News Experts Urge Against Trauma Counselling Immediately After Trauma (Pre-PTSD)

[anthony]

Trauma counselling following a serious incident, like the death of a workmate or a life threatening accident, far from helping may in fact make the situation worse, according to a leading Australian expert. Professor John Pead, from the Australian Centre for Post Traumatic Mental Health (ACPMH), is urging employers to be cautious about utilising trauma counselling.

‘There is no evidence to support the effectiveness of trauma counselling and it may in fact increase the risk of worse outcomes,’ Professor Pead notes. ‘This can occur where well intentioned counsellors inadvertently facilitate individuals in adopting the sick role, foster work avoidance and thereby contribute to longer term disability.’

This position is strongly backed by Work Solutions. ‘Recent evidence suggests that the traditional approach of structured group debriefing following a serious incident isn’t necessarily helpful and may even be harmful,’ Dr Melissa Lehmann, National Operations Manager for Psychology, Work Solutions, explained.

‘This is because individuals vary in their response to stressful incidents – some may want to explore their emotions while others prefer not to. Both responses are normal,’ she said. ‘The best primary response to a serious incident is to have the support of family, friends and colleagues. Eighty percent of people will recover on their own with this support and without the need for psychological treatment.’ That’s not to say that professional support and counselling no longer has a role.

‘It usually takes around three to four weeks for people to start to feel “normal” again following a serious or life threatening incident. If they’re not experiencing a reduction in symptoms or distress within this time, that’s when therapy should be considered,’ Dr Lehmann said.

‘In such a situation, the treatment recommended by the ACPMH is trauma focused cognitive behaviour therapy, which is best provided by clinical or senior psychologists.’ In response to the latest trauma research and in line with ACPMH guidelines, Work Solutions has developed the Employee Psychological Program (EPP) especially for Australian workplaces. ‘Unlike Employee Assistance Programs (EAPs), which typically address everyday issues like relationship difficulties, minor grief, and communication issues, EPPs address clinical issues like depression, alcohol abuse, acute grief and trauma,’ Dr Lehmann said.

‘While many people will bounce back after a crisis and successfully “get on with life”, the EPP is now available for those who need professional support to get their life back on track.’

Read more on attached PDF.

 

[Noone.]

Hello.

I have to say this is a very interesting thread.
I first started reading it and it was me to a tee, I had a serious accident and the death of my best friend and work mate.
I did not have the support of my administration at the time but I was able to hold
it together while the PTSD took shape within me.
I did wait some time before seeing a professional about my issues that was due in
part to the fact that I couldn't walk, but none the less.
I ended up seeing many doctors and depending on their agenda the diagnosis would
change, so I would have to agree with the above thread just going on my
personnal experiences.
I waited to get help and I am working and functioning as normal as could be expected
so maybe there is something to say for this.

Take care.

FIRE.

 

[Ursa]

Very interesting!

 

[Petchen]

Ah thanks for posting this article. i was thinking about it when I was trying to explain to the now ex BF about why I did not need to re-explain every damn trauma or why I was upset blah blah over and over rehash rehash blah blah....bang bang re pattern trauma over and over...duh....this aint rocket science here.

This research was also done in Africa with victims of ethic cleansing.

Anyway...thanks for posting.

~R

 

[cragger65]

Eye-opening. I was plunged into counciling, and much of what it warns of has come to pass with me. Scary when I think of it.

 

[2quilt]

I wonder why the brain works that way?
For the first weeks after 9/11, every station on the tv had replayed the video of the second plane hitting the tower so many GD times that people just shut off the dammed tv. Everyone was talking about it here, 24/7 and I wonder if instant counselling hurt or harmed the people who lost family members or whole roomsful of workmates. Everyone was nonstop processing. Was that good or bad?

I sought MH assistance then because 9/11 gave me flashbacks from my war,(Desert Storm) and the local MH advice line gave me an appt with a psycologist named...

wait for it folks...


