After a traffic crash, an assault, or a disaster, do not count on a single-session psychological debriefing done right afterward; if a month later the nightmares, flashbacks, and constant dread are still severe, go to a psychiatry department for trauma-focused psychological treatment

After a serious event, nightmares and being easily startled in the first weeks are common, and most people ease on their own. If it is still severe after a month, it may be post-traumatic stress disorder, and psychological treatment aimed at the trauma has a clear effect. Pulling someone, right after the event, to tell the whole course once does not prevent this illness. In a trial, the people who had it done were worse 3 years later.

Cost

A registration fee plus a treatment fee, usually 8 to 12 sessions. The hard part is that the treatment has to go back and touch the stretch of experience you most fear remembering.

Benefit

The National Health Commission's Standard for the Diagnosis and Treatment of Mental Disorders (2020 edition) states that on average about 8% of people who go through a psychological trauma go on to post-traumatic stress disorder. The core features are these. Nightmares and flashbacks: the scene of the event keeps coming back. Avoidance: staying away from topics, places, and people connected with the event. Constant watchfulness: easily startled, and insomnia. The diagnosis is made only when the symptoms last more than 1 month and seriously affect family, study, or work. In the section on acute stress disorder, the standard says most people return to normal through their own adjustment or through crisis intervention in the acute period. The treatment effect is in a 2020 pooled analysis: 114 trials that assigned people by lot, 8171 people. Trauma-focused cognitive behavioral treatment, compared with waiting for treatment or with usual care, had an SMD of -1.32 (95% CI -1.57 to -1.08, the range the true value likely sits in), and the evidence quality was moderate. Eye-movement desensitization and reprocessing (EMDR) was -1.23 (-1.69 to -0.76), and the evidence quality was low. SMD and d are the same ruler. Above 0.8 counts as large, and both of these are past that line. Ordinary supportive counseling, compared with waiting, showed no difference (-0.43, -0.90 to 0.04). A 2013 Cochrane review by the same group of authors had 70 trials and 4761 people, and pointed the same way. Trauma-focused cognitive behavioral treatment was -1.62 (-2.03 to -1.21). EMDR was -1.17 (-2.04 to -0.30). The evidence quality rated that time was very low. The British NICE 2018 guideline arranges it this way. For an adult whose symptoms are already severe within a month of the event, offer individual trauma-focused cognitive behavioral treatment. For someone diagnosed after a month, or whose symptoms are obvious, offer the same, usually 8 to 12 sessions. If the trauma was not caused by war and it is still not better after a full 3 months, also offer EMDR. If the symptoms are light and do not reach a diagnosis, watch through the first month, and arrange a review within that month. The psychological treatments listed in the domestic standard are the same kinds: prolonged exposure, cognitive processing therapy, and EMDR. A single-session debriefing done right after the event is covered in the material that follows. A 2002 Cochrane review pooled 11 trials. A single individual debriefing did not lighten the distress, and it did not prevent post-traumatic stress disorder. At 3 to 5 months the OR was 1.22 (0.60–2.46), no difference. A trial among them followed people to 1 year, and the people who had the debriefing had a higher risk of the illness instead. The OR was 2.88 (1.11–7.53), about 2.9 times. The authors' conclusion was: stop forcing a debriefing on people who have been traumatized. Another trial enrolled patients hospitalized after a traffic crash, assigned by lot. At 3 years, the debriefing group was clearly worse on psychiatric symptoms, anxiety while riding in a car, pain, physical problems, overall ability to live, and money problems. People whose flashbacks and avoidance were already severe at the start still had symptoms 3 years later if they had the debriefing. Those who did not have it recovered. The NICE guideline states plainly: do not offer a psychologically led debriefing to prevent or to treat post-traumatic stress disorder. The reason is that neither doing it individually nor doing it in a group showed a benefit, and there are signs of being worse than not doing it.

Notes

A single-session debriefing means, within a few days after the event, calling people together or talking with a person alone, and having them tell the whole course and the feelings at the time from the start. The domestic standard still lists a group debriefing in the psychological-treatment table for acute stress disorder. That does not match NICE. This item follows the trial results. If a workplace or a school organizes this kind of meeting after an event, you can decline to speak, and do not push someone else to speak. In the first weeks, first make sure of safety, of eating and sleeping, and of someone nearby. Register at psychiatry, psychology, or clinical psychology, and ask directly whether they can do trauma-focused psychological treatment. The reasoning is the same as item 9 of this section (do not start by paying for grief counseling). Not everyone needs a professional intervention. The effort should go to people who are still stuck after a month. People whose relative died by accident or by homicide often have these symptoms too; see item 4 of this section (a relative died by accident or by homicide). What to do first after a sexual assault is in section 13, item 42 (after a sexual assault). Cases that police, medical staff, and firefighters get from the work itself are already listed in the occupational-disease catalog. See section 19, item 10 (the note on the item about dust, noise, and chemical poisons).

Sources · 6

1. Lewis C, et al. (2020). Psychological therapies for post-traumatic stress disorder in adults: systematic review and meta-analysis. European Journal of Psychotraumatology. doi.org/10.1080/20008198.2020.1729633
2. Bisson JI, et al. (2013). Psychological therapies for chronic post-traumatic stress disorder (PTSD) in adults. Cochrane Database of Systematic Reviews, CD003388. doi.org/10.1002/14651858.CD003388.pub4
3. Rose S, et al. (2002). Psychological debriefing for preventing post traumatic stress disorder (PTSD). Cochrane Database of Systematic Reviews, CD000560. doi.org/10.1002/14651858.CD000560
4. Mayou RA, Ehlers A, Hobbs M (2000). Psychological debriefing for road traffic accident victims. Three-year follow-up of a randomised controlled trial. British Journal of Psychiatry. doi.org/10.1192/bjp.176.6.589
5. National Institute for Health and Care Excellence (2018). Post-traumatic stress disorder (NG116), recommendations 1.6.4, 1.6.5, 1.6.15–1.6.19. nice.org.uk/guidance/ng116/chapter/Recommenda…
6. 国家卫生健康委办公厅 (2020). 关于印发精神障碍诊疗规范（2020 年版）的通知（国卫办医函〔2020〕945 号），第八章创伤及应激相关障碍. nhc.gov.cn/yzygj/c100068/202012/b4305ace9e144…