The Trauma Lines Blog

Association of Traumatic Stress Specialists

Can Critical Incident Stress Debriefing Increase Chances of PTSD?

with one comment

One experts seems to think so.

TIME’s Maia Szalavitz interviewed Emory University psychology professor Scott Lilienfeld who is of the opinion that critical incident stress debriefing can actually increase someone’s chances of post-traumatic stress.

As we noted yesterday, the psychological impact of the devastation in Japan is expected to be massive. But is the technique commonly used by trauma responders doing more harm than good?

Here’s an excerpt from the TIME interview with the professor:

So, how could the counseling of survivors immediately after the tsunami and earthquake possibly backfire?

No one knows for sure why it’s not a good idea, but given what the research shows, [some kinds of debriefing can be harmful]. It usually involves putting people in groups very shortly after the traumatic event and strongly encouraging them to “Get their feelings out” and “Talk about it” and so on. In classic debriefing, they almost prescribe symptoms, saying things like “Don’t be surprised if you start feeling X, Y or Z” or “There’s a good chance you’ll have nightmares or flashbacks.” There’s some speculation that that [in itself] might bring some of the symptoms on, so I’m not sure that’s a great idea.

What does the research find?

The research shows that [this type of debriefing is] probably at best ineffective and may actually be harmful in some cases. [It’s not clear why]. Some of what happens is that you have to respect individual coping mechanisms. Some people are ready to talk and some prefer not to talk. One problem with classic debriefing is that it often strongly encourages or urges people to talk about emotional memories that they may not really want to talk about. It’s best to kind of leave it alone.

[Another] thing we know is that if you want to deal with anxiety, you have to allow anxiety to peak first and then pass, and give people enough opportunity to fully process it. [These techniques] may bring up some anxiety and increase it, maybe even bring up new anxieties and not really resolve them or make them worse.

But one recent paper claimed that the evidence of harm [from debriefing] was overstated, so there is still some controversy over whether it’s useless or actively harmful — but even these authors admit that when used sloppily, [debriefing] probably is harmful.

I’ve heard that another problem arises from the fact that the counselors are strangers. They come into a situation from outside and are not known to the survivors.

It could be that there would be problems with strangers, but I think that a bigger concern is that [interventions] have to respect people’s culture. There are certainly cultural similarities between the U.S. and Japan but there are also other cultural differences that have to be respected.

Japan tends to be, in a broad generalization, somewhat more of a collectivist culture. There’s often more respect for community and group harmony, group cohesion. There’s a danger in people coming in who are not sufficiently culturally sensitive to those kinds of issues. They need to be very careful that interventions they use are culturally attuned.

Click here to continue reading the TIME interview.


Written by traumalines

March 15, 2011 at 8:33 pm

One Response

Subscribe to comments with RSS.

  1. […] Some very reasonable guidance that applies to every debriefing, but perhaps even more important in other cultures:… […]


    March 21, 2011 at 11:04 am

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )


Connecting to %s

%d bloggers like this: