1 - Stress management and debriefing: historical concepts and present patterns

Summary

‘They had been brought to the last extremity of hope [yet they showed] a passionate conviction that it would be all right, though they had faith in nothing, but in themselves and in each other’. (Manning, 1990/1930, Introduction, p.xii)

EDITORIAL COMMENTS

Shalev challenges simplistic notions of debriefing as it is frequently applied and outlines its development in the historical contexts of understanding psychological trauma and post-trauma morbidity. He emphasizes the need to be responsive to the diversity of human responses in such situations, the significance of distress and arousal, and the psychological and neurochemical responses in the early post-trauma period. His conceptualization notes the need to consider the traumatogenic effects of extreme stress such as its undesirability, uncontrollability, unpredictability and inescapability. He suggests that prolonged distress during a critical post-trauma period may enhance or even create a ‘catastrophic memory’ through neuroendocrine mechanisms. The essence of preventing posttrauma morbidity is therefore to reduce distress and arousal.

Traditional approaches, which open up the expression of emotion, make interpretations of response, or describe symptomatic presentations, may be inappropriate. Furthermore, debriefing may be offered where the trauma or stress is continuing, or when other stressors such as loss and dislocation have also occurred. Because any intervention at this early stage may impact on a relatively small segment of the causative matrix, long-term evaluation may be inappropriate as a method of judging debriefing effectiveness.