Traumatology, Vol. 8, No. 4 (December 2002) Victim Perspective of Bank Robbery Trauma and Recovery Celeste A. Jones1 This study examines an expanded debriefing model used with bank robbery victims. The model provides organizational consultation before a trauma and aids recovery after the incident through individual assessment and organizational support. Victims’ perspective of the bank robbery, the recovery process, and satisfaction with the intervention was studied. Although victims’ stated their functioning level stabilized with a supportive organization environment, continued efforts must be made to explore effective assistance in dealing with traumatic workplace-related events. Key Words: bank robbery victims, organizational consultation, trauma, organizational support, recovery process, workplace-related trauma Businesses and government increasingly recognize the impact of workplace violence and trauma on occupational injury. Trauma in the workplace refers to events such as industrial accidents, crimes, or personnel injuries and illnesses that occur in the workplace and expose the employee to an unexpected crisis (Lewis, 1993). Trauma responses can vary in severity, duration, and recovery. House (1981) reports that a great deal of research in organizational psychology and sociology suggests that social support can reduce occupational stress, enhance health, and buffer the impact of occupational trauma. Resources are vital under ordinary circumstances; they are especially important under conditions of stress. What’s more, Hobfoll (1988) believes that traumatic stress is especially devastating due to the rapid loss of supportive resources that follow the trauma event. Although support from outside the work environment is important to the recovery process, work-related sources of support including work supervisors and co-workers can also be effective in reducing the stress and trauma experienced at the workplace (House, 1981). Although workplace trauma among bank employees is not a new phenomenon, there is limited literature specifically about bank robberies. Most of the literature concerning bank robberies is discussed incidentally in the context of armed robbery victims. Employee victims of bank robbery trauma have received little or no direct attention. These employees may suffer the additional stress and trauma associated with repeated exposure to workplace triggers and cues. The potential importance of the physical environment as a cuing source for past memories and emotions has been studied extensively (Smith & Vela, 2001). Although there is a consensus in the literature that all armed robbery victims have some psychological reaction to the event, there is little agreement concerning the impact, long-term symptomology, and recovery process (Bamber, 1992; Wakefield, 1993). 1 Assistant Professor of Social Work at California State University, Chico, School of Social Work. She can be reached at (530) 898 – 6874; email: firstname.lastname@example.org. 191 192 Victim Perspective Traumatic Stress Interventions A posttraumatic stress debriefing is a therapeutic intervention designed to prevent or reduce negative long-term psychological consequences. Raphael, Wilson, Meldrum, and McFarlane (1996) discuss the expansion of debriefing to include three distinct debriefing protocols: one that is “didactic” or “teaching,” and two that are “psychological” or “therapeutic.” Although the different approaches have distinct emphasis and goals, they are not mutually exclusive and occur within 12-48 hours after the traumatic event. The didactic debriefing process involves a more informational, rather than therapeutic approach and includes education about stress, ways to recognize it, and techniques of self-management. This approach is seen as preparatory to receiving counseling. Dunning’s model (1988) is an example of this type of debriefing process where the focus is on victim education of typical traumatic stress responses and on strategies that can be used to help regulate stress. This model does not focus on the therapeutic process or disclosure as a component of recovery. Psychological debriefing focuses on emotional ventilation suggesting that a catharsis promotes the healing process. This type of debriefing also involves a discussion of the signs and symptoms of a stress response. One version of psychological debriefing is Mitchell’s (1983) Critical Incident Stress Debriefing (CISD) which, in a group setting, provides education about typical trauma responses and coping strategies, and allows individuals to process their individual responses to the traumatic event. The purpose of this debriefing is to encourage participants to discuss and ventilate intense emotions, explore symbolic meanings in the event, generate