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PubMed2005

Debriefing after critical incidents for anaesthetic trainees.

This survey investigated the need, and the availability, of debriefing after critical incidents for training anaesthetists. A cross-sectional postal survey of all Australian anaesthetic trainees was conducted in May 2002. Four hundred and nineteen responses were analysed (response rate 64%). Debriefing after a critical incident was perceived by most trainees to be useful, however 36% (n = 149) had never been debriefed. Trainees ranked their preferred content for a debriefing as 'anaesthetic issues' followed by the 'psychological impact of the incident' 'patient issues' and 'surgical issues'. Almost half of respondents reported that they did not feel supported by their anaesthetic department after a negative outcome incident. Trainees who had debriefings were more likely to feel supported by senior colleagues. Debriefing after critical incidents should be an integral part of the supervision of anaesthetic trainees.

Adult↗
PubMed1998

Debriefing of American Red Cross personnel: pilot study on participants' evaluations and case examples from the 1994 Los Angeles earthquake relief operation.

The Multiple Stressor Debriefing (MSD) model was used to debrief 112 American Red Cross workers individually or in groups after their participation in the 1994 Los Angeles earthquake relief effort. Two composite case examples are presented that illustrate individual and group debriefings using the MSD model. A questionnaire which evaluated workers' experience of debriefing, was completed by 95 workers. Results indicated that workers evaluated the debriefings in which they participated positively. In addition, as participant to facilitator ratio increased, workers shared less of their feelings and reactions about the disaster relief operation. These findings, as well as more specific issues about debriefing, are discussed.

Adult↗
PubMed2003

[The role of psychological debriefing in the treatment of victims of trauma].

The application of psychological debriefing has become an expected and widespread intervention following exposure to trauma. This article assesses the wisdom of such an approach and reports upon expert consensus regarding its use. Meta-analytic and narrative reviews are summarised and areas of agreement and disagreement are outlined. In sum, it was concluded that the majority of people do not become traumatised from stressful events; that generic psychological debriefing, when applied to individuals, appears to have little impact on functioning; that a specific form of debriefing called Critical Incident Stress Debriefing holds the possibility of noxious effects for some participants and that those most deleteriously affected by debriefing appear to be those most distressed by the initial trauma; that there is no randomised controlled trial evidence to support the validity of group debriefing approaches; and that early intervention using Cognitive Behavioural techniques for those with clinically significant presentations appears the most promising approach. A generic set of guidelines for intervention following trauma is provided.

Crisis Intervention↗
PubMed1999

Conditions affecting experiences of the quality of psychological debriefings: preliminary findings from a grounded theory study.

The aim of the study was to develop a theoretical understanding of conditions and mechanisms affecting experiences of the quality of emotional debriefings, using a grounded theory approach. Twenty interviews were conducted with experienced male debriefing leaders and participants in the Stockholm fire brigade and the Swedish armored United Nations battalions serving in Bosnia. Data were analyzed according to the constant comparative method. A model was formulated according to which the quality of debriefings is formed by the dynamic interplay between group and debriefing leader characteristics. The key group and debriefing leader quality is security. Furthermore, individual group member resourcefulness and vulnerability, together with the degree of knowledge and support from the management of the organization, also affect experiences of the quality of debriefings. The model is discussed in relation to existing thoughts on potentially favorable mechanisms.

Adult↗
PubMed2001

The effects of group psychological debriefing on acute stress reactions following a traffic accident: a quasi-experimental approach.

