Debriefing

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Debriefing is a report of a mission or project or the information so obtained. It is a structured process following an exercise or event that reviews the actions taken. [1] As a technical term, it implies a specific and active intervention process that has developed with more formal meanings such as operational debriefing. It is classified into different types, which include military, experiential, and psychological debriefing, among others. [1]

Contents

Model

The popular meaning of debriefing is that "of telling about what has happened" with a sense of reviewing or going over an experience or actions in order to achieve order and meaning concerning what was reported. [1] It is a structured process that also evaluates the contributions of various participants in the determination of success or failure of the operation. [1] The processes may involve receiving an explanation; receiving information and situation-based reminders of context; and reporting of measures of performance, and/or opportunities to further investigate the results of a study, investigation, or assessment of performance after participation in an immersive activity is complete.[ citation needed ]

Aside from the goal of inciting reflection and encourage communication, debriefing is also used to explore the emotions of the participant. This variable helps frame the experience in such a way that it enhances the learning. [2] Effective debriefings typically include the following essential elements: [3]

Types

Military

Female intelligence officer at the Royal Air Force Station receiving a report from members of the crew of G George, Avro Lancaster of 460 Squadron RAAF, after an attack on Berlin, 26 November 1943. G for George crew debriefing 27 Nov 1943 AWM 069823.jpg
Female intelligence officer at the Royal Air Force Station receiving a report from members of the crew of G George, Avro Lancaster of 460 Squadron RAAF, after an attack on Berlin, 26 November 1943.

Throughout the existence of combat and the history of war, engaging with the emotional and psychological impact on soldiers has been an ongoing and conflicting conversation. Debriefings in the military originated for three purposes: to mitigate the psychological impact of traumatic events, alleviate acute stress response, and reduce the frequency of post-traumatic stress disorder, also known as PTSD. [4] Though there are several types of debriefing strategies, the following three are frequently used within military groups:

  1. Historical Group Debriefing refers to the process of collecting historical patterns of trauma through the use of group therapy. [4] This process happens with soldiers recounting combat events in chronological order and adding their own reactions of thoughts and feelings. The key objective of this strategy is to allow men to "talk it out" in a way that they are not commonly socialized to do so. Though this group therapy process does not aim to reduce stress, it has resulted in providing a feeling of relief and connection amongst the soldiers.
  2. Critical Incident Stress Debriefing (CISD) is a form of psychological debriefing that features a specific structure and format, which were developed to address critical incident stress experienced by emergency service workers. [5] It was developed by Jeffrey Mitchell and is considered the most widely used today. [5] It operates using the following three components: pre-incident functions, on-scene support services, and post-incident interventions. [4] Pre-incident functions refers to the education and coping mechanisms taught to those who are more vulnerable to traumatization before they enter combat. On-scene support services entails brief discussions and unstructured therapy sessions that occur within a few hours of an incident that may cause high stress responses in soldiers. Finally, post-incident interventions occur usually at least 24 hours after an incident to give the soldiers a bit more time to deescalate from a having high stress response to that incident. The process is peer-driven but backed-up by a group of professional counselors. [6]
  3. Process Debriefing is similar to the other debriefing strategies in that it focuses on the group narrative, however it differs because it prioritizes the leadership and effectiveness of the facilitators who lead the debriefing sessions. These facilitators are provided with professional development on how to plan for and lead the group sessions. In cases of deception-based experiences where the participant was manipulated or provided with false information, the process include a discussion with the participant how the deception might have temporarily altered or influenced his self-perceptions. [7]

All of these debriefing strategies maximize on the collective experience of soldiers, rather than on the individual. [8] There is a growing belief that allowing soldiers to reflect and problem-solve as a group builds their relationship with each other over time and ultimately, their effectiveness as a unit. It also provides them with an outlet rather than forcing them to become consumed by their thoughts. [9] Typically, the role of a soldier is seen as a job and a courageous duty, which does not give value to the psychological and emotional need of reflection. Conclusively, in order to make the role of a soldier more sustainable, captains and group leaders must prioritize debriefing strategies to focus more on the whole person.

