A 'big nail' in the CISM coffin

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Copyright © 2003, Dow & Company, Inc.

The Wall Street Journal

12 September 2003

Is Trauma Debriefing Worse Than Letting Victims Heal

Naturally?

SCIENCE JOURNAL

By Sharon Begley

842 Words

B1

THE EXECUTIVE was in a meeting in one of the Twin Towers when the first

plane

hit. Of the 30 people with him, he and only six others staggered out alive

that morning.

Crushed by the enormity of the tragedy, the man told his trauma

counselor that it was all he could do to try to understand why he had

lived while others died. Yet he had to cope with a great deal more.

Like thousands of other victims of Sept. 11, the executive underwent

psychological debriefing, a catch-all term for sessions in which a

counselor encourages a group of 10 to 20 trauma survivors or disaster

workers to

share, in a supportive environment, what they experienced, felt and thought.

Debriefing, say proponents, can prevent long-term psychological problems

such as

post-traumatic stress disorder. The disaster industry that emerged in the

1990s has vigorously promoted psychological debriefing, training more than

40,000 people a year in it. Members of the U.S. military undergo stress

debriefing

before deploying home from Iraq.

For the executive who survived the 2001 terrorist attacks, though,

hearing other victims describe what they saw and suffered that day was too

much.

When one described seeing a body part roll down a sidewalk, he had to flee

the

session.

FOR WEEKS afterward he suffered flashbacks and nightmares, finally

seeking help from Crisis Management International, an Atlanta-based company

that,

at the behest of 204 corporate clients, had sent hundreds of counselors to

New York within days of Sept. 11. " The group debriefing had led him right

into

what he couldn't get rid of in the first place: the memories and images of

9/11, " says CEO Bruce Blythe.

In science, anecdotes are not data. But stories like this executive's

are igniting a firestorm of controversy in psychology. After scrutinizing

dozens of studies of psychological debriefing, a panel of eminent

researchers

assembled by the American Psychological Society -- McNally of

Harvard

University in Cambridge, Mass.; of the University of New

South Wales

in Sydney and Anke Ehlers of King's College London -- has reached a clear

conclusion.

" Contrary to a widely held belief, pushing people to talk about their

feelings and thoughts very soon after a trauma may not be beneficial, " they

write in a paper to be published in November in the journal Psychological

Science

in the Public Interest (available at www.psychologicalscience.org/pspi).

" Although psychological debriefing is widely used throughout the world to

prevent PTSD, there is no convincing evidence that it does so. . . . For

scientific

and ethical reasons, professionals should cease compulsory debriefing of

trauma-exposed people. " Most survivors who have undergone

psychological debriefing call it helpful. But objectively comparing the

outcomes of

people who did and didn't undergo debriefing -- survivors of car accidents,

police officers exposed to trauma and disaster workers -- tells a different

story.

Debriefing has no effect on rates of PTSD.

A 2001 analysis, for example, examined peer-reviewed studies that randomly

assigned trauma survivors to receive " critical-incident stress debriefing, "

a commonly used protocol, or not. (Randomized controls let you separate

the effects of debriefing from natural recovery.) The conclusion: There is

no evidence that debriefing helps prevent PTSD in trauma survivors,

partly because most recover naturally.

MORE WORRISOME, debriefing may impede natural recovery. When police

officers who worked a plane crash underwent debriefing, they had

significantly more

PTSD symptoms 18 months later than officers who weren't debriefed. By

forcing survivors to relive horrific memories, says Prof. McNally,

" debriefing

may consolidate emotional memories more intensely, when what you need is

to shut down for a while. As one earthquake survivor in Turkey said, `It was

as if the debriefers opened me up as in surgery and didn't stitch me back

up.' "

, an associate professor at the University of

land, Baltimore County, who devised critical-incident stress debriefing,

dismisses the negative studies. Many include debriefings conducted by poorly

trained

or minimally experienced counselors, he says, or done too soon after the

trauma. Moreover, " this was never designed as a stand-alone. Crisis

intervention includes much more than debriefing. "

In fact, at least one debriefing study found a benefit. In 1999,

scientists reported that 42 emergency medical personnel who underwent

debriefing

after working the 1992 Los Angeles riots reported significantly fewer PTSD

symptoms than did 23 nondebriefed workers. Other pro-debriefing studies,

however, are problematic. Some failed to include a no-treatment group to

serve as a control.

In others, the follow-up period for assessing " lasting " psychological

damage was woefully short.

Businesses aren't waiting for academics to resolve the debate. Concerned

about the potential harm of debriefing, says Mr. Blythe, CMI has abandoned

it. The company's Web site now warns prospective clients that the science

behind debriefing is so iffy, and the suggestions of harm so troubling, that

requiring employees to undergo debriefing could invite lawsuits.

--- You can e-mail me at sciencejournal@....