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  1. Home
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  3. Psychological Debriefing
  • Cited by 62
Publisher:
Cambridge University Press
Online publication date:
January 2010
Print publication year:
2000
Online ISBN:
9780511570148
DOI:
https://doi.org/10.1017/CBO9780511570148
Subjects:
Psychiatry and Clinical Psychology, Medicine, Psychiatry
Information

Book description

Debriefing has emerged as one of the most controversial interventions in clinical psychology and psychiatry. This book, published in 2000, constitutes a presentation and analysis of evidence for the efficacy, and otherwise, of psychological debriefing, in theory and application, and appraises current research findings on the proper use of such interventions. With authoritative editorial guidance, the reader is taken through the controversies surrounding debriefing of various kinds, in various settings, and at various levels of organisational supervision and control. Contributors include many of the leading international authorities in post-traumatic studies, drawing on their first-hand experiences as investigators and also witnesses, of traumatic events and their effects. From major disasters affecting large numbers or even whole communities, to individual experiences of road traffic accidents, assault or childbirth, the range of topics and points of view presented will make this an essential reference and guide for all practitioners - whatever their point of view.

Reviews

‘At times truly horrific reading but fortunately tempered by the general opinion throughout the book that there is always the ‘possibility of help, the recognition of hurt, the reality of hope’ … This book certainly provides a wealth of theories, descriptions and experience, and as such could offer support to those psychiatrists working closely and regularly with trauma victims.’

Source: International Journal of Geriatric Psychiatry

‘Two recurring themes are welcome and reassuring. The first is the need to target interventions to those needing help … and the second is that debriefing should not be compulsory. This support is uniformly well written and offers some chapters to provoke, others to reference and one to bore. it has international appeal, covers a range of trauma and will be appreciated by many professionals, not just those with a special interest in psychological trauma.’

Source: British Journal of Psychiatry

‘The message of the book is the need to clarify, define, differentiate and test empirically. In a field which has not just great relevance but also a high profile, the book has done a valuable service by highlighting the key issues and going some way towards possible answers … Overall, however, this is a book that all those interested in stress and trauma will warmly welcome.’

Source: Sexual and Relationship Therapy

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Contents

Page 1 of 2

Contents
  • 1 - Stress management and debriefing: historical concepts and present patterns
    pp 17-31
  • View abstract

    Summary

    This chapter explains that debriefing should sit in the spectrum of response to those who have suffered severe psychologically traumatic experiences. The practice of debriefing has received substantial attention during the last two decades. The chapter attempts to contribute to the survival of debriefing by arguing that the interventions should not be viewed as treatment for trauma but rather as stress management techniques. Debriefing would often occur during a period of ongoing traumatization. Therapeutic flexibility has been wisely recommended for interventions conducted at the early stages of the response to trauma. Historical group debriefing (HGD) would combine aspects of institutional fact-finding debriefing with psychological understanding of human performance under stress. Finally, the chapter presents a study of debriefing in military units in support of the argument that simple reconstruction of a group narrative is sufficient to effectively reduce anxiety in recently exposed combat soldiers.
  • 2 - Debriefing: its role in the spectrum of prevention and acute management of psychological trauma
    pp 32-42
  • View abstract

    Summary

    This chapter emphasizes the core conceptual issues that must be clarified in terms of debriefing interventions and how intervention frameworks are often far behind and may bear little relationship to the developing research in the aetiology, phenomenology and course of post-traumatic morbidity. In general, debriefing is based on the hypothesis that the cognitive structure of the event is modified through retelling and by experiencing an emotional release that prevents or reduces the risk of more serious stress reactions. The chapter presents preliminary findings from two disaster studies and discusses the implications for training and further research on the natural debriefing process following trauma and disaster. Who attends a debriefing is important, since attendance is nearly always voluntary. Natural debriefing has potentially both psychological and practical advantages over formal debriefing, including saving on personnel resources.
  • 3 - Briefing and debriefing: group psychological interventions in acute stressor situations
    pp 43-57
  • View abstract

