Does debriefing after psychological trauma work? Time for randomised controlled trials

A Case Study of the Effects of Posttraumatic Stress Disorder on Operational Fire Service Personnel Within the Lancashire Fire and Rescue Service

BACKGROUND

Lancashire Fire and Rescue Service (LFRS), the subject of this evaluative research document employs 1400 people. 80% of employees are operational firefighters and officers whom operate across a range of duty systems and support functions, providing prevention, protection and emergency response to the communities of Lancashire.

METHODS

The overarching purpose of this epidemiological study is to assess the prevalence of post-traumatic stress disorder (PTSD) amongst operational LFRS personnel and to analyse the effects upon those who may be suffering from it, whether brought about by a single traumatic event or by repeated exposure to traumatic occurrences over a period of time. A combination of primary and secondary research was carried out. Primary data was collated using two recognised clinical questionnaires and statistical analysis was conducted with the aid of the software package SPSS.

RESULTS

The findings and statistical analysis showed that out of the 100 people surveyed, 30% of respondents had signs of probable distress. Of this quota, 4% showed symptoms of PTSD. The study considers how an organisation can recognise and manage PTSD and provides recommendations to assist in better recognising and managing the associated risks.

CONCLUSION

Based upon the findings, the authors conclude that the level of PTSD within LFRS is slightly lower than those found in other studies undertaken within the Fire and Rescue Service sector. The paper provides recommendations for future studies and a series of actions for consideration by LFRS senior management to improve PTSD support services for employees.

Learning from experience: Using action research to discover consumer needs in post-seclusion debriefing

Approximately 16% of consumers are secluded during an inpatient admission. Despite the harmful psychological consequences resulting from the use of physical force, restraint, control, and temporary sequestration of therapeutic communication, there is little evidence of nursing practices to support consumers who are secluded. This paper will outline the findings from an action research project examining post-seclusion debriefing practice. A series of focus groups was undertaken with mental health nurses (MHN) and consumer consultants (CC) to investigate current practice, identify consumer/clinician preferences, and scope future practice possibilities. The findings suggest that CC need assistance in dealing with the negative feelings evoked by seclusion. MHN use a range of approaches for debriefing; however, these sometimes do not meet consumer preferences. MHN focus on explaining why seclusion happened and how to avoid it. While mitigation is a critical issue, CC want more emotional support from debriefing. MHN saw the possibility of using the debriefing to support consumers' transit from seclusion to high-dependency status and then to low-dependency status. Opinions raised regarding the potential for CC to have a role in debriefing were divided. The findings will be used to inform the development of a consumer debriefing training program for MHN and CC.

Violence: incidence and frequency of physical and psychological assaults affecting mental health providers in Georgia

Threats to the physical safety and psychological well-being of mental health professionals present serious problems, according to 1,131 licensed mental health professionals in the state of Georgia. The professionals included clinical social workers, marriage and family therapists, professional counselors, psychiatrists, psychologists, and social workers. From a total of 6,431 surveys sent out, 1,131 (18%) were returned. The results revealed 2.696 separate accounts of 14,120 acts of physical or psychological assaults committed by 8,292 perpetrators. The results also showed that 61% of the respondents had been victimized in violent acts of a psychological or physical nature and that 29% had feared for their lives at least once during their professional careers. These data are consistent with other research that indicates that 6 out of 10 professionals will be assaulted during their professional careers.

Effects of psychotherapeutic treatments for PTSD: a meta-analysis of controlled clinical trials

This meta-analysis synthesized the results from controlled, clinical trials of psychotherapeutic treatments for posttraumatic stress disorder (PTSD). Psychotherapeutic modalities included behavioral, cognitive, and psychodynamic treatments, in group and individual settings. Participants in the studies included combat veterans from the Vietnam and Lebanon Wars, crime-related victims, and severe bereavement sufferers. The impact of psychotherapy on PTSD and psychiatric symptomatology was significant, d = .52, r = .25, when measured immediately after treatments were administered. Similarly, there was no decay in the effect of treatment at follow-up, d = .64, r = .31. Moreover, for target symptomes of PTSD and general psychological symptomes (intrusion, avoidance, hyperarousal, anxiety, and depression), effect sizes were significant, ranging from r's of .2-.49. Results suggest substantial promise for improving psychological health and decreasing related symptoms for those suffering from PTSD.