Debriefing After Psychological Trauma Harmful To Some

Healthfacts, May, 2002 by Maryann Napoli

A common treatment for people subjected to severe psychological trauma has come under scrutiny because it inflicts harm on some people. The method, known as debriefing, is intended to reduce post-trauma psychological distress by getting people to talk about the traumatic event with a trained therapist. The debriefing is usually provided on a short-term basis.

Originally developed to prevent and treat post-traumatic stress disorder (PTSD) in soldiers after combat, debriefing has become increasingly popular over the last 15 years as a treatment for victims of a wide range of traumatic events from violent crime to natural disasters. It is based on the idea that avoiding painful memories actually perpetuates the symptoms of PTSD. Debriefing is usually advised immediately after severe trauma. In some circumstances and in certain occupations, such as police work, debriefing has become mandatory.

Despite its popularity, debriefing had been studied only sporadically and minimally over the years; and it is only in the last decade that high- quality research has been published. High-quality clinical trials are those in which traumatized people were randomly assigned to be debriefed or not. To determine the efficacy of debriefing, all forms of supporting research were assessed for a recent update of a Cochrane review. The reviewers, Suzanna Rose, Jonathan Bisson, and Simon Wessely, determined that there is no strong evidence to show that debriefing: reduces a person's odds of developing PTSD, including depression and anxiety; is safe and effective for children; or can be an effective form of group therapy. Furthermore, there is no information about debriefing for those who had psychiatric disorders prior to the trauma because such people were excluded from all studies.

The most troubling finding by Rose and colleagues came from the best research--randomized, controlled trials with the longest followup (one tracked participants for 13 years). These trials provided the evidence that some people are worse off after debriefing. The reviewers concluded that for some people, "debriefing may actually cause the post-traumatic stress it is intended to prevent. This may be because talking about and reliving the trauma is a further traumatic event in itself." The reviewers also found that people most likely to develop PTSD are unlikely to be helped by a single debriefing session, and "indeed such an intervention may be harmful." Their findings were so alarming that the reviewers recommended an end to the compulsory post-trauma debriefing required of people in certain occupations.

This update of the Cochrane Review entitled "Psychological Debriefing for Preventing PTSD" appears in the latest version of the Cochrane Library, which is available by subscription on the Internet. A shortened version for consumers can be accessed at no charge at the Web site listed below. The Cochrane Collaboration is an international non-profit organization that conducts systematic reviews of all relevant trials to determine whether medical interventions are effective.

The reviewers acknowledged that their conclusions will be met with disbelief. In the subscription-only version of their review, Rose and colleagues discuss possible explanations for their findings. For example, they hypothesize that the relatively recent changes in awareness of the psychological effects of trauma could render debriefing obsolete. "It is possible that the general themes underlying debriefing are now part of the accepted culture--hence there is sufficient awareness of 'psychological first aid', either by the person themselves [sic] or their family and friends, that everybody experiences a 'bit of debriefing' anyway, thus reducing the possibility of showing any effects from a formal intervention." As for the harm, they suspect that debriefing may "medicalize" normal distress, thus increasing "the expectancy of developing psychological symptoms in those who would otherwise not have done so."

More Information: For the free, consumer version of this review, go to the Cochrane Consumer Network Web site (www.cochraneconsumer.com) and click into the word "new." Go to www.cochranelibrary.com to find out how to subscribe to the Cochrane Library, which provides an extensive version of this review.

MaMaryann Napoli is the associate director of the Center for Medical Consumers in New York City.