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Psychological debriefing for preventing post traumatic stress disorder (PTSD)

  1. Suzanna C Rose1,*,
  2. Jonathan Bisson2,
  3. Rachel Churchill3,
  4. Simon Wessely4

Editorial Group: Cochrane Depression, Anxiety and Neurosis Group

Published Online: 21 JAN 2009

Assessed as up-to-date: 2 DEC 2001

DOI: 10.1002/14651858.CD000560

Database Title

Additional Information

How to Cite

Rose SC, Bisson J, Churchill R, Wessely S. Psychological debriefing for preventing post traumatic stress disorder (PTSD). Cochrane Database of Systematic Reviews 2002, Issue 2. Art. No.: CD000560. DOI: 10.1002/14651858.CD000560.

Author Information

  1. 1

    Berkshire Healthcare NHS Trust, UK., Berkshire Traumatic Stress Service, Reading, Berks, UK

  2. 2

    Cardiff University, Department of Psychological Medicine, Cardiff, UK

  3. 3

    University of Bristol, Academic Unit of Psychiatry, Community Based Medicine, Bristol, Avon, UK

  4. 4

    Guy's, King's & St Thomas School of Medicine & Institute of Psychiatry, Academic Dept of Psychological Medicine, London, UK

*Suzanna C Rose, Berkshire Traumatic Stress Service, Berkshire Healthcare NHS Trust, UK., Erleigh Road Clinic, 25 Erleigh Road, Reading, Berks, RG1 5LR, UK. suzanna.rose@berkshire.nhs.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 21 JAN 2009

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Over approximately the last fifteen years, early psychological interventions, such as psychological 'debriefing', have been increasingly used following psychological trauma. Whilst this intervention has become popular and its use has spread to several settings, empirical evidence for its efficacy is noticeably lacking. This is the third update of a review of single session psychological "debriefing", first having been undertaken in 1997.

Objectives

To assess the effectiveness of brief psychological debriefing for the management of psychological distress after trauma, and the prevention of post traumatic stress disorder.

Search methods

Electronic searching of MEDLINE, EMBASE, PsychLit, PILOTS, Biosis, Pascal, Occ.Safety and Health,SOCIOFILE, CINAHL, PSYCINFO, PSYNDEX, SIGLE, LILACS, CCTR, CINAHL, NRR, Hand search of Journal of Traumatic Stress. Contact with leading researchers.

Selection criteria

The focus of RCTs was on persons recently (one month or less) exposed to a traumatic event. The intervention consisted of a single session only, and involved some form of emotional processing/ventilation, by encouraging recollection/reworking of the traumatic event, accompanied by normalisation of emotional reaction to the event.

Data collection and analysis

15 trials fulfilled the inclusion criteria. Methodological quality was variable, but the majority of trials scored poorly. Data from 6 trials could not be included the meta-analyses. These trials are summarised in the text.

Main results

Single session individual debriefing did not prevent the onset of post traumatic stress disorder (PTSD) nor reduce psychological distress, compared to control. At one year, one trial reported a significantly increased risk of PTSD in those receiving debriefing (OR 2.51 (95% CI 1.24 to 5.09). Those receiving the intervention reported no reduction in PTSD severity at 1-4 months (SMD 0.11 (95%CI 0.10 to 0.32)), 6-13 months (SMD 0.26 (95%CI 0.01 to 0.50)), or 3 years (SMD 0.17 (95%CI -0.34 to 0.67)). There was also no evidence that debriefing reduced general psychological morbidity, depression or anxiety, or that it was superior to an educational intervention.

Authors' conclusions

There is no evidence that single session individual psychological debriefing is a useful treatment for the prevention of post traumatic stress disorder after traumatic incidents. Compulsory debriefing of victims of trauma should cease. A more appropriate response could involve a 'screen and treat' model (NICE 2005).

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Psychological debriefing for preventing post traumatic stress disorder (PTSD)

This review concerns the efficacy of single session psychological "debriefing" in reducing psychological distress and preventing the development of post traumatic stress disorder (PTSD) after traumatic events. Psychological debriefing is either equivalent to, or worse than, control or educational interventions in preventing or reducing the severity of PTSD, depression, anxiety and general psychological morbidity. There is some suggestion that it may increase the risk of PTSD and depression. The routine use of single session debriefing given to non selected trauma victims is not supported. No evidence has been found that this procedure is effective.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

預防創傷後壓力症候群(PTSD)的心理匯報

過去近15年來，早期的心理介入，例如：心理"匯報"(debriefing)越來越常在心理創傷後被使用。當這種介入變得廣泛，其使用也擴展到不同的機構設置，有關其效果的實證證據卻是顯著地缺乏。這是一篇回顧單次會期心理匯報的第三次更新，第一次則是在1997年

目標

評估創傷後以簡短心理匯報處理心理壓力，以及預防創傷後壓力症候群的效果

搜尋策略

搜尋MEDLINE, EMBASE, PsychLit, PILOTS, Biosis, Pascal, Occ. Safety and Health, SOCIOFILE, CINAHL, PSYCINFO, PSYNDEX, SIGLE, LILACS, CCTR, CINAHL, NRR等電子資料庫。手動搜尋Journal of Traumatic Stress。與主要的研究者聯繫

選擇標準

RCT主要針對最近(一個月或更短期間)暴露於創傷事件的人。這個介入只有一次會期，藉由鼓勵對創傷事件回憶/重新處理，來處理/流通情緒，伴隨著對此事件的情緒反應的正常化

資料收集與分析

15個試驗符合納入的標準。方法學的品質不一，但大部分的試驗品質都不佳。其中6個試驗的資料無法納入後設分析。這些試驗以文字敘述的方式來總結

主要結論

單次會期的個別匯報與控制組相比，無法預防創傷後壓力症候群的發生，也不能減少心理壓力。1個試驗報告在一年後，接受匯報的個案顯著地增加罹患PTSD的風險(OR 2.51 (95% CI 1.24 to 5.09)。接受介入的參與者在PTSD的嚴重度上並沒有減輕，不論是在1 – 4月後(SMD 0.11 (95%CI 0.10 to 0.32)), 6 – 13 months (SMD 0.26 (95%CI 0.01 to 0.50))，或是3年後(SMD 0.17 (95%CI −0.34 to 0.67))。也沒有證據顯示匯報降低一般心理不健康，憂鬱或焦慮，或這種介入比教育取向的介入要好

作者結論

沒有證據顯示在創傷意外之後，單次會期的個別心理匯報對於預防創傷後壓力症候群是一種有效的治療。應該停止強迫創傷的受害者匯報。另一種更適當的反應則是以篩檢後治療(screen and treat)的模式介入(NICE 2005)。

翻譯人

本摘要由彰化基督教醫院陳美雀翻譯

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌

總結

結果並不支持對未經選擇的創傷受害者例行性地實施單次會期的匯報。沒有找到證據支持這個程序是有效的。這篇回顧關心的是單次會期的心理匯報在創傷事件後降低心理壓力，以及預防創傷後壓力症候群(PTSD)的發展上的有效性。心理匯報在預防或減輕PTSD的嚴重程度，憂鬱，焦慮，與一般心理不健康的效果，等同於控制組或教育性介入組，甚至更差。有一些證據顯示它可能增加罹患PTSD與憂鬱的風險。

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