By Alexis Artwohl, Ph.D.

[This article was originally published in The Tactical Edge, the professional publication of the National Tactical Officer’s Association (NTOA), and is reprinted with permission. ntoa.org]

TRUE OR FALSE QUIZ

  1. Critical incidents are psychologically devastating and likely to cause post-traumatic stress disorder.
  2. In order to prevent post-traumatic stress disorder (PTSD), everyone involved should be debriefed.

RESILIENCY

The answer to the first question is false. Yes, critical incidents can be upsetting. However, current research is increasingly showing that people in general are quite resilient, meaning that they quickly and naturally bounce back from the slings and arrows of life. This only makes sense, really. For many thousands of years, humans have been subjected to frequent traumatic stressors, many far worse than those that exist in modern life. If we weren’t naturally resilient, we would have perished as a species long ago. Yet here we are, still muddling through and taking our place in the sun in the history of the planet.

Researchers Lating and Bono point out, “Current estimates are that most people living in the United States will experience at least one violent or life-threatening event during their lives… Recent data suggest, however, that most people exposed to traumatic events do not experience serious disruptions in normal life functioning, and are in fact resilient.”

Creamer states, “A fundamental starting point in the immediate aftermath of trauma is to expect normal recovery. The presumption of clinically significant mental health problems in the early post-incident phase is inappropriate.”

In his review article on the neuroscience of resiliency, Stix came to the following conclusions:

1. People are naturally resilient and this is the norm rather than the exception.

2. Although temporarily upsetting, trauma and loss do not cause permanent damage in 90 percent of individuals.

3. Most will recover quickly with no professional help.

4. About 10 percent are less resilient and will not quickly bounce back. These individuals can benefit from professional help.

5. People’s natural resiliency is a complex and still poorly understood combination of genetic predisposition and life experiences.

6. The jury is still out on whether you can train people to be more generally resilient.

7. Coping styles are highly personal and incorporate a wide range of effective strategies that therapists have sometimes deemed not healthy, such as denial, egocentric bias that bordered on narcissism, repression of negative thoughts and emotions, blind faith in their own resilience and smiling and laughing their way through it. George Bonanno, a leading researcher in the area of resilience, termed this “coping ugly.” People may not do what others, including some therapists, think they should do to process the trauma, but it works for them. Interfering with these natural coping abilities and telling people how they should be reacting and coping may in fact do more harm than good.

8. As Stix sums up, “Sometimes the worst does happen, but our innate capacity to bounce back means that most of the time things will turn out all right.”

Research done by Honig and Sultan at the Los Angeles County Sheriff’s Department showed that resiliency was also the norm among almost 1,000 police officers who had been involved in on-duty critical incidents. Consistent with the research on resiliency, only about 10 percent experienced severe symptoms; the rest reported mild to moderate transitory symptoms.

IT’S UNLIKELY THAT DEBRIEFINGS PREVENT PTSD

The answer to the second question is also false. Debriefings, especially group CISD debriefings, are controversial in the field of psychology. Multiple researchers have pointed out that debriefings do not lower the incidence rate of PTSD. Some are even concerned that debriefings may cause more harm than good by interfering with people’s individualistic natural coping mechanisms and fostering the idea that trauma is supposed to cause serious psychological damage.

Creamer points out, “Despite its widespread use, the effectiveness of debriefing is far from clear… The research evidence is inconclusive… Research in this area is notoriously difficult to conduct and severe methodological problems limit the interpretability of most published studies… The field is polarized, with strongly held views both for and against the process.”

In her review article Dunning states, “One result has been the widely popular development of CISD teams positioned to respond within hours of the occurrence of a traumatic situation, yet what is troubling is that anecdotal and more methodologically rigorous research has seriously questioned the efficacy of debriefing police officers… In fact, many have concluded that CISD caused the very disorder it was said to prevent ― PTSD… It is now accepted by clinicians that debriefing accentuated the stress response and exacerbated traumatic stress in participants who were traumatized or if not already, caused an iatrogenic effect…

Following the 9/11 World Trade Center event, warnings were posted on the Web site of the American Psychological Association cautioning psychologists against the utilization of CISD protocols given the controversy that was occurring in the clinical and research fields.”

Stix wrote, “Several studies over more than 15 years have shown the technique is not effective and might cause harm… After the 2004 Indian Ocean tsunami, the World Health Organization warned against debriefings because they might prompt some victims to feel more unsettled.”

It seems unlikely that debriefings would be adequate to prevent PTSD and other long-term psychological consequences in the 10 percent of the population who are less resilient and therefore more vulnerable to any particular traumatic incident. Those individuals are more likely to benefit from professional treatments tailored to their individual needs.

Fortunately, there are now effective treatments for PTSD and other problems. As for debriefings causing harm, like any intervention it’s likely to depend on the quality and sophistication of the services that are being provided.

SO WHY DO DEBRIEFINGS?

