9/11 one year on: Bridging the worlds divisions

This week, THE LANCET'S editorial and an eight-page special report examine the impact of the events of September 11 last year on world politics and public health. The Special Report, replacing the news section for this week's issue, begins in the emergency rooms of New York City and ends at last week's World Summit on Sustainable Development (WSSD) in Johannesburg.

Authors of a study in this week's issue of THE LANCET provide strong evidence that formal counselling after traumatic events is ineffective--and that it could actually do more harm than good.

Traumatic events such as the September 11 2001 attacks have highlighted the issue of psychological support for people who have been traumatised; offers of emotional and practical support to victims are thought to be appropriate and caring human responses. However, conflicting evidence surrounds the effectiveness of single-session psychological debriefing, a commonly used approach to help people who have recently experienced trauma.

Arnold van Emmerik and colleagues from the University of Amsterdam, Netherlands, assessed the value of single-session debriefing after trauma in the subsequent prevention of chronic symptoms of post-traumatic stress disorder (PTSD) and other psychological disorders. They pooled and re-analysed previous studies, some of which involved a specific type of counselling called critical incident stress debriefing (CISD); this typically involves one three-hour, group therapy session for trauma victims. The investigators restricted their analysis to studies where single-session debriefing had been done within one month of the traumatic event, and to studies that involved the use of widely accepted psychological measures to assess behaviour.

Seven studies were reanalysed, which included data about five CISD interventions, three non-CISD interventions, and six controls (ie, no intervention at all). PTSD symptoms improved with Non-CISD interventions and no interventi

Contact: Richard Lane

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