Debriefing Traumatic Events

An article in the London Daily Telegraph quoted a study by Dutch scientists which suggests that victims of traumatic events who are undergoing recovery are hindered rather than helped by the introduction of Critical Incident Stress Debriefing (CISD). These scientists go on to theorize that CISD interventions may discourage victims from seeking help from family and friends where healing does occur. Claims such as this generally create confusion among trauma victims and it is helpful to understand how traumas impact victims and what factors aid in recovery.

There are different types of traumatic events: natural disasters such as floods, earthquakes and tornadoes, accidental disasters such as car crashes and fires, and deliberate disasters such as bombing, shootings, rape, assault, and terrorism. Some traumas are short-term and unexpected events, such as car crashes and robberies, while others can be sustained and repeated ordeals, such as war, kidnapping, abuse, and terrorist threats. Each of us responds in our own way and applies our own meaning to such events but for the most part we are reacting to the fear of death or injury to ourselves or others. We have lost, if only temporarily, a sense of personal safety and security. You and I are no different from combat and emergency personnel who may respond to a traumatic event with acute and chronic reactions, including vivid re-experiencing of the event, intrusive thoughts, feelings of helplessness and guilt, avoidance behaviours, as well as physiological hyperactivity. When these symptoms persist, we call this condition Post-Traumatic Stress Disorder.

When disaster strikes, most authorities encourage an immediate debriefing (CISD) of the events with the aid of experienced counsellors. We have all heard of a team of counsellors being rushed to a school where a student has committed suicide, or when hundreds of counsellors were deployed to assist trauma victims in New York following the 911 terrorist attacks. It is thought by many that a debriefing soon after a traumatic event will help to decrease the likelihood of additional traumatic reactions at a later date. The Dutch scientists appear to quarrel with this belief. Although there is limited research evaluating the outcome effectiveness of CISD, there are specific features of properly implemented CISD that many victims have found to be most helpful in their recovery. These include the following:

* The debriefer should insure that each participant’s basic needs are met. This may include phone calls to loved ones, medical attention, a safe environment, or a ride home.

* Each participant is invited to share their story of the event, their most intense emotions, and any personal meaning applied to the situation.

* The participant’s feelings and reactions are normalized. Some may believe themselves to be weak or out of control and it is helpful to realize that such thoughts, as well as personal feelings and reactions may be quite typical in these situations. The debriefer should also educate participants on feelings and reactions they may yet experience and explain that this is a normal healing process.

* Generally, CISD is done in a group setting which enhances group acceptance and peer support. While generally helpful, this is not always reliable as some individuals may be angry or resentful towards others or they may decline to either share or offer sympathy and comfort. This may also be true regarding well meaning family and friends who appear to offer less support than anticipated. Sometimes it is a matter of simply telling supporters what would be most helpful to you.

* The debriefer should encourage, teach, and reinforce coping efforts. This may include relaxation techniques, prayer, exercise programs, and the sharing of events with supportive loved ones. Effective self care and patience with one’s own healing process should be stressed.

* The debriefer should help facilitate the participant’s return to routine pre-incident functioning and encourage continued group support and/or professional assistance. The debriefer is mindful of “high risk” individuals who are currently unable to function effectively during the CISD session. Such individuals may, in fact, be further traumatized by the intervention and other assistance may be more appropriate and effective.

Victims generally want to regain a sense of control over their thoughts, feelings, and reactions. They want to feel safe again. Support members, care givers, and counsellors can do much to facilitate the healing process. Above all else, we want to trust and believe in the indomitable and indefatigable human spirit to survive and adapt to whatever is encountered.