Millions of people witnessed early, repeated television coverage of the September 11 (9/11), 2001, terrorist attacks and were subsequently exposed to graphic media images of the Iraq War. In the present study, we examined psychological- and physical-health impacts of exposure to these collective traumas. A U.S. national sample ( N = 2,189) completed Web-based surveys 1 to 3 weeks after 9/11; a subsample ( n = 1,322) also completed surveys at the initiation of the Iraq War. These surveys measured media exposure and acute stress responses. Posttraumatic stress symptoms related to 9/11 and physician-diagnosed health ailments were assessed annually for 3 years. Early 9/11- and Iraq War–related television exposure and frequency of exposure to war images predicted increased posttraumatic stress symptoms 2 to 3 years after 9/11. Exposure to 4 or more hr daily of early 9/11-related television and cumulative acute stress predicted increased incidence of health ailments 2 to 3 years later. These findings suggest that exposure to graphic media images may result in physical and psychological effects previously assumed to require direct trauma exposure.

Adverse childhood experiences (e.g., physical, sexual and emotional abuse, neglect, exposure to domestic violence, parental discord, familial mental illness, incarceration and substance abuse) constitute a major public health problem in the United States. The Adverse Childhood Experiences (ACE) scale is a standardized measure that captures multiple developmental risk factors beyond sexual, physical and emotional abuse. Lesbian, gay, and bisexual (i.e., sexual minority) individuals may experience disproportionately higher prevalence of adverse childhood experiences. To examine, using the ACE scale, prevalence of childhood physical, emotional, and sexual abuse and childhood household dysfunction among sexual minority and heterosexual adults. Analyses were conducted using a probability-based sample of data pooled from three U.S. states’ Behavioral Risk Factor Surveillance System (BRFSS) surveys (Maine, Washington, Wisconsin) that administered the ACE scale and collected information on sexual identity (n = 22,071). Compared with heterosexual respondents, gay/lesbian and bisexual individuals experienced increased odds of six of eight and seven of eight adverse childhood experiences, respectively. Sexual minority persons had higher rates of adverse childhood experiences (IRR = 1.66 gay/lesbian; 1.58 bisexual) compared to their heterosexual peers. Sexual minority individuals have increased exposure to multiple developmental risk factors beyond physical, sexual and emotional abuse. We recommend the use of the Adverse Childhood Experiences scale in future research examining health disparities among this minority population.

On 9/11 (September 11, 2001), the US public experienced a terrorist event of extraordinary scope and traumatic impact. Studies have documented substantial short-term psychological response to 9/11,^1-4 but its effect on physical health has received limited attention.⁵ Extremely stressful events may precipitate biological processes that increase one's risk of developing cardiovascular ailments.^6-11 Indeed, during the weeks following 9/11, rates of cardiovascular events increased significantly in New York City and surrounding areas.^12-14 Comparable findings were reported in Florida,¹⁵ suggesting the possibility that direct exposure may not have been necessary for the development of 9/11 stress-related health problems. These provocative findings imply that, for some individuals, indirect exposure to extreme stress may produce physiologic responses that contribute to cardiovascular ailments.

Police safety and use of force decisions during critical incidents are an ongoing source of concern for both police practitioners and the public. Prior research in the area of police performance reveals that psychological and physiological stress responses during critical incidents can shape the outcome of the incident, either positively or negatively. The goal of this study was to test a training method to improve use of force decision making among police. This randomized controlled pilot study consisted of training officers to apply techniques to enhance psychological and physiological control during stressful critical incidents. Of a pool of 80 police officers, potential participants were invited based on equivalent age, years of experience, physiological characteristics (i.e., body mass index [BMI] and cardiovascular reactivity), and expertise. Results revealed that the intervention group displayed significantly better physiological control, situational awareness, and overall performance, and made a greater number of correct use of force decisions than officers in the control group (all ps < .01). The relevant improvements in use of force decision-making found in this pilot study indicate that this training method warrants further investigation. Improved use of force decision making directly translates into potential lifesaving decisions for police and the civilians they are working with.

Police Special Forces (a.k.a. special weapons and tactics [SWAT]) officers are tasked with responding to the most critical situations, including incidents that require specialized skills and equipment beyond typical policing activities. In this study, we tested the feasibility of applying Arnetz and colleagues’ resilience promotion training that was developed for patrol officers to SWAT team officers (n = 18). The resilience promotion training program included psychoeducation focused on police stress and resilience, and the practice of resilience promotion techniques (controlled breathing and imagery) while listening to audio-recorded critical incident scenarios. The aims of this study were to (a) examine if a resilience training program was relevant and accepted by SWAT team officers and (b) assess participants’ physiological stress responses (heart rate, respiration) during the resilience training sessions to note if there were improvements in stress responding over time. Our findings revealed that participants were able to significantly reduce their average heart rate and improve their ability to engage in controlled respiration (i.e., breathing) during simulated critical incidents over the course of the 5-day training. Improvements in stress responding were observed even when the critical incident scenarios became more graphic. Results suggest that an intervention to reduce stress responses of SWAT officers to critical incident scenarios works in a simulated training setting. Translation of these findings to real-world occupational hazards is a recommended next step.