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PubMed2001

A review of psychological debriefing after extreme stress.

Preventive intervention after exposure to traumatic events is a subject of increasing interest among mental health professionals. Psychological debriefing, which aims to reduce the risk of posttraumatic stress disorder and other psychopathological sequelae of traumatic experiences, is an example of such an intervention. The authors review the history of psychological debriefing and examine its efficacy. They conclude that psychological debriefing might be an effective intervention after extreme stress, although more support from controlled studies is required.

Accidents, Traffic↗

PubMed2005

Reactions to treatment debriefing among the participants of a placebo controlled trial.

BACKGROUND: A significant proportion of trial participants respond to placebos for a variety of conditions. Despite the common conduct of these trials and the strong emphasis placed on informed consent, very little is known about informing participants about their individual treatment allocation at trial closure. This study aims to address this gap in the literature by exploring treatment beliefs and reactions to feedback about treatment allocation in the participants of a placebo-controlled randomized clinical trial (RCT). METHODS: Survey of trial participants using a semi-structured questionnaire including close and open-ended questions administered as telephone interviews and postal questionnaires. Trial participants were enrolled in a double-blind placebo-controlled RCT evaluating the effectiveness of corticosteroid for heel pain (ISRCTN36539116). The trial had closed and participants remained blind to treatment allocation. We assessed treatment expectations, the percentage of participants who wanted to be informed about their treatment allocation, their ability to guess and reactions to debriefing. RESULTS: Forty-six (73%) contactable participants responded to our survey. Forty-two were eligible (four participants with bilateral disease were excluded as they had received both treatments). Most (79%) participants did not have any expectations prior to receiving treatment, but many 'hoped' that something would help. Reasons for not having high expectations included the experimental nature of their care and possibility that they may get a placebo. Participants were hopeful because their pain was so severe and because they trusted the staff and services. Most (83%) wanted to be informed about their treatment allocation and study results. Over half (55%) said they could not guess which treatment they had been randomized to, and many of those who attempted a guess were incorrect. Reactions to treatment debriefing were generally positive, including in placebo responders. CONCLUSION: Our study suggests that most trial participants want to be informed about their treatment allocation and trial results. Further research is required to develop measure of hope and expectancy and to rigorously evaluate the effects of debriefing prospectively.

Adrenal Cortex Hormones↗

PubMed1993

Screening and psychological debriefing of adolescent survivors of life-threatening events.

There is a perceived need for schools and casualty departments to receive appropriate information and guidelines in order to minimise the effect of PTSD. A recommended screening battery for PTSD was administered at the start of a two-session debriefing group and again three months later to a group of seven young survivors of a minibus accident. No studies using this screen other than those of shipping disasters have been reported to date. Screen scores were compared with those of survivors of the cruise ship Jupiter. No significant differences were found between minibus survivors when assessed at six months (before intervention), and Jupiter survivors, who when assessed at five months had already undergone debriefing. Post-debriefing assessment of minibus survivors demonstrated significant reductions on all measures.

Adaptation, Psychological↗

PubMed1994

Psychological sequelae following the Gulf War. Factors associated with subsequent morbidity and the effectiveness of psychological debriefing.

BACKGROUND: The aim was to study the effect of brief counselling and psychological debriefing following a trauma on subsequent morbidity. METHOD: We investigated psychological morbidity in 62 British soldiers whose duties included the handling and identification of dead bodies of allied and enemy soldiers during the Gulf War. Of these soldiers, 69% received a psychological debriefing on completion of their duties. The subjects completed by post a demographic questionnaire, the General Health Questionnaire (GHQ-28) and the Impact of Events Scale. RESULTS: After nine months 50% had evidence of some psychological disturbance suggestive of posttraumatic stress disorder (PTSD); 18% had sought professional help; 26% reported relationship difficulties. Neither prior training nor the psychological intervention appeared to make any difference to subsequent psychiatric morbidity. Morbidity at nine months was more likely in those with a history of psychological problems and those who believed their lives had been in danger in the Gulf. CONCLUSIONS: These findings show that a psychological debriefing following a series of traumatic events or experiences does not appear to reduce subsequent psychiatric morbidity and highlights the need for further research in military and civilian settings.

Adult↗

PubMed1999

Theoretical perspectives of traumatic stress and debriefings.

The purpose of this article was to attempt to identify and examine the core set of elements or factors which are germane to understanding the process and effects of traumatic stress and psychological debriefings. Before these factors are addressed, relevant questions regarding the nature, level of care, and implementation of debriefings are raised. A person-environment interactional model is used to explain the typologies of traumatic events and stressor dimensions. Factors considered fundamental to crisis response, goals common to debriefings, and the need to recognize the diversity of traumatic events are then reviewed.

Crisis Intervention↗

PubMed1999

Critical incident stress debriefing (CISD): a meta-analysis.

Psychological debriefings represent a genre of group crisis interventions. Critical Incident Stress Debriefing (CISD) represents the oldest standardized variation of this genre. Recent reviews have called into question the effectiveness of CISD. In this study 5 previously published investigations were meta-analyzed revealing a large effect size (Cohen's d = .86) supporting the notion that the CISD model of psychological debriefing is an effective crisis intervention.

