Preliminary Investigation of the Impact of Stress Suppression Processes and Counseling Strategies for Police Officers: A Qualitative Content Analysis

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Topic

The topic of the article is fascinating and timely, as it relates to the health of police officers. Nowadays, they are subjected to serious stress, primarily mental, due to the high expectations placed on them by both their superiors and society. Police officers work in conditions of constant stress.

Introduction

Police officers face an environment of high pressure and risk every day, which often leads to psychological stress. Examples of this are the high workload, expectations from management and citizens, as well as frequent exposure to extreme situations. All these factors affect their psyche and inhibitory capacity. To analyse this problem, the author of the article uses a qualitative approach, including a literature review and in-depth interviews.

It is no secret to anyone that police officers are exposed to high risk — both physical and mental — arising from dangerous situations, violence and strong temptations. Mental stress is often associated with violence and an increased risk of death, which leads to insomnia, fatigue and anxiety. Frontline workers, including firefighters and police officers, are most affected. The author provides a detailed literature review on the behaviour of police officers under mental stress. It is known that psychological problems can also lead to physical illnesses.

An important criterion that affects mental strain is the difference between the psyches of men and women. Generally, women are more susceptible to external stimuli and tend to exhibit stronger fear reactions. Additionally, caring for children and fostering a stronger emotional bond between mother and child can increase sensitivity to stress. The article examines the mechanisms of inhibitory control in police officers under various stressful conditions, drawing on a literature analysis and interviews. It is demonstrated that stress can influence the suppression of impulsive and aggressive behaviour. The challenges that officers face before and during stressful events are also examined.

 

Literature review

Paragraph 2.1 could be expanded from the reaction of police officers to stress to a more general consideration of stress as a phenomenon. The author emphasises several main approaches: a stimulus-response approach and an interaction-based approach. In paragraph 2.1.3, the interaction-based approach is presented, according to which if an individual believes they can cope with the situation, a stress reaction may not occur.

Among the more significant paragraphs are: 2.2 - examines secondary traumatic stress and its relationship with physical illnesses; 2.3 - analyses proactive and reactive aggression, and a strong correlation has been established between reactive aggression and high levels of anger.

 

 

 

Methods and Results

The author uses the semi-structured interview method to investigate stress coping strategies. Interviews were conducted with seven police officers from different units. Their mental and physiological reactions to stress were analysed.

A mechanism for screening newly hired officers through psychological tests is proposed. Intervention is also carried out for officers displaying aggressive behaviour through EEG tests. The author suggests implementing monitoring and preventive measures for selecting senior officers based on assessments of stress and mental stability.

Table 1 presents the types of stress that police officers face.

Figure 3 visualises the “hot spots” of stress according to the interviewees.

Table 2 shows the thematic categories of stress, the role of video surveillance and pressure on police officers.

Table 4 includes stress coping strategies.

The author suggests two main areas for practical application: screening and prevention, as well as stress reduction through support strategies. By selecting candidates and preventing impulsive and aggressive behaviour, mental resilience in the system can be significantly improved. A multi-layered social strategy for reducing stress is proposed, including measures against anxiety, depression and emotional exhaustion. Appropriate measures can prevent future problems related to aggressive and mentally unstable behaviour.

The author needs to improve

How do you ensure the objectivity of the qualitative analysis in more details, given the small number of interviewed police officers? Do you plan to expand the sample in future studies?

Can you elaborate on the principle by which the interviewed officers were selected, and do you think that their individuality and gender are sufficiently representative of the different units within the Ministry of Interior system?

Do you distinguish in more details between different types of stress (acute, chronic, secondary traumatic) when analysing the data, and how does this affect the interpretation of the results?

How did you control for the influence of subjective factors (personal experience, emotional state, individual characteristics) on the responses of the interviewed officers?

Add Future work

How do you assess the validity of the proposed interventions, such as psychological tests and EEG monitoring?

Are there scientific data supporting their effectiveness in real-world settings?

Do you envisage using quantitative biophysiological indicators, such as heart rate variability or EEG signals, to support the qualitative analysis and increase scientific credibility?

The approach to coping with stress can be further analysed and validated by determining a stress index using continuous monitoring. Since stress is mainly related to the autonomic nervous system, and more specifically to its sympathetic division, it can be quantified through mathematical analyses. This would enable more in-depth conclusions and increase the author’s contribution. In future studies, I recommend using biophysiological indicators to assess the influence of the autonomic nervous system during stress, such as heart rate variability, heart rate, and EEG analysis. This would enhance the scientific value of the study and its contribution.

