A Qualitative Investigation of the Experience of Mindfulness Training among Police Officers

The primary objective of this study was to qualitatively assess the experience of Mindfulness- Based Resilience Training (MBRT) among police officers. MBRT is an 8-week intervention designed to enhance police officer resilience in the context of acute and chronic stressors inherent to policing. MBRT has demonstrated preliminary efficacy in decreasing aggression, burnout, alcohol use, sleep disturbance, and improving cortisol reactivity, psychological flexibility, and non-reactivity. Participants (n = 5) were police officers who completed an individual semi-structured interview post-MBRT. A coding schema was developed to identify and categorize participant responses, and then applied the final coding framework to all participant interviews. Results revealed perceived improvements in intrapersonal and interpersonal functioning, benefits of MBRT, and strategies for overcoming potential barriers to mindfulness practice. These preliminary qualitative results are consistent with quantitative psychological and physiological MBRT outcomes and provide further support for MBRT feasibility and acceptability.

1. INTRODUCTION

Policing is widely considered to be one of the most stressful occupations (Violanti et al., 2006; Violanti et al., 2011). Operational (e.g., critical incidents, interpersonal violence, and chronic stress) and organizational (e.g., shiftwork, lack of promotion opportunities, and job dissatisfaction) stressors contribute to significant negative health and behavioral outcomes for police officers, including elevated rates of depression and suicide (Violanti, 2004; Wild et al., 2016), post-traumatic stress disorder (Fullerton, Ursano, & Wang, 2004; van der Meer et al., 2017), and reduced longevity (Stanley, Hom, & Joiner, 2016). Officer burnout is associated with elevated anger and aggression (Rajaratnam, Barger, Lockley, & et al., 2011; Sack, 2009), poor problem-solving (Arslan, 2010), administrative and tactical errors, absenteeism, and falling asleep while driving (Rajaratnam et al., 2011). Failure to address issues related to officer health and well-being also negatively impact the community; police stress is associated with impaired decision-making (Nieuwenhuys, Cañal-Bruland, & Oudejans, 2012; Rajaratnam et al., 2011; Violanti et al., 2014) and is often a factor in excessive use of force (Nieuwenhuys, Savelsbergh, & Oudejans, 2012).

Given the value police culture places on toughness and emotional suppression (Burke, 2016), officers are less likely than the general public to engage in help-seeking behavior (Fox et al., 2012b), and those that do struggle to remain engaged in treatment (Siddle, Jones, & Awenat, 2003). While some interventions have been shown to lead to improvements in officer stress and mental health (McCrathy & Atkinson, 2012; Shipley & Baranski, 2002), authors of a recent meta-analysis identified small effect sizes among existing officer stress reduction interventions, and concluded that, “insufficient evidence exists to demonstrate the effectiveness of stress management interventions for reducing negative physiological, psychological or behavioral outcomes among police officers and recruits.” (Patterson, Chung, & Swan, 2014, p. 508). Novel interventions tailored to the specific cultural context and mental health needs of the law enforcement community are crucial. Preliminary evidence suggests mindfulness training (MT) may be a feasible and acceptable intervention to improve officer health.

Mindfulness training (MT) involves developing skills for increasing awareness of internal and external states such that an individual increases insight into automatic or habitual patterns of behaving and reacting, thereby increasing flexibility in behavioral response repertoire (Bowen et al., 2009). MT improves mental health and behavioral outcomes relevant to policing, including perceived stress (Khoury et al., 2013; Bassam Khoury, Sharma, Rush, & Fournier, 2015), physiological stress reactivity (Bergen-Cico, Possemato, & Pigeon, 2014; Lengacher et al., 2012) depression and suicidal ideation (Hofmann, Sawyer, Witt, & Oh, 2010; B. Khoury et al., 2013), burnout (Luken & Sammons, 2016; Regehr, Glancy, Pitts, & LeBlanc, 2014), and aggression (Fix & Fix, 2013; Zoogman, Goldberg, Hoyt, & Miller, 2014). The benefits of MT may be most impactful among high-stress populations, particularly those in which stress is known to affect onset or exacerbate negative mental health outcomes (Creswell & Lindsay, 2014; Nyklíček & Irrmischer, 2017). Resilience training (RT) also improves the capacity to adapt to stress and improve outcomes in high-stress populations (Epstein & Krasner, 2013; Leppin et al., 2014). Several pilot studies have shown RT is acceptable to police officers (Shochet et al., 2011; Varker & Devilly, 2012) and improves stress reactivity and behavioral performance in live or simulated critical incident simulation tasks (Andersen & Gustafsberg, 2016; Andersen et al., 2015; Arnetz, Arble, Backman, Lynch, & Lublin, 2013).

