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Impact of the HeartMath Self-Management Skills Program on Physiological and Psychological Stress in Police Officers

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Impact of the HeartMath Self-Management Skills
Program on Physiological and Psychological Stress
in Police Officers
Rollin McCraty, Ph.D., Dana Tomasino, Mike Atkinson
and Joseph Sundram, M.Ed.
HeartMath Research Center, Institute of HeartMath,
Publication No. 99-075. Boulder Creek CA, 1999.
Copyright © 1999 Institute of HeartMath. HeartMath
®
, Freeze-Frame
®
and Heart Lock-In
®
are registered
trademarks of the Institute of HeartMath.
Copyright © 1999 Institute of HeartMath
1
SUMMARY
Police work is often regarded as an extremely stressful occupation, and officers typically suffer a
variety of physiological, psychological and behavioral stress effects. It has been argued that
particular attention should be given to occupational stress in policing, as its potential negative
consequences affect society in more direct and critical ways than stress in most other occupations.
Officers operating under severe and chronic stress may well be at greater risk of error, accidents
and over-reaction that can compromise their performance, jeopardize public safety and pose
significant liability costs to the organization. However, police officers are rarely provided with
effective stress management strategies to help alleviate these problems. This study explored the
impact on a group of police officers from Santa Clara County, California of the HeartMath
®
stress
and emotional self-management training, which provides practical techniques designed to reduce
stress in the moment, improve physiological and emotional balance, increase mental clarity and
enhance performance and quality of life.
Areas assessed included: physical health and vitality, emotional well being, coping and
interpersonal skills, work performance, workplace effectiveness and climate, family relationships,
and physiological and psychological recalibration following acute stress. In addition, physiological
measurements were obtained to determine the real-time cardiovascular impact of acutely stressful
situations encountered in simulated police calls used in police training, and to identify officers at
increased risk of cardiovascular disease and premature mortality.
Results showed that the HeartMath training improved officers’ capacity to recognize and manage
their stress and negative emotions in both work and personal contexts. Over the course of the
study, officers trained in the stress management techniques experienced reductions in stress,
negative emotions and physical stress symptoms, as well as increased positive emotion and
physical vitality as compared to a control group that did not receive the training. Improvements in
family relationships, more effective communication and cooperation within work teams, and
enhanced work performance were also noted.
Heart rate and blood pressure measurements taken during simulated police call scenarios showed
that acutely stressful circumstances likely to be encountered on the job result in a tremendous
degree of physiological activation from which it takes the body a considerable amount of time to
recover. The HeartMath techniques learned in this study increased participants’ calmness, clarity
and focus during these scenarios and enabled them to rapidly and deeply recalibrate, both
physiologically and psychologically, after the intense stress was over.
Autonomic nervous system assessment based on heart rate variability analysis of 24-hour ECG
recordings revealed that 11% of the officers tested were at high risk for cardiovascular disease and
premature mortality. This is more than twice the ratio of at-risk individuals expected to be found
in the general population, and is consistent with epidemiological data indicating that police
officers as a group have over twice the average incidence of cardiovascular disease.
In conclusion, this study provides evidence that practical stress and emotional self-management
techniques can reduce damaging physiological and psychological responses to both acute and
chronic stress in police, and positively impact a variety of major life areas in a relatively short
period of time. In particular, results show that application of these interventions can produce
notable improvements in communication difficulties at work and in strained family relationships,
two areas that are well recognized to be major sources of stress for police.
Copyright © 1999 Institute of HeartMath
2
The data suggest that the integration of effective self-management programs in police training
could ultimately improve officers’ long-term health and emotional well being and increase work
effectiveness. Training in emotional self-management could also significantly benefit police
organizations by improving judgment and decision making, decreasing the frequency of on-the-job
driving accidents and the use of excessive force in high-stress situations. Potential outcomes
include fewer citizens’ complaints, fewer lawsuits, decreased organizational liabilities and
increased community safety. Finally, this study highlights the value of 24-hour HRV analysis as a
useful screening tool to identify officers who are at increased risk of developing serious long-term
health problems, so that efforts can be made to reverse or prevent the onset of disease in these
individuals.
BACKGROUND
The police officer is exposed to stress outside the range of usual human experience. The
operational duties of police work, by their nature, may at any time place officers in life-threatening
situations, in which the decisions they make can truly mean the difference between life or death for
both themselves and others. Many of these situations, such as major disasters or shooting
incidents, may well come under the category of traumatic stress. In addition to the intensity of the
acute stress experienced in the moment, the feelings that officers carry with them after such
emotionally charged incidents represent a more enduring source of stress for many police.
Constant exposure to society’s interpersonal violence, negative or confrontational interactions with
individuals, a sense of personal endangerment, fear of revenge from criminals, and subservience to
an ambivalent, watchful public produce negative emotional repercussions that can affect police
officers on a chronic basis.
1-5
In addition to the operational stressors inherent in police work, numerous studies have shown that
factors related to organizational structure and climate can be an even greater source of stress for
the police officer.
6-8
Shift schedules that disrupt normal sleep patterns and social life,
authoritarian management styles, poor interpersonal relationships with supervisors,
interdepartmental politics, lack of adequate planning and resources, lack of promotion and
transfer opportunities, excessive paperwork, lack of autonomy in performing duties and lack of
recognition for work accomplishments are among the organizational stressors faced by members
of the police force.
2, 6, 9
Without effective management, the various acute and chronic stressors of police work impose a
significant burden on physical and psychological health, leading to numerous adverse
physiological, emotional and behavioral outcomes.
1, 2, 10
Following acutely stressful incidents
encountered in the line of duty, bodily systems must recover from an extreme degree of
physiological arousal. Over time, repeated stress can lead to the chronic activation or
dysregulation of the body’s stress response systems, and the eventual exhaustion of the autonomic
nervous system. Police officers have been shown to have higher blood pressure and stress
hormone levels than clerical workers.
11
In the long term, this physiological strain may have a
significant harmful impact on health, leading to the high rates of stress-related illness known to
exist in the police profession.
10
Research has shown that police officers are over twice as likely as
people in other occupations to develop cardiovascular disease.
12
Police have also been found to
die at a higher rate from cancer than the general population.
13
At the psychological level, the stress of police work may result in chronic negative emotions such
as anger, anxiety or depression, which can eventually lead to psychological burnout or emotional
Copyright © 1999 Institute of HeartMath
3
exhaustion.
3, 14, 15
Post-traumatic stress disorder (PTSD) is also a severe consequence of exposure
to extremely stressful incidents of violence or major disaster among police officers.
16, 17
The high
rates of alcohol use among police are one reflection of unmanaged emotional stress.
10, 18
Other
research has confirmed that the mortality rate from suicide is nearly 3 times higher in police than
in other municipal employees.
13
Finally, the repercussions of unmanaged stress in police clearly
extends to officers’ families, where it is reflected in poor relationships with spouses and children
and the notably high rates of marital disruption and divorce known to exist within this profession.
10, 19, 20
The negative physiological and psychological effects of stress may also cause work performance to
deteriorate, leading to reduced efficiency and motivation in performing job duties, poor morale,
excessive absenteeism and premature retirement. One study conducted in the UK found that in
1990 over 1 million police working days were lost through sickness absence (an average rate of 11
days per officer) and that approximately 25% of these absences could be attributed specifically to
stress.
2
The inability to effectively manage stress has its most dangerous consequences in the line
of duty. Police work often places officers in situations where reaction speed, coordination and the
capacity to make rapid decisions and accurate judgments under pressure is critical, and inefficient
mental and emotional responses to stress can significantly impair these abilities.
21
In the extreme,
stress can cause officers to lose balance and composure to the degree that they employ
inappropriate or excessive force in dealing with subjects.
22
Recent years have seen the wide
publicization of incidents of police brutality and homicides committed by individual officers
throughout the country. Errors made in the line of duty can have grievous consequences not only
on the officers and the particular suspects they encounter, but also on the public’s perception of the
individual, an entire department and even the entire profession. These consequences can include
automobile accidents, injury, death, lawsuits, loss of credibility and even city-wide riots in reaction
to officer behavior in highly-charged situations.
It has been argued that special consideration should be given to occupational stress among police
forces, as its potential negative consequences affect society in more direct and critical ways than
stress in most other occupations.
23, 24
Police officers operating under severe and chronic stress
may well be at greater risk of error and over-reaction that can compromise their performance and
public safety. However, the police force is perhaps one of the organizations within which the stress
experienced by employees receives the least acknowledgment. Some have suggested that police
work in a professional environment that encourages emotional detachment from others as well as
from their own feelings.
10, 18, 25
The unrealistic expectations imposed by this occupational culture
discourage officers from admitting to feeling stress and from openly expressing negative emotions.
Thus, while police receive ample training in the theoretical knowledge and technical skills required
to perform their jobs and take effective action in an emergency situation, most receive little if any
training in the self-management skills needed to help them quickly regain psychological and
physiological equilibrium after the intense challenges of their work. Similarly, they are generally
not provided with tools to help them manage the emotions they may process internally long after
involvement in a traumatic incident. The unusually stringent demands for self-control,
compounded by the unavailability of effective strategies for inner self-management becomes an
added stressor in its own right for police.
4, 26
It is clear that practical stress management
techniques are needed not only to help officers remain more balanced during and after the acute
stresses of their jobs, but also to take action to better manage and seek real solutions to the chronic
stress related to organizational and family issues.
In this investigation a sample of police officers were provided training in a series of research-based
stress and emotional self-management interventions developed by the Institute of HeartMath
Copyright © 1999 Institute of HeartMath
4
(IHM) to help individuals to reduce stress and negative emotions, improve autonomic nervous
system balance and overall health, enhance performance and quality of life. The effects of this
training on both physiological and psychological recovery from acute stress as well as on sources
of chronic stress were explored.
PURPOSE
The aim of the present investigation was multi-fold: 1) to determine the nature and degree of
physiological activation produced by different stressful situations and activities likely to be
encountered by police in the line of duty, as measured by heart rate and blood pressure changes
during simulated scenarios used in police training; 2) to identify officers at increased risk of
cardiovascular disease and premature mortality by means of autonomic nervous system
assessment; 3) to provide training in practical stress management techniques to a sample of officers
and assess the impact of this training on: physiological activation and recalibration following the
intense stress of simulated police calls, physical health and vitality, emotional well being, work
performance, workplace effectiveness and climate, and family relationships.
METHODS
Participants
A total of 65 participants (64 sworn police officers and one city manager) from seven police
agencies in Santa Clara County, California were recruited for this study. The agencies represented
were Campbell, Los Altos, Los Gatos, Milpitas, San Jose State University, Santa Clara and
Sunnyvale Public Safety. The participants were 55 males and 10 females, with a mean age of 39
(age range: 24-55 years). The group was comprised of 43 patrol officers, 12 detectives and 9 officers
currently serving in administrative duties. Of the 64 sworn officers 16 had 1-5 years experience, 20
had 6-15 years experience and 28 had 16-30 years experience serving on the force. The average
level of experience for the group was 14.4 years spent serving on the force. Subjects were randomly
divided into an experimental group (n = 29) that was to receive the HeartMath self-management
training during the study and a waiting control group (n = 36) that was to receive the training once
the study was completed. Care was taken to ensure that there was an approximately equal
distribution between the two groups of officers of different levels of experience, from different
agencies and of both genders. Some adjustments were subsequently made to accommodate
scheduling concerns.
