Psychological Debriefing/Critical Incident Stress Debriefing

Rating

Category: Allied Health Options

What is it?

Psychological debriefing (PD) is an individual or group intervention which typically consists of a single session where participants are encouraged to give a full narrative account of a traumatic situation that includes facts, thoughts and feelings. PD involves exposure to a traumatic incident through internal imagery within a short time after the event.

How does it work?

PD was designed to reduce distress and prevent development of later psychological problems such as PTSD. In PD, emotional reactions to the traumatic event are considered in some detail with emphasis on normalisation. That is, individuals are reassured that they are responding normally to an abnormal event, as well as prepared to manage emotional reactions and find further support if necessary.

Is it effective?

There is no current evidence that PD is a useful treatment for the prevention of PTSD. Reviews examining the effectiveness of PD for the prevention of PTSD have consistently found that outcomes are either equivalent to or worse than for those who did not receive it, or were provided with educational interventions. There is therefore some suggestion that it may increase the risk of PTSD.

Are there any disadvantages?

There is some evidence that PD might be associated with unfavourable events in some clients. One possibility which could account for these adverse effects is that PD may lead to increased distress through re-exposure to the traumatic event without permitting training to assist emotional processing, which would happen in several sessions of exposure therapy. Another possible explanation involves those individuals who develop shame as a reaction to the traumatic event. Re-exposure may worsen this response and PTSD symptoms unless adequately addressed, which would be difficult in a single-session intervention like PD.

Evidence has also shown that, no matter how severe the trauma, not everyone develops symptoms. PD, by increasing awareness of psychological distress, may induce stress in those who otherwise would not have developed it.

Where do you get it?

PD can only be administered by a registered mental health professional.

What are the evidence limitations?

The studies included in the review have given variable information regarding the criteria for inclusion of PTSD participants. It was not clearly reported whether or not patients were diagnosed using DSM-IV criteria for PTSD.

Recommendations

Brief psychological debriefing should not be pursued for routine use following traumatic events. It is appropriate to identify individuals who are at highest risk to develop PTSD and offer them more intensive intervention programmes.

Key References

Bryant, RA 2007, ‘Early intervention for post traumatic stress disorder’, Early Intervention in Psychiatry, vol. 1, pp. 19-26.

Rose, S, Bisson, J & Wesseley, S 2003, ‘A systematic review of single-session psychological interventions (‘debriefing’) following trauma’, Psychotherapy and Psychosomatics, vol. 72, pp. 176-184.

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