Trauma on the Job: Post-Traumatic Stress Disorder in Law Enforcement Officers

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Karen Lansing, a licensed psychotherapist and Diplomate of the American Academy of Experts in Traumatic Stress, has had a unique career. Specializing in treatment of what she terms “duty-induced” post-traumatic stress disorder (PTSD), Lansing has successfully treated hundreds of law enforcement officers, firefighters, paramedics, lifeguards and military assets. But it’s the way she’s approached this calling that is so unusual. Not content to remain in the clinician’s chair, Lansing has extensive training in weapons and tactics and strives to spend as much time out on the ground with her client populations as in her office.

Lansing’s experience has given her an international vantage point into how we prepare officers for the mental and psychological aspects of the job and then how they’re supported (or not) after critical incidents. “There are some exceptional agencies that are evolving within these interesting times, such as Placer County (CA) Sheriff’s Department, the California Highway Patrol and Sacramento County Sheriff’s Department,” she says. “However, it’s not uncommon that in many others, preparation and support are lacking in scope and effectiveness relative to the ever-increasing complexities within the work of first response—and law enforcement in particular.”

International Experience
Lansing realized early on that the treatment protocol best suited for treating PTSD was designed for civilians. So she and her “first generation” of six officer clients customized it for the brains of those within emergency response and the military. She worked first with police, then firefighters, then the FBI and eventually the U.S. military, mainly attending to “lethal contact” trauma.

In late 2004, as the Northern Ireland peace process was still on unsteady ground in attempts to end The Troubles, the Police Service of Northern Ireland (PSNI) requested Lansing’s help. She relocated in 2005 to Northern Ireland for approximately eight years, serving the majority of that time with the PSNI.

Along with the duty-induced PTSD that had occurred during the bloody 30-year conflict, violence was still occurring throughout her tour of duty there. Lansing treated officers for trauma injuries from sniper attacks, car bombs (placed under officer’s personal vehicles or at the homes of their families), grenade attacks during riots, horizontal mortar attacks and terrorist ambushes of off-duty officers. Her experience with treating U.S. military assets deployed to Iraq and years of working with specialist teams had prepared her for the work in Northern Ireland. She spent as much time possible out on the ground with her officers, especially during the summer “riot seasons.”

PTSD in Law Enforcement
Many officers will recognize the classic symptoms of PTSD—inability to sleep, nightmares, intrusive memories that don’t fade in intensity, physical reactions to places or other things associated with the event, the feeling of always being on guard or, by contrast, feeling numb.1 “While driving, working out or in the shower—these are the most common places where the memories tend to surface,” Lansing says. “When you’re alone and in a semi-relaxed state, the brain just kind of goes there.”

Although it’s tempting to associate PTSD with a single incident, Lansing stresses that it is often caused by exposure to numerous traumatic incidents over several years or, in some cases, an entire career. “I typically see what we call cumulative PTSD,” she says. “Incidents involving shootings or improvised explosive devices will often open the door. It’s easier for an officer to come in after one of those incidents because everyone understands that they should be talking about it. But the shooting or ‘things that go bang’ are just the latest incident sitting on top of a stack of other traumatic incidents.”

EMDR Therapy
Using a model of therapy known as Eye Movement Desensitization and Reprocessing (EMDR), Lansing acts almost like a Field Training Officer, guiding the officer through a process of reliving the incident, resolving the trauma and then mining it for any “learning points” it has to offer that could be important in the future. Think of it as a clinically controlled flashback. “It allows the brain to reprocess the incident to full resolution in a safe environment,” Lansing says. “The officer is in full control, with me riding shotgun should he need some back-up if things get hung up.”

According to Lansing, PTSD disables the brain’s ability to access key details (sensory signals or early warnings) contained within a trauma-based memory. “Those memories are frozen in the present tense—as though the incident is still happening. The brain’s aware that the officer hasn’t learned all that he/she needs to know,” she says. “This is why it keeps pushing the incident up to the surface in dreams, intrusive images, flashbacks or body memories. In essence the brain is trying to say, ‘Don’t forget this—learn from it. It could save us later!’ Unfortunately, the processing gets stuck.”

