**2. Method**

#### **2.1. Participants**

We recruited 15 police officers (14 men). These officers ranged from 43 to 61 years old; their educational level ranged from 8 to 18 years of schooling; and the group comprised officers who were involved in three different catastrophic events (six police officers were involved in L'Aquila earthquake, four police officers were involved in the Viareggio train derailment, and five police officers were involved in the Avellino coach crash).

To exclude the presence of traumatic job-related events that occurred in the 6 months prior to the time of the testing, all participants completed the Trauma Symptom Inventory (TSI) ([38] Italian Version: [39]). We also asked them to complete the Maslach Burnout Inventory (MBI) ([40, 41]; Italian Version: [42]) to exclude the presence of burnout. None of the participants showed the presence of PTSD or burnout.

Furthermore, all participants completed an initial form that requested information about the respondents' age and level of education, gender, area of work, grade, training, supervisory responsibilities, partnership status and number of children, and length of time in the occupation. The confidentiality and anonymity of the data were emphasized. In **Tables 1** and **2**, the means and standard deviations of the respondents' information are shown.


**Table 1.** Means and (standard deviations) are reported.

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

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

We also analyzed the three groups to investigate the differences related to the specific event

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

We recruited 15 police officers (14 men). These officers ranged from 43 to 61 years old; their educational level ranged from 8 to 18 years of schooling; and the group comprised officers who were involved in three different catastrophic events (six police officers were involved in L'Aquila earthquake, four police officers were involved in the Viareggio train derailment, and

To exclude the presence of traumatic job-related events that occurred in the 6 months prior to the time of the testing, all participants completed the Trauma Symptom Inventory (TSI) ([38] Italian Version: [39]). We also asked them to complete the Maslach Burnout Inventory (MBI) ([40, 41]; Italian Version: [42]) to exclude the presence of burnout. None of the participants

Furthermore, all participants completed an initial form that requested information about the respondents' age and level of education, gender, area of work, grade, training, supervisory responsibilities, partnership status and number of children, and length of time in the occupa-

to regulate their emotions and cope with stress.

in which they participated.

**2. Method**

**2.1. Participants**

both primary and secondary victims.

showed the presence of PTSD or burnout.

three instructions in the modified cognitive interview (CI).

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

five police officers were involved in the Avellino coach crash).


**Table 2.** Information related to the traumatic event (presence/absence).

#### **2.2. Measures**

*Big Five Questionnaire (BFQ)* (Italian version: [43, 44]) is a 132-item self-reporting inventory in its original extended form and it is commonly used to assess personality traits. The BFQ is based on the five-factor model (FFM), a widely known theory that describes personality within five broad dimensions [45]. The five factors have been defined as openness to experience, conscientiousness, extraversion/vivaciousness, agreeableness, and emotional stability. The reliability of the five dimensions of the Italian version of the BFQ (Cronbach's alpha) is within the range of 0.73–0.90, while reliability of the 10 subdimensions ranges from 0.68 to 0.86.

The respondents indicate agreement with the extent to which each item describes them on a five-point scale, ranging from complete disagreement (1 = extremely false for me) to complete agreement (5 = extremely true for me).

*Coping Inventory for Stressful Situations-Adult (CISS)* ([46]; Italian Version: [47]). This is a selfreporting inventory composed of 48 items that investigated the way the respondents react in stressful and demanding situations. The CISS measures three types of coping styles: taskorientated, emotion-orientated, and avoidance coping. It also identifies two types of avoidance patterns: distraction and social diversion. In particular, (1) the task-oriented coping style involves active and offensive coping styles, stressing proactive responses to the stressors (e.g., "I focus on the problem and see how I can solve it"); (2) emotion-oriented coping style concerns coping styles directed at altering negative emotional responses to stressors, such as negative thinking (e.g., "My efforts will surely fail"), decreased self-confidence (e.g., "I cannot handle this problem") or poor self-image (e.g., "I am useless"); and (3) the avoidance coping style represents withdrawal behaviors and the redirection of personal resources toward different activities, such as sports and leisure time (e.g., "I buy something"). The Cronbach's alpha estimates for the CISS dimensions were good (emotion-oriented coping 0.82) or acceptable (task-oriented coping 0.75, outreach-oriented coping 0.72, treat oneself-oriented coping 0.72) [48].

