Behavioral: Mindfulness-Based Resilience Training<br>* MBRT is an 8-week program combining training in standardized mindfulness practices targeting factors that facilitate resilience, CBT, and psychoeducation. It contains experiential and didactic exercises including body scan, sitting and walking meditation, mindful movement and discussions.<br>|
| Active Comparator: Stress Management Education<br>SME was designed as an active control condition for other mindfulness-based intervention trials. SME uses a group-based didactic approach with modules on physiological and dietary effects of stress, time management, sleep physiology and insomnia, nutrition, exercise, stress hardiness, and factors mitigating impacts of stress. | Behavioral: Stress Management Education<br>* SME was designed as an active control condition for other Mindfulness-Based Intervention trials. SME uses a group-based didactic approach with modules on physiological and dietary effects of stress, time management, sleep physiology and insomnia, nutrition, exercise, stress hardiness, and factors mitigating impacts of stress.<br>|
| No Intervention: No Intervention Control<br>No contact control condition (other than baseline, post, and follow-up assessments) | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Aggression | Buss-Perry Aggression Questionnaire-Short Form. Scores range from 1-5, with higher scores indicating greater aggression. | baseline, post-intervention (week 8), 3-month followup, 6-month followup | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in C-reactive Protein | Blood spot analysis of high-sensitivity C-reactive protein. | baseline, post-intervention (8 weeks), 3 month followup | 
| Change in Interleukin-6 | Blood spot analysis of interleukin-6. | baseline, post-intervention (8 weeks), 3 month followup | 
| Change in Interleukin-10 | Blood spot analysis of interleukin-10. | baseline, post-intervention (8 weeks), 3 month followup | 
| Change in Tumor Necrosis Factor-alpha | Blood spot analysis of tumor necrosis factor-alpha. | baseline, post-intervention (8 weeks), 3 month followup | 
| Change in Psychological Resilience | Brief Resilience Scale. Scores range from 1-5, with higher scores indicating greater resilience. | baseline, post-intervention (8 weeks), 3 month followup, 6 month followup | 
| Change in Alcohol Use | Patient Reported Outcome Measurement System (PROMIS) Alcohol Use. Scores range from 39-77, with higher scores indicating greater alcohol use. | baseline, post-intervention (8 weeks), 3 month followup, 6 month followup | 
| Change in Alcohol Use Negative Consequences | Patient Reported Outcome Measurement System (PROMIS) Alcohol Use Negative Consequences.Scores range from 39-77, with higher scores indicating greater alcohol use negative consequences. | baseline, post-intervention (8 weeks), 3 month followup, 6 month followup | 
| Change in Depression | Patient Reported Outcome Measurement System (PROMIS) Depression. Scores range from 38-80, with higher scores indicating more depression. | baseline, post-intervention (8 weeks), 3 month followup, 6 month followup | 
| Change in Suicidal Thinking | Concise Heath Risk Tracking Scale-Self-Report. Scores range from 7-35, with higher scores indicating greater suicidal ideation. | baseline, post-intervention (8 weeks), 3 month followup, 6 month followup | 
| Change in Trauma Symptoms | PTSD Checklist for DSM-5. Scores ranges from 0-80, with higher scores indicating greater PTSD symptoms. | baseline, post-intervention (8 weeks), 3 month followup, 6 month followup | 
| Change in Burnout | Oldenburg Burnout Inventory. Scores range from 1-4, with higher scores indicating greater burnout. | baseline, post-intervention (8 weeks), 3 month followup, 6 month followup | 
| Change in Sustained Attention | Sustained Attention to Response Task. A computer-based go/no-go task that requires participants to withhold behavioral response to a single, infrequent target presented amongst a background of frequent non-targets. Increased errors indicates less sustained attention. | baseline, post-intervention (8 weeks), 3 month followup, 6 month followup | 
| Change in Perceived Stress | Perceived Stress Scale-10. Scores range from 0-40, with higher scores indicating greater perceived stress. | baseline, post-intervention (8 weeks), 3 month followup, 6 month followup | 
| Change in Sleep Disturbance | Patient Reported Outcome Measurement System (PROMIS) Sleep Disturbance. Scores range from 32-76, with higher scores indicating greater sleep disturbance. | baseline, post-intervention (8 weeks), 3 month followup, 6 month followup | 
| Change in Self-Compassion | Self-Compassion Scale-Short Form. Scores range from 1-5, with higher scores indicating greater self-compassion. | baseline, post-intervention (8 weeks), 3 month followup, 6 month followup | 
| Change in Mindfulness | Five Facet Mindfulness Questionnaire-Short Form. Scores range from 1-5, with higher scores indicating greater mindfulness. | baseline, post-intervention (8 weeks), 3 month followup, 6 month followup | 
| Change in Interoceptive Awareness | Multidimensional Assessment of Interoceptive Awareness-II. Scores range from 1-6, with higher scores indicating greater interoceptive awareness. | baseline, post-intervention (8 weeks), 3 month followup, 6 month followup | 
| Treatment Acceptability | Postcourse satisfaction survey. Scores range from 4-16, with higher scores indicating greater treatment acceptability. Measure only administered to Mindfulness-Based Resilience Training and Stress Management Education arms. | post-intervention (8 weeks) | 
| Treatment Compliance | Objective assessment of duration of homework practice. Measure only administered to Mindfulness-Based Resilience Training and Stress Management Education arms. | post-intervention (8 weeks) | 
| Treatment Expectancy and Credibility | Expectancy/Credibility Questionnaire. Scale for measuring treatment expectancy and rationale credibility for use in clinical outcome studies. Scores range from 7-21, with higher scores indicating greater expectancy and credibility. | baseline | 
| Global Impression of Change | Clinical Global Impressions Scale. Measure of perceived change in functioning as a result of the intervention. Scores range from 3-21, with higher scores indicating a greater impression of change. Measure only administered to Mindfulness-Based Resilience Training and Stress Management Education arms. | post-intervention (8 weeks) |