Experiential learning

Ernesto Yturralde, experiential trainer and researcher, explains: "In the field of experiential learning methodology, the debriefing is a semi-structured process by which the facilitator, once a certain activity is accomplished, makes a series of progressive questions in this session, with an adequate sequence that let the participants reflect what happened, giving important insights with the aim of that project towards the future, linking the challenge with the actions and the future." [10] It is analogous to "providing feedback" as it constitutes a vital component of any simulation intervention or any educational intervention, involving a process of explanation, analysis, and synthesis, with an active facilitator-participant interface. [11]

"Emotional Decompression" is one style of psychological debriefing proposed by David Kinchin in his 2007 book by that name. [12]

Experiential learning debriefing is the basis for debriefing in Medical Simulation, used widely within healthcare. [13]

Crisis intervention

Trauma-exposed individuals often receive treatment called psychological debriefing in an effort to prevent PTSD, which consists of interviews that are meant to allow individuals to directly confront the event and share their feelings with the counselor and to help structure their memories of the event. [14] However, several meta-analyses find that psychological debriefing is unhelpful and is potentially harmful. [14] [15] [16] A 2019 Cochrane Systematic Review found low-quality evidence suggesting potential benefit for some people, however, the studies performed had a high degree of uncertainty due to bias and the evidence is not strong enough to recommend multiple sessions of early psychological interventions for all people who are exposed to trauma. [17] As of 2017 The American Psychological Association assessed psychological debriefing as No Research Support/Treatment is Potentially Harmful. [18]

Critical Incident Stress Debriefing is a crisis intervention program that is used to provide initial psychosocial relief to rescue workers. It is generally conducted in a group session and held between 24 and 72 hours of the disaster. Each debriefing session follows seven phases:

  1. Introduction to set rules
  2. fact phase to establish what happened
  3. cognition phase to discuss thoughts about what happened
  4. reaction phase to discuss emotions associated with what happened
  5. symptoms phase to learn the signs and symptoms of distress
  6. educational phase to learn about post traumatic stress disorder (PTSD) and coping strategies
  7. re-entry phase to discuss any other issues and to provide any additional services. [19]

The goal of this type of debriefing is to stop the individuals from developing PTSD. Although this debriefing is widely used, there is uncertainty how it affects an individual. Researchers Mayou, Ehlers and Hobbs in 2000 were interested in evaluating the 3-year results of a randomized controlled trial of debriefing for consecutive subjects admitted to the hospital following a traffic accident. The patients were assessed in the hospital using the Impact of Event Scale (IES), Brief Symptom Inventory (BSI) and a questionnaire, and were then reassessed at 3 years and 3 months. The intervention used was psychological debriefing. The results showed that the intervention group had significantly worse psychiatric symptoms, travel anxiety, physical problems, and financial problems. [20]

In an earlier study conducted by Carlier et al. in 1998, they looked at the symptomatology in police officers that had been debriefed and not debriefed following a civilian plane crash. The results showed that the two groups did not differ in pre-event or post event distress. Furthermore, those who had undergone debriefing had significantly more disaster-related hyper arousal symptoms. [19]

Overall, these results showed that caution should be used when using Critical Incident Stress Debriefing. Studies have shown that it is ineffective and has adverse long-term effects, and is not an appropriate treatment for trauma victims.

Psychological research

In psychological research, a debriefing is a short interview that takes place between researchers and research participants immediately following their participation in a psychology experiment. The debriefing is an important ethical consideration to make sure that participants are fully informed about, and not psychologically or physically harmed in any way by, their experience in an experiment. Along with informed consent, the debriefing is considered to be a fundamental ethical precaution in research involving human beings. [21] It is especially important in social psychology experiments that use deception. Debriefing is typically not used in surveys, observational studies, or other forms of research that involve no deception and minimal risk to participants.

Methodological advantages of a debriefing include "the ability of researchers to check the effectiveness of a manipulation, or to identify participants who were able to guess the hypothesis or spot a deception." [22] If the data have been compromised in this way, then those participants should be excluded from the analysis. Many psychologists feel that these benefits justify a postexperimental follow-up even in the absence of deception or stressful procedures. [23] [24]

Organizational

Debriefing in the business discipline is largely instrumental to project management, particularly in "accelerating projects, innovating novel approaches, and hitting difficult objectives." [25] Debriefs are considered to primarily serve developmental purposes rather than evaluative or judgmental. They are also considered to have more of a developmental intent than an administrative intent, such as in a performance appraisal. [26] One difference in organizational and/or project management is that the debriefing process is not only conducted after the conclusion of other events, but can also be conducted in real-time to continuously evolve plans during execution. The main reason for focusing on debriefing in an organizational or even in a project management capacity, is to increase effectiveness of the team, both individually and collectively. One study found that properly conducted debriefings can help organizations realize individual and team performance improvements by about 20-25%. [27]

Techniques

Fundamentally, key questions to consider during a debriefing session are: [25]

  • What were we trying to accomplish?
  • Where did we hit (or miss) our objectives?
  • What caused our results?
  • What should we start, stop, or continue doing?

