Mindfulness-based resilience training for aggression, stress and health in law enforcement officers: study protocol for a multisite, randomized, single-blind clinical feasibility trial

Michael Christopher, Sarah Bowen, Katie Witkiewitz, Michael Christopher, Sarah Bowen, Katie Witkiewitz

Abstract

Background: Law enforcement officers (LEOs) are exposed to significant stressors, elevating their risk for aggression and excessive use of force, as well as mental health consequences, including post-traumatic stress disorder, burnout, alcohol misuse, depression, and suicide. Mindfulness training is a promising approach with high-stress populations that has been shown effective for increasing resilience and improving negative mental health outcomes common among LEOs.

Method: Implemented at two sites, the proposed study is designed to establish optimal protocols and procedures for a future full-scale, multisite trial assessing effects of mindfulness-based resilience training versus an attention control (stress management education) and a no-intervention control on physiological, behavioral, and psychological outcomes. To prepare for this future clinical trial, the current study is designed to: enhance efficiency of recruitment, engagement, and retention; optimize laboratory, assessment, and data management procedures; optimize intervention training and ensure fidelity to intervention protocols; and assess participant experience and optimize outcome measures across two sites. Herein, we describe the protocol and methodology of this multisite, randomized, single-blind clinical feasibility trial.

Discussion: The long-term objective of this line of research is to develop an intervention that will reduce violence and increase resilience and mental health among LEOs, as well as yield significant benefits for the communities and residents they serve.

Trial registration: ClinicalTrials.gov, NCT03784846. Registered on 24 December 2018.

Keywords: Aggression; Law enforcement; Mindfulness; Resilience; Stress.

Conflict of interest statement

MC, SB, and KW received funding from the National Center for Complementary & Integrative Health of the National Institutes of Health to conduct the study.

Figures

Fig. 1
Fig. 1
Schedule of enrollment, interventions, and assessments. *Baseline assessment only. MBRT mindfulness-based resilience training, mo months, NIC no-intervention control, SME stress management education

