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Debriefing After Trauma: The Final Word?

It really doesn’t work — and might even harm. . . .

In at least five studies, psychological debriefing immediately after traumatic exposure did not prevent post-traumatic stress disorder, and one study suggested that debriefing might even have harmful effects (see Journal Watch Psychiatry Oct 3 2001). In the current study, researchers in the Netherlands sought to determine whether the emotional stimulation or psychoeducation of debriefing produces adverse effects, and whether certain individuals would be more vulnerable to these effects. Two weeks after experiencing an assault or accident, 236 adults were randomized to emotional debriefing (limited to reconstruction of the trauma and accompanying emotions), psychoeducational debriefing (limited to information about PTSD symptoms) or no debriefing. Participants were assessed at 2 weeks, 6 weeks, and 6 months after debriefing.

All three groups showed equivalent reductions in levels of PTSD, anxiety, and depressive symptoms and in PTSD diagnoses; the average rate for PTSD diagnoses was 9.7% at baseline and 4.8% at 6 months. In the 25% of participants with high levels of arousal at baseline, those receiving emotional debriefing had significantly higher PTSD symptom scores at 6 weeks than did those receiving no debriefing.

Comment: This study documents that debriefing does not prevent the development of PTSD after traumatic exposure, whether the treatment emphasizes emotional abreaction or educational information, even if it is delayed for 2 weeks. Coupled with data from randomized controlled trials suggesting a preventive effect with cognitive-behavioral therapy administered a month after traumatic exposure, these findings suggest that the content of debriefing, more than its timing, accounts for its lack of efficacy. Finally, the emotion-charged review of traumatic experience might worsen the condition of exposed subjects already suffering early symptoms of hyperarousal.

— Peter Roy-Byrne, MD

Published in Journal Watch Psychiatry September 11, 2006

Citation(s):

Sijbrandij M et al. Emotional or educational debriefing after psychological trauma: Randomised controlled trial. Br J Psychiatry 2006 Aug; 189:150-5.

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