Often, structuring debriefings by following a plan or outline visiting the main functions of the debriefing process are considered more efficient. Most debriefings require at least some planning and organization prior to assembly of the team.

Technology

Digital tools have emerged aiming to automate the preparation of a debriefing session, based on the anonymous answers to questions asked of individual team members. This information can then be used to generate a discussion guide for the person in charge of the debrief to guide that particular session. [28] There is also an emergent debriefing model called "digital debriefing", which involves video-facilitated instructor debriefing. [29] Due to the technologies used, this type of debriefing can be conducted remotely. [30]

Efficacy and challenges

Studies show that when done correctly, debriefs work; and teams that practice regular debriefing outperform teams who do not by about 25%. [31] This demonstrates how debriefing can put a team on the fast-track to practical and observed learning and ensure team effectiveness.

A meta-analysis was performed to determine whether there is a consistent improvement in team effectiveness using debriefing techniques. Meta-analysis are statistical researching technique that include data from findings of all prior studies and are considered to be more reliable than findings that are derived from a single study. This one fully supports the idea that debriefing is a key component of successful project team management.

Debriefings are most effective when conducted interactively between the participants of the immersive activity and the assessment or observation personnel. [32] Self-facilitated after action reviews (AAR) or debriefings are common in small unit and crew activities, and in a training context are shown to improve Knowledge, Skills, and Abilities (KSAs) significantly when conducted formally using pre-defined measures of performance derived from front-end analysis. Debriefing organization can be based on linear or non-linear (or a combination of both) organization of markers used for recall. Typically the structure will use: Temporal, Spatial, Objective, and/or Performance derived markers to bring focus to a specific activity.

Teams in occupations and high-risk settings such as the healthcare field, emergency services like fire-fighting and policing, and military settings frequently use debriefing techniques for team learning and to avoid making costly mistakes. For example, in the health care field, it is important for a team of doctors to be high-performing in coming up with innovative solutions to health problems while maintaining the patients quality of life. Debriefings in the health care field are becoming increasingly popular and more widely used after claims of malpractice in emergency departments were reviewed and over 50 cases examined that showed how a high-performing team could have eliminated or mitigated major problems including death and impairments. [33]

Several examples of low-risk teams that can benefit from debriefing include: project teams, sports teams, production or manufacturing teams, and consultant teams.

Common challenges

Many leaders display all of the correct skills for successful leadership including interpersonal skills, technical competence, etc., but lack a very important skill which is the ability to effectively debrief and ensure continuous learning of their team. [34] Without guidance or structure for an effective debriefing process, it is more likely that leaders will experience some of the common challenges that are found in debriefing.

Below are some ways to maximize team effectiveness, avoid the common challenges faced in debriefing, and maintain high team performance:

See also

Related Research Articles

<span class="mw-page-title-main">Cognitive behavioral therapy</span> Type of therapy to improve mental health

Cognitive behavioral therapy (CBT) is a psycho-social intervention that aims to reduce symptoms of various mental health conditions, primarily depression and anxiety disorders. Cognitive behavioral therapy is one of the most effective means of treatment for substance abuse and co-occurring mental health disorders. CBT focuses on challenging and changing cognitive distortions and their associated behaviors to improve emotional regulation and develop personal coping strategies that target solving current problems. Though it was originally designed to treat depression, its uses have been expanded to include many issues and the treatment of many mental health conditions, including anxiety, substance use disorders, marital problems, ADHD, and eating disorders. CBT includes a number of cognitive or behavioral psychotherapies that treat defined psychopathologies using evidence-based techniques and strategies.

Post-traumatic stress disorder (PTSD) is a mental and behavioral disorder that develops from experiencing a traumatic event, such as sexual assault, warfare, traffic collisions, child abuse, domestic violence, or other threats on a person's life or well-being. Symptoms may include disturbing thoughts, feelings, or dreams related to the events, mental or physical distress to trauma-related cues, attempts to avoid trauma-related cues, alterations in the way a person thinks and feels, and an increase in the fight-or-flight response. These symptoms last for more than a month after the event. Young children are less likely to show distress, but instead may express their memories through play. A person with PTSD is at a higher risk of suicide and intentional self-harm.

