Psychological debriefing after trauma does not reduce PTSD
Aug 9, 2006, 12:44, Reviewed by: Dr. Venkat Yelamanchili
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The authors of the study hypothesise that encouraging highly aroused trauma survivors to express their feelings might activate the sympathetic nervous system to such a degree that the successful encoding of the traumatic memory is disrupted.
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By British Journal of Psychiatry,
Individual psychological debriefing does not reduce the symptoms of post-traumatic stress disorder (PTSD), anxiety or depression after psychological trauma, a new study from The Netherlands has found.
People who are highly aroused after a trauma may actually be made worse by single-session emotion-focused psychological debriefing.
Recent research has shown that individual single-session psychological debriefing does not prevent, and can even aggravate, symptoms of PTSD.
The aims of this randomised controlled trial, published in the August issue of the British Journal of Psychiatry, were to assess the effects of emotional debriefing alone, or educational debriefing alone, compared with no debriefing, on symptoms of PTSD, anxiety and depression.
236 adult survivors of a recent traumatic event were randomised to receive either the emotional debriefing, psychoeducational debriefing, or no debriefing (control group) approximately 2 weeks, 6 weeks and 6 months after the event.
Both types of debriefing lasted between 45 minutes and 1 hour and were individually administered.
It was found that psychiatric symptoms decreased significantly in all 3 groups over time, with no significant differences between them in PTSD symptoms.
Participants with more than two of the five early symptoms of high arousal actually had higher PTSD scores 6 weeks after an emotional debriefing session than similar participants in the control group.
The authors of the study hypothesise that encouraging highly aroused trauma survivors to express their feelings might activate the sympathetic nervous system to such a degree that the successful encoding of the traumatic memory is disrupted.
People receiving an emotional debriefing may also feel disempowered, which may keep them in a high state of arousal, causing PTSD symptoms to get worse rather than better.
The researchers comment that their findings are in line with recent expert statements that do not recommend single-session interventions (National Institute of Mental Health, 2002; National Collaborating Centre for Mental Health, 2005). There are all too many reasons, they say, for discontinuing this practice.
On the basis of current evidence, more benefits can be expected from early treatment only of those patients with acute stress disorder or acute PTSD with 4 or 5 sessions of cognitive behavioural therapy, or 12 sessions of cognitive therapy, in order to prevent a chronic course of PTSD. 
- Sijbrandji B, Olff M, Reitsma JB, Carlier IVE and gersons BPR (2006) Emotional or educational debriefing after psychological trauma: randomised controlled trial. British Journal of Psychiatry, 189, 150-155.
bjp.rcpsych.org
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