Study design
This study took place over a 16-week period. Data collection occurred at three different time
points in the study: baseline (at the start of the study), at 5 weeks on the first scenario day (pre-
HeartMath training), and at 16 weeks on the second scenario day (post-HeartMath training).
Baseline physiological and psychological measurements were collected for all participants at the
Santa Clara Police Department at the start of the study. Pre and post physiological and
psychological measurements were collected for the subgroup of officers involved in the simulated
police call scenario portion of the study at Moffett Airfield, Sunnyvale on the days the scenarios
were conducted. For those officers not involved in scenarios, pre and post psychological
measurements were collected at the same time points at their respective agencies. Experimental
group participants were trained in the HeartMath stress and emotional self-management
techniques at the Milpitas Police Department in three separate classroom sessions lasting 4-6 hours
each and spaced at approximately equal intervals over a period of one month. The first training
session was conducted 3 weeks after the first scenario day, and the last training session was
Copyright © 1999 Institute of HeartMath
5
completed 4 weeks before the second scenario day. The waiting control group received the same
training after the study was completed.
A subgroup of the officers (12 experimental group participants and 11 control group participants)
participated in the scenario portion of the study. The simulated police call scenarios were
conducted at Moffett Airfield, Sunnyvale in conjunction with Sunnyvale Public Safety. A total of
three different scenarios were conducted over the course of the study. Two of the simulations (a
building search and a high-speed car pursuit) were run on the same day, 5 weeks after baseline
measurements were taken and before the experimental group received the HeartMath stress and
emotional management training, and one scenario (a domestic violence episode) was conducted 11
weeks later, after the HeartMath training was completed. Physiological and psychological
measurements were collected from the participating officers on the days of the scenarios. In
addition, participants were asked to rate each simulation according to how stressful it was for
them, and training officers from Sunnyvale Public Safety completed an evaluation of the
participants’ performance in the scenarios.
The scenarios
The scenario portion of the study was run by the Sunnyvale Public Safety, which regularly puts its
officers through this type of training at least once a year. The scenarios are designed to simulate as
closely as possible real police calls that officers would receive on the job to investigate suspected
crimes. In the scenarios, the officers and trained role players carry specially designed fire arms
known as “simmunitions.” These are the same fire arms that officers use on the job, but have been
modified, making it impossible for live rounds to fit in their chambers. They contain special paint
cartridges instead of real bullets. The purpose of the scenario training is to give officers exposure
to and practice in the types of duties they would be required to perform under the pressure of a
real-life police call.
The approximate duration of each simulation in this study was 5-10 minutes, and 3 to 5 trained
role players were involved in each scenario. Before each scenario, officers went through a
“staging” procedure in which they were briefed on the nature and known details of the suspected
crime, as they would be in a real police call. Following each simulation, the officers went through a
debriefing session in which they were asked a series of questions about the events that occurred
during the scenario. Each scenario was observed by a researcher from the Institute of HeartMath
who recorded the timing of events and measured the officers’ blood pressure immediately after
the scenario ended. A brief description of each of the scenarios follows:
Building search: In this scenario officers receive a call regarding a silent alarm at a warehouse.
Officers are required to work with a back-up officer (a trained role player) to search the dimly-lit
facility for the suspect. When the suspect is spotted by the officer, he claims to be an employee and
reaches inside his jacket for identification. In this scenario the suspect does not have a weapon, and
follows the officer’s commands. The scenario ends when the officer brings the suspect under
control by handcuffing him. This scenario was designed as a low stress trial in which the officers
can become familiar with the scenario protocols.
High-speed pursuit: In this scenario officers engage in a high-speed car chase. The course was set
up on a runway at Moffett Field and was designed to approximate a city area (i.e. the street widths
and corners were the same as in a typical city district). While driving, officers receive a radio call
and are given specific information regarding the crime and suspect. While chasing the suspect’s
vehicle with siren on, officers are in continual communication over the radio with the dispatcher.
The suspect (a trained role player) engages in various maneuvers, including jumping out of his car
at one point and running towards the officer’s vehicle, with a gun pointed at the officer’s car. The
Copyright © 1999 Institute of HeartMath
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scenario ends when the suspect’s car pulls over and the officer orders him to get out of his vehicle.
In the debriefing session, officers are asked questions which require them to remember the
information they were given by the dispatcher and to assess the safety of their driving during the
scenario.
Domestic violence: In this scenario officers receive a call regarding a disturbance at a domestic
address. With a back-up officer (a trained role player) they are required to investigate. At the scene
(a civilian household) officers encounter an injured woman who is crying continuously and
holding a bloody towel to her head. When questioned, she claims she has fallen and hurt herself.
Officers then encounter the suspect (the woman’s husband) who has a weapon at his side which is
not visible to the officer. As the suspect is being questioned by the officer, he pulls out his weapon
in clear sight and points it at his wife. The suspect does not comply with the officer’s commands to
put down the weapon. After approximately 30 seconds the suspect points the weapon at the officer
and fires, if the officer does not shoot him first. If the officers fire first and hit the suspect, they
complete the scenario by handcuffing him. If the officer is shot, the scenario ends at that point.
The HeartMath stress and emotional self management training
The HeartMath stress and emotional self-management program
27
provides individuals with
practical, easy-to-learn techniques that can be used to recognize and transform inefficient mental
and emotional responses to stress in the moment. These interventions have been shown in
organizational settings to reduce stress, tension, negative emotion and fatigue, while enhancing
positive emotion, communication and job satisfaction.
28-32
Practice of the HeartMath techniques
has also been demonstrated to have significant physiological benefits, including reducing
inappropriate autonomic nervous system activation,
33
improving autonomic balance,
33, 34
facilitating entrainment of physiological systems,
33, 35
reducing stress hormone levels,
36
boosting
the immune system,
37, 38
and enhancing cardiovascular efficiency.
33
In addition, a growing
number of case histories demonstrate that practice of the techniques can reduce symptomatology
and improve clinical status in diverse patient populations.
39, 40
Notably, the techniques have been
shown to restore blood pressure to normal values in hypertensive individuals without the aid of
medication.
28
Through the training provided during this study, officers learned to identify and recognize the
specific issues, attitudes and experiences that contribute to their stress, and to make perceptual
and attitudinal shifts to transform inefficient reactions to potential stressors. Brief descriptions of
several of the core techniques officers learned in the training follow:
Freeze-Frame
®
41
: The Freeze-Frame technique is designed specifically to enable individuals to
intervene in the moment that stress is experienced. In essence, the technique instructs people to
consciously disengage from negative mental and emotional reactions as they occur by shifting their
attention to the area of the heart, then self-generating a positive or neutral feeling state. This
prevents or reverses the body’s normal destructive stress response and changes the bodily
feedback sent to the brain,
33, 35
thus arresting physiological and psychological wear and tear. As a
result of Freeze-Frame, one can think more clearly and often transform an inefficient, emotionally
draining response to a proactive, creative one. With practice, this tool can be used effectively in
less than one minute. In this study, officers were encouraged to use the Freeze-Frame technique
before entering the scenarios to center themselves in a state of inner balance and clarity, and after
the scenarios to achieve rapid physiological and psychological recalibration from stress.
Copyright © 1999 Institute of HeartMath
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Coherent Communication
29
: Lack of effective communication between people is a major source of
stress and inner turmoil. Often it is difficult to hear others because we are preoccupied by our own
internal thought processes. At work, ineffective communication among coworkers or between
supervisors and the work force can lead to feelings of hostility, mistrust and separation between
team members and has a negative impact on productivity and teamwork. At home, poor
communication with family members or loved ones is a major factor underlying strained personal
relationships. The Coherent Communication technique facilitates the sharing of ideas and
information with greater sincerity and effectiveness. Individuals learn to communicate more
openly and honestly and to stop internal dialog in order to listen to others more deeply. This
communication technique enables people to more readily understand the essence of a conversation
and often to perceive additional levels of subtlety within the information being communicated.
Heart Lock-In
®
27
: The Heart Lock-In technique enables people to “lock in” to a physiologically
coherent state associated with improved cardiovascular function, reduced fatigue, heightened
inner calm and mental clarity. With practice of the technique, individuals can effectively retrain
their physiological systems to sustain longer periods of balanced, coherent function. The technique
involves focusing one’s attention on the area of the heart and experiencing a sincere positive
feeling state such as appreciation while listening to music specifically designed to facilitate stress
reduction and promote physical, mental and emotional regeneration.
42, 43
Practice of this tool
promotes entrainment of physiological systems and helps to balance heart rhythms, emotional
states, hormonal and autonomic function.
36
In addition to the above techniques, other tools covered in the program help participants apply the
key concepts and techniques learned to actively address work and personal stressors and actualize
more of their core values both at work and in their personal lives. Also incorporated in the
program were several real-time demonstrations of the participants’ heart rate variability, including
one which illustrated heart rhythm entrainment during a Heart Lock-In.
MEASURES
Psychological measures
Personal and Organizational Quality Assessment (POQA) survey: This 80-item validated and
normed assessment tool provides a broad overview of the individual’s emotional stressors and
social attitudes, vitality and physical symptoms of stress, as well as measures of workplace
effectiveness. All participants in the study (n = 65) completed the POQA survey at three time
points: baseline, pre-HeartMath training (5 weeks after baseline) and post-HeartMath training (16
weeks after baseline).
Program Impact Assessment: This semi-structured interview was administered by a clinical
psychologist to the subgroup of experimental (n = 12) and control group (n = 11) participants who
took part in the scenarios. The interview was conducted on the day of the final scenario, four
weeks after the completion of the HeartMath training program. This assessment was designed to
determine the impact of the HeartMath training on four major life areas: coping skills, family
relationships, work performance and interpersonal skills. Officers were asked to rate to what
extent they noted an improvement over the previous six weeks in 32 specific aspects of
psychosocial functioning pertaining to these major areas (e.g. insight into my psychological well-
being; ability to manage my moods; tendency to assert my opinions, feelings and desires with
family members; tendency to respond to those I am close to with empathy versus criticism; ability
to adapt to changing work environments and schedules; ability to stay calm and clear when faced
Copyright © 1999 Institute of HeartMath
8
with the unknown; feeling accepted and supported by supervisors; extent to which I attempt to
resolve work conflicts constructively, etc.) Those officers who had been trained in the HeartMath
stress management techniques were asked to rate to what extent they attributed observed changes
to their integration of the techniques in their day-to-day lives. In addition, they were asked to
openly discuss changes in their ability to cope with emotional distress; in home life and
relationships; in their work performance; and in their interpersonal relationships at work that they
attributed to having received the HeartMath training. The approximate duration of the interview
was 10-15 minutes.
Scenario stress levels: Following each scenario, participating officers were asked to rate the
intensity of the stress they felt during the simulation on a scale of 1 to 10 (10 = maximum stress).
They were also asked to state what was the most stressful part of the scenario to them and why.