    Summary

    This chapter brings a very thoughtful appraisal of the significance of debriefing for different groups of personnel. The model presented here is based on extensive traumatic stress research and experience and appraisal of the use of supportive and preventive interventions in disaster and trauma situations. The chapter focuses on the potential value of what is called group stress debriefing (GSD) for professional rescue and emergency response teams, who are trained and mobilized. The way GSD is to be carried out depends on the pre-existing group structure, the group's level of professionalism and competence, its level of preparedness for the task-related event in question, and under what conditions the GSD is to be implemented. The different group levels are: group level 1: the professional team; group level 2: the reserve team; group level 3: natural groups; group level 4: random groups; and group level 5: victims groups.
  • 4 - Theoretical perspectives of traumatic stress and debriefings
    pp 58-68
  • View abstract

    Summary

    This chapter examines theoretically the concept of psychological debriefings as forms of intervention following exposure to traumatic stressors. It presents a critical event matrix analysis of psychological debriefings, i.e. a set of factors that can be placed into a conceptual matrix to identify the mechanisms, processes and factors germane to understanding the potential effects of debriefings and various types of intervention. A complex theoretical model of debriefings must specify the quantitative and qualitative differences between events requiring debriefings and how the nature of the traumatic event, in a sense, dictates the targeted interventions that may be required to aid those in need of assistance, either as a direct victim or as a responder. Understanding the applications and utility of conducting interventions after traumatic events will broaden the spectrum of knowledge and make informed choice possible for the greatest good for those who suffer from traumatic exposure.
  • 5 - Critical Incident Stress Management and Critical Incident Stress debriefings: evolutions, effects and outcomes
    pp 71-90
  • View abstract

    Summary

    This chapter describes and reviews the comprehensive Critical Incident Stress Management (CISM) system. The components of critical incident stress management include preincident education/mental preparedness training, individual crisis intervention, support/on-scene support, demobilization after disaster or large-scale events, defusing, critical incident stress debriefing, other significant support services for families and children, and follow-up services and professional referrals as necessary. The concepts and mechanisms that are thought to serve as a foundation for CISM as a crisis response system are: early intervention, the provision of psychosocial support, the opportunity for expression, and crisis education. These factors are the four cornerstones of CISM. The studies reviewed in the chapter indicate that a comprehensive, systematic and multicomponent crisis intervention approach to traumatic stress, namely CISM, has an excellent potential for mitigating critical incident stress and restoring people to normal life functions.
  • 6 - Debriefing with emergency services: Critical Incident Stress Management
    pp 91-107
  • View abstract

    Summary

    This chapter focuses on Mitchell's model of Critical Incident Stress Management (CISM) and Critical Incident Stress Debriefing (CISD) in emergency service agencies. CISM has all of the characteristics of a crisis intervention model. Knowledge about recovery from trauma is growing. Organizational problems in which the CISM programme is not accepted by the organization or unduly conflicts with existing support services. The essential elements of debriefing needs to be seen within a time context and within a framework that considers the individual and his or her interaction with others, including a debriefing, the immediate social and work support network and the broader community. Emergency services continue to lead the field with respect to trauma management in the workplace. It is important that constructive forums for discussion and writing be developed and maintained so that new developments can be described and improved evaluation research implemented.
  • 7 - Debriefing and body recovery: war grave soldiers
    pp 108-117
  • View abstract

    Summary

    This chapter reviews what is known about the psychological impact of body recovery, and in particular the possible effects on soldiers whose role it is to recover the bodies of colleagues or those of the enemy. Any factors resulting in increased identification with the dead generally result in greater distress. Soldiers in the Gulf War who were required to remove the personal effects of enemy dead, including personal correspondence and photographs of family and loved ones, found the experience intensely upsetting. Most soldiers found handling their own comrades, particularly those who had died as a result of friendly fire, more distressing than handling enemy dead. Dead psychological debriefing in particular helps to reduce subsequent morbidity. There is ample evidence to suggest that training and preparation may significantly reduce the likelihood of long-term psychological squeal after body-handling duties.
  • 8 - Debriefing and body recovery: police in a civilian disaster
    pp 118-130
  • View abstract

