POST-TRAUMATIC PSYCHOLOGICAL

INTERVENTION:

PSYCHOLOGICAL STRESS
DEBRIEFING

By:
Cristelle Liboon, RPm
Lea Sapphira Suron, RPm

 Introduction

There is also a professionalized form of trauma relief known as debriefing.

Debriefing typically consists of a single group session, set up if possible within 48
or 72 hours of the traumatic event. It is meant to provide initial psychosocial relief
to victims and rescue workers. A debriefing session is usually led by two
debriefers and lasts an average of two to three hours. Debriefing should be just
one component of a comprehensive Critical Incident Stress Management (CISM)
program carried out by properly qualified and trained team members (Robinson &
Mitchell, 1993).
 Psychological debriefing describes various
structured events, led by an individual or
team which include education and review
What is processes with a positive focus on resilience
coping strategies and sometimes a detailed
psychological review of emotional reactions (NIMH 2002).

debriefing? PD is a structured intervention designed to

promote the emotional processing of
traumatic events through ventilation,
normalizing reactions, and preparation for
possible future experiences.
 DEBRIEFING IN PRACTICE
Many different approaches to ■ debriefing was used in groups and with
debriefing were advocated by our individuals
■ models were often adapted to the needs of
case study organizations. In some
the organization
cases, debriefing operated in ■ there was much variation in the timing of a
isolation whereas in others it was debrief after an incident had occurred
part of a package of interventions or ■ there was mandatory or voluntary
practices concerned with post- attendance at debriefings
incident reaction. There were also ■ some debriefings were open only to those
directly involved in the incident; others were
huge variations across organizations
open to (or mandatory for) all staff. The
in the way debriefing was deployed: objectives of debriefing varied enormously
 Can debriefing reduce
subsequent PTSD symptoms?

Following a traumatic experience, many people are likely to suffer traumatic

symptoms such as flashbacks or hyper-arousal (Rick and Briner, 2000). People who
witnessed catastrophe will most likely experience traumatic symptoms. If symptoms
are short term this can be considered as normal and the symptoms will diminish
over a few weeks after the catastrophe.

In 2016, the American Psychological Association reported that psychological

debriefing for posttraumatic stress disorder is not supported by research and can be
potentially harmful. However, the authors of a 2019 review found that some of the
studies on the effectiveness of psychological debriefing considered variations that
did not conform to the methods described in the Cochrane Review article, and that
psychological debriefing deserves another look for its potential to help people return
to a state of normal functioning following exposure to trauma (THC Editorial Team,
2022).
 The point of departure for debriefing has always
been that it has a preventive effect on
psychological injury caused by psychodrama
Measuring (Carlier, I.V). That’s why debriefing is needed
Psychological after a catastrophe to somehow help ease the
traumatic experience. More specifically, it is
Effectiveness presumed that debriefing discourages the
development of PTSD (Mitchell, 1983; Dyregrov,
After Debriefing 1989; Mitchell & Everly, 1994 as cited by Carlier,
I.V).
 Enforced PD can lead to passive participation and
Risks of resentment in individuals (Bisson and Deahl, 1994).
There are studies that shows the difference of being
psychological forced and not forced. Flannery et al (1991) used this
observation to argue against mandatory debriefing. A
debriefing good example of enforced early intervention is the

case of the Americans held hostage in Iran in the late
1970s (Rahe et al 1990 as cited by Bisson and Deahl,
1994).

He argued that “clear definition of the limitations of

the crisis intervention approach and the point at
which more formal treatment is “required” is needed
(Bisson and Deahl, 1994).
Why might
The lack of positive feedback on the effects of
debriefing debriefing in reducing traumatic symptoms
has led researchers to seek explanations for
not work? why it doesn’t appear to fulfill this objective
(Rick and Briner, 2000).

ACCORDING TO RICK AND BRINER (2000), THERE ARE TWO

REASONS THAT MIGHT AFFECT DEBRIEFING:

one on one debriefing sessions, not group debriefs for which the
process was originally intended, and
·(with the exception of one) primary victims of trauma (eg
admissions to a burns unit, accident and emergency department,
and road traffic accident victims) not the secondary victims.
Implementation and coordination before
conducting psychological stress debriefing

The seven stages of CISD are purposefully designed to help people retell the event,
share reactions and symptoms, and learn factual information in order to promote
recovery and overall mental health. This program is intended to reduce symptoms
and the risk of developing mental health disorders like acute stress disorder, post-
traumatic stress disorder, substance use disorders, depression, and anxiety.