Physiological measures
Heart rate variability: Participants’ autonomic function was assessed by the analysis of heart rate
variability (HRV). The normal resting heart rate in healthy individuals varies dynamically from
moment to moment. Heart rate variability, which is derived from the electrocardiogram (ECG), is
a measure of these naturally-occurring beat-to-beat changes in heart rate and is an important
indicator of health and fitness. HRV is influenced by a variety of factors, including physical
movement, sleep and mental activity, and is particularly responsive to stress and changes in
emotional state.
34
The analysis of HRV can provide important information relative to the function
and balance of the autonomic nervous system, and decreased HRV is a powerful predictor of
future heart disease, increased risk of sudden death, as well as all-cause mortality.
44-46
In this
regard, HRV is becoming increasingly used as a non-invasive screening tool to identify at-risk
individuals.
39
In this study, heart rate variability analysis was performed for three main purposes:
(1) to compare average heart rate during the officers’ daily activities versus during the intense
stress of the scenarios; (2) to obtain a detailed, real-time record of the beat-to-beat changes in
officers’ heart rates as they occurred in response to different activities performed and emotions
experienced during the scenarios; and (3) to analyze officers’ autonomic nervous system function
and balance and determine if there were individuals in the group who were at risk of disease or
premature mortality.
Analysis of heart rate variability was performed from 24-hour ambulatory ECG (Holter)
recordings on a subgroup of 27 officers. Three-channel Holter recorders (Del Mar Avionics, Irvine,
California) which incorporate a time-lock control circuit to ensure accurate HRV analysis were
used for the data collection. Officers wore the recorders for 24 hours at all three time points in the
study (baseline, first scenario day/pre-HeartMath training, and second scenario day/post-
HeartMath training). The recorders were fitted when the officers arrived at the baseline data
collection or scenario training site. At that time, participants were given a log in which they were
asked to record the times of major activities in which they engaged and any significant changes in
emotional state they experienced throughout the day and night. During the scenarios, officers’
activities were observed and logged by an experimenter. All analysis was carried out at the
HeartMath Research Center using DADiSP/32 digital signal processing software. Autonomic
function was assessed in keeping with the recently published International Task Force Report
which standardized the nomenclature, analysis methods and definitions of the physiological and
pathological correlates of heart rate variability measures.
47
Blood pressure: Blood pressure was measured at baseline for all study participants, as well as
before and immediately after each scenario. For the baseline and pre-scenario measures, three left
arm readings were obtained at intervals of two minutes and the average of the last two readings
Copyright © 1999 Institute of HeartMath
9
was used as the reported value. For the post-scenario measure, one reading was obtained as soon
as the scenario ended.
Performance measures
Scenario evaluations: Following each scenario, an evaluation of the participants’ performance in
the simulation was completed by the training officer. For all three scenarios, participants were
rated on a five-point scale ranging from “poor” to “excellent” in the following four general
categories: ability to maintain focus during scenario; ability to make appropriate decisions; ability
to communicate clearly during the de-briefing; and ability to regain composure/balance after the
scenario. Additionally, for the high-speed pursuit scenario, officers answered a series of questions
which assessed their ability to remember relevant information communicated to them by the
dispatcher during the simulation and required them to self-assess their driving performance and
safety. For the domestic violence scenario, participants were evaluated by the training officer using
a five-point scale ranging from “poor” to “excellent” in nine additional categories pertaining
specifically to that scenario. These were: approach; contact/information collection; use of contact
and cover officers; use of cover; use of triangulation; positioning of involved parties; appropriate
escalation of force; appropriate weapons used; and arrest and control. The training officer also
provided a written evaluation of each participant’s performance for this scenario.
Scenario Impact Assessment: Following the domestic violence scenario, participants entered a
brief semi-structured interview with an experimenter in which they were asked to self-assess
changes in their performance in and responses to the scenarios that they had experienced over the
course of the study. Areas covered were: quality of job performance during the simulation; feeling
centered throughout the simulation; concern about evaluations of those observing the simulation;
quickness with which they felt they were returning to how they normally feel after the simulation;
and quickness with which they felt they were returning to how they normally feel after the current
simulation compared to the last one they encountered. Participants who had been trained in the
HeartMath techniques were asked to rate to what extent they attributed changes in these areas to
their integration of the interventions. They were also asked to openly comment on specific changes
they were aware of in their response to the simulation that they attributed to having received the
HeartMath training. The interview lasted approximately 5 minutes.
RESULTS
Due to personal or work-related circumstances, seven of the 65 original participants could not
complete the study. Therefore, the final analysis was carried out on 28 experimental group
participants and 31 control group participants. The subgroup involved in the scenario portion of
the study was comprised of 12 officers in the experimental group and 11 in the control group.
Program Impact Assessment Results: Coping skills, family relationships, work performance and
interpersonal skills
Responses to the Program Impact Assessment interview were analyzed using T-tests for
independent samples. Results indicated marked improvements in coping skills, family
relationships, work performance and interpersonal skills in the trained participants as compared to
the control group (Figure 1). At the end of the study period, in comparison to the control group,
officers trained in the HeartMath techniques were significantly more likely to interact with their
families with greater patience and understanding; to find themselves spending more time with
those that they care about; and to stay calm and clear when faced with the unknown in their jobs.
Participants’ comments in the interviews indicated that using the HeartMath techniques gave them
greater conscious awareness of their stress and emotions and a greater understanding that their
Copyright © 1999 Institute of HeartMath
10
own stress or well-being is truly a product of their perceptions. They also found they had a greater
capacity to deal with stressful situations in a more balanced way rather than becoming
overwhelmed by them. Using the techniques, they were able to take a time out to gain perspective
on a problem or issue before reacting emotionally, and to more easily make inner perceptual and
attitudinal shifts. Many of the officers felt that these improved coping skills reduced their stress
and increased the effectiveness with which they were able to perform their jobs. Trained
participants also noted that using the techniques resulted in less competition and greater
cooperation within their work teams, improved listening and more effective communication
among team members. These improved listening skills also extended to the officers’ interactions
with their families, enabling them to manifest greater care and compassion for their loved ones.
One commuting officer commented that practicing the Freeze-Frame and Heart Lock-In techniques
in the car enabled this individual both to arrive at work in a better frame of mind and go home in a
better frame of mind to spend quality time with spouse.
Overall, the trained officers indicated that the HeartMath training benefited them most by
increasing their ability to manage their moods (83%); improving their capacity to listen patiently to
family members and be understanding of their concerns (75%); and enabling them to gain greater
insight into their own psychological well-being (58%). The specific areas in which the training had
the least impact were: the ability to integrate intuition into actions at work (8%); the tendency to
discuss personal life matters with co-workers (8%); and the tendency to discuss with co-workers
emotionally difficult situations encountered on the job (17%).
Personal and Organizational Quality Assessment Results: Stress, emotions and physical stress
symptoms
Analysis of covariance (ANCOVA) was used to compare the responses to the Personal and
Organizational Quality Assessment (POQA) survey for the two groups. Results showed that as
compared to the control group, participants trained in the HeartMath techniques exhibited
considerable reductions in stress, negative emotions, depression and fatigue, and increases in
positive emotions, peacefulness and vitality over the sixteen-week study period (Figure 2). Trained
participants also showed reductions in a number of the physical stress symptoms measured,
particularly sleeplessness, indigestion and anxiety (Figure 3). Notably, over the sixteen weeks,
stress dropped by 20% in the trained officers while it declined only 1% in the control group.
Depression declined 13% among the trained officers while it increased by 17% in the control group
in the same time period. There was an 18% reduction in fatigue in the trained participants,
whereas those not trained in HeartMath showed a decline of only 1%. Sleeplessness dropped by
17% in the trained group while it increased in the control group by 6%. Further, the control group
showed a decline in all the positive scales measured (positive emotions, peacefulness and vitality),
while these measures increased over the course of the study in the group trained in the HeartMath
techniques. The means and standard deviations of the results for all participants are provided in
Table 1.
The POQA survey results were also analyzed to determine whether there were significant
differences among officers in the items measured due to level of experience, shift work or gender.
Only a few items varied significantly among these groupings. The only significant difference based
on experience level was in mental clarity. Officers with 16-30 years experience had significantly
higher levels of mental clarity than those who had served 1-5 years or 6-15 years on the force. The
only significant difference between officers working a night shift versus those working a day shift
was in job satisfaction. The night shift officers reported lower levels of job satisfaction than the day
shift officers. Two variables were significantly different between genders. Female officers reported
a higher level of sleeplessness than males, while male officers had higher levels of anger.
Scenario stress levels
Copyright © 1999 Institute of HeartMath
11
Participants rated the domestic violence scenario as the most stressful, followed by the high-speed
pursuit scenario, and finally the building search as the least stressful of the scenarios (Figure 4).
Scenario performance evaluations
Figure 5 summarizes the average scenario evaluation results for experimental and control group
participants in the four general areas that were evaluated for all three scenarios: ability to maintain
focus during scenario; ability to make appropriate decisions; ability to communicate clearly during
the de-briefing; and ability to regain composure/balance after the scenario. It is of note that the
experimental group tended to score lower in these areas than the control group in the two
scenarios that were conducted prior to the HeartMath training (the building search and high-speed
pursuit); however, after they received training in the HeartMath techniques, this trend reversed:
the experimental group scored higher than the control group in all key areas in the final scenario
(domestic violence), which participants reported to be the most stressful.
Figure 6 shows evaluation results for all subjects for the specific questions participants were
required to answer after the high-speed pursuit scenario. Thirty percent of the officers
remembered the suspect’s name that they were told by the dispatcher, 78% remembered the name
of the business at which the suspect worked, 86% felt they drove with due regard during the
scenario, and 74% answered that they drove within the limitations of the vehicle or their own
driving ability.
Figure 7 shows evaluation results for all subjects for the nine specific areas assessed in the
domestic violence scenario. Participants scored highest on average in the use of appropriate
weapons and contact/information collection. The poorest average performance was seen in the
positioning of involved parties, use of cover and use of triangulation. In most of the skills
evaluated, there was a fairly wide range of ability demonstrated among the different participants,
which most likely reflects their widely differing levels of experience in this type of scenario
training.
Effects of the HeartMath techniques on coping performance
Of the officers trained in the HeartMath techniques who underwent the final (domestic violence)
scenario, 83% noted in their interview that they saw clear improvements in their coping
performance that they attributed to their use of the techniques. Of this group, 80% felt that using
the Freeze-Frame technique immediately after the scenario enabled them to recalibrate from the
high stress and return to how they normally feel significantly more quickly as compared to in the
previous scenarios before they had been trained in the HeartMath tools. (In contrast, only 36% of
the control group noted any improvement in how quickly they were able to recalibrate after the
final scenario as compared to the previous ones). Several of the officers indicated that they also
planned to use the technique on the way home from the scenario, to gain an even deeper level of
inner balance. Sixty percent also used Freeze-Frame before (50%) or during (10%) the scenario, and
60% commented that they felt more centered throughout the scenario as a result of their
integration of the HeartMath techniques. Overall, participating officers’ comments indicated that
using the Freeze-Frame technique before entering the scenario helped them feel more calm,
focused, confident and better able to adjust to stress, while using the technique after the scenario
enabled them to more rapidly and deeply recover, both physiologically and psychologically, from
the intense stress they experienced.