    Summary

    This chapter provides a detailed discussion of Alexander's experience and research in the management of two groups of police officers involved in body-handling and recovery after a major oil rig disaster. It reports on the body-handling exercise following the Piper Alpha oil platform disaster. The chapter first describes the background to the exercise. Then, it addresses conceptual issues relating to the welfare provisions including debriefing made available to the personnel involved in the retrieval and identification of human remains after this disaster. The chapter also provides the empirical results of a three-year follow-up of these personnel. It offers some explanations for the interesting findings from this follow-up. The chapter further represents a critical appraisal of the results, with particular reference to defusing and debriefing. Finally, it highlights the primary conclusions that the study presented here appears to justify.
  • 9 - Debriefing after massive road trauma: perceptions and outcomes
    pp 131-144
  • View abstract

    Summary

    This chapter discusses the effects of massive road trauma, and examines the evidence of the efficacy of psychological intervention in these cases. It presents an outline of intervention strategies for survivors, bereaved, personnel and members of the community. It also discusses the recommendations given in relation to debriefing. The conditions under which group debriefing is used and suggested protocols to follow for survivors are described. There are several types of group debriefings, namely, operational debriefings, didactic debriefings, and psychological debriefings. Critical Incident Stress Debriefing (CISD), as developed by Mitchell, is the most widely used protocol for psychological debriefing. Debriefings and other crisis intervention strategies are provided generally after massive road trauma for emergency workers. The persistence of clinically significant sequelae to such disasters highlight the importance of assistance being available beyond the first few weeks, or even first months post crash.
  • 10 - Debriefing and motor vehicle accidents: interventions and outcomes
    pp 145-160
  • View abstract

    Summary

    This chapter summarizes the available data about the psychiatric impact of motor vehicle accidents (MVAs), and examines the aetiology of these effects. It discusses the studies of debriefing interventions designed to prevent the adverse effects. The chapter explores the question about how these may be limited or treated. The psychiatric consequences of MVAs are in many ways similar to those described for acute illnesses and events but, a small proportion of victims suffer cognitive and other disorders due to head injury and brain damage and many suffer from post-traumatic syndromes. Post traumatic stress disorder (PTSD) is very frequent following MVAs. Psychological debriefing has been conceptualized as an intervention that promotes adaptive adjustment to traumatic events, in part through facilitating emotional and cognitive processing of the experience. The evidence cited here suggests that psychological debriefing for individuals after road accidents does not reduce later psychiatric problems, particularly specific post-traumatic symptoms.
  • 11 - Debriefing with service personnel in war and peace roles: experience and outcomes
    pp 161-173
  • View abstract

    Summary

    This chapter presents the theory and development of psychological debriefing, looks at its outcomes, and discusses the difference between theory and practice. It also presents an alternative suggestion for the prevention of combat-related post-traumatic stress disorder (PTSD). Psychological debriefing has its roots in various forms of instrumental debriefing designed for the purpose of gathering information about, and drawing lessons from, a variety of tasks. Marshall's historical group debriefing is an important precursor of current psychological debriefing. The importance of debriefers being capable of identifying participants who are at risk for psychological morbidity has been stressed. Most of the evidence for the effectiveness of front-line treatment is based on clinical impressions in various wars. The findings showed that the more front-line treatment principles that a soldier's treatment incorporated, the more likely he was to return to his unit and the less likely to develop PTSD a year later.
  • 12 - Debriefing post disaster: follow-up after a major earthquake
    pp 174-181
  • View abstract

    Summary

    This chapter provides caution about the broadly based and extensive use of debriefing in communities affected by disasters. Psychological debriefing is an intervention intended to facilitate the prevention of, or recovery from, the adverse psychological sequelae of traumatic events. The data collected in the investigation of the psychosocial sequelae of the 1989 Newcastle earthquake provided an opportunity to examine the effectiveness of psychological debriefing. The naturalistic study design used in the investigation, together with an approach to data analysis that controlled for potential confounds, supports the validity of the results, which, in turn, concur with those of other naturalistic studies of debriefing as well as those employing a randomized controlled design. Debriefing identifies the lack of awareness of post-trauma stress responses as a target for change for which information is the putative change agent. It may also be that debriefing is helpful in unintended ways less accessible through measurements.
  • 13 - Debriefing after disaster
    pp 182-194
  • View abstract