The purpose of this study was to evaluate the effects of a Group Psychological Debriefing (GPD) on acute stress reactions and perceptions following a traumatic situation. A group of military personnel (N = 9) and a group of voluntary civilian firefighters (N = 9) were exposed to severe stress during rescue work in a tunnel following a fatal traffic accident. Both groups participated in an operational debriefing and received brief stress management counseling after the incident. In addition the military personnel also participated in a structured 2.5 hour GPD after the accident. Two weeks later both groups completed the Coping Style Questionnaire (CSQ-30), the Impact of Event Scale (IES), the Post Traumatic Symptom Scale (PTSS-10), the General Health Questionnaire (GHQ-30) and questions about stress and coping after the incident. Lower frequency of symptoms were found in the GPD compared to the non-debriefed group measured by the PTSS-10. Single item analyzes of the scale revealed lower levels of symptoms related to emotional arousal in the GPD participants. Furthermore, the GPD participants revealed more positive personal outcomes than the non-debriefed group after the accident. The total PTSS-10 score and mental preparedness were the two variables that were best able to classify participants as belonging to the two groups, thus indicating significant clinical differences between the debriefed and non-debriefed group and the potential usefulness of PTSS-10 scale as a brief screening inventory after traumatic events.

Accidents, Traffic↗
PubMed1998

Historical group debriefing after combat exposure.

BACKGROUND: Studies of group debriefing after extreme events have failed to show a significant long-term effect of this technique. However, the heterogeneity of the interventions studied and the length of time between debriefing and its assessment do not allow a proper interpretation of these findings. OBJECTIVE: This study evaluates the immediate effect of debriefing in Israeli soldiers exposed to combat. METHOD: Six small units (N = 39) have undergone historical group debriefing within 72 hours of exposure. State anxiety, self-efficacy, and combat evaluation were measured before and immediately after the sessions. RESULTS: Debriefing was followed by reduction in anxiety, improvement in self-efficacy, and increased homogeneity of the group. CONCLUSION: These effects may be attributable to enhancing group cohesion or to a proper beneficial effect of debriefing.

Crisis Intervention↗
PubMed2006

An analogue study of the effects of Psychological Debriefing on eyewitness memory.

Sixty-one participants from the community participated in a randomised controlled trial of group debriefing to assess the effect of this intervention upon memory for a stressful event. Participants were randomly allocated to one of three groups: debriefing; debriefing with an experimenter confederate present (who supplied three pieces of misinformation to the group regarding the stressful event); and a no-treatment control. All groups were shown a very stressful video and were again reviewed after 1 month. Members of the debriefing group where a confederate provided misinformation were more likely to recall this misinformation as fact than members of the other two groups. The debriefing group was also more accurate in their recall of peripheral content than the confederate group. Across all groups, participants were found to be more accurate at central rather than peripheral recall yet more confident for incorrect memories of the video than correct memories.

Adult↗
PubMed2001

Effect of timing of critical incident stress debriefing (CISD) on posttraumatic symptoms.

Seventy-seven civilian employees who were victims of robbery were randomly assigned to either an immediate (< 10 hr) or delayed (> 48 hr) debriefing group, using the J. Mitchell (1983) CISD protocol. Scores on the Posttraumatic Stress Diagnostic Scale were obtained at 4 time intervals: debrief, 2 and 4 days post-debrief, and 2 weeks postrobbery. The number and severity of symptoms did not differ at debrief, but were lower for the immediate than for the delayed group at each subsequent time interval. The number and severity of symptoms declined across time intervals; however, although this reduction was pronounced for the immediate group it was minimal for the delayed group. The results supported use of immediate debriefing with this type of incident and victim.

Adolescent↗
PubMed2001

Evaluating psychological debriefing: are we measuring the right outcomes?

The efficacy of critical incident stress debriefing (CISD) and psychological debriefing (PD) following potentially traumatising events has recently been challenged after a number of recent randomised controlled trials (RCTs) failed to demonstrate that CISD or PD prevents or reduces the incidence of posttraumatic stress disorder (PTSD). These studies have used measures of PTSD as the principal outcome and have generally not measured comorbid psychopathology, behavioral or social dysfunction. In a recent RCT of group debriefing amongst British soldiers returning from peacekeeping operations in Bosnia, PD had a significant effect in reducing a worrying level of alcohol misuse in the sample. The findings of this study suggest that that it is premature to conclude that debriefing is ineffective and that a broader range of outcome measures should be employed in future trials of debriefing.

Adult↗
PubMed1997

The process in psychological debriefings.

