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Brief psychological interventions ("debriefing") for trauma-related symptoms and the prevention of post traumatic stress disorder.

OBJECTIVES: To assess the effectiveness of brief psychological debriefing for the management of psychological distress after trauma, and the prevention of post traumatic stress disorder. SEARCH STRATEGY: Electronic searching of MEDLINE, EMBASE, PsychLit, PILOTS, Biosis, Pascal, Occ.Safety and Health, CDSR and the Trials Register of the Depression, Anxiety and Neurosis group. Hand search of Journal of Traumatic Stress. Contact with leading researchers. SELECTION CRITERIA: The inclusion criteria for all randomized studies was that they should focus on persons recently (one month or less) exposed to a traumatic event, should consist of a single session only, and that the intervention involve some form of emotional processing/ventilation by encouraging recollection/reworking of the traumatic event accompanied by normalisation of emotional reaction to the event. DATA COLLECTION AND ANALYSIS: 8 trials fulfilled the inclusion criteria. Quality was generally poor. Data from two trials could not be synthesised. MAIN RESULTS: Single session individual debriefing did not reduce psychological distress nor prevent the onset of post traumatic stress disorder (PTSD). Those who received the intervention showed no significant short term (3-5 months) in the risk of PTSD (pooled odds ratio 1.0, 95% ci 0.6-1.8). At one year one trial reported that there was a significantly increased risk of PTSD in those receiving debriefing (odds ratio 2.9, 95% ci 1.1-7.5). The pooled odds ratio for the two trials with follow ups just included unity (odds ratio 2.0, 95% ci 0.9-4.5). There was also no evidence that debriefing reduced general psychological morbidity, depression or anxiety. REVIEWER'S CONCLUSIONS: There is no current evidence that psychological debriefing is a useful treatment for the prevention of post traumatic stress disorder after traumatic incidents. Compulsory debriefing of victims of trauma should cease.

Crisis Intervention↗

A model for a statewide critical incident stress (CIS) debriefing program for emergency services personnel.

PURPOSE: Emergency services personnel are highly vulnerable to acute and cumulative critical incident stress (CIS) that can manifest as anger, guilt, depression, and impaired decision-making, and, in certain instances, job loss. Interventions designed to identify such distress and restore psychological functioning becomes imperative. METHODS: A statewide debriefing team was formed in 1988 through a collaborative effort between an academic department of emergency medicine and a social work department of a teaching hospital, and a metropolitan area fire department and ambulance service. Using an existing CIS debriefing model, 84 prescreened, mental health professionals and emergency services personnel were provided with 16 hours of training and were grouped into regional teams. Debriefing requests are received through a central number answered by a communicator in a 24-hour communications center located within the emergency department. Debriefings are conducted 48-72 hours after the event for specific types of incidents. Follow-up telephone calls are made by the debriefing team leader two to three weeks following a debriefing. The teams rely on donations to pay for travel and meals. RESULTS: One hundred sixty-eight debriefings were conducted during the first four years. Rural agencies accounted for 116 (69%) requests. During this period, 1,514 individuals were debriefed: 744 (49%) firefighters, 460 (30%) EMTs, and 310 (21%) police officers, dispatchers, and other responders. Deaths of children, extraordinary events, and incidents involving victims known to the responders (35%, 14%, and 14% respectively) were the most common reasons for requesting debriefings. Feedback was received from 48 (28%) of the agencies that requested the debriefing. All of those who responded felt that the debriefing had a beneficial effect on its personnel. Specific individuals identified by agency representatives as having the greatest difficulty were observed to be returned to their pre-incident state. CONCLUSIONS: CIS debriefings are judged as beneficial. A statewide response team is an effective way to provide these services at no cost to agencies.

Adaptation, Psychological↗

The influence of occupational debriefing on post-traumatic stress symptomatology in traumatized police officers.

Certain individuals, such as police officers, are exposed to traumatic events as part of their occupational roles. In an effort to prevent psychological illnesses, notably the post-traumatic stress disorder, from arising out of work-related traumatic incidents, psychological interventions have been developed such as Critical Incident Stress Debriefing (Mitchell, 1983; Mitchell & Everly, 1996). The present study tests the hypothesis that debriefing reduces the psychological morbidity caused by work-related incidents. Because debriefing techniques were not designed for application on a 'one-off' basis (Robinson & Mitchell, 1993), the procedure studied here consisted of three successive debriefing sessions (at 24 hours, 1 month and 3 months post-trauma), which included traumatic stress education. In a sample of 243 traumatized police officers, a subgroup of debriefed officers (N = 86) was compared with non-debriefed internal (N = 82) and external (N = 75) control groups. No differences in psychological morbidity were found between the groups at pre-test, at 24 hours or at 6 months post-trauma. One week post-trauma, debriefed subjects exhibited significantly more post-traumatic stress disorder symptomatology than non-debriefed subjects. High levels of satisfaction with debriefing were not reflected in positive outcomes. The findings are translated into recommendations for the future use of debriefing in police practice.

Adult↗

The critical incident stress debriefing process for the Los Angeles County Fire Department: automatic and effective.

