Intervention and treatment programs after traumatic events

Brief Programs Critical Incidence Stres Debriefing (Violanti, ch.4) Mitchell, 1983 :CISD :For prevention Core elements and 7 stages 1.Introduction-rules 2.Facts : What exactly happened ? 3.Thoughts: What did you think, what went through your mind during the event ? 4.Experiencing: How did you feel ? Emotions, catharsis and ventilation

5. Symptoms: What are the physical and psychological symptom s they experience ? 6. Education: Normalization and useful coping strategies 7. Closing: Answers to questions and giving opportunities for future care. CISD varies in: timing; intensity; duration; practitioners and number of participants

Explanations for CISD effectiveness: Psychodynamic: Catharsis, release of internal tension Cognitive: Coping strategies and cognitive restructuring Group process, support, exchange of information, self-help, helping others BUT: May undermine self-esteem and belief in personal control (I needed to take part in a support program)

Is it effective ? Satisfaction: Most participants are reasonably or very satisfied. However, satisfaction not found related to objective indices of well being (i.e; symptomatology, sick leave, earlier work returns) Controlled Outcome Studies: Research with control groups doesn’t support effectiveness strongly (more symptoms in CISD grps or no difference)

Scientific evidence vs Institute’s & licensed clinicians Pseudoscientific promotion Pseudoscientific communication Demands of clinical market place

Alternative Programs Wait...then screen for PTSD (more than a month-ASD) Acute PTSD (< 3 months) for preventing chronic PTSD Brief treatments:3-6 sessions, referred to as crisis intervention counselling Time-limited therapy (Ford et al, 1997) Eclectic, for 3 sessions Reconstruction of trauma Psychoeducation No affect focussing Cognitive reconstruction İnterpersonal problem solving

Foa et al, 1995 Brief prevention For sexual or other violence victims 1.Psychoeducation 2.Relaxation 3.Imaginal exposure 4.In-vivo exposure 5.Cognitive restructuring (better than control group) Stepped Care: Start with debriefing without emotional and educational components for ASD, then use Foa.

CBT for PTSD Trauma education Exposure (imaginal and later graded in-vivo) Learning skills for coping with anxiety (such as breathing retraining, relaxation) Dealing with and changing negative thoughts ("cognitive restructuring"), managing anger, preparing for stress reactions ("stress inoculation"), handling future trauma symptoms addressing urges to use alcohol or drugs when trauma symptoms occur ("relapse prevention"), communicating and relating effectively with people (social skills or marital therapy).