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Individual Differences
and Debriefing Effectiveness

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


Individual Differences and Debriefing Effectiveness


Carmen C Moran, School of Social Work, University of NSW, Australia Email: C.Moran@unsw.edu.au
Keywords: individual differences, coping, stress, emergency worker

Carmen C Moran

School of Social Work
University of NSW
Australia


Abstract

In the past, awareness of the nature of emergency worker stress has been constrained by images of individual strength and coping even in the face of extreme events. Today, it is often assumed that certain events are so horrific that virtually everyone will react the same way. The stereotype of the macho stoic has been replaced by that of the vulnerable emergency worker. This paper argues against both stereotypes. Although certain circumstances can be horrific in themselves, emergency workers have a variety of coping styles and not all will be affected by events to the same degree. Moreover, debriefing may sometimes run counter to individual coping and impair rather than help some individuals. Acceptance of individual differences in reactions to traumatic stress may help us better manage emergency workers' training and in-service education, but there is the risk it may be misinterpreted as blaming an individual for reacting to events.


Individual Differences and Debriefing Effectiveness


Introduction

As recently as 1993, Elliot and Smith discussed stress related trauma among emergency workers as a long neglected area of study (Elliot & Smith, 1993, p35). This may have been true in the past, but there has been a burgeoning recognition of stress and trauma in emergency work in recent years. Perhaps the more relevant point today is that despite numerous papers on trauma and critical incident stress in the 1980s and 1990s, few studies satisfy the criteria of evaluative research paradigms and so we have little rigorous information on the nature of change following critical incident stress debriefing (CISD).

The nature of critical incidents, the environments in which they occur, and the organisational imperatives of emergency services make it extremely difficult to study the process of critical incident stress and debriefing under controlled conditions that can be achieved elsewhere, for example in hospital clinical trials (Kenardy & Carr, 1996; White, 1996). Nevertheless, most work on CISD has occurred in the framework of evaluating the benefits of interventions. In emergency organisations, there is considerable support for debriefing and it may seem churlish to question its value. This paper recognises its perceived value to those exposed to trauma, but we need to be circumspect when discussing the acceptance of debriefing. Not all emergency workers attend debriefing, and not all complete research questionnaires on stress. Individual differences can contribute to the perceived effectiveness of debriefing.


Individual differences and stress appraisal

The term `individual differences' refers to differences in personality, itself defined as an individual's relatively stable characteristic pattern of thoughts, feelings and behaviours. Although there are certain expected relationships between events and reactions, for example people tend to react with sorrow to the death of a spouse, there can be differences in the intensity and type of reaction across individuals. In some instances, the expected reaction does not occur or is in the opposite direction.

Much has been written on the nature of stress and coping in the last decade, largely influenced by the work of Lazarus and Folkman (1984) which gives priority to individual appraisal in determining what is stressful. This view is sometimes referred to as the transactional model of stress. According to this model, our perceptions and interpretations of events around us contribute to our experience of stress. The transactional model of stress thus sees individuals very much as the source of their stress reactions because of the process of appraisal. In the emergency context, it seems simplistic to adopt this view because it minimises the extent of trauma encountered during emergency work. That is, there are many extreme circumstances where the role of appraisal is severely constrained by the nature of the incident, and it seems insensitive and naive to say a person is reacting a certain way because of how they are thinking about the incident. It could be argued some incidents are horrific in themselves. Nevertheless, as researchers we are faced with the fact that not all emergency workers react to the same incident in the same way. Paton (1994) has preferred to use the term schemata to explain to individuals' tendencies to perceive and process information in the environment in habitual ways.

People also differ in their coping style (general tendency to deal with situations in a particular way) and their coping strategies (specific behaviours they engage to deal with a stressor or event). There are many typologies of coping, although most reflect to some degree that of Lazarus and Folkman in which coping is divided into problem focussed and emotion focussed strategies (Parker & Endler, 1992). Emergency workers may be more prone to use problem focussed than emotion focussed coping (Moran & Britton, 1994a), but whether this changes with type of incident has not been established. Coping is a dynamic process which changes in response to the demands of life and personal appraisal of circumstances (de Ridder, 1997).

People may have stable coping preferences, although as Carver, Scheier and Weintraub (1989) found, habitual ways of coping do not adequately predict coping strategies used in specific situations. Coping style also has a poor track record in predicting post-trauma symptoms (Shalev, 1996) but our current tools for assessing coping may be at fault (de Ridder, 1997). If we can find out more about what helps some people cope with extreme or traumatic incidents, such as existing schemata or coping strategies, we may be able to use this information to enhance selection, training or intervention procedures in emergency work.


