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13 in addition to the criteria just described. Individuals for whom teams (e.g., US Navy Special Psychiatric Intervention Teams these same symptoms persist for less than one month would (SPRINT), the US Army Stress Management Team (SMT)). be classified as having Acute Stress Disorder (ASD; American Also noted is the fact that these interventions have been gen- Psychiatric Association, 2000). As noted previously, dissocia- erously applied in the absence of any scientific evidence that tion or removing oneself mentally from an inescapable sit- they serve the purpose of reducing psychiatric morbidity, and uation is one possible response to traumatic stress. There is further note that the same has been true for most acute inter- evidence that if dissociation is present in the early or acute ventions that "are often performed post-trauma on the basis stages of the traumatic stress reaction, the risk is increased of good intentions and theorized benefits" (Katz et al., 2002, for developing subsequent PTSD (Birmes, Brunet, Carreras, p. 208). Until more recently, these models have been rou- Ducasse, Charlet, Lauque, Sztulman & Schmitt, 2003) although tinely utilized in emergency and disaster situations despite a conflicting results have been reported (Wittman, Moergeli, lack of evidence-based outcome studies demonstrating their & Schnyder, 2006). safety, usefulness in the acute phase following disaster, and Symptoms of PTSD usually appear within the first 3 months whether they decrease the risk for longer-term post traumatic following exposure to the traumatic event. However, a signifi- reactions. In fact, it has been noted that debriefing is often cant number of individuals may also experience delayed-onset the "default" in organizations dealing with disaster (cited in PTSD (Buckley, Blanchard, & Hickling, 1996) in which symp- Blythe & Slawinski, 2004). toms may not appear for months or years (American Psychi- However, these methods and models are now questioned by atric Association, 2000). The duration of PTSD also varies. For many experts in the field. Due to questions about their effec- trauma victims with early onset PTSD, PTSD has been shown tiveness in decreasing distress and preventing negative long- to persist from months to years following the disaster (Galea, term outcomes in those individuals exposed to traumatic events Nandi, A. & Vlahov, D., 2005). Even with appropriate treat- (Blyth & Slawinski, 2004; Greenberg, 2001; Pennebaker, 2001) ment, PTSD can persist as a lifetime chronic condition with pe- and several large-scale meta-analyses that have not yielded riods of exacerbation and remission of symptoms (Noy, 2004). positive findings regarding psychological debriefing and CISD/ CISM (Rose, Bisson, Wessely, 2003; Rose, Bisson, Churchill & Wessely, 2005; van Emmerik, Kamphuis, Hulsbosch, & Early Intervention Issues and Emmelkamp, 2002), these methods have come under much Strategies in the Acute Stages scrutiny and criticism. Following a Traumatic Event In review of debriefing methods, it is indicated that the Prior to the 1980s, there were no mental health interven- application of debriefing is controversial and, although some tions following disasters. In response to the needs of the show benefits in the short term, others report a worsening of Vietnam veterans in the early 1980s, Psychological Debrief- symptoms. Some studies that do show benefits are not con- ing (PD) began to be routinely applied in circumstances in- trolled, and when controlled these studies do show short-term volving traumatized victims of disaster and other adverse but no long-term benefits in decreasing adverse long-term events. PD is a group of intervention methods that is applied outcomes (Deahl, Gillhan, & Thomas, 1994; Hobbs, Mayou, within 4872 hours following a trauma. Sessions encourage Harrison, & Worlock, 1996; Kenardy, Webster, Lewin, Carr, group participants to describe factual events and process the Hazell, & Carter, 1996). These analyses suggest that at best emotional components of the trauma experience. Its use rests psychological debriefing can help people feel better in the on the belief that this immediate processing of the event allows short term but that it has a negligible effect on long-term out- the individual to reorganize the memory of the event so that it comes for prevention of PTSD and stress-related problems. is recalled in a less traumatic way (Van der Kolk, 1997). Crit- In some cases, those who have received psychological debrief- ical Incident Stress Debriefing (CISD), developed by Mitchell ings have shown increased acute distress and poorer long- in 1988, expanded and further articulated a process for psy- term outcomes than those that received non-CISD or no chological debriefing (Everly & Mitchell, 2000; Mitchell, 2004; formal support. This fact suggests that debriefing may actu- Mitchell, 1988; Riddell & Clouse, 2004) that was later termed ally be harmful. Critical Incident Stress Management (CISM). The debate continues, but most experts in the field have Katz et al. (2002) review the literature from 1966 to 2002 made some recommendations regarding how to best proceed. related to what interventions have been used for prevention Namely, more well-designed studies concerning the short- and intervention during the first 2 months after an event. and long-term effects of debriefing are needed to clarify the Their review of acute psychiatric interventions indicates nature of the current controversy. Despite the fact that some that the primary focus has been on attempts to minimize the studies have found CISM to have a positive effect and that long-term effects of disaster trauma on its survivors. They most research on traumatic stress indicates that some form of note that several organizations have come up with intervention reprocessing of the events is a necessary part of the recovery