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Debriefing patients soon after trauma may stifle recovery.

RANCHO MIRAGE, CALIF. -- Trauma isn't over until the victim's brain says that it is.

Don't debrief victims or ask them to recount the trauma until enough time has passed that the victim can differentiate the memory of the trauma from the experience of trauma.

"It has nothing to do with temporal time. It has to do with psychological time," Dr. Charles R. Marmar said at the annual meeting of the American College of Psychiatrists.

Psychologically debriefing people in the first hours after a traumatic event, while they are in a state of heightened adrenergic activity, and asking them to re-experience the traumatic event is likely to aggravate their recovery, explained Dr. Marmar, professor of psychiatry at the University of California, San Francisco.

A well-designed study of hospitalized accident victims who were randomly assigned to debriefing or a control group found that if patients had regained composure, debriefing did no harm.

However, if patients were highly agitated at the time of the debriefing, and if the debriefing included asking them to give a vivid portrayal of what happened, patients were significantly less likely to be doing well at 4 months and at 3 years after the event (Br. J. Psychiatry 2001; 178:182-3).

"Don't aggravate memory consolidation, and don't aggravate fear conditioning" with too-early debriefing, Dr. Marmar said. "Don't ask rape victims when they're lying on a gurney for a forensic examination to talk about their rape."

As a consultant to his local police department, Dr. Marmar helped them institute a policy under which officers gather only minimal factual information after an assault. In addition, the officers delay further gathering of data and evidence for at least 1 week when possible.

For those patients who develop posttraumatic stress disorder, the best validated psychological treatment with the largest effect is cognitive-behavioral therapy, according to Dr. Marmar.

If conducted in an appropriate amount of time after the trauma, cognitive-behavioral therapy can safely include a component of heavy, prolonged imaginal exposure in which the person continuously rehearses the traumatic event by speaking, writing, or thinking about it.

A study of 45 civilian trauma survivors with acute stress disorder and at risk of developing chronic PTSD showed that prolonged exposure and prolonged exposure plus anxiety management can be more effective than supportive counseling (Am. J. Psychiatry 1999;156:1780-6).

The study, conducted by researchers at the University of South Wales, Sydney, Australia, found that PTSD can be prevented, depending on the timing of cognitive-behavioral therapy. The cognitive-behavioral therapy started 2-5 weeks after the trauma.

BY SHERRY BOSCHERT

San Francisco Bureau
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Title Annotation:Adult Psychiatry
Author:Boschert, Sherry
Publication:Clinical Psychiatry News
Geographic Code:1USA
Date:Apr 1, 2007
Words:425
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