In the EMDR model of treatment, clients are trained to gain more control over their symptoms, then move to sessions that neutralize the trauma. In the last segment of the resolution session, any previously suppressed learning points start to surface. Often, Lansing says, these learning points are tactical in nature—“For example, ‘that click to my right was the first indication I wasn’t alone.’ Or I may ask, ‘Where was your partner in relation to your arch of fire? Or, who decided where that car would pull over—them or you?’ I can spot those learning points because of my training. I’m really more of a tactical advisor in those sessions than a psychotherapist.”

In the final phase of treatment Lansing will commonly conduct client-directed walkthroughs of an incident scene, or conduct weapons range sessions. “If there’s any unprocessed memory fragments still in there, we work to force them to the surface in those clinical cross-checks,” she says. “Additionally, things become clearer on a scene and the client can move newly gained information from theory to practice.”

Lansing attends to the most highly triggering event first—typically it’s an officer-involved shooting or other critical event that led the officer to seek therapy. Once that event is neutralized, “we assess which memories show up the most next,” she says. “We then knock those off one at a time.” She stresses that it’s not necessary to go through every traumatic incident the client has had. Due to the cumulative nature of the duty-induced trauma, most officers possess other disturbing memories that have been waiting to be dealt with, many for years. “With one officer who came in with 50 horrific incidents on his ‘dance card,’ we did just eight EMDR sessions—the most I’ve ever done in one case,” she says.

Post-Traumatic Sleep Disorder?
Through her review of current research, Lansing has discovered the connection between sleep and PTSD. In fact, she’s begun trying to lobby those in the psychological realm to get PTSD changed to post-traumatic sleep disorder. “Officers suffering from PTSD are not crazy. They’re severely sleep deprived and then traumatized,” Lansing says. “REM sleep is when the brain finds solutions to problems, learns from events, works through distressing incidents and repairs itself. But PTSD patients can’t get into REM sleep enough or at all if they’re not sleeping properly.” This is why EMDR so completely treats PTSD. It replicates REM sleep but in a waking state.2

Lansing sees sleep as the root cause of PTSD for two reasons: First, lack of sleep can increase the chances that officers will make a tactical/perceptual mistake (which, in turn, can change a “normal” incident into a critical one),3 and second, merely being sleep deprived can reduce an officer’s chances of recovering normally from a traumatic event.

“If you just missed three nights of adequate sleep, you’re in trouble neurologically. Reactions slow down, micro sleep can set in without warning—which is one of the reasons more officers are killed in car collisions on-duty—and you’re less able to pick up on subtle cues,” Lansing says. “Research articulates that if you’re sleep deprived before the traumatic event, you’re more vulnerable to developing PTSD. With that problematic sleep pattern being established as normal, especially for those working graveyard shifts, the brain becomes inoperable in terms of self-maintenance.”4-6

Unfortunately, Lansing says, most law enforcement leaders have little if any awareness of the sleep/PTSD connection. “We have never before had more complications involved in law enforcement than we do now,” she says. “We put officers out there and expect them to do the ‘least worst’ in the course of potentially lethal, rapidly unfolding events. Things can unfold faster than the brain is able to keep up with. We’re pushing officers into very dangerous terrain by not taking the sleep factor into serious account.”

Role of Leadership
Although helping those with PTSD is Lansing’s first motivation, her other driving force is the need to work systemically within agencies at all levels—officers, trainers and leadership—to improve PTSD understanding.

Lansing sees a “huge connection” between leadership and the ability of an individual to recover from a traumatic event. What she knew anecdotally for many years was made concrete during the Iraq war when the Pentagon required a series of reoccurring reports to be conducted in theatre. This arose out of the seriously increasing numbers of suicides occurring as the war went on.

In the first study, done in 2006, Marines, Army and National Guard forces activated downrange were assessed. First, the soldiers were screened regarding their psychological status (i.e., levels of PTSD, depression and anxiety present). Soldiers were then asked to answer 17 questions that assessed whether their leaders were high or low in positive leadership skills. All levels of combat (mild, moderate and extreme) were evaluated.

Within the Marines, teams who were operating in consistently high levels of combat engagement and rated their leaders as “high” in positive leadership skills had a 19 percent incidence of psychological hardship (e.g., PTSD, depression, anxiety). For those who rated their leaders as “low” in positive leadership skills, the incidence of psychological hardship rose to 44 percent. These trends were consistent across the three military branches and were repeated in subsequent assessments.7

“That’s a staggering spread,” Lansing says, “but it reflects the largest obstacle I encounter in my work. “The biggest problem I have when treating duty-induced PTSD isn’t with neutralizing the event and facilitating the opportunity for adaptive learning for the first responder. I can take care of that very easily. But if I encounter trauma after the event rendered due to poor leadership, I may never be able to bring their officer back.” In all of the many hundreds she has helped return fully to the job after treating their PTSD, there are nine who Lansing was not able to return, six in one law enforcement agency and three in another. “These were very troubled agencies and all nine were lost due to this leadership issue,” Lansing says.

