Can Post-Trauma Counseling Make Things Worse?

by Symptom Advice on March 23, 2011

By Christopher Shea

A Time reporter interviews Scott Lilienfeld, a professor of psychology at Emory University, about “critical incident stress debriefing.”

Once held up as a way to fend of post-traumatic stress disorder, debriefing has fallen out of favor, for reasons that Lilienfeld explains:

It usually involves putting people in groups very shortly after the traumatic event and strongly encouraging them to “get their feelings out” and “Talk about it” and so on. in classic debriefing, they almost prescribe symptoms, saying things like “Don’t be surprised if you start feeling X, Y or Z” or “There’s a good chance you’ll have nightmares or flashbacks.” There’s some speculation that that [in itself] might bring some of the symptoms on …

In helping people work through anxiety, he adds,

you have to allow anxiety to peak first and then pass, and give people enough opportunity to fully process it. [Debriefing] may bring up some anxiety and increase it, maybe even bring up new anxieties and not really resolve them or make them worse.

Lilienfeld does note that the research is not clear-cut on these questions, and that some recent papers have suggested that the downside of post-trauma counseling has been overstated.

One approach taken by charities that assist children is to attempt to establish semi-normal routines, even in crisis zones. rather than have the children talk about what they’re feeling, such groups will create playgrounds near refugee camps, for example.

The Time writer suggests that “psychology seems to have a bias against distraction,” and suggests that “you could go for a run or even just watch TV,” to fend off traumatic memories. maybe so, but even Lilienthal, who plays up the resilience of people who have faced trauma, observes that as many as 30% of survivors may experience some post-traumatic symptoms.

Understandably, therefore, research is underway to see if there are ways to prevent traumatic memories from lodging in the brain in a way that will cause future psychological harm. it sounds bizarre, but one avenue that has shown promise is to have the survivors play games that involve the mental manipulation of objects in space. (The study I’m thinking of made use of the video game Tetris.) such exercises are partly a distraction, but, more importantly, they may also interfere with the cognitive creation of the kinds of memories that cause night sweats.

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