BACKGROUND:

Over approximately the last last fifteen years early psychological interventions such as psychological 'debriefing' have been increasingly used to treat psychological trauma. While these intervention have become popular and their use spread to several settings - efficacy had largely not been tested empirically. In 1997 a systematic review of single session psychological "debriefing" was undertaken and this subsequently became a protocol and Cochrane Review published in 1998 (Issue2). This update forms the first substantive update of the original review.
OBJECTIVES:

To assess the effectiveness of brief psychological debriefing for the management of psychological distress after trauma, and the prevention of post traumatic stress disorder.
SEARCH STRATEGY:

Electronic searching of MEDLINE, EMBASE, PsychLit, PILOTS, Biosis, Pascal, Occ. Safety and Health,SOCIOFILE, CINAHL, PSYCINFO, PSYNDEX, SIGLE, LILACS, CCTR, CINAHL, NRR, Hand search of Journal of Traumatic Stress. Contact with leading researchers.
SELECTION CRITERIA:

The inclusion criteria for all randomized studies was that they should focus on persons recently (one month or less) exposed to a traumatic event, should consist of a single session only, and that the intervention involve some form of emotional processing/ventilation by encouraging recollection/reworking of the traumatic event accompanied by normalisation of emotional reaction to the event.
DATA COLLECTION AND ANALYSIS:

11 trials fulfilled the inclusion criteria. Quality was generally poor. Data from two trials could not be synthesised. Two trials involved the use of the intervention in an obstetric setting.
MAIN RESULTS:

Single session individual debriefing did not reduce psychological distress nor prevent the onset of post traumatic stress disorder (PTSD). Those who received the intervention showed no significant short term (3-5 months) in the risk of PTSD (odds ratio 1.22 (95% ci 0.60 to 2.46 )). At one year one trial reported that there was a significantly increased risk of PTSD in those receiving debriefing (odds ratio 2.88 (1.11 to 7.53))odds ratio 95%). There was also no evidence that debriefing reduced general psychological morbidity, depression or anxiety.
REVIEWER'S CONCLUSIONS:

There is no current evidence that psychological debriefing is a useful treatment for the prevention of post traumatic stress disorder after traumatic incidents. Compulsory debriefing of victims of trauma should cease.

Psychological debriefing for preventing post traumatic stress disorder (PTSD)

Although psychological debriefing (PD) represents the most common form of early intervention for recently traumatized people, there is little evidence supporting its continued use with individuals who experience severe trauma. This review identifies the core issues in early intervention that need to be addressed in resolving the debate over PD. It critiques the available evidence for PD and the early provision of cognitive-behavioral therapy (CBT). Based on available evidence, we propose that psychological first aid is an appropriate initial intervention, but that it does not serve a therapeutic or preventive function. When feasible, initial screening is required so that preventive interventions can be used for those individuals who may have difficulty recovering on their own. Evidence-based CBT approaches are indicated for people who are at risk of developing posttraumatic psychopathology. Guidelines for managing acutely traumatized people are suggested and standards are proposed to direct future research that may advance our understanding of the role of early intervention in facilitating adaptation to trauma.

Early intervention for trauma: Current status and future directions.

Rime et af. (1992) showed that most emotional experiences are shared with others shortly after they occurred. They proposed that social sharing represents an integral part of emotional experiences. The present chapter examines the generalizability of the phenomenon across various research procedures that overcome the limits of previous studies. Existing findings are extended to chil- dren and older populations, and individual and cultural differences are consid- ered. Furthermore, the role of the intensity of the emotion and its relation with extent of social sharing is investigated. The chapter then addresses the contribu- tion of social sharing to emotional recovery. Given that findings were generally not consistent with the view that sharing alleviates the memory of the shared emotional experience, the chapter discusses alternative potential effects and functions of social sharing.

Social sharing of emotion : new evidence and new questions

Prolonged exposure in patients with chronic PTSD: predictors of treatment outcome and dropout.

The atrocities of war have detrimental effects on the development and mental health of children that have been documented since World War II. To date, a considerable amount of knowledge about various aspects of this problem has been accumulated, including the ways in which trauma impacts child mental health and development, as well as intervention techniques, and prevention methods. Considering the large populations of civilians that experience the trauma of war, it is timely to review existing literature, summarize approaches for helping war-affected children, and suggest future directions for research and policy.

The psychosocial aspects of children exposed to war: practice and policy initiatives

Background The aim was to study the effect of brief counselling and psychological debriefing following a trauma on subsequent morbidity. Method We investigated psychological morbidity in 62 British soldiers whose duties included the handling and identification of dead bodies of allied and enemy soldiers during the Gulf War. Of these soldiers, 69% received a psychological debriefing on completion of their duties. The subjects completed by post a demographic questionnaire, the General Health Questionnaire (GHQ-28) and the Impact of Events Scale. Results After nine months 50% had evidence of some psychological disturbance suggestive of posttraumatic stress disorder (PTSD); 18% had sought professional help; 26% reported relationship difficulties. Neither prior training nor the psychological intervention appeared to make any difference to subsequent psychiatric morbidity. Morbidity at nine months was more likely in those with a history of psychological problems and those who believed their lives had been in danger in the Gulf. Conclusions These findings show that a psychological debriefing following a series of traumatic events or experiences does not appear to reduce subsequent psychiatric morbidity and highlights the need for further research in military and civilian settings.

Psychological sequelae following the Gulf War. Factors associated with subsequent morbidity and the effectiveness of psychological debriefing.

On 2 August 1990 Iraq invaded Kuwait and held hostage all its inhabitants. Amongst those forced to stay were 71 British servicemen and their families who were held hostage for up to four and a half months. This study investigated the mental health status of this group of individuals at 6 and 18 months after the final hostage was released. Participants completed the Impact of Event Scale and the 28-item version of the General Health Questionnaire at both 6 and 18 months. In addition they completed a questionnaire regarding background factors, the dimensions of the trauma and the effects of their hostage experience. The Impact of Event Scale scores changed little over time whereas the General Health Questionnaire scores reduced significantly (p = .001) over the 12-month period suggesting that despite ongoing intrusive and avoidance phenomena levels of psychological distress did reduce. Those variables most strongly associated with a poor psychological outcome were witnessing physical violence and perceived deterioration in physical and mental health. Poor outcome at 6 months was strongly correlated with poor outcome at 18 months.

Margaret M. Searle

Papers

Psychological sequelae following the Gulf War. Factors associated with subsequent morbidity and the effectiveness of psychological debriefing.

Follow-up study of British military hostages and their families held in Kuwait during the Gulf War