Surviving Port Arthur : the role of dissociation in the impact of psychological trauma and its implications for the process of recovery

Psychological trauma results from exposure to an inescapable stressor that overwhelms a person's ability to cope. During the period of perceived threat a defensive process of denial and suppression frequently operates to control a person's emotional response to the situation. Emergency services personnel in particular, may actively employ a task- oriented approach to traumatic incidents: and suppress their anxiety and fear in order to maintain concentration and undertake their duties most effectively. In psychological terms, this behaviour may be seen as purposeful, adaptive dissociation. However, recent studies of emergency services personnel reveal that there are possible long-term risks associated with the experiencing dissociation during a traumatic situation. While the ability to control emotional response may be viewed as an effective way of coping during an intense or traumatic situation, there is an inherent danger that this inhibition of emotions may become the source of long term psychological and physiological disturbance. Psychological debriefing is a popular method of assistance for emergency services personnel following a traumatic incident. It is designed to promote the cognitive and emotional processing of a traumatic event. During a debrief, participants describe the traumatic experience (including their reactions and emotions) in order to begin to integrate and master key features of the experience. While there is abundant anecdotal evidence suggesting that psychological debriefings can be beneficial, there have also been conflicting reports as to their actual effectiveness. Investigators have indicated that rigorous investigation of the effectiveness of psychological debriefing and its role in post-trauma recovery is urgently required. In particular, such investigations need to provide a clear answer to the question 'Is psychological debriefing related to the prevention of PTSD symptoms and associated psychological sequelae?' In this study, an investigation was undertaken of 96 emergency services personnel involved in the response to the 'Port Arthur massacre', a critical incident in which a lone gunman randomly killed 32 visitors in a popular tourist venue in southern Tasmania. All participants were individually interviewed on two occasions: eight months after and twenty months after the incident. Two key findings from the research project we presented. Firstly, experiencing dissociative symptoms at the time of the incident was predictive of long-term psychological and physiological distress. Secondly, within the group of emergency services personnel who experienced dissociation at the event, those who disclosed their related thoughts and feelings at the subsequent group debriefings showed significantly less long-term psychological distress. The results of this study offer insight into how the impact of biological chances caused by a traumatic event can be modified by the psychological processing of that event. The results support the suggestion that following a traumatic situation, a person needs to process and integrate the memory of that event if he or she is to 'recover' from his or her reaction to the situation. Psychological debriefing appears to provide an opportunity for the necessary psychological processing to commence and assist emergency services personnel in managing what might otherwise develop into PTSD