Debriefing and research

This paper argues that some recent research, which claims to have shown that psychological or critical incident debriefing (CID) is ineffective or can make people worse, does not provide an adequate evaluation of the effectiveness of this type of intervention. Despite the limitations of this research, it appears to have influenced some authorities and organisations to such an extent that many have now abandoned, or been advised to abandon, CID as a response to traumatic events. This paper also argues that there are certain criteria vital to the context, content and conduct of the use of CID which must be reflected in research into its effectiveness. Unless we get these criteria right, CID will continue to be misunderstood, misrepresented and misused. CID is not a panacea for all traumatic ills and it might not prevent the development of post‐traumatic stress disorder (PTSD), as was perhaps once believed, but it is one response, amongst many, which could be used and offered when traumatic incidents occur.     

Group critical incident stress debriefing with emergency services personnel: a randomized controlled trial

Although single-session individual debriefing is contraindicated, the efficacy of group psychological debriefing remains unresolved. We conducted the first randomized controlled trial of critical incident stress debriefing (CISD) with emergency workers (67 volunteer fire-fighters) following shared exposure to an occupational potentially traumatic event (PTE). The goals of group CISD are to prevent post-traumatic stress and promote return to normal functioning following a PTE. To assess both goals we measured four outcomes, before and after the intervention: post-traumatic stress, psychological distress, quality of life, and alcohol use. Fire brigades were randomly assigned to one of three treatment conditions: (1) CISD, (2) Screening (i.e., no-treatment), or (3) stress management Education. Controlling for pre-intervention scores, CISD was associated with significantly less alcohol use post-intervention relative to Screening, and significantly greater post-intervention quality of life relative to Education. There were no significant effects on post-traumatic stress or psychological distress. Overall, CISD may benefit broader functioning following exposure to work-related PTEs. Future research should focus on individual, group, and organizational factors and processes that can promote recovery from operational stressors. Ultimately, an occupational health (rather than victim-based) approach will provide the best framework for understanding and combating potential threats to the health and well-being of workers at high risk for PTE exposure.     

Assessing the impact of stressful incidents in organizations: the development of an extended impact of events scale

Employers are becoming increasingly aware of the risks to employee wellbeing associated with the traumatic incidents that occur in the workplace. Despite this increased organizational awareness of the need to protect employees from the damaging effects of traumatic events, there has been little provision to help organizations to evaluate their management systems and post trauma interventions. This problem of a lack of evaluation has become more important as a growing body of evidence has provided evidence that suggests that trauma debriefing, the widely used approach to traumatic stress may be ineffective or damaging. The problem for an organization is to have a means of assessing the impact of a traumatic incident on exposed employees soon after the event and at regular intervals as a way of tracking the effectiveness of the treatment and rehabilitation programme. This paper examines the development and validation of a traumatic stress questionnaire designed to be used by trained practitioners working with traumatized employees. The extended impact of events scale (IES-E), took the 15 items from the impact of events scale (IES) and added eight new items which had been chosen on the basis of existing theory and clinical experience to represent the traumatic stress symptom of hyperarousal. Two studies are reported which examine the structure and reliability, and then the discriminant validity of the extended scale when used with a working population. The first study involved a factor analysis of the IES-E items using data collected from 105 subjects who had formally reported exposure to stressful work events to their employing organization. The second study then used the IES-E to compare employees self-reporting of the impact of either a major positive or a major negative life event. The results of the first study confirmed the presence of the re-experience and avoidance symptoms as a response to a traumatic event (as in the IES) but, in addition, identified a new factor, arousal and a new measurement model based on a single general factor. The reliability coefficients for all three scales and the general factor were found to be good. The second study showed that IES-E scores on re-experience, avoidance, arousal and the general factor could be used to discriminate between the subjects reporting major positive and negative life events. Two measurement models can therefore describe the impact of stressful events, the first based on three orthogonal factors, and the second based on a single general factor. The theoretical implications of these findings are explored.     

Critical incident stress management (Cism): A review of the literature

Critical incident stress management (CISM) comprises a range of crisis intervention services that usually include precrisis training, individual crisis counseling, group debriefing, and postincident referral for primary and secondary victims. CISM is utilized to address the aftermath of violent acts, and has evolved from earlier crisis intervention and group psychological debriefing procedures. These approaches have been used throughout the world, and CISM is emerging as a standard of care. This article reviews the literature on crisis intervention, group debriefing, and CISM interventions within a methodological context. Strengths and weaknesses of the literature as a whole are presented. Implications of the findings are discussed.     

