Wednesday, May 22, 2013

Does early psychological intervention prevent or cause trauma?

Scientific American     Devastating tornadoes have a lot in common with other major traumas, like life-threatening accidents, the Boston bombing and the Newtown shooting – especially the emotional distress they leave in their aftermath. As predictable and common as that distress is, though, early psychological response after trauma is still surprisingly controversial. It’s the center of a heated scientific debate that stewed and bubbled and then boiled over.

It began when a technique from the battlefield crossed over to civilian life. Soldiers traditionally debrief to share information and learn from missions and incidents. Psychological debriefing evolved along with military psychiatry instead of only discussing what happened, groups discussed feelings and coping too.

Psychological debriefing then spread to civilian first responders. Like soldiers, trauma was in the line of normal duty for them. They needed to be prepared and to cope with the stress, and debriefing was part of normality

Then psychological debriefing spread out to victims of trauma, too. And on to experiences like childbirth.

Some people expected that professional care could prevent post-traumatic stress disorder (PTSD) and other psychological harm. But in the search for an affordable and efficient intervention that could be offered to everyone, it was often a single session. [...]

Just as we worry about saying the wrong thing and further distressing someone in crisis, professionals can make things worse for people too. And maybe everyone doesn’t benefit from dwelling on the trauma in the immediate aftermath of a crisis.

A few trials of single session debriefing were done in the ‘90s. The people weren’t traumatized in the line of duty. They had suffered traumas like burns, road accidents or crimes. Or they had been debriefed around childbirth. And when discouraging results came in, controversy erupted. [...]

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