Types of Debriefing Following Disasters
The aim of all disaster mental-health management, including any type of debriefing, should be the humane, competent, and compassionate care of all affected. The goal should be to prevent adverse health outcomes and to enhance the well-being of individuals and communities. In particular, it is vital to use all appropriate endeavors to prevent the development of chronic and disabling problems such as PTSD, depression, alcohol abuse, and relationship difficulties. Debriefings are a type of intervention that are sometimes used following a disaster or other traumatic event.
Different Types of Debriefing
- Operational debriefing is a routine and formal part of an organizational response to a disaster. Mental-health workers acknowledge it as an appropriate practice that may help survivors acquire an overall sense of meaning and a degree of closure.
- Psychological or stress debriefing refers to a variety of practices for which there is little supportive empirical evidence. It is strongly suggested that psychological debriefing is not an appropriate mental-health intervention.
- Critical Incident Stress Debriefing (CISD) is a formalized, structured method whereby a group of rescue and response workers reviews the stressful experience of a disaster. CISD was developed to assist first responders, such as fire and police personnel; it was not meant for the survivors of a disaster or their relatives. CISD was never intended as a substitute for therapy. It was designed to be delivered in a group format and meant to be incorporated into a larger, multi-component crisis intervention system labeled Critical Incident Stress Management (CISM). CISM includes the following components: pre-crisis intervention; disaster or large-scale demobilization and informational briefings (town meetings); staff advisem*nt; defusing; CISD; one-on-one crisis counseling or support; family crisis intervention and organizational consultation; follow-up and referral mechanisms for assessment and treatment, if necessary.
Currently, many mental-health workers consider some form of stress debriefing the standard of care following both natural (earthquakes) and human-caused (workplace shootings, bombings) stressful events. Indeed, the National Center for PTSD's Disaster Mental Health Guidebook (which is currently being revised) contains information on how to conduct debriefings.
However, recent research indicates that psychological debriefing is not always an appropriate mental-health intervention. Available evidence shows that, in some instances, it may increase traumatic stress or complicate recovery. Psychological debriefing is also inappropriate for acutely bereaved individuals. While operational debriefing is nearly always helpful (it involves clarifying events and providing education about normal responses and coping mechanisms), care must be taken before delivering more emotionally-focused interventions.
A recent review of eight debriefing studies, all of which met rigorous criteria for being well-controlled, revealed no evidence that debriefing reduces the risk of PTSD, depression, or anxiety; nor were there any reductions in psychiatric symptoms across studies. Additionally, in two studies, one of which included long-term follow-up, some negative effects of CISD-type debriefings were reported relating to PTSD and other trauma-related symptoms (1).
Therefore, debriefings as currently employed may be useful for low magnitude stress exposure and symptoms or for emergency care providers. However, the best studies suggest that for individuals with more severe exposure to trauma, and for those who are experiencing more severe reactions such as PTSD, debriefing is ineffective and possibly harmful.
The question of why debriefing may produce negative results has been considered and hypotheses have been formulated. One theory connects negative outcomes with heightened arousal in the early posttrauma phase and in long-term psychopathology (2,3). Because verbalization of the trauma in debriefing is limited, habituation to evoked distress does not occur. The result may be an increase rather than a decrease in arousal. Any such increased distress caused by debriefing may be difficult to detect in a group setting. Thus, attempting to use debriefing to override dissociation and avoidance in the immediate posttrauma phase may be detrimental to some individuals, particularly those experiencing heightened arousal. Another consideration is that the boundary between debriefing and therapy is sometimes blurred (e.g., challenging thoughts), which may increase distress in some individuals (3). Finally, those facilitating the debriefing sessions frequently are unable to adequately assess individuals in the group setting. They may erroneously conclude that a one-time intervention is sufficient to prevent further symptomatology.
Practice guidelines on debriefing formulated by the International Society for Traumatic Stress Studies
conclude there is little evidence that debriefing prevents psychopathology. The guidelines do recognize that debriefing is often well received and that it may help (1) facilitate the screening of those at risk, (2) disseminate education and referral information, and (3) improve organizational morale. However, the practice guidelines specify that if debriefing is employed, it should:
- Be conducted by experienced, well-trained practitioners
- Not be mandatory
- Utilize some clinical assessment of potential participants
- Be accompanied by clear and objective evaluation procedures
The guidelines state that while it is premature to conclude that debriefing should be discontinued altogether, "more complex interventions for those individuals at highest risk may be the best way to prevent the development of PTSD following trauma."
References
- Rose, S., Bisson, J., & Weseley, S. (2001). Psychological debriefing for preventing Posttraumatic Stress Disorder (PTSD). The Cochrane Library, Issue 3: Update Software Ltd.
- Shalev, A.Y. (2001). Posttraumatic Stress Disorder. Primary Psychiatry 8(10), 41-46.
- Bryant, R.A. (2000). Cognitive behavioral therapy of violence-related posttraumatic stress disorder. Aggression and Violent Behavior 5(1), 79-97.