Occupational violence: Armed holdup—A risk management approach

Workplace violence covers a wide spectrum of incidents of aggression that may occur at work. One area of particular concern relates to holdups. This study reviewed all incidents of robbery (holdups and bag snatches) occurring in a quasi-government wagering organization throughout Queensland, Australia between 1990 and August 1993. The study covered 30 robberies, at 28 sites with 34 subjects, 22 of whom consented to complete a questionnaire related to the stressfulness and impact of the event. Most robberies occurred at opening or closing time, at sites situated on a main thoroughfare, predominantly on a Monday. Single males (n =15) or a pair (n =15) mostly carrying a gun were the perpetrators. Nineteen of the 22 victims attended critical incident debriefing and most found this valuable. Only one subject interviewed lost time for stress (and this was the fourth time she had been robbed). One subject not interviewed was hospitalized. Other subjects had minor physical injuries, but suffered emotionally for up to a year after the incident. Recommendations focused on the hierarchy of control (environmental and engineering controls in preference to people-focused change). Additionally training in the normal processes of grief and trauma was recommended.     

A qualitative study on the development of workplace bullying: Towards a three way model

Up to now, researchers have identified various individual and work‐related factors as potential antecedents of workplace bullying. The aim of the present study is to integrate this line of research in view of explaining how these antecedents may develop into workplace bullying. Key informants, such as union representatives, employees with a confidence role concerning workplace bullying, human resource managers, prevention workers and social service employees, analysed bullying incidents or cases within their organization. We combined the various perspectives on the same incident into one plan. Then, all 87 case plans were united in a global model that reflects the development towards bullying. The results suggested three processes that may contribute to the development of bullying. Firstly, bullying may result from inefficient coping with frustration. Such coping mechanisms are likely to be active for perpetrators, and passive for victims. Secondly, bullying may be the consequence of escalated conflicts. Thirdly, bullying may result from destructive team and organizational cultures or habits. Individual and work‐related antecedents may affect these processes in two ways: they may be at the origin of the three processes, and they may relate to the employees' coping style. Implications for theory and research are discussed. Copyright © 2008 John Wiley & Sons, Ltd.     

Preface

Abstract

Few phenomena are as widely experienced across different individuals, cultures, and contexts as that of traumatic stress. Whether as victims, perpetrators, supporters, or simply observers, most if not all people can identify to some extent with the psychological and physical consequences produced by traumatic events. Such incidents are as varied as the individuals who must deal with them: The grief produced by the sudden death of a loved one, the self-doubt present in a victim's response to rape, the loss of autonomy following a debilitating injury, and the absence of social identity in the wake of genocidal terror are just a few of the experiences that make up the subject matter of traumatic stress. The consequences of such events also reach beyond the individuals who directly suffer these ordeals. Those who interact with the victims as they attempt to overcome the traumas often endure their own costs. The child who survives the death of a sibling does so in the difficult context of the parents' grief. Individuals close to a victim of severe physical injury frequently must take on new responsibilities as they deal with a friend whose capabilities and limitations have been forever altered. The family of a man who has lost his beloved wife must attempt to find solace for themselves while still offering comfort to the one who was closest to her. The consequences of traumatic events, while certainly devastating for the most immediate victims, are therefore also experienced by the people in the social network that surrounds those victims.     

Systematic Review of the Impact of Suicides and Other Critical Incidents on Railway Personnel

The review summarizes current scientific knowledge on the effects of railway critical incidents on railway workers and the associated risk and protective factors. Diagnosable traumatic reactions sometimes occur after a serious incident. However, the most frequent effects are long‐term impairments that do not meet diagnostic criteria but can still profoundly affect people's lives. Risk factors that can increase the negative effects of incidents include characteristics of the employee, coping mechanisms, the type of incident, and the support and care received. Prevention and intervention programs should consider the diversity of reactions to develop relevant support programs.     

Impact of employee assistance programs on substance abusers and workplace safety

Businesses have dealt with substance abuse in different ways. Some organizations have established Employee Assistance Programs (EAPs) to address these problems. One large national company chose to fire employees with positive drug screens, offer them EAP services, and then consider them for rehire after treatment. A study of performance records for 12,167 employees with safety incidents revealed that rehired employees had a significantly higher incident rate than the company's general population. Results indicated no difference in pre‐ and post‐EAP incident rates for rehired workers, and the post‐EAP incident rate fluctuated for 2 years. Implications of hiring/rehiring individuals who abuse drugs and alcohol are discussed, and suggestions are made for future research.     