Hussein.

I screamed foul language at her and hung up.

 

[BethRSA]

Very interesting info. I believe it's true. To force someone to go to counselling when there's a trauma may not be what the person needs.

I think what needs to happen is when there's a trauma, people need to have access to counselling, but also know that if they want to go at any time, it's fine and good. We don't all have the same reactions to trauma so the "cookie cutter" approach won't work.

 

[Petchen]

Lots more when you google "ptsd and debriefing"

April 1, 2004
Psychiatric Times. Vol. 21 No. 4

Psychological Debriefing Does Not Prevent Posttraumatic Stress Disorder


Richard J. McNally, Ph.D.




Individuals exposed to horrifying, life-threatening events are at heightened risk for posttraumatic stress disorder. Given the substantial personal and societal costs of chronic PTSD, mental health care professionals have developed early intervention methods designed to mitigate acute emotional distress and prevent the emergence of posttraumatic psychopathology. The method most widely used throughout the world is psychological debriefing.
Psychological debriefing is a brief crisis intervention usually administered within days of a traumatic event (Raphael and Wilson, 2000). A debriefing session, especially if done with a group of individuals (e.g., firefighters), usually lasts about three to four hours. By helping the trauma-exposed individual "talk about his feelings and reactions to the critical incident" (Mitchell, 1983), the debriefing facilitator aims "to reduce the incidence, duration, and severity of, or impairment from, traumatic stress" (Everly and Mitchell, 1999).


The most popular model, Critical Incident Stress Debriefing (CISD), has seven phases (Mitchell, 1983; Mitchell and Everly, 2001) (Figure). The facilitator begins by explaining that debriefing is not psychotherapy, but rather a method for alleviating common stress reactions triggered by critical events (introduction). The facilitator then asks each participant, in turn, to describe what happened during the trauma in order "to make the whole incident come to life again in the CISD room" (fact phase) (Mitchell, 1983). After each participant has done so, the facilitator asks group members to describe their thoughts as the traumatic event was unfolding (thought phase). The facilitator then moves to the phase designed to foster emotional processing of the experience (feeling phase). Operating under the assumption that "everyone has feelings which need to be shared and accepted" (Mitchell, 1983), the facilitator asks questions such as "What was the worst part of the incident for you personally?" (Everly and Mitchell, 1999). The assumption is that participants will benefit by ventilating and reliving the emotions provoked by the trauma in a public gathering. After this phase, the facilitator then asks each participant whether they are experiencing any psychological or physical stress reactions that might be shared with the group (reaction phase). The facilitator then conceptualizes these reactions as nonpathological responses to terrible events and provides stress management tips (strategy phase). Finally, the facilitator summarizes what has occurred during the session and assesses whether any participants require referral for further assistance (re-entry phase).
According to Mitchell (1983), a single debriefing session "will generally alleviate the acute stress responses which appear at the scene and immediately afterwards and will eliminate, or at least inhibit, delayed stress reactions." Everly and Mitchell (1999) recommended that debriefing should be offered to anyone exposed to a critical incident, regardless of whether the person is experiencing stress-related symptoms. Although individuals exposed to trauma often receive debriefing on a one-on-one basis, according to Everly and Mitchell, debriefing is best suited for groups of people exposed to the same critical incident.
Developed originally for firefighters, police officers and other emergency service personnel, debriefing has become standard practice in diverse settings where adverse events sometimes occur, such as businesses, schools, hospitals and the military (Everly and Mitchell, 1999). Indeed, an entire debriefing industry has emerged to meet this need. Hence, Mitchell and Everly's International Critical Incident Stress Foundation trains approximately 40,000 individuals each year to provide debriefing and related services to those exposed to trauma. Moreover, Everly and Mitchell (1999) have argued that businesses may be at risk for lawsuits should they fail to provide services such as debriefing for employees exposed to critical incidents.