The respondents were asked to rate each item on a five-point scale, ranging from (1) "not at all" to (5) "very much."

*The Post-Traumatic Growth Inventory (PTGI)* ([49]; Italian Version: [50]) measures the positive outcomes reported by people who have experienced traumatic events. This scale is composed of 21 self-statements including the components of new possibilities, relating to others, personal strength, spiritual change, and appreciation of life. The respondents were asked to indicate for each statement the degree to which the change listed occurred in his/her life as the result of the crisis on a six-point Likert scale, which ranged from 0 ("I did not experience this change as a result of my crisis") to 5 ("I experienced this change to very great degree as a result of my crisis"). The intermediate scores and the changes experienced were the following: 1, a very small degree of change experienced; 2, a small degree of change experienced; (3, a moderate degree of change experienced; and 4, a great degree of change experienced. At the beginning of the inventory, the respondents were given space to indicate the difficult life event that occurred (e.g., bereavement, injury-producing accidents, separation or divorce of parents, relationship break-up, criminal victimization, illness, retirement, disaster, vehicular accident, and other events) and when it occurred. In the Italian version, the internal reliability of this instrument is Cronbach's alpha = 0.93, while the reliability of the five dimensions of the Italian version of the PTGI (Cronbach's alpha) is within the range of 0.42–0.73 [50].

**2.2. Measures**

[48].

all" to (5) "very much."

agreement (5 = extremely true for me).

*Big Five Questionnaire (BFQ)* (Italian version: [43, 44]) is a 132-item self-reporting inventory in its original extended form and it is commonly used to assess personality traits. The BFQ is based on the five-factor model (FFM), a widely known theory that describes personality within five broad dimensions [45]. The five factors have been defined as openness to experience, conscientiousness, extraversion/vivaciousness, agreeableness, and emotional stability. The reliability of the five dimensions of the Italian version of the BFQ (Cronbach's alpha) is within the range of 0.73–0.90, while reliability of the 10 subdimensions ranges from 0.68 to 0.86.

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

The respondents indicate agreement with the extent to which each item describes them on a five-point scale, ranging from complete disagreement (1 = extremely false for me) to complete

*Coping Inventory for Stressful Situations-Adult (CISS)* ([46]; Italian Version: [47]). This is a selfreporting inventory composed of 48 items that investigated the way the respondents react in stressful and demanding situations. The CISS measures three types of coping styles: taskorientated, emotion-orientated, and avoidance coping. It also identifies two types of avoidance patterns: distraction and social diversion. In particular, (1) the task-oriented coping style involves active and offensive coping styles, stressing proactive responses to the stressors (e.g., "I focus on the problem and see how I can solve it"); (2) emotion-oriented coping style concerns coping styles directed at altering negative emotional responses to stressors, such as negative thinking (e.g., "My efforts will surely fail"), decreased self-confidence (e.g., "I cannot handle this problem") or poor self-image (e.g., "I am useless"); and (3) the avoidance coping style represents withdrawal behaviors and the redirection of personal resources toward different activities, such as sports and leisure time (e.g., "I buy something"). The Cronbach's alpha estimates for the CISS dimensions were good (emotion-oriented coping 0.82) or acceptable (task-oriented coping 0.75, outreach-oriented coping 0.72, treat oneself-oriented coping 0.72)

The respondents were asked to rate each item on a five-point scale, ranging from (1) "not at

*The Post-Traumatic Growth Inventory (PTGI)* ([49]; Italian Version: [50]) measures the positive outcomes reported by people who have experienced traumatic events. This scale is composed of 21 self-statements including the components of new possibilities, relating to others, personal strength, spiritual change, and appreciation of life. The respondents were asked to indicate for each statement the degree to which the change listed occurred in his/her life as the result of the crisis on a six-point Likert scale, which ranged from 0 ("I did not experience this change as a result of my crisis") to 5 ("I experienced this change to very great degree as a result of my crisis"). The intermediate scores and the changes experienced were the following: 1, a very small degree of change experienced; 2, a small degree of change experienced; (3, a moderate degree of change experienced; and 4, a great degree of change experienced. At the beginning of the inventory, the respondents were given space to indicate the difficult life event that occurred (e.g., bereavement, injury-producing accidents, separation or divorce of parents, relationship break-up, criminal victimization, illness, retirement, disaster, vehicular accident,

*The Trauma Symptom Inventory (TSI)*. The Italian version of the TSI [39] was a translation of the original questionnaire [38] with exactly the same item numbering.