    Summary

    This chapter reviews some of the studies that show the potential impact of disaster stress on disaster workers, rescue workers and others. In the most acute phase of a disaster, there will be mainly nonprofessional rescuers. It is important to try to estimate personal coping strategies during rescue work, as well as what kind of formal and informal debriefing activities having been carried through and the personally experienced effects of these interventions. Rescue workers who have been under extreme psychological stress with traumatic experiences or an overwhelming personal threat may be at risk of developing post-traumatic stress disorders (PTSDs). For the Swedish peace-keeping soldiers, the post-trauma support was of limited favourable effect. Poor mental health after NATO service seemed to be more related to mental health and sense of coherence before service than to trauma exposure and post-trauma support.
  • 14 - Children and debriefing: theory, interventions and outcomes
    pp 195-212
  • View abstract

    Summary

    This overview of the conceptualization of the debriefing model and its application to children and adolescents reflects a strong clinical basis and understanding of the developmental issues relevant to the impact of critical incidents in this age range. Most of the debriefing practices currently provided for children are replications or derivatives of the adult models and are given a range of names, including creative debriefing, group treatments, classroom interventions and Critical Incident Stress Debriefing (CISD). This chapter introduces a framework for differentiation of the concept of debriefing from the group-based technique or format and the processes engaged within a well conducted debriefing. Prior to engaging a child in any response or management activity, including group debriefing, it is essential to identify, for each child, the quality of the impact of the event and the life context in which it has occurred for that child.
  • 15 - Debriefing adolescents after critical life events
    pp 213-224
  • View abstract

    Summary

    This chapter describes a background of development and its implications for debriefing children and specifically adolescents, after a traumatic event. It suggests the effectiveness of a delayed intervention, which may perhaps be appropriate because it is provided at a time of greater sense of security for the young person. While children and young people are equally affected by traumatic events, the specific manifestations of their symptomatology occur along a developmental perspective. Post-traumatic stress disorders (PTSD) has been found in children exposed to a wide range of incidents when assessed at varying times ranging from a few days to over a year after the event, using a variety of different assessment measures. Interventions that have reported using group debriefing or have incorporated the core aims and structure of this process have typically been described in relation to transport disasters. The composition of psychological debriefing groups has received minimal attention.
  • 16 - Delayed debriefing: after a disaster
    pp 227-240
  • View abstract

    Summary

    This chapter challenges the conventions of psychological debriefing as an intervention that is only applicable in the earliest period post disaster. As psychological debriefing has become more widely accepted, its original highly specific workplace focus has been broadened. The usual application of debriefing to the immediate post-disaster period may reflect its military and emergency services origins. The chapter proposes that it is useful to disentangle the underlying conceptual assumptions involved in psychological debriefing in order to inform an expanded use of the psychological principles that debriefing must be utilized to be effective. Psychological debriefing emphasizes supporting natural processes of recovery and removing barriers to resolution of the emotional impact of life-threatening events. Research on psychological debriefing procedures is often difficult to implement because of the intense and compelling level of need when one is responding to catastrophic situations.
  • 17 - Debriefing in different cultural frameworks: responding to acute trauma in Australian Aboriginal contexts
    pp 241-253
  • View abstract

    Summary

    This chapter presents a description of chronic traumatization and its effects, over many generations, and in many different forms, for Australian Aboriginal peoples. It highlights an issue critical for the whole field of debriefing, that of prolonged traumatization and the impacts of disadvantage and other socially determined pervasive trauma and loss. Repeated traumatization and enduring traumatic stress responses are thought to potentiate the impact of subsequent traumatic events and also prolong recovery from the initial trauma. The quality of care offered by state mental health services has been crucial for Aboriginal Australians, since accessibility to other services has been restrained by financial and, for rural and remote dwellers, geographical considerations. Australian Aboriginal people are well aware that recovery from acute, chronic and collective traumatization defies a wholesale remedy and cannot be adequately addressed by any short-term methods.
  • 18 - The concept of debriefing and its application to staff dealing with life-threatening illnesses such as cancer, AIDS and other conditions
    pp 254-271
  • View abstract

