Evidence Based Practice and Psychological Debriefing
BackgroundEvidence based practice is increasingly being used to make treatment policy decisions. This paper describes the basis and rationale of evidence based practice in counselling and psychotherapy including the use of systematic reviews and the work of the Cochrane Collaboration. The application under discussion will be the examination of the empirical evidence surrounding single session psychological ‘debriefing’ for adults.
Over approximately the last fifteen years early psychological interventions such as psychological 'debriefing' have been increasingly used to treat psychological trauma. While these interventions have become popular and their use spread to several settings - efficacy had largely not been tested empirically. In 1997 a systematic review of single session psychological "debriefing" was undertaken and this subsequently became a protocol and Cochrane Review published in 1998 (Issue2). A substantive update of the review was published in 2001 and a further update is currently in preparation for publication later this year. This presentation will present findings from the last review and indicate current good practice as seen from a European perspective.
Methodology of the review to be presented
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,SOCIOFILE, CINAHL, PSYCINFO, PSYNDEX, SIGLE, LILACS, CCTR, CINAHL, NRR, 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 & analysis
11 trials fulfilled the inclusion criteria. Quality was generally poor. Data from two trials could not be synthesised. Two trials involved the use of the intervention in an obstetric setting.
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 (odds ratio 1.22 (95% ci 0.60 to 2.46)). At one year one trial reported that there was a significantly increased risk of PTSD in those receiving debriefing (odds ratio 2.88 (1.11 to 7.53)) odds ratio 95%).
There was also no evidence that debriefing reduced general psychological morbidity, depression or anxiety.
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.
Ref: Rose S, Bisson J and Wessely S. Psychological debriefing for preventing post-traumatic stress disorder (PTSD) (Cochrane Review). In the Cochrane Library, 2004 Issue 1 Oxford: Update Software.
