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Post-traumatic stress disorder needs more than counselling

EMBARGOED UNTIL 12.00 NOON SUNDAY 1 JUNE 2003

The popular view that early access to counselling after a traumatic event helps prevent more serious mental health problems for the sufferer in the future has been further challenged by research on stress debriefing after childbirth, published in the current edition of the Medical Journal of Australia.

Commenting on the research, Dr Alexander McFarlane, Professor of Psychiatry at the University of Adelaide, said early intervention is an appealing and inexpensive way of dealing with traumatic events such as the Bali bombings and the Canberra bushfires, that can lead to predictable psychiatric illness.

"But the research adds to the now substantial evidence that psychological debriefing has no value in prevention," Dr McFarlane said.

"Treatment based on cognitive behavioural principles, rather than counselling, is effective in the treatment of acute stress disorder," he said.

"The failure to establish the effectiveness of debriefing means that more expensive, longer term programs need to be evaluated.

Dr McFarlane said the public health challenge is how to minimise and manage predictable post-traumatic psychiatric illness, adding that while contact soon after the event will not prevent illness, it can provide a bridge for later screening and treatment.

"However governments do not appear to be prepared to fund necessary services despite their advocacy calls for prevention. The risk is that considerable benefits could be lost due to a lack of support," he said.

"Although there is a need to offer care and psychological first aid to survivors of traumatic events, we should not be fooled into believing this has any substantial long-term effect.

"The groups who pose the greatest challenge for prevention are emergency service workers and service personnel, who seldom become unwell on their first traumatic exposure, but have repeated exposures.

The Medical Journal of Australia is a publication of the Australian Medical Association.

CONTACT: Professor Alexander McFarlane, 0419 810 962

Judith Tokley, AMA, 0408 824 306

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