Physiological results
Figures 8 - 18 provide a summary of the physiological data collected from the participants. The
heart rate and blood pressure results clearly indicate that all the scenarios resulted in a
considerable degree of physiological stress and activation.
Copyright © 1999 Institute of HeartMath
12
Heart rate
A primary indicator of stress and autonomic nervous system activation is increases in heart rate.
Figure 8 shows the average increase in heart rate of all the officers during each of the scenarios.
The stress and activity of the scenarios produced profound elevations in heart rate, with the
average heart rates ranging from 128-143 bpm, which is between 40 to 55 bpm above the officers’
normal average daytime heart rates. The normal average daytime heart rate is indicated by the
horizontal line in Figure 8. The largest increases in heart rate were seen in the domestic violence
scenario, with an average increase of 55 bpm above the daytime average. This was closely followed
by the building search scenario, with a mean increase of 52 bpm above the normal daytime
average, and then the high speed pursuit with an increase of 40 bpm above the daytime average.
Figure 9 illustrates an example of the heart rate increases experienced by a single officer during the
different scenarios. During the peak action of all three scenarios, this officer’s heart was beating
faster than 3 beats per second.
In addition to the average heart rate analysis, the ambulatory ECG recordings allowed us to
monitor the beat-to-beat changes in heart rate that occurred in response to the different activities in
which officers engaged during the scenarios. Figures 10 - 12 provide typical examples of the heart
rate variability (the beat-to-beat changes in heart rate) in individual officers during each of the
three scenarios. The times at which different activities or events occurred are clearly marked on
the graphs. In all three simulations, a large and very rapid increase in heart rate is evident as the
officer shifts from a preparatory mode (staging) to the actual action of the scenario. Further
increases are seen as the scenarios reach their most stressful peak. Although heart rate begins to
decrease rapidly as soon as the simulations are over, in the building search and domestic violence
scenario examples it remains substantially elevated relative to baseline for some time after the
scenarios have ended. Analysis of the 24-hour ECG recordings revealed that it took an average of 1
hour and 5 minutes after the scenarios ended for officers’ heart rates to return to their normal
baseline values. In several cases, heart rate did not recalibrate to baseline for over 2 hours
afterwards.
Figure 13 shows an example of the change in heart rate experienced by one officer who used the
Freeze-Frame technique to help recalibrate after the intense stress of the domestic violence
scenario. When the scenario was over the participant’s heart rate began to drop, but initially
stabilized at a value above its normal baseline range. As the participant Freeze-Framed, there was
an immediate, further reduction in heart rate back to baseline.
Blood pressure
Figure 14 shows the average changes in systolic and diastolic blood pressure for all the
participants before and after the scenarios. Baseline average blood pressure values taken on a day
on which the officers were not involved in scenarios were 124/76 mmHg. Significant increases in
blood pressure were observed in the scenarios. The officers’ average blood pressure was 166/98
mmHg after the building search, 145/96 mmHg following the high speed pursuit and 175/95
mmHg after the domestic violence scenario, indicating average rises of 40 mmHg for systolic and
20 mmHg for diastolic pressure. Figure 15 shows an example of the blood pressure changes
experienced by one officer during the three scenarios.
The most extreme increases in systolic blood pressure were seen in the domestic violence scenario.
Figure 16 details the individual changes in each officer’s systolic pressure during this scenario.
There was considerable variation in the degree of blood pressure increases among the individual
participants. In five of the officers, systolic blood pressure rose to over 200 mmHg, indicating
Copyright © 1999 Institute of HeartMath
13
increases in the range of 80-120 mmHg above their starting values. The largest increase in systolic
pressure was from 122 to 243 mmHg (an increase of 121 mmHg). The smallest change measured
was from 137 to 152 mmHg (an increase of 15 mmHg),
In general, there was little difference in the physiological measures between the trained
participants and the control group, as was expected. However, analyses of the blood pressure
results revealed one notable trend. As shown in Figure 17, during the two scenarios conducted
prior to the HeartMath training, (the building search and high-speed pursuit), the experimental
group had a higher average increase in systolic blood pressure than the control group. However,
after they received training in the HeartMath techniques, this trend reversed: the experimental
group had a lower average systolic blood pressure than the control group in the final scenario
(domestic violence), which participants reported to be the most stressful. The average increase in
diastolic blood pressure was also lower in the trained group during the final scenario.
Risk assessment
From the heart rate variability analysis of each participant’s baseline 24-hour electrocardiogram,
six key measures of autonomic nervous system function and balance commonly used in risk
assessment were calculated. For a more detailed explanation of these measures and their clinical
relevance, see reference 39. Of the 27 officers whose HRV was analyzed, three (11%) were found to
have low HRV and are therefore considered to be at high risk for cardiovascular disease and
premature mortality. Figure 18 illustrates the scatter plots showing all participants’ values for each
of the six measures analyzed. Average values for normal healthy individuals according to age are
indicated by the center dotted line on each graph, and normal reference ranges (95% confidence
intervals) are delineated by the two solid lines. Note that for several of the measures (very low
frequency, low frequency and high frequency power) three of the officers’ values fall outside the
normal reference range for their age groups.
Copyright © 1999 Institute of HeartMath
Program Impact Assessment Results
0
5
10
15
20
25
30
Coping Skills Family
Relationships
Work Performance Interpersonal Skills
Score
HeartMath Group Control Group
*
N=25
Figure 1. Improvements in major life areas following the HeartMath training.
Coping
skills, family relationships, work performance and interpersonal skills were assessed by means
of a semi-structured interview conducted 4 weeks after the completion of the HeartMath stress
and emotional self-management training. Officers trained in the HeartMath techniques showed
improvements in all areas as compared to a control group that did not receive the training. The
* symbol shows statistical significance, indicating a p value of less than .05.
Copyright © 1999 Institute of HeartMath
-14%
-18%
-18%
3%
0%
-8%
-1%
16%
1%
-1%
-2%
-4%
-3%
5%
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**
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*
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*
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25%
Global Negative Emotion
Anger
Distress
Depression
Sadness
Fatigue
Positive Emotion
Vitality
Survey Score % Change
HeartMath Group Control Group
Personal and Organizational Quality Assessment
Results
Figure 2. Improvements in stress and emotional well being following the HeartMath
training.
Compares the differences between the average pre- and post-training scores for each psychological
variable measured by the POQA survey. The “global negative emotion” score is the overall average of
the individual scores for the anger, distress, depression and sadness constructs. Participants were
assessed at the start of the study and 16 weeks later (4 weeks after the completion of the
HeartMath
training). As compared to a control group, participants trained in the HeartMath techniques exhibited
considerable reductions in distress, depression, anger, sadness, fatigue and overall negative emotion,
and increases in positive emotions, peacefulness and vitality over the study period. Note that the
control group not trained in the techniques experienced a marked rise in depression over the same
time period. †p < .1, *p < .05, **p < .01.
Copyright © 1999 Institute of HeartMath
-17%
-15%
-7%
-20%
6%
6%
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-7%
0%
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-25%
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5%
10%
15%
20%
25%
Sleeplessness
Anxiety
Body Aches
Indigestion
Rapid Heartbeats
Survey Score % Change
HeartMath Group Control Group
Physical Stress Symptoms
Figure 3. Changes in physical stress symptoms following the HeartMath training
. Illustrates
changes in five physical symptoms of stress as assessed for all participants at the start of the study and
16 weeks later (4 weeks after the completion of the HeartMath training). There was a reduction in
sleeplessness, anxiety and indigestion in the HeartMath group. The HeartMath group also reported
more rapid heartbeats than the control group, which may be due to an increased awareness of their
heartbeats after the training program.
Copyright © 1999 Institute of HeartMath
Mean ± SD Mean ± SD Mean ± SD Mean ± SD Mean ± SD Mean ± SD
Global Negative Emotion 2.13 ± .50 2.00 ± .59 1.78 ± .49 1.96 ± .47 1.93 ± .54 1.97 ± .69
Anger 2.44 ± .74 2.25 ± .72 2.11 ± .70 2.42 ± .66 2.33 ± .68 2.24 ± .82
Distress 2.56 ± .57 2.44 ± .66 2.05 ± .64 2.26 ± .59 2.26 ± .72 2.23 ± .82
Depression 1.46 ± .51 1.37 ± .57 1.27 ± .36 1.32 ± .38 1.33 ± .47 1.54 ± .65
Sadness 2.05 ± .76 1.93 ± .78 1.68 ± .63 1.84 ± .74 1.80 ± .69 1.86 ± .81
Fatigue 2.94 ± .90 2.81 ± .78 2.42 ± .85 2.48 ± .58 2.44 ± .57 2.45 ± .81
Positive Emotion 4.08 ± .46 4.06 ± .50 4.19 ± .43 4.28 ± .54 4.12 ± .61 4.21 ± .67
Peacefulness 3.77 ± .69 3.82 ± .74 4.06 ± .49 3.97 ± .64 3.87 ± .75 3.83 ± .88
Vitality 3.99 ± .58 4.07 ± .70 4.18 ± .53 4.19 ± .52 4.12 ± .63 4.06 ± .74
Social Support 4.35 ± .52 4.21 ± .60 4.31 ± .50 4.29 ± .57 4.18 ± .68 4.10 ± .78
Mental Clarity 4.43 ± .45 4.32 ± .48 4.35 ± .44 4.41 ± .46 4.24 ± .66 4.13 ± .65
Job Satisfaction 4.52 ± .59 4.44 ± .64 4.29 ± .67 4.44 ± .60 4.37 ± .65 4.34 ± .89
Goal Clarity 3.96 ± .84 4.08 ± .71 4.06 ± .67 4.10 ± .70 4.10 ± .68 4.20 ± .71
Productivity 4.57 ± .41 4.52 ± .52 4.39 ± .44 4.40 ± .51 4.39 ± .52 4.40 ± .60
Communication Effectiveness 3.64 ± .53 3.73 ± .60 3.68 ± .68 3.81 ± .66 3.77 ± .72 3.92 ± .78
Sleeplessness 2.46 ± 1.10 2.50 ± 1.14 2.04 ± .84 2.00 ± 1.13 1.94 ± 1.00 2.13 ± .92
Anxiety 2.86 ± .85 2.79 ± .88 2.43 ± .74 2.48 ± .85 2.42 ± .76 2.29 ± .97
Body Aches 2.50 ± 1.11 2.46 ± 1.00 2.32 ± .90 2.45 ± .96 2.19 ± 1.08 2.29 ± 1.01
Indigestion 2.32 ± 1.06 1.96 ± 1.04 1.86 ± .89 1.77 ± .92 1.61 ± .84 1.77 ± .92
Rapid Heartbeats 1.82 ± .94 2.00 ± .98 1.93 ± .90 1.71 ± .74 1.42 ± .62 1.42 ± .62
Experimental group N=28
Control group N=31
Analysis of covariance (ANCOVA)
HeartMath Group Control Group
Baseline 5 weeks 16 weeks Baseline 5 weeks 16 weeks
Table 1. Personal and Organizational Quality Survey Means and Standard Deviations
Copyright © 1999 Institute of HeartMath
Scenario Stress Levels
8.5
6.2
7.3
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10
Building
Search
High-Speed
Pursuit
Domestic
Violence
Stress Level
Figure 4. Scenario stress levels.
