Debriefing interventions have sprung from the understandable desire to reduce—if not eliminate—victims’ suffering after traumatic loss. Unfortunately, no compelling evidence has shown that an intervention given within a few days of a traumatic event can prevent significant psychological distress.
Evidence does suggest, however, that components of psychological debriefing discussed here may help you provide effective “first aid” to trauma victims and identify persons at risk for chronic psychological problems.
Complicated grief reactions
Death of a family member or close friend is among life’s most painful loses. When death occurs unexpectedly—as from violence, accident, natural disaster, or suicide—survivors’ emotional and psychological response can be pronounced.
Most survivors report great distress immediately after trauma or traumatic loss, but only an estimated 9% develop chronic psychopathology,1 such as complicated grief (Table 1).2,3 If the death was violent, surviving loved ones may experience complicated grief and posttraumatic stress disorder (PTSD)4 (Table 2).
Complicated grief is associated with considerable morbidity and risk of physical illness.5 PTSD develops in approximately one-third of cases involving sudden, unexpected death of a close friend or relative1 and can result in comorbid—but distinguishable—reactions to the loss (Box).6
Evidence-based secondary and tertiary intervention protocols have been developed for PTSD,7 but no practice guideline exists for treating or preventing complicated grief. Few controlled trials have been done.8
Table 1
Clinical features of complicated grief
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Source: Reference 3 |
Clinical features of posttraumatic stress disorder
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Source: DSM-IV-TR |
- educating individuals about stress reactions and how to cope with them
- instilling messages that stress reactions are normal
- helping affected persons process and share their emotions
- providing information about and opportunity for further intervention, if needed.
Traumatic loss. Although complicated grief (CG) and posttraumatic stress disorder (PTSD) can both develop following the loss of a loved one from a traumatic event, CG also can develop after expected deaths from natural causes. PTSD is exceedingly uncommon if a loved one’s death did not result from homicide, suicide, or accident, whereas CG can occur when the loss was not particularly violent or sudden.
Avoidance vs preoccupation. The fundamental difference between CG (Table 1) and PTSD (Table 2) symptoms is the degree that survivors avoid cues and contexts that remind them of their loss.
Those with PTSD go to great lengths to avoid thinking about the traumatic event and actively avoid situations that may remind them of it. This avoidance, paradoxically, exacerbates intrusive memories, as trying not to think about something increases the frequency of those thoughts.
Individuals with CG do not avoid reminders of the deceased. Quite the opposite, they seek out reminders (such as photos or recordings) and find solace in them. Reminders may contribute to their ongoing rumination or preoccupation, in which they retreat into memories of the deceased rather than engage in present life.
Hyperarousal symptoms that are required for PTSD diagnosis are largely absent in CG. Even when persons with CG experience arousal, it is not akin to scanning the environment for danger or threat, as is typical with PTSD. Persons with CG have a pronounced negative affect and bereavement-related depression, rather than an exaggerated startle response or heightened physiologic reactivity.