Psychological debriefing in schools

• Published in: Canadian Medical Association journal (CMAJ) Vol. 182; no. 9; pp. 883 - 884
• Main Authors: Szumilas, Magdalena, Wei, Yifeng, Kutcher, Stan
• Format: Journal Article
• Language: English
• Published: Canada CMA Joule Inc 15.06.2010; CMA Impact, Inc; Canadian Medical Association
• Subjects: Crisis Intervention; Health aspects; Humans; Intervention; Post traumatic stress disorder; Psychological aspects; Risk factors; School environment; Schools; Services; Stress Disorders, Post-Traumatic - prevention & control; Stress Disorders, Post-Traumatic - psychology; Student health services; Students - psychology; Canada
• ISSN: 0820-3946; 1488-2329
• DOI: 10.1503/cmaj.091621

School staff, administrators and health care providers are often called upon to deal with suicides, violent incidents and emergencies affecting students. Critical incident stress debriefing and management are techniques of psychological debriefing commonly applied following traumatic events (Box 1).1,2 The widespread acceptance of these techniques was based on the assumption that they were effective and safe and would substantially reduce acute symptoms of distress associated with exposure to traumatic events, thereby decreasing the risk of post-traumatic stress disorder. However, recent research suggests that these interventions are ineffective and may be harmful.1,3-7 Cochrane reviews of single-session and multiple - session interventions for psychological debriefing indicated that they neither prevent post-traumatic stress disorder nor significantly reduce acute psychological distress when compared with control treatments in adults.1,3 Further, the reviews recommended against routine use of psychological debriefing to prevent post-traumatic stress disorder. Other analyses showed that people who received psychological debriefing exhibited more severe symptoms of post-traumatic stress disorder than controls; 7 that the intervention increased the risk of the stress disorder; 5 and that critical incident stress debriefing, in particular, was potentially harmful.4 These findings are in stark contrast to the positive results noted in earlier studies by the creators and marketers of critical incident stress debriefing and management.2,8 Research on the effectiveness and safety of such interventions in schools is very limited.9 Authors in one Cochrane review noted that they were "unaware of the evidence base surrounding debriefing in children" (16 years or younger).1 Despite evidence of ineffective and indeed harmful effects in adults and the absence of evidence in children, some schools use these interventions following suicide, accidental death or other traumatic events among their students. Several provinces recommend these interventions in school policy documents, and some school boards employ crisis or grief counsellors. In this light, perhaps we should consider [McNally RJ] and colleagues' comments about companies and employees: "Given the absence of data showing that debriefing works, and given some studies suggesting that debriefing may impede natural recovery from trauma, companies may be at heightened risk [for liability] if they do debrief their employees, especially if they fail to provide informed consent."6