Shows the officers’ ratings of the three scenarios according to
how
stressful they perceived each to be. The domestic violence scenario was rated as the most stressful,
followed by the high-speed pursuit, and the building search was the least stressful to participants.
Copyright © 1999 Institute of HeartMath
Ability to maintain focus during the scenario
1
2
3
4
5
Building search High-speed pursuit Domestic violence
HeartMath Group Control Group
Pre-Training Post-Training
Ability to make appropriate decisions
1
2
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5
Building search High-speed pursuit Domestic violence
HeartMath Group Control Group
Pre-Training Post-Training
Ability to communicate clearly during the de-
briefing
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5
Building search High-speed pursuit Domestic violence
HeartMath Group Control Group
Pre-Training Post-Training
Ability to regain composure/balance after the
scenario
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5
Building search High-speed pursuit Domestic violence
HeartMath Group Control Group
Pre-Training Post-Training
Figure 5. General scenario evaluation results: HeartMath group vs. control group
. This set of
graphs summarizes the average scenario evaluation results for experimental and control group
participants in the four general areas that were evaluated for all three scenarios (results for each key
area evaluated are displayed as a separate graph). Note that the experimental group tended to
score
lower than the control group in the two scenarios that were conducted prior to the HeartMath
training (the building search and high-speed pursuit); however, after they received training in the
HeartMath techniques, this trend reversed: the experimental group scored higher than the control
group in all key areas in the final scenario (domestic violence), which participants reported to be the
most stressful.
General scenario evaluation results: Group Comparison
Copyright © 1999 Institute of HeartMath
High-Speed Pursuit Scenario Evaluation Results
30%
78%
86%
74%
0%
10%
20%
30%
40%
50%
60%
70%
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90%
100%
Remembered
suspect's name
Remembered
name of the
business
Drove with due
regard
Driving within
limitations of the
vehicle or own
abilities
Percentage of Subjects
N=23
Figure 6. High-speed pursuit scenario evaluation results.
Quantifies all participants’ responses to
the specific questions answered after the high-speed pursuit scenario.
Copyright © 1999 Institute of HeartMath
Domestic Violence Scenario Evaluation Results
1
2
3
4
5
Approach
Contact/information collection
Use of contact and cover officer
Use of cover
Use of Triangulation
Positioning of Involved parties
Appropriate escalation of force
Appropriate weapons used
Arrest and control
N=23
Figure 7. Domestic violence scenario evaluation results.
Shows average evaluation scores for all
participants for the nine specific areas assessed in the domestic violence scenario. Participants scored
highest
on average in the use of appropriate weapons and contact/information collection, while the poorest average
performance was seen in the positioning of involved parties, use of cover and use of triangulation.
Copyright © 1999 Institute of HeartMath
Average Heart Rate of All Scenario Subjects
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Daytime Average
Building Search - Staging
Building Search
Building Search - Recovery
High-Speed Pursuit - Staging
High-Speed Pursuit
High-Speed Pursuit - Recovery
Domestic Violence - Staging
Domestic Violence
Domestic Violence - Recovery
Heart Rate (BPM)
Daytime average heart rate
N=21
Figure 8. Average increases in heart rate during the scenarios.
Plots average heart rate for all officers
before (staging), during, and after (recovery) each scenario. The stress and activity of the scenarios produced
profound elevations in officers’ heart rates. The average heart rate was 140 bpm during the building search
scenario, 128 bpm during the high-speed pursuit, and 143 bpm during the domestic violence scenario. These
values represent increases of 40 to 55 bpm above the officers’ normal average daytime heart rate of 88 bpm,
which is indicated on the graph by the horizontal line.
Copyright © 1999 Institute of HeartMath
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185
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Baseline
Building Search - Staging
Building Search
Building Search - Recovery
High-Speed Pursuit - Staging
High-Speed Pursuit
High-Speed Pursuit - Recovery
Domestic Violence - Staging
Domestic Violence
Domestic Violence - Recovery
Heart Rate (BPM)
Average Daytime Heart Rate
Heart Rate Changes in One Officer During the Scenarios
Figure 9. Heart rate changes in one officer during the scenarios.
This graph provides an example of the
increases in heart rate experienced by one participant during the three scenarios. During the peak action of all
three scenarios, this officer’s heart was beating faster than 3 beats per second. The largest increase occurred in
the domestic violence scenario, with heart rate rising to 192 bpm. The officer’s normal average daytime heart
rate (81 bpm) is indicated by the horizontal line on the graph.
Copyright © 1999 Institute of HeartMath
Staging
Opens door
Encounters suspect
Suspect reaches in pocket
Handcuffing
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Clock Time
Heart Rate (BPM)
Figure 10. Heart rhythm of one officer during the building search scenario.
This graph provides a typical
example of an officer’s heart rate variability (beat-to-beat changes in heart rate) during the building search
scenario. Changes in heart rate are an important physiological indicator of stress and autonomic nervous system
activation. Note the sharp and pronounced increase in heart rate as the officer prepares to enter the building.
There is a further increase in heart rate as the officer encounters and interacts with the suspect. Although heart
rate drops once the scenario has ended, it still remains considerably elevated, compared to baseline, for some
time afterwards.
Heart Rhythm of One Officer During the Building Search Scenario
Copyright © 1999 Institute of HeartMath
Staging
Starts car
Siren on
Suspect gets out of car
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Clock Time
Heart Rate (BPM)
Figure 11. Heart rhythm of one officer during the high-speed pursuit scenario.
This graph provides a
typical example of an officer’s heart rate variability (beat-to-beat changes in heart rate) during the high-speed
pursuit scenario. The stress and physiological arousal experienced by the participant is reflected in the large
and rapid increase in heart rate that occurs as the officer prepares to begin the chase. This elevated heart rate is
maintained for the duration of the scenario.
Heart Rhythm of One Officer During the High-Speed Pursuit Scenario
Copyright © 1999 Institute of HeartMath
Staging
Opens door
Questions battered victim
Sees man with gun
Guns go up
Shots fired
Cuffing
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Clock Time
Heart Rate (BPM)
Figure 12. Heart rhythm of one officer during the domestic violence scenario.
This graph provides a typical
example of an officer’s heart rate variability (beat-to-beat changes in heart rate) during the domestic violence
scenario. Heart rate begins to rise as the officer prepares to enter the residence. There is then an extremely
sharp, further increase in heart rate as the participant spots the armed suspect. During the peak stress of the
scenario, as gun shots are fired between the officer and suspect, the officer’s heart is beating at over 200 beats
per minute -- faster than 3 beats per second. Heart rate begins to decrease once the scenario has ended, but still
remains elevated at a level substantially above baseline. In this particular participant, it took over 2 hours after
the scenario for heart rate to return to normal.
Heart Rhythm of One Officer During the Domestic Violence Scenario
Copyright © 1999 Institute of HeartMath
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Clock Time
Heart Rate (BPM)
Freeze-Frame
Scenario
Heart Rhythm of One Officer Using Freeze-Frame
After the Domestic Violence Scenario
Figure 13. Heart rhythm of one officer using Freeze-Frame after the domestic violence scenario.
This
graph provides an example of the change in heart rate experienced by one officer who used the Freeze-Frame
technique to help recalibrate after the stress of the domestic violence scenario. Note that when the scenario
ends, the participant's heart rate begins to drop, but remains elevated in a range above its normal baseline
range. As the officer uses the Freeze-Frame technique, there is an immediate, further reduction in heart rate
back to baseline.
Copyright © 1999 Institute of HeartMath
Average Blood Pressure During the Scenarios
Figure 14. Average blood pressure during the scenarios.
This graph shows the average systolic and
diastolic blood pressure for all participants during each of the scenarios, as compared to a baseline reading
taken on a normal workday on which the officers were not involved in the scenarios. For each reading, systolic
pressure values are indicated by a dot, diastolic values are marked by a square, and the two values are
connected by a vertical line. Baseline systolic and diastolic pressure values are indicated by the two horizontal
lines on the graph. The stress and activity of all three scenarios produced significant elevations in blood
pressure. The officers’ average blood pressure was 166/98 mmHg after the building search, 145/96 mmHg
following the high speed pursuit and 175/95 mmHg after the domestic violence scenario, indicating average
rises of 40 mmHg for systolic and 20 mmHg for diastolic pressure.
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After Building Search After High-Speed
Pursuit
After Domestic
Violence
mmHg
Systolic Diastolic
N=21
Baseline
Diastolic
Baseline
Systolic
Copyright © 1999 Institute of HeartMath
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Baseline
Building Search - Staging
Building Search - Recovery
High-Speed Pursuit - Recovery
Domestic Violence - Staging
Domestic Violence - Recovery
mm/Hg
Systolic Diostolic
Systolic
Diastolic
Example of Blood Pressure Changes From One Officer
Figure 15. Blood pressure changes in one officer during the scenarios.
This graph provides an example of
the blood pressure elevations experienced by one participant during each of the scenarios, as compared to a
baseline reading taken on a normal workday on which the officer was not involved in the scenarios. This
officer experiences the largest increase in systolic pressure during the domestic violence scenario, with his
systolic reading jumping from 122 mmHg before the simulations to 243 mmHg by the time the scenario has
ended.
Copyright © 1999 Institute of HeartMath
50
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sys_T3 t3rm_sys
mmHg
Before
After
N=21
Systolic Blood Pressure in All Subjects Before and After
the Domestic Violence Scenario
Figure 16. Systolic blood pressure increases in all officers during the domestic violence scenario
. This
graph details the individual changes in each officer’s systolic blood pressure during the domestic violence
scenario. There was substantial variation in the blood pressure responses among the different officers. In five
of the officers, systolic blood pressure rose to over 200 mmHg during the scenario, indicating increases in the
range of 80-120 mmHg above their starting values. The largest elevation in systolic pressure was from 122 to
243 mmHg (an increase of 121 mmHg). The smallest change measured was from 137 to 152 mmHg (an
increase of 15 mmHg).
Copyright © 1999 Institute of HeartMath
Systolic Blood Pressure
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Pursuit
Domestic Violence
Average Change (mmHg)
HeartMath Group Control Group
N=21
Pre-Training Post Training
Diastolic Blood Pressure
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25
30
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Pursuit
Domestic Violence
Average Change (mmHg)
HeartMath Group Control Group
N=21
Pre-Training Post-Training
Average Increases in Blood Pressure: Group Comparison
Figure 17. Average increases in blood pressure during the scenarios: HeartMath group vs. control group.
These graphs compare the average amount of increase in systolic and diastolic blood pressure experienced
during the scenarios in HeartMath group vs. control group participants. (Values shown represent the mean
difference between the blood pressure readings taken before the scenarios and those taken immediately
afterwards.) It can be seen that during the two scenarios conducted prior to the HeartMath training, (the
building search and high-speed pursuit), the experimental group had a higher average increase in systolic blood
pressure than the control group. However, after they were trained in the HeartMath techniques, this trend
reversed: the experimental group had a lower average systolic blood pressure than the control group in the final
scenario (domestic violence), which participants reported to be the most stressful. The average increase in
diastolic blood pressure was also lower in the HeartMath group during the final scenario.