Does It Work?

According to Mitchell and Everly (2001), research on their debriefing methods "proves their clinical effectiveness far beyond reasonable doubt." Other scholars, however, have drawn drastically different conclusions. After conducting a meta-analysis of randomized, controlled trials (RCTs) on debriefing, Rose et al. (2001) concluded,

There is no current evidence that ... psychological debriefing is a useful treatment for the prevention of post traumatic stress disorder after traumatic incidents. Compulsory debriefing of victims of trauma should cease.​

Another meta-analysis revealed that individuals exposed to Mitchell's version of debriefing failed to experience symptomatic relief, whereas individuals who were not exposed to CISD did show improvement (van Emmerik et al., 2002).


Although most studies have failed to uncover any beneficial effect of debriefing, two have shown that it can impede natural recovery from trauma. Bisson et al. (1997) randomly assigned hospitalized burn victims to either a debriefing session or to a no-treatment (assessment-only) condition. Burn victims in the treatment condition received a single one-on-one debriefing session that lasted between 30 and 120 minutes, occurring from two to 19 days after the burn accident. In some cases a partner (usually a spouse) attended the session. The debriefer followed Mitchell's protocol. There were no significant differences between the groups at the initial assessment on questionnaire measures of depression, anxiety and posttraumatic stress. At the three-month follow-up assessment, the rate of PTSD assessed via clinical interview was non-significantly higher in the debriefed group than in the control group (21% versus 15%). At the 13-month assessment, the rate of PTSD was significantly higher in the debriefed group than in the control group (26% versus 9%). Moreover, the debriefed group scored significantly higher on questionnaire measures of depression, anxiety and PTSD relative to the control group. Bisson et al. concluded that even if debriefing is merely inert, rather than toxic, "its routine use should be discontinued."
In another study, Hobbs et al. (1996) assessed victims of road traffic accidents who had been randomly assigned to either a one-on-one debriefing session or to a no-treatment (assessment-only) condition. Individuals assigned to the debriefing condition received a single one-hour session between 24 and 48 hours after their accidents. Four months later, neither the debriefed nor the control group reported a reduction on measures of PTSD, anxiety or depression (Hobbs et al., 1996). Three years later, the debriefed group reported significantly more PTSD symptoms, general psychiatric symptoms and fear of traveling as a passenger in an automobile than did the non-debriefed group (Mayou et al., 2000). Additional analyses revealed that participants who had initially scored high on a self-report measure of PTSD symptoms and who were not debriefed improved markedly by the three-year follow-up assessment, whereas high-scorers who were debriefed remained markedly symptomatic three years later. The authors concluded, "Psychological debriefing is ineffective and has adverse long-term effects. It is not an appropriate treatment for trauma victims" (Mayou et al., 2000).


Debriefing Advocates Respond


In response to these findings, debriefing advocates have issued two responses (Everly and Mitchell, 1999; Mitchell, 2003). First, they have cited other studies that they believe confirm the efficacy of debriefing. Unfortunately, every one of these studies (none RCTs) is methodologically flawed, and most of them are so weak as to render their findings uninterpretable (for a review, see McNally et al. [2003]).
Second, they have argued that the negative studies lack probative import and are irrelevant to how debriefing is conducted in actual practice. The main critiques against the negative studies are:

• They use one-on-one debriefing, not group debriefing;
• Inappropriate measures have been used to evaluate the efficacy of debriefing;
• People directly exposed to trauma (primary victims) have been studied, rather than the emergency service personnel for whom CISD was originally developed;
• Negative studies depart from approved protocol in ways that render the findings irrelevant; and
• Critical Incident Stress Debriefing must not be evaluated on its own but only in the context of a comprehensive Critical Incident Stress Management (CISM) program.