References

    1. Violanti JM, Andrew ME, Mnatsakanova A, Hartley TA, Fekedulegn D, Burchfiel CM. Correlates of hopelessness in the high suicide risk police occupation. Police Pract Res. 2016;17(5):408–419. doi: 10.1080/15614263.2015.1015125.
    1. Violanti JM, Fekedulegn D, Andrew ME, Charles LE, Hartley TA, Burchfiel CM. Adiposity in policing: mental health consequences. Int J Emerg Mental Health. 2011;13(4):257–266.
    1. Kop N, Euwema M, Schaufeli W. Burnout, job stress and violent behaviour among Dutch police officers. Work Stress. 1999;13(4):326–340. doi: 10.1080/02678379950019789.
    1. Kurtz DL, Zavala E, Melander LA. The influence of early strain on later strain, stress responses, and aggression by police officers. Crim Justice Rev. 2015;40(2):190–208. doi: 10.1177/0734016814564696.
    1. Wang Z, Inslicht SS, Metzler TJ, Henn-Haase C, McCaslin SE, Tong H, Neylan TC, Marmar CR. A prospective study of predictors of depression symptoms in police. Psychiatry Res. 2010;175(3):211–216. doi: 10.1016/j.psychres.2008.11.010.
    1. Faust KL, Ven TV. Policing disaster: an analytical review of the literature on policing, disaster, and post-traumatic stress disorder. Sociol Compass. 2014;8(6):614–626. doi: 10.1111/soc4.12160.
    1. McCarty WP, Skogan WG. Job-related burnout among civilian and sworn police personnel. Police Q. 2013;16(1):66–84. doi: 10.1177/1098611112457357.
    1. Yun I, Lee C-H. Hazardous alcohol use among South Korean police officers: examining predictions from general strain theory. Int J Law Crime Justice. 2015;43(2):194–213. doi: 10.1016/j.ijlcj.2014.08.002.
    1. Bibbey A, Carroll D, Roseboom TJ, Phillips AC, de Rooij SR. Personality and physiological reactions to acute psychological stress. Int J Psychophysiol. 2013;90(1):28–36. doi: 10.1016/j.ijpsycho.2012.10.018.
    1. Nater UM, Skoluda N, Strahler J. Biomarkers of stress in behavioural medicine. Curr Opin Psychiatry. 2013;26(5):440–445. doi: 10.1097/YCO.0b013e328363b4ed.
    1. Violanti JM, Fekedulegn D, Andrew ME, Hartley TA, Charles LE, Miller DB, Burchfiel CM. The impact of perceived intensity and frequency of police work occupational stressors on the cortisol awakening response (CAR): findings from the BCOPS study. Psychoneuroendocrinology. 2017;75:124–131. doi: 10.1016/j.psyneuen.2016.10.017.
    1. Galatzer-Levy IR, Steenkamp MM, Brown AD, Qian M, Inslicht S, Henn-Haase C, Otte C, Yehuda R, Neylan TC, Marma CR. Cortisol response to an experimental stress paradigm prospectively predicts long-term distress trajectories in response to active police service. J Psychiatr Res. 2014;56:36–42. doi: 10.1016/j.jpsychires.2014.04.020.
    1. Groer M, Murphy R, Bunnell W, Salomon K, Van Eepoel J, Rankin B, White K, Bykowski C. Salivary measures of stress and immunity in police officers engaged in simulated critical incident scenarios. J Occup Environ Med. 2010;52(6):595–602. doi: 10.1097/JOM.0b013e3181e129da.
    1. Andersen JP, Dorai M, Papazoglou K, Arnetz BB. Diurnal and reactivity measures of cortisol in response to intensive resilience and tactical training among Special Forces Police. J Occup Environ Med. 2016;58(7):e242–e248. doi: 10.1097/JOM.0000000000000756.
    1. Patterson GT, Chung IW, Swan PW. Stress management interventions for police officers and recruits: a meta-analysis. J Exp Criminol. 2014;10(4):487–513. doi: 10.1007/s11292-014-9214-7.
    1. Wongtongkam N, Day A, Ward PR, Winefield AH. The influence of mindfulness meditation on angry emotions and violent behavior on Thai technical college students. Eur J Integr Med. 2015;7(2):124–130. doi: 10.1016/j.eujim.2014.10.007.
    1. Wongtongkam N, Ward PR, Day A, Winefield AH. A trial of mindfulness meditation to reduce anger and violence in Thai youth. Int J Ment Heal Addict. 2014;12(2):169–180. doi: 10.1007/s11469-013-9463-0.
    1. Fix RL, Fix ST. The effects of mindfulness-based treatments for aggression: a critical review. Aggress Violent Behav. 2013;18(2):219–227. doi: 10.1016/j.avb.2012.11.009.
