A scare tactic.

In regard to "The Evolution of Psychological First Aid" (2nd quarter 2006) by Bob VandePol, Lyle Labardee, and Richard Gist, I was greatly bothered by the use of inference and innuendo to tell EA professionals that our training is outdated and may be harmful and that we should subscribe to their version of "evidence-based practice." Let's look at the evidence on which they base their criticisms.

The authors assert that some "widely practiced and promoted approaches--most specifically debriefing [which they do not define] and related techniques--have proven, in a growing range of controlled studies, to be ineffective ... and a few well controlled studies have reported adverse outcomes." The problem with that statement is that it simply is not true. Let's check their assertions against their references.

Rose et. al. (2002, not 2004 as cited *) evaluated "studies" where the intervention "consisted of a single session only," which is not recommended in any model I'm aware of, and that "involved some form of emotional processing/ventilation," which is a rather ill-defined term. The "studies" themselves didn't define the term "debriefing," so it isn't clear what was being studied, and the "methodological quality" was "variable." In short, Rose and his co-authors drew conclusions from studies whose methodology is suspect about a practice that wasn't defined and that was used in a way that isn't recommended. Are we really to consider this credible and reliable, let alone a "well-controlled" study?

Similarly, the meta-analysis by van Emmerick et al. (2002) looked at "studies" of "single session debriefings" specifically using the term "CISD," a direct reference to the model espoused by the International Critical Incident Stress Foundation. Yet, as van Emmerick notes, "CISD was never designed to be a standalone intervention, but rather part of a broader, multicomponent CISM-type intervention that included training in being prepared for a crisis, follow-up, and referral. The efficacy of this type of intervention was not the subject of our meta-analysis ...". In fact, van Emmerick selected, among others, Bisson's horrible "study" where he went into a hospital to conduct single-session "debriefings" with burn victims who were still in pain and undergoing treatment. Try getting that study design through the Human Subjects Committee of any university!

The authors warn us not to practice what we're not trained adequately to do (a valid warning), try to debunk our "familiar training" via bad research, and recommend we leave crisis work to "specialty partners" who have "conversance and capabilities that fall increasingly outside of the training most EA professionals bring to their positions." The "familiar training" that is the target of their attacks appears to be the "broader, multi-component CISM-type intervention[s]" that were explicitly not studied by the sources they cite.

Is there a need for research? Absolutely But what we need is quality research. The authors' statement that we should not "... cling to the familiar ... risk[ing] standing static while advancing information and expectations lead our clients to look elsewhere for new approaches ..." is not evidence-based; rather, it's a scare tactic. I know what I have seen work time and again when it's done right.

David L. Swihart, M.C., LPC 

Employee Assistance Coordinator

University of Arizona Life and Work Connections

Tucson, Arizona

[phone]

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* There are 0 results out of 4,320 records for "Brief Psychological Interventions for Trauma-related Symptoms and Prevention of Post Traumatic Stress Disorder" in title, abstract, or keywords in 2004 in The Cochrane Database of Systematic Reviews on The Cochrane Library Website. If the article, as cited by VandePol, Labardee, and Gist, is to be found elsewhere, please let me know where I can find it. The citation I used is as follows:

Rose, S., J. Bisson, R. Churchill, and S. Wessely. 2002. Psychological debriefing for preventing post traumatic stress disorder (PTSD). The Cochrane Database of Systematic Reviews 2002, Issue 2. Art. No.: CD000560. DOI: 10.1002/14651858.CD000560