Mindfulness-Based Resilience Training (MBRT; Christopher et al., 2016; Christopher et al., 2018) was designed to enhance resilience for LEOs in the context of acute and chronic stressors inherent to policing. MBRT was delivered in eight weekly 2-hour sessions with an extended 6-hour class in the seventh week. Sessions contained experiential and didactic exercises, including body scan, sitting and walking meditations, mindful movement, and group discussion. Content and language were adapted for an LEO population; the primary focus of the curriculum was learning strategies to manage stressors inherent to police work, including critical incidents, job dissatisfaction, and public scrutiny, as well as interpersonal, affective and behavioral challenges common to LEOs’ lives. The adaptation process was overseen by a co-developer of MBRT (co-author R.G.), who is a police lieutenant and certified mindfulness trainer. Several LEOs in the training division in their respective departments were additionally consulted on program content and delivery. An initial version of MBRT was pilot tested and qualitative feedback solicited from LEO participants, leading to further adaptations. In a small RCT, compared to no intervention controls, MBRT participants experienced greater reductions in salivary cortisol, self-reported aggression, organizational stress, burnout, sleep disturbance, and reported increases in psychological flexibility and non-reactivity at post-training (Christopher et al., 2018). Additionally, quantitative benchmarks for feasibility (i.e., attendance, adherence, attrition, and acceptance of randomization) and acceptance (i.e., high mean likelihood of attending MBRT in the future and recommending it to other officers) were met (Christopher et al., 2018). In this study, we qualitatively evaluated MBRT participant experience to further assess intervention feasibility and acceptability, and to guide intervention refinement.

2. MATERIALS AND METHODS

2.1. Participants

Law enforcement officer participants from an MBRT group (N=10) were invited to participate in a brief telephone interview to provide feedback about the intervention (see Appendix A for the interview guide). Five participants agreed to provide this feedback and were offered a $20 Starbucks gift card as compensation for participating in the study. Four participants were male and one was female, with a mean age of 44.2 years (range = 35–57, SD = 8.4) and 16.8 years of police service (range = 8–31, SD = 8.7). Three participants identified as White, one as Black/African American, and one as Native Hawaiian/Pacific Islander. The sample was comprised of three officers, one lieutenant, and one captain representing four different municipal police departments.

2.2. Analysis

All interviews were audio recorded and transcribed by research assistants not involved in data collection or analysis. Research assistants successfully completed NIH ethics compliance training and received supervision from the study PI (MC), who has a history of published qualitative research in the area of mindfulness training. A combination of directed and conventional content analysis was applied to the interviews (Hsieh & Shannon, 2005). The directed content analysis involved a priori construction of conceptual themes and areas of interest in order to best assess the experiences of officers undergoing MBRT, and interview questions were developed to most comprehensively assess this information. Development of conceptual themes was overseen by our subject matter expert and population confederate, a police lieutenant (RG). Subthemes nested within each interview prompt were determined via inductive, conventional content analysis; three coders (AB, JK AE) independently reviewed the transcriptions in order to determine consistent and significant themes within the conversations and developed their own coding schemes, but were not modified after the interviews began. Coders then compared their independent coding schemes for areas of convergence, resolving inconsistencies collaboratively to develop a final coding scheme based on coder consensus and study PI (MC) feedback. The final coding scheme was applied to transcripts for coders to develop clear definitions for each thematic category (Braun & Clarke, 2014; Coffey & Atkinson, 1997; Hsieh & Shannon, 2005), and to identify illustrative quotes to represent both a priori and conventionally developed themes. Triangulation (Patton, 1990) was used to enhance reliability and validity by integrating a diversity of sources, investigators, and theories to inform a well-rounded coding scheme.

3. RESULTS

The data analysis resulted in a number of distinct codes that were categorized as (1) most helpful elements, (2) least helpful elements, (3) obstacles, (4) overcoming obstacles, (5) intrapersonal functioning, (6) interpersonal functioning, and (7) suggested improvements (see Table I). Each code was further divided into content specific subcodes. Each of the codes and subcodes are explored below with illustrative participant quotes.

Table I.

