Stress Control for Military, Law Enforcement, and First Responders

This article was published in National Defense Research Institute in 2021 (here).

Note: This article was not submitted to ExultX Spotlight by the authors. However, due to its relevance, we have decided to share it with our community. This text is a commentary on the original article, attempting to highlight the key points. For a more thorough and complete understanding of the content, we strongly recommend everyone to read the original article.

All rights to the findings belong to the authors of the article. Responsibility for the commentary lies with ExultX.

Combat and Operational Stress Control (COSC) is the U.S. military’s comprehensive strategy for preventing, identifying, and managing stress reactions among service members. It is designed to help personnel cope with both combat and operational stressors throughout the deployment cycle, ensuring that individuals and units remain effective while mitigating long-term psychological damage.

COSC includes a variety of programmes, policies, and interventions to address stress-related issues before, during, and after deployment. The goal is to enhance resilience, maintain operational readiness, and support reintegration into civilian or military life.

Various interventions fall under COSC, each targeting different aspects of stress control:

Stress Inoculation Training (SIT): A cognitive-behavioural approach to prepare personnel for stressors by gradually exposing them to stressful scenarios.

Psychological First Aid (PFA): A crisis intervention method to stabilise personnel after traumatic incidents.

Resilience Training (e.g., Master Resilience Training - MRT): Helps build mental toughness and adaptive coping skills.

Trauma Risk Management (TRiM): A peer-led programme aimed at reducing stigma around mental health support.

Critical Incident Stress Debriefing (CISD): A structured group discussion following traumatic events.

Biofeedback & Mindfulness Programmes: Helps personnel regulate physiological responses to stress.

Embedded Mental Health Teams: Provides continuous access to mental health professionals in operational environments.

The article presented is a systematic review conducted by the RAND Corporation, investigating the effectiveness of interventions (outlined above) designed to prevent, identify, and manage stress reactions in military personnel, law enforcement officers, and first responders. These groups are frequently exposed to high-stress situations, leading to physical, behavioural, and psychological effects, including post-traumatic stress disorder (PTSD).

1. Description of the Methodology

The study follows a systematic review approach, analysing multiple studies published between 1990 and 2020. The methodology includes:

Data Sources: Searches were conducted in databases such as PsycINFO, PubMed, PTSDpubs, Cochrane Central, and the U.S. Defense Technical Information Center.

Selection Criteria: Studies were included if they evaluated stress control interventions for active-duty military, law enforcement, or first responders. Excluded studies involved veterans, civilians, or non-comparable interventions.

Study Designs: The review included 38 controlled trials, 35 cohort comparisons, and 42 case studies.

Outcome Measures: The analysis focused on physiological (e.g., heart rate, sleep), psychological (e.g., PTSD, anxiety, depression), behavioural (e.g., alcohol use, return to duty), and occupational effects, along with intervention acceptability.

Statistical Analysis: Meta-analysis was conducted where possible, using standardised mean differences and risk ratios to compare intervention effectiveness.

2. Key Takeaways

The key findings demonstrate that COSC programmes contribute to immediate operational readiness but have limited impact on long-term PTSD and depression symptoms. Certain interventions, such as psychological first aid and decompression programmes, have shown potential in reducing distress and facilitating reintegration.

However, no significant difference was observed between COSC programmes and standard stress management training. Additionally, many studies were affected by high attrition rates, baseline differences, and small sample sizes, undermining the reliability of their findings. To enhance understanding and effectiveness, more rigorous trials are needed, with a focus on long-term psychological outcomes and intervention-specific effectiveness.

3. Day-to-Day Applications

For Military and First Responders: Implementing validated stress management techniques such as mindfulness or structured psychological first aid could help improve coping mechanisms.

For Leadership and Programme Developers: Developing more targeted interventions with rigorous evaluation could enhance mental health support within high-stress professions.

For Policymakers: The study highlights the need for better-designed stress interventions and systematic tracking of long-term outcomes.

For Health Professionals: Incorporating evidence-based COSC practices into military and law enforcement mental health services can improve support structures for personnel.

Learn more about the article here.