Editor- In their recent study Small et al researched the
effectiveness of psychological debriefing on mothers who had undergone
operative delivery. (1)This study was very useful as there is currently
little evidence to back up the application of this technique. However, we
would like to raise some points related to the methodology.
Our first concern was the of postal questionnaires. This method has
obvious limitations. These may have been overcome by the use of
interviews.
The authors did not ask their subjects whether they attended any
other forms of counselling during the period between delivery and six
month follow-up. This is an important omission as subjects in the control
group may have sought and received effective debriefing from another
source, thus explaining why no significant difference was found.
It has been suggested that debriefing has the potential to cause
psychological harm. (2,3) We would like to suggest that healthcare workers
should provide more than one debriefing session as this could be of more
psychological value. The first session, which has been suggested to cause
secondary trauma by ‘raking up the coals’ would then be followed up by
more sessions which would consider the healing process. (4,5)
We look forward to seeing further research in this area, perhaps
comparing the outcomes of one debriefing session against several.
Sonali Dutta
Stuart Davidson
Stage 3 Medical Students
Department of Epidemiology and Public Health,
The Medical School,
University of Newcastle upon Tyne,
Newcastle upon Tyne
NE2 4HA
1. Small R, Lumley J, Donohue L, Potter A, Waldenstrom U. Randomised
controlled trial of midwife led debriefing to reduce maternal depression
after operative childbirth. BMJ 2000;321:1043-1047.
2. Kenardy JA, Webster RA, Lewin TJ, Carr VJ, Hazell PL, Carter GL.
Stress debriefing and patterns of recovery following a natural disaster. J
Trauma Stress 1996;9:37-49.
3. Bisson J, Jenkins P, Alexander J, Bannister C. Randomised controlled
trial of psychological debriefing for victims of acute burn trauma. Br J
Psychiatry 1997;171:78-81.
4. Raphael B, Meldrum L. Does debriefing after psychological trauma work?
BMJ 1995;310:1479-80.
5. Wessely S, Rose S, Bisson J. A systematic review of brief
psychological interventions ("debriefing") for the treatment of immediate
trauma related symptoms and the prevention of post traumatic stress
disorder. In: Cochrane Collaboration. Cochrane Library. Issue 4.
Competing interests:
No competing interests
24 November 2000
Sonali Dutta
Stage 3 Medical Student
Department of Epidemiolgy and Public Health, University of Newcastle upon Tyne
Rapid Response:
Debriefing to reduce postnatal depression
Editor- In their recent study Small et al researched the
effectiveness of psychological debriefing on mothers who had undergone
operative delivery. (1)This study was very useful as there is currently
little evidence to back up the application of this technique. However, we
would like to raise some points related to the methodology.
Our first concern was the of postal questionnaires. This method has
obvious limitations. These may have been overcome by the use of
interviews.
The authors did not ask their subjects whether they attended any
other forms of counselling during the period between delivery and six
month follow-up. This is an important omission as subjects in the control
group may have sought and received effective debriefing from another
source, thus explaining why no significant difference was found.
It has been suggested that debriefing has the potential to cause
psychological harm. (2,3) We would like to suggest that healthcare workers
should provide more than one debriefing session as this could be of more
psychological value. The first session, which has been suggested to cause
secondary trauma by ‘raking up the coals’ would then be followed up by
more sessions which would consider the healing process. (4,5)
We look forward to seeing further research in this area, perhaps
comparing the outcomes of one debriefing session against several.
Sonali Dutta
Stuart Davidson
Stage 3 Medical Students
Department of Epidemiology and Public Health,
The Medical School,
University of Newcastle upon Tyne,
Newcastle upon Tyne
NE2 4HA
1. Small R, Lumley J, Donohue L, Potter A, Waldenstrom U. Randomised
controlled trial of midwife led debriefing to reduce maternal depression
after operative childbirth. BMJ 2000;321:1043-1047.
2. Kenardy JA, Webster RA, Lewin TJ, Carr VJ, Hazell PL, Carter GL.
Stress debriefing and patterns of recovery following a natural disaster. J
Trauma Stress 1996;9:37-49.
3. Bisson J, Jenkins P, Alexander J, Bannister C. Randomised controlled
trial of psychological debriefing for victims of acute burn trauma. Br J
Psychiatry 1997;171:78-81.
4. Raphael B, Meldrum L. Does debriefing after psychological trauma work?
BMJ 1995;310:1479-80.
5. Wessely S, Rose S, Bisson J. A systematic review of brief
psychological interventions ("debriefing") for the treatment of immediate
trauma related symptoms and the prevention of post traumatic stress
disorder. In: Cochrane Collaboration. Cochrane Library. Issue 4.
Competing interests: No competing interests