Is Psychological Debriefing Harmful to Trauma Survivors?

Disasters and undesirable happenings such as accidents are associated with short-term and long term effects (Bisson, 2002). Most survivors of accidents, floods and terrorist attacks may suffer from trauma.

Most organizations have been instrumental in bringing forth social supportive services to avert development of serious issues. One of such interventions is Psychological Debriefing (PD). It is however important to appreciate that not all have supported the intervention. Grant Devilly and Peter Cotton share the view that PD is harmful in the recovery process of trauma survivors.

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Mitchell is of the contrary opinion. This paper gives a critical analysis of the authors’ stands. The paper also compares these views with those of the contemporary research.

Facts about Psychological Debriefing

Psychological debriefing is usually carried out by organizations for good reasons. Devilly and Cotton regard it as emotional first-aid administered to trauma survivors. PD is part of the interventions of Corporate Social Responsibility (CSR). Devilly and Cotton are of the view that no organization would turn a blind eye towards trauma survivors. This intervention has made PD one of the most widely used procedures (Bisson, 2002).

They consider the use of the intervention a routine practice for organizations especially in situations that trigger psychological distress. Bank robberies, fire outbreaks and natural disasters are good examples (Bryant, 2002). Mitchell, on the other hand, suggests that the use of PD may indeed be widespread. However, he emphasizes that only trained persons should handle it.

The handling of PD by untrained persons makes it difficult to address issues of trauma. The fact that PD only supplements psychotherapy is supported well supported. Accordingly, PD should not be viewed as an alternative to psychotherapy. Rather, it is a crisis intervention measure that offers social support to trauma survivors (Mayou, 2000).

Opinions Regarding PD

Devilly and Cotton are of the opinion that Critical incident Stress Management (CISM) and Critical Incident Stress Debriefing (CISD) are one. They purport that most studies involving CISD have been explained in the CISM scope. It is important to note that this proposition is not supported conclusively.

In addition, they consider research and practices in PD to be very young. Widespread use of an intervention that is not fully backed by research is critical. Most organizations adopt PD techniques after traumatic experiences (Bryant, 2002). These techniques are regarded to go beyond ‘emotional first-aid’. Mitchell however has different opinions regarding PD. CISD and CISM are two words that are used exclusively.

Mitchell affirms that CISD is a process within CISM. Whereas CISM refers to the field, CISD refers to the group process in the intervention of traumatic experiences. IN ADDITION, Mitchell asserts that much research has been carried out to validate the use of PD in handling trauma cases.

PD is Harmful to Survivors of Trauma

Most psychologists are of the view that CISM and CISD mitigate the impacts of long term poor functioning (Mayou, 2000). Studies indicate that Post Trauma Stress Disorder (PTSD) is a possible likelihood especially for those exposed to stressful event (Bryant, 2002). Devilly and Cotton concur that history of stress is a prime risk factor for depression.

PD increased the probability of developing PTSD. Studies indicate that PD interventions were worse than no-interventions as far as PTSD is concerned. The conditions of people who received CISD deteriorated in regards to other PTSD symptoms AND recovery.

Devilly and Cotton agree that a healthy workforce translates to a productive workforce. However, organizational clinical interventions have shown little or no effects on the performance outcomes. The greatest problem has and is still on developing interventions that avert sick workforce after trauma. PD is regarded as tool that ensures that organizations are protected from litigation.

Howell’s case is an indication that CISD are usually conducted on grounds of assisting the traumatized. Devilly and Cotton failed to address some issues in their study. Devilly and Cotton failed to conclude on the CISM/CISD debate. A person who depends on their analysis to distinguish between the two will be more confused.

PD is not Harmful to Survivors of Trauma

Mitchell insists that PD is not a harmful intervention for trauma survivors. He insists that PD is not traumatic terrorism as Devilly and Cotton purport. The WTO bombing in 2001 was a global issue that called for rapid intervention. The use of trained police officers to offer debriefing sessions to the victims of the terrorism attack was commendable (Deahl, 2000). This confirms the fact that properly trained persons produce positive outcomes.

Single session debriefings are critically opposed by many organizations like The American Red Cross, Salvation Army and American Academy of Experts in Traumatic Stress. CISD has been confused with single session debriefings. The confusion that exists between CISM and CISD has been addressed. It is considered wrong to equate the two. CISM is a vast field that incorporates among many some processes such as CISD.

