Psychological Debriefing
National Center for PTSD Fact Sheet
By Jonathan L. Bisson, Alexander McFarlane, and Suzanna Rose
The following fact sheet is posted with permission from the Journal of
Traumatic Stress and was originally printed in Volume 13, Number 4, pp.
555-557. These treatment guidelines, as well as guidelines for other effective
PTSD treatments, are reprinted in the book Effective Treatments for PTSD1.
Description
Psychological debriefing (PD) has been widely advocated for routine use
following major traumatic events. Several methods of PD have been described,
although most researchers consider a PD to be a single-session semistructured
crisis intervention designed to reduce and prevent unwanted psychological sequelae
following traumatic events by promoting emotional processing through the
ventilation and normalization of reactions and preparation for possible future
experiences. PD was initially described as a group intervention, one part of a
comprehensive, systematic, multicomponent approach to the management of
traumatic stress, but it has also been used with individuals and as a
stand-alone intervention. Its purpose is to review the impressions and
reactions of clients shortly after a traumatic incident. The focus of a PD is
on the present reactions of those involved. Psychiatric "labeling" is
avoided, and emphasis is placed on normalization. Participants are assured that
they are normal people who have experienced an abnormal event.
General Strength of the Evidence
Identified studies vary greatly in their quality, but, overall, the quality
of the studies, including the randomized controlled trials, is poor. The
studies provide little evidence that early PD prevents psychopathology
following trauma but confirm that it is well received overall by participants.
Some negative outcomes following individual PD were found, but, overall, the
impact of early PD was neutral when all the identified studies were considered
collectively. The only positive randomized, controlled trial involved a
combination of group PD and education conducted 6 to 9 months after a
hurricane.
Course of Treatment
PD has generally been described as a group intervention lasting up to a few
hours shortly after (often within a few days) a traumatic event, and as one
component of a critical-incident stress management program. It has also been
described as a one-time intervention for individuals and as one component of a
treatment package for chronic PTSD.
Recommendations
Indications
Given the current state of knowledge neither one-time group or individual PD can be advocated as being able to prevent the subsequent development of PTSD following a traumatic event (Level B). However, there may be benefits to aspects of PD, particularly when it is employed as part of a comprehensive management program (Level C). There appears to be good evidence that it is a well-received intervention for most people (Level A), and even though it may not prevent later psychological sequelae, it may still be useful for screening, education, and support. It may be that appeals for "flexibility" in the therapeutic approach to immediate trauma survivors, such as those published following the Kings Cross Fire2, are important. The possibility that group PD, in combination with an educational session several months after a traumatic event, may be effective has been raised by one positive study but clearly needs replicating.
Contraindications
Some studies of individual PD have raised the possibility that the intense
reexposure involved in the PD can retraumatize some individuals without
allowing adequate time for habituation, resulting in a negative outcome
(individual; Level B). Therefore, if PD or any similar intervention is to be
employed, it is essential that it is provided by experienced, well-trained
practitioners, that it not be mandatory, and that potential participants be
properly clinically assessed. If employed, the intervention should be
accompanied by clear and objective evaluation procedures to ensure that it is
meeting set objectives.
Summary
The absence of rigorous research in this area is disappointing. It is essential
that efforts be made to determine what, if anything, should be offered to individuals
following traumatic events. The results of randomized, controlled trials, and
other trials, indicate that one-time PD for individuals following traumatic
events does not prevent the development of later psychological sequelae, but
it is a well- received intervention for most people. It would be premature to
conclude that PD should be discontinued as a possible intervention following
trauma, but there is an urgent need for randomized, controlled trials, especially
with group PD as part of a comprehensive traumatic-stress management program,
and with alternative early interventions. Given the current state of knowledge,
it would seem most appropriate to focus on detecting individuals who develop
PTSD (perhaps through detecting acute stress disorder) or other disorders following
traumatic events and offering them treatments that have been shown to work.
The role of education is unclear and needs further evaluation, but basic education
about trauma psychology, potential symptoms, and how to seek help without considering
the traumatic event in detail may represent an appropriate way of detecting
individuals who require more complex intervention.
Related Fact Sheets
Critical
Incident Stress Debriefing
Discussion of CISD: a facilitator-led group process conducted soon after a
traumatic event with individuals under stress from trauma exposure
Cognitive-Behavioral
Therapy
Answers questions about the effectiveness of Cognitive-Behavioral Therapy as
a technique for early intervention
Common
reactions to trauma
An explanation of common reactions to trauma by Dr. Edna Foa
Symptoms
Learn about how traumatic experiences affect people, what survivors need to
know, and the common symptoms of PTSD
References
1. Foa, E., Keane, T., & Friedman, M. (2000). Effective Treatments for
PTSD. New York: Guilford Press.
2. Turner, S.W., Thompson, J. A. & Rosser, R. M. (1989). The king's cross fire: Planning a "phase two" psychosocial response. Disaster
Management, 2, 31-37.
Suggested Readings
Mitchell, L. T. (1983). When disaster strikes ... Journal of Emergency
Medical Services, 8, 36-39.
Raphael, B., Meldrum, L., & McFarlane, A. C. (1995). Does debriefing
after psychological trauma work? British Medical Journal, 310, 1479
-1480.
Rose, S. (1997). Psychological debriefing: History and methods. Counselling-The
Journal of the British Association of Counselling, 8, 148-15 1.
Wessely, S., Rose, S., & Bisson, J. (1998). A systematic review of
brief psychological interventions ("debriefing") for the treatment of
immediate trauma related symptoms and the prevention of posttraumatic stress
disorder [CD-ROM]. Oxford, UK: Update Software, Inc.
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