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Editorial
Volume 1998-1

The Australasian Journal of Disaster
and Trauma Studies
Volume : 1998-1


Justin Kenardy, PhD, School of Psychology, University of Queensland, Brisbane, Queensland 4072, Australia. Email: kenardy@psy.uq.edu.au


Guest Editorial
Volume : 1998-1

Justin Kenardy, PhD

School of Psychology,
University of Queensland,
Brisbane, Queensland 4072
Australia


Special Issue:
Psychological (Stress) Debriefing: Where are we now?

Psychological Debriefing is a structured intervention designed to promote emotional processing of traumatic events through the ventilation and normalisation of reactions and preparation for future experiences. It is widely viewed as a means of preventing and reducing post trauma psychological distress and has become very popular due to increased recognition of psychological effects post-trauma. Until recently most helping professionals involved in its application would probably have assumed that evidence of its efficacy had been documented. Unfortunately this is not the case.

There have been many anecdotal reports of the effectiveness of stress debriefing but only a handful of recent systematic evaluations of the effectiveness or efficacy of stress debriefing. There is evidence from uncontrolled studies that indicates that debriefing is a positive experience (eg Robinson & Mitchell, 1993). However Jean Griffiths and Rod Watts (Griffiths & Watts, 1992) conducted research following the Kempsey and Grafton Bus Crashes that indicated that debriefed victims actually had high levels of distress. Sandy Mc Farlane (McFarlane, 1988) found that while debriefing helped reduce acute post-trauma stress following the Ash Wednesday Fires, it also predicted increased delayed stress. Also Martin Deahl and colleagues (Deahl, Gillham, Thomas, Searle, & Srinivansan, 1994) in Britain found no differences in traumatic stress symptoms between debriefed and non-debriefed Gulf War soldiers. These findings have been replicated substantively in later studies (Bisson, Jenkins, Alexander, & Bannister, 1997; Hobbs, Mayou, Harrison & Worlock, 1996; Hobbs & Adshead, 1997; Hytten & Hasle, 1989; Kenardy et al., 1996; Lee, Slade, & Lygo, 1986).

So when it became apparent from the data collected after the Newcastle Earthquake that questions concerning the effectiveness of psychological debriefing could be answered we proceeded to do so. It might be worthwhile describing the Newcastle Earthquake Study first though. When the Newcastle Earthquake hit in 1989 Vaughan Carr from the University of Newcastle Department of Psychiatry decided to set up a study of the prospective impact of this large scale trauma on the community (Carr, Lewin, Webster & Kenardy, 1997.) What resulted was a prospective longitudinal study of 1,089 inhabitants of Newcastle assessed four times over two years. As part of that study it was decided to specifically assess a subsample of professional and volunteer disaster workers. As with the larger study 196 helpers were followed up at six-monthly intervals over the next two years. Serendipitiously questions about psychological debriefing were included in the questions and scales administered so we could directly compare the 65 debriefed versus 133 non-debriefed helpers. What we found surprised us. While debriefing was generally reported as helpful, there was no relationship to rate of recovery found, and in fact we did find a slight trend for reduced rate of recovery amongst debriefed helpers. Furthermore we found no relationship between the reported degree of helpfulness of debriefing and the actual outcome in terms of symptoms of post-trauma and other psychological distress.

Whilst our study was not intended as an evaluation of debriefing and failed to randomise helpers to either a debriefed or no debriefing condition (a necessary requirement to avoid the confounding effects of self-selection) we did try to control for factors that might have influenced that self-selection process such as degree of exposure to danger and self-reported distress. However since the study was not designed to evaluate it cannot be concluded that Stress Debriefing is ineffective. However, we were concerned. And while it should not be concluded that we cease using Psychological Debriefing we should be very vigilant of possible negative effects and of any discrepancy between perceived helpfulness and actual outcomes. Finally we cannot conclude that the apparent lack of impact of Psychological Debriefing lies in how it was applied because first it must first be shown that Stress Debriefing can to be effective and we just don't know this yet.

For us this finding highlighted how little we do know about Psychological Debriefing. As yet we still do not know how useful Psychological Debriefing is. In particular we do not know whether information giving is productive. In terms of that information, we do not know when it is best given, how and by whom. For example does information need to be presented by a debriefer or would handouts be sufficient. We also do not know what information is useful to whom. For example some information may trigger in some individuals a heightened sense of distress. We do not know the impact of self disclosure. There is a commonly held view that self-disclosure of traumatic experience is desirable. However what we do not know is if and when it is not. Debriefing may be useful as functioning as a time to screen for those who may be likely to go on to develop ongoing problems, yet I suggest that we still do not know what to look for. We do not have a clear notion yet of what are the "early warning signs" and how they are best detected.

There is a need for researchers and practitioners to examine the parameters effecting debriefing. There has been much said about who should provide the debriefing. The need in the debrief for understanding the trauma from the participants' point of view would support the notion of peers as debriefers. Peers may be more likely than "outsiders" to comprehend operational and organisational factors as well as the particular social circumstances of the participants.