The definition of CISM in at least eight peer reviewed journals is a clear attestation that indeed the field is advanced and backed by enough literature. Despite the fact that Mitchell insists that PD is not harmful, he fails to give some instances in which the intervention has proved fruitful. In addition, he fails to give the most appropriate time when psychotherapy should be given.

How Credible Were the Authors?

The credibility of the authors supporting and opposing the intervention of PD varies. Devilly and Cotton argue on grounds of insufficient information. Their discussion opens doors for more debate.

They show an open view towards issues of CISD, CISM and early interventions. It is however sad to note that their analysis is premised on personal grounds. They insinuate that Mitchell and Everly are ICISF (International Critical Incident Stress Foundation) directors.

This claim is confirmed false. The objectivity of their study is jeopardized by personal differences. Mitchell is fast to counter the views of his opponents. However, he fails to really convince his audience on why PG should be encouraged. Devilly and Cotton give a critical analysis within their argument.

They propose other alternative intervention principles that can be used in place of PD. This approach gives an indication that future research regarding alternative interventions is well grounded. On the contrary, Mitchell fails to give us future improvements on PG interventions which he claims require special handling. Proper cases to support the efficiency and success of PD are lacking.

Devilly and Cotton are Right

It is true that traumatic interventions are special and require specialized persons. It is absurd to apply PD in situations where the victims are unaware of the implications associated with the procedure (Bisson, 2002). Devilly and Cotton may be ignorant of the differences that exist between CISM and CISD. However, the fact that they give a detailed insight to the two is encouraging.

This opens the door for more understanding of the underlying principles. The extensive research carried out before as Mitchell purports is not captured anywhere. Mitchell only summarizes the literature by insisting that CISM incorporates CISD.

The gains associated with PD are not captured at all. Use of terms such as multi-million dollar industry and trauma tourism is exaggerated and misplaced. It is important to note that the use of PD has only persisted since no other interventions have been practiced. Devilly and Cotton insist that the use of PD has been widespread for several reasons.

The fact that organizations fear litigation procedures and feel socially responsible for traumatic occurrences is clear. Devilly and Cotton are therefore correct in their assertion that PD interventions are harmful .The harm is not only psychological for PTSD victims, but also financial for the organizations that seek psychological support for their employees.

Contemporary Research

Most research findings indicate that PD is harmful to trauma survivors. The procedure is associated with several issues that limit its importance (Deahl, 2000). Studies indicate that most people suffering from PTSD get worse after being subjected to PD. Randomized Clinical Trials have failed to give any substantial benefits associated with the procedure (Mayou, 2000).

The understanding of the cultural behavior is a prerequisite towards conducting a successful PD. PD conducted in Sri Lanka after the 2004 Tsunami produced important revelations (Deahl, 2000). It was difficult for ‘traumatologists’ to conduct PDs effectively.

Cultural ignorance was the greatest impediment towards the success. Sri Lankans were therefore rendered to be in a state of denial. A trial verifying the efficiency of PD in accident victims proved futile in Oxford (Hobbs, 2006). The fact that PD is considered an act of professionalizing stress is evident.

Most people become worse after experiencing traumatic experiences. PD intervention is associated with negative ramification (Hobbs, 2006). Most victims are uncomfortable with the psychologists that conduct such briefings. Most victims become more traumatized when true facts regarding their state are shared.

It is important that information regarding the possible impacts of the experience is shared. The psychological preparation of trauma survivors is difficult. The fact that unknown persons conduct these briefings on a one-time basis leads to undesirable results (Mayou, 2000).

Conclusion

It is vitally important to note that traumatic experiences may have long term effects to the survivors. However, organizational interventions should not be compulsory.

PD should be offered on voluntary basis to avert serious issues concerned with trauma. Other intervention principles that aim at updating critical management policy and offering immediate practical social support should also be enforced.

References

Bisson, J. (2002). Randomised controlled trial of psychological debriefing for victims of acute burn trauma. British Journal of Psychiatry, 171, 78–81

Bryant, R. (2002). Treating acute stress disorder: an evaluation of cognitive behavior therapy and supportive counselling technques. American Journal of Psychiatry, 156, 1780–1786.

Deahl, M. (2000). Preventing psychological trauma in soldiers. The role of operational stress training and psychological debriefing. British Journal of Medical Psychology, 73, 77–85.

Hobbs, M. (2006). A randomised controlled trial of psychological debriefing for victims of road traffic accidents. British Medical Journal, 313, 1438–1439

Mayou, R. (2000). Psychological debriefing for road traffic accident victims: three year follow-up of a randomised controlled trial. British Journal of Psychiatry, 176, 589–593

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