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Excerpt
This text, a collection of writings by international experts in the field of acute posttraumatic stress intervention, critically evaluates current practices in the field and offers ideas and recommendations for future investigation. Acute posttraumatic stress interventions refer to brief interventions implemented usually by a mental health professional soon after a stressful or traumatic event with the purpose of preventing posttraumatic stress disorder (PTSD). These protocols are frequently referred to as "psychological debriefings" and are distinguished from treatment interventions for PTSD. As explained by the authors, these debriefings have been widely adopted since the early 1980s by many different types of organizations and tend to involve either individual or group meetings with a mental health professional or trained peer after a stressful or traumatic event. The most common method, and one that has been implemented in numerous work-related settings, has been Critical Incident Stress Debriefing (CISD).
These methods of debriefing, and CISD in particular, have been extremely popular and continue to receive widespread support from professions such as law enforcement and emergency services. Research studies examining the efficacy of these interventions, however, have not found a lower incidence of PTSD among those who participate in debriefing. In fact, some studies have found that debriefing interventions have been associated with increased incidence of PTSD. In light of this disparity between the continued use of standard psychological debriefing and the lack of research to support its efficacy, this book makes an important contribution to the field. It addresses problems with current methods of acute posttraumatic stress intervention and offers alternative approaches to conceptualizing and implementing these protocols.
Paton, Violanti, and Dunning provide an introduction and overview of the text in addition to describing their model based on resilience and growth rather than negative symptomatology. Stuhlmiller and Dunning argue that the present pathogenic paradigm underlying current debriefing models hinders the facilitation of resilience at both an individual and collective level. They also provide some historical background to psychological debriefing and describe how debriefing has appealed to organizations as a method of containing litigation and compensation costs related to workers' claims for stress-related problems. The authors discuss how this factors into the decision of organizations to continue implementing such protocols with little empirical support. Stuhlmiller and Dunning also raise important issues such as whether acute posttraumatic interventions are necessary for everyone and when and who should administer an intervention.
A chapter by Carlier and Gersons provides a detailed description of debriefing, describes theories about how it prevents PTSD, and reviews the research literature assessing its efficacy. In their review of the literature, they distinguish between assessments of satisfaction, which have shown a high level of satisfaction from participants, and evaluation of outcomes, which have failed to find that interventions are able to prevent PTSD. They also provide some discussion of reasons for the lack of significant findings across studies.
Gist and Woodall provide a critique of the CISM model for use with occupational stress, and in particular in fire and rescue work. They stress the importance of facilitating and enhancing resilience in any acute intervention with this population and emphasize individual differences among these workers and the problems inherent in debriefing all workers in a uniform way. From a very different perspective, psychiatrist Perren-Klingler raises cross-cultural issues related to acute posttraumatic stress intervention. She provides clinical examples of intervening after a traumatic event with people of different cultures, including refugees from Kosovo.