Codes, subcodes, and illustrative quotes from Mindfulness-Based Resilience Training participants (N = 5)

Codes	Subcodes	Illustrative quotes
Most helpful elements	Dedicated practice space	“Actually going someplace as opposed to having to do it on my own... made it easier...”
	Body scan	“The body scan... made you use your brain, your mind, and your body... you put it all together...”
	Mindful movement	“We are doing yoga stuff... and I felt really good...”
	Informal mindfulness practices	“Being mindful, doing simple things like brushing your teeth, or... grabbing the door knob ... it takes myself down a little bit...”
Least helpful elements	Walking meditation	“I found my mind wandering... it was just hard for me to focus back and keep myself on task...”
Obstacles	Scheduling	“The most difficult thing... was to just find the time each day to really make sure that I was trying to keep up with doing things outside of class on my own.”
	Stigma	“I think a lot of officers would... shut the training out before they even start it.”
Overcoming obstacles	Encouragement	“For the people I... work with... we can always... smile and wave because you have this bonding thing together.”
	Adaptations	“I could do some of it sitting in my patrol car in the back lot.”
Intrapersonal functioning	Increased relaxation	“I find myself to be a little more relaxed and I am not quite as... uptight... I have slowed down a bit.”
	Increased awareness of present moment	“I am focusing on the present as opposed to really worrying about down the road...”
	Improved physical wellbeing	“I felt like my blood pressure was going down... and it felt really good on my body and when I went there I wasn’t sore.”
Interpersonal functioning	Increased nonreactivity	“... I used to fly off the handle; I don’t anymore...”
	Improved family communication	“...My wife told me... ‘I can see how hard you are working on being respectful.’”
	Improved camaraderie	“We all seemed a little more open around each other.”
Suggested improvements	Booster sessions	“Continue to offer the training; it’s well worth it... and offer a refresher...”

3.1. Most Helpful Elements

Theme 1: Dedicated practice space

Three participants identified having a dedicated intervention space away from the police department as a helpful aspect of the training. Two separate participants spoke to the idea of having a dedicated practice space:

The venue was kind of cool. I have driven by that place many other times and never went in to look at it so it was kind of a fun like “hey” well, you know, I have been there now. (Participant 5)

Actually going someplace as opposed to having to do it on my own, it made it easier… But if I was left to my own devices, it rarely gets done if any. So I did enjoy going somewhere to the class. (Participant 2)

Theme 2: Body scan

Participants identified the body scan as a helpful practice that they regularly implemented. For example, one participant commented, “the body scans I really enjoyed… I find myself doing that at least once a day” (Participant 1). The participant later noted:

I immediately recognized what that body scan was and how important that was to me and how good that felt. If we hadn’t done the body scan week one, right out of the chute, I might have struggled with it a little bit more. (Participant 1)

Theme 3: Mindful movement

Most MBRT sessions involve a considerable amount of mindful movement and gentle yoga practice. One participant identified with the usefulness of mindful movement and stated:

We are doing yoga stuff… it was great and I felt really good on that because it not only helps you stretch and everything like that… but it also helps you kind of clear your head when you are doing it because you are concentrating while you’re doing it so that is very restful. (Participant 5)

Theme 4: Informal mindfulness practices

As with other mindfulness-based interventions (MBIs), MBRT involves the application of mindful attention and awareness to everyday life (e.g., mindful eating), as well as informal practices common to day-to-day policing (e.g., mindful encounters). Two participants shared thoughts on how informal practices were beneficial:

My awareness of the little things, like when we did all the little exercises, like when you are brushing your teeth focus on thinking about what exactly you are doing and just kind of being aware of it…even like the most simple task, driving, or breathing, eating, all these basic things that are just part of your life…now I think my mind is more aware of what I am doing. (Participant 4)

I try to incorporate that multiple times throughout the day just to you know, especially when I am getting tuned up or a little antsy or something, it just it takes myself down a little bit, by just doing that, you know, just focusing on at that time and it usually helps. (Participant 1)

3.2. Least Helpful Elements

Theme 1: Walking meditation

During walking mediation, participants are coached through slowly walking around the room and attend to physical and mental experiences as they complete the practice. Several participants identified walking meditation as a less helpful and challenging aspect of MBRT. For example, a participant stated, “the walking thing I could never quite disconnect enough to really feel beneficial in itself. Stressful is not the right word but I felt like I wasn’t doing something right and I was frustrated with that” (Participant 5), and another mentioned, “I just struggled with that because I found my mind wandering and looking out the window, and everything and it was just hard for me to focus back and keep myself on track” (Participant 1).