Author Response

Please see the attachment

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

Intro:  Good description of policing as a high-risk, high-stress occupation, citing the multifaceted stressors.  Recent increased duties  with additional responsibilities and decreased workforce due to illness from Covid-19 have led to increased workloads, increased risk of physical trauma, emotional and psychological stress with increased stress induced symptoms including emotional dysregulation, depression/anxiety, PTSD and burnout. There is no clear statement of the purpose of the study in the Introduction.

Literature Review: Review of previous studies showing the link between stress and physical, emotional and psychological disorders.  An individual’s internal resources, cognitive assessment, and positive or negative coping abilities effects whether a stress response occurs. Police officers experience early life stress, primary stressors from direct and indirect physical/emotional/verbal aggression and secondary traumatic stress (indirect trauma through exposure to victims).  Repeated stressors accumulate and negative coping mechanisms such as denial, self-blame, and alcohol abuse may provide short-term stress relief while ultimately worsening stress symptoms and can develop into serious mental health issues or social dysfunction. Establishing robust psychological support systems and coping training mechanisms for frontline police officers is essential to enhance their emotional resilience and occupational well-being.

A discussion of aggressive behavior does not need to be included – it is an aspect of emotional dysregulation.

Research Design and Methods:  

The purpose of the study appears to be here but belongs in the Introduction –“to examine the individual and organizational coping strategies employed by police officers in response to occupational stress. The insights and recommendations derived from the interviews serve as a reference for practical agencies in formulating support policies and adjusting institutional frameworks”. 

3.1.1 Figure 1 – Conceptual study framework not clear – what were the police traits? It is not clear how the text following this figure pertains to the study framework – these have been stated previously.

Interview questions cited.  Qualitative analysis of responses clearly described. Limitations of the study – small sample size, geographic concentration, researchers’ biases and subjective interpretations – were appropriately cited.

 

Research Findings and Discussion:

Five themes of stressors faced on duty were identified- Hierarchical Pressure Transmission, Excessive Workload, Self-Expectations and Role Identity, Family and Shift-Related Stress, Critical Incidents and Media Pressure.  Fig 2 is unnecessary.  Role of CCTV and pressure on police officers identified five thematic categories – Heavy dependence on CCTV, Inadequate System Coverage, Delay in Reporting Affects Access,  Time-Consuming Retrieval Process, Lack of Public Awareness. It is not clear how this effects stress or stress management. Five negative Stress management patterns were identified – Internalization and Personality Traits, Externalized Conflict Behaviors, Retaliatory Workplace Behaviors, Anonymous Online Venting, Emotionally Repressive Organizational Culture.  Below this is a Summary of Privacy-Protective Design in Mental Health Systems – this does not belong here – it is not a result of the interviewing questionnaires. Three coping strategies were identified – Social support, Professional support, Individual Coping.  It was not apparent from the information provided how often these coping strategies were utilized or whether they were effective. In fact, it seems that some of these coping strategies either were not available or not utilized because of stigma, etc.  The information in Fig 4 is not obtained from this study – it does not belong here – could go in suggestions.

 

Conclusion and Suggestions: The authors cite two findings from this study – (1) stress and emotional regulation may serve as crucial foundations for suppressing impulsive and aggressive behavior and (2) identifying the challenges police officers face in stress coping and emotional regulation.  Although these statements may be true, they don’t arise from the findings of this study.  Likewise, the recommendations cited may be valid but are not supported by any data arising from this study. Some of the recommendations (such as EEG testing to evaluate officers who have exhibited violent or emotionally dysregulated behavior during duty) are not supported by the small qualitative study nor the literature review.

COMMENTS: This study is critically flawed by the small number of subjects interviewed.  Many of the conclusions and recommendations come from other studies, therefore, this study does not add anything to the field.  Some of the recommendations are not supported by this study or by the literature.

 

Author Response

Please see the attachment

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

There seems to be an inordinate amount of COVID information in the introduction but not the discussion. I recommend at bare minimum of mentioning this in the limitation or adding content in the discussion.

 

Lines 51-53, as compared to the general population (list other occupations)?

Lines 59-66, there needs to be a citation as there is a lot of content that needs to be supported by the literature.

Lines 68 to 75, there is mention of firefighters and LEOs but what about EMTs?

Line 81, recommend changing from mental illness or operationalize the dx.

Line 82, you say correlation, then 67% in line 83. Clarify, because it sounds like they mean variance. If they mean correlation % needs to get removed.

Lines 110-111, reword because that is very confusing.

