Single session debriefing

Single session psychological debriefing does not prevent post traumatic stress disorder (PTSD) and may contribute to PTSD.

 

women meeting

Why is psychological debriefing important?

Psychological debriefing is a treatment intended to reduce the psychological effects that occur after exposure to trauma. It involves promoting emotional processing by “encouraging recollection/ ventilation/ reworking of the traumatic event”.  Debriefing is intended to reduce psychological stress following a traumatic incident and prevent the development of PTSD. The estimated lifetime prevalence of PTSD is 5% in men and 10% in females. 

Does psychological debriefing work? 

  • This review found no significant differences between the group receiving debriefing and controls in diagnosis and severity of depression, or diagnosis of anxiety.  At 3 months follow up there were no differences between groups for diagnosis of PTSD however, at 13 months follow up those receiving debriefing were more than twice as likely to have been diagnosed with PTSD as controls.

Equity: can we expect the same results in the disadvantaged? 

  • Single session psychological debriefing caused more harm than benefit and those who received this intervention were more likely to develop PTSD.  There is no reason to expect different results among disadvantaged populations. 

Intervention Delivery 

  • All interventions provided single session psychological debriefing that took place within one day to one month of the traumatic event.  

Population and Setting 

  • Most studies involved people attending hospitals and trauma clinics following trauma. One study recruited from police stations and medical services, one involved deployed soldiers on a peacekeeping mission, and three studies involved obstetric patients. One study involved parents or relatives of trauma victims.  

  • All studies were conducted in high income countries including the United Kingdom, Ireland, Netherlands , Australia, and USA.

Summary of Findings [SOF] Tables: Psychological debriefing for preventing post traumatic stress disorder 

Patient or population: Persons aged 16 and older exposed to a traumatic event in the previous 4 weeks 
Settings: Hospitals and trauma clinics in high-income countries 
Intervention: Psychological debriefing  
Comparison: Control, educational intervention, or immediate debriefing vs. delayed debriefing 

Outcomes 

 

Anticipated absolute effects per year 

Relative Effect 
(95% CI) 

No of Participants 
(studies) 

Quality of the evidence 
(GRADE) 

 

 

Risk without psychological debriefing (Control) 

Risk difference with psychological debriefing (95% CI) 

 

 

 

PTSD diagnosis 
3-6 months follow up 

 

7 per 100 

1 more per 100 (from 2 fewer to 5 more) 

OR 1.17 (0.70-1.98) 

(3 studies)1 

Moderate 

PTSD diagnosis 
6-12 months follow up 

 

9 per 100 

1 fewer per 100 (6 fewer to 12 more) 

OR 0.93 (0.35-2.46) 

(1 study)2 

Moderate 

PTSD diagnosis 
12 months or more follow up 

 

4 per 100 

5 more per 100 (from 1 to 14 more) 

OR 2.51 (1.24, 5.09) 

103 
(1 study)1 

Moderate 

Adverse Events: At 13 months follow up, PTSD diagnoses were higher in the intervention than control group. 

About quality of evidence (GRADE) 
High quality (High): Further research is very unlikely to change our confidence in the estimate of effect.  
Moderate quality (Moderate): Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. 
Low quality (Low): Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. 
Very low quality (Very Low): We are very uncertain about the estimate. 

  1. To calculate the anticipated absolute effects per year, we used the Bisson 1997 study.

  1. To calculate the anticipated absolute effects per year, we used the Rose 1999 study. 

    Relevance of the review for disadvantaged communities 

    Single session psychological debriefing does not prevent post traumatic stress disorder (PTSD) and may contribute to PTSD. 
    There is no reason to expect different results among disadvantaged populations.

    Findings 

    Interpretation 

    Equity - Which of the PROGRESS groups examined 

    All of the included studies were conducted in high-income countries (UK, Netherlands, US, Ireland, Australia) and included patients attending hospitals or trauma clinics. Participants in one study were soldiers and three studies involved obstetrics patients.  Most of the studies included more males than females and excluded anyone already diagnosed with a psychiatric disorder. 

    Single session psychological debriefing was not found to be effective and in the study with longer follow up it was found to be harmful. These results are likely applicable in lower resource settings. 

    Equity Applicability 

    The majority of included studies had a disproportionate number of male participants. None of the included studies involved children and none occurred after a mass disaster/trauma. Additionally, all the included studies used known psychiatric condition as exclusion criteria. 

    More research is needed on the effects of single (or longer duration) psychological debriefing for certain populations, including children and those with a known psychiatric disorder. This may require study designs other than RCTs.  

    The review reports on the effectiveness of single session psychological debriefing provided after a traumatic event in a variety of settings including hospitals, trauma clinics, and soldiers on a peacekeeping mission.  

    Single session debriefing is not effective in reducing PTSD following a traumatic event. None of the included studies reported on the effectiveness of single session debriefing following a natural disaster affecting a large population.  

    Cost-equity 

    The review did not report on the cost-effectiveness of single session psychological debriefing.  

    Single session psychological debriefing was not found to be effective and is therefore not cost-effective. 

    Monitoring & Evaluation for PROGRESS groups 

    Single session debriefing requires “intense imaginal exposure” to the traumatic incident provided within a short time of the incident.  

    Single session debriefing may expose patients to increased psychological stress. Psychological debriefing provided over multiple sessions may be more effective, however will require more resources and adherence by patients and providers.  Other study types may be needed. 

    There is sufficient evidence to suggest that single session psychological debriefing is not effective and may cause harm.  

    Single session debriefing is not recommended.

     

Comments on this summary? Please contact Jennifer Petkovic.