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The Neuropathology & Neurobiology of Cumulative Traumatic Stress in Law Enforcement
- 1. The Neuropathology & Neurobiology of Cumulative TraumaticStress in Law Enforcement
- 2. BIO Education: B.A. Psychology M.A. Counseling Psychology Ph.D. Clinical Psychology M.Ed. Higher Education Leadership Experience: 12 year police veteran: Patrol, CID, Special ops Academy Instructor Field Evidence Tech Background Investigator Hostage Negotiator Victim Services Specialist Domestic Violence Specialist Critical Incident Stress Management Trainer Compassion Fatigue Educator Acute Traumatic Stress Trainer Board Certified Expert Traumatic Stress DSP CISM Team Mental Health Coordinator Dr. Ellen Marshall
- 3. Hypothesis As aresult of exposure to cumulative traumatic stress, law enforcement officers experience altered brain neuropathways which in turn causes changes in perception, thought processes, behavior, and emotions.
- 4. DSM-V PTSD: Injury “Experiencingrepeated or extreme exposure to aversive details of the traumatic event(s) (e.g. first responders collecting human remains, police officers repeatedly exposed to details of child abuse)” (DSM-V, 2013, p. 271) It’s not a disorder having a reaction to seeing violence and tragedies beyond the mind’s ability to understand.
- 5. Cumulative Traumatic Stressin Law Enforcement “Continual exposure to traumatic events as a result of an individual’s occupation in law enforcement resulting in the cumulative experiencing of trauma symptoms.” Marshall, E.K. (2006). Cumulative career traumatic stress (CCTS): A pilot study in law enforcement. Journal of Police and Criminal Psychology, 21, 62-72.
- 6. Cumulative Traumatic Stress Officer gradually experiences an increasing impairment in his or her ability to function in one or more areas of his or her life. Officer is unable to identify exactly when the trauma symptoms began, but reports a gradual increase in the intensity and number of symptoms developed over time. Officer is unable to resolve the symptoms using normal coping mechanisms.
- 7. Trauma Exposure Homicide Suicide MV fatalities Severed, maimed, rotting, burnt bodies Child abuse/neglect/sexual assault Death of a child Attempts to injure/kill officer Dead bodies Human suffering Human cruelty/brutality Threat of terrorism Threat of mass causality event Changes The Brain
- 8. Direct experiencingor witnessing event, learning of event to close other: How many child death, abuse, neglect calls? How many MV fatalities? How many suicides/homicides? How many serious assaults/DV calls? How many rapes? How many medical emergencies/CPR/FA/DF? How many officer funerals? How many officer deaths/suicides? How many dead bodies? Exposure to actual or threatened event: How many times has someone hurt you or attempted to hurt you? How many times have you perceived your life was in danger? How many times have you fought someone? How many felony stops? How many shootings? Shot anyone? Felt scared for your life? Do you recall the images like a slideshow or movie?
- 9. BOLO: Potential Problems Marital Difficulties Withdrawal Self-Medication Anger/Easily irritated Anxious/Jumpy People say you’ve changed Loss of social contacts Suicidal thoughts Sexual promiscuity Stressed all the time Increased use-of-force Cynicism Apathy Depression/Anxiety Inability to cope Impaired job performance Physical illness Increased risk-taking Increased civilian complaints Self-doubt Memory/concentration problems Loss of sleep/sleep too much Weight gain/loss Addiction of any kind
- 10. BOLO Increased hypervigilance Emotional numbing Making poor decisions Making more mistakes Concentration/memory problems Only seeing the negative Racing thoughts Increased worrying Trouble sleeping or sleeping too much Anxious and/or jumpy Flashbacks/Nightmares Irritability/Anger/Violence Changed perception of others/world Feeling overwhelmed Feeling isolated Moods changing Feeling unhappy more than happy Feeling helpless/hopeless Having a racing heart, chest pain, dizziness, HBP Sick more often Appetite changes Neglecting responsibilities Withdrawing from others Using substances to relax and/or sleep Problems getting along w/others
- 11. Factors Overinvestment in therole of police officer Self-identity rooted in policing Special unit on-calls; 24/7 job investment Adrenalin addiction Police Sub-Culture Distrust of anyone outside of police culture No agency support Back-Stabbing/Rumors John Wayne Syndrome Don’t talk about Be tough Don’t show emotions Personal Issues Pre-Existing Trauma/s Military deployment Childhood trauma/s On duty traumatic event/s History of mental health problem/s Even in the family High stress level on job and/or outside of job Poor Coping skills Little or no support system Not using support system Emotional suppression Denial Self-Medicating
- 12. Effect on Family Impatience/Arguments Yelling at kids/spouse DV/child abuse Communication failure causes doubt/suspicion/misunderstanding Withdrawal causes family to feel ignored, unloved, etc. Promiscuity/Separation/Divorce “Cheaper to keep her” doesn’t work Children are stressed/feel helpless Problems w/sleep, behavior, school, and more Spouse feels helpless/hopeless
- 13. Structural Changes in the Brain:Policing Connection
- 14. Amygdala Reacts F/F/F ResponseInitiatedPre-frontal cortex shuts down BRAIN BATH of Hormones & Neurotransmitters Cortisol adrenaline, noradrenalin, epinephrine, etc. released Fight/Flight Response Fight/Flight Easily Triggered; Becomes Habit- BRAIN CHANGES- Amygdala Hijacked Repeated Experiencing of Traumatic Events Neurons wire together Traumatic Event
- 15. Result: Fight/Flight Response LEO’sexperience the FF response repeatedly, daily, over years The “Brain Bath” of neurotransmitters released in FF cause brain to respond quickly/immediately w/FF (at any time) Increased experienced FF causes changes in brain neuropathways *The brain’s neural pathways are altered. *Thinking/Perception/Behaviors/ Emotions are changed.
