Early Intervention Key in PTSD Treatment
There is no such thing as a routine call for law enforcement officers. Each time an officer is dispatched, they never know what they will encounter. The vast majority of calls result in something as benign as issuing a citation, but some calls can quickly morph into a critical incident where the officer is exposed to a traumatic event, such as a shooting or a wreck that claims the life of a child.
When officers are involved in a critical incident, early intervention is essential to their mental health, said Angela Childers, a trauma therapist with the Soldier Center in Clarksville, Tenn.
Childers specializes in treatment of post-traumatic stress disorder (PTSD), complex trauma and grief, and has worked with the Kentucky Post-Critical Incident Seminar (KYPCIS) in providing law enforcement officers an avenue to properly manage the aftermath of critical incidents.
What is PTSD?
Following a critical incident, the brain initiates its coping mechanism, Childers said.
“It’s like a malfunction of the memory network because we can’t reprocess the event because it was too overwhelming. It gets stored in an odd place,” Childers said. “No one is immune from it. But the thing we know about PTSD or depression … all of them are dysfunctionally-stored memories, whether it is something from childhood, from combat or law enforcement.”
The first step is education, Childers stated. Officers must understand what PTSD is and why it is happening.
“PTSD is a normal response to abnormal exposure,” Childers continued. “A person is never supposed to see a kid dead on a highway; that’s not OK. The brain’s normal response to (traumatic situations) is, ‘Oh my gosh. I’m getting overwhelmed.’ (The memory) is put aside so the officer can do their job, and the brain tries its best to keep it in that box.”
The problems occur when officers bury the incident and attempt to go on like nothing ever happened. Childers said it happens all the time in police culture.
“Law enforcement is supposed to be strong, and they’re not supposed to need or ask for help,” she continued. “What I found while working with PCIS, many officers have no idea that what is happening to them are actually symptoms of what will eventually lead to PTSD.”
Often, that mentality leads to problems down the road, as the accumulation of critical incidents eventually takes its toll, Childers said. It can be months or years before signs of PTSD begin to show.
“That is when the brain says it’s time to work on it,” she continued. “That is when the symptoms start coming. When (the officer) slows down, the brain starts having nightmares or flashbacks. That’s the brain saying, ‘We need to do something with this.’”
Early intervention or treatment is vital. Within the first 90 days of an event, the incident can settle down into the memory network, which causes PTSD symptoms. Early intervention keeps the memory from settling down and forces the officer to handle issues healthily.
Modern medicine has come up with several ways to help those experiencing PTSD symptoms, but Childers said pharmaceuticals only mask the problem.
“We’re very blessed to have so many different types of medications for mental health,” she said. “Those medications help with symptoms, but they don’t help overall with PTSD. It will stop most people from recalling nightmares, but their spouse will still say, ‘He was fighting and kicking all night.’ ”
Eventually, the brain will override medication after a certain amount of time, and when that happens, the officer is back to square one, Childers added.
Reprocessing events intentionally is key, and that is where Eye Movement Desensitization and Reprocessing (EMDR) comes into play, she explained.
“When I say reprocess it, I’m referring to EMDR when we identify a specific event,” Childers said. “Once we reprocess it, it is stored in the memory where it is supposed to be. It’s not easily accessible unless the person wants to recall the memory intentionally.”
Childers, who is an EMDR-certified provider, cited an article from the September 2018 EMDR International Association magazine to make her point.
According to the article, “Following a traumatic event, predicting who will develop symptoms is difficult and uncertain. PTSD is often preceded by subclinical symptoms that place individuals at risk for delayed-onset PTSD in the months and even years following exposure.”
Triggers of PTSD are many, Childers said, and it is hard to predict what will initiate symptoms.
It can be a similar event, a smell or even a sound, she added.
“I’ve had guys say, ‘I’ve worked plenty of suicides, but this one stands out to me,’” she continued. “For whatever reason, the brain is saying, ‘OK, that’s one too many.’ After that, they are susceptible to that memory returning.”
That’s where resiliency training is beneficial, Childers said.
According to mayoclinic.org, the most important exercise for improving your resiliency is to train attention and awareness. Becoming more intentional and purposeful will decrease negative thoughts and draw attention to what is most meaningful. Along with increased resilience, training focused on this exercise can lower stress and anxiety, and boost the individual’s quality of life.
“Between intentionality with education, early intervention and resiliency training, I believe we reduce their susceptibility for developing PTSD,” Childers said.
Role of the Agency Leader
In the first 90 days following a critical incident, an agency should be proactive in its response, and it all starts with the leadership being educated and buying in to programs such as KYPCIS, Childers said.
“I would like it to be mandatory throughout the state for every agency to be required to send officers who have had critical incidents to KYPCIS and everybody has to learn about PTSD,” she said. “It seems that it is those guys who are made to attend KYPCIS who get the most out of it.
“My question is: Why would someone wait until they are developing symptoms before they begin to reprocess these events?” Childers continued. “Early intervention should be highly encouraged before onset and accumulative traumatic exposure. What does that look like from a leadership standpoint? It remains to be seen how important this work is for purposes of prevention and employee longevity.”