Clinical trial NCT05521360: Autonomic Modulation Training for Police Exposed to Post-Traumatic Stress Injuries
Official title: Autonomic Modulation Training: A Biological Approach to Building Resilience and Wellness Capacity Among Police Exposed to Post-Traumatic Stress Injuries (PTSI)
Study type: INTERVENTIONAL
Overall status: RECRUITING
Phase: NA
Conditions: Stress, Physiological
Stress, Psychological
Keywords: Post Traumatic Stress Symptoms
Depressive Symptoms
Anxiety Symptoms
Operational Stress
Organizational Stress
Police
HRV Biofeedback
Psychophysiology
Lead sponsor: University of Toronto
Sponsor class: OTHER
Collaborators: name: Canadian Institutes of Health Research (CIHR)
First posted: 2022-08-30
Enrollment: 250
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Allocation: RANDOMIZED
Intervention model: PARALLEL
Intervention model description: Participants are randomized to either the experimental or matched wait-list control group.
Primary purpose: PREVENTION

Brief summary: Police officers are exposed to hazardous, disturbing events that impose stress and long-term trauma. Upwards of 15-26% of public safety personnel (PSP) report one or more mental health symptoms. Accumulated stress and posttraumatic stress injuries (PTSI) result in chronic physical and mental health disorders including anxiety, depression, substance abuse, and cardiovascular disease. PTSI are related to reduced occupational performance, absenteeism, and risky behaviour, with implications for both police and public safety. Recent empirical evidence and government reports highlight a mental health and suicide crisis among various PSP sectors in Canada. Prior research forms an urgent call for evidence-based programs that build resilience and wellness capacity to prevent PTSI symptoms before they manifest as severe, chronic, diagnosable disorders. The current study addresses the limited effectiveness issues associated with existing interventions for PTSI among PSP and also considers sex and gender as central determinants of health.

Advances in physiology and neuroscience demonstrate that resilience is maintained by the healthy functioning of psychophysiological systems within the body. Objective biological measures have shown that chronic stress and trauma disrupt both psychological and physiological functioning, eroding resilience and reducing wellness capacity. Traditional interventions to build resilience among PSP have not adequately addressed the physiological underpinnings that lead to mental and physical health conditions, as well as burnout and fatigue following trauma. Together with previous empirical research lead by the NPA, the current proposal addresses this gap in PSP intervention research by employing Autonomic Modulation Training (AMT), a biological approach to building resilience and wellness capacity among PSP exposed to PTSI. Prior research shows that core AMT techniques effectively reduce psychophysiological stress and mental health symptoms in clinical and non-clinical populations. Further, research has shown that AMT techniques improve police health and occupational performance when completed during scenario-based, in-person training.

The aim of the proposed study is to test if a web-based delivery of AMT for police officers can build resilience and wellness capacity, and reduce symptoms of PTSI with similar effectiveness as in-person training. An additional novel scientific contribution of the current proposal includes an examination of sex and gender in baseline biological presentation of PTSI among police, and in response to a resilience building intervention.

Detailed description: Hypotheses

Self-reported PTSI symptoms and resilience

H1. Symptoms of PTSI will be significantly reduced following completion of the AMT intervention, as measured by the Personal Health Questionnaire (PHQ-8), General Anxiety Disorder Scale (GAD-7), Depression, Anxiety, and Stress Scale (DASS), PTSD checklist (PCL-5), Copenhagen Burnout Inventory (CBI), Perceived Stress Scale (PSS), Alcohol Use Disorder Identification Test (AUDIT). Occupational/operational stress exposure will be measured by the Police Stress Questionnaire (PSQ) to account for possible exposures to stress and potentially traumatic events over the course of the intervention. Self-reported and COVID related stress will also be evaluated.

H2. Functional wellness capacity and resilience will be significantly improved following completion of the AMT intervention, as measured by the Brief COPE, Resilience Scale for Adults (RSA-33), and Brief Resilience Scale (BRS), White Bear Suppression Inventory (WBSI), Perseverative Thinking Questionnaire (PTQ), Ultra-Brief Penn State Worry Questionnaire (UB-PSWQ), Ultra-Brief Rumination Response Styles (UB-RRS), Good Health Practices Scale (GHPS).

H3. Sex and gender differences in PTSI will be observed at baseline and post-intervention assessment. We expect that females will report more symptoms of PTSI and lower resilience at baseline, and a greater reduction of PTSI symptoms and greater increase in resilience at follow-up than males. Gender role stress, discrimination, and harassment will be explored as moderators of PTSI symptoms at baseline and in response to the AMT intervention. Sex is measured by self-reported sex at birth, gender discrimination is measured by Workplace Gender Discrimination Scale (WGDS) and harassment is measured by the Gender Experiences Questionnaire (GEQ).