    1. Gao J, Fan J, Wu BWY, Zhang Z, Chang C, Hung Y-S, Fung PCW, Sik H. Entrainment of chaotic activities in brain and heart during MBSR mindfulness training. Neurosci Lett. 2016;616:218–223. doi: 10.1016/j.neulet.2016.01.001.
    1. Hughes JW, Fresco DM, Myerscough R, van Dulmen MH, Carlson LE, Josephson R. Randomized controlled trial of mindfulness-based stress reduction for prehypertension. Psychosom Med. 2013;75(8):721–728. doi: 10.1097/PSY.0b013e3182a3e4e5.
    1. Nyklíček I, Mommersteeg PMC, Van Beugen S, Ramakers C, Van Boxtel GJ. Mindfulness-based stress reduction and physiological activity during acute stress: a randomized controlled trial. Health Psychol. 2013;32(10):1110–1113. doi: 10.1037/a0032200.
    1. Matousek RH, Pruessner JC, Dobkin PL. Changes in the cortisol awakening response (CAR) following participation in mindfulness-based stress reduction in women who completed treatment for breast cancer. Complement Ther Clin Pract. 2011;17(2):65–70. doi: 10.1016/j.ctcp.2010.10.005.
    1. Duchemin A-M, Steinberg BA, Marks DR, Vanover K, Klatt M. A small randomized pilot study of a workplace mindfulness-based intervention for surgical intensive care unit personnel: effects on salivary α-amylase levels. J Occup Environ Med. 2015;57(4):393–399. doi: 10.1097/JOM.0000000000000371.
    1. Creswell JD, Lindsay EK. How does mindfulness training affect health? A mindfulness stress buffering account. Curr Dir Psychol Sci. 2014;23(6):401–407. doi: 10.1177/0963721414547415.
    1. Khoury B, Sharma M, Rush SE, Fournier C. Mindfulness-based stress reduction for healthy individuals: a meta-analysis. J Psychosom Res. 2015;78(6):519–528. doi: 10.1016/j.jpsychores.2015.03.009.
    1. Khoury B, Lecomte T, Fortin G, Masse M, Therien P, Bouchard V, Chapleau MA, Paquin K, Hofmann SG. Mindfulness-based therapy: a comprehensive meta-analysis. Clin Psychol Rev. 2013;33(6):763–771. doi: 10.1016/j.cpr.2013.05.005.
    1. Goldberg SB, Tucker RP, Greene PA, Davidson RJ, Wampold BE, Kearney DJ, Simpson TL. Mindfulness-based interventions for psychiatric disorders: a systematic review and meta-analysis. Clin Psychol Rev. 2018;59:52–60. doi: 10.1016/j.cpr.2017.10.011.
    1. Chi X, Bo A, Liu T, Zhang P, Chi I. Effects of mindfulness-based stress reduction on depression in adolescents and young adults: a systematic review and meta-analysis. Front Psychol. 2018;9:1034. doi: 10.3389/fpsyg.2018.01034.
    1. Goyal M, Singh S, Sibinga ES, et al. Meditation programs for psychological stress and well-being: a systematic review and meta-analysis. JAMA Intern Med. 2014;174(3):357–368. doi: 10.1001/jamainternmed.2013.13018.
    1. Chiesa A, Serretti A. Are mindfulness-based interventions effective for substance use disorders? A systematic review of the evidence. Substance Use Misuse. 2014;49(5):492–512. doi: 10.3109/10826084.2013.770027.
    1. Polusny MA, Erbes CR, Thuras P, et al. Mindfulness-based stress reduction for posttraumatic stress disorder among veterans: a randomized clinical trial. JAMA. 2015;314(5):456–465. doi: 10.1001/jama.2015.8361.
    1. Luken M, Sammons A. Systematic review of mindfulness practice for reducing job burnout. Am J Occup Ther. 2016;70(2):7002250020p1–7002250020p10. doi: 10.5014/ajot.2016.016956.
    1. Regehr C, Glancy D, Pitts A, LeBlanc VR. Interventions to reduce the consequences of stress in physicians: a review and meta-analysis. J Nerv Ment Dis. 2014;202(5):353–359. doi: 10.1097/NMD.0000000000000130.
    1. Zenner C, Herrnleben-Kurz S, Walach H. Mindfulness-based interventions in schools—a systematic review and meta-analysis. Front Psychol. 2014;5:603. doi: 10.3389/fpsyg.2014.00603.
    1. Kallapiran K, Koo S, Kirubakaran R, Hancock K. Review: Effectiveness of mindfulness in improving mental health symptoms of children and adolescents: a meta-analysis. Child Adolesc Mental Health. 2015;20(4):182–194. doi: 10.1111/camh.12113.
