TRAUMA THERAPY WIDELY ADMINISTERED AFTER SEPT. 11 CAN EXACERBATE TRAUMA

FAYETTEVILLE, Ark. - Research from the University of Arkansas concludes that single-session debriefing therapies - those so widely administered to witnesses and rescue workers in the days following September 11 - deliver no preventative or beneficial effects against trauma. In fact, results from controlled studies indicate that such intervention treatments may prolong or intensify the trauma some people experience, said Jeffrey Lohr, UA professor of psychology.

Lohr’s research, summarized in an article written last spring, supports the conclusions of another study on post-traumatic debriefing, conducted by a team of researchers at the University of Amsterdam and published in the Sept. 7 issue of "The Lancet."

Both studies examined controlled, scientific experiments on the efficacy of single-session debriefing treatments and compared recovery rates among recipients of such treatments to those among people who received more conventional forms of therapy. The Dutch researchers performed a statistical analysis of those experiments, while Lohr and his co-authors conducted a qualitative review.

"Looking at the same body of research through both qualitative and quantitative methods, we found the same thing - that scientific studies provide no evidence to support the claim that debriefing prevents or mitigates the onset of post-traumatic stress disorder. And some of those studies suggest that certain people fare worse with debriefing than if they’d received no treatment at all," Lohr said.

"That’s a strong statement against use of these treatments, that two research teams, independent of each other and using different means of analysis, came to the same conclusion," he added.

Lohr’s study - co-authored by Wayne Hooke of Portland Community College, Richard Gist of the University of Missouri - Kansas City, and David Tolin of the Institute of Living in Hartford, Conn. - will be published in December as one chapter of a book about bogus science in the mental health field. Titled "Science and Pseudoscience in Clinical Psychology," the book is co-edited by Lohr, Scott Lilienfeld of Emory University and Steve Lynn of Binghamton University and will be published by Guilford Publishers.

Though the book addresses a range of topics, including multiple personalities, herbal and alternative medications, memory recovery and commercialization in the mental health industry, Lohr’s chapter focuses on controversial treatments for trauma. The chapter reviews evidence supporting the efficacy of conventional trauma therapies. It then investigates the research behind controversial new treatments - particularly Critical Incident Stress Debriefing (CISD), the most popular form of single-session debriefing treatments.

Developed more than a decade ago to help emergency service personnel overcome their reactions to traumatic events, CISD is often a mandatory procedure in firehouses, police departments and emergency offices across the nation. But with the events of September 11, thousands of psychologists and counselors thronged to the disaster areas, offering debriefing to rescue workers, witnesses and the public at large.

"What you’ve got is a cottage industry - people who make careers out of following trauma around, promoting this new psychological technology," Lohr said. "And there’s really no way of protecting people against it. Right now, the mental health field has no mechanism for the monitoring and remediation of this kind of promotion of psychological services, based on bad science."

The CISD procedure consists of a single group session led by a CISD-trained professional and conducted within 72 hours of a traumatic event. Participants relive the events through discussion - stating facts about the event, disclosing their thoughts and feelings, discussing possible symptoms of trauma and planning their return to normal social interaction. This two to three-hour procedure attempts to achieve a form of group catharsis while normalizing the emotions and reactions of individuals who have experienced a traumatic event.

The CISD protocol differs from conventional therapies in that it preempts the natural development of trauma symptoms. It represents a sort of psychological inoculation, Lohr said - attempting to prevent PTSD in all patients, even those who, over time, may never have developed the clinical condition. In addition, the CISD sessions are neither ongoing nor individualized, two key facets of conventional treatment.

These differences may be part of the reason that CISD fails to deliver psychological benefits. But the research that Lohr and his colleagues examined indicates more than a lack of benefit; it suggests the potential for greater harm. Such harm may arise from the fact that ineffective debriefing techniques may take the place of more proven, conventional therapies - leaving people with the belief that they have been treated but without the benefits of treatment.

Furthermore, Lohr suggests that CISD treatment may disrupt the natural social processes and networks through which people support and comfort each other in times of crisis.

"In any social group, whether its an engine house or a family, there are ways in which advice, support and counseling get passed from the older, more experienced members to the younger," Lohr said. "But if everyone sits down in a CISD session, it’s likely that the old hands aren’t going to tread where they normally would. It’s possible that personal, healing opportunities are being missed because of the application of this franchise treatment."

Lohr’s article represents the latest link in a chain of cautions against bogus trauma therapies. Just days after the terrorist attacks, Lohr joined 20 esteemed colleagues from around the world in drafting a letter to the "Monitor," published by the American Psychological Association. The letter urged mental health professionals to refrain from forcing treatment during that time of natural grief and horror. It also warned against intervening in ways that could trigger or exacerbate later trauma.

This year, Lohr and his colleagues published an article in the summer issue of "Clinical Psychologist" identifying and criticizing the questionable marketing techniques employed by distributors of bogus trauma therapies.