Experts Unite on Early Trauma Support

Should journalists and other witnesses of traumatic or violent events receive mandatory counseling or debriefing in the immediate aftermath?

Should journalists and other witnesses of traumatic or violent events receive mandatory counseling or debriefing in the immediate aftermath?

No, concludes a major article published in the July 1, 2007, edition of the American Journal of Psychiatry (AJP).

The paper's co-authors, British trauma psychiatrist and researcher Jonathan Bisson of the Cardiff University and psychologist George Everly of Johns Hopkins University and the US-based International Critical Incident Stress Foundation (ICISF), two of the world's leading authorities in different approaches to trauma, agree on the importance of practical and pragmatic support and a trauma-aware culture than automatic and immediate counseling for journalists or others affected by traumatic events.

The AJP article is significant in uniting proponents of what until relatively recently had been conflicting — and, to both professionals and non-professionals confusing — approaches to trauma response.

The Everly-Bisson paper culminates a two-year discussion between the two experts, initiated and mediated by the Dart Center for Journalism and Trauma, based at the University of Washington in Seattle, and its London affiliate, the Dart Centre in Europe.

Bisson and Everly use a case study involving a fictional journalist distressed by reporting the aftermath of a bomb attack. They argue for pragmatism, empathy and information as the most important immediate elements of trauma response, followed by formal psychological intervention if individuals are assessed to need it.

"We're delighted to have helped them find this sensible common ground," said the Dart Center's chairman emeritus Frank Ochberg, M.D., and Mark Brayne, director of Dart Centre in Europe, who are named in the AJP paper as co-authors.

"Bisson and Everly speaking together on this most authoritative platform sends all the right signals to trauma professionals," they said. "It will also help the media to understand what's now known to work best in supporting people who've been through the worst possible experiences."

In the 1980s, George Everly (Johns Hopkins School of Medicine and the Johns Hopkins Center for Public Health Preparedness) co-developed with former US fireman Jeffrey Mitchell an approach to disaster mental health which became known as Critical Incident Stress Management (CISM), more widely popularized as Critical Incident Stress Debriefing (CISD), or simply Psychological Debriefing.

In CISD, a trained facilitator encourages survivors and victims to share their experiences and emotions while the impact of the trauma is still fresh. Despite what Bisson and Everly agree in their paper was an absence of reliable evidence as to its effectiveness, CISD has become widely used around the world in the aftermath of traumatic incidents.

Jonathan Bisson, Senior Lecturer in Psychiatry at Britain's Cardiff University, was one of the British government's key advisers in drawing up recommendations in 2005 (National Institute for Clinical Excellence) explicitly discouraging the use of such debriefing for individuals as a routine form of support in the immediate aftermath of traumatic events.

"People cope with stress in differing ways," write Bisson and Everly in their AJP paper, "and no formal intervention should be mandated for everyone."

Instead, they recommend that those affected be provided shortly after the event with empathic, practical and pragmatic psychological support, with information about possible reactions, about what they can do to help themselves and how they can access support from family and community.

"It is important that provisions be made for individuals to obtain the appropriate early support after a traumatic event," they continue. "However, any early intervention approach should be based on an accurate and current assessment of need."

Their AJP paper also encourages exploration of what they term a psychological first aid approach which takes explicit account of people's natural resilience.

In the journalistic case study, Bisson and Everly say that despite the journalist's significant initial distress after covering the aftermath of the bomb attack, there was no indication that an early formal intervention would have helped.

They go on, however, to highlight the value of awareness training and peer support in the workplace which enabled the journalist and his colleagues to recognize some weeks after the bomb attack that he had been affected, becoming withdrawn, irritable and hypervigilant, and displaying many of the symptoms of acute Post Traumatic Stress Disorder (PTSD).

In their case study, Everly and Bisson describe how the journalist was encouraged, successfully, to seek professional therapeutic help in the form of cognitive behavioral therapy.