3.3. Obstacles

Theme 1: Scheduling

Officers reported that specific factors related to policing, such as scheduling shiftwork were barriers to completing MBRT. One participant stated, “if I was working a normal schedule instead of graveyard I think it would have been easier because you have a little bit more of a routine” (Participant 1). A second participant shared, “during that time [of the intervention] I got held over, ordered over, stuck on a late call, you name it” (Participant 2).

Theme 2: Stigma

Several participants described cultural stigma as a possible hurdle to completing MBRT. For example, one participant stated, “I was just kind of like trying to keep an open mind about it but I think a lot officers would might possibly be like, ‘yeah, this is not going to work for me’ so they might already shut the training out before they even start it” (Participant 4). Similarly, another participant stated, “I am really cognizant about not using the “Y” word in class because cops hear yoga and they run away” (Participant 5).

3.4. Overcoming Obstacles

Theme 1: Encouragement

Participants expressed appreciation of facilitator encouragement and enthusiasm as helpful in overcoming the identified barriers. One participant noted:

Just encouragement I think from instructors…just letting them know…there is a purpose to this training and there is a reason why you guys believe that it is important. I think if you guys explain that and reassure all the officers about that I think that would help. (Participant 4)

Theme 2: Adaptations

As with other MBIs, MBRT emphasizes creatively generalizing practice and applying the skills in diverse settings, beyond formal meditative practices. Participants noted this as helpful in overcoming barriers to practice. For example, a participant shared, “I could do some of it sitting in my patrol car in a back lot” and “just taking the time and being mindful, doing simple things like brushing your teeth, or you know, grabbing the door knob” (Participant 1).

3.5. Improved Intrapersonal Functioning

Theme 1: Increased relaxation

Most officers identified increased relaxation as a primary change after completing MBRT. For example, one participant stated, “this is actually doing a pretty good job at relaxing me and taking my mind off work” (Participant 4). Two other participants shared similar thoughts:

I think that after the training I find myself to be a little more relaxed and I am not quite as uptight about things as I was before. So I mean maybe, it sounds silly but it’s kind of like I have slowed down a little bit. (Participant 3)

As stress kicks up, you know, different calls, different things that you end up going to through the day, you know, it’s not that I can just stop what I am doing and go into a 20-minute body scan, but you know, I can do mindfulness, you know slow down and just relax and just focus on me. (Participant 1)

Theme 2: Increased awareness of present moment

Participants commented on a general increase in present-moment awareness. One participant mentioned:

I have tight deadlines and I used to obsess on the deadlines whereas now it’s more along the lines of just focusing on the work and it will get done…so I think that has allowed me to really just kind of, I don’t know, maybe the real term is I am focusing on the present as opposed to really worrying about down the road to whether or not I am going to make this deadline. (Participant 3)

Theme 3: Improved physical wellbeing

Officers described various improvements in physical health that they attributed to MBRT. For example, one participant stated, “I got shoulder issues, knee issues, lower back issues from the job…from you know decades of doing the job. So, it’s where I get the most relief out of that is when I am doing stretching exercises” (Participant 5). Two other participants shared similar thoughts:

I felt like my blood pressure was going down and it was just super, it just felt really chill and it felt really good on my body and when I went there I wasn’t sore, I was like, oh okay, I am kind of looking forward to coming here again this week. (Participant 4) I would basically get myself to the point of almost having like a migraine type headache. During the training what I noticed was that anytime that I felt myself kind of getting those triggers that would be a time to just close the door at my office and pull out my iPad, where I had some of the recordings and just do some sitting or do something and it helped me avoid getting a worse headache. (Participant 3)

3.6. Improved Interpersonal Functioning

Theme 1: Increased nonreactivity

When probed about changes noticed in various life domains, such as on the job and in daily life, several officers noted a sense of increased nonreactivity. This was evident by statements such as, “I noticed that pause more and more, and I seem to utilize that pause mainly to my benefit to where I am not getting any complaints or anything of that nature,” (Participant 2), “In conversations I have with people around the class at work, we were talking about just kind of a slowing down a half step and thinking another little bit before you react and that’s been very beneficial,” (Participant 5), and “I used to fly off the handle I don’t anymore which is really nice. And I like to, hopefully that will stay, but you know this job is just, I call it a bitch” (Participant 2). Similarly, another participant stated:

When kids are acting out and starting to get on your nerves it just makes it easier to take a deep breath, block it out for a split second, and just be mindful of everything and then go straight into everything else. (Participant 1)

