Psychological debriefing has for years been seen as the “gold standard” in preventing the development of PTSD after traumatic events. However, does this widely used method really live up to its hopes?
What is psychological debriefing?
Debriefing is a one-time intervention session, usually conducted within 24-72 hours after a traumatic event. The method involves a detailed discussion of the traumatic experience and the thoughts and emotions associated with it. Theoretically, this is meant to “ventilate” emotionally and normalize reactions.
Curtis (1995) proposes an eight-step approach to debriefing:
- Identification.
- Labeling.
- Articulation.
- Expression.
- Externalization.
- Ventilation.
- Validation.
- Acceptance.
Objectives of psychological debriefing
Debriefing has two primary goals.The first is to minimize the psychological stress that occurs after a traumatic event. The second goal is to prevent the development of psychological disorders, primarily PTSD.
- Preventive Goals
- Prevention of the development of PTSD.
- Reduction of the risk of developing psychological disorders.
- Early identification of individuals at risk of developing psychological problems.
- Therapeutic Objectives
- To reduce the intensity of psychological stress.
- To promote emotional processing of the trauma.
- Enabling expression of difficult emotions in a safe environment.
- Normalizing reactions to traumatic events.
Practice the use of debriefing
The use of psychological debriefing has evolved significantly over the years. Initially, the method was used mainly in military environments, but over time its use has expanded to many other areas of crisis intervention.
Many institutions and organizations have implemented debriefing programs as part of standard procedures following traumatic events. Debriefing is used in both individual and group forms, depending on: the type of traumatic event, the organizational context, and available resources.
What does the research say?
Recent scientific research is shedding new perspecitve on the effectiveness of debriefing:
- The Bisson (1997) study:
- After 13 months, those receiving debriefing had a significantly increased risk of PTSD (OR 2.51)
- Marked mental deterioration was observed compared to the control group
- Hobbs (1996) study:
- After 3 years, debriefed subjects showed worse outcomes for high initial IES scores (Impact of Event Scale. IES indicators, the Impact of Event Scale, is most commonly used to measure post-traumatic stress symptoms)
- Particularly unfavorable effects were observed for those with initially high levels of stress
Research over the past two decades shows that the routine use of debriefing may not only be ineffective, but actually harmful to some participants.
Objections to psychological debriefing
- Risk of retraumatization. Forcing participants to recall a traumatic event in detail very soon after its occurrence can lead to a deepening of the trauma. The natural defense mechanisms that protect the psyche from undue stress are thus disrupted.
- Lack of a personalized approach. The standard debriefing procedure does not take into account individual differences in response to trauma. Some people need more time to naturally work through the event, while others prefer different coping strategies.
- False sense of security. A single session can give the illusory belief that “we’ve dealt with it,” while trauma often requires long-term therapeutic work.
- Problematic timing. Conducting debriefing during the acute stress phase can disrupt natural adaptive processes and coping mechanisms.
An alternative approach, what instead of psychological debriefing?
Instead of routine debriefing, contemporary research suggests a more varied approach:
- Early identification of individuals at increased risk of developing PTSD.
- Individual counseling tailored to the needs of the individual.
- Psychoeducation on normal responses to traumatic events.
- Support in activating natural resources and coping mechanisms.
Practical conclusions
As a specialist, I would recommend significantly reducing the use of classic debriefing. Instead, the focus should be on:
- Careful observation and monitoring of the affected person’s reactions.
- Providing basic support and a sense of security.
- Enabling access to professional help for those who need it. Check out our offer – online psychotherapy
- Respecting individual strategies for coping with trauma.
Despite the noble goals and objectives, contemporary research shows that debriefing’s effectiveness in achieving these goals is limited. Therefore, a more individualized approach to helping people after traumatic experiences is now recommended.
Summary
Contemporary approaches to psychological assistance after traumatic events should be more flexible and individualized, with an emphasis on respecting natural coping mechanisms and a willingness to share one’s experiences.
A critical view of debriefing does not imply a complete rejection of all forms of early psychological intervention, but rather calls for a more thoughtful and evidence-based approach to helping those immediately following traumatic events.
Bibliography:
- Rose, S., Bisson, J., Churchill, R., & Wessely, S. (2002). Psychological debriefing for preventing post traumatic stress disorder (PTSD). Cochrane Database of Systematic Reviews, (2).
- van Emmerik, A. A., Kamphuis, J. H., Hulsbosch, A. M., & Emmelkamp, P. M. (2002). Single session debriefing after psychological trauma: a meta-analysis. The Lancet, 360(9335), 766-771.
- Bisson, J. I., Jenkins, P. L., Alexander, J., & Bannister, C. (1997). Randomised controlled trial of psychological debriefing for victims of acute burn trauma. British Journal of Psychiatry, 171, 78-81.
- Hobbs, M., Mayou, R., Harrison, B., & Worlock, P. (1996). A randomised controlled trial of psychological debriefing for victims of road traffic accidents. BMJ, 313(7070), 1438-1439.
- Doctor R, Curtis D, Isaacs G. Psychiatric morbidity in policemen and the effect of brief psychotherapeutic intervention: A pilot study. Stress Medicine 1994;10(3):151-7
- https://pmc.ncbi.nlm.nih.gov/articles/PMC7032695/