Authors of a study in this week's issue of THE LANCET provide strong evidence that formal counselling after traumatic events is ineffective--and that it could actually do more harm than good.
Traumatic events such as the September 11 2001 attacks have highlighted the issue of psychological support for people who have been traumatised; offers of emotional and practical support to victims are thought to be appropriate and caring human responses. However, conflicting evidence surrounds the effectiveness of single-session psychological debriefing, a commonly used approach to help people who have recently experienced trauma.
Arnold van Emmerik and colleagues from the University of Amsterdam, Netherlands, assessed the value of single-session debriefing after trauma in the subsequent prevention of chronic symptoms of post-traumatic stress disorder (PTSD) and other psychological disorders. They pooled and re-analysed previous studies, some of which involved a specific type of counselling called critical incident stress debriefing (CISD); this typically involves one three-hour, group therapy session for trauma victims. The investigators restricted their analysis to studies where single-session debriefing had been done within one month of the traumatic event, and to studies that involved the use of widely accepted psychological measures to assess behaviour.
Seven studies were reanalysed, which included data about five CISD interventions, three non-CISD interventions, and six controls (ie, no intervention at all). PTSD symptoms improved with Non-CISD interventions and no intervention--CISD did not have any positive effect. Furthermore, CISD did not improve natural recovery from other trauma-related disorders. The investigators offer various suggestions for the failure of CISD, including the theory that formal therapy such as CISD may prevent people from seeking natural family or social support systems.
Despite these findings, Richard Gist from Missouri Fire Department and the University of Missouri, Kansas City, USA, and Grant Devilly from the University of Melbourne, Australia, conclude in an accompanying Commentary (p 741): "Promising approaches are emerging, with high sensitivity and specificity, allowing straightforward and relatively non-intrusive assessment to identify those at greatest risk of clinical progression to post-traumatic stress disorder. These approaches are designed for implementation 2–4 weeks post-impact, when brief-series cognitive behavioural therapy has efficacy in treating post-traumatic stress disorder in high-risk populations."
Contact:
Mr Arnold van Emmerik,
Department of Clinical Psychology, University of Amsterdam,
Roetersstraat 15,
1018 WB Amsterdam, Netherlands;
T) 31-20-525-6715;
F) 31-20-639-1369;
E) kp_emmerik@macmail.psy.uva.nl
Dr Richard Gist,
Kansas City, Missouri Fire Department, and University of Missouri-Kansas City,
Kansas, MI 64106, USA;
T) 816-513-1715;
F) 816-513-1712;
E) Richard_Gist@kcmo.org
Journal
The Lancet