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BMJ. Apr 1, 2000; 320(7239): 943.
PMCID: PMC1117858

Time could be the active ingredient in post-trauma debriefing

David Brown, consulting occupational psychologist

Editor—Evidence exists that debriefing after trauma is ineffective.1 I was one of three psychologists who ran post-trauma debriefing sessions after a fatal accident in a factory. Each psychologist dealt with a group of 10-15 workers and later we compared outcomes.

One psychologist said that staff were angry with management for allowing the accident to happen, but that she had successfully settled them down. The other said that just a little anger had been expressed. No anger had been expressed in my group at all, so I asked the other psychologists what they had said to their groups.

The first had done classic debriefing, warning workers that they might feel anger and other symptoms. The second had talked about how to handle any feelings that might arise, with less emphasis on listing the possible outcomes. I was already suspicious of “debriefing,” so I had taken what I called “the Country Women's Association approach.” Country women have dealt with disasters for centuries and probably understand trauma better than psychologists do. They put up a tent near the site of the accident, keeping people comfortable, supported, and fed until they feel able to go home. This sounds just like the well tested behavioural treatment called exposure.

So I kept the tea and coffee flowing and protected the group against emotionally disturbing influences until everyone settled down. I explained what we were doing (waiting comfortably for reactions to settle, to prevent fear being learnt). They could relate to that and gave their own examples. I did not pressure anyone to volunteer symptoms. Mostly people just chatted to each other. I prompted people to speak about their best memories of the man who had died. I said that some people might find thoughts coming back and I told them how to deal with that. Anyone who was troubled could see me or ring me. Two people did, both of whom said that they had pre-existing problems and that the accident had brought those problems back to the surface.

So when dealing with people after an accident we need to remember that emotionally aroused people are suggestible. If we suggest that they might feel angry it is likely to come true. And if the secret of treatment is simply to keep people there for 90 minutes or so, feeling safe in the presence of the fearful thing, then we might need to consider eliminating the more confronting parts of the standard debriefing session.

References

1. Yamey G. Psychologists question “debriefing” for traumatised employees. BMJ. 2000;320:140. . (15 January.) [PMC free article] [PubMed]

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