Copyright © 1999 Institute of HeartMath
SDNN
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Figure 18. Risk assessment.
This set of graphs summarizes risk assessment results for all officers analyzed. From the heart rate variability analysis of
officers' baseline 24-hour electrocardiograms, six key measures of autonomic nervous system function and balance commonly used in risk assessment
were calculated. The scatter plots show values for all participants analyzed for each of these measures. Power is plotted on the vertical axis and age is
plotted on the horizontal axis. The descending diagonal lines on the graphs indicate the natural decline in heart rate variability that occurs with
increasing age. Average values for normal healthy individuals according to age are indicated by the center dotted line on each graph, and normal
reference ranges (95% confidence intervals) are delineated by the two solid lines. Note that for several of the measures (very low frequency, low
frequency and high frequency power) three of the officers' values fall below the normal reference range for their age groups. This abnormally low
heart rate variability places these individuals at increased risk of cardiovascular disease, sudden death and premature mortality from all causes. In this
sample of police officers, 11% were found to be at high risk, which is over twice the ratio expected to be seen in a typical sample of the general
population. This figure is consistent with results of epidemiological studies which reveal that police officers as a group have greater than double the
average incidence of cardiovascular disease found in the general population.
Copyright © 1999 Institute of HeartMath
14
DISCUSSION
The data collected in this investigation clearly illustrate the extreme degree of physiological
arousal elicited by the acutely stressful circumstances to which police can be exposed in their
work. It should be emphasized that the heart rate and blood pressure changes measured in this
study occurred in response to scenarios that the officers knew were only simulations; thus it is
highly likely that the degree of physiological activation officers undergo when exposed to real
danger is even more profound. Of the different types of police calls simulated in this study, the
domestic violence scenario was rated as the most stressful by the participants and also produced
the greatest rises in heart rate and systolic blood pressure.
The heart rate recordings show that it takes the body a considerable amount of time to recalibrate
from such intense levels of stress. In this group of officers, results showed that on average, heart
rate remained elevated well above baseline for more than one hour after the scenario debriefing
process had ended. Consideration of the intense physiological arousal that police officers endure in
response to acute stress is of significance given the high rates of stress-related illness, particularly
cardiovascular disease, in police.
10, 12
Police are known to have over twice the incidence of
cardiovascular disease as the general population, and one study determined that being employed
in law enforcement places one at a greater risk of developing cardiovascular disease than having
high blood pressure, diabetes, being overweight or smoking.
12
In recent years, emotional stress
has become increasingly recognized as a critical risk factor in cardiovascular morbidity and
mortality.
48-50
While the body has built-in homeostatic feedback systems that enable it to
recalibrate from stress-induced physiological responses, it has been shown using animal models
that emotional responses to stress, if repeated consistently over time, can be sufficiently powerful
to override the body’s feedback systems and lead to chronic disease. In this way, initially
reversible physiological adjustments to stress can eventually lead to exaggerated and persistent
activity of the sympathetic nervous system and irreversible structural changes to the
cardiovascular system, resulting in chronic hypertension or other pathophysiological conditions.
51-53
Chronic sympathetic activation can also result in eventual exhaustion of the autonomic
nervous system, which has a body-wide impact, predisposing one to illness and increasing the risk
of premature mortality.
40, 54
Along these lines, the results of the heart rate variability (HRV) analysis revealed that three of the
27 officers tested fell below the normal ranges for their age groups in several key measures of
autonomic nervous system function and balance, placing them at increased risk of cardiovascular
disease, sudden death and premature mortality from all causes. The number of high-risk
individuals identified in this study equaled approximately 11% of the sample, which is 2.2 times
the ratio that would be expected to be found in an average population. This is remarkably
consistent with the epidemiological findings indicating that police officers have 2.3 times the risk
of cardiovascular disease as compared to the general population.
12
This study’s findings therefore
suggest that 24-hour HRV analysis can be a useful screening tool to identify at-risk individuals in
organizational settings. Our work indicates that low HRV, often accompanied by fatigue, is
frequently found in individuals who suffer prolonged or chronic stress. Encouragingly, a growing
number of case histories show that consistent practice of the HeartMath techniques can help
increase HRV and restore healthy autonomic function and balance in individuals who are at risk.
39, 40
We therefore recommend that once at-risk individuals are identified, they be given intensive
training in these techniques to help them reduce stress and improve their health.
Copyright © 1999 Institute of HeartMath
15
Heart rate variability is also a marker of the efficiency of the body’s neural feedback mechanisms
and reflects the individual’s capacity to effectively organize physiological and behavioral resources
in response to environmental demands. As with many of the body’s regulatory systems, the
greater the range of variability, the healthier the individual and the greater one’s physiological and
behavioral flexibility in response to external challenges. Thus, individuals with low heart rate
variability have reduced capacity to adjust rapidly and respond effectively to stressful stimuli.
55
This is particularly relevant, as police officers are continually confronted in their work with
numerous and diverse challenges, often occurring within a short time span, which require a wide
range of behavioral responses. Quick adaptability and flexibility under stress determines an
officer’s capacity to respond efficiently and effectively to these external demands. The greater
officers’ response potential or possible range of behavior, the more likely they are to be able to deal
efficiently and effectively with the challenges inherent in their work. By helping restore natural
physiological variability in officers with low HRV, practice of the HeartMath tools can increase the
behavioral flexibility that is crucial to optimal performance.
Overall, this study’s findings point to the importance of achieving quick and deep recalibration
following intense stress. This recalibration is also of prime importance at the psychological level, as
stress hormones released during the “fight-or-flight” stress response are now known to suppress
the function of higher brain centers concerned with concentration, inhibition of inappropriate
responses or distractions, effective planning, decision making and other forms of rational thought.
21
There is also evidence that cortisol, the principal glucocorticoid hormone released under stress,
inhibits memory retrieval.
56
For the police officer, the ability to think rationally under stress, to
concentrate, plan ahead, remember and organize crucial information, make effective decisions and
control inappropriate emotion-triggered reactions, is critically important, and in some cases can
determine the difference between life and death for oneself and other parties.
This study’s findings are encouraging, as the results of the interviews with the officers involved in
the scenarios provide initial evidence that use of the self-management interventions learned in the
study enabled the majority to recalibrate more quickly and deeply to a state of increased
physiological and psychological balance following the simulations. Officers who used the Freeze-
Frame technique before the scenarios also noted that it helped them feel more centered, balanced
and confident in the midst of these stressful situations. These benefits are also reflected in the
evaluations completed by the scenario training officers. The trends showed that in the two
scenarios conducted prior to the HeartMath training, the experimental group scored lower on
average than the control group in their ability to maintain focus, make appropriate decisions,
communicate clearly during the de-briefing and regain balance after the scenarios. In contrast, in
the domestic violence scenario, which was conducted after the HeartMath training, the
experimental group scored higher than the control group in all these categories. This is also of
consequence, as the domestic violence simulation was considered by participants to be the most
stressful of the scenarios. Notably, a similar pattern was observed in the blood pressure trends,
which showed that the experimental group had a higher average systolic blood pressure than the
control group during the scenarios that occurred prior to the HeartMath training, but a lower
average systolic blood pressure in the final scenario that was conducted after the HeartMath
training. Diastolic blood pressure values for the experimental group were also lowest during the
final simulation as compared to the scenarios that were conducted before the self-management
training.
Human responses to acute stress are readily felt and generate strong feedback in our systems,
driving us to regain physiological and psychological balance through both automatic bodily
mechanisms and conscious actions. In contrast, life’s chronic stressors, including job pressures,
strained interpersonal relationships, communication difficulties and unmanaged negative thought
and emotional patterns, can be more insidious and ultimately even more harmful, as they can
Copyright © 1999 Institute of HeartMath
16
sustain a background level of emotional imbalance that causes a low-grade stress response to be
chronically activated. With time, the body and psyche “adapt” to this less-than-optimal functional
state, which continually drains energy, obscures mental clarity, causes performance to deteriorate,
and produces wear and tear on our internal systems, promoting physiological responses that
accelerate aging and disease progression.
57
It is therefore particularly encouraging that the
techniques in this study had a measurable effect on participants’ ability to effectively manage the
chronic stress in their lives. Results revealed significant reductions in global negative emotion,
stress and depression as well as increases in peacefulness and vitality over the six weeks of the
study. Anger, sadness and anxiety were also reduced, as were several physical stress symptoms.
One of most prominent effects of the integration of the HeartMath techniques among the trained
officers in this study was greatly improved listening and communication. The program assessment
interviews indicated that these improved communication skills had a significant impact both
within work teams and in officers’ relationships with their spouses and families -- two key areas in
which a typical lack of effective communication is a significant and well-recognized source of
stress in the lives of many police officers.
2, 10
In this study, results indicated that the officers’
increased ability to listen more effectively to one another resulted in less competition, greater
cooperation and team cohesiveness, and increased work efficiency. In particular, officers in
supervisory positions expressed a greater readiness and capacity to listen with greater sincerity
and care to their staff members, and noted how this created an improved work environment and
greater cooperation from employees. It is a likely possibility that these benefits contributed to the
significant increase in overall work performance seen over the course of the study. Officers’
implementation of their improved communication skills at home also produced significant
benefits, with 75% of the participants noting an improvement over the course of the study in their
capacity to listen patiently to family members and to be understanding of their concerns. Officers’
comments suggest that sincerely applying this increased care and sensitivity in their personal
relationships could help dissipate a significant amount of the underlying stress in this key area of
their lives.
The greatest and, in our view, most important effect of the self-management training was seen in
the participants’ increased ability to manage their moods. Eighty-three percent of the participants
noted an improvement in this area. This is of particular significance, as research on human stress
has clearly shown that it is really our unmanaged internal mental and emotional reactions to
situations and events that are the most fundamental source of the “stress” we experience. Notably,
in a recent study of job stress in police officers, individuals’ confidence in their ability to manage
their negative emotions was shown to effectively buffer the negative physiological and
psychological effects of occupational stress.
58
Officers who believed they could not control the
negative emotions they experienced proved to be more vulnerable to the negative consequences of
occupational stressors, and reported increasingly severe distress as the frequency of occupational
stressors rose. On the other hand, officers who were confident in their own ability to manage their
negative moods were less likely to experience physiological and psychological distress, even if
they were exposed to high levels of potential stressors.
The HeartMath interventions are specifically designed to target stress at its source by helping
individuals reduce or transform negative mental and emotional responses as they are experienced.
In this study, providing officers with practical, easy-to-use tools to recognize and eliminate stress
in the moment significantly increased participants’ awareness of their stress, as well as their
confidence in their own ability to effectively manage or transform stressful emotional reactions.
Results suggest that the application of these improved coping or emotional management skills
reduced the stress officers felt in a variety of areas of their lives, including significant relationships
and interactions at work and at home, as well as helping them to achieve deeper levels of internal
Copyright © 1999 Institute of HeartMath
17
balance during and after acutely stressful situations. For a summary of the key benefits of the
HeartMath training gained by police officers in this study, see Box 1.