On the other hand if the debriefing is to be considered part of an overall debriefing management process whose boundaries stretch beyond the actual debriefing, then it could be argued that someone detached from the organisation my be more appropriate in order to prevent possible conflicts of interest. The professional qualifications of such a person may be generic (eg counsellor) or specific (eg mental health professional, clinical psychologist, clinical social worker).

How is debriefing to be provided? There are a number of debriefing "methods" (eg Red Cross, Mitchell, Dyregrov) with their own protocols. Given the heterogeneity it is not possible to clearly determine the adequacy of one over the other. In fact, there is an ongoing development of debriefing. Newer "hybrid" protocols emerge from older ones without evaluation of either.

Protocols are assumed to be useful and appropriate and therefore maintained, or they are changed on the basis of clinical rather than empirical evidence. One example is the decisions that guide most appropriate time for provision of debriefing. There is a commonly held point of view that debriefing should be held as close in time and space to the actual trauma. A time of 72 hours has been identified as the most desirable upper limit. How was the decided? On what evidence? Clearly there is a need to examine the impact of information provision and emotional disclosure at varying times after trauma.

Finally, psychological debriefing may need to clarify its purpose. If it is indeed to be a preventative intervention then that should guide associated activities such as identification of "at risk" participants, follow-up and evaluation. If on the other hand its purpose is to "bond" participants that would lead to a very different set of desirable outcomes.

The great attraction of debriefing is that it has excellent face validity in the eyes of practitioners and many members of the public. It is a response to the psychological distress experienced following a trauma. However there may be some who see psychological debriefing as a way to divest themselves of ongoing responsibility for those who may have continuing problems subsequent to the trauma. Perhaps the most problematic issue is the precription of psychological debriefing following traumas. If there were unequivocal evidence that debriefing contributes to the recovery of an individual this position might be defensible. But at present the literature provides no support for this position (Wessely, Rose, & Bisson, 1997.)

The following issue of the Australasian Journal of Disaster and Traumatic Stress is devoted to the vexed issue of psychological debriefing. Each of the contributors to this issue have provided a considered, and at times challenging, perspective on the problem. I would urge readers to keep an open mind to the issues raised. An article outlining the CISD/CISM position was invited and submitted, but a decision to withdraw it was made by the author(s) following the peer review process.


References

Bisson, J., Jenkins, P. Alexander, J., & Bannister, C., (1997) Randomised controlled trial of psychological debriefing for victims of acute burn trauma. British Journal of Psychiatry, 171, 78-81.

Carr, V.J., Lewin, T.J., Webster, R.A., & Kenardy, J. (1997) A synthesis of the findings from the Quake Impact Study: A two-year investigation of the psychosocial sequelae of the 1989 Newcastle Earthquake. International Journal of Social Psychiatry and Psychiatric Epidemiology,32,123-136.

Deahl, M.P., Gillham, A.B., Thomas, J. , Searle, M.M., & Srinivasan, M. (1994). Psychological sequelae following the Gulf war: factors associated with subsequent morbidity and the effectiveness of psychological debriefing. British Journal of Psychiatry, 265, 60-65.

Griffiths, J. & Watts, T. (1992). The Kempsey and Grafton bus crashes: The aftermath. Lismore, NSW: Instructional design Solutions, University of New England

Hobbs, M., & Adshead, G. (1997). Preventative psychological intervention for road crash victims. In Mitchell, M., (Ed.) The aftermath of road accidents: Psychological, Social and Legal Perspectives. London, Routledge.

Hobbs, M., Mayou, R., Harrison, B. & Worlock, P. (1996). A randomised controlled trial of psychological debriefing for victims of road traffic accidents. British Medical Journal. 313, 1438-1439.

Hytten, K., & Hasle, A. (1989). Firefighters: A study of stress and coping. Acta Psychiatrica Scandinavica 80(Suppl. 355) 50-55.

Kenardy,J.A., Webster, R.A., Lewin, T.J., Carr, V.J., Hazell, P.L. & Carter, G.L. (1996). Stress debriefing and patterns of recovery following a natural disaster. Journal of Traumatic Stress, 9, 1, 37-49.

Lee, C., Slade, P., & Lygo, V. (1986). The influence of psychological debriefing on emotional adaptation in women following early miscarriage: A preliminary study. British Journal of Medical Psychology, 69, 47-58.

McFarlane, A.C. (1988). The longitudinal course of posttraumatic morbidity: The range of outcomes and their predictors. The Journal of Nervous and Mental Disease, 176, 1, 30-39.

Robinson, R. & Mitchell, J.T. (1993). Evaluation of psychological debriefing. Journal of Traumatic Stress, 6: 367-82.

Wessely, S., Rose, S., & Bisson, J. (1997) A systematic review of brief psychological interventions ("debriefing") for the treatment of immediate trauma related symptoms and the prevention of post traumatic stress disorder. Manuscript submitted for publication.


Copyright

Justin Kenardy, PhD © 1998. The author assign to the Australasian Journal of Disaster and Trauma Studies at Massey University a non-exclusive licence to use this document for personal use and in courses of instruction provided that the article is used in full and this copyright statement is reproduced. The authors also grant a non-exclusive licence to Massey University to publish this document in full on the World Wide Web and for the document to be published on mirrors on the World Wide Web. Any other usage is prohibited without the express permission of the author.


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