The recent tragic bus crash in NSW’s Hunter Valley has once again raised the question of how to deal with the potential psychological effects of traumatic events.
It’s interesting to revisit the same debate after every disaster, and apparently few lessons have been learned after decades of research. After the Hunter Valley incident, those affected were offered immediate psychological counseling.
While we cannot say what form of counseling was offered, the traditional approach is known as psychological debriefing. This typically involves counselors providing trauma survivors with a single counseling intervention within days of the event.
While the content of the intervention can vary, it usually involves education about stress reactions, encouragement to disclose one’s memories of the experience, some basic strategies for coping with stress, and possibly background information.
But evidence shows that this approach, however well-intentioned, may not help or, worse, hurt.
Read more: Experiencing trauma can change some people’s outlook on life sometimes for the better
The belief that feelings should be shared
The encouragement of people to discuss their emotional reactions to trauma is the result of a long-standing notion in psychology (dating back to the classic writings of Sigmund Freud) that disclosing one’s emotions is invariably beneficial to one’s mental health.
From this perspective, the impetus for psychological debriefing has traditionally been rooted in the notion that trauma survivors are vulnerable to psychological disorders, such as post-traumatic stress disorder (PTSD), if they do not talk about their trauma by receiving this intervention. very precocious .
The scenario of trauma counselors appearing in the aftermath of traumatic events has been commonplace for decades in Australia and elsewhere.
After the 9/11 terrorist attacks in New York City in 2001, up to 9,000 counselors were mobilized and more than $200 million was earmarked to address growing mental health needs. But fewer people than expected have sought help under this program and $90 million has remained unspent.
Read more: 9/11 Anniversary: A Watershed for Psychological Disaster Response
What do we know about psychological reactions to disasters?
The overwhelming evidence indicates that most people will adjust to traumatic events without any psychological intervention.
Long-term studies indicate that approximately 75% of trauma survivors will experience no long-term discomfort. Others will experience short-term difficulties and subsequently adjust. A minority (usually around 10%) will experience chronic psychological problems.
The latter group is the one that requires care and attention to reduce their mental health problems. Experts now agree that other trauma survivors may rely on their own coping resources and social networking sites to adjust to their traumatic experience.
The finding in many studies that most people adjust to traumatic experiences without formal mental health interventions has been an important impetus for questioning the value of psychological debriefing in the immediate aftermath of disasters.
In short, the evidence tells us that universal interventions such as psychological debriefing are not indicated for everyone involved in a disaster attempting to prevent PTSD and other psychological disorders in trauma survivors. These attempts do not prevent the ailment they are targeting.
Not a new conclusion
In the aftermath of the 2004 Indian Ocean earthquake and tsunami, the World Health Organization listed a warning (which is still valid) that people should not be subjected to psychological debriefing in a single session because it is not supported by evidence.
Worse than simply being ineffective, debriefing can be harmful to some people and can increase the risk of PTSD.
The group of trauma survivors who are most vulnerable to the toxic effects of debriefing are those who are most distressed in the acute phase immediately following the trauma. This group of people have worse mental health outcomes if they are debriefed early.
This may be because their traumatic memories are overly consolidated due to emotional disclosure so soon after the event, when stress hormones are still very active.
In normal clinical practice a person would be assessed in terms of suitability for any psychological intervention. But in the case of universal psychological debriefing there is no prior assessment. Therefore, there is no assessment of the risks that the intervention may entail for the person.
Read more: How to manage the psychological effects of natural disasters
Most international bodies have moved away from psychological debriefing. Early intervention could now be offered as psychological first aid.
This new approach is intended to provide foundational support and coping strategies to help the person deal with the immediate consequences of adversity. One of the most important differences between psychological first aid and psychological debriefing is that it does not encourage people to disclose their emotional responses to trauma.
But despite the growing popularity of psychological first aid, it’s difficult to gauge its effectiveness as it doesn’t explicitly aim to prevent a disorder like PTSD.
Wanting to help
So if there’s so much evidence, why do we keep having this debate about how optimally to help psychological adjustment after disasters? Maybe it’s because it’s human nature to want to help.
Evidence suggests that we should be monitoring the most vulnerable people and directing resources to them when they need them, usually a few weeks or months later when the dust of the trauma has settled. Counselors may want to promote their businesses in the acute phase after disasters, but it may not be in the best interests of trauma survivors.
In short, we need to develop better strategies to ensure we meet the needs of survivors, rather than counselors.
If you have any concerns about this article or if you are concerned about someone you know, please call Lifeline on 13 11 14.
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