    1. Johnson DC, Thom NJ, Stanley EA, Haase L, Simmons AN, Shih PA, Thompson WK, Potterat EG, Minor TR, Paulus MP. Modifying resilience mechanisms in at-risk individuals: a controlled study of mindfulness training in Marines preparing for deployment. Am J Psychiatry. 2014;171(8):844–853. doi: 10.1176/appi.ajp.2014.13040502.
    1. Stanley EA, Schaldach JM, Kiyonaga A, Jha AP. Mindfulness-based mind fitness training: a case study of a high-stress predeployment military cohort. Cogn Behav Pract. 2011;18(4):566–576. doi: 10.1016/j.cbpra.2010.08.002.
    1. Epstein RM, Krasner MS. Physician resilience: what it means, why it matters, and how to promote it. Acad Med. 2013;88(3):301–303. doi: 10.1097/ACM.0b013e318280cff0.
    1. Schroeder David A., Stephens Elizabeth, Colgan Dharmakaya, Hunsinger Matthew, Rubin Dan, Christopher Michael S. A Brief Mindfulness-Based Intervention for Primary Care Physicians: A Pilot Randomized Controlled Trial. American Journal of Lifestyle Medicine. 2016;12(1):83–91. doi: 10.1177/1559827616629121.
    1. Kaplan JB, Bergman AL, Christopher M, Bowen S, Hunsinger M. Role of resilience in mindfulness training for first responders. Mindfulness. 2017;8(5):1373–1380. doi: 10.1007/s12671-017-0713-2.
    1. Leppin AL, Bora PR, Tilburt JC, Gionfriddo MR, Zeballos-Palacios C, Dulohery MM, Sood A, Erwin PJ, Brito JP, Boehmer KR, et al. The efficacy of resiliency training programs: a systematic review and meta-analysis of randomized trials. PLoS One. 2014;9(10):e111420. doi: 10.1371/journal.pone.0111420.
    1. Arnetz BB, Nevedal DC, Lumley MA, Backman L, Lublin A. Trauma resilience training for police: psychophysiological and performance effects. J Police Crim Psychol. 2009;24(1):1–9. doi: 10.1007/s11896-008-9030-y.
    1. Arnetz BB, Arble E, Backman L, Lynch A, Lublin A. Assessment of a prevention program for work-related stress among urban police officers. Int Arch Occup Environ Health. 2013;86(1):79–88. doi: 10.1007/s00420-012-0748-6.
    1. Andersen JP, Papazoglou K, Koskelainen M, Nyman M, Gustafsberg H, Arnetz BB. Applying resilience promotion training among Special Forces Police officers. SAGE Open. 2015;5(2):2158244015590446.
    1. Pals SL, Murray DM, Alfano CM, Shadish WR, Hannan PJ, Baker WL. Individually randomized group treatment trials: a critical appraisal of frequently used design and analytic approaches. Am J Public Health. 2008;98(8):1418–1424. doi: 10.2105/AJPH.2007.127027.
    1. Fjorback LO, Arendt M, Ornbol E, Fink P, Walach H. Mindfulness-based stress reduction and mindfulness-based cognitive therapy: a systematic review of randomized controlled trials. Acta Psychiatr Scand. 2011;124(2):102–119. doi: 10.1111/j.1600-0447.2011.01704.x.
    1. Eberth J, Sedlmeier PJM. The effects of mindfulness meditation: a meta-analysis. 2012;3(3):174–89.
    1. BlueTeam: frontline software for IAPRO []. Accessed 9 July 2018.
    1. Ariel Barak, Farrar William A., Sutherland Alex. The Effect of Police Body-Worn Cameras on Use of Force and Citizens’ Complaints Against the Police: A Randomized Controlled Trial. Journal of Quantitative Criminology. 2014;31(3):509–535. doi: 10.1007/s10940-014-9236-3.
    1. Jetelina KK, Jennings WG, Bishopp SA, Piquero AR, Reingle Gonzalez JM. Dissecting the complexities of the relationship between police officer–civilian race/ethnicity dyads and less-than-lethal use of force. Am J Public Health. 2017;107(7):1164–1170. doi: 10.2105/AJPH.2017.303807.
    1. Jetelina KK, Reingle Gonzalez JM, Bishopp SA. Gradual escalation of use-of-force reduces police officer injury. Inj Prev. 2018;24(1):35–40. doi: 10.1136/injuryprev-2016-042198.
    1. Eldridge SM, Lancaster GA, Campbell MJ, Thabane L, Hopewell S, Coleman CL, Bond CM. Defining feasibility and pilot studies in preparation for randomised controlled trials: development of a conceptual framework. PloS One. 2016;11(3):e0150205. doi: 10.1371/journal.pone.0150205.