The TSI includes 100 self-statements that are subdivided into 3 validity scales (inconsistent response, response level, and atypical response scales) and 10 clinical scales. The validity scales are designed to detect conflicting, underreporting and overreporting response sets, respectively [38]. The clinical scales measure the extent to which the responder endorses the four categories of distress. Specifically, anxious arousal (AA), depression (D), and anger/irritability (AI) represent the dysphoric mood states that are often encountered by those experiencing significant psychological trauma. The scales of intrusive experiences (IE), defensive avoidance (DA), and dissociation (DIS) are designed to measure the re-experiencing and avoidance symptoms of PTSD. The sexual concerns (SC) and dysfunctional sexual behavior (DSB) scales measure attitudes and feelings regarding sex as well as sexual problems, respectively. The impaired self-reference (ISR) and tension-reduction behavior (TRB) scales tap into difficulties with the self and affect regulation, including the outward behavior manifestations that are used to manage negative effects, such as self-mutilation [38]. The internal consistency reliabilities of the Italian version of the TSI ranged from 0.71 to 0.83 for the validity scales and from 0.70 to 0.90 for the clinical scales across the samples [39]. The respondents are asked to rate the items on a four-point Likert scale, with "0" representing no experience of the symptom and "3" representing frequent occurrences over the past 6 months.

*The Maslach Burnout Inventory (MBI)* ([40, 41]; Italian Version: [42]) measures the outcome of chronic stress. This scale is composed of 22 items that rated on a frequency and intensity scale and measures three dimensions: emotional exhaustion (EE), depersonalization (D), and personal accomplishment (PA). The Cronbach's alpha estimates for the Italian version of the MBI dimensions were 0.88 for EE, 0.70 for D, and 0.83 for PA [51]. The frequency scale ranges from 0 (never) to 6 (every day), while the intensity scale ranges from 1 (never) to 6 (very strong).

*Modified Cognitive Interview (CI) protocol for investigating the traumatic event*. We used three of the four techniques used to interview the eyewitnesses in the CI; we specifically considered the context reinstatement and asked them about free recall, mental images, and the changed perspective. We did not ask participants to perform the changed order, in which the interviewees are asked to report as many details as they could in reverse order, starting with the last scene remembered. We also asked participants about the presence/absence of other events that they considered traumatic and the most traumatic event they had ever experienced, coping strategies adopted during the event, the event aftermath, the presence/absence of sleep disorders, intrusive memories of the event, health disorders, and useful suggestions they would provide to select law enforcement recruits.

In general, the procedure for the CI involved several steps. The researchers first ensured that the participant was comfortable and then asked him/her to imagine into the mood he/she experienced during the event and concentrate (if needed, he/she could also close his/her eyes for 10 s to think). Later, the researchers gave the participant the mental reinstatement of the context instruction to encourage him/her to report all information that he/she could accurately remember.

Specifically, the CI began with this recommendation: "I want that you tell me everything you can remember, every little detail you can remember, even if you think it is not important or if you are not sure about it." Four different instructions were then given. (1) The "free recall" technique [52] asked the participants to report as many as details as they could to accurately recreate the scene. This technique has been shown to be one of the most valuable components of the CI (e.g., [53]). (2) We also modified the "image" technique because we asked the participants to report as many as details as they could regarding the first and the most emotionally impactful images of the event. (3) A modified "changed perspective" technique was used, in which we asked the participants to try to observe the scene above from a bird'seye view and report as many details as they could, in addition to the emotion experienced.

### **2.3. Coding and scoring**

All CI were audio-recorded and transcribed verbatim. Later, the CIs were scored to evaluate each unit of information recalled by the participants. The units of information or details were categorized according to whether they were reported in the free recall, image, or changed perspective instructions. Two different coders (psychology post-doc students) scored the interviews; only when an agreement between them was reached were the audiotape details coded.

For all the three techniques, we extracted and analyzed the number of scenes recreated, negative emotions, vividness of mental images, and self-experiences. We also used ATLAS.ti for the analysis and coding of the interviews.