Crisis Intervention↗

PubMed2001

Financial services employees' experience of peer-led and clinician-led critical incident stress debriefing following armed robberies.

This study investigates financial services employees' experience of critical incident stress debriefing (CISD) and their views about peers and clinicians as facilitators. Semi-structured interview accounts of four participants who had experienced both peer-led and clinician-led CISD were analyzed using grounded theory. A core category, ambivalence, permeated each interview and divided into two poles: pathologizing and normalizing. The most frequently occurring sub-category was a dislike of professionalism. Participants preferred the peer debriefer who was perceived to have more personal involvement and with whom they felt more empowered and understood. The findings suggest that the status of the debriefer as 'peer' or 'clinician' may be a crucial variable in the effectiveness of CISD and should be considered when reviewing the outcome literature.

Adult↗

PubMed2003

Evaluation of stress debriefing interventions with military populations.

Military members are frequently exposed to traumatic events. In an attempt to mitigate the psychological impact of traumatic events, formal interventions, such as Critical Incident Stress Debriefing and Process Debriefing, have been developed and implemented. Through a literature review of psychological debriefing interventions in the military, several anecdotal and research-based observations are discussed. Suggestions for clinical application and programmatic research are made based on these empirical findings.

Combat Disorders↗

PubMed2004

The effectiveness of critical incident stress debriefing with primary and secondary trauma victims.

Critical incident stress debriefing (CISD) (Mitchell, 1983) has been under intense scrutiny recently in the psychology literature. Several authors have concluded that CISD has no effect or even negative effects on victims of trauma (Bisson, McFarlane, & Rose, 2000; van Emmerik, Kamphuis, Hulsbosch, & Emmelkamp, 2002). This review calls these conclusions into question by critically contrasting: (1) studies that utilize CISD with emergency services personnel ("secondary" victims of trauma, for whom the CISD and the larger Critical Incident Stress Management models were first created) and (2) studies that utilize CISD with primary victims of trauma. This review suggests that CISD is an effective method of reducing risk for PTSD-related symptoms in emergency services personnel. However, when debriefings are conducted with primary victims of traumatic events (e.g., accident victims, burn victims still in the hospital), the results are much less promising. The authors conclude that protocols are needed for interventions with primary victims to help mitigate the impact of trauma on this population. Appropriate interventions might include risk assessment and appropriate referral services, or in some instances, focused psycho-educational group debriefings. Further research is clearly warranted to examine the effectiveness of alternative interventions for the primary victim population.

Crime Victims↗

PubMed2006

Critical incident stress debriefing for law enforcement: practical models and special applications.

Critical incident stress debriefing (CISD) has evolved and diversified to address the needs of various subpopulations of public safety and emergency services personnel, including law enforcement. This article describes the concept of critical incident stress as it applies to police officers and other law enforcement agents. It then discusses the traditional debriefing models and the specialized modifications and applications that have been introduced to deal with the needs of law enforcement individuals and groups. Next, the role of peer-debriefing is described in addressing law enforcement critical incident stress, as well as specific examples of model programs within different types of law enforcement agencies. Finally, the as yet incompletely resolved legal and administrative issues surrounding the use of peers versus professional clinicians for critical incident intervention are addressed.

Adult↗

PubMedDate not supplied

Clinical placement: prebriefing and debriefing as teaching strategies.

This paper discusses use of debriefing processes as a teaching strategy. Such an everyday session in the clinical setting is distinguished from conventional debriefing in critical incident or post-trauma emergency situations. The group processes described can also be used to defuse fears before students experience clinical placement. Debriefing sessions are most valuable following the clinical placement day when students' heads may be whirling from over-stimulation of various kinds. The sessions facilitate use of therapeutic communication skills. They work with student emotions and affirm feelings as an integral aspect of teaching-learning. They also provide a forum in which students may practise assertive interventions in role play relevant to specific unsatisfactory interactions experienced on the ward. Positive feedback from the clinical teacher and peers helps build up student confidence.

Emotions↗

PubMed1993

Debriefing: a therapeutic intervention.

An injured soldier may not have the benefit of the mental health interventions available to other combatants. A team of psychiatric liaison nurses report on the therapeutic effects of debriefing in the treatment of the traumatically injured soldier. Debriefing not only affords an opportunity for the patient to share thoughts and feelings about the trauma, but provides additional data regarding effective coping mechanisms. This information also assists the health care team to identify individuals at risk for developing post-traumatic stress disorder. Patient teaching can then be directed toward helping each individual recognize the signs and symptoms of stress unique to him/her and mobilize a plan for obtaining assistance. Debriefing also assists the treatment team in identifying a soldier's specific information deficits regarding the system, i.e., medical boards and convalescent leaves.

Combat Disorders↗

PubMed1993

Multicultural factors in the space environment: results of an international shuttle crew debrief.