    1. Tickle-Degnen L. Nuts and bolts of conducting feasibility studies. Am J Occup Ther. 2013;67(2):171–176. doi: 10.5014/ajot.2013.006270.
    1. Bowen DJ, Kreuter M, Spring B, Cofta-Woerpel L, Linnan L, Weiner D, Bakken S, Kaplan CP, Squiers L, Fabrizio C, et al. How we design feasibility studies. Am J Prev Med. 2009;36(5):452–457. doi: 10.1016/j.amepre.2009.02.002.
    1. Whitehead AL, Julious SA, Cooper CL, Campbell MJ. Estimating the sample size for a pilot randomised trial to minimise the overall trial sample size for the external pilot and main trial for a continuous outcome variable. Stat Methods Med Res. 2016;25(3):1057–1073. doi: 10.1177/0962280215588241.
    1. Eldridge SM, Chan CL, Campbell MJ, Bond CM, Hopewell S, Thabane L, Lancaster GA. CONSORT 2010 statement: extension to randomised pilot and feasibility trials. BMJ. 2016;355:i5239.
    1. Sim J, Lewis M. The size of a pilot study for a clinical trial should be calculated in relation to considerations of precision and efficiency. J Clin Epidemiol. 2012;65(3):301–308. doi: 10.1016/j.jclinepi.2011.07.011.
    1. Julious Steven A. Sample size of 12 per group rule of thumb for a pilot study. Pharmaceutical Statistics. 2005;4(4):287–291. doi: 10.1002/pst.185.
    1. Hertzog MA. Considerations in determining sample size for pilot studies. Res Nurs Health. 2008;31(2):180–191. doi: 10.1002/nur.20247.
    1. Billingham SA, Whitehead AL, Julious SA. An audit of sample sizes for pilot and feasibility trials being undertaken in the United Kingdom registered in the United Kingdom Clinical Research Network database. BMC Med Res Methodol. 2013;13:104. doi: 10.1186/1471-2288-13-104.
    1. Rush AJ, Trivedi MH, Carmody TJ, Ibrahim HM, Markowitz JC, Keitner GI, Kornstein SG, Arnow B, Klein DN, Manber R, et al. Self-reported depressive symptom measures: sensitivity to detecting change in a randomized, controlled trial of chronically depressed, nonpsychotic outpatients. Neuropsychopharmacology. 2005;30(2):405–416. doi: 10.1038/sj.npp.1300614.
    1. Hays R, Anderson R, Revicki D. Psychometric considerations in evaluating health-related quality of life measures. Qual Life Res. 1993;2(6):441–449. doi: 10.1007/BF00422218.
    1. Fayers PM, Machin D. Quality of life: the assessment, analysis and reporting of patient-reported outcomes: Hoboken: Wiley; 2015.
    1. Schwabe L, Haddad L, Schachinger H. HPA axis activation by a socially evaluated cold-pressor test. Psychoneuroendocrinology. 2008;33(6):890–895. doi: 10.1016/j.psyneuen.2008.03.001.
    1. Schwabe L, Schachinger H. Ten years of research with the socially evaluated cold pressor test: data from the past and guidelines for the future. Psychoneuroendocrinology. 2018;92:155–161. doi: 10.1016/j.psyneuen.2018.03.010.
    1. Becker L, Rohleder N. Time course of the physiological stress response to an acute stressor and its associations with the primacy and recency effect of the serial position curve. PLoS One. 2019;14(5):e0213883. doi: 10.1371/journal.pone.0213883.
    1. Boyle NB, Lawton C, Arkbage K, West SG, Thorell L, Hofman D, Weeks A, Myrissa K, Croden F, Dye L. Stress responses to repeated exposure to a combined physical and social evaluative laboratory stressor in young healthy males. Psychoneuroendocrinology. 2016;63:119–127. doi: 10.1016/j.psyneuen.2015.09.025.
    1. von Dawans B, Trueg A, Kirschbaum C, Fischbacher U, Heinrichs M. Acute social and physical stress interact to influence social behavior: the role of social anxiety. PLoS One. 2018;13(10):e0204665. doi: 10.1371/journal.pone.0204665.
    1. Lesage FX, Berjot S, Deschamps F. Clinical stress assessment using a visual analogue scale. Occup Med (Oxford, England) 2012;62(8):600–605. doi: 10.1093/occmed/kqs140.
    1. Gaab J, Rohleder N, Nater UM, Ehlert U. Psychological determinants of the cortisol stress response: the role of anticipatory cognitive appraisal. Psychoneuroendocrinology. 2005;30(6):599–610. doi: 10.1016/j.psyneuen.2005.02.001.