Step 1: Assess the Critical Incident

Step 2: Identify Safety & Security Issues
Step 3: Allow Venting of Thoughts, Feelings, & Emotions
Step 4: Share Emotional Reactions
Step 5: Review Symptoms & the Incident’s Impact
Step 6: Teach & Bring Closure to the Incident
Step 7: Assist In Re-Entering the Workplace/Community
The process of
psychological
stress debriefing
Psychological debriefing is delivered in group sessions and oftentimes, therapists also use those
approaches to an individual to help prevent the development of PTSD. It covers multiple components to
try to address every phase of a traumatic event that a person has experienced. While it can take several
forms, the most common type used within psychology is critical incident stress debriefing, which
addresses stressful experiences emergency workers deal with in their jobs (THC Editorial Team, 2022).

The psychological debriefing process involves therapeutic interviews to allow people to confront what
happened and express their feelings about the traumatic experience (THC Editorial Team, 2022).
 The first is the Seven-stage
approach which includes the
following: The second approach is the
Eight-stage approach which
1. Introduction
includes the following:
2. The facts
1. Identification
3. Thoughts and impression
2. Labeling
4. Emotional reactions
3. Articulation
5. Normalization
4. Expression
6. Planning for the future
5. Externalization
7. disengagement
6. Ventilation
Psychological stress debriefing will be given to the 7. Validation
respondents who will experience catastrophe within 8. Acceptance
24 to 72 hours. If catastrophe happens, the following
are suggested interventions that can be used to
reduce the trauma that they experience. The
following activities or intervention are prepared for
kids, teens and adults.
PSYCHOLOGICAL STRESS
DEBRIEFING IN CHILDREN
Traumatic stress is a Whether your child lived
normal reaction especially through the disturbing
Lose interest in friends, family,
to a natural or manmade or activities they used to
event itself, witnessed it, or
enjoy.
disaster or other experienced traumatic Experience nightmares or
disturbing event. It can stress in the aftermath, other sleep problems.
leave children of any age they’re likely to be affected Become moody, disruptive, or
feeling overwhelmed by by an array of intense, angry.
stress and trigger a wide confusing, and frightening Struggle with school and
range of intense emotions emotions (HelpGuide, homework.
Complain of physical problems
and physical or behavioral 2022). According to
such as headaches or
reactions (HelpGuide, HelpGuide (2022) children
stomachaches.
2022). ages 6-11 may have the Develop unfounded fears.
following signs of trauma; Feel depressed, emotionally
numb, or guilty over what
happened.
A need for psychological stress debriefing for children is really important.
Research has consistently shown that children experience severe reactions to
stress following a natural disaster, including clinical needs and behavioral health
issues such as posttraumatic stress disorder (PTSD), functional impairments,
traumatic stress symptoms, and other mental disorders (Koplewicz & Cloitre,
2006 as cited my SAMHSA, 2022). Children may feel anxious, scared, and
vulnerable following an event such as earthquake, flash floods, etc.

The time frame of psychological stress debriefing for children is 24 to 72

hours after the catastrophe. The objective of psychological stress debriefing
is to help the children reduce the trauma and anxiety that they are
experiencing by providing interventions. Since children can’t fully express
their emotions, other modalities can be considered. Children use play,
drawing, dramatization and relationships with others, as well as language, to
communicate their experiences (Rady, et.al, 2009).
 Activity for children:

Paper Mosaics (Art Activity)

Content:
Materials: The person who will conduct this activity will
Participants: children ages x One long or short piece of introduce the concept of mosaics as a
6-11 are encouraged to colored construction paper creative, calming and fun stress reduction
join this activity x Colored construction paper strategy. The participants will be shown
scraps or discarded magazines pictures of mosaics from books or from the
Objective: Children learn to
x Pencil internet. The children will be asked if they
make paper mosaics as a have seen a mosaic or if they have
creative stress reduction x Scissors
experiences in making mosaics at school.
activity. x Glue
The children will also be given examples of
Time Frame: 1 to 2 hours x Pictures of mosaics from mosaics that can be seen everywhere like a
books, internet and/or bathroom tile. Therapist reviews materials
teacher’s samples to be used and general rules applied to this
type of activity in the classroom.
 Activity for children:

Paper Mosaics (Art Activity)