Eye movement desensitization and reprocessing (EMDR) is a form of psychotherapy that is controversial within the psychological community. It was devised by Francine Shapiro in 1987 and originally designed to alleviate the distress associated with traumatic memories such as post-traumatic stress disorder (PTSD).

Critical incident stress management (CISM) has been misunderstood and unfairly criticized as a controversial, non-empirical, adaptive, short-term psychological helping-process that focused solely on an immediate and identifiable problem. Much of the "controversy" stems from confusion of terms. The overall ICISF Model of Critical Incident Stress Management includes several tactics to help mitigate the effects of a critical incident. It includes pre-incident preparedness to acute crisis management through post-crisis follow-up. Its purpose is to enable people to return to their daily routine more quickly and with less likelihood of experiencing post-traumatic stress disorder (PTSD). The term CISM is frequently confused with one of the group intervention tactics under the model. That is the Critical Incident Stress Debriefing (CISD).

Mindfulness-based cognitive therapy (MBCT) is an approach to psychotherapy that uses cognitive behavioral therapy (CBT) methods in conjunction with mindfulness meditative practices and similar psychological strategies. The origins to its conception and creation can be traced back to the traditional approaches from East Asian formative and functional medicine, philosophy and spirituality, birthed from the basic underlying tenets from classical Taoist, Buddhist and Traditional Chinese medical texts, doctrine and teachings.

Exposure therapy is a technique in behavior therapy to treat anxiety disorders.

Childhood trauma is often described as serious adverse childhood experiences (ACEs). Children may go through a range of experiences that classify as psychological trauma; these might include neglect, abandonment, sexual abuse, emotional abuse, and physical abuse, witnessing abuse of a sibling or parent, or having a mentally ill parent. These events have profound psychological, physiological, and sociological impacts and can have negative, lasting effects on health and well-being such as unsocial behaviors, attention deficit hyperactivity disorder (ADHD), and sleep disturbances. Similarly, children whose mothers have experienced traumatic or stressful events during pregnancy have an increased risk of mental health disorders and other neurodevelopmental disorders.

Crisis intervention is a time-limited intervention with a specific psychotherapeutic approach to immediately stabilize those in crisis.

Incident stress is a condition caused by acute stress which overwhelms a staff person trained to deal with critical incidents such as within the line of duty for first responders, EMTs, and other similar personnel. If not recognized and treated at onset, incident stress can lead to more serious effects of posttraumatic stress disorder.

<span class="mw-page-title-main">Medical simulation</span> Medical training and evaluation technique

Medical simulation, or more broadly, healthcare simulation, is a branch of simulation related to education and training in medical fields of various industries. Simulations can be held in the classroom, in situational environments, or in spaces built specifically for simulation practice. It can involve simulated human patients, educational documents with detailed simulated animations, casualty assessment in homeland security and military situations, emergency response, and support for virtual health functions with holographic simulation. In the past, its main purpose was to train medical professionals to reduce errors during surgery, prescription, crisis interventions, and general practice. Combined with methods in debriefing, it is now also used to train students in anatomy, physiology, and communication during their schooling.

Mindfulness-based stress reduction (MBSR) is an eight-week evidence-based program that offers secular, intensive mindfulness training to assist people with stress, anxiety, depression and pain. Developed at the University of Massachusetts Medical Center in the 1970s by Professor Jon Kabat-Zinn, MBSR uses a combination of mindfulness meditation, body awareness, yoga and exploration of patterns of behavior, thinking, feeling and action. Mindfulness can be understood as the non-judgmental acceptance and investigation of present experience, including body sensations, internal mental states, thoughts, emotions, impulses and memories, in order to reduce suffering or distress and to increase well-being. Mindfulness meditation is a method by which attention skills are cultivated, emotional regulation is developed, and rumination and worry are significantly reduced. During the past decades, mindfulness meditation has been the subject of more controlled clinical research, which suggests its potential beneficial effects for mental health, athletic performance, as well as physical health. While MBSR has its roots in wisdom teachings of Zen Buddhism, Hatha Yoga, Vipassana and Advaita Vedanta, the program itself is secular. The MBSR program is described in detail in Kabat-Zinn's 1990 book Full Catastrophe Living.

PTSD or post-traumatic stress disorder, is a psychiatric disorder characterised by intrusive thoughts and memories, dreams or flashbacks of the event; avoidance of people, places and activities that remind the individual of the event; ongoing negative beliefs about oneself or the world, mood changes and persistent feelings of anger, guilt or fear; alterations in arousal such as increased irritability, angry outbursts, being hypervigilant, or having difficulty with concentration and sleep.

