Cognitive Training

With a call from the Police to improve post-incident support and the neuropsychological understanding of how this can be achieved, the Trauma Resilience in UK Policing project successfully conducted a 2-year trial of trauma-processing techniques in 2017. Results published in 2019 suggest the techniques to be immediately effective in improving a sense of ease and safety around traumatic scenarios and improves recall. The study shows the techniques to do no harm, proves the concepts that trauma processing techniques are a) teachable and b) that their application in operational policing is both feasible and well-received. 

Why trauma impact prevention techniques? 

In 2016, serving and former police officers across the UK called for more support after attending difficult or traumatic incidents on the job (2016 Injury on Duty Report by the Police Dependants’ Trust, now Police Care UK). In the same year, new evidence from neuropsychology suggested that trauma processing can be enhanced by stimulating hippocampal processing in the brain (see Miller et al., 2017 for a review). In the wider field of neuroscience, high profile studies were demonstrating that the hippocampus was receptive to training and rewiring or "self-directed neuroplasticity" (see Maguire et al., 2001 Taxi Driver study). 

Amid the wave of terror attacks in 2017 and in particular in the wake of the Manchester arena attack in 2017, the need to understand what can be done to enhance and protect trauma resilience in policing became a pressing public issue. 

In 2018, the University of Cambridge and the then Police Dependants' Trust engaged with over 18000 to ask important questions about trauma management and wellbeing in forces, and in doing so established the first UK police PTSD prevalence rate (1 in 5) and the first-ever Complex-PTSD prevalence rate (12%) in a working population (Brewin, Miller, Soffia et al., 2019 in press). The survey 'Policing: The Job & The Life' revealed that over 2/3 of officers and staff on the front line had 'insufficient opportunity to make sense of traumatic incidents' before moving on to the next job and over half reported that trauma was 'not well managed' in their force.  

Providing officers and staff with quick, simple and effective techniques to boost the hippocampus and to practice making sense of difficult incidents is a sensible solution to build resilience to future trauma exposure and to help minimise the risk of developing complex disorder from trauma. 

What did we do?

Forty-six new recruits were taught and practised new trauma processing techniques over a period of three days in May 2018, then refreshed with a 2-hour session in August 2018. Twenty-six officers formed a control group who were trained in February 2019. The research team monitored the level of trauma impact on the 70+ participants every 4 weeks until April 2019. 

The techniques involved testing specific forms (allocentric and egocentric) of spatial memory using drawing and mapping as well as episodic memory through the generation of extended timelines. Allocentric spatial processing is considered useful in trauma processing and has been used clinically for many years (Smith et al., 2015; Miller et al., 2017). The techniques have also been used in the forensic investigations and the Cognitive Interview to improve witness recall (Dando et al., 2008; Hope et al, 2013). The techniques are paper-based and materials comprised a participant workbook, Visual Assessment Scales on ease-of feeling and training presentations. 

What were the results?

The techniques significantly improved how “at ease” individuals felt about the difficult incidents, with a large effect size. Ninety-nine percent of participants were able to recall and use “safety cues” to reset the stress response. The techniques also improved recall with over 65% of participants remembering between one and ten new details about what happened.

Feedback on the accessibility of the training and how it is best put to operational use (as well as our data from the trial) all came together in our paper in Police Journal: Theory, Practice, Principles in July 2019. The paper is available from SAGE publications and we hope its findings will resonate with- and have implications for- policing beyond trauma resilience, including post-incident operational practice, force resilience programmes, therapeutic interventions and wider forensic investigation. Access the full article published in the Police Journal through SAGE Publications, here.

Of the (over) 1200 officers trained through the Train-The-Trainer model in 2020, fewer than one in 150 delegates experienced difficulty in the training sessions pertaining to trauma retriggering (an understandable concern for those not yet familiar with the training). What is more, detailed control data (n= 32) was collected between September 2020 and March 2021 which measured in-session health and wellbeing (using the Edinburgh-Warwick questionnaire) as was felt sense of ease about the training incident scenario being used (on a Visual Rating Scale of 0 to 10) and item recall. Results indicated that wellbeing was consistent throughout the training sessions and that both improvement in ease of feeling and improvement in recall about the incident were demonstrated as an effect of the techniques rather than an effect of simply time spent reflecting on the incident. Knowledge tests about the techniques also showed them to be teachable and learnable within the training session time (an average of four hours). 

Since 2019, the named "Trauma Impact Prevention Techniques (TIPT)" were taken up by thousands of officers across the UK based on positive experiences and word of mouth between forces with consistent and highly positive feedback. Non-police bodies and other emergency response services regularly express interest in the techniques and acknowledge their applicability to -and relevance for- any occupation which involves frequent exposure to challenging, difficult and potentially traumatic human experiences. The Fire Fighters' Charity have now been trained in TIPT and specialist units involved in intelligence work were also being trained in 2023. 

There was also specialist material which considered alternative methods of making sense of trauma in high risk roles. The material looked at atypical or secondary trauma processing (where conventional hippocampal processing of live incidents is less relevant) and collated resilience tools and advice from real life officers and staff working in specialist roles such as Child Sexual Exploitation, 999 Call Handling, Firearms, Post-Incident Procedures, Family Liaison, Technical Surveillance Units and Counter Terrorism. 

What's on offer now?

"TIPT" was delivered by Police Care UK until June 2024.

References

• Brewin, C.B., Miller, J.K., Soffia, M., Peart, A., Burchell, B. (2019 in press). Posttraumatic Stress Disorder and Complex Posttraumatic Stress Disorder in U.K. Police Officers. Journal of Consulting and Clinical Psychology.
• Dando C, Wilcock R and Milne R (2008) The cognitive interview: the efficacy of a modified mental reinstatement of context procedure for frontline police investigators. Applied Cognitive Psychology 23: 1. 
• Hope L, Mullis R and Gabbert F (2013) Who? What? When? Using a timeline technique to facilitate recall of a complex event. Journal of Applied Research in Memory and Cognition 2: 20–24.
• Miller J (2016) Navigating trauma: How PTSD affects spatial processing, Police Professional 532: 12–17. 
• Miller JK, McDougall S, Thomas S, et al. (2017a) The impact of the brain-derived neurotrophic factor gene on trauma and spatial processing. Journal of Clinical Medicine 6: 108. 
• Miller JK, McDougall S, Thomas S, et al. (2017b) Impairment in active navigation from trauma and post-traumatic stress disorder. Neurobiology of Learning and Memory 140: 114–123.