The debriefing context

This paper will not detail the nature of CISD which can be found elsewhere (eg Mitchell & Bray, 1990). Some consideration of debriefing nevertheless is necessary, in order to provide a context for discussing individual differences. The term debriefing has been broadly used to refer to various stages of support in a traumatic or critical incident context, including on site informal support, defusing (discussion of feelings shortly after coming of a shift) and formal debriefing (some hours or days after the incident, in a large group setting, with mental health teams or peer support personnel as leaders). This paper is mainly concerned with formal debriefing.

There are several forms of formal debriefing, but most appear to have some relationship with CISD as documented by Mitchell (1983, 1988), although over the years they may have been modified to be more flexible in the emergency environment or match the requirements of particular emergency organisations. Debriefing can give an opportunity to ventilate feelings, provide social support, expedite cognitive reframing and minimise subsequent post-trauma symptoms. The variability in the aims of debriefing makes it difficult to assess its effectiveness. For those who believe it provides social support and emotional assistance, debriefing is seen to work, and this conclusion is generally supported by ratings from emergency responders indicating they value the intervention (eg Robinson, 1989; Robinson & Mitchell, 1993, 1995; Temple, 1991). If the aim of debriefing is to reduce post trauma symptomatology, particularly related to PTSD, the beneficial effects are more debatable. Some research studies indicate that debriefing can actually lead to poorer adaptation to trauma than no debriefing (see Raphael et al, 1996; Bryant, 1994). The variability of its aims and putative processes makes it easy either to overstate or understate the value of debriefing, depending on what one means by debriefing.

Discussing and evaluating debriefing have also been complicated as a result of the higher profile that debriefing has in the 1990s. Debriefing occurs in a wider context than in the last decade, with more informed emergency services and more frequent media mention of debriefing in their coverage of emergencies. During television coverage of the 1997 Thredbo landslide and the NSW 1994 bushfires (wildfires), media commentators several times reported emergency personnel were highly stressed by their work and were being debriefed as they came off their shifts. This media discussion of debriefing raises concerns. In traditional debriefing sessions confidentiality is highlighted, yet we have recent evidence of individuals talking on television about what the workers are experiencing, and this seems to be information revealed during early stage defusing or debriefing. Those being interviewed may intend to provide other people at risk with information about potential symptoms. Media presentations are highly edited, usually very brief and selective, and only the more graphic aspects of reactions are presented to the general public, some of whom will be the emergency workers who may question why disclosures are so publicly discussed. In addition, individual differences in reactions to traumatic incidents is given little coverage.

Most emergency organisations now have special debriefing procedures and teams in place. Despite this, mental health workers sometimes converge on disaster sites (Moran, 1995), and researchers may do the same (Raphael & Meldrum, 1993). The marketing of debriefing by independent psychological services may inhibit a critical evaluation of its effects. The increase in litigation and workers' compensation for job stress have increased the organisational imperative to provide debriefing and stress counselling services, but this may not be accompanied by any similar pressure to evaluate their impact.

The context of debriefing has thus changed over time, the aims and procedures vary, and the expectations for debriefing to be provided are much more public than when it was first introduced. In this wide context it is easy for individual differences in reactions to stress and debriefing to become lost. Studying individual differences is further complicated by two rather different stereotypes of the emergency worker, the macho stoic and the vulnerable tertiary victim.


Emergency worker characteristics


The right stuff?

Expectations about emergency workers' vulnerability have tended to be discussed in terms of extremes. For many years there was the stereotype of the stoical worker who was impervious to stress (Alexander & Wells, 1991). We no longer expect emergency workers to be a homogenous group (Paton & Smith, 1996), but there are consistent expectations about recruits and procedures are geared to select those who will be able to cope in stressful circumstances of emergency work. These characteristics are not necessarily selected using formal questionnaires or tests. As Flin (1996) argues, psychological tests do not offer sufficient predictive validity to be useful in selection procedures for emergency work. She concludes those doing the recruiting at the level of commander, for example, find it easier to select out the wrong stuff (eg anxiety, personality disorder) than select in the right stuff.

