Running Head: DEBRIEFING VICTIMS OF SEVERE TRAUMA

The Effects of Debriefing Victims of Severe Trauma among Soldiers Daniel Kerubakeran SCSJ 0004054 Erihire Tivere Aboloje SCSJ 0004974 Ms Uma Nagalingam Segi College, Subang Jaya Upper Iowa University

Running Head: DEBRIEFING VICTIMS OF SEVERE TRAUMA

NAME: ERHIRE TIVERE ABOLOJE ID: SCSJ TOPIC: DEBRIEFING VICTIMS OF SEVERE TRAUMA.

INTRODUCTION Psychological debriefing is a type of post-traumatic care, for which several models have being developed in the past two decades (Arnold, Kamphuis, Alexander, & Paul, 2002). For example, Everly, Flannery, and Mitchell (2000) describe three stages in the development of these models. The first stage is the Crisis Intervention Approach, in which there are many individually applied techniques. The second stage is the group psychological debriefing. It has been used to reduce immediate distress, prevent post-traumatic stress disorder, and identify individuals who were at risk of developing chronic problems and who needed referral for further treatment. There

Running Head: DEBRIEFING VICTIMS OF SEVERE TRAUMA

are three types of group psychological debriefing: critical incident stress debriefing (CISD) or the Mitchell model, the Raphael model, and process debriefing (Raphael, 1986). CISD has been integrated in the more comprehensive critical stress management model (CISM). Psychological debriefing has received a lot of attention from the scientific community. Despite the large number of publications on this issue, debate continues on the effectiveness of single session debriefing in the prevention of symptoms of chronic post-traumatic stress disorder (PTSD), and other negative psychological outcomes after trauma. Conclusions varied from there is no current evidence that psychological debriefing is a useful treatment for the prevention of PTSD after traumatic incidents to crises intervention procedures, group debriefings, and especially CISM approaches are effective in reducing the negative psychological aftermath of a variety of critical incidents (Rose, Bisson, & Wessely, 2002). The theory being considered is the dual representation theory of PTSD. It was proposed by Brewin. According to this theory, features and details of traumatic events such as the sounds, smells, and sights, for example, are initially retained in a system called situationally accessible memory, which is a bit like episodic memory. When individuals reflect upon this information and attempt to understand or integrate the features and details, the insights that follow are retained in another system called the verbally accessible memory, which is like the semantic memory (Brewin & Joseph, 1996). After a traumatic experience, people sometimes attempt to dissociate from the event. For example, they distract themselves from memories of this event and try to avoid negative mood states. Therefore, most of the features or details of this event will be retained in situationally

Running Head: DEBRIEFING VICTIMS OF SEVERE TRAUMA

accessible memory which is the memory that represents information and spatial images (Brewin, 2001). In their journal article on traumatology, Deahl, Gilham, Thomas, Searle and Srinivasan (1994) investigated how prone soldiers were to disease, and found that debriefing did not reduce psychiatric morbidity. They selected participants who wanted to take part in the debrief, and emphasized on the importance of a rapid and locally held debriefing and concluded that soldiers were suspicious towards outsiders, including mental health personnel. One major criticism of their method is the self-selection process used. This implies that the participants in the debrief group personally wanted to take part in the debrief. Also, it is not clear what the debriefing consists of.

Chemtob Tomas, Law & Cremniter (1997) carried out a study on the influence of debriefing on psychological distress. In their study, they described how victims of a hurricane had their problems reduced compared to a group who only later received the same type of intervention. They reported reduction in problems in those who had gone through debriefing. The effectiveness of the intervention was evaluated by the use of the Impact of Event Scale. It was used before and following the intervention, Some positive criticisms to this approach include the lack of data regarding the participants ahead of the debriefing, the use of heterogeneous participants, and carrying out the procedure six to nine months following the disaster. Justin Kenardy and colleagues (1996) also conducted a research on rescue personnel after an earthquake. They found no effect of debriefing during the two years following the earthquake. Participants were mainly professionals and females. They were also self-selected.

Running Head: DEBRIEFING VICTIMS OF SEVERE TRAUMA

A major criticism of this study is that the authors had no control over the debriefing procedures, and the background and training of the debriefing leaders were not stated in the research. Another criticism of the research is the fact that more females were used, and females usually report more distress on most measures (Breslau, Davis, Andreski, Peterson, & Schulz, (1997). Hobbs, Mayou, Harrison & Worlock (1996) observed a group of victims after traffic accidents. They had an intervention group which went through a debriefing section that lasted for an hour. This was done about 24 to 48 hours following the accidents. Four months after the debriefing, the researchers found no significant decline in symptoms in those they were debriefing and the control group. A major criticism of this approach is that the researchers ought to have allowed more time for the physical healing to take place before the psychological debriefing can be effective. Bisson, Jenkins, Alexander & Bannister (1997) grouped patients wounded in a fire into a debrief group and a control group. About 26% of the group undergoing psychological debriefing were found to have PTSD after thirteen months, while in the control group 9% were diagnosed with PTSD. It was later discovered that the group that went through psychological debriefing already had experienced twice as many traumas, especially fire traumas, than the control group. This explains why there was little improvement among those that went through the debriefing session. A criticism of this research is that the timing was too early because it is clinically unsound to intervene with psychological debriefing while physical healing is taking place. The aim of this research proposal is to show the effectiveness of debriefing on soldiers facing trauma. The independent variable is debriefing session. The dependent variable is

