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Psychological Debriefing

Jonathan L. Bisson, Alexander McFarlane, and Suzanna Rose

The following fact sheet is posted with permission from the Journal of Traumatic Stress and was originally printed in Volume 13, Number 4, pp. 555-557. These treatment guidelines, as well as guidelines for other effective PTSD treatments, are reprinted in the book Effective Treatments for PTSD ¹.

Description

Psychological debriefing (PD) has been widely advocated for routine use following major traumatic events. Several methods of PD have been described, although most researchers consider a PD to be a single-session semistructured crisis intervention designed to reduce and prevent unwanted psychological sequelae following traumatic events by promoting emotional processing through the ventilation and normalization of reactions and preparation for possible future experiences. PD was initially described as a group intervention, one part of a comprehensive, systematic, multicomponent approach to the management of traumatic stress, but it has also been used with individuals and as a stand-alone intervention. Its purpose is to review the impressions and reactions of clients shortly after a traumatic incident. The focus of a PD is on the present reactions of those involved. Psychiatric "labeling" is avoided, and emphasis is placed on normalization. Participants are assured that they are normal people who have experienced an abnormal event.

General Strength of the Evidence

Identified studies vary greatly in their quality, but, overall, the quality of the studies, including the randomized controlled trials, is poor. The studies provide little evidence that early PD prevents psychopathology following trauma but confirm that it is well received overall by participants. Some negative outcomes following individual PD were found, but, overall, the impact of early PD was neutral when all the identified studies were considered collectively. The only positive randomized, controlled trial involved a combination of group PD and education conducted 6 to 9 months after a hurricane.

Course of Treatment

PD has generally been described as a group intervention lasting up to a few hours shortly after (often within a few days) a traumatic event, and as one component of a critical-incident stress management program. It has also been described as a one-time intervention for individuals and as one component of a treatment package for chronic PTSD.

Recommendations

Indications

Given the current state of knowledge neither one-time group or individual PD can be advocated as being able to prevent the subsequent development of PTSD following a traumatic event (Level B). However, there may be benefits to aspects of PD, particularly when it is employed as part of a comprehensive management program (Level C). There appears to be good evidence that it is a well-received intervention for most people (Level A), and even though it may not prevent later psychological sequelae, it may still be useful for screening, education, and support. It may be that appeals for "flexibility" in the therapeutic approach to immediate trauma survivors, such as those published following the Kings Cross Fire ², are important. The possibility that group PD, in combination with an educational session several months after a traumatic event, may be effective has been raised by one positive study but clearly needs replicating.

Contraindications

Some studies of individual PD have raised the possibility that the intense reexposure involved in the PD can retraumatize some individuals without allowing adequate time for habituation, resulting in a negative outcome (individual; Level B). Therefore, if PD or any similar intervention is to be employed, it is essential that it is provided by experienced, well-trained practitioners, that it not be mandatory, and that potential participants be properly clinically assessed. If employed, the intervention should be accompanied by clear and objective evaluation procedures to ensure that it is meeting set objectives.

Summary

The absence of rigorous research in this area is disappointing. It is essential that efforts be made to determine what, if anything, should be offered to individuals following traumatic events. The results of randomized, controlled trials, and other trials, indicate that one-time PD for individuals following traumatic events does not prevent the development of later psychological sequelae, but it is a well- received intervention for most people. It would be premature to conclude that PD should be discontinued as a possible intervention following trauma, but there is an urgent need for randomized, controlled trials, especially with group PD as part of a comprehensive traumatic-stress management program, and with alternative early interventions. Given the current state of knowledge, it would seem most appropriate to focus on detecting individuals who develop PTSD (perhaps through detecting acute stress disorder) or other disorders following traumatic events and offering them treatments that have been shown to work. The role of education is unclear and needs further evaluation, but basic education about trauma psychology, potential symptoms, and how to seek help without considering the traumatic event in detail may represent an appropriate way of detecting individuals who require more complex intervention.

References

1. Foa, E., Keane, T., & Friedman, M. (2000). Effective Treatments for PTSD. New York: Guilford Press.

2. Turner, S.W., Thompson, J. A. & Rosser, R. M. (1989). The king's cross fire: Planning a "phase two" psychosocial response. Disaster Management, 2, 31-37.