Thursday, November 24, 2011

CIA: Psychological Debriefing (PSY515)

Critical Issue Analysis: Psychological Debriefing
Issue 3 consists of an article written by Grant J. Devilly and Peter Cotton entitled Psychological Debriefing and the Workplace: Defining a Concept, Controveries and Guidelines for Intervention, and a rebuttal argument by J. T. Mitchel entitled A Response to the Devilly and Cotton Article. The goal of this paper is to lay out the facts, opinions, strengths, weaknesses, and a critical evaluation of each position as it relates to psychological debriefing.
What are at least two facts presented by each side of the critical issue?
In these two articles many of the facts contradict each other on several points or are completely at odds with each other entirely. For instance, Devilly and Cotton claim that critical incidence stress debriefing (CISD) has been superseded by critical incident stress management (CISM), because of the evidence against CISD (Halgin, 2009). Mitchel counters that CISD was misconstrued as a blanket term for the entire field at its inception but that the official publication of the Internal Critical Incident Stress Foundation (ICISF) has repeatedly clarified that CISD is a, “…6-phase small group discussion process” (p. 79) and CISM is the umbrella term for the entire field of study. Apparently, Devilly and Cotton got the impression by the emphasis on CISM as the name of the field and CISD as only one component within the field, that this constituted an abandonment of CISD for the implementation of CISM.
Devilly and Cotton cite statistics that claim that only 8% of those suffering from acute stress disorder (ASD) go on to develop post-traumatic stress disorder (PTSD) when cognitive-behavioral therapy (CBT) is used as an early intervention. To be clear, ASD—which can last from about 2 days to 4 weeks after the incident—is the precursor for the onset of PTSD—which can last from 1 month or more after the incident (BehaveNet clinical capsule, 1996-2010). Devilly and Cotton suggest that CBT might be more effective than CISD at stopping the onset of PTSD after an incident. Mitchel responds that, “…there has never been a negative outcome study of the actual CISD when properly trained personnel adhere to the commonly accepted standards of practice” (Halgin, 2009, p. 81). Further, Mitchel goes on to explain that CISD and CBT are not in direct competition, that psychotherapy could never replace crisis interventions and vice versa.
What are at least two opinions presented by each side of the critical issue?
Devilly and Cotton are of the opinion that generic psychological debriefing (PD) is, at the best inert, and at its worst, noxious to the victims who participate (Halgin, 2009). In fact, Devilly and Cotton cite sources that claim that PD might increase the chances of PTSD in people who suffer from crises. Conversely, Mitchel explains that Devilly and Cotton, and their subsequent cited studies, are actually referencing single session debriefing in their result, which the ICISF does not recommend. In sum, there appears to be a bit of miscommunication on the actual subject of conversation. This could be due in part to the admonition by both articles that an entire class of debriefing has been clumped together as CISD in most literature.
There does appear to be quite a bit of miscommunication between the involved parties when it comes to the scope and practical usability of CISD. Devilly and Cotton go to work beating away at the straw man of PTSD, while Mitchel makes it clear that in cases of disaster CISM teams rarely utilize CISD as a stand-alone response and are much more likely to employ one-on-one support. Moreover, Devilly and Cotton highlight depression as more likely effect of crises; however, Mitchel explains that CISD can be used in many different types of situations, not just disasters and crises.
What are some of the strengths associated with the Pro side of the issue? What are some of the weaknesses?
I have to give a hand to Devilly and Cotton; they really do a good job of invalidating single-session debriefing that does not employ a stringent phase-based strategy. There is now no doubt in my mind that immediate debriefing and reliving of a traumatic event direct after the event is inert of harmful for a patient. Nonetheless, Devilly and Cotton’s great strength is also their greatest weakness: they reference and disqualify several types of trauma treatment that are not strictly-speaking CISD. They probably should have references the ICISF’s actual web site and publications as a basis for their research. Then they could have avoided the misrepresentations of CISD.
What are some of the strengths associated with the Con side of the issue? What are some of the weaknesses?
One of the greatest strengths of Mitchel’s paper is that he clearly defines and lays out the dimensions of each psychological approach to trauma: CISD, CISM, PD, and CBT. Further, Mitchel clarifies the actual approaches that Devilly and Cotton are using (i.e. single session debriefing). Then Mitchel shows that CISD is not a first response technique but rather is intended to be implemented several weeks or longer after the disaster. The one great downfall of Mitchel’s article is that he doesn’t lean heavily enough on hard facts and statistics. I would like to have seen a few specific double-blind, randomized studies testing the effectiveness of CISD in the long-term. Mitchel states that, “…CISM, even if called by another name, is a successful crisis intervention program” (Halgin, 2009, p. 80). However, Mitchel doesn’t go on to explicate the statistical likelihood that ASD will turn into PTSD in victims who have undergone CISD. That would have added more credibility to his article.
How credible were the authors of each argument? Explain your answer.
The first article by Devilly and Cotton seems very unfounded and no well-researched. I wouldn’t say that it is not credible, what I would say is that it is not applicable to the decision of whether CISD exhibits efficacy in doing what it claims to do. Devilly and Cotton based their assertions on misinformation, unrelated interventions, and unrelated academic articles. If they were trying to discount single session debriefing they would be right on the mark, but they address the actual subject of CISD very little head on.
The problem with Mitchel’s articles, as mentioned above, is that he does not reference enough hard statistics about the efficacy of CISD in preventing ASD from turning into PTSD. I would like to have seen the actual probabilities, research designs, and statistics (i.e. mean, standard deviation, etc…). It would have given him more credibility to answer blind assertions with hard statistics, than to only counter with criticisms of the former article.
Based on the statements presented in this critical issue, which author do you agree with? Why?
I would have to say that I agree most with Mitchel’s, rather than Devilly and Cotton’s, on almost every point—with the one exception of statistical backing on Mitchel’s part. Mitchel dismantles and inspects every article that Devilly and Cotton use as their basis of criticism, debasing every point that they made one by one. Of particular glaring interest, is Devilly and Cotton’s use of the Flannery book to criticize CISD. Mitchel points out specifically that Flannery’s ASAP approach, which shows great results, is a form of CISM—even by the author’s own admonition on the read cover of the book. It is those types of oversights that degrade the article by Devilly and Cotton.
Which side of this critical issue does contemporary research support? Please provide specific examples in your response.
Richards (2001) found in a particular field trial that CISM had, “…significantly less post trauma morbidity at follow-up…compared to CISD alone” (p. 351). He goes on to explain that even though CISM has been found to be much effective than CISD at preventing the onset of PTSD, debriefing—specifically CISD—as an integrated CISM should not stop being used as a response to trauma. His suggestion is that a CISM approach, using CISD as one component, should undergo randomized controlled studies as soon as possible to determine the statistical probability that such interventions actual effect the precursors of PTSD (i.e. ASD, stress disorders, etc…).
References
BehaveNet clinical capsule. (1996-2010) APA diagnostic classification: DSM-IV TR. Retrieved October 21, 2011, from http://www.behavenet.com/capsules/disorders/adhd.htm
Halgin, R. (2009). Taking sides: Clashing views in abnormal psychology (5th ed.). New York, NY: McGraw-Hill.
Richards, D. (2001). A field study of critical incident stress debriefing versus critical incident stress management. Journal of Mental Health, 10(3), 351-362. Retrieved from EBSChost.

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