Emotional or educational debriefing after psychological trauma: Randomised controlled trial
Sijbrandij M, Olff M, Reitsma JB, Carlier IV, Gersons BP;
Commented by , 24 Aug 2006
Background
Psychological debriefing is commonly offered to survivors of traumatic events. There is little evidence, however, to support the efficacy of psychological debriefing in preventing post-traumatic stress disorder (PTSD).
Aims of the study
To re-examine the effect of psychological debriefing on the occurrence of symptoms of PTSD, anxiety and depression in survivors of traumatic events.
Method
Randomized controlled study comparing the efficacy of emotional ventilation debriefing, educational debriefing and no debriefing on the occurrence of PTSD in 236 survivors of a traumatic event, at two weeks, 6 weeks and 6 months. Symptoms of PTSD were assessed with the Structured Interview for PTSD (SI-PTSD), symptoms of anxiety and depression with the Hospital Anxiety and Depression Scale (HADS).
Results
Symptoms of PTSD, anxiety and depression decreased over time in all three groups. There was no significant difference in SI-PTSD and HADS scores between the three groups. At the six-week follow-up, participants with high baseline hyperarousal scores had significantly higher SI-PTSD scores if they had received emotional debriefing than similar participants in the control group.
Professor Pull's comments
Individuals who have been exposed to life-threatening events are at increased risk for PTSD. To mitigate acute emotional distress and to prevent the emergence of PTSD, different methods of early intervention have been proposed over the years.
The method of early intervention most widely used follows the Critical Incidents Stress Debriefing (CISD) protocol originally designed by Mitchell (ref. 1) for the debriefing of groups of participants. The CISD protocol includes elements of emotional ventilation and elements of education. It has seven phases, including an introduction, a fact phase, a thought phase, a feeling phase, a reaction phase, a strategy phase, and a re-entry phase.
After an introductory phase, the facilitator asks each participant, in turn, to first describe what happened during the trauma (fact phase), then to describe their thoughts (thought phase), and their feelings (feeling phase) as the traumatic event was unfolding, and to report whether they are experiencing any psychological or physical stress reactions (reaction phase).
In the two last phases, the facilitator provides educational information to the group as well as stress management tips (strategy phase), summarizes what has occurred during the session, and clears up any misunderstandings (re-entry phase).
According to Mitchell and Everly (ref. 2), research on CISD interventions "proves their clinical effectiveness far beyond reasonable doubt." This opinion has, however, been challenged by many authors in recent years. A number of randomized controlled trials and meta-analyses did not find any differences between debriefed and non-debriefed trauma victims in terms of prevalence rates for PTSD, symptoms of PTSD, anxiety or depression.
Moreover, the results of several studies suggest that trauma victims may in fact be at higher risk for adverse outcomes as a result of debriefing.
In the present study, the authors did not find any significant outcome differences between trauma victims who had received psychological debriefing and those who had not, with one exception: a subgroup of patients with high baseline hyperarousal had more PTSD symptoms at 6 weeks than control participants. As such, the results give support to a growing body of research data that cast doubt not only on the efficacy but also on the inocuity of psychological debriefing.
References
1. Mitchell JT. When disaster strikes...the critical incident stress debriefing process. Journal of Emergency Medical Services 1983; 8 (1); 36-39
2. Mitchell JT, Everly GS Jr (2001). Critical Incident Stress Debriefing: An Operations Manual for CISD, Defusing and Other Group Crisis Intervention Services; 3rd ed. Ellicott City; Md.: Chevron Publishing Corporation