Line 113, clarify what and how “professional caregivers” mean.

Lines 130-134, that needs a citation.

Lines 195-197, that would be good to put in a table since its not reported anywhere in the submission.

I like Figure 2 a lot, but there is no mention of it in the text or how it was constructed. Please clarify

Line 308, there is a bullet point missing.

Lines 379-383, since this is the first significant finding, I recommend expanding it with citations.

In the practical applications, #1, I recommend reviewing this study (http://dx.doi.org/10.1037/tra0000429) and incorporating into what has been done and what can be done by future research.

Line 411, “the study” is which one. This study or a separate one they are referencing?

 

Author Response

Please check the file in the attachment.

Author Response File: Author Response.pdf

Round 2

Reviewer 2 Report

Comments and Suggestions for Authors

2^nd review - Impact of the Stress Suppression Processes and Counseling Strategies for Police Officers: A Qualitative Content Analysi

The authors did a good job in rearranging and clarifying multiple problems that were noted in  my previous review.  However, there are still two problems remaining.

1. The authors write “This study explored the inhibitory control processes of police officers under different stress conditions through a literature analysis and semi-structured in-depth interviews.” The study does not do this – it is a preliminary investigation of a small number of officers into their perceptions of how and why they respond in stressful situations and what they think might ameliorate these negative responses.  Consider changing title to “Preliminary Investigation of the Impact of the Stress Suppression Processes and Counseling Strategies for Police Officers: A Qualitative Content Analysis”
2. It also does not investigate electrophysiologic and brain imaging information in relation to officers’ decision making and behavioral responses. I looked at the abstracts of references 45, 46, 48, 49, 53. Mancke, et al proposes a multidimensional model of aggression in personality disorder but does not seem to recommend EEG to evaluate behaviours that develop under stressful situations in previous normal people.  Crowe investigates fMRI not EEG and also does not seem to suggest fMRI as a tool to evaluate this population.  The other articles also did not seem to recommend EEG or imaging to evaluate this population.  Can the authors provide me with specific references that would support the recommendation for EEG evaluation and/or other neural imaging in this or a similar population (like EMTs or early responders)?  If not, no recommendation of EEG or functional or neural imaging should be made in this paper.  I suggest changing the following:

 

1. Delete lines 473-477: “This study explored the inhibitory control processes of police officers under different stress conditions through a literature analysis and semi-structured in-depth interviews. The goal was to better understand how officers adjust to cognitive and emotional conflict, and how they regulate aggressive behavior and psychological responses during social interaction.
2. Line 505-511:” Intervention for officers exhibiting aggressive behavior: For officers who have exhibited violent or emotionally dysregulated behavior during duty, we recommend the use of EEG testing and psychological evaluations to implement follow-up counseling and behavioral adjustment training. These intervention strategies are derived from the existing literature and the present qualitative findings, and their effectiveness in real-world settings will need to be empirically evaluated in future quantitative or mixed-methods studies.” I recommend the change to “Intervention for officers exhibiting aggressive behavior: For officers who have exhibited violent or emotionally dysregulated behavior during duty, we recommend psychological and neurological evaluations (including neurologic imaging and other studies if indicated) along with  follow-up counseling and behavioral adjustment training.  These intervention strategies are derived from the existing literature and the present qualitative findings, and their effectiveness in real-world settings will need to be empirically evaluated in future quantitative or mixed-methods studies.
3. Line 517 – delete “This study investigated the inhibitory control processes and emotional regulation mechanisms among police officers.”
4. Line 524-529- delete-“Application Model Aligned with the Research Hypotheses Based on observations of electrophysiological and behavioral indicators, this study identifies officers’ response patterns in the “decision phase” (e.g., choosing the degree of punishment) and the “outcome phase” (e.g., processing competitive feedback) as valuable references for assessing the physiological and psychological mechanisms linked to aggression under varying decision-making scenarios.
5. Line 589-592 – delete “Second, EEG-based measures of inhibitory control and emotional processing may be integrated with behavioral tasks and psychometric instruments to examine how stress affects cognitive control and aggression related responses at both neural and behavioral levels. You might add “future investigation into the use of EEG, imaging and functional imaging might further elucidate the neural mechanisms underlying these decisions and behaviors.”
6. Line 609-610 – “In summary, this study provides an in-depth, qualitative examination of frontline police officers’ experiences of occupational stress, emotional regulation, and coping processes,…….” Delete “in-depth” and change to “preliminary”

 

Author Response

Please see attachment

Author Response File: Author Response.pdf