A Critical View on Debriefing

by Richard Gist, PhD

This contribution is excerpted from a May 1996 post to the traumatic-stress list by Richard Gist, concerning the effectiveness of debriefings following natural or man-made disasters. It is reproduced here with the author's permission.

It is important (though always treated as some form of sacrilege) to note one more time that "debriefing" fails to emerge in a range of empirical studies as any sort of "a most important first step in a disaster" (sic), and many studies seem to be suggesting an oddly paradoxical negative effect for at least some of those most at risk. The "debriefing" movement is a truly classical example of how powerful the "Barnum effect" can become, even among folks ostensibly trained in critical empirical paradigms. It seems like a good thing to do, and we've told one another (and the world) repeatedly that it is; we ask people if it helped, and they say they felt better--that's enough, isn't it?

Not really . . . we ask people if they'd like a doughnut, and most say yes; we ask if their doughnut was tasty; most agree. So do we now conclude that doughnuts are important elements of nutrition? Do we rush to stuff doughnuts into any open mouth? High concentrations of sugar and fat make the fare desirable on the surface, but also render it less than healthy beneath.

There's a significant literature on this . . . in a couple of places:

There's piece after piece of "show and tell" in trade magazines, newsletters, and such, plus any number of proprietary seminars and conferences chock full of allusions to "scientific" information--here we find quite intemperate claims of "proven approaches" to "the right kind of help," and even aspersions that any other approach can somehow prove harmful! We've even seen claims of "data" and allusions to "studies" touted to "prove" the efficacy and criticality of this simplistic but labyrinthically aggrandized intervention system, but these evaporate like a bottle of Evian spilled on the desert floor when we go in search of the data themselves.

The principal purveyors, as happens in so many of these "movements," often hold credentials that respond to even light scrutiny much like that silvery stuff on a rub-off lottery ticket; exaggeration and misstatement go unchallenged in the revival tent atmosphere of the faithful, and are treated like heresy when heard from "outsiders." Serious researchers may pass through such environs, but quickly come to eschew the transparently disingenuous machinations pretending as science and set about the slow and thankless process of sifting through the silt. That's been taking place for several years now around this topic, and in the refereed academic journals of our discipline we find a growing chain of structured, reasonably partitioned empirical studies which report with an eerie consistency:

  1. No preventative effect from debriefing;
  2. No differential ill-effect from its absence;
  3. An equally consistent (but generally discounted) finding which seems to suggest that those who most seek this intervention show poorer longer-term resolutions.

But the bandwagon rolls and rolls and rolls . . . it's fun and affirming, I guess, to ride it, even if the trip is for nought (at least from the client perspective). But watch where the vehicle goes . . . additional traffic in a disaster zone is not exactly a welcome sight.

A Short Reference List
(not at all exhaustive; simply copied from a recent manuscript)

Alexander, D. A., & Wells, A. (1991). Reactions of police officers to body handling after a major disaster: A before and after comparison. British Journal of Psychiatry, 159, 547-555.

Bisson, J. I., & Deahl, M. P. (1994). Psychological debriefing and prevention of post-traumatic stress: More research is needed. British Journal of Psychiatry, 165, 717-720.

Deahl, M. P., Gillham, A. B., Thomas, J., Searle, M. M., & Strinivasan, M. (1994). Psychological sequelae following the Gulf war: Factors associated with subsequent morbidity and the effectiveness of psychological debriefing. British Journal of Psychiatry, 165, 60-65.

Gist, R., & Taylor, V. H. (1996). Line-of-duty deaths and their effect on co-workers and their families. Police Chief, 63(5), 34-37.

Gist, R. (1995, August). Who cares about firefighter health and safety? In J. M. Melius (Chair), Who does care? Symposium conducted at 13th Symposium on Occupational Health and Hazards of the Fire Service, John P. Redmond Foundation/International Association of Fire Fighters, San Francisco, CA.

Gist, R., & Woodall, S. J. (1995). Occupational stress in contemporary fire service. Occupational Medicine: State of the Art Review, 10, 763-787.

Gist, R. & Woodall, S. J. (In review). And then you do the hokey-pokey and you turn yourself about. Manuscript for conference symposium.

Hytten, K., & Hasle, A. (1989). Firefighters: A study of stress and coping. Acta Psychiatrica Scandinavia, 355(supp.), 50-55.

Kernardy, J. A., Webster, R. A. , Lewin, T. J., Carr, V. J., Hazell, P. L., & Carter, G. L. (1996). Stress debriefing and patterns of recovery following a natural disaster. Journal of Traumatic Stress, 9, 37-49.

McFarlane, A. C. (1988) The longitudinal course of posttraumatic morbidity: The range of outcomes and their predictors. Journal of Nervous and Mental Disease, 176, 30-39.

Raphael, B., Meldrum, L., & McFarlane, A. C. (1995). Does debriefing after psychological trauma work? Time for randomized controlled trials. British Medical Journal, 310, 1479-1480.

Redburn, B. G. (1992). Disaster and rescue: Worker effects and coping strategies. Doctoral dissertation (community psychology), University of Missouri-Kansas City. [University Microfilms No. AAD93-12267; Dissertation Abstracts International, 54(01-B), 447.]

Redburn, B. G., Gensheimer, L. K., & Gist, R. (1993, June). Disaster aftermath: Social support among resilient rescue workers. Paper presented at the Fourth Biennial Conference on Community Research and Action, Society for Community Research and Action (Division 27, American Psychological Association), Williamsburg, VA.

Simmons, T. (1995). What makes them winners . . . Phoenix FireWorks, 19(5), 1; 4-5; 8.

Woodall, S. J. (1994). Personal, organizational, and agency development: The psychological dimension--A closer examination of critical incident stress management. Applied research project, Strategic Analysis of Fire Department Operations, Executive Fire Officer program, National Fire Academy. (Available from Learning Resource Center, National Emergency Training Center, Emmitsburg, MD.)

Richard Gist, Ph.D.

Consulting Community Psychologist:
Kansas City (MO) Fire Department
South Metro Fire Protection District
Kansas City (MO) Health Department

Director, Social Sciences and Social Services
Johnson County Community College
12345 College Boulevard
Overland Park, Kansas 66210-1299
Page: (816) 989-8741 Mobile: (816) 223-8240 Voice: (913) 469-8500, Extension 3933 Fax: (913) 469-2585

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