EDITORIAL COMMENTS

This carefully focussed review of psychological traumatization after motor vehicle accidents shows that such consequences are not uncommon. Hobbs and Mayou review those studies that have provided any sort of intervention of the debriefing kind after motor vehicle accidents, considering Wve studies including one of their own.

None of these studies showed benefits for a brief one-off intervention. Their own careful and manualized, controlled trial of a debriefing intervention showed that there might well be an increase in psychological symptoms in the group who received intervention. The authors hypothesize that it may be that early psychological/debriefing interventions interfere with the progressive and titrated processing of the experience. Or they may reinforce dissociation by exposure/re-exposure to the trauma. The authors conclude by concurring with Ørner's finding that debriefing should not be routinely applied after critical incidents of this kind in view of the lack of scientific evidence regarding its effectiveness.

It may indeed be that a single, active, debriefing session re-exposes without a real opportunity for cognitive processing of the experience. Immediate emotional support, information and practical help, with perhaps later individual crisis intervention are seen as appropriate, as is cognitive behaviour therapy.

These findings are clearly similar to the large-scale studies of Watts (Chapter 9), particularly with respect to his findings concerning survivors. They constitute a further cause for concern about the widespread use of psychological debriefing techniques in such settings, particularly as they may be seen to obviate the need for appropriate follow-up interventions more tailored to individual need for those who are at risk of post-trauma morbidity.