**1. Introduction**

In the early morning of 6 April 2009, a 6.9-Richter-magnitude earthquake struck L'Aquila (Abruzzo, Italy) and affected more than 45 towns and small villages, killing 309 people, injuring 1,600 people, and forcing more than 80,000 inhabitants to leave their homes. Police officers at the scene were among the first to assist in communicating to those trapped under the ruins and organizing rescue efforts in L'Aquila and the surrounding areas.

Two and a half months later, on 29 June 2009, a derailment of a freight train and subsequent fire in the railway station in Viareggio (Tuscany, Italy) occurred, which also involved a derailed wagon that crashed into a number of houses. A large area of Viareggio was damaged in the fires caused by the wagons, which were carrying liquefied petroleum and caused explosions. Thirty-three people were killed in the explosions and from collapsing houses. The deaths occurred at the time of the explosion and in the following days due to the severity of the injuries. Twenty-five people were injured, and 100 were left homeless. Police officers were among the first to intervene at the scene to secure the area and assist other rescuers.

Approximately 4 years later, on 28 July 2013, a coach with 48 people on board that was traveling to Naples from Telese Terme following a pilgrimage hit several vehicles before breaching a barrier and falling down a 30-m slope near the town of Avellino (Campania, Italy). This coach crash is considered the country's worst road accident. Forty people died, and 10 were severely injured.

Disasters can strike at any time and place. First responders, such as police officers, are repeatedly exposed to traumatic events as part of their daily routine. A discussion on the seriousness of a traumatic experience, which can trigger post-traumatic stress reactions, is still active [1]. One question thus concerns when one can pass from acceptable reactions, though they are occasionally imbued with suffering, to reactions that have a greater psychopathological meaning.

Stress is a pervasive experience that occurs when one's perceived demands outweigh one's perceived resources [2]. Although low to moderate levels of acute stress can be adaptive, the accumulated effects of chronic exposure to stress can lead to negative outcomes, including exhaustion, cognitive dysfunction, avoidance behavior, poor health behaviors, depressive symptoms, and negative social relationships [3]. It must be emphasized that traumatic stress reactions can differ according to the experienced event: In cases of technological or natural disasters or major terrorist attacks, the tendency is to increase mutual contact and look for reassurance in others [4]. This is also in line with neuroimaging studies in which specific networks of brain areas underpin post-traumatic stress disorder (PTSD) after various traumatic events [5, 6].

Over 85% of emergency personnel involved in traumatic incidents have experienced a traumatic stress reaction at some point [7]. Events that are considered stressful include being shot at, being physically threatened, having one's family threatened, working with victims who have been badly beaten [8–10], and experiencing the death of a fellow officer and physical attacks [11, 12]. Collins and Gibbs [9] report that stressors that are most frequently identified **1. Introduction**

injured.

ical meaning.

events [5, 6].

In the early morning of 6 April 2009, a 6.9-Richter-magnitude earthquake struck L'Aquila (Abruzzo, Italy) and affected more than 45 towns and small villages, killing 309 people, injuring 1,600 people, and forcing more than 80,000 inhabitants to leave their homes. Police officers at the scene were among the first to assist in communicating to those trapped under the ruins and

Two and a half months later, on 29 June 2009, a derailment of a freight train and subsequent fire in the railway station in Viareggio (Tuscany, Italy) occurred, which also involved a derailed wagon that crashed into a number of houses. A large area of Viareggio was damaged in the fires caused by the wagons, which were carrying liquefied petroleum and caused explosions. Thirty-three people were killed in the explosions and from collapsing houses. The deaths occurred at the time of the explosion and in the following days due to the severity of the injuries. Twenty-five people were injured, and 100 were left homeless. Police officers were among the

Approximately 4 years later, on 28 July 2013, a coach with 48 people on board that was traveling to Naples from Telese Terme following a pilgrimage hit several vehicles before breaching a barrier and falling down a 30-m slope near the town of Avellino (Campania, Italy). This coach crash is considered the country's worst road accident. Forty people died, and 10 were severely

Disasters can strike at any time and place. First responders, such as police officers, are repeatedly exposed to traumatic events as part of their daily routine. A discussion on the seriousness of a traumatic experience, which can trigger post-traumatic stress reactions, is still active [1]. One question thus concerns when one can pass from acceptable reactions, though they are occasionally imbued with suffering, to reactions that have a greater psychopatholog-

Stress is a pervasive experience that occurs when one's perceived demands outweigh one's perceived resources [2]. Although low to moderate levels of acute stress can be adaptive, the accumulated effects of chronic exposure to stress can lead to negative outcomes, including exhaustion, cognitive dysfunction, avoidance behavior, poor health behaviors, depressive symptoms, and negative social relationships [3]. It must be emphasized that traumatic stress reactions can differ according to the experienced event: In cases of technological or natural disasters or major terrorist attacks, the tendency is to increase mutual contact and look for reassurance in others [4]. This is also in line with neuroimaging studies in which specific networks of brain areas underpin post-traumatic stress disorder (PTSD) after various traumatic

Over 85% of emergency personnel involved in traumatic incidents have experienced a traumatic stress reaction at some point [7]. Events that are considered stressful include being shot at, being physically threatened, having one's family threatened, working with victims who have been badly beaten [8–10], and experiencing the death of a fellow officer and physical attacks [11, 12]. Collins and Gibbs [9] report that stressors that are most frequently identified

organizing rescue efforts in L'Aquila and the surrounding areas.

