© 2001 The Royal College of Psychiatrists
Correspondence |
Psychological debriefing - does it never work?
Department of Behavioural Sciences in Medicine, University of Oslo, PO Box 1111 Blindern, N-0317 Oslo, Norway
Mayou et al (2000) conclude in their 3-year follow-up study of road traffic accident victims that psychological debriefing is ineffective and has, in fact, adverse long-term effects. The intervention group reported significantly worse outcome at 3 years in terms of more severe psychiatric symptoms, impact of event symptoms, anxiety, depression, obsessive-compulsive problems and hostility, pain, major chronic health problems and financial problems. The findings support the suggestion that routine use of psychological debriefing among trauma victims should be discontinued (Bisson et al, 1997).
However, this conclusion is premature. A most serious problem in previous research is that the term psychological debriefing has been used for different types of interventions, for example, in terms of number of sessions and individual or group debriefing. Mayou et al offered individual one-session intervention, without any followup. This kind of intervention is contrary to most clinical thinking: first, assess the trauma; second, offer treatment accordingly. Nobody would recommend that all victims of traffic accidents should be given a standard surgical procedure of 15 minutes in the operating room. For patients with major traumas, the results may be worse than having no operation. The conclusion based on such an approach might easily be that surgery after traffic accidents should not be performed.
A flexible and individual approach is a much more reasonable and appropriate strategy (Rose et al, 1999). Future studies of psychological debriefing should use an individualised design including screening of psychopathology before intervention, if any, is offered. To assess the effect of one session of debriefing, only subjects who are likely to benefit from such a limited intervention should be included (i.e. those who are at greatest risk for post-traumatic stress disorder should be excluded).
The Impact of Event Scale scores for patients with high initial scores was 25.9 v. 11.8 in the control group (Mayou et al, 2000). This may indicate that the trauma of meeting a debriefer for 1 hour was comparable to the trauma of the traffic accident itself.
If the findings of Mayou et al are valid, it shows a tremendous potential for psychological intervention. However, we are still not convinced that a 1-hour psychological intervention unintentionally can do so much harm.
REFERENCES
- Bisson, J. I., Jenkins, P. L., Alexander, J., et al
(1997) Randomised controlled trial of psychological
debriefing for victims of acute burn trauma. British Journal of
Psychiatry, 171,
78-81.
[Abstract/Free Full Text] - Mayou, R. A., Ehlers, A. & Hobbs, M. (2000)
Psychological debriefing for road traffic accident victims. Three-year
follow-up of a randomised controlled trial. British Journal of
Psychiatry, 176,
589-593.
[Abstract/Free Full Text] - Rose, S., Brewin, C. R., Andrews, B., et al (1999) A randomized controlled trial of individual psychological debriefing for victims of violent crime. Psychological Medicine, 29, 793-799.[CrossRef][Medline]
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