As reported in Monday’s Boston Globe, the Boston Marathon bombings have left many people in that city — those who were injured, of course, and their families, but also first responders and witnesses to the blasts — struggling with severe anxiety, feelings of helplessness, nightmares, flashbacks and other symptoms of post-traumatic stress disorder (PTSD).
Some of those individuals will need long-term psychological counseling to learn how to manage and overcome those symptoms. But, as British psychologist Vaughan Bell points out in an article published Sunday in the Observer (a sister publication of the Guardian newspaper), there is one thing they and others who experience a traumatizing event — whether it be a bombing, a natural disaster like a tsunami, or a devastating accident — do not need: a flood of volunteer psychologists swooping in to do single-session treatments known as “psychological debriefing.”
In our trauma-focused society it is often forgotten that the majority of people who experience the ravages of natural disaster, become the victims of violence or lose loved ones in tragedy will need no assistance from mental health professionals.
Most people will be shaken up, distressed and bereaved, but these are natural reactions, not in themselves disorders. Only a minority of people — rarely more than 30% in well-conducted studies and often considerably less — will develop psychological difficulties as a result of their experiences, and the single most common outcome is recovery without the need of professional help. But regardless of the eventual outcome, you are likely to be at your most stressed during the disaster and your stress levels will reduce afterwards even if they don’t return to normal. Your body simply cannot maintain peak levels of anxiety.
These are important facts to bear in mind because, from the point of view of the disaster therapist, psychological debriefing seems to work — stress levels genuinely drop. But what the individual therapist can’t see is that this would happen more effectively, leaving less people traumatised, if they did nothing. To put icing on the rather grim cake, researchers also asked patients whether they found the technique helpful as they walked out of the door. The patients reported that it seemed useful even though follow-up assessments showed that it impaired their recovery. Even faulty life-jackets give you hope, of course. The one-off nature of the treatment just compounded the problem as it was easy for the therapists to assume that instant feedback was a guide to effectiveness.
Denounced by WHO
Indeed, studies suggests that such single-session debriefings are actually harmful. Researchers have found, for example, a strong association between traumatic-event debriefing and an increased risk of PTSD.
Noting that psychological debriefing fails to reduce the risk of posttraumatic stress, anxiety or depression, the World Health Organization has denounced the practice of sending volunteer psychologists to talk with survivors of traumatic events.
What the WHO endorses instead is a technique called psychological first aid. As Bell notes, psychological first aid “is perhaps most remarkable for the fact that it contains so little psychology. It is really just a communication guide for dealing with traumatised people and explicitly advises against encouraging people to ‘process’ what happened.”
First do no harm
Getting well-meaning organizations to stop the disproven psychological-debriefing approach has been a challenge, however, as Bell explains:
The practice of instant psychological interventions for just-traumatised people is hard to resist. On the emotional level, professionals are drawn to “do something” to help people who are suffering. This is an admirable human motivation, though being aware of what works is a professional responsibility. We would find it less commendable if a trauma surgeon tried leeches and brandy, regardless of their good intentions. There is a slightly darker undercurrent to this, of course. The idea that rescuers can arrive in disaster areas and prevent mental illness in a single meeting is an attractive fantasy but often serves the needs of relief workers and their image more than disaster-affected communities.
It would be great if single-session treatments worked, but considering the dangers of past attempts, we would want to be sure that they were safe and helpful before we used them.
You can read Bell’s article on the Observer’s website.