group support, and initiate the grief process. Mitchell’s recent work has expanded CISD to include psychologically based support services, “defusing” sessions which are shorter and less structured, and follow-up counseling and other services (Mitchell & Dyregrov, 1993; Raphael, Wilson, Meldrum, & McFarlane, 1996). An alternative and more comprehensive debriefing intervention developed by L. Bergmann1 is used with employee victims and managerial staff following a traumatic event in a workplace (personal communication, May 28, 1998). This enhanced debriefing model (EDM) incorporates a structured, time-limited group-based intervention much like CISD, but places special attention on work-place support in the recovery process. Another unique aspect of this model is its’ emphasis is on consultation and training of managers before an incident occurs. In this way, management can be aware of the roles that environment and organizational structure plays in modulating employee stress responses. With consultation and training before the trauma, an organization can operationalize a supportive mentality and prepare for employee reactions to trauma. Designed to address conditions of risk created by the incident, EDM differs from other debriefing techniques. In addition to addressing the needs of the individuals exposed to the trauma, EDM focuses attention on the environmental context before and after the trauma. This is accomplished by providing an appraisal of workplace support and making suggestions designed to increase organizational cohesiveness, especially during the critical moments immediately following the trauma. For instance, EDM may help the managerial staff of an organization identify possible non-supportive aspects of the work environment that may interfere with victim recovery. The importance of work environment support in the recovery process is emphasized to the organization through on-going consultation with human resource directors and managers. Since much of the Jones 193 consultation occurs before any critical incident, managers and human resource directors are ready to respond supportively to employees when traumatic incidents occur. Trauma Response Trauma symptoms can manifest mental health disturbances that influence physical, social, emotional, and mental functioning level. The duration of symptoms and associated impairment of functioning can be short-term (under 6 months), long-term (7 months or greater), or delayed. Symptoms that continue over three months may warrant a diagnosis of adjustment disorder. If the symptoms remain for over six months, the individual is diagnosed with post-traumatic stress disorder (PTSD) (American Psychology Association, 1994). Traumatic encounters confront an individual with experiences completely different from what would normally be experienced in everyday life. Following a traumatic event, many people suffer from intrusive thoughts about what has happened (McFarlane, 1992). Furthermore, the personal meaning of the traumatic experience evolves over time. Personal meaning often involves negative feelings such as anger, loss, betrayal, and helplessness. For some, however, personal meaning may evolve into a renewed appreciation of their lives (Lyons, 1991) and even for the organization in which they work. Treatment of traumatic stress is concentrated on alleviating acute and chronic symptoms. Support from friends, family, co-workers, supervisors, and others can all play a role in the recovery process and enhance the functioning level (House, 1981). Susser, Herman, and Aaron (2002) studied trauma recovery from the September 11, 2001 attack on the World Trade Center. They reported that a sense of community, trusted leadership, and social cohesion strengthened individuals and assisted in their recovery from psychological trauma. Although many recipients of debriefing interventions report that counseling following a traumatic event assists the recovery process, the current body of knowledge offers little empirical evidence from outcome studies that suggest how best to treat traumatic stress responses. Rose and Bisson (1998) indicate that given the lack of effectiveness research, continued use of early psychological interventions without evidence of its utility is problematic. They argue that research in this area should focus on the type of stressor itself (the trauma), the host, and the quality of environmental support. Bank Robbery Trauma. When exposed to a bank robbery, an employee victim can often experience a traumatic response. A unique aspect of bank robbery trauma is that it occurs at the workplace, where employees ordinarily feel reasonably safe. Although this traumatic event occurs in the workplace, the response is similar to other traumatic events and can lead