Some relevant debate concerning the efficacy of debriefing in various settings has re-emerged as a result of the recent incident in New York, Pennsylvania and Washington, DC. The following was forwarded to me by Penny Dahlen. At the end of these comments, I have added some additional information for those interested. I encourage debate and comments on these important areas.This information came from the CESNET-LISTSERV. **********************************************************************
-----Original Message-----
From: Lynn Brandsma [mailto:lynn.brandsma@VILLANOVA.EDU]
Sent: Tuesday, September 18, 2001 10:59 AM
To: CESNET-L@LISTSERV.KENT.EDU
Subject: Re: NYTimes.com Article: Some Therapists
CautionThatTraumaServicesCould Backfire
The following URLs may be of interest to those following this debate over debriefing. The second and third ones in particular are from the Cochrane Collaboration, part of the UK Dept. of Health mental health guidelines. Following a thorough and comprehensive literature review, the Cochrane report strongly recommends against the routine use of debriefing following traumatic or stressful events. It is noteworthy that this report was a collaborative effort supported by the government, general practitioners, psychiatrists, counselors, psychologists, and some advocacy groups.
http://taxa.psyc.missouri.edu/abnormal/2000/msg00065.html http://www.update-software.com/abstracts/ab000560.htm http://www.doh.gov.u k/mentalhealth/treatmentguideline/
I would also recommend the following sources for reviews of debriefing:
Gist, R., Lubin, B., & Redburn, B.G. (1998). Psychosocial, ecological, and community perspectives on disaster response. Journal of Personal and Interpersonal Loss, 3, 25-51.
Mayou, R.A., Ehlers, A., & Hobbs, M. (2000). Psychological debriefing for road traffic accident victims. British Journal of Psychiatry, 176, 589-593.
Dishion, T. J., McCord, J., & Poulin, F. (1999). When interventions harm: Peer groups and problem behavior. American Psychologist, 54(9), 755-764.
Gottfredson, G.D. (1987). Peer group interventions to reduce the risk of delinquent behavior: A selective review and a new evaluation. Criminology, 25, 671-714.
Lohr, J.M., Montgomery, R.W., Lilienfeld, S.O., & Tolin, D.F. (1999, in press). Pseudoscience and the commercial promotion of trauma treatments. In R. Gist and B. Lubin (Eds.), Response to disaster: Psychosocial, community, and ecological approaches (pp. 291-326). Washington, DC: Taylor and Francis.
Gist, R., & Lubin, B. (1999). Response to disaster: Psychosocial, community, and ecological approaches. Philadelphia: Brunner/Mazel.
Richard Gist, a community psychologist and firefighter who is a leading expert in this area, has summed up the evidence concerning debriefing thusly:
"1) There is no demonstrable preventive effect from this intervention (to wit, it clearly does not alter likelihood of PTSD or other sequelae);
2) What palliative effect it may provide is no greater than nor demonstrably superior to that achieved through any other venue of discussion or exchange;
3) No data have appeared in any refereed venue that would suggest the superiority of any current model over any other;
4) Paradoxical effects, very possibly of iatrogenic origin, have been demonstrated in several independent studies;
5) The more rigorous the study, the more objective its measurements and protocols, the more discerning the venue of publication, and the more independent the researchers from the "CISM movement" itself, the more likely it has been to find neutral to negative assessments."
In the wake of this terrible tragedy, there is much that needs to be done and much that we can do. But let's make sure that our efforts are in the right direction.
Lynn
Lynn Brandsma, Ph.D. Villanova University Dept. of Education and Human Services Villanova, PA 19085 lynn.brandsma@villanova.edu
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NYTimes.com Article: Some Therapists Caution ThatTraumaServicesCould Backfire
There are actually several studies suggesting that debriefing may be harmful. One can find flaws with any single study, but the convergence of a body of literature suggesting negative effects should give pause to those who promote these interventions. In addition, the proponents of debriefing simply assume that it works, despite the absence of empirical evidence. The onus is on the proponents of debriefing to demonstrate its safety and effectiveness before marketing it to vulnerable persons. Such demonstration is even more critical when serious questions exist about potential negative effects in some individuals.
