R933ex:
There are many historical studies and references, perhaps you have viewed them already. All bolding of text is mine for emphasis.
This article summarizes the majority of main stream research results:
Posttraumatic Stress Disorder (PTSD) and Acute Stress Disorder
http://www.anxietytreatment.ca/posttrauma.htm
Critical Incidence Stress Debriefing (CISD) – CISD is a procedure that is often used with groups of individuals within one to three days of having experienced a trauma (e.g., a natural disaster, accident, terrorist attack, etc.). The treatment encourages trauma victims to share their thoughts and experiences, and the therapist discusses thoughts and emotional reactions that the individuals are likely to experience. Participants are typically encouraged to stay with the procedure. The strategies listed here are similar to those listed earlier in the section on psychoeducation for PTSD. The difference is that in CISD, all trauma victims are exposed to the treatment, not just those who develop PTSD or other adjustment problems. The data on CISD are mixed, but generally not supportive of the procedure. Some studies have shown the people having undergone CISD following a trauma are no better off than people who did not receive this treatment. Furthermore, a few studies have actually shown that people who undergo CISD are functioning more poorly later on, relative to those who have not undergone the procedure. Critics of CISD have recommended against using this procedure for all trauma victims. Instead, they encourage professionals to help victims with their basic needs (e.g., contacting insurance companies, etc.), provide support, and allow them to discuss the trauma only if they want to. More intensive treatment should be reserved for people who are still experiencing anxiety symptoms some time after the trauma has passed.
From 1994
http://www.tema.ca/lib/CISD%20-%20Value%20and%20Limitations%20in%20Disaster%20Response.PDF.
Are debriefings effective with disaster victims? Case reports and anecdotal evidence of debriefing suggest that they may indeed lead to symptom mitigation (9); however, there has not been rigorous, controlled investigation to date. The lack of data on the effectiveness of CISD present significant intervention risks, particularly with unknown or unassessed victims/participants, as is often the case in the provision of disaster mental health services. Recent reviews (21, 22) of the empirical evidence for the efficacy of a range of PTSD treatments (i.e., pharmacotherapy, behavior therapy, cognitive therapy, psychodynamic and hypnotherapies) indicate that certain procedures may be well-suited to one individual but not another, and that certain treatments may be more suitable for certain symptoms. This may also be the case in interventions for non-pathological stress reactions. Salient clinical issues such as intervention timing, short and long-term effects, victim-intervention matching, individual vs. group treatment, contraindications, pre-morbidity, etc., need further study. Clearly, disaster helpers cannot wait for definitive proof of the efficacy of their efforts. In general, programmatic and therapeutic interventions typically develop from anecdotal evidence and we acknowledge that the difficulties in studying disaster protocols are numerous (for detailed discussion of practical, conceptual, and methodological issues, see 23). While it is true that psychoeducational intervention may help some disaster victims, we caution against the unquestioned acceptance of CISD debriefing procedures as a sufficient intervention following community-wide disasters. We propose that debriefing be viewed within its function to address a limited aspect of victims' disaster experience, that it serve as a means to educate participants about other critical factors affecting stress response, and that it be a means to make referrals to other related resources. Lastly, we recommend that other education-oriented interventions (e.g., outreach presentations to organizations, institutions, self-help groups, and special populations, media programs, hot lines, etc.) and efforts to mobilize and strengthen social networks receive equal effort by disaster mental health practitioners.
From Capt(N) Town's CFC paper entitled The Effect of sustainment on stress in Operations: http://wps.cfc.forces.gc.ca/papers/amsc/amsc2/town1.doc
Therefore, the final conclusion derived from this analysis is that the operational level commander fulfils a pivotal role in establishing the priority to be applied to stress management and training. The commander needs to ensure that a viable plan is in place to deal with stressors that likely will arise in some form during the deployment. Failure to complete this aspect of preparation could well affect the military force's ability to sustain combat or operational effectiveness.
From 1991-95 Croatia Board of Inquiry - http://www.forces.gc.ca/boi/engraph/sustainment_e.asp
With respect to CISD, stress debriefing must be administered as quickly as possible after traumatic incidents. For that reason, the Canadian Forces requires more personnel trained as critical incident stress debriefers.
The Board recommends the following:
Ensure that adequate personnel, including P Med Tech QL 6A-qualified, are deployed to address occupational health and safety issues.
Cross-train medical officers and padres to be critical incident stress debriefers, and train volunteer peer counsellors at all ranks.
From 1996: TRAUMANEWS Vol. 5 No. 2 1996 The Newsletter of the Canadian Trauma Response Network
http://www.ctsn-rcst.ca/tnews5no2.html#Effective
Last winter we included the abstract of a study by Kenardy which reported a comparison of emergency workers who had CISD intervention with a group who had not. He found no advantage for the CISD group in the number of PTSD symptoms at the follow up. At the ISTSS conference in Boston last November there were several reports making similar comparisons.
Crockett and Passey reported on Canadian soldiers given debriefings. 10.8% of the debriefed developed PTSD, 11% in those who were not debriefed.
Carlier found that police who were debriefed were no less likely to suffer PTSD symptoms than those who were not debriefed, and had increased symptoms if they had been receiving therapy prior to the trauma and debriefing. All the participants had found the debriefing "helpful", but the perception of helpfulness was not related to the extent of subsequent emotional problems
From 2002 Tarnak Farms BOI http://www.globalsecurity.org/military/library/report/2002/tarmak_fr-10_e.htm -
Patients were monitored for their psychological well-being, and underwent Critical Incident Stress Debriefing (CISD). Throughout this period, Major McLeod was able to keep both the families and the chain of command up to date as to the soldier’s condition. On 23 April 2002, the patients were discharged to the care of Canadian Forces Aeromedical Evacuation personnel and were medically evacuated to Canada aboard a Canadian Forces CC-150 Polaris aircraft.
Within the 3 PPCLI BG at Kandahar, the CISD Peer Support Response Team was immediately activated, meeting “A” Company personnel when they returned to camp at about 23:30Z. Personnel were provided with the information that was known at the time and a brief overview of the range of normal reactions following a traumatic event. One peer was assigned to the FST and one to the morgue in support of the casualty collection teams and soldiers concerned about their friends. They were assisted by two US Mental Health Specialists.
The personnel of “B” Company and “C” Company were debriefed early on 18 April 2002. Individual and group defusing was done with the personnel who had been involved in the “clean-up” at Tarnak Farm. Then, 48 hours after the incident, peer support personnel were debriefed and reassigned as required for further defusing and debriefing activities.