Psychological first aid (PFA) is a technique designed to reduce the occurrence of post-traumatic stress disorder. It was developed by the National Center for Post Traumatic Stress Disorder (NC-PTSD), a section of the United States Department of Veterans Affairs, in 2006. It has been endorsed and used by the International Federation of Red Cross and Red Crescent Societies, Community Emergency Response Team (CERT), the American Psychological Association (APA) and many others. It was developed in a two-day intensive collaboration, involving more than 25 disaster mental health researchers, an online survey of the first cohort that used PFA and repeated reviews of the draft.

Trauma risk management (TRiM) is a method of secondary PTSD prevention. The TRiM process enables non-healthcare staff to monitor and manage colleagues. TRiM training provides practitioners with a background understanding of psychological trauma and its effects.

Metacognitive therapy (MCT) is a psychotherapy focused on modifying metacognitive beliefs that perpetuate states of worry, rumination and attention fixation. It was created by Adrian Wells based on an information processing model by Wells and Gerald Matthews. It is supported by scientific evidence from a large number of studies.

Secondary trauma can be incurred when an individual is exposed to people who have been traumatized themselves, disturbing descriptions of traumatic events by a survivor, or others inflicting cruelty on one another. Symptoms of secondary trauma are similar to those of PTSD. Secondary trauma has been researched in first responders, nurses and physicians, mental health care workers, and children of traumatized parents.

Trauma-sensitive yoga is yoga as exercise, adapted from 2002 onwards for work with individuals affected by psychological trauma. Its goal is to help trauma survivors to develop a greater sense of mind-body connection, to ease their physiological experiences of trauma, to gain a greater sense of ownership over their bodies, and to augment their overall well-being. However, a 2019 systematic review found that the studies to date were not sufficiently robustly designed to provide strong evidence of yoga's effectiveness as a therapy; it called for further research.

<span class="mw-page-title-main">Trauma and first responders</span> Trauma experienced by first responders

Trauma in first responders refers to the psychological trauma experienced by first responders, such as police officers, firefighters, and paramedics, often as a result of events experienced in their line of work. The nature of a first responder's occupation continuously puts them in harm's way and regularly exposes them to traumatic situations, such as people who have been harmed, injured, or killed.

<span class="mw-page-title-main">Narrative exposure therapy</span> Short-term therapy for trauma-related disorders

Narrative Exposure Therapy (NET) is a short-term psychotherapy used for the treatment of post-traumatic stress disorder and other trauma-related mental disorders. It creates a written account of the traumatic experiences of a patient or group of patients, with the aim of recapturing self-respect and acknowledging the patient's value. NET is an individual treatment, NETfacts is a format for communities.

Psychological trauma in adultswho are older, is the overall prevalence and occurrence of trauma symptoms within the older adult population.. This should not be confused with geriatric trauma. Although there is a 90% likelihood of an older adult experiencing a traumatic event, there is a lack of research on trauma in older adult populations. This makes research trends on the complex interaction between traumatic symptom presentation and considerations specifically related to the older adult population difficult to pinpoint. This article reviews the existing literature and briefly introduces various ways, apart from the occurrence of elder abuse, that psychological trauma impacts the older adult population.

References

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  36. ↑ Eddy, Erik R.; D'Abate, Caroline P.; Tannenbaum, Scott I.; Givens-Skeaton, Susan; Robinson, Greg (2006). "Key characteristics of effective and ineffective developmental interactions". Human Resource Development Quarterly. 17 (1): 59–84. doi: 10.1002/hrdq.1161 . ISSN   1044-8004.

37. Calle-Domínguez, C. (2022)Debriefing entre iguales como herramienta de aprendizaje para la formación de enfermeras experiencia en postgrado de emergencias hospitalarias [Tesis Doctoral]. Madrid: Universidad Europea de Madrid. Recuperado a partir de: https://dialnet.unirioja.es/servlet/tesis?codigo=310220

38. Calle-Domínguez, C. Evaluación y satisfacción del debriefing facilitado por un instructor frente al facilitado por iguales. Metas de Enfermería. 2022; 25 (6):15-23. Recuperado a partir de: https://www.enfermeria21.com/revistas/metas/articulo/81957/evaluacion-y-satisfaccion-del-debriefing-facilitado-por-un-instructor-frente-al-facilitado-por-iguales/

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