Box 1. Key Benefits of the HeartMath Training for Santa Clara County Police Officers
• Increased awareness and self-management of stress reactions
• Reduced distress, anger, sadness and fatigue
• Reduced sleeplessness and physical stress symptoms
• Increased peacefulness and vitality
• Reduced competition, improved communication and greater cooperation within
work teams
• Improved work performance
• Greater confidence, balance and clarity under acute stress
• Quicker recalibration following acute stress
• Improved listening and relationships with family
One advantage of the Freeze-Frame technique learned by participants in this study is that, in
contrast to many relaxation or exercise stress management protocols, the technique does not
require an extended block of time or separate space outside the normal workplace environment to
practice. Rather, it is specifically intended for use in the midst of stressful situations, when it is
most needed. This benefit is particularly relevant for police, whose jobs often demand that they be
constantly vigilant and able to maintain inner balance and clarity in the midst of performing their
duties, frequently under highly stressful circumstances. Further, our experience with numerous
individuals indicates that with practice, the self-management skills facilitated by the HeartMath
techniques become essentially “automatic” and can therefore be effectively implemented in
moments of crisis without any time lost. An additional advantage of the techniques used in this
study is that they are quickly and easily learned, and can yield immediate benefits if used
sincerely. It is of note that significant improvements in several areas that are commonly recognized
as major sources of stress in police were achieved in this study in as little as one month’s time after
the completion of the HeartMath training. This also presents the possibility that additional
improvement could be achieved with continued practice of the techniques over a longer time
period.
CONCLUSIONS AND FUTURE DIRECTIONS
Police officers as an occupational group endure particularly high levels of stress. The physiological,
psychological and behavioral effects of stress in police can be severe, and include extremely high
rates of suicide, alcohol use, cardiovascular diseases and other stress-related illnesses. Chronic
Copyright © 1999 Institute of HeartMath
18
anxiety, depression, psychological burnout and disrupted family relationships are other common
manifestations of prolonged unmanaged stress in police officers. In the line of duty, the inability to
effectively manage one’s stress responses can significantly impair judgment and decision making
abilities and in the extreme can result in the inappropriate application of force, driving accidents,
injury and death. These consequences severely compromise public safety and can lead to citizen
unrest, lawsuits and high liability costs to police agencies. The numerous and severe effects of
stress in the police profession clearly point to the need for effective stress management strategies
for this population.
The results of this investigation provide convincing evidence that the application of practical stress
and emotional management techniques can reduce damaging physiological and psychological
responses to both acute and chronic stress in police, and positively impact a variety of major life
areas in a relatively short period of time. Officers who practiced the HeartMath techniques during
this study experienced marked reductions in negative emotions, fatigue and physical stress
symptoms as well as increased peacefulness, physical vitality and improved work performance. In
particular, significant improvements occurred in communication difficulties at work and in
strained family relationships, two prominent sources of stress for police. Results suggest that the
techniques provided in this study were effective in reducing the most fundamental source of
participants’ stress by giving them greater ability to manage and transform stress-producing
perceptions and negative emotional reactive patterns.
This study also provides important insight into the physiological impact of acute on-the-job stress
as experienced in real time by police officers, as measured by cardiovascular responses to
simulated police call scenarios. The acute stress of the scenarios produced rapid and pronounced
increases in heart rate and blood pressure, from which it took officers a considerable amount of
time to recover. The HeartMath interventions helped officers maintain greater clarity and inner
balance under the pressure of these high-stress situations and also enabled them to recalibrate
more quickly afterwards, both psychologically and physiologically. In addition, this study points
to 24-hour HRV analysis as a useful screening tool to identify officers who are at increased risk of
developing serious long-term health problems, so that efforts can be made to reverse or prevent
the onset of disease in these individuals. Intensive training in stress management interventions
known to increase HRV and improve autonomic nervous system balance can be of particular
benefit for officers who are at-risk.
While additional research is clearly needed to explore the longer-term effects of the interventions
employed in this study, the results of this initial investigation suggest that in the long-term,
gaining increased levels of emotional self-management could potentially benefit police officers in a
wide range of capacities. These potential benefits include: enhanced work/life balance; a reduction
in the high rate of domestic problems, particularly divorce; improved work climate and
organizational effectiveness; reduced cardiovascular morbidity and improved overall health; and
reduced early retirement for stress-related causes. In addition, providing training in practical self-
management strategies could help alleviate some of the major organizational burdens faced by
police forces. For example, officers with competence in self-management skills are likely to make
better decisions when confronted with challenges in the line of duty, resulting in reduced use of
inappropriate or excessive force, fewer accidents, fewer citizens’ complaints, fewer lawsuits, and
reduced liability costs at the individual agency level.
The continued and accelerated rise of stress and unrest in today’s societies is likely to mean an
increasing workload for police in the future. The need for officers to maintain internal balance
through these unbalanced times will likely generate an increased emphasis on training in stress
and self-management for those employed in law enforcement. The integration in police training of
programs providing officers with practical and effective self-management techniques has
Copyright © 1999 Institute of HeartMath
19
enormous potential to result in more comprehensive training for officers in skills enabling them to
perform their jobs with greater effectiveness and ultimately provide better protection to the
citizens whom they serve.
Copyright © 1999 Institute of HeartMath
20
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Technical Report
Military personnel, police officers, firefighters, and other first responders must prepare for and respond to life-threatening crises on a daily basis. This lifestyle places stress on personnel, and particularly so on military personnel who may be isolated from support systems and other resources. The authors conducted a systematic review of studies of interventions designed to prevent, identify, and manage acute occupational stress among military, law enforcement, and first responders. The body of evidence consisted of 38 controlled trials, 35 cohort comparisons, and 42 case studies with no comparison group, reported in 136 publications. Interventions consisted of resilience training, stress inoculation with biofeedback, mindfulness, psychological first aid, front-line mental health centers, two- to seven-day restoration programs, debriefing (including critical incident stress debriefing), third-location decompression, postdeployment mental health screening, reintegration programs, and family-centered programs. Study limitations (risk of bias), directness, consistency, precision, and publication bias were considered in rating the quality of evidence for each outcome area. Overall, interventions had positive effects on return to duty, absenteeism, and distress. However, there was no significant impact on symptoms of psychological disorders such as PTSD, depression, and anxiety. Because of study limitations, inconsistency of results, indirectness, and possible publication bias, there was insufficient evidence to form conclusions about the effects of most specific intervention types, components, settings, or specific populations.
... HeartMath was a program involving 3 training sessions aimed at reducing stress, improving physiological and emotional balance, increasing mental clarity, and enhancing performance and quality of life. McCraty et al. [37] reported improvements in some of these areas including considerable decreases in fatigue and the overall global negative emotion subscale; the latter subscale is the average of the individual scores for the anger, distress, depression, and sadness constructs based on the Personal and Organizational Quality Assessment survey [37]. Sijaric-Voloder et al. [41] also reported on the development and evaluation of a stress management program for police officers involving 4 sessions a week over 4 weeks covering stress and trauma awareness, relaxation training, problem-solving skills, and communication techniques. ...
... HeartMath was a program involving 3 training sessions aimed at reducing stress, improving physiological and emotional balance, increasing mental clarity, and enhancing performance and quality of life. McCraty et al. [37] reported improvements in some of these areas including considerable decreases in fatigue and the overall global negative emotion subscale; the latter subscale is the average of the individual scores for the anger, distress, depression, and sadness constructs based on the Personal and Organizational Quality Assessment survey [37]. Sijaric-Voloder et al. [41] also reported on the development and evaluation of a stress management program for police officers involving 4 sessions a week over 4 weeks covering stress and trauma awareness, relaxation training, problem-solving skills, and communication techniques. ...
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Article
Background: First responders are a high-risk population for occupational stress injuries as they often encounter prolonged stress within their line of work. The aim of this rapid overview of reviews is to summarize existing evidence on interventions for the prevention and management of occupational stress injury (OSI) in first responders. Methods: MEDLINE, EMBASE, PsycINFO, CINAHL, Web of Science, and Cochrane Library were searched for systematic reviews examining the impact of prevention, rehabilitation, and resilience-building strategies targeting frontline community safety personnel in February 2019. Pairs of reviewers screened titles and abstracts followed by full-text articles and conducted data abstraction and quality appraisal using the AMSTAR II tool. To ensure a rapid overview process, the search strategy was limited to the last 10 years, quality appraisal of reviews and abstraction of study-level data was completed by one person and verified by another, and the quality of the individual primary studies was not appraised. The findings were summarized descriptively. Results: A total of 14 reviews with 47 unique primary studies were found after screening 1393 records. A majority of studies targeted OSI in police officers (78.7%), followed by firefighters (17%) and correctional officers (4.3%). Of the 47 included primary studies, 24 targeted prevention of OSI (i.e., resilience training, stress management, suicide prevention, and other health promotions) and 23 targeted rehabilitation (i.e., drug therapy, psychotherapy, and other therapies). Prevention strategies including resilience training programs had positive outcomes, while suicide prevention and psychotherapy interventions reported mixed results. Conclusions: Some promising interventions targeting the prevention and rehabilitation of OSI among police officers, firefighters, and correctional officers were identified in the included studies, and these results will serve as a basis for the development of evidence-based strategies to mitigate future risks in this population. However, several gaps were also identified in this area that will require further investigation prior to widespread implementation of effective interventions. Systematic review registration: PROSPERO CRD42019125945.
... As pointed out, the development of social performance is associated with emotional responding and coherent heart. Whereas, the heart coherence (the balanced level of HRV) leads into the decrease of psychological distresses, and decrease of problematic behaviors and concerns, and improves academic achievements and social performance among students (McCraty, 1999;Childre & Rozman, 2003;Cornes & Frank, 1994;Ross, 2011). ...
... The results from various studies indicate that the heart coherence decreases psychological distress, problematic behaviors, improves performance and academic achievements, and personal behaviors among students (Ross, 2011;Childre & Rozman, 2003;McCraty, 1999). One of the best ways that may help Muslim individuals to improve their heart coherence is Zikr and remembrance of Allah. ...
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Article
A good level of heart coherence is important for individuals to overcome the emotional and psychological stresses and conduct proper communication with one another. Zikr or remembrance of Allah, as the main pleasing performance to Allah, has direct effects on the emotional and psychological situation of Muslims. The levels of heart coherence and the effects of any intervention on the rhythmic actions and reactions of human heart are measurable through the use of heart rate variability (HRV)-biofeedback technology and HRV techniques. Thus, this study was conducted through the application of a mixed method research design, which included the use of HRV-biofeedback technology and some interviews, to assess the probable relationship between Ziki, heart coherence and intrapersonal communication of Muslim university students from different nationalities. This study had 20 participants from 10 different countries. From all participants, six of them were interviewed to support the HRV data through their direct views. The results from this study confirmed the existence of a close relationship between Zikr and the levels of heart coherence among the participants. Based on the results, Zikr performance had significant positive effects on the increase of heart coherence among the participants, and heart coherence is among the main factors that affect the process of intrapersonal communication within the human body. The results from this study may encourage individuals to perform Zikr performance as an effective treatment for their emotional and psychological disorders.
