Years ago, I treated an officer who had been in a shooting. On the day of the shooting, he fought hard for his life. He fought even harder in the years that followed to get his life back. As a clinician trained in eye movement desensitization and reprocessing (EMDR), I was able to help him put this horrific event into the past, psychologically speaking. Yet years of suffering had taken its toll. While relieved, he questioned why nobody had told him about EMDR and how we could do better at getting the information out there. I responded that I was doing my best, having written an article about EMDR in the December 2021 issue of APB (see apbweb.com/2021/12/emdr-a-treatment-for-trauma) and trained agencies on support options. After our session, I continued to reflect on that conversation, unsatisfied with my response. He wasn’t the only officer who had not heard of EMDR and suffered needlessly.

In investigating what others were doing around the world to increase first responders’ access to EMDR or a trauma-informed protocol, I found what I could never have predicted: a cop-turned-counselor who had created an EMDR-based peer-led intervention called Acute Stress Adaptive Protocol, or ASAP for short. I contacted one of the developers, Sonny Provetto, and asked about the training and how it could be safely delivered by peer supporters who are not licensed mental health providers. Here’s what I learned.

ASAP can be the lifeline that lets officers drop the weight of cumulative trauma while teaching them skills to better navigate the turbulent waters.

What is ASAP?

ASAP is based on key components of EMDR. As a reminder, I’ve written an article on EMDR, as has fellow APB contributor Dan Willis in the April 2021 issue (see apbweb.com/2021/04/ptsd-treatment-that-works). It has become the treatment of choice for first responders because it is highly effective with assisting the brain to process stuck memories, giving significant relief from symptoms of PTSD. The problem, as the opening story illustrates, is that it isn’t helpful if cops don’t know about it. Compounding the issue is that there aren’t enough clinicians trained in EMDR. Even if there were enough trained clinicians, some first responders won’t seek counseling. Research from a survey conducted by the Fraternal Order of Police shows that officers are more likely to seek support from a peer than a clinician.^[1]Fraternal Order of Police (2018). Report on FOP/NBC Survey of Police Officer Mental and Behavioral Health. fop.net/officer-wellness/survey According to the survey, 69% said they felt that an incident had a lingering effect on them. This, coupled with the fact that 90% felt that there was a stigma for asking for help, is quite troubling. The survey also reported that 73% of respondents stated that peer support was one of the most helpful options. Yet officers also didn’t feel like there were enough resources to them. This leaves us with concern about their wellness and wondering how to increase access to resources. ASAP is a very timely, appropriate tool, as it brings the intervention to the first responder and is delivered by those cited to be one of the most helpful options.

Is it safe and evidence-based?

EMDR is reserved for licensed mental health providers for good reasons. So the creators of ASAP, certified EMDR consultants, took great care to develop a protocol that is safe for non-licensed providers to offer. ASAP training includes information about trauma, critical incident stress, the benefits of mindfulness and trauma processing. The training involves significant practice, with feedback support and ongoing consultation after the training. Like any other specialty skill, not all peer supporters need to be trained in ASAP. As always, peer teams are also well advised to have an EMDR-trained clinician attached to the team for additional support.

ASAP has been administered over the last two years to more than 650 first responders and has been used by peers for critical incidents such as officer-involved shootings (OIS). One key aspect of the protocol is that officers are silent and do not have to share elements of the traumatic event. With over 500 first responders and 145 organizations trained in the protocol, it is routinely regarded as a “game changer.” Research with these 500 first responders has shown that one ASAP session resulted in a 66% reduction in distress, with an additional 42% reduction after the second ASAP. Additional research shows a 44% reduction in PTSD symptoms and a 50% reduction in moral injury.^[2]2 Farrell, D., Provetto, S., Moran, J., Lavis, T., Miller, P., & Kiernan, M. (2024). Intensive Treatment for PTSD and Moral Injury — The Vermont Protocol: A Proof-of-Concept Study. EMDR … Continue reading^[3]Farrell, D., Provetto, S., Moran, J., Lavis, T., Miller, P., & Kiernan, M. (2023). Adapting EMDR Group Interventions for the Purpose of Task-Shifting — Addressing the Global Burden of Trauma. … Continue reading

What should I expect from an ASAP session?

Brevity: Conducting an ASAP takes between 45–60 minutes. The first 10 minutes serves to introduce the process and the facilitators. Attendees are not introduced to afford anonymity in multiagency ASAP drop-in sessions. The next 15–20 minutes are mindfulness exercises, followed by another 15–20 minutes of processing the troubling event(s) that brought attendees to the ASAP. The duration of the event is similar between individual and group delivery.

Privacy: ASAPs are set up classroom style, with attendees facing forward and not each other. Instead, attendees are looking at the back of the head of the person in front of them. In this way, the visibility of facial expressions is very limited at best.

Confidentiality: Attendees do not talk about their reason for being there. Ten people can be there for the same call or for 10 different events, personal or professional. Since there is no talking, there is no concern regarding confidentiality.

Mindfulness exercises: Facilitators(s) guide attendees through three mindfulness exercises that, on their own, are great tools for managing everyday stress. If attendees decide to leave after this phase, they would still significantly benefit from attending this part. In an ASAP, attendees are facilitated to Step 1: Practice focusing; Step 2: Focus on a positive memory; and Step 3: Focus on one of their strengths. These mindfulness exercises counteract three understandable but problematic tendencies stemming from first responder work: 1) to have their mind a million places at once, 2) to focus on negative events or memories and 3) to be self-critical.

Distress reduction: Like EMDR, attendees will rate their level of distress at various times throughout the ASAP. Facilitators will quickly scan the distress score (on a 0–10 scale) written on a form that attendees have in front of them. Attendees keep this form for themselves, and no record is kept of what was seen by facilitators. They are just trying to ensure that they make themselves available for anyone who might want more support. The benefits of the ASAP are immediate for many, with additional processing and benefit occurring over the next two to three days.

Follow-up support: At the conclusion of the distress reduction phase, attendees are invited to remain for refreshments and connect with any facilitator, peer support person, chaplain or clinician as desired.

When and where to use or offer an ASAP

Critical incident: Like a critical incident debriefing, an ASAP can be incident-driven and open to anyone involved in the incident. It can be offered to the entire group or, if preferred, on a one-on-one basis. Peer support teams with ASAP-trained peers are advised to note this designation in their team roster.

Drop-in basis: Many agencies have chosen to offer drop-in ASAPs for anyone wishing to attend. For instance, they will offer it once a month at rotating times and days to allow equal access for varying schedules.

As with other interventions, ASAP is best offered off-site to promote confidentiality. It is also best to offer it off duty when attendees are not expected to report for duty immediately afterward.

ASAP as a line upstream

We can all do better at working upstream with tools like ASAP. Officers should never have to find themselves at the bottom of the waterfall, wondering how they got there. ASAP can be the lifeline that lets them drop the weight of cumulative trauma while teaching them skills to better navigate the turbulent waters.