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.
Is sleep-deprivation helpful?
Sleep deprivation eliminates fear generalization: New way to treat PTSD?
See Kuriyama, Soshi, and Kim (2010).
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