Processing:
Instructions: Follow-up by having participants share
1. Participants will sit on a table or on the floor.
their mosaics with the group and facilitate
2. Using a pencil, participants draw the outline of an object, shape or
scene on a short or long piece of paper.
a discussion about what participants liked
3. Participants then cut different small colored square paper “tiles” from and found challenging about the activity.
the used construction paper or used magazines (tear out pages you Make a connection between the activity
would like to use and then cut the pictures up into little square “tiles”). and stress reduction and discuss the
4. Explain to participants that each outline should be filled with tiles of impact of the activity with participants. If
the same color.
participants enjoyed the activity, plan a
5. Working with one shape/area/figure at a time, students apply glue to
the inside of their outlined shapes, and then place the paper “tiles” in follow-up lesson to give participants a
the shape/outline, leaving a small space between each paper “tile” (for chance to improve their mosaic making
some shapes, participants may have to cut “customized tiles” to skills.
effectively fill in the shape).
6. Participants repeat the glue and placement of “tiles” in each
shape/outline of their drawings until the mosaic is complete.
PSYCHOLOGICAL STRESS
DEBRIEFING IN TEENS
According to HelpGuide (2022), teens or
adolescents with the age of 12 to 17 may
experience signs the following signs of
As Jose Rizal mentioned that
trauma: children and adolescents are the
Have flashbacks to the event, suffer hope and future of this nation,
from nightmares or other sleep hence it is important to preserve
problems. their health and well-being,
Avoid reminders of the event. especially in the face of disaster.
Abuse alcohol, drugs, or nicotine Youth differ from adults based on
products. varied physiological, cognitive,
Act disruptive, disrespectful, or and emotional developmental
aggressive. factors, making them more
Complain of physical ailments. vulnerable to the damaging
Feel isolated, guilty, or depressed. effects of natural disasters
Lose interest in hobbies and interests.
(SAMHSA, 2018).
Have suicidal thoughts.
PSYCHOLOGICAL STRESS
DEBRIEFING IN TEENS

When planning interventions for The time frame of psychological stress

disaster-affected communities, it debriefing for teens is 24 to 72 hours
is crucial to consider the unique after the catastrophe. Same with
children, the objective of psychological
sensitivities of children and youth,
stress debriefing is to help teens reduce
as well as their tendency toward
the trauma and anxiety that they are
resilience, in tailoring post- experiencing by providing interventions.
disaster response interventions to Also, the goal is to build rapport and have
promote successful recovery and a safe place where they can divert their
healing for the community and its negative feelings to a fun and open
young survivor (SAMHSA, 2018). emotion. Some teens are too shy to
express their feelings and might express
it in different ways. Hence, different
modalities can also be applied in this
activity.
 Activity for Teens:

Freeze Dance (Physical Activity)

Content:
Participants move/dance to match the
Participants: Activity can be applied to teens ages
tempo, beat and rhythm of the music. When
12-17 years old.
the music stops, participants FREEZE, when
Objective: Gross motor activities provide stress
music resumes, participants continue to
reduction for young children. move/dance to match the music. It is
Time frame: 2 to 3 hours suggested that the sequence of music starts
Materials: slow and calm, moves to fast, upbeat pace
x cell phone and portable speakers or tape player and then returns to slow and calm to end the
x Music (5 to15 minutes of music) activity.
x Note: It is best to use instrumental music/no
lyrics; you may download music from an internet
source.
 Activity for Teens:

Freeze Dance (Physical Activity)

3. Review activity rules with
Processing:
participants:
Instructions: Therapists may follow-up by
x Move to match the music
1. If necessary, arrange the using Movement to Match
x FREEZE when the music stops
area to provide ample space for x When the music starts again, Music at other times to
the activity. move to match the music relieve tension, stress in the
2. Participants take a place in x Activity involves only environment. Make a
the designated movement, no voices connection for participants
“movement/dance” area with 4. Start the music. between regular physical
sufficient personal space so as 5. Stop music at timely intervals. activity, health and stress
not to run into other 6. Note suggested sequence of
reduction.
participants OR students may music; always end with slow,
be positioned in a circle and calming music.
move in the same direction
around the circle.
PSYCHOLOGICAL STRESS
DEBRIEFING IN ADULTS
Psychological intervention after trauma
appears to meet some real and The objective is to help the adults become
symbolic needs for the victims, helping calm and to provide a safe place for them.
them to overcome their sense of They need someone who can help them
cope, rise and create strategies to reduce
helplessness and guilt about surviving
fears and anxieties that they are feeling.
as well as other overwhelming emotions
They also need an ear to openly listen for
(Kaplan,Z. Et al., 2001).
their heartaches, negative experiences
without any judgements. Critical incident
Debriefing relies on three therapeutic stress management was developed to
components: ventilation in a context of provide a safe, open, and non-judgmental
group support, normalization of space for trauma survivors, enabling each
responses, and education about participant to their initial reactions and
postevent psychological reactions emotions following a critical incident
(BetterHelp Editorial Team, 2022). (BetterHelp Editorial Team, 2022).
PSYCHOLOGICAL STRESS
DEBRIEFING IN ADULTS

