By Charlotte Copeland
Let’s be honest – the world has changed; and so has the workplace.
‘Workplace mental health’ is now a normalised phrase. There’s been a healthy shift towards putting mental welfare on the map in terms of organisational responsibilities. Accompanying that shift, there’s been an associated natural uplift in organisations that support businesses in meeting legislative and best practice guidelines for workplace mental health.
Alongside the growing awareness of the importance of mental health, we’ve also seen a seismic shift regarding psychological trauma. This recognition was triggered by the inclusion of Post-Traumatic Stress Disorder (PTSD) in the Diagnostic and Statistical Manual of Mental Disorders in 1980; which, finally officially acknowledged psychological trauma as a clinical condition.
Before 1980, psychological trauma had, for centuries, been unofficially recognised by different cultures; from lay-people to literary icons, academics to medics. References to the effects of psychological trauma were even discovered in the historical and literary text dating back to the third century BC!
However, the recognition of PTSD as a mental health condition in 1980 succeeded only after a turbulent relationship with both the medical and psychological professions; a relationship that was influenced predominantly by war and the effects of warfare on soldiers.
As that change in recognition occurred, psychological trauma, and the severe end of that scale – PTSD, became almost ubiquitous language; just think about how often you may have heard people say (often jokingly) that they feel ‘traumatised’, when referring to something that was a slight surprise or mild shock.
Nevertheless, as awareness improved, so did the recognition that psychological trauma should be taken seriously and treated with the same reverence that would be afforded any mental health condition. This meant that research into the condition, and how it could be both prevented and effectively treated, became a focus for the medical and psychological professions.
In all the research that has been carried out since 1980, there are a few misconceptions that have crept in, almost becoming folklore, and misinforming professionals and lay-people alike. The antidote is thorough research, but in the hectic world within which we live, this can often get missed.
Three key misunderstandings that are often cited:
- Psychological debriefing does more harm than good
- The only effective treatments for psychological trauma are those on the NICE guidelines; namely Eye-Movement Desensitisation Reprocessing (EMDR) and Trauma-Focused Cognitive Behavioural Therapy (TF-CBT)
- Mental Health/Psychological First Aid is always the best first-line support
Let’s take the first misconception and explore a little further.
Psychological debriefing does more harm than good?
To be clear, since 1974, Critical Incident Stress Debriefing (CISD) has a significant level of research backing it, clearly demonstrating that it is a highly efficient method of emotional decompression, which:
- Helps mitigate the psychological impact of a distressing event
- Facilitates a swifter recovery
- Restores innate human adaptive functioning
- Identifies individuals who require further specialist support (triage).
CISD is a specialised and highly structured form of psychological debriefing that is specifically designed for homogeneous groups. It’s one of a multi-tactic suite of interventions available as part of Critical Incident Stress Management (CISM) protocols, however, it’s not the only form of psychological debriefing available – and this is where, in part, some of the misunderstanding may have begun.
Much has been written since 1995 when critics first raised their heads (or more likely – their eyebrows) about psychological debriefing. Many specialists within the field of psychological trauma decried the effectiveness of debriefing, with some suggesting it even had the potential to be harmful. Such was the shock wave that this concept produced, that the idea entered psychological folklore as an absolute – when in fact the research indicated something quite different.
Whilst we’ll save the deep dive into the history of the arguments that reigned in the annals of psychology for another time, there are salient aspects that can be drawn from what occurred that are important to highlight. This is particularly so because the ‘folklore’ still reigns stronger than up-to-date fact in many minds.
Essentially, the research that decried debriefing, when analysed against CISD standards, has been found to have 11 clearly identified CISD errors in common. These major errors were in the debriefing protocol the researchers used; errors that ultimately rendered the research redundant in terms of providing insight and education into the effectiveness of psychological debriefing. Of the 11 major errors in protocol, the top 3 to highlight are:
- Group debriefing was used as a one-to-one intervention
(Note: CISD is a group debriefing protocol and not designed for one-to-one work) - Primary victims received the debrief, often whilst still recovering, such as in the hospital.