- 16. Neurological Components of CumulativeTraumatic Stress Parts of the brain impacted: AMYGDALA Determines threats, signals danger, starts F/F, stops F/F, fear conditioning Stays hyper-alert w/cumulative traumatic stress CCTS causes LEO to function from amygdala Hippocampus Stores memories Interacts with amygdala Pre-Frontal Cortex Regulates behaviors, impulses, emotions, & fear
- 17. Most significant neurochemicals released duringFFF that aid in changing the brain: Cortisol: Kills Pre-frontal Cortex Brain Cells! released by the adrenal glands during the stress response; increases heart rate and blood pressure and results in arousal and anxiety. Dopamine: associated with attention, motivation, bonding, and pleasure; mobilizes the body for fight-flight-freeze response. Serotonin: affects mood, impulse control, and survival; plays a key role in depression, aggression, and anxiety. Norepinephrine: regulates arousal, alertness, attention, and motivation; makes senses more alert under stress. Epinephrine (Adrenaline): prepares us for danger or threat by focusing attention, sharpening senses, and increasing fear. Neuropeptides: Endorphins buffer stress, reduce pain (e.g., runner’s high). Fight/Flight Chemical Reaction
- 18. Synaptic Plasticity &LEO’S Repeated F/F causes brain neurons to wire together Resulting thoughts trigger F/F Repeated negative thoughts follow the same pattern (negativity bias) Firing off much quicker The more trauma experienced, the more the brain wiring is changed The neurons join together Perception is changed Brain automatically responds in F/F more often, faster, & when not necessary Hypervigilance, Agitation, Anger, Hostility, Aggression, Flashbacks, Negative Thinking-Emotions-Behavior
- 19. Consequences: “Flipping Your Lid” Anxiety Stress Aggression Neg. Reactivity Faulty Perceptions (negative bias) Depression Withdrawal Memory/Concentration Difficulties Overreacting/Hypervigilance Emotional Numbing Self Medication/Addiction • LEO lives in a continuous state of amygdala hyperarousal for F/F. • Thinking part of brain not effective.
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- 21. What Can BeDone: ‘Synaptic Pruning’/Re-Wire the Brain Synaptic pruning: Un-wire the neurons so the connections separate Neurons that fire together, wire together. Neurons that fire apart, wire apart. Change perceptions Change habitual thoughts Change habitual behaviors Change habitual emotions Recognize Stop Change
- 22. Changing Thoughts Thoughts are real,but not always true Don’t believe all your thoughts
- 23. The bodydoesn’t know what thoughts are real or imagined. It reacts the same to each.
- 24. Ok. So whatcan you do? Is your perception real? Challenge the negative thoughts & emotions Recognize where the thoughts/emotions are coming from DETOX YOUR BRAIN Choose to think about a positive experience/person Pay more attention to positives Breathe Exercise Eat well Take time to be quiet Be patient w/yourself Get help if needed
- 25. Change Your Perceptions:Realistic? Heed the Warning Signs: What happens to you? Assess if the Thoughts Are Real: Evidence? Neutralize the Negative Emotions: Douse the fire Gain a New Perspective & Apply It: Re-frame Eliminate Dysfunctional Behaviors: New actions
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- 28. What It CanDo For You Reduces stress & trauma related stress Develops awareness of habitual ways of thinking, behaving, & feeling Develops focus Un-wires fight/flight neuropathways Slows F/F reactivity Allows space to think before acting
- 29. RE-WIRE TECHNIQUES: SLOW THEFIRING 5 Deep Breaths Progressive Muscle Relaxation Practice Mindfulness Meditation
- 30. Self-Care Exercise. Walkthe dog. Play with the kids. Join a team sport. Eat regular, well-balanced meals. Lots of water. Avoid sugars, processed foods, caffeine, nicotine, limit alcohol. Get a physical/blood test to check your numbers once/year. Learn stress reduction techniques. Reduce overtime. Plan vacations. Find joy. What makes you happy? Laugh. Develop interests/hobbies outside of work. Get enough sleep. Develop supportive relationships inside and outside of work. Increase time with family & friends. Talk to others. Educate yourself on police stress/trauma/coping skills Get help. You're not weak. Getting help is a sign of strength.
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- 32. Contact info Email: coppsych@aol.com Cell: 302-381-5265 EllenMarshall, Ph.D., B.C.E.T.S.