From a liability perspective, this loss translates into hundreds of thousands of dollars expended to replace and recapture the lost experience and skills that leave prematurely with that asset. And the added costs of lost duty hours and worker’s compensation move into the millions. “Treating 10 officers over the course of 9 to 12 months, the cost savings to the agency can be in the neighborhood of $3 million,” Lansing says. “That money can then be spent on much-needed additions, such as equipment, training or new hires.”

But Lansing worries that today’s climate—in which officers’ decisions are increasingly being called into question in the light of several high-profile use-of-force incidents—is causing some leaders to abandon their line officers. “I’ve seen officers coming through my door who did things perfectly within policy and with good rationale backing their decisions and responses,” she says. “These are not lethal contact events, there’s no suspect threatening to sue. Even so, the officers are being disciplined in the wake of those IAs.”

As Lansing notes, this kind of behavior generates learned helplessness. “The idea that policy, procedure and training would no longer be considered as a standard of measure to assess an officer’s decisions and actions leads to drops in proactive policing,” she says.

Lansing has long argued that PTSD can be minimized by training first responders as well as ensuring that officers get at least seven hours of sleep and receive early clinical interventions, such as department-wide annual check-ins with a psychotherapist. Since 2008, she’s also focused on the need for better leadership training.

“There’s a lot of work to do in most agencies around making good leaders,” Lansing says. She notes that Sacramento County Sheriff’s Office has begun a leadership course for their young officers that she’s impressed with. “Then on the other side, I see officers who get promoted into top rungs of leadership who have so little real contact with the streets anymore—a total disconnect.”

This is especially problematic because research shows that just getting empowered with a promotion and an increase in pay creates isolation.8 “There are definite neurological changes that can happen as well,” Lansing says. “The mirroring sector of the brain goes quiet—that’s the critical area that causes empathy to be accomplished.”

Lansing points out that poor leadership has a very practical impact on agencies: “Some of the most expensive people within any law enforcement agency are those with poor leadership styles. They can increase the use of sick days, anxiety, depression and self-medication. They can create more intense PTSD than the instigating critical incidents generate. Healthier law enforcement agencies don’t happen by accident. They all have one thing in common: a sustainable and ongoing supply of healthier leaders.”

A Final Message
It’s both cliché and truth to say that cops and firefighters are loathe to admit weakness, that they’re used to being the ones that solve problems rather than admit that they have them. If there is one message she would like to send to officers, Lansing says, it is to look at the type of work she does not as therapy, but high-level training.

“Emergency response agencies are required to do maintenance on rigs, equipment and weaponry, yet we are totally leaving the most important tool unattended to—until we’re a mess,” she says. “We need to be training from the academy to the highest levels of command that this kind of maintenance is essential. It’s a matter of performance, safety and life.”

Notes
1. Lansing K. Possible PTSD Indicators.

2. Stickgold R. EMDR: A Putative Neurobiological Mechanism of Action. Journal of Clinical Psychology. 2002;58(1):61–75.

3. Wyllie D. (8/9/14) How Lack of Sleep May Cause Deadly Police Errors.

4. Lindsey D. (August 2007) Police Fatigue: An Accident Waiting to Happen. FBI Law Enforcement Bulletin.

5. Germain A, Buysse DJ, Shear MK et al. Clinical Correlates of Poor Sleep Quality in Posttraumatic Stress Disorder. Journal of Traumatic Stress. 2004;17(6):477–84.

6. Force Science Research Institute. (3/24/11) Anti-Fatigue Measures Could Cut Cop Deaths 15 Percent, Researcher Claims.

7. Office of the Surgeon Multinational Force-Iraq and Office of the Surgeon General United States Army Medical Command. (11/17/06) Mental Health Advisory Team (MHAT) IV Operation Iraqi Freedom 05-07 FINAL REPORT.

8. Blanchard K. (8/10/13) Power Robs the Brain of Empathy. Science.

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