Critical Incident Stress Debriefings have become an intervention method used in various cultures, countries and groups following critical incidents. Although the structure of such meetings has been adequately described, utilization of the group processes involved has received less attention. A model, process debriefing (PD), based on experiences from Europe, is presented. Some differences between the current CISD process in the United States and the Europe based model are outlined. Various factors that impact the process of debriefings are discussed with a special emphasis on leadership, and implications of these group process variables for psychological debriefing are presented. It is emphasized that the continued exploration and discussion of process issues is critical to advance the understanding of the critical elements of debriefing.

Crisis Intervention↗
PubMed2000

Psychological debriefing: controversy and challenge.

OBJECTIVE: The efficacy of psychological debriefing following potentially traumatising events has become extremely controversial. This review aims to identify the issues underlying this controversy and their theoretical, social and political ramifications which are important in other areas of psychiatry and the social sciences. METHOD: The historical background to the debriefing debate and the (largely negative) results of recent randomised controlled trials (RCTs) are reviewed. RESULTS: Despite the negative results of recent RCTs, psychological debriefing remains the most widely used structured intervention following potentially traumatising events, designed to reduce the incidence of long-term psychiatric morbidity. The clinical relevance these trials and their applicability in vivo is questioned. There are implicit difficulties in conducting rigorous randomised controlled trials of group debriefing, and such trials may be unachievable. CONCLUSIONS: Demonstrating the efficacy of debriefing or other preventive interventions presents major challenges to investigators and it is unlikely the controversy will be resolved in the near future.

Crisis Intervention↗
PubMed2000

Randomised controlled trial of midwife led debriefing to reduce maternal depression after operative childbirth.

OBJECTIVE: To assess the effectiveness of a midwife led debriefing session during the postpartum hospital stay in reducing the prevalence of maternal depression at six months postpartum among women giving birth by caesarean section, forceps, or vacuum extraction. DESIGN: Randomised controlled trial. SETTING: Large maternity teaching hospital in Melbourne, Australia. PARTICIPANTS: 1041 women who had given birth by caesarean section (n= 624) or with the use of forceps (n= 353) or vacuum extraction (n= 64). MAIN OUTCOME MEASURES: Maternal depression (score >/=13 on the Edinburgh postnatal depression scale) and overall health status (comparison of mean scores on SF-36 subscales) measured by postal questionnaire at six months postpartum. RESULTS: 917 (88%) of the women recruited responded to the outcome questionnaire. More women allocated to debriefing scored as depressed six months after birth than women allocated to usual postpartum care (81 (17%) v 65 (14%)), although this difference was not significant (odds ratio=1.24, 95% confidence interval 0.87 to 1.77). They were also more likely to report that depression had been a problem for them since the birth, but the difference was not significant (123 (28%) v 94 (22%); odds ratio=1. 37, 1.00 to 1.86). Women allocated to debriefing had poorer health status on seven of the eight SF-36 subscales, although the difference was significant only for role functioning (emotional): mean scores 73.32 v 78.98, t= -2.31, 95% confidence interval -10.48 to -0.84). CONCLUSIONS: Midwife led debriefing after operative birth is ineffective in reducing maternal morbidity at six months postpartum. The possibility that debriefing contributed to emotional health problems for some women cannot be excluded.

Adult↗
PubMed2000

Participants' understanding of the process of psychological research: debriefing.

In a broad-based study of experiences in psychological research, 65 undergraduates participating in a wide range of psychological experiments were interviewed in depth. Overall findings demonstrated that participants hold varying views, with only 32% of participants characterizing their experiences as completely positive. Participants' descriptions of their debriefing experiences suggest substantial variability in the content, format, and general quality of debriefing practices. Just over 40% of the debriefing experiences were viewed favorably. Positive debriefing experiences were described as including a thorough explanation of the study and detailed information concerning the broader relevance of the experiment to the field of psychology. The most common complaint, characterizing 28.8% of the responses, was that the debriefing was unclear and that insufficient information was provided. Participants' views of psychological research and the discipline of psychology were also elicited. Results are discussed in terms of ethical and methodological implications.

