Professionals working in trauma often receive requests for critical incident debriefing. Sometimes there is pressure from worried managers to ensure staff’s well-being is covered, and that the organisation’s liability will be minimised. However, the notion of debriefing ‘psychologically’ has shown to be ineffective, and may do more harm than good. Unfortunately, the notion of a psychological debrief is something in popular culture.
Critical Incident Stress Debriefing (CISD) was developed in 1983 (Mitchell 1983). It was developed for use with first responders and was part of a whole system of care called Critical Incident Stress Management. It then appeared to move into the general population, being used in such situations as post-bank robberies. The term ‘psychological debriefing’ is also used to describe a group process close to the end of a traumatic incident.
Current evidence suggests that CISD or psychological debriefing does not improve or prevent PTSD symptoms. This appears to apply to both first responder and the general population. There are several studies that show that it actually makes symptoms worse. Carlier et al. (1998) in a study of police found that those who had debriefing exhibited more hyper-arousal at follow-up than those who did not. Mayou et al. (2000) in a study of road accident victims discovered they had a worse outcome at three years. Bisson et al. (1993) found that among their study of burn trauma victims, 26 percent of the debriefing group had PTSD at follow-up. This compared with 9 percent of the control group. Finally, a Cochrane Review (Rose et al. 2001) of 11 clinical trials found no evidence that psychological debriefing reduced general psychological morbidity, depression, or anxiety. They recommended that compulsory debriefing of victims of trauma should cease.
From a practical point of view participating in a group discussion after a traumatic event may be shaming for those who are questioning their actions in the moment of trauma. Similarly, some people may prefer not to talk with colleagues about traumatic events that have had a deeply personal impact.
So If not psychological debriefing what then?
Current recommendations are for Psychological First Aid. This is not a specific group process or mandatory to attend; many organisations made attendance at CISD mandatory. There are many resources for psychological first-aid including free training and guides written by not for profit organisations.
- Australian Red Cross Psychological First Aid Guide (pdf)
- WHO Psychological first aid: Guide for field workers
In summary, psychological debriefing, a single session intervention offers no advantage and might do harm, and there are alternatives. That is why we should not do it.
References
Carlier IVE, Lamberts RD, van Uchelen AJ, Gersons BPR. Disaster-related post-traumatic stress in police officers: a field study of the impact of debriefing. Stress Med. 1998;14:143–148. doi: 10.1002/(SICI)1099-1700(199807)14:3<143::AID-SMI770>3.0.CO;2-S.
Mayou RA, Ehlers A., Hobbs M. Psychological debriefing for road traffic accident victims. Br J Psychiat. 2000;176:589–593.
Bisson JI, Jenkins PL, Alexander J, Bannister C. Randomised controlled trial of psychological debriefing for victims of acute burn trauma. Br J Psychiat. 1997;171:78–81.
Rose S, Bisson J, Wessely S. Psychological debriefing for preventing post traumatic stress disorder (PTSD). Cochrane Database Syst Rev. 2001;3
Mitchell J. When disaster strikes…. the critical incident stress debriefing procedure. Journal of Emergency Medical Services 1983;8(1):36–9.