    1. Bernstein DP, Stein JA, Newcomb MD, Walker E, Pogge D, Ahluvalia T, Stokes J, Handelsman L, Medrano M, Desmond D, et al. Development and validation of a brief screening version of the Childhood Trauma Questionnaire. Child Abuse Negl. 2003;27(2):169–190. doi: 10.1016/S0145-2134(02)00541-0.
    1. Devilly GJ, Borkovec TD. Psychometric properties of the credibility/expectancy questionnaire. J Behav Ther Exp Psychiatry. 2000;31(2):73–86. doi: 10.1016/S0005-7916(00)00012-4.
    1. Smith BW, Dalen J, Wiggins K, Tooley E, Christopher P, Bernard J. The Brief Resilience Scale: assessing the ability to bounce back. Int J Behav Med. 2008;15(3):194–200. doi: 10.1080/10705500802222972.
    1. Pilkonis PA, Yu L, Colditz J, Dodds N, Johnston KL, Maihoefer C, Stover AM, Daley DC, McCarty D. Item banks for alcohol use from the Patient-Reported Outcomes Measurement Information System (PROMIS): use, consequences, and expectancies. Drug Alcohol Depend. 2013;130(1–3):167–177. doi: 10.1016/j.drugalcdep.2012.11.002.
    1. Pilkonis PA, Choi SW, Reise SP, Stover AM, Riley WT, Cella D, PROMIS Cooperative Group Item banks for measuring emotional distress from the Patient-Reported Outcomes Measurement Information System (PROMIS®): depression, anxiety, and anger. Assessment. 2011;18(3):263–283. doi: 10.1177/1073191111411667.
    1. Yu L, Buysse DJ, Germain A, Moul DE, Stover A, Dodds NE, Johnston KL, Pilkonis PA. Development of short forms from the PROMIS™ sleep disturbance and sleep-related impairment item banks. Behav Sleep Med. 2011;10(1):6–24. doi: 10.1080/15402002.2012.636266.
    1. Trivedi MH, Wisniewski SR, Morris DW, Fava M, Gollan JK, Warden D, Nierenberg AA, Gaynes BN, Husain MM, Luther JF. Concise Health Risk Tracking scale: a brief self-report and clinician rating of suicidal risk. J Clin Psychiatry. 2011;72(6):757–764. doi: 10.4088/JCP.11m06837.
    1. Blevins CA, Weathers FW, Davis MT, Witte TK, Domino JL. The Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5): development and initial psychometric evaluation. J Trauma Stress. 2015;28(6):489–498. doi: 10.1002/jts.22059.
    1. Demerouti E, Mostert K, Bakker AB. Burnout and work engagement: a thorough investigation of the independency of both constructs. J Occup Health Psychol. 2010;15(3):209–222. doi: 10.1037/a0019408.
    1. Diamond PM, Magaletta PR. The short-form Buss–Perry Aggression Questionnaire (BPAQ-SF): a validation study with federal offenders. Assessment. 2006;13(3):227–240. doi: 10.1177/1073191106287666.
    1. Bohlmeijer E, ten Klooster PM, Fledderus M, Veehof M, Baer R. Psychometric properties of the Five Facet Mindfulness Questionnaire in depressed adults and development of a short form. Assessment. 2011;18(3):308–320. doi: 10.1177/1073191111408231.
    1. Raes F, Pommier E, Neff KD, Van Gucht D. Construction and factorial validation of a short form of the Self-Compassion Scale. Clin Psychol Psychother. 2011;18(3):250–255. doi: 10.1002/cpp.702.
    1. Mehling WE, Acree M, Stewart A, Silas J, Jones A. The Multidimensional Assessment of Interoceptive Awareness, version 2 (MAIA-2) PLoS One. 2018;13(12):e0208034. doi: 10.1371/journal.pone.0208034.
    1. Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983;24(4):385–396. doi: 10.2307/2136404.
    1. Fischer D, Stewart AL, Bloch DA, Lorig K, Laurent D, Holman H. Capturing the patient's view of change as a clinical outcome measure. Jama. 1999;282(12):1157–1162. doi: 10.1001/jama.282.12.1157.
    1. Bowen S, Chawla N, Marlatt GA. Mindfulness-based relapse prevention for addictive behaviors: a clinician's guide. NY: Guilford Press; 2010.
    1. Bowen S, Witkiewitz K, Clifasefi SL, Grow J, Chawla N, Hsu SH, Carroll HA, Harrop E, Collins SE, Lustyk MK, et al. Relative efficacy of mindfulness-based relapse prevention, standard relapse prevention, and treatment as usual for substance use disorders: a randomized clinical trial. JAMA Psychiatry. 2014;71(5):547–556. doi: 10.1001/jamapsychiatry.2013.4546.