Risk Factors,Self-Attributions,and Adjustment Problems Among Victims of Sexual Coercion1

College women (N= 125) were surveyed about their experiences with sexual coercion. Forty-two percent of the sample reported one or more coercive incidents involving completed intercourse (26%) or attempted intercourse (16%). Only 6% of these incidents were reported to police or campus authorities. Of the victims, 92% knew their assailants, at least casually. A combination of demographic, sexual history, and personality characteristics predicted 21 % of the variance in experience with sexual coercion. The variables most highly associated with reported victimization were frequency of sexual activity and religiosity; women who were more sexually active and who attended religious services less often were more likely to report experiencing sexual coercion than were women who were less sexually active and who attended religious services more often. A combination of situational and attitudinal variables predicted 52% of the variance in victim attributions. The variables most highly correlated with attributions were degree of victim assertiveness and the type of force used by the assailant; less assertive women and women who had been coerced by the use of economic or psychological force made relatively more internal attributions about the coercion incidents they had been involved in than did women who were more assertive and women who had been coerced by means of physical force. Finally, a combination of situational and attitudinal variables predicted 34% of the variance in victim-reported adjustment problems following the coercion incident. The use of economic or psychological force, greater physical injury, and relative acceptance of interpersonal violence were associated with more severe adjustment problems, whereas the use of physical force, less physical injury, and relative rejection of interpersonal violence were associated with less severe adjustment problems. The implications of these results for the reduction of acquaintance assault and for the counseling of victims are discussed.     

Aggressive encounters between patients and general hospital staff: Staff perceptions of the context and assailants' levels of cognitive processing

A considerable body of research has accumulated regarding aggression toward health care staff, yet little is known about the contextual factors involved. The present study examined the context within which aggressive incidents occurred and the dynamics of the interaction between staff and patients. Two aspects in particular were investigated; firstly, whether incidents were preceded by some anxiety provoking stimulus and secondly, the assailants' levels of cognitive processing apparent at the time of the incident. A prospective study collected data concerning incidents of physical assault and threatening behaviour in a general hospital. Staff were interviewed soon after the incident occurred. A content analysis determined that 82.8% of incidents involved experiences delivered by the staff victims likely to have provoked anxiety in the assailant. Most commonly, incidents involved staff intervening in the patient's intended behaviour. In addition, in 64% of cases, assailants were actually displaying some impairment in cognitive processing at the time of the incident Data suggest that many patients may not have been fully aware of their situation and might have experienced some difficulty in comprehending the staff member's actions. Patients who do not appear to understand what is happening may require additional time and effort to ensure they comprehend fully and accept what the staff member is intending to do, particularly if patients are experiencing an event likely to increase anxiety levels. Aggr. Behav. 30:534–543, 2004. © 2004 Wiley‐Liss, Inc.     

心理弹性如何影响员工创造力：心理安全感与创造力自我效能感的作用

摘 要 通过对350名知识型员工及其领导的配对问卷调查,探讨心理弹性对知识型员工创造力的作用机制。结果表明,心理弹性对心理安全感有显著的正向影响;心理安全感完全中介了心理弹性对创造力的影响;创造力自我效能感调节了心理安全感对创造力的正向作用;创造力自我效能感调节了心理安全感在心理弹性与创造力之间的中介作用。     

Dealing with trauma at work—the employee's story

This paper describes the responses of employees to traumatic incidents at work. Although organizational policies and procedures have a strong influence on employee behaviours at times of trauma, the psychological contract formed between the employee and the organization is an equally powerful influence. The employee's responses to trauma are described in a three phase model; this model separates the responses at the time of the trauma from the acute responses following the trauma and the chronic responses, some of which may last for many years. Typical employee responses at each trauma phase are illustrated with case material taken from workplace settings. Finally, the paper returns to the importance of the psychological contract and describes how the organizational care programmes can be enhanced or damaged by the way the organization deals with the aftermath of the trauma and its traumatized employees.     

Management of Post-Traumatic Stress Disorder in the Military: An Intervention Model

Military Forces are involved in combat, peacekeeping operations and disaster management. The nature of such operations include violent conflict, death of women and children, child soldiers and own forces. These traumatic circumstances can contribute to the development of post traumatic stress disorder (PTSD) in members involved. This article discusses the role and function of psychological debriefing for trauma with operational military units. It also proposes a preliminary intervention model to manage PTSD in military forces.     

