Psychological debriefing – are we doing more harm than good?
As a physician, I believe in evidence-based medicine. The purpose of evidence-based medicine is to optimize decision making by emphasizing the use of evidence from well designed and well-conducted research. I believe the same principle should apply to the profession of policing. So why do North American law enforcement agencies regularly use psychological debriefing after a critical incident?
Critical Incident Stress Debriefing
The most common forms of psychological debriefing are Critical Incident Stress Debriefing (CISD) and Critical Incident Stress Management (CISM).
CISD was developed in the late 1980s. After 9/11, a number of respected researchers, including those with the Cochrane Collaboration, studied CISD effectiveness. The Cochrane Collaboration is a non-profit/non-government research group and considered a gold standard of medical research. It is dedicated to exploring the efficacy of many different types of medical treatment so physicians and their patients are able to make informed decisions.1
The Cochrane Collaboration determined there was no evidence that psychological debriefing is effective. It concluded that compulsory debriefing of trauma victims should not be undertaken, stating “there is little evidence to support the use of psychological intervention for routine use following traumatic events.”
In addition, it concluded psychological debriefing may actually cause adverse effects. McNally et al (2003) echoes this concern and states there is no convincing evidence psychological debriefing works and that studies of “individualized debriefing and comparative, non-randomized studies of group debriefing have failed to confirm the method’s efficacy. Some evidence suggests that it may impede natural recovery. For scientific and ethical reasons, professionals should cease compulsory debriefing of trauma-exposed people.”2
The American Psychological Association has also weighed in and describes psychological debriefing as having no research support and as potentially harmful.3
Why is psychological debriefing potentially harmful? Sitting around post incident and being encouraged or mandated to discuss your feelings, in front of your peers, ‘pathologizes’ or ‘medicalizes’ normal responses to trauma. CISD can force an individual to second guess whether their feelings, emotions and responses are maladaptive or abnormal whereas, in fact, these responses are normal and will dissipate over time. Individuals respond to trauma in a number of ways but overall most do not develop PTSD.
In an insightful piece written for the American Society of Evidence Based Policing, Renee Mitchell explores the harmful effects of CISD and questions why it is still being used by police agencies, often on a mandatory basis, when it was debunked over a decade ago.4
What should we do now?
When I served with the Canadian Armed Forces in Southern Afghanistan, as the Officer Commanding of the Mental Health Unit, the CF had already stopped using CISD. This was a decade ago. We were in good company – the American Armed Forces, the Australian contingent and the Royal Navy had also ceased practicing CISD.
Instead, the model we used was psychoeducation and psychological first aid. Personnel involved in a critical incident were educated as to the possible symptoms they might experience after a traumatic event. They were informed these symptoms can differ from person to person and were a “normal” response. These could include avoidance of others; ruminating about the incident and what they could have done or not done; restlessness; irritability; intrusive thoughts about the incident; insomnia and disturbing dreams, to name a few.
The facilitator is there to educate the group and to answer questions. If the symptoms are particularly troublesome, or persist after a few days, the member can opt for one-to-one “psychological first aid.” A three- or four-day prescription of a non-addictive sleep aid might be prescribed, if required, in order to regulate sleep. If needed, three to four sessions of Cognitive Behavioural Therapy (CBT) would be recommended.
The purpose of this psychological education/first aid model is to: listen; convey compassion; assess needs; ensure that basic physical needs are met; not force someone to talk; encourage, but not force, social support; provide information; protect from additional harm; allow ventilation of feelings as appropriate for the individual; and when appropriate, refer to a mental health specialist.5
Mitchell & Lewis (2017) opine that “although good intentions are behind our social interventions, good intentions do not equal positive outcomes. We have an ethical duty to our public and our officers to be up to date on empirical research concerning our interventions.”6
In other words, we need to practice evidence-based medicine in policing.
2 McNally, R., Bryant, R. & Ehlers, A. (2003). Does early psychological intervention promote recovery from posttraumatic stress? Psychological science in the public interest, 4(2), 45-79.
3 Society of Clinical Psychology, American Psychological Association www.div12.org/PsychologicalTreatments/treatments/ptsd—debriefing.html
4 Mitchell, R. (2018) www.americansebp.org/the-harmful-effects-of-critical-incident-stress-debriefing-cisd-why-police-departments-should-stay-up-to-date-on-evidence-based-practices/
5 McNally, R., Bryant, R. & Ehlers, A. (2003). Does early psychological intervention promote recovery from posttraumatic stress? Psychological science in the public interest, 4(2), 45-79.
6 Mitchell, R., & Lewis, S. (2017). Intention is not method, belief is not evidence, rank is not proof: Ethical policing needs evidence-based decision making. International Journal of Emergency Services, 6(3), 188-199.
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