To debrief or not to debrief our heroes: that is the question

Authors


  • Declaration of interest: Dr. Debbie Hawker is a strong believer in the value of high-quality randomized controlled trials (RCTs), evidence-based practice and cognitive behavioural therapy. She worked for 9 years as a therapist on RCTs at Oxford University Department of Psychiatry. She now provides training, resources and consultations for people working with NGOs, and she has written a manual on debriefing aid workers. Almost all of her current work is voluntary and any royalties from her manual go directly to the charity People In Aid. Dr. John Durkin is a trainer and consultant to fire, rescue and paramedic services. Dr. David Hawker is a voluntary debriefer for Tearfund, a non-governmental organization (NGO). The views expressed in this article are those of the authors and do not reflect the official policy or position of any institution with which the authors are affiliated.

Abstract

Psychological debriefing was developed in the 1980s as an approach for use with people whose work exposes them to stressful incidents. It aims to help them to process the thoughts and emotions arising from their work. Subsequently, several randomized controlled trials tested truncated forms of debriefing in a different population: primary victims of unexpected trauma. These trials, and particularly two in which debriefing appeared to be harmful, led two major reviews to warn practitioners not to offer debriefing. Consequently, many organizations have stopped providing debriefing to employees who face trauma in their routine work. This paper argues that there are at least three reasons for the apparent failure of ‘debriefing’ in the two studies that reported adverse effects. First, the ‘debriefing’ did not follow protocol in terms of timing, length, and training and independence of the debriefer. Second, the patients who were ‘debriefed’ reported more severe initial symptoms than those who were not. Third, ‘debriefing’ was used with individuals for whom it was not originally intended. Psychological debriefing is intended to be used with groups of people who have been briefed together before going on to work together in stressful situations. Such groups have reported that they find psychological debriefing helpful, and research is emerging indicating that appropriate debriefing may indeed benefit these groups. We call for reviewers to recognize the limitations of debriefing research and not to overgeneralize their conclusions. Copyright © 2010 John Wiley & Sons, Ltd.

Key Practitioner Message:

• Warnings about the dangers of psychological debriefing are based on studies using an intervention that is very different from that used for disaster workers and military personnel.

• Evidence relating to primary victims of trauma has been overgeneralized to secondary victims.

• Psychological debriefing may harm if it is too short, too probing, conducted too soon or delivered by debriefers with insufficient training or experience.

• Research is urgently needed on appropriate debriefing for occupational groups briefed to work in stressful situations.

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