to victims experiencing significant levels of post-traumatic stress (Harrison & Kinner, 1998). The response to workplace trauma is similar to other traumatic events with respect to feeling threatened, unprotected, helpless, and frightened. However, by returning to the same environment where the trauma took place, bank robbery victims can experience a continued level of psychological stress well after the incident. Leymann (1985) found 5- 8% of bank robbery victims experienced psychological stress symptoms 6 months 194 Victim Perspective following the event, while Tunnecliffe and Green (1986) reported that 11 out of 16 armed robbery victims had clinical conditions up to 2 years following the event. In a recent study of armed robbery victims, Harrison and Kinner (1998) found that even after 6 months the armed robbery victims were still experiencing significant levels of post- traumatic stress. Given the paucity of research in this area, this study explored aspects of an enhanced debriefing intervention with bank robbery victims. Subsequent to EDM, all victims were assessed from 0 -12 months after a bank robbery and on exposure levels, trauma symptoms, general social anxiety following the bank robbery, and satisfaction with the quality of the intervention. Methodology Procedure and Sample A bank in the southern part of the United States that contracted for EDM services participated in the study. The sample was divided into two groups—those who were victims of a bank robbery (victim participant group) and those who were employed at the bank for at least six months but not exposed to a bank robbery (non-victim participant group). All employees working the day of the robbery in the branch bank or the bank headquarters that dealt with customers in everyday operations and were exposed to a bank robbery were considered potential victim participants. A list of the branch banks that had experienced a robbery within the past 12 months was generated. All victim participants had experienced an enhanced debriefing intervention. The researcher visited each branch bank before their workday began or at the end of the workday. The researcher discussed the purpose of this study and questionnaire packets were distributed to volunteers. Everyone was informed that two movie ticket passes were included in each packet, and the use of the pass was not dependent on the packet being returned. Participants were asked to complete the questionnaire packet within 48-hours of receiving the packet and mail the self-addressed stamped packet back to the researcher. Distributed were 86 instrument packets, 43 victim and 43 non-victim, at 13 branch banking offices. A total of 51 instrument packets were returned during the data collection period, 27 victim packets and 24 non-victim packets from all 13 branches. The victim response rate was 63% and the non-victim response rate was 59%. Victims were asked to report the date they were exposed to a bank robbery within the last 12 months. Victim response packets were grouped into one of three time categories depending upon the date of their robbery. There were seven (25.9%) victim response packets grouped in the less than 3 month category (Group 1), ten (37.0%) in the 3 to 6 months category (Group 2) and ten (37.0%) in the 7 to 12 months category (Group 3). Table 1 summarizes the major demographic characteristics for the entire sample. Jones 195 Table 1 Frequencies and Percentages of the Demographic Characteristics of the Sample All Victims Non-Victim Variable N (%) N (%) N (%) 51 (100) 27 (52.9) 24 (47.1) Gender Female 42 (82.4) 20 (74.1) 22 (91.7) Male 9 (17.6) 7 (25.9) 2 (8.3) Age 18-20 2 (3.9) 2 (8.3) 21-24 13 (25.5) 8 (29.7) 5 (20.8) 25-29 8 (15.7) 4 (14.8) 4 (16.7) 30-34 11 (21.6) 5 (18.5) 6 (25.0) 35-39 11 (21.6) 7 (25.9) 4 (16.7) 40-44 5 (9.8) 3 (11.1) 2 (8.3) 44 and older 1 (1.9) 1 (4.2) Ethnic Group African American 13 (25.5) 6 (22.2) 7 (29.2 ) AI/NA/AN 2 (3.9) 1 (8.3) Asian/Pacific Islander 1 (2.0) 1 (3.7) Hispanic 2 (3.9) 2 (7.4) Non-Hispanic White 30 (58.8) 16 (59.3) 14 (58.3) Other 3 (5.9) 2 (7.4) 1 (4.2) Manager/Non-Manager Manager 9 (17.6) 8 (29.6) 1 (4.2) Non- Manager 42 (82.4) 19 (70.4) 23 (95.8) Note. AI/NA/AN = American Indian/Native American/Alaskan Native. Measures Exposure Questionnaire. Since no measure was available, an exposure questionnaire was created. Nine questions about specific details of the bank robbery were included. These items whether the individual saw the robbery, was in the same room with the robber, was able to identify the robber, felt threatened by the robber, saw a weapon, believed they or someone else could have been harmed, felt helpless or fearful, was touched by the robber, or was physically injured. All of the questions had a “yes” or “no” response. The “no” answers were scored as zero and the “yes” answers scored as one. The number of “yes” responses determined the total score, with a higher score representing a higher level of exposure. Impact of Event Scale-Revised (IES-R). The Impact of Event Scale-Revised (IES-R) is a general indicator of stress associated with traumatic events (Horowitz, Field, & Classen, 1993). The 22-item self-report scale assesses the experience of post-traumatic stress for a specific event that has occurred. The higher the score, the more symptoms 196 Victim Perspective the individual is experiencing (Horowitz et al., 1993). Newman, Kaloupek, and Keane (1996) reported that the IES-R is the most widely used instrument for assessing PTSD related symptoms across several trauma samples. Fischer and Corcoran (1996) indicated that the IES-R was an appropriate measure for monitoring an individual’s progress in treatment. The IES-R measures three domains of response to traumatic stress: (1) intrusive phenomena; (2) avoidance and numbing phenomena, and; (3) hyperarousal phenomena. Reliability for the IES subscales is very positive. The internal consistency for the subscales has coefficients ranging from .70 to .90 (Horowitz, Wilner, & Alvarez, 1979). Validity has been supported through significant sensitivity and difference to change over the course of treatment (Zilberg, Weiss, & Horowitz, 1982). Social Avoidance and Distress Scale (SAD). The Social Avoidance and Distress Scale (SAD) is a 28-item unidimensional scale assessing two aspects of anxiety - feelings of distress and discomfort and avoidance of social interactions (Fischer & Corcoran, 1996). Reliability using Kuder-Richardson Formula produced a correlation of .94, internal consistency had a correlation of .77, and test-retest reliability with two samples yielded correlations of .69 and .79 (Watson & Friend, 1969). This scale is a measure of general anxiety rather than specific types of anxiety such as phobias. Evidence of known-group validity was reported by Fischer and Corcoran (1996). Client Satisfaction Questionnaire (CSQ-8). The CSQ-8 is an eight-item measure that is used to assess client satisfaction with services (Larsen, Attkisson, Hargreaves, & Nguyen, 1979). The CSQ-8 yields a global measure of the client’s perception of the general value of the services. Scores can range from 8 to 32, with higher scores indicating greater satisfaction (Larsen et al., 1979). The CSQ-8 has been tested with a variety of populations and ethnic groups (Fischer & Corcoran, 1996). Larsen et al. (1979) reported the reliability for the CSQ-8 yielded internal consistency alpha scores ranging from .86 to .94. Concurrent validity was reported as good when comparing client rating to therapist rating of client progress (Larsen et al., 1979). Open-ended Questions. The qualitative part of the questionnaire was three open- ended questions. One question asked participants to describe the bank robbery experience. Another question asked participants to comment on how their life had changed since the robbery. The third asked what it was about the help you received that assisted you in your recovery. Results Exposure Questionnaire The Exposure Questionnaire (EQ) has a possible total score range of 0 to 10. The total score was the overall total of “yes” responses the individual reported. Participants’ scores on the EQ ranged from 1 to 8 with a mean of 5.93 and a standard deviation of 2.35. Scores on the EQ did not approach the maximum possible score of 9, but 37% of the victims reported a score of 8 and 18.5% reported a score of 7. There were victim participants from all three time periods—less than 3 month category (Group 1), 3 to 6 months category (Group 2) and 7 to 12 months category (Group 3)—that reported having an exposure score of 8. A total of 74% of the victims reported a score of 5 or above, Jones 197 indicating that the majority of victim participants experienced moderate to high levels of traumatic exposure. Across the three groups the average exposure did not vary significantly (Group 1= 6.71, Group 2 = 5.30, and Group 3 = 5.89). Frequencies and percentages of the EQ are presented in Table 2. Table 2 Frequencies and Percentages of the Exposure Questionnaire (EQ) Totals EQ 1 2 3 4 5 6 7 8 Totals (N) (N) (N) (N) (N)(N) (N) (N) % % % % % % % % Group 1 (1) (1)(1) (4) 3.7% 3.7% 3.7% 14.8% Group 2 (1) (1) (2) (1) (2) (3) 3.7% 3.7% 7.4% 3.7% 7.4% 11.1% Group 3 (1) (1) (1) (1) (3) (3) 3.7% 3.7% 3.7% 3.7% 11.1% 11.1% Group (2) (1) (3) (1) (2) (3) (5) (10) Total 7.4% 3.7% 11.1% 3.7% 7.4% 11.1% 18.5% 37.0% Note. Group 1 = less than 3 month category, Group 2 = 3 to 6 months category and Group 3 = 7 to 12 months category. Impact of Event Scale-Revised The IES-R scores for the sample group ranged from 22 