Trauma, managing



Notes on harm minimisations of traumatic experiences. I’m especially interested in the notion that the best thing to do in the immediate aftermath of a Bad Thing is to do your best to forget all about it, or use drugs to control the stress. This is the opposite of what we do later on in the process, when consider it bad to depend on drugs, and bad to be unable to talk about it. See below for some references about how talking through a traumatic event immediately afterwards can increase the risk of PTSD. I am presuming the timing of this point where talking is bad, to where it is good, is is crucial.

Is one-off debriefing harmful?

I was referred to Bell (2013) who argues that one-off debriefing is harmful. Of course it is complicated and muddy. Hilda Bastian’s article Dissecting the controversy about early psychological response to disasters and trauma seems like a reasonable lay introduction

Somewhere along the way, the belief had spread that it was always better to get your emotions out than bottle things up. Debriefing fit right in(Raphael and Meldrum 1995) with that belief. Offering professional care to people in crisis also meets the need people are feeling when they see heart-wrenching scenes in Oklahoma now: to do something immediately to help relieve intense distress.…

People who got debriefing often said it had helped—and people who were debriefed were coping well or recovering from deep distress. But then, most people will cope and recover after trauma, even without particular help. Robust randomized controlled trials were needed to be sure if debriefing was genuinely helping, and if it was the best way to respond.

Just as we worry about saying the wrong thing and further distressing someone in crisis, professionals can make things worse for people too. And maybe everyone doesn’t benefit from dwelling on the trauma (Health (UK) 2005) in the immediate aftermath of a crisis.

She goes on to argue that the evidence is weak that it is actually harmful to debrief. By the same token, the evidence is weak that it helps, and you are making yourself culpable by doing it. I imagine this is why the WHO guide (Organization, Foundation, and International 2011) says:

WHO (2010) and Sphere (2011) describe psychological debriefing as promoting ventilation by asking a person to briefly but systematically recount their perceptions, thoughts and emotional reactions during a recent stressful event. This intervention is not recommended.

Gartlehner et al. (2013) argue:

Evidence supporting the effectiveness of most interventions used to prevent PTSD is lacking. If available in a given setting, brief trauma-focused CBT might be the preferable choice for reducing PTSD symptom severity in persons with acute stress disorder and collaborative care might be preferred for trauma patients requiring surgical hospitalization; by contrast, debriefing appears to be an ineffective intervention to reduce symptoms and prevent PTSD.

References

Bell, Vaughan. 2013. “Minds Traumatised by Disaster Heal Themselves Without Therapy.” The Guardian: Science, May 11, 2013. http://www.theguardian.com/science/2013/may/12/natural-disasters-healing-psychology-worse.
Brunet, Alain, Scott P. Orr, Jacques Tremblay, Kate Robertson, Karim Nader, and Roger K. Pitman. 2008. “Effect of Post-Retrieval Propranolol on Psychophysiologic Responding During Subsequent Script-Driven Traumatic Imagery in Post-Traumatic Stress Disorder.” Journal of Psychiatric Research 42 (6): 503–6. https://doi.org/10.1016/j.jpsychires.2007.05.006.
Brunet, Alain, Daniel Saumier, Aihua Liu, David L. Streiner, Jacques Tremblay, and Roger K. Pitman. 2018. “Reduction of PTSD Symptoms With Pre-Reactivation Propranolol Therapy: A Randomized Controlled Trial.” The American Journal of Psychiatry 175 (5): 427–33. https://doi.org/10.1176/appi.ajp.2017.17050481.
Burbiel, Joachim C. 2015. “Primary Prevention of Posttraumatic Stress Disorder: Drugs and Implications.” Military Medical Research 2 (October): 24. https://doi.org/10.1186/s40779-015-0053-2.
Gartlehner, Gerald, Catherine A. Forneris, Kimberly A. Brownley, Bradley N. Gaynes, Jeffrey Sonis, Emmanuel Coker-Schwimmer, Daniel E. Jonas, et al. 2013. Interventions for the Prevention of Posttraumatic Stress Disorder (PTSD) in Adults After Exposure to Psychological Trauma. AHRQ Comparative Effectiveness Reviews. Rockville (MD): Agency for Healthcare Research and Quality (US). http://www.ncbi.nlm.nih.gov/books/NBK133344/.
Health (UK), National Collaborating Centre for Mental. 2005. Early Interventions for PTSD in Adults. Post-Traumatic Stress Disorder: The Management of PTSD in Adults and Children in Primary and Secondary Care. Gaskell. https://www.ncbi.nlm.nih.gov/books/NBK56498/.
Kuriyama, Kenichi, Takahiro Soshi, and Yoshiharu Kim. 2010. “Sleep Deprivation Facilitates Extinction of Implicit Fear Generalization and Physiological Response to Fear.” Biological Psychiatry, Neuroplasticity in Anxiety Disorders, 68 (11): 991–98. https://doi.org/10.1016/j.biopsych.2010.08.015.
Organization, World Health, War Trauma Foundation, and World Vision International. 2011. “Psychological first aid: guide for field workers.” World Health Organization. https://apps.who.int/iris/handle/10665/44615.
Raphael, B., and L. Meldrum. 1995. “Does Debriefing After Psychological Trauma Work?” BMJ (Clinical Research Ed.) 310 (6993): 1479–80. https://doi.org/10.1136/bmj.310.6993.1479.
Rose, S., J. Bisson, R. Churchill, and S. Wessely. 2002. “Psychological Debriefing for Preventing Post Traumatic Stress Disorder (PTSD).” The Cochrane Database of Systematic Reviews, no. 2: CD000560. https://doi.org/10.1002/14651858.CD000560.

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