Evaluation of emergency workers' characteristics frequently relies on studies performed on workers with some years experience. Several of these studies have come to the conclusion that there is no such thing as `the right stuff'. Moran and colleagues, for example, noted emergency workers are not necessarily hardier than most (Moran, Britton & Corey, 1992; Moran & Britton, 1994b) although some individuals in their samples scored very high on this dimension.

One characteristic of emergency workers that is related to stress and coping is optimism (Moran & Colless, 1995a) or hopefulness (Carr et al 1996). They rate their chances of being impaired following stressors as lower than average (Moran & Colless, 1995a). This is related to the phenomenon of benign illusions discussed by Taylor (1989), who argued such thoughts enhance wellbeing. It is not clear whether such optimism is stress inoculating to those in emergency work, but studies are suggesting this could be the case. Carr and colleagues found hopefulness was associated with fewer trauma symptoms in emergency workers dealing with the Newcastle (Australia) earthquake (Carr et al, 1996). Even if optimism mitigates the effects of exposure to traumatic incidents, we cannot be confident it will always do so. Furthermore, an optimistic outlook with few other coping strategies may actually make the emergency worker more vulnerable to particularly traumatic incidents. Other coping strategies noted in emergency workers include humour, suppression and focussing on the task at hand (Moran, 1990).

Cultural background may influence coping and reactions to incidents, but in Australia the majority of emergency workers are either of Anglo-Celtic origin or second generation Australians (eg Moran et al, 1992). This bias is not due to any formal policy, but is perhaps a consequence of cultural expectations and opportunities. It would be interesting to evaluate the impact of ethnicity on emergency workers' trauma where there are sufficient numbers for comparison. To date there do not seem to be any major differences reported (McCammon, 1996).

Culture does not only refer to ethnicity of course. The culture (ethos) of the emergency organisation can influence reactions to trauma and stressful incidents. Humour, for example, is a coping strategy often found in extreme environments (Moran, 1990), but one which frequently depends on the acceptance of coworkers. Rosenberg (1991) found humour was passed on from experienced to inexperienced emergency paramedics through observational learning. A novice worker may also learn from observation not to joke under certain circumstances. Other coping strategies may also develop in this way. Perhaps one of the more influential sources of observational learning is the informal debriefing sessions which occur during clean up at the station or depot after an incident. Anecdotally, many workers report these informal sessions are as valuable as formal ones. However, Moran and Colless (1995a) found formal debriefing sessions were more likely to be rated as useful when respondents had past experience with traumatic incidents. Formal debriefing sessions expose workers to information and opportunities for referral they might not otherwise encounter during informal sessions.

Many workers mention they learn how to deal with stressful incidents and traumatic exposures through working with more experienced workers. For example, station officers may show new emergency workers their first dead body in a deliberate but controlled fashion, rather than let the new emergency worker face this alone. They actively model coping styles, as well as gradually expose the new worker to trauma. Of course, this is not always possible and recruits just out of training can find themselves in the midst of trauma within hours of starting their first shift.

Personal vulnerability

The negative impact of trauma on emergency workers has been widely discussed in recent years, putting paid to the macho stereotype. Discussion in the past was often limited to the effects of combat and not widely disseminated. Providing this information to a wider forum was long overdue, but unfortunately in some circles it was adopted so enthusiastically that a new stereotype emerged, that of the highly vulnerable emergency worker. There is variability in emergency workers' personalities, stress coping strategies and resources which interact with the specific nature of incidents. In other words, not everyone matches the new stereotype. This is not to say severe reactions do not occur after severe incidents, or that we can predict who is at risk.

Moran and Colless (1995b) factor analysed the responses of over 700 firefighters and reported negative reactions could be summarised by five factors:

  1. self perceptions of not coping,
  2. physical symptoms,
  3. dwelling on incident,
  4. negative behaviours, and
  5. post-trauma type symptoms.

In another sample of emergency responders, Moran also noted that severity and length of reaction to a previous traumatic incident was associated with length of emergency service. In this case, experience with previous stressful incidents was more important than individual differences in predicting negative reactions (Moran & Britton, 1994b). These data were obtained by questionnaire and do not necessarily indicate clinical levels of reactions.

The current diagnostic criteria of PTSD recognises the role of individual differences and the contribution of factors such as social support, childhood experiences and personality variables to the development PTSD (American Psychiatric Association, 1994, p426). This is not to say the nature of the incident is irrelevant. Emergency workers frequently mention certain incidents are especially traumatic, such as those which involve children, multiple deaths, threat to one's own life (Dyregrov & Mitchell, 1992; McCammon et al, 1988; Moran & Colless, 1995a). The point to be made is that diagnostic criteria remind us that we cannot expect each victim to be affected to the same degree by a traumatic incident. In the absence of data that emergency workers are a particularly homogenous group, some variation of reactions in emergency workers is to be expected also.

