Gist's Response to Labardee's Reply|
Mr. Labardee seems to be struggling with some misconceptions regarding all this, most of which could (as is usually the case) be relieved by actually reading the material involved.
Where to begin? Well, first off . . as the "outspoken community psychology professor" of whom he writes, I'd suggest that the very best way to plumb my thoughts might have been to use the e-mail contact address supplied with the original Lancet piece (though that would have again required reading the original source . . . but I quibble). Had he done so, he might have learned the extent to which the various issues involved reflected the proposed active elements of CISD, as dictated by Mitchell & Everly. Change the letters anyway you wish, folks, but the rose by any other name still bears its thorns.
Now, that, too, is a matter both we and van Emmerick's group addressed directly in our pieces--once again, though, you gotta' read the originals (as any grad student *should* have been taught over and over again). There's no evidence that debriefing operates any differently incorporated in the "new and imporved" formula, and indeed no evidence at all for any efficacy of that formulation--which still includes the demonstrated inert to toxic element. Aresnic is still arsenic, even when mixed with Jello pudding and topped with whipped cream and a cherry . . . but anyway, the burden rests with propoents to demonstrate efficacy. Proclamations don't suffice and repetition just doesn't equate to validity.
Regarding the NIMH panel--yep, I wasn't there. Of course, Cam Ritchie--who organized and chaired the panel--was also quoted in the Post about the panel's negative view on debriefing. Everly's quote comes from his dissent--the only person of the five dozen, I'm told by several colleagues attending, to argue in favor of the stuff. Wonder if that had anything to do with its direct relationship to his livelihood? None the less, to quote a singular dissent as if the position of a panel while ignoring the quoted remarks of its chair is more than just a little odd . . .
The panel report--if one reads the original (how many times must we say that?)--does not recommend debriefing or related interventions at *any* point of response or recovery, except for operational (defined as explicitly nonpsychological) debriefing in the context of incident management and assessment activities. What is recommended--as in ours and van Emmerick's pieces--is CBT with graded exposure based on assessment at about five weeks.
Debriefing is not to trauma counseling as CPR is to emergency medicine--for several reasons. Most important, of course, is that CPR actually works while CISD is inert at best and paradoxically inhibiting of recovery for some . . . indeed, the van Emmerick metaanalysis (if one reads the original) shows it inert overall, inhibitory to some, less effective than nonintervention, and even less effective when compared to other intervention approaches--to wit, it doesn't prevent PTSD, may inhibit natural resolution, is less effective than doing nothing, and is notably less effective than about anything else you might try instead.
That brings us to the crux of our Lancet commentary, illustrated here in even more highlighted poignancy by Mr Labardee's intended rejoinder: Given all this, why in the name of all that's sensible would Mr. Labardee and his friends want to be doing this? Well, it's easy to do, it makes us feel useful and important, we can bill for it, and people seem to appreciate the fact that we cared. They appreciate the fact that we bring 'em warm doughnuts, too--but that hardly makes 'em nutritious.
Richard Gist, Ph.D.
University of Missouri