    1. Wahbeh H, Zwickey H, Oken B. One method for objective adherence measurement in mind-body medicine. J Altern Complement Med. 2011;17(2):175–177. doi: 10.1089/acm.2010.0316.
    1. Robertson IH, Manly T, Andrade J, Baddeley BT, Yiend J. `Oops!': performance correlates of everyday attentional failures in traumatic brain injured and normal subjects. Neuropsychologia. 1997;35(6):747–758. doi: 10.1016/S0028-3932(97)00015-8.
    1. Caretaker Medical: Wireless Vital Sign Monitoring. []. Accessed 4 Jan 2019.
    1. Hoge EA, Bui E, Marques L, Metcalf CA, Morris LK, Robinaugh DJ, Worthington JJ, Pollack MH, Simon NM. Randomized controlled trial of mindfulness meditation for generalized anxiety disorder: effects on anxiety and stress reactivity. J Clin Psychiatry. 2013;74(8):786–792. doi: 10.4088/JCP.12m08083.
    1. Deyo RA, Diehr P, Patrick DL. Reproducibility and responsiveness of health status measures statistics and strategies for evaluation. Control Clin Trials. 1991;12(4):S142–S158. doi: 10.1016/S0197-2456(05)80019-4.
    1. Hevey D, McGee HM. The effect size statistic: useful in health outcomes research ? J Health Psychol. 1998;3(2):163–170. doi: 10.1177/135910539800300201.
    1. Stratford PW, Riddle DL. Assessing sensitivity to change: choosing the appropriate change coefficient. Health Qual Life Outcomes. 2005;3:23. doi: 10.1186/1477-7525-3-23.
    1. Lowe B, Kroenke K, Herzog W, Grafe K. Measuring depression outcome with a brief self-report instrument: sensitivity to change of the Patient Health Questionnaire (PHQ-9) J Affect Disord. 2004;81(1):61–66. doi: 10.1016/S0165-0327(03)00198-8.
    1. Oken BS, Chamine I, Wakeland W. A systems approach to stress, stressors and resilience in humans. Behav Brain Res. 2015;282:144–154. doi: 10.1016/j.bbr.2014.12.047.
    1. Szivak TK, Kraemer WJ. Physiological readiness and resilience: pillars of military preparedness. J Strength Cond Res. 2015;29(Suppl 11):S34–S39. doi: 10.1519/JSC.0000000000001073.
    1. Ali N, Pruessner JC. The salivary alpha amylase over cortisol ratio as a marker to assess dysregulations of the stress systems. Physiol Behav. 2012;106(1):65–72. doi: 10.1016/j.physbeh.2011.10.003.
    1. Middel B, van Sonderen E. Statistical significant change versus relevant or important change in (quasi) experimental design: some conceptual and methodological problems in estimating magnitude of intervention-related change in health services research. Int J Integr Care. 2002;2:e15. doi: 10.5334/ijic.65.
    1. Sivan M. Interpreting effect size to estimate responsiveness of outcome measures. Stroke. 2009;40(12):e709. doi: 10.1161/STROKEAHA.109.566836.
    1. Fok CC, Henry D. Increasing the sensitivity of measures to change. Prev Sci. 2015;16(7):978–986. doi: 10.1007/s11121-015-0545-z.
    1. Lee AC, Driban JB, Price LL, Harvey WF, Rodday AM, Wang C. Responsiveness and minimally important differences for four Patient-Reported Outcomes Measurement Information System (PROMIS) short forms: physical function, pain interference, depression, and anxiety in knee osteoarthritis. J Pain. 2017.
    1. Revicki DA, Cella D, Hays RD, Sloan JA, Lenderking WR, Aaronson NK. Responsiveness and minimal important differences for patient reported outcomes. Health Qual Life Outcomes. 2006;4:70. doi: 10.1186/1477-7525-4-70.
    1. O’Cathain A, Hoddinott P, Lewin S, Thomas KJ, Young B, Adamson J, Jansen YJ, Mills N, Moore G, Donovan JL. Maximising the impact of qualitative research in feasibility studies for randomised controlled trials: guidance for researchers. Pilot Feasibility Stud. 2015;1(1):32.
    1. Krueger RA, Casey MA. Focus groups: a practical guide for applied research, 4th ed. Thousand Oaks: Sage; 2009.
    1. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101. doi: 10.1191/1478088706qp063oa.