to 82, with a mean of 46.48 for victims (SD = 18.45) and 25.25 for non-victims (SD = 5.65). Compared to the non-victim group (p < .002), all three victim groups reported moderately high levels of traumatic stress symptomology (see Table 3). Though significantly greater than the non- victim group, victim group comparisons did not vary significantly. Social Avoidance and Distress Scale Scores ranged from 0 to 12 for the sample. The victim group (all 3 victim groups combined) had a mean of 13.96 (SD = 2.23) and the non-victim group had a mean of 13.85 (SD = 1.75). There were also no differences between the three victim groups. All groups reported similar levels of social anxiety and group scores did not approach the maximum score. CSQ-8 Overall the groups had mean scores above the midpoint of 20 on a scale of 8 to 32 (Mean = 22.33; SD = 7.00). Over 70 % of the participants responded above 20 on satisfaction with EDM services. Mean and standard deviations for each group are presented in Table 4. Group 1 reported higher satisfaction than the other groups. Groups 2 and 3 satisfaction scores did not vary. 198 Victim Perspective Table 3 Mean and Standard Deviations of Impact of Event Scale-Revised (IES-R) Subscales and Social Avoidance and Distress Scale (SAD) Level of Intrusion Avoidance Hyperarousal SAD Group N Subscale Subscale Subscale Mean SD Mean SD Mean SD Mean SD Group 1 7 15.71 6.26 16.85 6.87 14.43 4.99 13.71 1.50 Group 2 10 15.80 7.54 16.40 6.54 15.30 5.79 14.50 1.78 Group 3 10 15.70 6.85 16.50 7.32 12.90 6.54 13.20 1.87 Non-victims 24 8.03 2.28 8.92 1.79 8.25 2.15 14.00 2.19 Note. Group 1 = less than 3 month category, Group 2 = 3 to 6 months category and Group 3 = 7 to 12 months category. Table 4 Mean and Standard Deviations for Client Satisfaction Questionnaire (CSQ-8) Level of N CSQ-8 Group Mean SD Minimum Maximum Group 1 7 25.00 8.756 10 32 Group 2 10 21.70 3.561 14 27 Group 3 10 21.10 8.373 8 32 Total 27 22.33 7.000 8 32 CSQ-8 Note. Group 1 = less than 3 month category, Group 2 = 3 to 6 months category and Group 3 = 7 to 12 months category. Jones 199 Open-ended Questions A summary of the qualitative findings suggest that victims of a bank robbery feel as though they have something important to say about the recovery process. The first qualitative question asking the victims to describe the experience received only 11 responses; only 40.7% of the victims chose to write about their robbery experience. In contrast, 24 (88.8%) of the responded to the two remaining questions that focused on recovery issues. Among victims who chose to respond to Question 1, the most common description of the experience was that it was frightening (63.6%; 7 out of 11). For Question 2, about how life has changed, many victims felt the robbery had made them more cautious, alert, suspicious and watchful (79.1%; 19 out of 24). Finally, the majority of the victims indicated that offering EDM following the robbery and talking about the experience during EDM assisted in their recovery (79.1%; 19 out of 24). Group Differences in Open-Ended Question Responses Different themes appeared for the open-ended responses for the various times in each victim group. When asked to describe the experience most of the respondents in all the groups chose not to respond to this question. All three Group 1 respondents focused on describing the experience from a personal perspective, focusing on their feelings, being frightened or angry. The three Group 2 participants that responded focused on the facts of the robbery act, discussing what happened during the robbery. In the Group 3, there was only one participant who chose to respond, focusing on both feelings and details of the robbery, feeling “frightened as she lay on the floor during the robbery.” With respect to question 2, what difference had the robbery made in their life, of the three Group 1 participants who responded, one focused on feelings of fear, another on a renewed appreciation for life, and the third stated that the robbery experience made no difference. Nine of the ten Group 2 participants responded to this question. Two respondents reported that little or no difference was made, but the remaining seven participants seemed to reflect a heightened sense of awareness and cautiousness in their responses. For instance, “I look at customers more closely...I look at each one of them as a potential robber;” “I try to be more observant,” “The robbery has made me more suspicious of others and a little more ‘on edge’.” All ten participants in Group 3 responded. Two reported that that the robbery made little or no difference in their lives. The remaining eight participants focused on feelings of fear and paranoia. One wrote, “I look around more before I get out of my car and before I walk