Road victim trauma: an investigation of the impact on the injured and bereaved*

Every day in the United Kingdom ten people are killed and between 900 and 1,000 injured on the roads and, consequently, the health of large numbers of the victims, relatives and friends are adversely affected. Yet despite the magnitude of the problem little has been done to assess the full impact of road crashes on those involved, or to identify the best ways to provide help and support. This paper describes the impact of road traffic incidents on a large group of injured and bereaved victims, who approached Road Peace (a national charity for road traffic victims) for support. The research that examined data collected over an eight-year period was able to identify the nature of the impact of the traumatic exposure of these victims. The paper goes on to examine the needs of the road crash victims and suggests ways that timely support and advice could help to reduce the levels of distress.     

how organizations should respond to rape in the workplace

Each year, approximately 51,000 incidents of rape and sexual assault occur in the workplace. If an incident of rape occurs in the workplace, management can adopt several procedures for both the assaulted victim and the organization. First, encourage coworkers to show support for the victim. Second, plan the employee's return to work. Third, provide career and other forms of counseling and assistance for the victim. Fourth, and most important, show concern for the employee. An organization can use a variety of administrative controls and environmental designs as preventive measures to help protect employees from being raped or sexually assaulted in the workplace.     

The Impact of Resource Loss and Critical Incidents on Psychological Functioning in Fire-Emergency Workers: A Pilot Study

The relationship between critical incident exposure and resource loss, as conceptualized by Conservation of Resources (COR) theory, in predicting later psychological outcome (e.g., depressive symptoms, anger expression, and state anger) was examined in a sample of 150 fire-emergency workers from a Fire Department in a mid-sized, midwestern city. Additionally, a measure of critical incidents (Critical Incidents Inventory) was developed, and preliminary data on its validity are presented. Results from multiple regression analyses indicated that fire-emergency workers' exposure to critical incidents was directly related to their report of depressive symptoms, outward expression of anger, and state anger. Additionally, results indicated that fire-emergency workers' resource loss was strongly related to their psychological outcome. Results also suggest that resource loss may mediate the impact of critical incident stress exposure on depressive symptoms and the outward expression of anger. These results offer support to applying COR theory to populations under extreme stress.     

An exploration of psychological and physical injury schemas in civil cases

Civil plaintiffs often seek compensation for their psychological injuries. Yet little is known about jurors' preconceived notions (or schemas) for a prospective plaintiff's pain and suffering. The present studies examined (a) whether jurors have psychological injury schemas (Studies 1 and 2), (b) whether their existence and development vary by the type of civil case (Studies 1 and 2) or its severity (Study 2), and (c) how psychological injury schemas compare with physical injury schemas on a number of theoretically and legally relevant judgments (e.g., injury severity, availability, and plaintiff credibility; Study 2). Study 1 (N = 233) presented undergraduate mock jurors with 2 negligence incidents (car accident and slip and fall) and 2 intentional tort incidents (sexual assault and kidnapping) and asked them to report the typical incident and injuries that would result from the defendant's conduct. Results supported the sparse existence of psychological injury schemas but found that they were more developed in the kidnapping and sexual assault incidents than in the car accident and slip and fall incidents. Study 2 (N = 288) additionally manipulated incident schema severity (mild vs. severe) while having participants separately report and rate their psychological and physical injury schemas on judgments of legal and theoretical interest. Results indicated that although mock jurors' psychological injury schemas contained fewer injuries than their physical injury schemas, the reported psychological injuries were rated as more severe than physical injuries. We discuss how schemas may underlie the disparate treatment of psychological and physical injuries by legal decision‐makers.     

A Role for Prospective Longitudinal Investigations in the Study of Traumatic Stress and Disasters1

Much of our knowledge concerning the short- and long-term effects of traumatic stress and disasters has been developed through the study of victims and control subjects after the events have happened. There are a number of problems inherent in such a post hoc research strategy that make it difficult to isolate the specific contributions of the severe stressor itself to subsequent adjustment. Common problems include difficulty specifying baseline adjustment, necessary reliance on retrospective and sometimes monomethod data, difficulties in recruiting representative samples of victims, and convincing control groups. Many of these problems could be circumvented by the use of ongoing longitudinal and multimeasure studies of psychosocial development. This strategy would allow one to study the effects of severe and traumatic events as they happen to subjects during their participation in such studies. Systematic and mutliple measures of baseline adjustment of victims and nonvictims as well as preplanned assessments for postevent adjustment would be available. Problems involved in implementing such collaborative research ventures are reviewed, and solutions are proposed.