    1. Braun Virginia, Clarke Victoria. What can “thematic analysis” offer health and wellbeing researchers? International Journal of Qualitative Studies on Health and Well-being. 2014;9(1):26152. doi: 10.3402/qhw.v9.26152.
    1. Taylor JA, Hall DA, Walker D-M, McMurran M, Casey A, Stockdale D, Featherstone D, Thompson DM, MacDonald C, Hoare DJJP, et al. A psychologically informed, audiologist-delivered, manualised intervention for tinnitus: protocol for a randomised controlled feasibility trial (Tin Man study). 2017;3(1):24.
    1. Donovan J, Mills N, Smith M, Brindle L, Jacoby A, Peters T, Frankel S, Neal D, Hamdy F. Quality improvement report: Improving design and conduct of randomised trials by embedding them in qualitative research: ProtecT (prostate testing for cancer and treatment) study. Commentary: presenting unbiased information to patients can be difficult. BMJ. 2002;325(7367):766–770. doi: 10.1136/bmj.325.7367.766.
    1. Guyatt GH, Osoba D, Wu AW, Wyrwich KW, Norman GR. Methods to explain the clinical significance of health status measures. Mayo Clin Proc. 2002;77(4):371–383. doi: 10.4065/77.4.371.
    1. Williams JM. The New York Times. vol. NY: CLXV; 2016. Shootings further divide a nation torn over race.
    1. Hutto JW, Green RD. Social movements against racist police brutality and Department of Justice Intervention in Prince George’s County, Maryland. J Urban Health. 2016;93(1):89–121. doi: 10.1007/s11524-015-0013-x.
    1. Tolliver WF, Hadden BR, Snowden F, Brown-Manning R. Police killings of unarmed Black people: centering race and racism in human behavior and the social environment content. J Hum Behav Soc Environ. 2016;26(3–4):279–286. doi: 10.1080/10911359.2015.1125207.
    1. McClintock Andrew S., Rodriguez Marcus A., Zerubavel Noga. The Effects of Mindfulness Retreats on the Psychological Health of Non-clinical Adults: a Meta-analysis. Mindfulness. 2019;10(8):1443–1454. doi: 10.1007/s12671-019-01123-9.
    1. Cushing RE, Braun KL. Mind–body therapy for military veterans with post-traumatic stress disorder: a systematic review. J Altern Complement Med. 2018;24(2):106–114. doi: 10.1089/acm.2017.0176.
    1. Petrie K, Crawford J, Baker ST, Dean K, Robinson J, Veness BG, Randall J, McGorry P, Christensen H, Harvey SB. Interventions to reduce symptoms of common mental disorders and suicidal ideation in physicians: a systematic review and meta-analysis. Lancet Psychiatry. 2019;6(3):225–234. doi: 10.1016/S2215-0366(18)30509-1.
    1. Joyce Sadhbh, Shand Fiona, Lal Tara J, Mott Brendan, Bryant Richard A, Harvey Samuel B. Resilience@Work Mindfulness Program: Results From a Cluster Randomized Controlled Trial With First Responders. Journal of Medical Internet Research. 2019;21(2):e12894. doi: 10.2196/12894.
    1. Joyce S, Shand F, Tighe J, Laurent SJ, Bryant RA, Harvey SB. Road to resilience: a systematic review and meta-analysis of resilience training programmes and interventions. BMJ Open. 2018;8(6):e017858. doi: 10.1136/bmjopen-2017-017858.
    1. Jha AP, Morrison AB, Parker SC, Stanley EA. Practice is protective: mindfulness training promotes cognitive resilience in high-stress cohorts. Mindfulness. 2017;8(1):46–58. doi: 10.1007/s12671-015-0465-9.
    1. Christopher MS, Goerling RJ, Rogers BS, Hunsinger M, Baron G, Bergman AL, Zava DT. A pilot study evaluating the effectiveness of a mindfulness-based intervention on cortisol awakening response and health outcomes among law enforcement officers. J Police Crim Psychol. 2016;31(1):15–28. doi: 10.1007/s11896-015-9161-x.
    1. Christopher Michael S, Hunsinger M, Goerling LRichard J, Bowen S, Rogers Brant S, Gross Cynthia R, Dapolonia E, Pruessner Jens C. Mindfulness-based resilience training to reduce health risk, stress reactivity, and aggression among law enforcement officers: a feasibility and preliminary efficacy trial. Psychiatry Res. 2018;264:104–115. doi: 10.1016/j.psychres.2018.03.059.

Source: PubMed

3
Se inscrever