Is psychological debriefing a harmful intervention for survivors of trauma?
Psychological debriefing (PD) is a formal form of delivering emotional and psychological aid instantly after a traumatic incident. It aims to inhibit the growth of post-traumatic stress disorder (also known as PTSD) and other adverse sequelae. Despite the extensive use of psychological debriefing, grave apprehensions have been raised about its efficiency and potential to hurt survivors of trauma.
Generally psychological debriefing interventions comprises of single session which might last between one to three hours, straightaway after a traumatic incident. The timing of the therapy and the qualifications of the personnel who provides psychological debriefing - differs; psychological debriefing is usually given to people in groups. Psychological debriefing is conducted by using different names like crisis intervention approaches, group psychological debriefing, critical incident stress debriefing, and process debriefing, and so on.
Critical Incident Stress Debriefing (CISD) is the one that is usually used and has seven phases (Mitchell, 1983; Mitchell and Everly, 2001). The psychologist initiates by describing about the nature of PD by telling that it is not a psychotherapy but rather a way to treat common stress reactions among people which are prompted by grave incidents. According to Mitchell (1983), the psychologist then probes the client with regard to the grave incident that happened in order to make the whole event come to life again in the CISD room. Following these events, the psychologist then asks the members of the group to narrate their thoughts as the event was advancing – this is known as thought phase.The psychologist then moves to the phase devised to promote emotional processing of the occurrence – this is known as feeling phase. According to Mitchell (1983), working under the notion that everybody has feelings which needs to be shared and acknowledged, the psychologist probes the client, for instance, "In your view, what was the worst part of the event?"
It is believed that the participants will benefit by expressing and experiencing the emotions again that would be provoked by the trauma in a public gathering. After this stage, the psychologist then questions every participant whether they are undergoing any stress reactions (psychological or physical) that might be shared with the group – this is called reaction phase. The psychologist then conceptualizes these responses as non-pathological responses to awful incidents and provides strategies for stress management – which is called strategy phase. Finally, the psychologist condenses what has happened in the course of the session and evaluates whether any of the participants needs referral for further assistance – this stage is called re-entry phase. Though after it has been conducted, people are likely to state that debriefing is useful for short term only. But the long term effects of the debriefing on trauma is highly dubious. Moreover, one meta-analysis discovered that psychological debriefing after a traumatic incident was linked with added symptoms in comparison to those who have received no treatment (Van Emmerik et al., 2002). It has been recommended that psychological debriefing may hamper natural recovery processes after a traumatic incidence.
In sharp contrast to the studies conducted before, a study by Campfield and Hills (2001) mentioned that PD is useful in inhibiting symptoms of PTSD soon after a traumatic incidence for a longer periods of time. However, the current facts demonstrate that individual PD should not be used by the psychologists following traumatic incidents.
Statistically, nearly 10-20% of individuals acquire PTSD after experiencing trauma. Given the high occurrence of trauma, PTSD remains worthy of prolonged attention and understanding. From a glass half-full perspective, however, it seems that most of the individuals recover from trauma without developing PTSD. After experiencing trauma, people may display PTSD like signs and symptoms i.e. unpleasant reminiscences of the trauma, nightmares, hyper-vigilance, numbing; but many of these symptoms fade over time. Despite being a popular method within the field, efficiency of PD is far from proved. It has been observed from various studies that after a traumatic incidence, PD is either beneficial for some time or makes no difference at all. It seems obvious that people who receive PD are susceptible to ensuing psychological illness/disease. Therefore, whenever PD is used, a formal follow up is also conducted by the psychologists to make sure the client has not developed any further mental disease but if he/she has developed one, then should be treated as soon as possible. Hence, follow up is essential following a PD. The recent studies suggests that presence or absence of additional issues, for instance, severe stress reaction, personality, past psychiatric history possibly influence the psychological consequences of people who are involved in traumatic incidents. Certainly, when people have ample amount of social support and don’t have additional vulnerable issues, then, in such a scenario, PD would be totally unnecessary.Although the data that supports PD is inadequate, clinical practice proposes that many people regard the opportunity to vent out feelings of anger and guilt and develops relief from the insight that these are just emotional reactions to trauma. Mostly the feelings expressed by the clients’ in the PD are purely personal and hence they find it very difficult to disclose the information and generally are suspicious of ‘outsiders’ – especially mental health workers/professionals. Psychologists’ feel that it should be duty of the team i.e. a group of emergency workers for PD to be successful.
However, the responsibility of the mental health professionals should be aimed towards educating these groups instead of providing service themselves. Suitable means are essential whenever PD or any other psychological intervention is presented to huge amount of people. According to Fahy and Wesseley, PD currently falls into that group where it needs proper evaluation. When it comes to evaluation, it is essential to use prospective controlled study designs and random allocation (PD v/s non-intervention groups) to assess the effectiveness of PD. Also, during the pre- and post-treatment phase, mental health professionals should pay equal attention to the dimensions of trauma along with other variables that might influence the psychological outcome. This however would provide a clearer picture as to whether or not PD should be used by psychologists.
Researchers appear to obtain different inferences regarding the effectiveness of PD which purely depended on the evaluation criteria that were used and the degree to which the techniques were applied. But, as per the studies conducted in the past, PD has proved to be ineffective and/or harmful for the survivors of trauma.