This chapter presents the theory and development of psychological debriefing, looks at its outcomes, and discusses the difference between theory and practice. It also presents an alternative suggestion for the prevention of combat-related post-traumatic stress disorder (PTSD). Psychological debriefing has its roots in various forms of instrumental debriefing designed for the purpose of gathering information about, and drawing lessons from, a variety of tasks. Marshall's historical group debriefing is an important precursor of current psychological debriefing. The importance of debriefers being capable of identifying participants who are at risk for psychological morbidity has been stressed. Most of the evidence for the effectiveness of front-line treatment is based on clinical impressions in various wars. The findings showed that the more front-line treatment principles that a soldier's treatment incorporated, the more likely he was to return to his unit and the less likely to develop PTSD a year later.

This chapter provides caution about the broadly based and extensive use of debriefing in communities affected by disasters. Psychological debriefing is an intervention intended to facilitate the prevention of, or recovery from, the adverse psychological sequelae of traumatic events. The data collected in the investigation of the psychosocial sequelae of the 1989 Newcastle earthquake provided an opportunity to examine the effectiveness of psychological debriefing. The naturalistic study design used in the investigation, together with an approach to data analysis that controlled for potential confounds, supports the validity of the results, which, in turn, concur with those of other naturalistic studies of debriefing as well as those employing a randomized controlled design. Debriefing identifies the lack of awareness of post-trauma stress responses as a target for change for which information is the putative change agent. It may also be that debriefing is helpful in unintended ways less accessible through measurements.

Psychological debriefing after disastrous events has become a widespread and popular trend over the past 15 years. When debriefing resulted in large numbers of workers' compensation, payments and insurance or civil claims, the modality was rejected by the police administrators who perceived it as instigating malingering and secondary gain. By using standardized context-free formats, the debriefer is actually helping to co-construct experience by directing the narrative according to a predetermined set of concerns. The debrief process fails to recognize that the reflective approach it requires only adds to the fears and frustration of traumatically impaired individuals, who may become anxious, confused, or shut down in the debriefing process. Debriefings have in many instances become mandatory mental health treatment programmes. By adopting the salutogenic model, many of the issues outlined by emergency workers become eliminated.

This chapter reviews what is known about the psychological impact of body recovery, and in particular the possible effects on soldiers whose role it is to recover the bodies of colleagues or those of the enemy. Any factors resulting in increased identification with the dead generally result in greater distress. Soldiers in the Gulf War who were required to remove the personal effects of enemy dead, including personal correspondence and photographs of family and loved ones, found the experience intensely upsetting. Most soldiers found handling their own comrades, particularly those who had died as a result of friendly fire, more distressing than handling enemy dead. Dead psychological debriefing in particular helps to reduce subsequent morbidity. There is ample evidence to suggest that training and preparation may significantly reduce the likelihood of long-term psychological squeal after body-handling duties.

This chapter summarizes the available data about the psychiatric impact of motor vehicle accidents (MVAs), and examines the aetiology of these effects. It discusses the studies of debriefing interventions designed to prevent the adverse effects. The chapter explores the question about how these may be limited or treated. The psychiatric consequences of MVAs are in many ways similar to those described for acute illnesses and events but, a small proportion of victims suffer cognitive and other disorders due to head injury and brain damage and many suffer from post-traumatic syndromes. Post traumatic stress disorder (PTSD) is very frequent following MVAs. Psychological debriefing has been conceptualized as an intervention that promotes adaptive adjustment to traumatic events, in part through facilitating emotional and cognitive processing of the experience. The evidence cited here suggests that psychological debriefing for individuals after road accidents does not reduce later psychiatric problems, particularly specific post-traumatic symptoms.

This chapter discusses the effects of massive road trauma, and examines the evidence of the efficacy of psychological intervention in these cases. It presents an outline of intervention strategies for survivors, bereaved, personnel and members of the community. It also discusses the recommendations given in relation to debriefing. The conditions under which group debriefing is used and suggested protocols to follow for survivors are described. There are several types of group debriefings, namely, operational debriefings, didactic debriefings, and psychological debriefings. Critical Incident Stress Debriefing (CISD), as developed by Mitchell, is the most widely used protocol for psychological debriefing. Debriefings and other crisis intervention strategies are provided generally after massive road trauma for emergency workers. The persistence of clinically significant sequelae to such disasters highlight the importance of assistance being available beyond the first few weeks, or even first months post crash.

This chapter describes a background of development and its implications for debriefing children and specifically adolescents, after a traumatic event. It suggests the effectiveness of a delayed intervention, which may perhaps be appropriate because it is provided at a time of greater sense of security for the young person. While children and young people are equally affected by traumatic events, the specific manifestations of their symptomatology occur along a developmental perspective. Post-traumatic stress disorders (PTSD) has been found in children exposed to a wide range of incidents when assessed at varying times ranging from a few days to over a year after the event, using a variety of different assessment measures. Interventions that have reported using group debriefing or have incorporated the core aims and structure of this process have typically been described in relation to transport disasters. The composition of psychological debriefing groups has received minimal attention.

This chapter challenges the conventions of psychological debriefing as an intervention that is only applicable in the earliest period post disaster. As psychological debriefing has become more widely accepted, its original highly specific workplace focus has been broadened. The usual application of debriefing to the immediate post-disaster period may reflect its military and emergency services origins. The chapter proposes that it is useful to disentangle the underlying conceptual assumptions involved in psychological debriefing in order to inform an expanded use of the psychological principles that debriefing must be utilized to be effective. Psychological debriefing emphasizes supporting natural processes of recovery and removing barriers to resolution of the emotional impact of life-threatening events. Research on psychological debriefing procedures is often difficult to implement because of the intense and compelling level of need when one is responding to catastrophic situations.