After a car crash, an assault or a disaster yourself, don't count on a one-time psychological debriefing right after the event; if a month later nightmares, flashbacks and being on edge are still severe, see a psychiatrist for trauma-focused psychotherapy

If you are thinking about suicide right now, call or text 988. If you are in immediate danger, call 911.

Cost

Registration plus treatment fees; generally 8 to 12 sessions. The hard part is that treatment means going back to touch the experience you most dread remembering.

What you get

The National Health Commission's Standards for the Diagnosis and Treatment of Mental Disorders (2020 edition) (《精神障碍诊疗规范（2020 年版）》) state that on average about 8% of people who experience psychological trauma develop post-traumatic stress disorder. The core symptoms fall into three groups. First, nightmares and flashbacks, with the scene of the event coming back again and again. Second, avoiding topics, places and people connected with the event. Third, constant alertness, being easily startled and insomnia. The diagnosis is made only when symptoms last more than 1 month and seriously affect family, study or work. In its section on acute stress disorder, the Standards say most people return to normal through self-adjustment or crisis intervention in the acute phase. For treatment effects, look at a 2020 pooled analysis of 114 randomized trials with 8171 people. Trauma-focused cognitive behavioral therapy compared with waiting-list or usual care had an SMD of −1.32 (95% CI −1.57 to −1.08, the plausible range), with moderate-quality evidence. Eye movement desensitization and reprocessing (EMDR) was −1.23 (−1.69 to −0.76), with low-quality evidence. SMD and d are the same yardstick; 0.8 and above counts as large, and both pass that line. Ordinary supportive counseling compared with waiting showed no difference (−0.43, −0.90 to 0.04). The same authors' 2013 Cochrane review, with 70 trials and 4761 people, pointed the same way. Trauma-focused cognitive behavioral therapy was −1.62 (−2.03 to −1.21) and EMDR −1.17 (−2.04 to −0.30). But the quality of evidence in that review was rated very low. The UK's NICE 2018 guideline arranges care this way. For adults whose symptoms are already severe within a month of the event, offer individual trauma-focused cognitive behavioral therapy. For those diagnosed or with clear symptoms after a month, offer the same, generally 8 to 12 sessions. For trauma not caused by war, if it has not resolved at 3 months, EMDR is also offered. For mild symptoms that do not reach a diagnosis, watch in the first month and arrange a follow-up within a month. The psychotherapies listed in China's Standards are also these: prolonged exposure, cognitive processing therapy and EMDR. For one-time debriefing right after the event, look at three sources. A 2002 Cochrane review pooled 11 trials: a single individual debriefing did not reduce distress and did not prevent post-traumatic stress disorder. At 3 to 5 months OR 1.22 (0.60–2.46), no difference. One of the trials followed people to 1 year, and those who had had debriefing were actually at higher risk of this illness. OR 2.88 (1.11–7.53), about 2.9 times. The authors concluded that compulsory debriefing of traumatized people should stop. Another trial enrolled hospitalized patients after car crashes and assigned them randomly. After 3 years, the debriefing group was clearly worse in psychiatric symptoms, anxiety when riding in a car, pain, physical problems, overall ability to function in life and financial problems. Among those whose flashbacks and avoidance were already severe at the start, those who had debriefing still had symptoms at 3 years, while those who did not had recovered. The NICE guideline states plainly: do not offer psychologically focused debriefing for the prevention or treatment of post-traumatic stress disorder. The reason is that neither individual nor group debriefing showed any benefit, and there were signs of being worse than doing nothing.

Notes

A one-time debriefing is a single session in the first few days after an event, bringing people together or seeing them alone, in which they go through what happened and how they felt from the beginning. China's Standards still list group debriefing in the psychotherapy table for acute stress disorder, which is inconsistent with NICE; this item follows the trial results. If your workplace or school holds such a meeting after an incident, you don't have to speak if you don't want to, and don't push others to speak. In the first few weeks, first make sure of safety, eating and sleeping, and having people around. Register at psychiatry, psychology or clinical psychology, and ask directly whether trauma-focused psychotherapy can be done. The reasoning is the same as §29.9 (don't start by paying for grief counseling): not everyone needs professional intervention, and the effort should go to those still stuck after a month. People whose relative died in an accident or homicide often have these symptoms too; see §29.4 (a loved one died by an accident or homicide). For what to do first after a sexual assault, see §13.42 (after a sexual assault). PTSD arising from work among emergency rescue workers such as police, medical staff and firefighters has been added to the occupational disease list. For details, see §19.10 (the note on the dust, noise and chemical poisons item).

Evidence grade

A : Specific numbers from meta-analyses, large cohorts or randomized trials; for law and policy, the statute or official text.

Sources

1. Lewis C, et al. (2020). Psychological therapies for post-traumatic stress disorder in adults: systematic review and meta-analysis. European Journal of Psychotraumatology. https://doi.org/10.1080/20008198.2020.1729633
2. Bisson JI, et al. (2013). Psychological therapies for chronic post-traumatic stress disorder (PTSD) in adults. Cochrane Database of Systematic Reviews, CD003388. https://doi.org/10.1002/14651858.CD003388.pub4
3. Rose S, et al. (2002). Psychological debriefing for preventing post traumatic stress disorder (PTSD). Cochrane Database of Systematic Reviews, CD000560. https://doi.org/10.1002/14651858.CD000560
4. Mayou RA, Ehlers A, Hobbs M (2000). Psychological debriefing for road traffic accident victims. Three-year follow-up of a randomised controlled trial. British Journal of Psychiatry. https://doi.org/10.1192/bjp.176.6.589
5. National Institute for Health and Care Excellence (2018). Post-traumatic stress disorder (NG116), recommendations 1.6.4, 1.6.5, 1.6.15–1.6.19. https://www.nice.org.uk/guidance/ng116/chapter/Recommendations
6. 国家卫生健康委办公厅 (2020). 关于印发精神障碍诊疗规范（2020 年版）的通知（国卫办医函〔2020〕945 号），第八章创伤及应激相关障碍. https://www.nhc.gov.cn/yzygj/c100068/202012/b4305ace9e14440792eb76d29602c88a.shtml

Translated from the Chinese original. Original book, section 29, tip 14. Content may be out of date and rules differ by place. When you actually deal with an agency, a doctor or a court, follow what local officials, doctors and lawyers tell you. Disclaimer