Theme 2: Improved family communication

Participants reported a change related to increased patience and respect with family. For example, one participant shared, “My wife commented that I seemed happier” (Participant 1). While another participant stated:

One time my wife told me, “I can actually see the class kick in while we were talking.” And she just like shook her head, we were having kind of a heated discussion and it really helped the discussion tremendously because she was like “I see how hard you are working on being respectful” and that was very beneficial. (Participant 5)

Theme 3: Improved camaraderie

Participants spoke to a change in connectiveness and improved camaraderie with each other. One participant shared two separate examples:

We all seemed a little more open around each other. And I contributed that directly back to this mindful stuff where I am sitting back and I am, you know, what’s my goal, my goal isn’t to get the shift covered, my goal is to grow this sergeant into a lieutenant or potential chief, you know so, just having the opportunity to do that kind of stuff. (Participant 5) The last time I had any interaction with [another study participant] was on a tragic call when an officer got shot and killed and [the study participant] and I rescued a couple of guys that were pinned down and later, we went back and carried the gurney, the stretcher out with the dead officer on it behind the SWAT truck. So the last time we saw each other, well we saw each other in the hall at a debriefing and it was just kind of like a point at each other high five, you know ‘how you doing’ kind of thing. And then I hadn’t seen him, so this was the first opportunity we did and it was nice to have a lot of conversation after class and during classes. You know, before class and after class about you know, ‘how is life?’ ‘how are you doing?’ ‘hey, thanks for your help… you know, just some really decent conversation around that it was kind of cool to reconnect. (Participant 5)

3.7. Suggested Improvements

Theme 1: Booster sessions

All participants expressed an interest in the development of ongoing trainings or booster sessions so that course alumni could access brief “refresher” courses after completing the 8-week MBRT course.

4. DISCUSSION

The goal of this study was to qualitatively evaluate MBRT participant experience to further assess feasibility and acceptability, and to guide intervention refinement. Transcribed telephone interviews were independently coded for themes in responses. These preliminary results suggest MBRT is feasible and acceptable, with promise to meet the specific mental health and wellbeing needs of police and first responders.

Participants perceived several MBRT elements to be helpful. Several participants noted having a dedicated, off-precinct, space was essential to their enrolling and continuing in the training. This was particularly meaningful to our team as we gave significant consideration to location of the training. We considered offering the training using police department facilities to potentially increase retention and attendance; however, among this small sample, there was a clear preference for having an off-precinct, dedicated intervention space.

A majority of participants identified the body scan and mindful movement practices as the most beneficial elements of MBRT. This is consistent with previous quantitative (Colgan, Christopher, Michael, & Wahbeh, 2016; King et al., 2013) and qualitative (Colgan, Wahbeh, Pleet, Besler, & Christopher, 2017; Price, McBride, Hyerle, & Kivlahan, 2007) MT studies with veterans. These largely body-focused practices are linked to increased interoceptive awareness (Fischer, Messner, & Pollatos, 2017; Mehling et al., 2018), which in turn can enhance decision-making under duress (Kirk et al., 2016; Lobel, Granic, & Engels, 2014).

Several respondents described a struggle with walking meditation to the extent that they perceived a “correct” way to do the practice, anticipating an impact on present experience that never occurred. Bringing curious attention and awareness to frustration and distractibility that arise during walking meditation can make it a particularly applicable practice; noticing dissatisfaction or frustration with a practice is, paradoxically, a useful skill to practice. Challenges with shift work and changing schedules were perceived by participants as barriers to future officers enrolling and completing MBRT. Variability in officer shifts and schedules posed a challenge to the research team, and even holding the training outside of normal business hours did not fully overcome this challenge. Interestingly, veterans reported similar barriers in a qualitative analysis of their responses to MBSR (Martinez et al., 2015).

Cultural stigma related to help seeking behavior, and the harmful impact on officer health and wellbeing is well documented (Fox et al., 2012a; Haugen, McCrillis, Smid, & Nijdam, 2017; Karaffa & Koch, 2016). MBRT was developed with the goal of adapting MT to be more compatible with police culture. While quantitative data suggest MBRT is feasible and acceptable to police officers (Christopher et al., 2016; Christopher et al., 2018), participants identified aspects of their own organizational culture, such as negative preconceptions of help-seeking behavior, that could represent barriers to implementing MBRT.