Attitude↗
PubMed1992

Pulling together: building a community debriefing team.

1. Research shows that many emergency workers are affected physically and emotionally by critical incident stress. 2. Debriefings conducted by trained team members are an effective method to mitigate the impact of critical incident stress. A debriefing is a structured, time-limited group intervention. 3. Cooperation among community agencies is essential for the development and effective functioning of a critical incident stress debriefing team. 4. Several teams in Illinois have organized to form a Critical Incident Stress Debriefing Network. The Illinois network is part of an international organization composed of critical incident stress debriefing providers.

Adaptation, Psychological↗
PubMed1999

Helpful and hurtful aspects of psychological debriefing groups.

Psychological debriefing groups have become one of the most common interventions to help people in trauma and crisis. The rapid spread of such groups makes it important to consider both positive and possible negative results of such groups. Debriefing groups provide an opportunity for normalization of a crisis experience. However, as with any powerful intervention, there is the danger that such groups may harm participants. Good leadership reduces the possibility of a negative outcome and requires an emphasis on the early parts of the debriefing to build trust and authority. This, as well as different ways of handling problems in the group process, are outlined. Future challenges to the genre of psychological debriefing are presented, including when not to use debriefing groups.

Adaptation, Psychological↗
PubMedDate not supplied

[Secondary prevention of posttraumatic stress disorder: challenging psychological debriefings].

This paper examines the efficacy of secondary prevention procedures following a trauma (psychological debriefing). After examining psychological processes leading to the onset of PSTD, 3 prevention procedures are presented: the CISD of Mitchell, the debriefing procedure of Brom and Kleber, and a cognitive and behavioral debriefing procedure. Outcome studies of these procedures are reviewed. They suggest that CISD has no proven efficacy, while the cognitive and behavioral debriefing procedure significantly decreases the probability of onset of PTSD following a trauma. Guidelines are provided for designing optimal debriefing procedures.

Humans↗
PubMed1995

Traumatic event debriefing: service delivery designs and the role of social work.

Traumatic events are incidents that lie outside the range of usual human experience and are so powerful that they are capable of overwhelming any person's normal coping abilities and causing severe stress reactions. Traumatic event debriefing (TED), conducted 24 to 72 hours after exposure to the traumatic event, uses a form of intensive group crisis intervention. The method is designed to help reduce acute stress symptoms and accelerate the recovery process, thereby diminishing the subsequent development of posttraumatic stress disorder. Social workers have the precise constellation of skills, social-environmental perspectives, and practice methodologies indispensable both to developing TED teams and to leading the debriefings. This article addresses the evolution of debriefing-type psychological interventions for trauma victims, the debriefing process itself, three environment-specific debriefing team designs, and the unique qualifications of social workers to develop and lead the teams.

Crisis Intervention↗
PubMed1993

Emergency nurses' perceptions of critical incidents and stress debriefing.

INTRODUCTION: This is a descriptive study of questionnaire responses of 682 members of three state ENAs, with supporting interview data from 26 of those participants. The objective was to determine (1) the types of clinical events perceived as critical and (2) the usefulness of critical incident stress debriefings for emergency nurses. METHODS: Questionnaires asking emergency nurses to rate clinical incidents as critical and to respond to questions about their experiences with debriefings were sent to members of three state ENAs. Structured interviews about personal experiences with critical incidents and debriefings were conducted with 26 respondents. RESULTS: Emergency nurses responding to the questionnaire viewed the death of a child and the death of a coworker as the most critical of the possible events. The majority of interviewees saw an incident related to the death of a child as the most critical in their careers. Of the questionnaire respondents, 32% had participated in debriefings; 88% of those found them helpful in reducing critical incident stress. DISCUSSION: The findings suggest that managers should be alerted to the possibility of acute stress responses when emergency nurses experience a child's death. Education regarding stress and debriefings may be helpful to ED personnel.

Adult↗