Evaluating psychological debriefing: Are we measuring the right outcomes?

Abstract

The efficacy of critical incident stress debriefing (CISD) and psychological debriefing (PD) following potentially traumatising events has recently been challenged after a number of recent randomised controlled trials (RCTs) failed to demonstrate that CISD or PD prevents or reduces the incidence of posttraumatic stress disorder (PTSD). These studies have used measures of PTSD as the principal outcome and have generally not measured comorbid psychopathology, behavioral or social dysfunction. In a recent RCT of group debriefing amongst British soldiers returning from peacekeeping operations in Bosnia, PD had a significant effect in reducing a worrying level of alcohol misuse in the sample. The findings of this study suggest that that it is premature to conclude that debriefing is ineffective and that a broader range of outcome measures should be employed in future trials of debriefing.

A group randomized trial of critical incident stress debriefing provided to U.S. peacekeepers

“…The existing trials fail to sufficiently test the efficacy of CISD for several reasons (see Everly & Mitchell, 2001): (a) They targeted primary victims of trauma, which is contrary to the guidelines for various forms of group debriefing (e.g., Weisaeth, 2000) and CISD in particular (e.g., Mitchell & Everly, 1996); (b) they applied debriefing to individuals, rather than occupational groups of similarly exposed individuals, which is the modal context for CISD; (c) they did not adhere to the procedures prescribed by CISD; (d) they failed to detail the content of the intervention or provide treatment validity data (although the same can be said of studies used to support claims of CISD's efficacy; Litz & Gray, 2004); and (d) they focused on traumatic stress (Deahl, Srinivasan, Jones, Neblett, & Jolly, 2001) and neglected other arguably relevant clinical and organizational outcomes.…”

Effects of Medical Crisis Intervention on Anxiety, Depression, and Posttraumatic Stress Symptoms: A Meta-Analysis

“…This difference may be explained by the focus of the individual interventions mitigating the arousal and re-experiencing symptoms of posttraumatic stress and less on grief, guilt, resilience, and recovery from depressive symptoms. Lastly, while these outcome measures of anxiety, depression, and posttraumatic stress are most often cited as dependent variables in the literature, there may be additional outcomes, such as social and occupational level of functioning, worth examining [42].…”

Managing acute stress response to major trauma

“…In the best controlled and most rigorous of the recent studies [9], it was found that PD did not reduce PTSD symptoms among British soldiers exposed to war trauma in Bosnia, although this intervention was associated with significant reductions in alcohol consumption. A second study designed to determine the optimal post-traumatic time interval at which to offer PD, Campfield and Hills [10], found better results for robbery victims debriefed within 10 hours of the crime than for those for whom debriefing was delayed until 48 hours post-robbery.…”