Los Angeles County Fire Department has one of the oldest Critical Incident Stress Management (CISM) programs in the country. One core component for the LACoFD has been the Critical Incident Stress Debriefing (CISD). Two important questions for the emergency managers are: 1) Do individuals find a significant difference in symptom reduction for events that were debriefed? 2) Does helpfulness of a debriefing for a specific individual correlate with recommending the process for others? A Department-wide evaluative survey was conducted in 1996 to determine the satisfaction and effectiveness of the debriefing program. Individuals reported a significant difference in the speed of symptom reduction for incidents that were debriefed versus incidents that were not debriefed. The majority of individuals would recommend the debriefing process to others regardless of whether they personally found the process helpful or not. Based on this, the recommendations are to continue the debriefing process for specific events and to make the process mandatory; furthermore, it is recommended that the term "mandatory" be changed to "automatic." By using the term "automatic," debriefings become standard operating procedures. By doing so, a method to protect the psychological welfare of emergency personnel becomes as automatic as putting on safety protection equipment [International Journal of Emergency Mental Health, 2000, 2(4), 249-257].

Adaptation, Psychological↗

A review of the literature on debriefing or non-directive counselling to prevent postpartum emotional distress.

BACKGROUND: childbirth generates powerful emotions and may lead to the development of symptoms of depression, anxiety, and trauma in some women. Debriefing and non-directive counselling have been used as early interventions to reduce the prevalence of depression and post-traumatic stress. METHODS: a review of the literature was conducted to describe the current state of knowledge on the effectiveness of a single debriefing session or non-directive counselling session to reduce depression and trauma symptoms in women following birth. FINDINGS: a total of three studies reported in four papers examined the use of debriefing or non-directive counselling to prevent or reduce psychological morbidity following birth. The two largest RCTs indicate that a single debriefing session with the woman whilst in the postnatal ward is of no statistically significant value in reducing psychological morbidity and may even be harmful. In contrast, women reported that an opportunity to talk with someone about the birth was helpful in facilitating recovery. CONCLUSION: there is insufficient evidence to draw conclusions about the effectiveness of debriefing following childbirth, primarily because it is unclear if a standardised debriefing intervention was used. Future research should clearly describe the intervention and test alternative interventions; measure a broader range of outcomes including trauma symptoms; use inclusion criteria that acknowledge the complex contributing factors to depression and trauma; and examine the value of including the woman's partner (or significant other) in the debriefing or counselling session(s). Future studies should investigate the timing or place of the intervention, the provision of more than one opportunity to discuss the birth, and target the intervention to women who are more likely to develop trauma symptoms or post-traumatic stress disorder.

Adaptation, Psychological↗

Stress debriefing and patterns of recovery following a natural disaster.

Stress debriefing has been used extensively following traumatic events; however, there is little evidence of its effectiveness. This paper reports the effects of stress debriefing on the rate of recovery of 195 helpers (e.g., emergency service personnel and disaster workers) following an earthquake in Newcastle, Australia (62 debriefed helpers and 133 who were not debriefed). Post-trauma stress reactions (Impact of Event Scale) and general psychological morbidity (General Health Questionnaire: GHQ-12) were assessed on four occasions over the first 2 years postearthquake. There was no evidence of an improved rate of recovery among those helpers who were debriefed, even when level of exposure and helping-related stress were taken into account. More rigorous investigation of the effectiveness of stress debriefing and its role in posttrauma recovery is urgently required.

Disasters↗

Debriefing following trauma.

In this paper we address three areas. First we review the literature on clinical intervention using debriefing, second we examine who attends debriefings by looking at a study of the 1989 plane crash at Ramstein, Germany and lastly we examine the effect of natural debriefing, i.e., talking to family and friends on psychiatric outcome in disaster workers by looking at a study of the Sioux City, Iowa United plane crash, 1989. Our data suggest that those with high exposure and females were more likely to attend a debriefing. People most likely to talk about the disaster with spouse/significant other, coworker and/or another person were: those with acute PTSD, higher total and intrusive Impact of Event symptoms, older, married, those with higher levels of education and higher levels of disaster exposure. Better understanding of who attends formal debriefings will help identify potential high-risk groups. Similarly, whether talking about the disaster is associated with fewer or greater psychological symptoms is important to understanding the outcome, mechanisms, and risks of debriefing.

Accidents, Aviation↗

Critical incident stress debriefing following traumatic life experiences.

This study was designed to explore the use of critical incident stress debriefing as a therapeutic intervention following traumatic life events. A case study approach was used to allow the researchers to adopt a more flexible and overtly involved stance. Initial contact took place 24 h following the traumatic life experiences of three women. Critical incident stress debriefing was provided and data were collected and recorded within an ethical framework. Six months following the traumatic life experiences the women were interviewed again to explore their perceptions of the intervention that was provided. The results demonstrated positive outcomes. The women concluded that the debriefing intervention provided a safe forum for them to explore their needs, process their experiences and create constructive narratives. A carefully constructed critical incident stress debriefing intervention was used within the context of its objectives and acknowledged limitations. The study was small and generalizations cannot be made to other individuals who experience similar tragedies. Nevertheless, evidence from previous research coupled with the findings from this study suggests that mental health nurses might benefit from being educated and trained in critical incident stress debriefing. Further research needs to be carried out to explore the use of different models of stress debriefing applied to special circumstances. The goal of such interventions should be to alleviate symptoms and to prevent the development of a full-blown post-traumatic stress disorder.

Crisis Intervention↗

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↗

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↗

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↗

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↗

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↗

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↗

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↗

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↗

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↗

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↗