Running Head: DEBRIEFING VICTIMS OF SEVERE TRAUMA

soldiers facing trauma. Debriefing is defined as recounting of what transpired during a specific event (Raphael & Wilson, 2000). The operational definition of trauma is a mental condition caused by severe shock that lasts for a long time. The hypothesis is that debriefing reduces the occurrence of Post Traumatic Stress Disorder (PTSD) among soldiers. METHODS Participants The participant picked in this research is a group of 100 soldiers from the Malaysian Army ( Tentera DiRaja Malaysia) (TRDM) who are assigned to be sent to a war zone. Eg, Somalia. Materials The materials being used in this research is an informed consent, Slides on how the situation will be like at the warzone (briefing). A set of questionnaire PTSD- Military version (PCL-M) and another set of qusitionaire of Acute Stress Disorder Scale by Bryant, R., Moulds, M., & Guthrie, R. (2000). Procedure A group of 100 soldiers will be split up in to two groups. Group A and B will be given the informed consent form so that they are aware of what is being done. Group A and b will be given the acute stress disorder scale form to see the level of stress the soldiers have in current time. Later on, group A will be briefed by using slides on what they are going to confront at the battlefield while group B will not be briefed at all. Later then, when the both group returned back from the warzone another questionnaire will be given which is the PTSD Military version (PCL-

Running Head: DEBRIEFING VICTIMS OF SEVERE TRAUMA

M). This to prove that group A will not have much effect of traumatic disorder because of the early exposure has been given to them rather than group B which most likely to have PTSD since they are not given any kind of exposure Both of the assessment will be evaluated and recorded for future reference. Design This questionnaires are given not based on forced given answer but its flexible enough to give an answer based on scale from very dissatisfied to very satisfied. The acute stress disorder scale is given to see any current stress that is being avoided or going through by the soldiers which it could lead to PTSD. PTSD military version is to see the level of trauma is going through by the soldiers after being exposed to the situation. References

Running Head: DEBRIEFING VICTIMS OF SEVERE TRAUMA

Appendix

Acute Stress Disorder Scale (ASDS)

Bryant, R., Moulds, M., & Guthrie, R. (2000). Acute Stress Disorder Scale: A self-report measure of Acute Stress Disorder. Psychological Assessment, 12(1), 61 - 68.

Contact: Richard Bryant, PhD rbryant@psy.unsw.edu.au

Briefly describe your recent traumatic experience:

Did the experience frighten you?

Yes

No

Please answer each of these questions about how you have felt since the event. Circle one number next to each question to indicate how you have felt. 1 = Not at all

Running Head: DEBRIEFING VICTIMS OF SEVERE TRAUMA

2 = Mildly 3 = Medium 4 = Quite a bit 5 = Very much

1. During or after the trauma, did you ever feel numb or distant from your emotions? 2. During or after the trauma, did you ever feel in a daze? 3. During or after the trauma, did things around you ever feel unreal or dreamlike? 4. During or after the trauma, did you ever feel distant from your normal self or like you were watching it happen from outside? 5. Have you been unable to recall important aspects of the trauma? 6. Have memories of the trauma kept entering your mind? 7. Have you had bad dreams or nightmares about the trauma? 8. Have you felt as if the trauma was about to happen again? 9. Do you feel very upset when you are reminded of the trauma? 10. Have you tried not to think about the trauma? 11. Have you tried not to talk about the trauma? 12. Have you tried to avoid situations or people that remind you of the trauma? 13. Have you tried not to feel upset or distressed about the trauma? 14. Have you had trouble sleeping since the trauma? 15. Have you felt more irritable since the trauma? 16. Have you had difficulty concentrating since the trauma? 17. Have you become more alert to danger since the trauma? 18. Have you become jumpy since the trauma? 19. When you are reminded of the trauma, so you sweat or tremble or does your heart beat fast?

1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2

3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3

4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4

5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5

Running Head: DEBRIEFING VICTIMS OF SEVERE TRAUMA

10

PTSD CheckList Military Version (PCL-M)

Name: __________________________________________ Instruction to patient: Below is a list of problems and complaints that veterans sometimes have in response to stressful life experiences. Please read each one carefully, put an X in the box to indicate how much you have been bothered by that problem in the last month. Not at all A little bit Moderatly Quite a bit Extremely (1) (2) (3) (4) (5)

No.

Response

Repeated, disturbing memories, thoughts, or 1. images of a stressful military experience from the past? Repeated, disturbing dreams of a stressful military 2. experience from the past? Suddenly acting or feeling as if a stressful military 3. experience were happening again (as if you were reliving it)? 4. Feeling very upset when something reminded you

Running Head: DEBRIEFING VICTIMS OF SEVERE TRAUMA

11

5.

6.

7.

8. 9.

of a stressful military experience from the past? Having physical reactions (e.g., heart pounding, trouble breathing, or sweating) when something remindedyou of a stressful military experience from the past? Avoid thinking about or talking about a stressful military experience from the past or avoid having feelings related to it? Avoid activities or situations because theyremind you of a stressful military experience from the past? Trouble remembering important parts of a stressful military experience from the past? Loss of interest in things that you used to enjoy?

10. Feeling distant or cut off from other people? Feeling emotionally numb or being unable to have 11. loving feelings for those close to you? 12. Feeling as if your future will somehow becut short? 13. Trouble falling or staying asleep? 14. Feeling irritable or having angry outbursts? 15. Having difficulty concentrating? 16. Being super alert or watchful on guard? 17. Feeling jumpy or easily startled? PCL-M for DSM-IV (11/1/94) Weathers, Litz, Huska, & Keane National Center for PTSD - Behavioral Science Division This is a Government document in the public domain.