Lynn
Lynn Brandsma, Ph.D. Dept. of Education & Human Services Villanova University lynn.brandsma@villanova.edu
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Deb Pender wrote:
The literature that is cited as finding harmful effects is Based upon at least one study done in England where they did not follow the protocols for formal debriefing, misapplied the concepts for individual women facing miscarriage, and did not provide follow-up interventions. Not surprising this was found harmful. Debriefing, as defined in the CISM model is not conducted until an event is over. While the crisis is still occurring, efforts are direct towards sharing accurate & brief information and shoring up defenses. The primary mechanism is to make sure people are coping well enough to continue what they are doing and to scene out those who are impaired to the level of needing a higher level of support and monitoring, including hospitalization and intensive psycho-therapy. Back to debriefing: the ICISF Model of CISM services, included eight major means of intervening all based on timing and appropriateness of each intervention. Debriefing is ONLY used when the event is over. The ICISF protocols include guidelines that no one is forced to speak if they do not want to do so. It is a psycho-educational structure group intervention. Rarely are people ordered to attend. When they are debriefers respect their boundaries and encourage them to share only if they choose. Often they will share their own ideas of what helps them get through tough times. Debriefers who follow the protocols, do not attempt to do psychotherapy. Debriefing is not psychotherapy nor a substitute for psychotherapy. In the course of the debriefing we may recognize individuals who need more help and private follow-up with them to see if they would like a referral or brief one on one time with a trainer peer.
Then debriefing is only finished after the follow-up in completed. There are many more guidelines connected to the process. I defer you to Everly, G. S. & Mitchell, J.T.(2000). The debriefing "controversy" and crisis intervention: A review of the lexical and substantive issues. International Journal of Emergency Mental Health, Vol 2 (4) 211-226.
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NYTimes.com Article: Some Therapists Caution That Trauma ServicesCould Backfire
Ed and others,
I just found out early this morning that the NY Times picked this up. The article did not include the editorial so I thought I would pass it along to you. It was sent to the APA Monitor. This was signed by 19 helping professionals. I was one of those. Here it is:
Primum non nocere. The enormity of the tragic events of September 11 is difficult to grasp. There can be little doubt that the psychological impact of these horrific events will be felt at both individual and community levels for days, months, and even years to come. As psychologists, our instinct is to help, and indeed there is much that we can do. As citizens, we can give blood and make financial contributions to emergency organizations. As specialists in human behavior, we can offer our support to victims and their families. We can do our best to empathize with their suffering, and we can reinforce constructive coping responses. In concert with other health care providers, we can offer appropriate psychological services to those who develop psychological disorders such as post traumatic stress disorder or depression.
But in times like these it is imperative that we refrain from the urge to intervene in ways that--however well intentioned--have the potential to make matters worse. Several independent studies now demonstrate that certain forms of postdisaster psychological debriefing (treatment techniques in which survivors are strongly suggested to discuss the details of their traumatic experience, often in groups and shortly after the disaster) are not only likely to be ineffective, but can be iatrogenic. Unfortunately, this has not prevented certain therapists from descending on disaster scenes with well-intentioned but misguided efforts. Psychologists can be of most help by supporting the community structures that people naturally call upon in times of grief and suffering. Let us do whatever we can, while being careful not to get in the way.
Lynn Brandsma, Ph.D.
> Villanova University
> Dept. of Eduacation and Human Services
> Villanova, PA 19085
> lynn.brandsma@villanova.edu
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Someone who has done a lot of work and research in this area is Suzanna Rose. She is a research counselor at the Cognition, Emotion and Trauma Group in the Department of Psychology at Royal Holloway at the University of London. She is also a clinical nurse specialist in psychological trauma at the Posttraumatic Stress Clinic in London's West Middlesex University Hospital. She has worked for the British Red Cross and prior to the 1991 Persian Gulf War, she went to Baghdad and brought out hostages from Iraq. She also counseled relatives of those who died in the Locharbie plane terrorist bombing over Scotland in 1988. She supports evidence-based research on the efficacy of debriefing and has published a number of seminal articles on the topic, primarily in European journals. She presented material on the topic in Laramie two years ago at the Rocky Mountain Region Disaster Mental Health Conference.
For further information on Debriefing research, mass casualties, terrorism and disaster mental health and PTSD, Children and families in disasters, and other relevant topics, go to the conference proceedings web page at:
https://www.angelfire.com/biz/odochartaigh/conference.html
I will send additional comments in the next few days. Those of you who wish to make comments or other responses, plesae do so and send your comments to me at: GeorgeDoherty@mail2consultant.com
Thanks in advance.
George W. Doherty
O'Dochartaigh Associates
P.O. Box 786
Laramie, WY 82073-0786
Rocky Mountain Region Disaster Mental Health Newsletter https://www.angelfire.com/biz3/news
Critical Incident Stress Workshops - Laramie, WY - November 16-17, 2001 https://www.angelfire.com/biz3/news/cismuw.html
