Time for randomised controlled trials

Some people believe strongly that talking through traumatic or stressful experiences may help the psychological recovery of those who have suffered psychological wounding. This belief has led to military psychiatrists providing immediate interventions at the front line that are intended to heal and return soldiers to activity,1 and it has fuelled psychological debriefing methods such as Mitchell's critical incident stress debriefing.2 Debriefing programmes have expanded rapidly, reflecting a powerful social movement that sees them as meeting the needs of workers in emergency services, victims of disasters, and those who have been affected by trauma and violence in wider society.3 4 5 Yet, although military psychiatry has succeeded in returning troops to action, outcome studies suggest that soldiers who are repeatedly traumatised by returning to combat may suffer even higher rates of severe and chronic post-traumatic stress disorder in the longer term.1

The proponents of debriefing agree that it needs evaluation, yet there is a dearth of systematic evaluation and outcome studies. In one of the few systematic evaluations, many subjects reported two weeks after debriefing that they had found it helpful and felt less stressed.6 Nevertheless, 41% of the group of chiefly female welfare workers (n=65) and almost 6% of the group of chiefly male emergency workers (n=102) reported the traumatic experience to be “still having considerable or great impact on them,” with a high frequency of cognitive and …