    Summary

    This chapter reviews concepts of stress as applied to health care professionals, and the perceived extent of the problem. It discusses factors that have been identified as contributing to the psychological symptoms and distress of health care professionals. The chapter also explains the models of interventions that have been used in some settings, as part of a critical evaluation of the role of Critical Incident Stress Debriefing (CISD) in these settings. The applicability of traumatic stress models to experience in health care fields is evidenced by the nature of stressors themselves. Several studies have described the extent of concerns experienced by staff working in the area of HIV, documenting varying levels of stress. Training needs to provide appropriate recognition of the emotional vulnerability of health care professionals and appropriate mechanisms of support and intervention that are readily available and nonstigmatizing.
  • 19 - Traumatic childbirth and the role of debriefing
    pp 272-280
  • View abstract

    Summary

    This chapter considers the potential application of the debriefing model of intervention to women adversely affected by the experience of childbirth, particularly an occasion that might be traumatic. In the terminology used for post-traumatic stress disorder (PTSD), antenatal classes are essentially seeking to provide stress inoculation (SI). SI provides a battery of coping strategies aimed at dealing with the event itself, as well as the accompanying emotions. Childbirth has now become relatively safe, and this has resulted in de-emphasizing the impact of childbirth as an event of special significance. Fifteen per cent of pregnancies are miscarried and there is abundant evidence that spontaneous miscarriage is a highly traumatic event for many women who experience it. There is almost a complete absence of research addressing the question of whether some form of debriefing can diminish adverse psychological outcomes following childbirth.
  • 20 - Debriefing health care staff after assaults by patients
    pp 281-289
  • View abstract

    Summary

    This chapter reports an interesting and reportedly effective programme used to lessen the stressor impact of assaults by patients on staff in psychiatric inpatient settings. Workplace violence may end in death, serious injury, lost productivity and human suffering. While the medical needs of employee victims are attended to, less attention is usually addressed to the psychological impact of these events in the victims' lives. The chapter specifically examines the primary nature of health care violence: assaults by psychiatric patients against staff. Assaulted Staff Action Programme (ASAP) is highly modular and flexible and has been adapted for a variety of health care settings. Untreated acute distress from psychological trauma associated with assaults may result in impaired employee victim functioning. The present findings from the ASAPs demonstrate that Critical Incident Stress Management (CISM) approaches can be subject to rigorous experimental enquiry.
  • 21 - Multiple stressor debriefing as a model for intervention
    pp 290-302
  • View abstract

    Summary

    This chapter provides a comprehensive discussion of the concept and practice of multiple stressor debriefing (MSD). MSD addresses the thoughts and feelings about the stressors that personnel encounter while participating in a disaster operation. The model of debriefing is applicable to many other trauma-response groups such as medical, police and fire personnel, Federal Emergency Management Agency (FEMA) workers, as well as direct victims. The primary advantage of an individual debriefing is that it provides an opportunity to aid persons who might not otherwise receive an appropriate level of individual attention. An advantage of a family debriefing is that families can be quickly and effectively mobilized to provide support for the affected person. Evaluating the effectiveness of debriefings through anonymous questionnaires or by asking participants for their feedback at the conclusion of the debriefing is an important step in creating a useful intervention.
  • 22 - Concerns about debriefing: challenging the mainstream
    pp 305-320
  • View abstract

    Summary

    Psychological debriefing after disastrous events has become a widespread and popular trend over the past 15 years. When debriefing resulted in large numbers of workers' compensation, payments and insurance or civil claims, the modality was rejected by the police administrators who perceived it as instigating malingering and secondary gain. By using standardized context-free formats, the debriefer is actually helping to co-construct experience by directing the narrative according to a predetermined set of concerns. The debrief process fails to recognize that the reflective approach it requires only adds to the fears and frustration of traumatically impaired individuals, who may become anxious, confused, or shut down in the debriefing process. Debriefings have in many instances become mandatory mental health treatment programmes. By adopting the salutogenic model, many of the issues outlined by emergency workers become eliminated.

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