From the issue dated October 24, 2003
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The Debriefing Debate: One Popular Therapy Is Called Into Question
One night in November 1988, the Kansas City fire department responded to a report of a small pickup truck burning at a highway construction site. By the time the first company arrived at the scene, the fire had spread to a trailer that housed ammonium nitrate and other explosives. The trailer detonated, forming a crater 8 feet deep and 80 feet across. Six firefighters died. The next day, the department flew in Jeffrey T. Mitchell, a former paramedic who had developed a technique called "critical-incident stress debriefing" to provide counseling to the survivors. Mr. Mitchell's system "intuitively seemed to make sense," says Richard Gist, the academic director of the social-sciences and social-services program at Johnson County Community College, and an assistant to the director of the Kansas City fire department. In a stress debriefing, survivors of a traumatic event are brought together in a group between 2 and 10 days after the incident. They are asked to recall the details of the trauma and to discuss their emotional reactions. The counselor offers stress-management tips and assures the survivors that their reactions to trauma are not signs of psychopathology. Despite his initial optimism, Mr. Gist says that he "came away with a sense of gnawing discomfort" after he witnessed Mr. Mitchell's sessions with the Kansas City survivors. Was it really a good idea to encourage firefighters to relive the trauma in such grisly detail so soon after the fact? Fifteen years later, thanks in part to studies conducted by Mr. Gist and his colleagues, enormous controversy surrounds stress debriefing and a related set of practices, collectively known as critical-incident stress management. At least two controlled studies suggest that debriefing may delay some people's recovery from trauma -- perhaps because it promotes the habit of ruminating over painful images and memories before a wounded psyche is ready to do so. In 2001, Britain's National Health Service listed stress debriefing as "contraindicated." Developing Alternatives Crisis Management International, a psychological-services company based in Atlanta, recently abandoned critical-incident stress management and is developing an alternative technique. "I realized that there are all these wannabe counselors running around out there who don't even know the criteria for post-traumatic stress disorder if you ask them," says Bruce T. Blythe, the company's chief executive officer. "I started talking to some of the researchers, to see about how to provide better training. But after speaking with [them], I realized that the problem was deeper than training. We needed to look at changing the model itself." The evidence against critical-incident stress management is far from cut and dried, however. Several of the most frequently cited studies that found negative outcomes from the system were based on one-on-one debriefings of civilians. The technique was designed for firefighters and other emergency workers, and it is meant to be administered in group settings. George S. Everly Jr., a close colleague of Mr. Mitchell's and the former chairman of the board of the International Critical Incident Stress Foundation, says, "We need more tests -- but tests that validly represent the independent variables." He would like to see tests that more closely match his own treatment design, with groups of physically healthy firefighters rather than (as one study had it) individual crime victims with broken limbs. (Mr. Everly concedes that many of the positive studies about debriefing are also based on tests that poorly mirror the actual technique.) The debate over stress debriefing is emblematic of a broader concern that psychology does a weak job of establishing the safety and efficacy of new therapies. If this were a drug treatment, the Food and Drug Administration would require a series of carefully structured trials to settle the question. Some researchers argue that a central body -- the American Psychological Association or the National Institute of Mental Health -- should step in to resolve the debriefing debate. Others say that the responsibility lies with the therapists who create new techniques. Mr. Everly says that he would be happy to work together with the scholarly critics of critical-incident stress debriefing to design and conduct studies that might shed new light on this vexing question. http://chronicle.com Section: Research & Publishing Volume 50, Issue 9, Page A16 | |||||||||||||||
Copyright © 2003 by The Chronicle of Higher Education