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  Traumatic Event Debriefings Getting Second Thoughts
      By Rudy M. Yandrick

Following the World Trade Center attack on September 11, 2001, scores of counseling firms dispatched critical incident stress debriefing (CISD) specialists to New York to aid survivors and emergency workers. Among the firms was Atlanta-based Crisis Management International (CMI), whose task was to provide trauma relief to workers or 204 employers in the vicinity of Ground Zero.

Like other debriefing firms, CMI's interventions provided immediate stress relief, attested to by a satisfaction rate of 99.7 percent that also fostered the belief that the interventions has diminished the participant's potential for post-traumatic stress disorder (PTSD). But critics of CISD, mainly researchers armed with empirical studies, are now arguing against a particular practice they call "rehashing," during which participants are encourages to share their thoughts, reactions and symptoms of distress that they experienced wither during or after the incident.

"Now we are seeing evidence that debriefing – which always seem like the right things to do at the time – can cause eventful harm for some, and we've had to reassess some of our basic assumptions about the practice, " said CMI Chief Executive Officer Bruce T. Blythe, author of Blindsided: A Managers Guide to Catastrophic Incidents in the Workplace.

"While CISD ostensibly is practiced to help survivors of critical events purges themselves of emotional trauma, for some people it may seal in the very demons that later morph into PTSD – the same illness that plagued legions of Vietnam veterans during the 1970s," said Richard Gist, a community psychologist and associate professor at the University of Missouri-Kansas City.

The controversy has been fueled by finding from a study led by Isreli researcher Karni Ginzburg, who examined the occurrence of PTSD in people having different coping styles. Studying people who had suffered myocardial infarctions, she found that people with a "repressive" coping style – who ignore or divert their attention form a potentially traumatizing event – fared far better in the onset of PTSD and its earlier form, acute stress disorder, than did other personality types, such as high-anxious" copers. For example, seven months after the event, while 19 percent of the high-anxious group had clinical PTSD and another 44 percent had subclinical symptoms, the repressors had only 7 percent and 11 percent, respectively.

"Encouraging natural repressors to bare their souls in a debriefing, or even requiring them to be in a room as others do, may interfere with their natural coping process," Gist explained. Debriefers, rather than helping survivors to distance themselves form an event, may tend to rush in a pry open vivid recollections that people are trying to exorcise.

Misuse by Businesses

After a critical incident, the priority for many employers is to rapidly normalize operations, leading to a classic mistake: After an initial debriefing, there is no follow-up with employees. This can have profound organizational repercussions, leading to prolonged workers' compensation episodes and high turnover.

According to Philip Deming, President of King of Prussia, PA-based Deming & Associates and a member of the Society for Human Resource Management's Workplace Health, Safety an Security Committee, "Many companies act passive-aggressively, rushing to the rescue of employees right away, then burying the event as though it never happened," he said. At one financial firm where a shooting occurred after an initial debriefing the event was swept under the rug. "They lost every employee to turnover within six months because management didn't want to deal with the 'post' piece of it," Deming said.

Still, debriefings are standard policy these days for many businesses, which may handle them like a mandatory staff meeting. "The on-size-fits-all method of herding traumatized people into a room and doctoring them is both disrespectful and discounts their own ability to process events," said E. Larry Newton, a psychologist with Peter Rock Consulting in Charlotte, NC

Further, while studies show that a person's lifetime risk of exposure to an event that could give rise to post-traumatic reactions is between 60 percent and 90 percent, the proportion of individuals who actually reported PTSD was only 8 percent, according to the federal government's National Comorbidity Survey released in 1995. "The challenge is in determining who the 8 percent are and when they need help," adds Newton. "You won't find that out by putting everyone through the same process. So why add insult to stress?"

Debriefing firms are stating to get the message. Today, Blythe, who considers himself a "recovering debriefer," has reformatted his employer services accordingly. CMI's newly minted "Resiliency Management Program" includes a crisis preparedness process that results in a business response plan; a post-crisis management consultation to address organizational needs; resiliency debriefings, in which participants learn methods for personal recovery; a web site with the theme "Bouncing Back" that offers individual education and research; and more specialized therapy to those exhibiting signs of PTSD. "We don't do any more 'rehashing,'" he said.

Rebutting the Critics

The debriefing debate is not without its own controversy, though. According to Jeffrey T. Mitchell, clinical associates professor in the department of emergency health services at the University of Maryland-Baltimore County, many of the conclusions drawn by the debriefing research are invalid due to false assumptions and poor methodologies.

In many studies, "Inadequate trained personnel were misapplying a group of individuals for whom the process was never designed and under circumstances in which the intervention would be considered inappropriate," said Mitchell, who founded the CISD movement and who submitted a 59-page rebuttal to the research claims of critics.

Lawyers To Get The Final Say?

It may be the courts that get the last word in the debate. Employers failure to plan for traumatic workplace events, as well as harmful outcomes from CISD interventions, will be scrutinized as never before, according to Terri Stivarius, a partner in the San Francisco-based labor and employment law firm Littler Mendelson. She said she believes that the cumulative body of research on CISD and PTSD will spur a new breed of lawsuit.

"It could develop into the scenario in the 1980s movie Silkwood, where employees were exposed to contaminations at an Oklahoma plutonium plant, but now with physical injuries being substituted with mental and emotional ones," she said.

Stivarius speculated that litigation worries will have the greatest impact on employee assistance programs (EAPs), which commonly play matchmaker between staff or third-party debriefers ad client organizations requesting CISD services. By limiting their purview to generalized workplace problems, she said EAPs may escape being sued by an employee alleging medical malpractice. Additionally, they will need to more carefully screen service providers who come to them claiming to be CISD specialists. "Most EAPs today offer debriefings as part of their standard service delivery package. But if an EAP's screening process investigates only whether the person has had any debriefing training and, if they have then counted them as qualified, that EAP is going to be increasingly vulnerable."

"HR professional will eventually be held accountable for screening, too." She adds. "There doesn't right now exist a standard instrument that employers can use to screen critical incident specialists, but there needs to be one."

RUDY M. YANDRICK IS A MECHANICSBURG, PA.. BASED FREELANCE WRITER SPECIALIZING IN HUMAN RESOURCE AND EMPLOYEE ASSISTANCE ISSUES.