There is increasing interest and concern about the multicultural and multinational factors which might negatively affect adjustment and performance of Space Station Freedom (SSF) crews, living and working for long periods of time in the space environment. To begin identifying potential problem areas, a crew debrief questionnaire (called an "International Crew Debrief") was mailed to U.S. astronauts who flew on Shuttle missions between 1981-1990 with one or more crewmembers from other countries. There were 20 U.S. astronauts who flew on international space missions; 9 of these responded to the questionnaire, for a return rate of 45%. There were 42 incidents reported: 9 in the preflight period; 26 inflight; and 7 in the postflight period. Most of these incidents were rated as having a low or medium impact, but five of the inflight incidents were rated to have a "high" mission impact. A number of causes for the problems were listed, and are discussed. Debrief respondents provided useful and timely recommendations on preflight training which may help facilitate the integration of multinational crews, and prevent multicultural or multinational factors from interfering with mission operations.

Cultural Characteristics↗

PubMedDate not supplied

Do nurses perceive that there is a need for defusing and debriefing following the resuscitation of a patient in the accident and emergency department?

Defusing and debriefing are techniques that have been used to prevent staff developing psychological problems such as post traumatic stress disorder (Mitchell, 1988). It has been identified that nurses may be susceptible to a form of post-traumatic stress disorder known as prolonged duration stress disorder (Scott and Stradling, 1994). This study employs a non-experimental survey to identify the current practice of defusing and debriefing in an accident and emergency department and explores nurses' perceptions of the need for defusing and debriefing following the resuscitation of a patient. A theoretical framework of cognitive therapy is utilised to structure the study.

Attitude of Health Personnel↗

PubMed1994

A strategy for trauma debriefing after railway suicides.

Following an increase in the incidence of railway suicide from an average of four events a year up to 1989 to 12 in 1990 an initiative was developed between the District Department of Clinical and Community Psychology, Exeter Health Authority and British Rail, Western Region. Traincrew leaders and management had become increasingly aware of the severity of the short- and long-term effects on drivers of experiencing a suicide. Although a management strategy had been developed over time to deal with what had been a rare phenomenon it was clear that such a dramatic increase in suicides warranted a more professional approach to debriefing and trauma counselling. This paper describes the strategies adopted by psychologists in developing an understanding of the stresses of experiencing suicides and other major incidents. The outcome of small group sessions with affected drivers is outlined. An account of the strategy developed through workshops with traincrew leaders is detailed and a three-stage debriefing (shock, search, adjustment) and follow-up protocol is discussed. This process is proposed for adoption as normal procedure following suicides or similar traumas for drivers and line managers.

Adaptation, Psychological↗

PubMed2000

Education and debriefing: strategies for preventing crises in crisis-line volunteers.

Telephone crisis lines offer an important service to individuals in crisis. The accessibility as well as a lack of other means of support leads many individuals to call the line. The role of the volunteer is to listen and support the caller as well as provide information and referrals to other agencies. Agencies are presented with a high turnover of volunteers and are then faced with the task of recruiting and training replacements. Volunteers are often exposed to horrific accounts of human pain and suffering which may affect their personal thoughts, feelings, beliefs and actions and influence the decision to quit. Compassion fatigue is one term used for this inherent "cost of caring." Many factors contribute to this cost including the nature of crisis calls, the repeat caller, and personal coping mechanisms. Educating and debriefing the volunteer are two strategies that may prevent the onset of compassion fatigue and volunteer resignation. Debriefing is viewed as an effective strategy for volunteers as it has been found to be successfull in assisting other helpers in many different contexts to cope and deal with the traumatic events that they experience or hear about.

Burnout, Professional↗

PubMed1997

Jail suicide and the need for debriefing.

Although first introduced more than 15 years ago, Critical Incident Stress Debriefing (CISD) has not been frequently utilized within the correctional community. As a structured protocol designed to prevent or mitigate traumatic stress, CISD has two main goals: (1) to lessen the impact of distressing critical incidents on the personnel exposed to them; (2) to accelerate recovery from those events before harmful stress reactions have a chance to damage the performance, careers, health, and families of personnel responding to emergencies. The need for debriefing remains acute. Whenever I conduct a jail-suicide prevention training seminar and explain the importance of the CISD process, correctional officers invariably approach me at the end of the workshop and begin to explain their experience with an inmate's suicide. Their voices are always characterized by frustration. This is one officer's story.

Adaptation, Psychological↗

PubMed2001

Effectiveness of psychological debriefing.

OBJECTIVE: To identify literature concerning the effectiveness of psychological debriefing (PD) and analyse results according to different criteria of success and different uses of the intervention format. METHOD: Literature search was made in databases PubMed, PsycInfo and Psychlit. Twenty-five studies were selected for a thorough description. Forty-two studies provided additional information. RESULTS: Results indicate that, in general, debriefing does not prevent psychiatric disorders or mitigate the effects of traumatic stress, even though people generally find the intervention helpful in the process of recovering from traumatic stress. The intervention holds potential as a screening procedure, and there may be economic arguments for continued use. When used with adherence to traditional descriptions of treatment group, events, group format, leadership and time spent, a preventive effect emerges. No tendency according to timing was found. CONCLUSION: Current uses of PD are problematic. The concept needs to be redefined, and the scope of application must be revised. The objectives for use need to be clarified.

Crisis Intervention↗