Psychological debriefing for preventing post traumatic stress disorder (PTSD)

BACKGROUND: Over approximately the last last fifteen years early psychological interventions such as psychological 'debriefing' have been increasingly used to treat psychological trauma. While these intervention have become popular and their use spread to several settings - efficacy had largely not been tested empirically. In 1997 a systematic review of single session psychological "debriefing" was undertaken and this subsequently became a protocol and Cochrane Review published in 1998 (Issue2). This update forms the first substantive update of the original review. OBJECTIVES: To assess the effectiveness of brief psychological debriefing for the management of psychological distress after trauma, and the prevention of post traumatic stress disorder. SEARCH STRATEGY: Electronic searching of MEDLINE, EMBASE, PsychLit, PILOTS, Biosis, Pascal, Occ. Safety and Health,SOCIOFILE, CINAHL, PSYCINFO, PSYNDEX, SIGLE, LILACS, CCTR, CINAHL, NRR, Hand search of Journal of Traumatic Stress. Contact with leading researchers. SELECTION CRITERIA: The inclusion criteria for all randomized studies was that they should focus on persons recently (one month or less) exposed to a traumatic event, should consist of a single session only, and that the intervention involve some form of emotional processing/ventilation by encouraging recollection/reworking of the traumatic event accompanied by normalisation of emotional reaction to the event. DATA COLLECTION AND ANALYSIS: 11 trials fulfilled the inclusion criteria. Quality was generally poor. Data from two trials could not be synthesised. Two trials involved the use of the intervention in an obstetric setting. MAIN RESULTS: Single session individual debriefing did not reduce psychological distress nor prevent the onset of post traumatic stress disorder (PTSD). Those who received the intervention showed no significant short term (3-5 months) in the risk of PTSD (odds ratio 1.22 (95% ci 0.60 to 2.46 )). At one year one trial reported that there was a significantly increased risk of PTSD in those receiving debriefing (odds ratio 2.88 (1.11 to 7.53))odds ratio 95%). There was also no evidence that debriefing reduced general psychological morbidity, depression or anxiety. REVIEWER'S CONCLUSIONS: There is no current evidence that psychological debriefing is a useful treatment for the prevention of post traumatic stress disorder after traumatic incidents. Compulsory debriefing of victims of trauma should cease.