Thoughts on Psychological Debriefings: A Noted Authority on Psychological Debriefings Cautions against "Throwing the Debriefing Baby out with the Reactionary Bath Water" in the Debate over Post-Traumatic Stress Disorder

Article excerpt

In the past several years, debate over the efficacy of psychological debriefings has intensified. While controversy and examination often generate useful discussion, the recent trashing of debriefings as a viable service seems a bit reactionary (if not downright unjustified) and is founded on inadequate and poorly designed research.

Part of the problem is that somewhere along the line, someone apparently said or inferred that debriefings prevent post-traumatic stress disorder (PTSD). That is certainly a naive notion. Most mental health professionals understand that if an individual experiences an incident or process that results in a bona fide diagnosis of PTSD, a single intervention of any type will not suffice to manage the disorder. A multi-modal approach of talk therapy in combination with medication and other interventions, such as eye movement desensitization and reprocessing (EMDR), hypnosis, cognitive behavioral therapy, exercise, and support groups, usually is required to deal with the disorder over an extended period of time.

Some "experts" have even made the remarkable assertion that debriefings may, in fact, cause PTSD. According to an article in Crisis Management Quarterly, "Possibly because CISDs focus on re-hashing and re-telling upsetting events, a diagnosis of PTSD could be more likely. As a result, a negative outcome, supported by the growing body of reputable research, could provide the basis for lawsuits alleging negligence in an organization's crisis response." (1)

There is little question that a debriefing must comprise more than "re-hashing and re-telling upsetting events" or it will be of limited benefit. Nonetheless, more and more organizations are dismissing debriefings based on faulty studies and naive misconceptions. For example, the American Red Cross and the American Psychological Association stated in a draft conclusion that post-trauma debriefings "have not been shown to prevent later difficulties and may even cause problems to become entrenched or more severe over time." (2)

An equally valid hypothesis may be that since debriefings are voluntary, only those who are truly upset about an incident will decide to attend a debriefing, and these individuals may be so traumatized they will develop PTSD even if they do not attend an intervention. Moreover, some people may recognize the symptoms of PTSD as a result of attending a debriefing and then decide to avail themselves of further services. We will never know, because anyone who understands research design is aware of the impact of self-selection bias on statistical results.

Some studies refer to the Cochrane Library and position it as the benchmark analysis in the field. (3) The Cochrane Library looked at studies of individuals from many different facilities who received crisis interventions that bore "little resemblance" to psychological debriefings and that sometimes were used in "situations where major stress reactions are not expected." (4) The interventions were provided by a diverse group of practitioners without the benefit of a specific model.

Comparing the Cochrane Library to debriefings is an "apples to oranges" proposition. As the British Psychological Society noted, "There are serious flaws in many of the studies that evaluate debriefings. Several fail to define debriefing or describe the protocol used or the training of the debriefers." (5) Again, minus a valid research design, we should hesitate to decimate an intervention that, at the least, has a fair amount of anecdotal support.

PSYCHOLOGICAL AGENDAS

Another possible reason for the controversy over debriefings is that some mental health professionals prescribe a rather rigid intervention structure. While having a theoretical framework or intervention model is important, it is impossible to take a one-size-fits-all approach to psychological debriefings. I have always felt, for example, that a critical incident stress debriefing (CISD) is designed strictly for police, fire, and emergency medical and mental health personnel who are in the forefront of crisis, trauma, and disaster response or who deal directly with the victims of such incidents. …