... As pointed out, the development of social performance is associated with emotional responding and coherent heart. Whereas, the heart coherence (the balanced level of HRV) leads into the decrease of psychological distresses, and decrease of problematic behaviors and concerns, and improves academic achievements and social performance among students (McCraty, 1999;Childre & Rozman, 2003;Cornes & Frank, 1994;Ross, 2011). ...
... The results from various studies indicate that the heart coherence decreases psychological distress, problematic behaviors, improves performance and academic achievements, and personal behaviors among students (Ross, 2011;Childre & Rozman, 2003;McCraty, 1999). One of the best ways that may help Muslim individuals to improve their heart coherence is Zikr and remembrance of Allah. ...
Full-text available
Article
A good level of heart coherence is important for individuals to overcome the emotional and psychological stresses and conduct proper communication with one another. Zikr or remembrance of Allah, as the main pleasing performance to Allah, has direct effects on the emotional and psychological situation of Muslims. The levels of heart coherence and the effects of any intervention on the rhythmic actions and reactions of human heart are measurable through the use of heart rate variability (HRV)-biofeedback technology and HRV techniques. Thus, this study was conducted through the application of a mixed method research design, which included the use of HRV-biofeedback technology and some interviews, to assess the probable relationship between Ziki, heart coherence and intrapersonal communication of Muslim university students from different nationalities. This study had 20 participants from 10 different countries. From all participants, six of them were interviewed to support the HRV data through their direct views. The results from this study confirmed the existence of a close relationship between Zikr and the levels of heart coherence among the participants. Based on the results, Zikr performance had significant positive effects on the increase of heart coherence among the participants, and heart coherence is among the main factors that affect the process of intrapersonal communication within the human body. The results from this study may encourage individuals to perform Zikr performance as an effective treatment for their emotional and psychological disorders.
... One study described the development and testing of a unique HeartMath stress and emotional self-management technique (McCraty & Tomasino, 1999). One study investigated an intervention as a treatment for police officers diagnosed with PTSD (Gersons, Carlier, Lamberts, & van der Kolk, 2000), and was the only study which required that study participants experience stress prior to or as a condition to participating in the study. ...
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Article
The objectives of this systematic review were to identify, retrieve, evaluate and synthesize the available evidence regarding outcomes of stress management interventions provided to veteran police officers and recruits. Included studies required a population consisting of veteran police officers, police recruits, and/or civilian (non‐sworn) police personnel; a randomized controlled trial (RCT), random assignment to conditions, or quasi‐experimental designs that included a control group; a psychosocial or other type of stress management intervention; quantitative outcomes although studies that utilized qualitative methods (focus groups, interviews) were included as long as these studies focus on the interventions examined in the RCT studies; and published and non‐published studies conducted in any geographic location. The results of the present review indicate that stress management interventions had no significant effect on psychological, behavioral or physiological outcomes. Whereas stress can contribute to negative psychological, behavioral and physiological outcomes the 12 primary studies examined psychological stress outcomes. Only three studies examined behavioral outcomes, and two examined physiological outcomes. Near null effects were found for psychological, behavioral, and physiological outcomes. Moderator analyses, although difficult and exploratory with so few studies, also failed to find any meaningful differences across the studies. These results do not provide evidence to support the efficacy of stress management interventions for police officers or recruits. Given the weakness of the research designs, we can neither claim that these programs are effective or ineffective. More rigorous studies are needed that evaluate the efficacy of stress management interventions among police officers and recruits. Abstract BACKGROUND Law enforcement organizations began to take notice of officer stress during the late 1970s. Stress has been found to not only affect the officers' job performance, but their personal lives and relationships as well. Because police officers are first responders to potentially stressful situations, their ability to successfully manage stress is critical not only to their own mental health but to the safety of society as a whole. Research has found that police officers who have difficulties coping with stress exhibit maladaptive behavior and personality traits such as aloofness, authoritarianism, cynicism, depersonalization, emotional detachment, suspiciousness, and excessive use of alcohol. High levels of stress can lead to serious physiological (headaches, stomachaches, backaches, ulcers, heart attacks) and psychological (anxiety, depression, flashbacks, and panic attacks) symptoms. Stress among police officers has also been connected to police misconduct and can also have a negative effect on the law enforcement organization due to lawsuits resulting from officers' performance. Other organizational effects include impaired officer performance, lower productivity, poor morale, poor public relations, labor‐management problems, tardiness and missed work, and officer turnover. Law enforcement organizations provide a wide variety of stress management interventions aimed at ameliorating officer stress. OBJECTIVES The objectives of this systematic review were to identify, retrieve, evaluate and synthesize the available evidence regarding outcomes of stress management interventions provided to veteran police officers and recruits. The review question is: What are the effects of officer stress management interventions on stress outcomes? SEARCH STRATEGY A variety of search methods were used to identify studies. These methods included: (1) searching electronic databases; (2) handsearching relevant journals, books, and conference proceedings; (3) searching Internet websites; (4) visually scanning reference lists from relevant studies; (5) contacting organizations and authors who have knowledge of police stress management and development program evaluations; and (6) citation searching. SELECTION CRITERIA The criteria for inclusion of retrieved studies focused on population characteristics and sampling strategies, interventions, study methods and designs, data analysis and outcome results. Included studies required a population consisting of veteran police officers, police recruits, and/or civilian (non‐sworn) police personnel; a randomized controlled trial (RCT), random assignment to conditions, or quasi‐experimental designs that included a control group; a psychosocial or other type of stress management intervention; quantitative outcomes although studies that utilized qualitative methods (focus groups, interviews) were included as long as these studies focus on the interventions examined in the RCT studies; and published and non‐published studies conducted in any geographic location. DATA COLLECTION AND ANALYSIS The meta‐analysis was performed using the computer software program Comprehensive Meta‐Analysis Version 2.2.050 (Borenstein et al. 2009a). For studies reporting multiple outcomes and time points these were not treated as independent. Effect sizes were separated out by outcome type (psychological, behavioral and physiological) and analyzed separately for different outcomes types. Among studies that contained multiple outcomes, the outcomes were averaged. Effect sizes were not averaged across different outcome types. Most often effect sizes were calculated using reported means, standard deviations and sample sizes, although some effect sizes were calculated using reported Cohen's d and t‐test results. RESULTS The results of the present review indicate that stress management interventions had no significant effect on psychological, behavioral or physiological outcomes. Whereas stress can contribute to negative psychological, behavioral and physiological outcomes the 12 primary studies examined psychological stress outcomes. Only three studies examined behavioral outcomes, and two examined physiological outcomes. Near null effects were found for psychological, behavioral, and physiological outcomes. Moderator analyses, although difficult and exploratory with so few studies, also failed to find any meaningful differences across the studies. These results do not provide evidence to support the efficacy of stress management interventions for police officers or recruits. Given the weakness of the research designs, we can neither claim that these programs are effective or ineffective. CONCLUSIONS More rigorous studies are needed that evaluate the efficacy of stress management interventions among police officers and recruits. Several recommendations are proposed for future research. First, police organizations should conduct evaluation research of their current stress management interventions that includes random assignment. Second, stress management interventions for police officers and recruits should focus on specific types of stress (i.e., organizational or personal). The type of stress that is the focus of the intervention should be described in studies. Finally, more qualitative data are needed to contextualize participants' experiences with the intervention.
... The study Impact of the HeartMath self-management skills program physiological and psychological stress in police officers (McCraty & Tomasino, 1999) used volunteer participants who were first recruited to volunteer in the program, then randomly assigned to an experimental and a control group. Subjective and objective data were collected at three time points in the experimental group and two time points in the control group. ...
... Among other findings through the biofeedback technology under the HeartMath Institute suggestions is the full ability of human beings on tuning into their hearts to initiate the state of psychophysiological coherence (Ross, 2011). Furthermore, the heart coherence (the balanced level of HRV) leads into the decrease of psychological distresses, problematic behaviors and concerns, and improves classroom behaviors, academic achievements and social performance among students (McCraty, 1999;Childre & Rozman, 2003;Ross, 2011). ...
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Thesis
Previous studies on interpersonal communication competence and intercultural communication competence were mostly conducted in the western parts of the world. The findings from such work were reported based on the answers of individuals on survey questionnaires. It is arguable that whether the results from studies in the western parts of the world answer the probable questions for the Asian context of communication, and whether the results from the regular surveys are relevant enough. Thus, this study was carried out to assess the relationship between interpersonal communication competence (IPCC), intercultural communication competence (ICCC), and heart rate variability (HRV) among international postgraduate students of a Malaysian public University. An embedded design of mixed methods which included quantitative, interview and HRV data sets was applied to conduct this study. The participants of this study were 128 postgraduate students from 17 different countries. The results from this study have confirmed the existence of relationships between IPCC, ICCC and HRV attributes of the participants. The results have also confirmed that the participants who were good in HRV were also good in IPCC and ICCC, and vice versa. The mean scores of individuals with good HRV scores and relatively low HRV scores, for IPCC and ICCC were 171.7 and 164.9 respectively. Based on the results, the participants with higher mean scores in IPCC had desirable scores in HRV as well. The participants with higher scores in IPCC with scores of 22.6 in the first relaxation session and 17.6 in the mental arithmetic test, while the participants with relatively low scores in IPCC got 7.5 and 12.1 for the mentioned sessions of HRV, respectively. The findings from this study confirmed the relationship between interpersonal communication competence and HRV of the participants. However, the mean score of the participants for IPCC (99.46) was higher than their mean score for ICCC (67.57). It means that in some cases individuals might be good in interpersonal communication because of their contacts with their own people, but they are still not good in intercultural communication because of the lack of their interactions with other international postgraduate students. Based on the results, it was found that their personal abilities, positive attitudes towards cultural differences, their good levels of English language proficiency, and the available environmental opportunities helped most of the participants to have more successful interactions.
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Article
Salivary IgA, heart rate and mood were measured in thirty individuals before and after experiencing care or anger. Two methods of inducing the emotional states were compared: self-induction and external induction via video tapes. Anger produced a significant increase in total mood disturbance and heart rate, but not in S-IgA levels. Positive emotions, on the other hand, produced a significant increase in S-IgA levels. Examining the effects over a six hour period we observed that anger, in contrast to care, produced a significant inhibition of S-IgA from one to five hours after the emotional experience. Results indicate that self-induction of positive emotional states is more effective at stimulating S-IgA levels than previously used external methods. Self-induction techniques may therefore be useful in minimizing the immunosuppressive effects of negative emotions.
Book
A critical assessment of available evidence on police stress featuring a detailed discussion of stress experiences of women, homosexual and ethnic minority officers. Examines the role of routine stressors and highlights stress problems associated with major trauma incidents. Documents treatment for post traumatic stress disorder and pinpoints risk factors. Includes a review of the latest research in Britain, North America and Australia.
Article
This investigation examined psychological burnout among 833 men and women in teaching using a framework developed by Cherniss (1980). Work setting characteristics in concert with person variables (both individual differences and extra-work factors) were hypothesized to result in experienced stress. Some individuals cope with these sources of stress by developing the negative attitude change termed psychological burnout. Respondents provided data by completing questionnaires anonymously. The data provide strong preliminary support for the model and produced findings consistent with previous research. Suggestions for organizational intervention are offered.