Therapy
Psychological Debriefing: Description, Use, and Effectiveness
THC Editorial Team June 18, 2022
Contents
- Overview
- What Is Psychological Debriefing?
- History of Psychological Debriefing
- Does Psychological Debriefing Work?
- Summary/Key Takeaways
Following a traumatic event, some people undergo a process called psychological debriefing. This therapeutic approach is widely used with first responders and military personnel exposed to traumatic events as a part of their jobs. While it is a seemingly intuitive approach to help prevent the development of posttraumatic stress disorder, there is significant controversy about its efficacy and the potential harm it could cause.
What Is Psychological Debriefing?
Psychological debriefing is a type of therapy used for crisis intervention to support people who have experienced trauma. It is generally delivered in group sessions, but therapists also use this approach with individual clients to help prevent the development of PTSD. It includes multiple components to try to address every phase of a traumatic event. While it can take several forms, the most common type used within psychology is critical incident stress debriefing, which addresses stressful experiences emergency workers deal with in their jobs.1 Psychological debriefing employs a structured process, typically occurring within 24 and 72 hours following a traumatic event, to address and help make sense of the participants’ thoughts and emotions surrounding what happened.
The psychological debriefing process involves therapeutic interviews to allow people to confront what happened and express their feelings about the traumatic experience. Therapists might ask participants to provide information about the traumatic experience and help them walk through aspects of their experience based on the situation’s context. Debriefing encourages reflection and communication so that the participants can explore and express their emotions and enhance learning about the situation. Participants are encouraged to actively engage in the discussion so that each receives input from several sources about what they have experienced.2
The debriefing session typically begins with an introduction and establishment of the rules, a fact-gathering phase during which participants tell what happened, a discussion phase during which participants give their thoughts about what occurred, and a reaction phase during which they share the emotions they have experienced as a result, and a discussion about the symptoms they should watch for and coping skills.
Debriefing has been alluded to using the following frameworks:2
Seven-stage approach:3
1. Introduction
2. The facts
3. Thoughts and impressions
4. Emotional Reactions
5. Normalisation
6. Planning for the future
7. Disengagement
Eight-stage approach:4
1. Identification
2. Labelling
3. Articulation
4. Expression
5. Externalisation
6. Ventilation
7. Validation
8. Acceptance
History of Psychological Debriefing
Psychological debriefing originated in 1983 with psychologist Jeffrey T. Mitchell’s use of an approach he termed critical incident stress debriefing. Together with George S. Everly, Mitchell developed this system to manage the stress people experience from involvement in or witnessing traumatic events. He used it with emergency medical technicians and ambulance workers in groups after they had witnessed traumatic events.3 Since the 1980s, variations of psychological debriefing have been used in various contexts, with individuals and groups. Its initial emphasis was to treat groups of people, such as first responders and members of the military, who jointly experienced traumatic events to help them process their emotions and thoughts about what happened. However, it has been somewhat controversial, with questions about its effectiveness.2
Does Psychological Debriefing Work?
Although psychological debriefing might seem intuitive in its approach by enabling people to express their emotions and thoughts about traumatic experiences soon after the events have occurred, numerous studies have questioned its effectiveness, and some have found that it could be potentially harmful. A 2002 article published in the prestigious Cochrane Database of Systematic Reviews concluded that the effectiveness of a single session of psychological debriefing is not supported by evidence.2 A 2014 meta-analysis found that psychological debriefing has limited value and could be potentially harmful.5 Additionally, some studies reviewed in a 2016 literature review found that psychological debriefing leads to poorer outcomes and could be potentially harmful.6 Finally, a recent literature review of 790 studies that included 11 that met the researchers’ study criteria found that psychological debriefing groups showed little to no benefits for the prevention of PTSD.7
In 2016, the American Psychological Association reported that psychological debriefing for posttraumatic stress disorder is not supported by research and can be potentially harmful.8 However, the authors of a 2019 review found that some of the studies on the effectiveness of psychological debriefing considered variations that did not conform to the methods described in the Cochrane Review article, and that psychological debriefing deserves another look for its potential to help people return to a state of normal functioning following exposure to trauma.9
Summary/Key Takeaways
Although psychological debriefing has been used to help people process their thoughts and emotions following exposure to trauma, there is little evidentiary support for this therapeutic practice. Instead, multiple studies have found it ineffective at best and potentially harmful at worst. People who need treatment following exposure to trauma might want to consider other therapeutic modalities with more empirical support.