Participants endorsed improvements in intrapersonal functioning post-MBRT, including increased relaxation, physical functioning, and awareness. Given the significant negative impact of police stress on health and wellbeing (Gershon, Barocas, Canton, Xianbin Li, & Vlahov, 2009; Hickman, Fricas, Strom, & Pope, 2011; Wang et al., 2010), practices that facilitate a sense of relaxation may be an important element of MT with this specific population. Several meta-analyses and systematic reviews suggest MT activates the parasympathetic nervous system (Gotink et al., 2015; Tang, Holzel, & Posner, 2015) and improves biomarkers of the physiological stress response (Pascoe, Thompson, Jenkins, & Ski, 2017; Sanada et al., 2016), which may account for participants’ perception of increased relaxation after participation in MBRT. Consistent with an uncontrolled pilot MBRT study (Christopher et al., 2016) and RCTs in high-stress groups, participants described improvements in physical functioning, including reduced headaches (Cathcart, Galatis, Immink, Proeve, & Petkov, 2014; Omidi & Zargar, 2014) and chronic pain (Cherkin et al., 2016; la Cour & Petersen, 2015). Participants also described a sense of increased awareness of processes that may have typically felt on auto-pilot. This increased awareness is consistent with the considerable attention paid in MBRT to fostering a generally mindful approach to daily life. These findings are consistent with other qualitative studies of MBIs in high stress occupations that reported increased awareness and improvements in mental and physical health as a result of participation in the course (Banerjee et al., 2017). A qualitative analysis of veterans’ experience in MBIs also found increases in awareness and relaxation (Colgan et al., 2017), which is also consistent with the findings of the current study.

Participants also endorsed improvements in interpersonal functioning post-MBRT, including increased nonreactivity, positive family communication, and camaraderie. The mindfulness practices in MBRT focus on increasing awareness of automatic reactions to external (and internal) stimuli, thereby reducing the negative impact of these patterns, particularly in communicating with others. This is consistent with similar findings suggesting the importance of mindful nonreactivity to positive interpersonal interactions (Huston, Garland, & Farb, 2011). Participants also described several improvements in family communication, including increased patience and attention during interactions with significant others. This is consistent with previous research linking mindfulness and intimate relationship satisfaction (Barnes, Brown, Krusemark, Campbell, & Rogge, 2007). Several participants endorsed improved camaraderie, as evidenced by reports of increased openness and support with other officers, as well as increased comfort in processing past traumatic events. This is consistent with review-level research suggesting mindfulness training can improve workplace outcomes such as performance, relationships, and well-being of individuals in organizations (Good et al., 2016). These noted improvements are reflective of some of the specific interpersonal problems that this population disproportionately experiences (Avdija, 2014; McCrathy & Atkinson, 2012; O’Hara, Violanti, Levenson, & Clark, 2013). Finally, MT with police and other high-stress groups may improve outcomes by implementing follow-up booster sessions or a structured way for alumni to access mindfulness training and practice opportunities beyond the eight week intervention.

While this study uniquely contributes to the MT literature, several significant limitations should be noted. First, the small sample size limits the conclusions that can be drawn from this data, and these findings need to be replicated with larger samples. It is important to note that thematic saturation was likely not reached, which limits the implication of our findings. While emergent themes were certainly complimentary between participants, the lack of redundancy suggests that there may be other themes that our interviews did not capture. With a larger sample size, it is likely that adequate saturation would have been reached. Second, a subsection of intervention group participants volunteered to provide their experience with MBRT, which likely introduced selection bias into the study (i.e., this process of recruitment likely overrepresented officers who held a positive opinion of MBRT). Third, although our data analysis followed a systematic, rule-governed procedure to ensure a certain degree of intersubjectivity of the findings, qualitative methodology remains a subjective approach that reflects the participants’ experiences.

5. CONCLUSION

Despite these limitations, the current study provides useful information regarding officers’ perceptions of their experience in MT. Alongside an uncontrolled MBRT study (Christopher et al., 2016) and the parent RCT (Christopher et al., 2018), we believe that the current study builds upon existing evidence of feasibility and acceptability. Overall, these findings can help serve to refine and adapt MBRT in future trials, improving the quality of intervention delivery to a population in great need of innovative mental health and wellness interventions.

Appendix A: Interview Protocol

• Were there aspects of the training you found to be most helpful?

• Were there aspects of the training you found to be less helpful?

• What were the biggest obstacles to completing the course?

• Has the training led to any changes you’ve noticed in your day-to-day life?

• Has the training led to any changes you’ve noticed at work?

• Are there any changes that people around you commented on as a result of the training?

• Were there any changes in the relationship you had with the other group members over the course of the training?

• Do you have any suggestions on how we might improve the training?