There are humane considerations which affect discussion of this variation. Informing emergency workers that `most people' would react the same way under the circumstances may help them acknowledge their feelings and enhance recovery, regardless of whether this view is accurate. We need to be careful before removing self-enhancing beliefs in the interests of emphasising individual differences.

The trauma membrane and coping

Lindy (1985) and others have used the term `trauma membrane' to summarise the way emergency workers shield themselves from the horrors around them and continue with activities as though they are unaffected. In some cases this is seen as a psychic defence which is useful at the scene but which should be shed soon afterwards. Many researchers and clinicians have encountered workers who have denied feelings and reactions after the incident, only to have them emerge later as more severe symptoms. We cannot make the general assumption that denial is always bad, however. As studies in areas such as coronary heart disease indicate denial may be a health enhancing strategy in some circumstances or at some point (eg see Taylor, 1991, p370).

It would also be simplistic to say workers deny their reactions because of the machismo ethos of emergency organisations. This may be the case for some, but others may deny feelings because of other personal characteristics such as religious or cultural background, or they have successfully coped using this strategy in the past. Working within the organisation may help change those with an unrealistic macho image of themselves or an unhealthy reliance on denial, and exposure to group discussion in formal organisational debriefing sessions may be the best way to achieve this change. Whether this will also help those whose reasons for defensive denial are more idiosyncratic is not yet known because research on critical incidents has not addressed this level of individual responsiveness.

Of course, if emergency workers are not focussing on the horror of a situation this does not mean they are using denial. There are many ways to put information out of mind, and these may involve either conscious or unconscious processes. The defensive style of repression has a long history of being regarded as a poor coping strategy. Suppression, on the other hand, is considered a healthy and conscious defensive style (Andrews et al, 1989). In popular folklore there is the understanding that memory is kind - in other words, forgetting sometimes helps us. Forgetting may help a person cope by reducing arousal and avoidance (Raphael et al, 1996).

If it requires a person to focus on the horror of an event and describe their reactions to it, debriefing may weaken an existing coping or defensive style such as suppression and make the person feel worse. Conversely, some people cope by dwelling on an incident (forming a coherent narrative, perhaps). Aiming to reduce distress by reducing thoughts about the incident could make things worse by removing another form of coping. Clearly, to take one coping strategy in isolation and label it as either good or bad would be inaccurate. Coping occurs in a context, with both internal and external features that influence the value of a particular strategy or personal style. Similarly, debriefing contexts and characteristics vary, and not all require a person to share feelings when quiet reflection or not focussing on the event may be more appropriate for them.


Are negative reactions necessarily bad?

Recently, in the context of intervention after trauma Raphael and colleagues asked `can the wounds of the horror ... be quickly sealed over?' (Raphael, et al, 1996, p463). It is useful to consider whether sealing over wounds (admittedly a metaphor) is a necessary index of successful resolution of a traumatic experience. That is, the existence of sorrow and hurt in human lives is not something we should always seek to remove. Raphael and colleagues also question the `sense of imperative to act which may undermine a propensity for reflection' (p474).

The value of coping is sometimes assessed by looking at whether it leads to a change in circumstances or events. As de Ridder (1997) points out, thinking over a problem may be seen as rumination if the circumstances remain unchanged but as problem-solving if circumstances are changed for the better. In the emergency context such post-hoc labelling of coping needs to be carefully scrutinised. The level of negative feelings and the degree to which they impair functioning may better indicate the impact of trauma and help decide whether people are coping satisfactorily.


Positive reactions in emergency work

Many writers are now acknowledging that emergency work can lead to positive reactions. It can seem indelicate to discuss how workers might benefit from others' suffering, but workers may get a new sense of meaning or value their contribution in such a scenario (Anderson, et al., 1991). In a study referred to earlier in the discussion of negative reactions, Moran and Colless (1995b) also factor analysed positive responses rated by emergency workers. Four factors were noted which were labelled as:
  1. exhilaration,
  2. sense of occupational achievement,
  3. enhanced appreciation of life and colleagues, and
  4. a sense of control.