Objective biological indicators of PTSI symptoms and resilience

H4. Resting HRV will significantly increase following completion of the AMT intervention. Changes in resting HRV will be measured by time and frequency domain parameters based on data collected from the wearable HR monitors (e.g., high and low frequency HRV, LF/HF ratio, and the root mean square of successive differences (RMSSD) as recommended in the standards of practice for HRV analysis.

H5. RSA will significantly increase following completion of the AMT intervention. RSA is measured by obtaining the respiratory frequency. Greater power at the respiratory frequency indicates a higher level of RSA and will be analyzed using the gold standard HRV analysis program, Kubios.

H6. Recovery from acute stress will significantly improve following completion of the AMT intervention. Acute stress will be induced by completion of the online Paced Auditory Serial Addition Test (PASAT) and the Stroop Emotion Face Interference Task. Acute stress recovery will be assessed via a time domain measure of HRV (RMSSD).

H7. Based on inconsistencies in the extant literature, we will conduct exploratory analyses of any potential sex and gender differences in HRV, RSA, and acute stress recovery at baseline and post-intervention assessments. Although we expect to see improvements in self-reported and objective measures of PTSI and resilience overall (i.e., independent of sex and gender), we hypothesize that gender role stress and gender discrimination will moderate these effects. Further, it is possible that the magnitude of post-intervention changes is greater among women given the additional burden of exposure to a hyper-masculinized working environment. Because AMT provides tools for effective stress management, women may find more benefit from the intervention in managing the wider array of sociocultural stressors they experience compared to males.

Eligibility criteria: Inclusion Criteria:

* Current employment as an active duty (i.e., not on an extended medical or disability leave) frontline law enforcement officer in Canada.
* Must be fluent in English.

Exclusion Criteria:

* Non-Canadian law enforcement officers. Police administrators and civilian employees (i.e., non-sworn members) are not eligible.
* Officers that do not have weekly access to a personal computer to complete the online AMT intervention

Primary outcomes:
measure: Post-traumatic stress disorder (PTSD) symptoms
timeFrame: From baseline to follow-up (immediate post intervention assessment)
measure: Depression symptoms
timeFrame: From baseline to follow-up (immediate post intervention assessment)
measure: Global psychological symptoms
timeFrame: From baseline to follow-up (immediate post intervention assessment)
measure: Anxiety symptoms
timeFrame: From baseline to follow-up (immediate post intervention assessment)
measure: Alcohol use
timeFrame: From baseline to follow-up (immediate post intervention assessment)
measure: Perceived stress
timeFrame: From baseline to follow-up (immediate post intervention assessment)
measure: Self-reported stress
timeFrame: From baseline to follow-up (immediate post intervention assessment) and session-to-session changes
measure: COVID stress experience
timeFrame: From baseline to follow-up (immediate post intervention assessment)
measure: Burnout symptoms
timeFrame: From baseline to follow-up (immediate post intervention assessment)
measure: Occupational police stress
timeFrame: From baseline to follow-up (immediate post intervention assessment)
measure: Coping
timeFrame: From baseline to follow-up (immediate post intervention assessment)
measure: General resilience
timeFrame: From baseline to follow-up (immediate post intervention assessment)
measure: Social resilience
timeFrame: From baseline to follow-up (immediate post intervention assessment)
measure: Thought suppression
timeFrame: From baseline to follow-up (immediate post intervention assessment)
measure: Repetitive thinking
timeFrame: From baseline to follow-up (immediate post intervention assessment)
measure: Worry
timeFrame: From baseline to follow-up (immediate post intervention assessment)
measure: Rumination
timeFrame: From baseline to follow-up (immediate post intervention assessment)
measure: Good health practices
timeFrame: From baseline to follow-up (immediate post intervention assessment)
measure: Overall functional wellness
timeFrame: From baseline to follow-up (immediate post intervention assessment)
measure: Difficulties in performing life activities due to health conditions
timeFrame: From baseline to follow-up (immediate post intervention assessment)
measure: Difficulties in performing work activities due to health conditions
timeFrame: From baseline to follow-up (immediate post intervention assessment)
measure: Workplace discrimination
timeFrame: From baseline to follow-up (immediate post intervention assessment)
measure: Gender-based workplace harassment
timeFrame: From baseline to follow-up (immediate post intervention assessment)
measure: Resting heart rate variability (HRV)
timeFrame: From baseline to follow-up (immediate post intervention assessment)
measure: Physiological recovery from acute stress
timeFrame: From baseline to follow-up (immediate post intervention assessment)
measure: Respiratory Sinus Arrhythmia (RSA)
timeFrame: From baseline to follow-up (immediate post intervention assessment)
measure: Sex and gender differences in PTSI, occupational stress, and physiology
timeFrame: From baseline to follow-up (immediate post intervention assessment)
Secondary outcomes:
Other outcomes:
Locations:
city: Mississauga
country: Canada
facility: University of Toronto Mississauga
state: Ontario
Study officials:
affiliation: University of Toronto
name: Judith P Andersen, PhD
role: PRINCIPAL_INVESTIGATOR
References: