The Problems Associated with Crisis Debriefing: Towards a Better Response

May 28

By Stacey Sutherland

Traditional crisis debriefing typically involves counselors or professionally trained (or informally trained) facilitators providing trauma survivors with a single debriefing session lasting one to three hours within days of the event. Depending on the debrief model, the content of the debrief can vary, it usually involves psychoeducation about stress reactions, some encouragement for the survivor to disclose memories of the experience, and possibly some basic stress-coping strategies followed by referral information.

There is currently very limited data to prove the efficacy of crisis debriefing in any format.

Some concerns about the limitations and efficacy of traditional crisis debriefing are as follows:

Crisis debriefing does not involve clinical assessment thus there is no way to determine if a person is actually an appropriate candidate for this intervention (i.e does this person have a history of trauma, of dissociative response, etc?)
There is compelling data suggesting that because stress hormone levels are still high shortly after the event, crisis debriefing (which elicits trauma memory with emotional disclosure) can encode and over-consolidate the traumatic memory to the long-term detriment of the survivor.
Growing evidence shows that the majority of people adapt following traumatic events without trauma interventions.
Crisis debriefing may deter people from utilizing and accessing their own normal family, friend, and community support structures for longer term connection and care.
The training and qualification of debriefers can be inconsistent and incomplete.
The brevity of the intervention could be problematic.

There is an increasing shift away from traditional crisis debriefing toward Psychological First Aid (PFA) and PFA-informed models of crisis intervention. These approaches prioritize trauma-sensitive support by promoting adaptive coping, calming and stabilization, and fostering self-efficacy and empowerment. A core emphasis is placed on creating safety and offering compassionate presence through active listening—without pressuring survivors to recall traumatic memories or engage in emotional disclosure, as is often expected in debriefing models.

Skills for Psychological Recovery (SPR) is also a useful intervention for survivors long term. Crisis counseling, offered by a trained interventionist, is recommended for survivors who require more support and typically involves a strengths-based approach over 2-3 sessions. There is evidence that EMDR may be effective for acute traumatic stress and is a safe modality. However, treatment at 3 months and beyond post incident has demonstrated the most efficacy.

Pharmacologically, there is moderate evidence that steroid medications (llike hydrocortisone) administered early for acute traumatic stress symptoms may prevent the development of PTSD or reduce its severity.There is also evidence that because neuroinflammation can occur in acute trauma, anti-inflammatory agents like ibuprofen and naproxen may be helpful in reducing the risk of PTSD.

Benzodiazapram has historically been administered for acute traumatic stress management but there is strong evidence against this as it may worsen the overall severity of trauma symptoms, significantly increase the risk of developing PTSD, worsen psychotherapy outcomes, and increase aggression, depression, and the likelihood of substance use.

Summary recommendations for supporting survivors after critical incidents:

Follow PFA-based and Trauma-Sensitive Care principles and practices in engaging with survivors post-incident. Facilitate support in the form of personal connection with trained peer crisis supporters, trusted friends, family, and community members as well as local and web-based resources. Be prepared to offer crisis counseling (possibly including EMDR) as a more comprehensive intervention. This should be provided by a trained and experienced provider.

Consideration should also be made regarding appropriate medical and pharmacological interventions such as the administration of steroids and antiinflammatory agents.

For survivors whose symptoms persist or increase one month or more post-incident, they should be referred to a mental health professional for clinical assessment and psychotherapeutic/psychiatric interventions.