148 A Multidimensional Approach to Post-Traumatic Stress Disorder - from Theory to Practice

first to intervene at the scene to secure the area and assist other rescuers.

among police officers are most likely to involve organizational issues such as work demands, lack of control over the workload, lack of communication, and inadequate support. Several studies on first rescuers reported low levels of PTSD symptoms e.g., [13–18], although Levy-Gigi et al. [19] highlighted the hidden consequences of being repeatedly exposed to traumatic experiences. Specifically, the presence of an impaired reversal learning has emerged [20] in individuals who were not diagnosed with PTSD but were repeatedly exposed to traumatic events in the line of duty; these individuals fail to encode traumatic associations in the appropriate context [19]. Furthermore, Levy-Gigi and colleagues [19] found that the specific type of impairment may vary due to the function of the occupation; specifically, they observed differences between firefighters and crime-scene investigation police officers. One interpretation of these differences was related to the different roles that they play in an event. Generally speaking, these first responders arrive at the scene at different times: Firefighters arrive at the scene soon after the occurrence, followed by the police. Firefighters rescue people and properties, whereas the police collect and provide evidence that may be useful in court in the event of prosecution. For this reason, firefighters' actions result in immediate positive or negative feedback according to the severity of the event, but police actions do not immediately affect the event or its outcome [19]. Some studies suggest that these differences may have a role in self-perception and the subsequent development of PTSD symptoms [21].

Factors that mitigate post-traumatic stress or post-traumatic growth have not yet been established. In particular, individual differences in post-trauma outcomes and the way in which certain putative key workplace, social support, and coping variables may combine to influence these outcomes are still open to debate [22]. Coping with stress requires subjective appraisal and reappraisal of the situation [23].

The selection process for police officers includes a measurement of personality traits, and potential recruits undergo strict screening procedures prior to their acceptance into the department. Several studies empirically suggest the existence of a "police personality" [24, 25], hypothesizing that this personality is a dynamic process that is affected by life experiences and recognizes the extraordinary job experiences that are unique to police work (see [25]). Specifically, the police personality is a characteristic or a set of characteristics that are acquired by individuals after they become officers and are illustrative of the personality attributes possessed solely by police officers. These personality characteristics may be common to police officers but may not necessarily be exclusively so [25]. Personality traits are considered significant predictors of police performance [26–28], with higher levels of conscientiousness and lower levels of neuroticism identified as the most significant predictors of police membership and performance [28, 29]. In general, people who score high in conscientiousness have also been characterized by the use of active coping skills and refrain from the use of passive coping skills [30]. The term *coping* refers to cognitive and behavioral efforts that are used to manage specific external and/or internal demands that are appraised as stressful or exceeding one's personal resources [31]. Coping strategies may be either problem focused or emotion focused [32]. Problem-focused coping refers to responses that are aimed at directly altering or resolving a stressful situation, whereas emotion-focused coping refers to responses aimed at managing and regulating one's emotional reactions to the stressful situation [33]. In general, problem-focused coping strategies are more useful than emotion-focused coping strategies [34, 35]. The ability to cope with stress is considered a crucial factor within police settings. Anshel [36] individuates poor coping skills as significant predictors of high-level stress in police work. Grubb et al.'s [37] findings suggested the existence of a "police personality/profile" and linked good coping skills with the tendency to use fewer maladaptive cognitive strategies to regulate their emotions and cope with stress.

In the present study, we investigated the role of personal traits and coping strategies in developing or being resilient to post-traumatic stress disorder as well as in predicting posttraumatic growth. For this reason, we interviewed police officers who responded to three different catastrophic events that occurred in 2009 and 2013. We asked to the respondents to freely recall and imagine the event, as well as imagining that the perspective changed. We then analyzed the number of memories reported, emotions, and personal experiences as part of the three instructions in the modified cognitive interview (CI).

We also analyzed the three groups to investigate the differences related to the specific event in which they participated.

We hypothesized the following observations: (1) proactive coping strategies are seen more often than maladaptive strategies, and the type of coping style may be associated with the presence of trauma symptoms; (2) the observation of specific personality traits are not observed because of the homogeneous sample, that is, we compared police officers involved in different types of disasters but not different types of rescuers; and (3) differences are found only for L'Aquila earthquake event because only in this event did rescuers experience the stress of being both primary and secondary victims.