It is recommended that these debriefing sessions occur within 24 to 72 hours of the

traumatic event. Ideally, stress debriefing should occur shortly after the traumatic
event to increase the method's effectiveness (BetterHelp Editorial Team, 2022). This
allows survivors to process their experience without becoming overwhelmed.

During these group sessions, the facilitator helps participants understand their
emotional reactions, validates their responses, and provides stress management
tools and resources for continued support (BetterHelp Editorial Team, 2022).
 Activity for Adults:

Visual Imagery
Content: Therapist leads participants
through the process of visual imagery as a
Participants: All adults ages 18 and up are
relaxation technique Instructions:
encouraged to participate in this activity.
1. Participants sit comfortably for this
Objective: Participants can learn the process of
activity
visual imagery as a technique to help themselves 2. Use a calm, low, slow voice and give
calm down sufficient time between each visual
Time Frame: 2 to 3 hours suggestion for participants to “ease” into the
Materials: No materials needed vision and “see” each step
3. Create your own visual scenario
appropriate to participants' age, experience
and interest.
 Activity for Adults:

Visual Imagery
When you are ready to leave, go to the edge of
the water and throw in anything that has been
Example: Close your eyes. “See” in your mind’s bothering you, anything you wish to be rid of
eye a beautiful beach. The sun is shining in your life, anything you are feeling sad or
warmly, the breeze coming from the ocean is angry about, anything you worry about (e.g.
soft and warm, palm trees are overhead and a problems at home, violence in your
few seagulls circle about. Imagine walking neighborhood, bullies, death of a loved one,
barefoot in the warm sand, feel your feet sink in issues with friends). Picture it as a big rock, a
the sand with each step. Walk toward the chain, a heavy bag over your shoulders, or any
water’s edge and let the water roll over your image that helps you see it as undesirable.
feet. Jump in the water; it is warm, gentle and Throw it in the ocean as far as you can. Watch
very refreshing. Come out of the water and it sink and get taken by the waves. When the
“visit” is done, be thankful for the release of
walk to your big beach towel, lay down and
the burden, the problem, the worry; then walk
relax. Rest for a while in all the peace and
peacefully back through the warm sand and
beauty surrounding you. Imagine how it looks,
take a rest on your beach towel.
how it sounds, how it smells. Breathe in deeply
the warm ocean air, stay as long as you like.
 Activity for Adults:

Visual Imagery

Extension:
4. Practice this imagery in class for 10-20 minutes, depending Practice visualizations with the group several
on the level of understanding of the participant. times until participants achieve competence
Processing:
with the technique. Encourage participants to
Allow time for participants to debrief and share about where
practice this at home or at any time to relieve
they went in their visualization and what they felt about the
experience/technique. This can be done in pairs, small groups stress. The activity may be reinforced by
or sharing with the whole group. Sample guiding questions: having participants write down how they felt
- Where did your visualization take you? after completing the activity. They could keep
- Do you feel more calm/relaxed after going through this a journal of post-visualization feelings and
exercise? thoughts. You may also provide participants
- What did you see, hear, feel, smell during your with time to create their own visualizations
visualization/did anything in particular stand out? and take turns leading the group through
- What was it like throwing your burdens into the water? visualization exercises.
- How does it feel to be back in the classroom?
- Is this technique/exercise something you might do in the
future to calm down, relax and reduce your stress?
References
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https://www.researchgate.net/publication/265311811_Trauma_management_vs_stress_debriefing_what_sho
uld_responsible_organisations_do
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Conditions in Children and Youth Exposed to Natural Disasters.
https://www.samhsa.gov/sites/default/files/srb-childrenyouth-8-22-18.pdf
THC Editorial Team (2022). Psychological Debriefing: Description, Use, and Effectiveness.
https://thehumancondition.com/psychological-debriefing-effectiveness/
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trauma/helping-children-cope-with-traumatic-stress.htm
Rady, A., Elsheshai, A., Wafa, H., Elkholy, O. (2009). Psychological stress debriefing for children.
https://ispub.com/IJPSY/1/1/12214
THANK YOU
SO MUCH!