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Notes From the Presenters
-Lang’s theory centered around subjective report, avoidance beahvior, and psycho- physiological disturbance -McFarlane (1988) found that Australian firefighters involved in a series of bushfires who developed a delayed-onset PTSD reaction were more likely to receive debriefing than those who hadn’t. -Deahl et al. (1994) found no differences between Gulf war soldiers (gravediggers) who recieved PD soon after the incident and those who did not. -Hyton & Hasle (1989) did not find differences between those firefighters who recieved PD and those who did not after exposure to multiple dead bodies following a major hotel fire. -Griffiths & Watts, 1992 - even though reported to be helpful, those who attended PD showed sig. higher scores for morbidity and distress on general health questionnaire and impact of Events scale. -Kenardy et al., - workers after earthquake had general decrease in sx w/ less improvement over 2 yrs - still rated as helpful. -Brom et al., 1993 - demonstrated no difference w/ grp of road traffic accident victims. Early interventions found to be effectuve, but riddled with problems from research design problems included (Raphael 77, Duckworth 86). -Robinson & Mitchell, 1993 - welfare workers subjective reports 2 wks after debriefing were positive and indicative of decreasing stress. Mitchell said that not everyone in every instance will benefit from a CISD." Some may not need any additional professional assistance following a distress-related event whereas some may need more. -Flannery et al 1991 said - may lead to passive participation and resentment if " forced" to attend these programs (amer. hostage/Iran). -McFarlane (1989) concerned that overenthusiasm for primary prev. mehtods may delay dx and effective treatment of those who DO suffer psych. sequelae. -Raphael, Meldrum, McFarlane, 1995 - debriefing may exaggerate the traumatic process or may be assoc. w/ delayed presentation as in Kenardy & Watts 94 said. -threat to life and hx. of psych. problems correlated w/ psot-traumatic morbidity and subsequent relationship problems. -Koopman et al., 94 - debriefing may not work ucz doesn’t take account of subjects levels of arousal, defensive styles and coping processes, cogn. impairments assoc. w/acute trauma, dissociatvie phenomena relating to traumatic experienc, and other pathogenic influences (past trauma reflects this concept - but no studies on effectiveness - not all trauma composed of single element (ex., threat of life), loss, separation, and dislocation also separate stressors to address - need diff. interventions/timing. -what if PD medicalizes normal responses to stress. -are reactive processes in PD really "symptoms" or natural phases to recovery lead to secondary traumatization?? (Raphael & Muldrum et al, 1995). -presence of absence of factors such as acute stress reaction, personality, past psychiatric hx. , adeuqate social support are likely to affect psych. outcome more than presence/absence of PD, If indiv. have an adquate support network and don’t have other vulnerability factors, PD may be redundant. -Bisson & Deahle, 94 - future research use sound methodologyw/ propsective controlled design and random allocation, attn to adequate measurement of dimensions of truama, vars that may affect the outcome, and both pre and pst tx asessement. -working group of Lincolnshire Joint Emergency Services Initiative for Staff at risk following critical incidents to review published outcome evidence and consider implications for future delivery of staff-supported services m- said pub. evid inconclusive - imprudent to continue calims for PD - d/c use of CISD protocol in fall of ’97. -it can improve quality of life for emergency providers, allow them to discuss their feelings and reactions to a critical incident, and deal with burnout, safety issues, stress, anxiety, and grief (Ostrow, 96). -prevents long-term psychotherapy? – havent’ seen clear results on that yet. -it is very difficult for people to self report the onset of fear. Even after witnessing or being involved in a traumatic event, individuals may have difficulty attributing later problems to actual events that occurred at the time of the disaster. Are those w/ delayed onset different from those with observable acute sx. after trauma. -Rachman went on to discuss fear acquisition by transmission of information and/or instruction. While there may not be sufficient evidence to support these notions, Rachman identified these alternative pathways (either vic or info-driven) as important paths to consider.