In spite of the fact that debriefings may well not prevent PTSD, various authors have pointed out they still have value when skillfully done. Clark and Haley state “CISM is an effective and valuable crisis intervention system that can mitigate the impact of traumatic incidents on police officers and other emergency responders.” Bohl discusses the benefits of debriefings tailored specifically for law enforcement. Creamer points out that although debriefings have not been proven to be effective in preventing PTSD, “A final point worthy of note is the consistent finding that participants in debriefings usually report high satisfaction ratings with the experience, even when it does not reduce long-term symptoms.” Consistent with this finding, Honig and Sultan found that of almost 1,000 officers who were ordered to attend a mandatory individual debriefing with a police psychologist, 60 percent stated that they would not have attended voluntarily, yet 100 percent found it helpful.

So, there are valid reasons other than the prevention of PTSD to provide high-quality debriefings to police officers. Best, Artwohl and Kirschman provided the following reasons why they can be valuable:

  • Debriefings provide an opportunity to be educated about attention, perception, memory and decision-making under stress.
  • Group debriefings can provide a more complete and accurate picture of the event which trauma survivors often find helpful.
  • Group debriefings mobilize peer support and provide a supportive social milieu for recovery.
  • The availability of individual and group debriefings is a demonstration by the agency and peers that they have concern for the officers and want to help.
  • For those who may develop PTSD or other mental health issues, debriefings provide education about these potential reactions and where and how to seek help.
  • Debriefings educate officers about the impact of critical incidents on family members.
  • Debriefings educate and support officers through the investigative process and potentially negative media and community reactions.

The educational component of debriefings is important because regardless of the task or challenge an individual is facing, anything that increases skill, mastery and confidence will help the individual perform better. In this case, the performance demand will be negotiating the challenges of a critical incident’s aftermath. This is especially important in officer-involved shootings whose aftermath will entail skillfully confronting a variety of legal and administrative risks, intense media and community scrutiny and the impact on family members. These challenges in and of themselves can drag on for weeks, months or even years, so it is important that officers have as much knowledge as possible so they know what to expect and can garner additional ideas on how to cope.

The social support component is also important since that has been shown to be one of keys for a healthy life in general. Officers will often be sensitive to support (or lack thereof) from peers and their agency. Debriefings are a way to emphasize and formalize that support and thereby lessen the risk that officers will feel abandoned by their employers and co-workers.

Although most individuals are resilient and will bounce back naturally without any formal intervention, one problem is that there is no way to predict with certainty which 10 percent of individuals in any particular event will go on to develop long-term problems that will need treatment. Therefore, it is helpful to educate everyone about possible problems that might arise so those few who are vulnerable can recognize the issues in themselves or others and know where and how to seek treatment.

Resources that assist agencies and officers in the aftermath of a critical incident include guidelines on officer-involved shootings and peer support written by the Police Psychological Services Section of the International Association of Chiefs of Police. See references below for information on how to obtain the guidelines.

SUMMARY

Most people are naturally resilient and will quickly bounce back from life’s traumas with no formal interventions. Only about 10 percent will go on to develop PTSD or other problems that will need treatment. Although research shows debriefings are unlikely to prevent PTSD in vulnerable individuals, they can still provide education that may enhance the natural coping skills of the majority who do not develop the disorder.

For those who are not as resilient, the education can help them realize when recovery is lagging and where and how to seek help. The social support component can be helpful for all. Debriefings can formalize the social support of employers and peers and thus enhance the relationship between officers and their employers.

THOUGHTS? Have debriefings helped you? Do you consider them useful/helpful? We’re interested in your feedback! E-mail us at: editor@calibrepress.com

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References

Best, S., Artwohl, A., and Kirschman, E. “Critical Incidents.” In Handbook of Police Psychology, ed, Jack Kitaeff. New York: Routledge, 2011.

Bohl, N. “Professionally Administered Critical Incident Debriefing for Police Officers.” In Police Psychology Into the 21st Century, ed. Kurke, M. I. and Scrivner, E. M. 169-188. Hillsdale, N.J.: Lawrence Erlbaum Associates, 1995.

Clark, D.W. and Haley, M. “Crisis Response Tools for Law Enforcement.” The Police Chief, 24(8) (2007): 94-101.

Creamer, Mike. “Acute Psychological Intervention for Law Enforcement Following Trauma Exposure: What Is The Current Best Practice?” Law Enforcement Executive Forum (May 2006): Vol. 6, No. 3.

Dunning, Christine. “Maintaining Police Officers at Peak Mental Functioning: Risk Management of On-the-Job Mental Injuries Sustained in Response to Violent, Catastrophic, and Disastrous Events.” Law Enforcement Executive Forum, 4(2) (2004): 129-146.

Honig, A.L. and Sultan, S.E.. “Reactions and Resilience Under Fire: What an Officer Can Expect.” The Police Chief (December 2004) Vol. LXXI, No. 12, 54-60.

“Officer-Involved Shooting Guidelines.” IACP/PSS: International Association of Chiefs of Police: Police Psychological Services Section. http://psych.theiacp.org.

“Peer Support Guidelines.” IACP/PSS: International Association of Chiefs of Police: Police Psychological Services Section. http://psych.theiacp.org.

Lating, J.M. and Bono, S.F. “Crisis intervention and fostering resiliency.” International Journal of Emergency Mental Health. 10(2) (2008): 87-93.

Stix, Gary. “The Neuroscience of True Grit.” Scientific American, March 2011.