In another study, Hobbs et al. (1996) assessed victims of road traffic accidents who had been randomly assigned to either a one-on-one debriefing session or to a no-treatment (assessment-only) condition. Individuals assigned to the debriefing condition received a single one-hour session between 24 and 48 hours after their accidents. Four months later, neither the debriefed nor the control group reported a reduction on measures of PTSD, anxiety or depression (Hobbs et al., 1996). Three years later, the debriefed group reported significantly more PTSD symptoms, general psychiatric symptoms and fear of traveling as a passenger in an automobile than did the non-debriefed group (Mayou et al., 2000). Additional analyses revealed that participants who had initially scored high on a self-report measure of PTSD symptoms and who were not debriefed improved markedly by the three-year follow-up assessment, whereas high-scorers who were debriefed remained markedly symptomatic three years later. The authors concluded, "Psychological debriefing is ineffective and has adverse long-term effects. It is not an appropriate treatment for trauma victims" (Mayou et al., 2000).
Debriefing Advocates Respond
In response to these findings, debriefing advocates have issued two responses (Everly and Mitchell, 1999; Mitchell, 2003). First, they have cited other studies that they believe confirm the efficacy of debriefing. Unfortunately, every one of these studies (none RCTs) is methodologically flawed, and most of them are so weak as to render their findings uninterpretable (for a review, see McNally et al. ).
Second, they have argued that the negative studies lack probative import and are irrelevant to how debriefing is conducted in actual practice. The main critiques against the negative studies are:
- They use one-on-one debriefing, not group debriefing;
- Inappropriate measures have been used to evaluate the efficacy of debriefing;
- People directly exposed to trauma (primary victims) have been studied, rather than the emergency service personnel for whom CISD was originally developed;
- Negative studies depart from approved protocol in ways that render the findings irrelevant; and
- Critical Incident Stress Debriefing must not be evaluated on its own but only in the context of a comprehensive Critical Incident Stress Management (CISM) program.