Not surprisingly, these reactions were more likely to occur with task oriented incidents such as fighting fires and less likely to occur with person oriented incidents such as rescue work, but they were occasionally associated with the latter (eg 23% with motor vehicle accidents). Even when stress in emergency workers is high, there still can be some positive outcomes in terms of finding meaning, in a philosophical sense, or learning from the incident (Shepherd & Hodgkinson, 1990; Werner et al, 1993). Hyten and Hasle (1989) noted that 66% of workers reported some positive outcomes after a hotel fire which involved handling dead bodies. The best debriefing is probably that which allows for discussion of such feelings.

If there is only a focus on distress emergency workers may feel guilty or lose faith in the wisdom of those attempting to work with them after the incident. This bias can occur with researchers as well. Moran (1994, p5) quotes one emergency worker after a major incident in NSW: `I've been filling in forms (since the incident) and I'm amazed that I don't feel the way they say I should'.

Denying the existence of positive feelings may have the paradoxical effect of diminishing our appreciation of the depth of suffering of those negatively affected by emergency work. That is, if we do not allow for individual differences in positive coping and assume everyone feels the same, we are also not allowing for individual differences in the depths of distress. As those who work with individuals experiencing post-traumatic stress know, suffering is sometimes so great that it leads to suicide.


Training and stress inoculation

Critical incident stress and debriefing have been incorporated as topics in the training and in-service education of many emergency organizations. For example, in the NSW Fire Brigades peer support team members participate in formal class sessions with recruits in which they discuss types of traumatic incidents they may encounter, the reactions that can occur, and who within the organisation can help.

Many writers (Flin, 1996; Paton, 1996, Shalev, 1996, Ursano et al, 1996) are suggesting emergency services teach recruits techniques to anticipate and deal with stress. These techniques may resemble those of stress inoculation training (Meichenbaum, 1985). Evaluating the impact of this training would be easier if we had better predictors of stress reactivity and coping than we do (de Ridder, 1997, Paton & Smith, 1996) but even with the instruments we have, measuring stress and coping variables may help determine individuals particularly at risk. The idea of identifying those at risk may not find favour with emergency workers, however. The emphasis on critical incident stress probably has been accepted by the emergency worker because the term and procedures treat the individual as less culpable in the stress-reaction equation, and to return to the idea of individual differences may be seen as a step backward providing employers with an opportunity to blame the victim. Also, as Britton and colleagues note, a large number of emergency workers are volunteers and it would be uneconomical for authorities to use stress predictors to eliminate those potentially but not definitely at risk (Britton, Moran & Corey 1994). Stress inoculation training has the likely benefit of enhancing the wellbeing of emergency workers who have a high probability of being exposed to traumatic incidents. Whether such training would be extended to volunteers remains to be seen.


Conclusion

It has not yet been established that we need to find alternatives to formal debriefing sessions. Emergency workers generally rate the sessions as valuable, and some studies indicate they are useful in minimising negative reactions. However, other studies indicate debriefing may do harm (see Kenardy and Gist & Woodall - this volume). We do not have sufficient information about individual differences to predict confidently the individual impact of debriefing at this stage, although we can make certain hypotheses. Characteristics of debriefing such as ventilation of feelings, focussing on negative reactions, reliving thoughts at the scene, disclosing this information to others and listening to others talk of incidents may occasionally work in opposition to personal styles of dealing with stressful events.

The main aim of most debriefing sessions appears to be to provide workers with the opportunity to discuss negative reactions, but this should not rule out the opportunity to discuss positive ones. Even following traumatic disaster work some emergency workers, quite rightly, feel that they have done a good job. It is important we do not impose the vulnerable stereotype in the same way the macho stereotype was imposed on emergency workers in the past. The real emergency worker may occasionally be found at these extremes, but many can also be found in the middle ground, with both personal strategies for dealing with stress and vulnerabilities to it that occasionally require external help. Perhaps the best form of debriefing is that which takes this individual variability into account.

This paper has not addressed the degree to which coping resources influence coping strategies. Social support is a resource which can buffer the impact of stress (Cohen & Wills, 1985) and this may be one of the pathways through which debriefing works. That is, the debriefing process facilitates the emergency group members providing each other with social support. Orner (1995) has argued trauma recovery in emergency workers is a group phenomenon hence we should study debriefing in terms of what it does to group processes rather than focus on individuals' reactions. To take this suggestion too far, however, is to overlook the fact that groups are made up of individuals.


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Copyright

Carmen C Moran © 1998. The author assigns 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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