Each of these specious critiques is devoid of merit, and each has been rebutted in detail elsewhere (for a review, see McNally et al. [2003]). Although debriefing advocates often complain that researchers fail to follow protocol precisely in studies showing null or toxic effects, these advocates must first demonstrate that their method actually works. Then their complaints about protocol departures may be warranted--only after they have furnished convincing evidence of the efficacy of their method.


Conclusions

Despite repeated attempts to document that psychological debriefing can prevent posttraumatic psychopathology, there is no convincing evidence that it does so. Even if the procedure is not harmful, its continued implementation may delay the development of truly effective crisis interventions, while wasting time, money and resources on a method that is, at best, inert.

Dr. McNally is professor of psychology at Harvard University. He has more than 230 publications, many on PTSD, and is author of the book Remembering Trauma (2003), Belknap Press/Harvard University Press.

 

[anthony]

Yep... being ex-military, they used to attempt to debrief us each time from operation. If something bad occurred, they would also attempt. It just didn't work. You would give them the standard answer... "yep, all is good" just so you can get the hell out of their and get on with being with your mates and doing your job. Debriefing fails in a massive way. There is a catch from what I have seen, being that if a person is already an emotional, talkative person, then they will talk about it and get it out quickly, though that specific personality type is highly unlikely to ever obtain PTSD regardless the trauma they endure because they don't keep the secrets, instead they talk about everything at the emotional level as their personality. Lucky them.

 

[tgrl]

As someone who has suffered traumic events, I know that counseling after the event would be a good idea. I'm not sure who these experts are who urge against it, but they are wrong.

However, with severe trauma like prolonged combat, one debriefing session is not enough, it would take more like many of them over the course of about a year.

 

[onebravegirl]

I am not sure that I agree with these experts. What made my( and anyone I know personally with PTSD) trauma exist was the fact that no one walked me through what was normal and ab-normal behaviour after a Trauma. No one was there to say that what I felt OK and that it can be made sense of. Hence the running, avoiding depression and fears that lead to me crashing and being Diagnosed with Complex PTSD. And to me that is what trauma therapists help with. The earlier the Trauma is addressed the easier it is for your brain to make sense of everything. To me trauma occurs when no one explains what it all means, gets ignored and suppressed for years and then explodes because your brain is trying to make sense out of all the unanswered questions.
I am not saying that everyone should be treated like they will automatically get PTSD. But I do believe that addressing possible side-effects of having been through a life endangering event would certainly be helpful. The panic that happens to people when they start having emotional responses to triggers and not know if it is normal could be somewhat alleviated if a person was warned ahead of time. Just my thought, I am not an "expert" just a survivor.
O

 

[ebell83]

Pre-PTSD counseling

I was never given the opportunity to have "pre-PTSD" counseling. Or even post traumatic event counseling. The closest anyone came to this was a base chaplain that contacted my now ex-husband and me at the hospital the morning our daughter died. He quoted the Bible, some immemorable verses about replacing sons and daughters and everything happening for a reason, and told us that "he was available if we needed anything." That was it. The words "grief counseling" were thrown around a lot, but no one told us what that meant or who to talk to. So, I shut down completely and my ex started throwing parties, becoming outgoing, etc. We were a prime example of how people respond differently to the same stress. It was this different response that finally drove me to leave him. Do I think that immediate counselling would have worked? I'm not sure, but I know not even being offered it isolated us even more.

I am remarried, and my husband now refers to "debriefing" with a lot of sarcasm and disdain. He expereinced many cases of it after missions overseas. He doesn't trust it, and thinks it's a way for people to check their own a** so that if someone does react adversely, the people in charge can say "not our fault, we checked everyone." But, he says it's not thorough and not effective. Most of the guys just want to be left alone to sort out their own thoughts. The probelm is, after they get left alone, no one comes back to check in.

So there you have it, two different sources of trauma, two different responses from therapists and counselors, and two different schools of throught on what should happen. I don't know, maybe immediate therapy isn't necessary for every event, but a better screening process and way to help people who are confused and scared is necessary.