WHO Single-session Psychological Debriefing: Not Recommended

[tniuqs]

World Health Organization

Single-session Psychological Debriefing: Not Recommended

The purpose of this brief communication is to draw attention to some aspects of mental health interventions in emergency situations. The world is witnessing an increasing number of conflicts and disasters - causing enormous mental suffering. As a result, more and more governmental, nongovernmental and United Nations agencies are involved in the provision of mental health assistance to affected populations. One of the most popular approaches is the so-called ‘single-session psychological debriefing.’ It is the technical opinion of WHO's Department of Mental Health and Substance Abuse -based on the available evidence - that it is not advisable to organize single-session psychological debriefing to the general population as an early intervention after exposure to trauma.

Mental health interventions during and after disasters and conflicts are being discussed widely in the medical literature and popular media. It is well-known that common mental problems (mood and anxiety disorder, trauma-related problems) increase after exposure to severe trauma and loss and that forrmal/informal services for people with pre-existing disorders often collapse during emergencies. Fortunately, a range of sound strategies for social and mental health interventions are available to reduce disorder and distress. These are summarized by the Department in the document Mental Health in Emergencies: Mental and Social Aspects of Health of Populations Exposed to Extreme Stressors, available in four languages (English, Arabic, French, and Spanish). Single-session psychological debriefing is not among the recommended strategies.

Single-session psychological debriefing is a formal type of early intervention after exposure to trauma for which several models have been developed in the past two decades. Its origins can be traced to efforts to reduce psychiatric casualties among soldiers immediately after combat throughout the last century. It became prominent in the 1980s when the principles were transferred to civilian life. Presently, it is seen more and more frequently that relief agencies seek to deliver psychological debriefing to the entire surviving population in certain trauma-affected communities. Debriefing typically involves promoting some form of emotional processing/catharsis by encouraging recollection/ventilation/reworking of the traumatic event in a single session in the near aftermath of the trauma.

Psychological debriefing as an early intervention after trauma is likely ineffective and some evidence suggests that some forms of debriefing may be counterproductive by slowing down natural recovery. Authoritative sources for this conclusion include: (1) van Emmerik et al. (Single session debriefing after psychological trauma: a meta-analysis; Lancet. 2002 Sep 7; 360: 766-71), (2) Rose et al. (Psychological debriefing for preventing post traumatic stress disorder [PTSD] [Cochrane Review]. In: The Cochrane Library, Issue 2, 2004. Chichester, UK: Wiley), and (3) National Institute of Mental Health (Mental Health and Mass Violence: Evidence-based Early Psychological Interventions for Victims/survivors of Mass Violence. A Workshop to Reach Consensus on Best Practices). NIH Publication No. 02-5138. Washington: US Government Printing Office, 2002).

There are a few proponents of debriefing who question the aforementioned conclusion. They argue that the debriefing that has been studied is different from the debriefing that is given in emergencies. Also, it is known that many recipients and providers of debriefing are satisfied (i.e., they are satisfied even though it does not reduce psychological problems). Much of the critical evidence on debriefing is quite recent, which explains why many well-meaning agencies and professionals are still involved and without a doubt will continue to be involved in psychological debriefing.

In conclusion, (a) emergencies are associated with wide distress and elevated rates of common mental disorders and trauma-related problems, (

single-session psychological debriefing to the general population is not recommended as an early intervention and © a range of social and mental health interventions exist to address social and mental problems during and after emergencies (see Mental Health in Emergencies: Mental and Social Aspects of Health of Populations Exposed to Extreme Stressors).

1 For questions, please contact Dr Mark van Ommeren, Department of Mental Health and Substance Abuse (vanommerenm@who.int)

http://www.who.int/mental_health/media/en/note_on_debriefing.pdf

[Eydawn]

This appears to be directed at mass debriefings of victims, as opposed to the use of small focused group debriefings of responders.

Not sure really what to say about this; like many things in psychology, many viewpoints, many approaches...

Wendy

CO EMT-B

[DFIB]

My avatar describes beyond words what I think of the UN.

[Chief1C]

I'll be the first to tell people that debriefing is mandatory.. But I've never been to one, and I would quit before I had to attend one. Unless it's held in a bar. Alcohol - The social jaws of life.

[Kaisu]

Once again, I miss our friend Dust. He railed against these debriefings, calling them ineffective and damaging. I happen to agree. The idea that I would allow some undereducated, overconfident department stars to rummage around in my psyche is ls laughable.

[romneyfor2012]

I have to disagree to a point. I agree with crap that if you have serious mental health issues you should see a professional. But how many EMS/Fire people have benefits that allow you to go to a mental health person, and how many would actually go if they had the insurance coverage ? I think allowing the group to vent about what they have been through is a good thing. I have been to a handful of these and was frequently the "moderator"; I did not pretend to be a mental health professional, I was just the veteran in the room who had seen it before. Frequently, grown men cried, which told me that they needed the moment to express what was bouncing around in their head. As long as the meetings are voluntary, I see nothing wrong with it. To me the statement from WHO is nothing more than a commercial for counselors who feel threatened and do not want to lose business. Just because something bad happens does not mean you need to see a psychiatrist, you might just need a hug.

[DFIB]

I don't talk to strangers about the "darkness inside". As far as a grown mans tears having significance, What does that mean? We have insight to the rest of his life? What if he is emotional and cries all the time? What if he is taking hormone replacement therapy and is feeling a "little insecure"? What if he is a "big brother" plant and cryes to get others to show their weakness?

Edited November 25, 2011 by DFIB

[tniuqs]

I have to disagree to a point. I agree with crap that if you have serious mental health issues you should see a professional. But how many EMS/Fire people have benefits that allow you to go to a mental health person, and how many would actually go if they had the insurance coverage ? I think allowing the group to vent about what they have been through is a good thing. I have been to a handful of these and was frequently the "moderator"; I did not pretend to be a mental health professional, I was just the veteran in the room who had seen it before. Frequently, grown men cried, which told me that they needed the moment to express what was bouncing around in their head. As long as the meetings are voluntary, I see nothing wrong with it. To me the statement from WHO is nothing more than a commercial for counselors who feel threatened and do not want to lose business. Just because something bad happens does not mean you need to see a psychiatrist, you might just need a hug.

Before you jump up and down about the benefits of this CISD stuff, check out Dr. Bryan Bledsoe website "handouts" "Snake Oil for the Masses" a powerpoint presentation regarding the topic at hand and the meta studies most interesting whom is profiting this and without question I believe that it was Bledsoe published way before the WHO article was published. In fact reliving the event shortly after an 'Incident" can and does put it into long term memory banks and can contribute to PTSD.

How the UN became mentioned .. is way beyond my diminutive comprehension. <shrug>

Edited November 25, 2011 by tniuqs

[DFIB]

Just because something bad happens does not mean you need to see a psychiatrist, you might just need a hug.

I need a hug!

Edited November 25, 2011 by DFIB

[tniuqs]

I need a hug!

Most seriously my coping measures and perhaps my personal longevity in this area of EMS, would be the friends that I work with, a simple hug can go a very long way, we are after all just primates and physical contact is very supportive, if one looks to studies in NICU physical contact (gestational age dependant) the "gerbils" thrive after physical contact at > 40 weeks.

Just saying the "I need a hug" should not be as tongue in cheek as I believe it was intended, perhaps should not be overlooked, (correct me if I am wrong)

We have had a tradition of EMS 'tough guys" hey this shit don't bother me .. to find out down the road that it really DID.

cheers