1. Home>
2. Specialties>
3. Psychiatry>
4. Summary and Comment

Responding to Trauma: Take Care to Do No Harm

After the catastrophic terrorist attacks in the U.S. on September 11, mental health professionals immediately tried to stem the tide of psychiatric effects of trauma and to respond to the emergence of post-traumatic stress disorder (PTSD). Yet, the efficacy of single-session psychological debriefing remains unclear. These researchers provide 3-year follow-up data on 61 of 106 car-accident victims who originally had been randomized to receive no intervention or a single 1-hour debriefing session after the accident. A 4-month follow-up had been conducted previously.

Three years after the accidents, self-reported measures (including PTSD symptoms of intrusion or avoidance, general emotional distress, physical symptoms, pain, financial problems, and quality of life) were consistent with outcomes at 4 months: Debriefing was associated with significantly poorer outcomes than no intervention. For patients with initially high levels of PTSD symptoms in the no-intervention group, recovery was evident at 4 months and maintained at 3 years. In dramatic contrast, those with high levels in the debriefing group continued to experience high rates of symptoms. Individuals with few baseline symptoms maintained low symptom levels, regardless of treatment.

Comment: The results of this study are limited to victims of motor-vehicle accidents who underwent a single debriefing intervention. Nonetheless, the study joins the ranks of other follow-up investigations indicating that although psychological debriefing is reported to have positive ratings at the time of delivery, the intervention provides little or no benefit and possibly may cause harm, compared with no intervention. The desire to help and the popularity of single-session debriefing protocols do not justify the continued application of interventions that are equal to or worse than natural recovery. Results from other studies support the efficacy of preventive treatments that last more than one session and that are delivered later after the trauma (see below for additional references).

— MW Otto

Published in Journal Watch Psychiatry October 3, 2001

Citation(s):

Mayou RA et al. Psychological debriefing for road traffic accident victims: Three-year follow-up of a randomised controlled trial. Br J Psychiatry 2000 Jun 176 589-593.

• Original article (Subscription may be required)
• Medline abstract (Free)

Other Publications That Raise Concern about the Efficacy of Psychological Debriefing:

Bisson JI et al. Randomised controlled trial of psychological debriefing for victims of acute burn trauma. Br J Psychiatry 1997 Jul 171 78-81.

Carlier IV et al. The influence of occupational debriefing on post-traumatic stress symptomatology in traumatized police officers. Br J Med Psychol 2000 Mar 73 87-98.

• Medline abstract (Free)

Rose S et al. A randomized controlled trial of individual psychological debriefing for victims of violent crime. Psychol Med 1999 Jul 29 793-799.

Wessely S et al. Brief psychological interventions ("debriefing") for trauma-related symptoms and the prevention of post traumatic stress disorder. Cochrane Database Syst Rev 2000 2 CD000560-CD000560.

• Medline abstract (Free)

Alternative Approaches That Address Symptoms among Individuals with Acute Stress Disorder:

Bryant RA et al. Treating acute stress disorder: An evaluation of cognitive behavior therapy and supportive counseling techniques. Am J Psychiatry 1999 Nov 156 1780-1786.

Bryant RA et al. Treatment of acute stress disorder: A comparison of cognitive-behavioral therapy and supportive counseling. J Consult Clin Psychol 1998 Oct 66 862-866.

Foa EB et al. Evaluation of a brief cognitive-behavioral program for the prevention of chronic PTSD in recent assault victims. J Consult Clin Psychol 1995 Dec 63 948-955.

• Original article (Subscription may be required)
• Medline abstract (Free)