22 - Concerns about debriefing: challenging the mainstream

Summary

EDITORIAL COMMENTS

Stuhlmiller and Dunning challenge some of the basic concepts and beliefs surrounding debriefing. They describe its evolution from military to civilian settings (emergency workers), and then its rapid expansion as a panacea for all trauma experiences. They hypothesize that debriefing has evolved in a medical or pathologizing model and that its processes may encourage pathology outcomes in a process of medicalization of normal life experience. debriefing has evolved in a technological age, as a technological solution. They go on to discuss the impetus of its popularization.

The authors also contest the universal application of debriefing, suggesting that this is inappropriate, as all events, even the most traumatic, do not universally lead to morbidity or post-traumatic stress disorder. They see as problematic the failure to substantiate debriefing as effective, the differences in what is defined as a critical incident, the assumption of adverse effects, and the failure to separate stress and trauma responses psychologically and in terms of their inherent biochemical phenomena.

The appropriateness of self-reflection is also explored, particularly when it is associated with the potential for negative rumination, and in circumstance of ongoing stress or the need to remain active in response to it. Stuhlmiller and Dunning question what should be disclosed and also the capacity of this to be helpful to those who are traumatized and may be suVering significant cognitive distortion or dissociation.