(Note: CISD is designed for secondary, not primary, level exposure – witnesses, emergency personnel etc.) - The situation was ongoing
(Note: CISD should only ever occur after the situation is over; different interventions and protocols exist for ongoing situations)
All 11 items are vitally important in terms of meeting the CISD protocol, but for brevity here, a ‘top 3’ have been highlighted. What the 11 items ostensibly, and inadvertently, also showed, was that, when compared with the strong evidential research where CISD protocol had been followed, that:
- CISD protocol is highly effective,
- That any move away from the protocol results in a minimal benefit to participants.
What does this mean for organisations?
What this has ultimately meant, is that whilst there are multiple types of psychological debriefing interventions available, CISD currently has the most robust research to support its effectiveness.
CISD is highly structured, and always run with support from mental health professionals – it is not an intervention for only peer-level support (which can be seen as a limitation). However, CISD is only one type of intervention within CISM for managing critical incident stress.
Optimising the right solution for any given situation is about ensuring the appropriate strategic solutions are employed in a timely manner. The subject area is not rocket science; but it is a science and, arguably, an art, all of its own.
The easiest solution is to ensure your organisation has access to experienced CISM strategists. CISM experts will:
- Evaluate the current and ongoing psychological risk to the people you are responsible for;
- Provide consultancy on policy development and SOPs;
- Identify appropriate personnel and provide training in trauma-focused psychological first aid.
You should be given access to mental health professionals trained in CISM who can be deployed to your location, and ideally you will have access to 24/7 specialist telephone support before, during and after an incident where you consider your personnel may be experiencing extreme stress or distress.
A few simple preparatory steps with the right professional expertise in support and managing the impact of situations (from bullying to assault, severe injury to loss of life) can ensure an organisation and its personnel remain healthy and functioning.
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If your organisation would like to understand more about effective management of workplace stress and trauma, call our team on 0161 635 1010.
Or email us at clientservices@safehaven.co.uk
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Charlotte Copeland is the Founder and CEO of SafeHaven CISM, the UK’s only internationally accredited psychological crisis management service in the UK, as well as the countries most established CISM service; and SafeHaven Trauma Centre, a UK centre of excellence for the treatment of psychological trauma. For more information visit www.safehaven.co.uk.
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References
American Psychiatric Association. (1980). Diagnostic and statistical manual of mental disorders (3rd ed.). Washington, DC: London: American Psychiatric Association.
Birmes, P., Hatton, L., Brunet, A., & Schmitt, L. (2003). Early historical literature for post‐traumatic symptomatology. Stress and Health, 19(1), 17-26. doi:10.1002/smi.952
Crocq, M. A., & Crocq, L. (2000). From shell shock and war neurosis to posttraumatic stress disorder: A history of psychotraumatology. Dialogues in Clinical Neuroscience, 2(1), 47-55.
Kinchin, D. (2007). A guide to psychological debriefing: Managing emotional decompression and post-traumatic stress disorder. Jessica Kingsley Publishers.
Lasiuk, G. C., & Hegadoren, K. M. (2006). Posttraumatic stress disorder part I: Historical development of the concept. Perspectives in Psychiatric Care, 42(1), 13-20. doi:10.1111/j.1744-6163.2006.00045.x
McHugh, P. R., & Treisman, G. (2007). PTSD: A problematic diagnostic category. Journal of Anxiety Disorders, 21(2), 211-222. doi:10.1016/j.janxdis.2006.09.003
Mitchell, J.T. Everly, G.S, Jr. (1997). Scientific evidence for Critical Incident Stress Management. Journal of Emergency Medical Services, 22, 87-93.
Mitchell, J.T. and Everly, G.S., Jr., (2001). Critical Incident Stress Debriefing: An operations manual for CISD, Defusing and other group crisis intervention services, Third Edition. Ellicott City, MD: Chevron Publishing Corporation.
Mitchell, J. T. (2003) Crisis Intervention and CISM: A research summary. ICISF.
NICE (2017) About NICE: who we are. Retrieved 16 January from: https://www.nice.org.uk/about/who-we-are
NICE (2005) Post-traumatic Stress Disorder (PTSD): management. NICE clinical guideline [CG26}. Retrieved from: http://guidance.nice.org.uk/CG26 [NICE guideline]