BMJ  2005;331:50 (2 July), doi:10.1136/bmj.331.7507.50-a

Letter

Coping with the aftermath of trauma

NICE guidelines on post-traumatic stress disorder have fundamental flaw

The first 150 words of the full text of this article appear below.

EDITOR—Gersons and Olff discuss coping with the aftermath of trauma.¹ The guidelines from the National Institute for Health and Clinical Excellence (NICE) that they mention conclude that early psychological intervention or debriefing does not prevent post-traumatic stress disorder, and might even be harmful.² A significant reason for this is that a professional intervention can unwittingly embed a preoccupation with a traumatic event in the mind of the survivor (although intending the opposite) and thus impede forward momentum in getting back to normal.

Yet NICE is recommending trauma focused psychological therapy—which sits on the same conceptual territory as debriefing—as first line treatment for people identified as having post-traumatic stress disorder. I agree that formal cognitive behaviour approaches would be appropriate for a minority who develop, say, a handicapping phobic avoidance pattern after a traumatic event. But re-exposure to the details of the traumatic event, and the emotions evoked by . . . [Full text of this article]

Institute of Psychiatry, Maudsley Hospital, London SE5 8AP derek.summerfield@slam.nhs.uk

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