to the bank door.” Another said, “I am a totally changed person…I am somewhat paranoid and extremely scared.” A third responded, “I feel more aware of each person that comes into my work place. It is an experience I will never forget.” Finally, with respect to question 3 concerning what helped in their recovery, five of the seven Group 1 participants responded. All five reported that talking about the incident helped them. Two added that learning their feelings was a normal response to trauma reassured them that they were not “going crazy.” One Group 2 participant did not respond to this question. Three others reported nothing they did nor any assistance they received was helpful. Another stated, “I don’t believe that the reason I recovered is because of assistance. I think it is merely a question of time.” The remaining five participants felt that the social support they received and knowledge that others had 200 Victim Perspective similar emotional reactions helped them in their recover. Three Group 3 participants said “nothing” helped in their recovery. One other commented, “I failed to make appointments to seek help. I paid / am paying for that dearly.” Two others reported that simply knowing someone was available to talk with helped in their recovery. The remaining four participants expressed the importance of social support in their recovery. Discussion Very little research has been directed toward understanding trauma associated with either bank robberies or workplace trauma in general. The unique aspect of workplace trauma concerns the possibility of significant personal harm where daily safety issues are generally not an issue. Moreover, victims of bank robberies often continue functioning in the environment in which the trauma occurred. This might help account for the persistence of stress-related trauma symptoms reported by victims in this study, even when victims received debriefing and otherwise had social support available to them. Victims in all groups reported moderately high levels of trauma exposure as well as trauma-related stress symptoms. This confirms earlier findings of persistence of symptomology after a year (e.g., Tunnecliffe & Green, 1986) and suggests that the recovery process requires more than one debriefing session following the robbery event. There was no difference among the groups on the SAD. This suggests that trauma due to their bank robbery experience did not affect their general social anxiety. The victim groups reported social avoidant behaviors similar to those in the non-victim group. However, the qualitative data indicated that anxiety about interacting with customers did arise after the robbery. This suggests an increase in their workplace anxiety. There were interesting differences between the groups with respect to the qualitative questions asked. Group 1 participants were more satisfied with the debriefing than participants in the other groups. This finding may be due to the fact that they had experienced the trauma and the debriefing recently. Perhaps they were more focused on having survived the trauma as opposed to daily safety issues. In addition, the permanency of possible long-term symptomolgy had not had time to manifest. Group 1 tended to focus on their personal perspective and feelings when describing the experience. The participants felt the robbery had made them more fearful or appreciative of life and thought that what helped with the recovery process was talking about it or knowing that what they felt was normal. Group 2 participants were less satisfied with the intervention and focused more on the facts and details of the robbery when asked to describe the experience. These participants felt the robbery had made them more aware and cautious of their surroundings. They felt that either social support or sharing their feelings with the group was helpful. The Group 2 responses were in sharp contrast to the Group 1 responses. Group 3 respondents were also less satisfied with the intervention and also focused on feelings and facts about the robbery when describing the experience. These participants indicated that the robbery has made them more fearful and paranoid. In terms of recovery, several mentioned the importance of having social support and knowing that there were professionals available. This is consistent with Leymann and Lindell (1990) who reported that social support for armed robbery victims is crucial in reducing post-trauma distress. Jones 201 In general, participants became less satisfied with enhanced debriefing as a function of time since initial trauma and debriefing. Moreover, employees in the long- term victim group (over 6 mos.) continued to be symptomatic; all groups reported similar trauma-related stress symptoms. Actual recovery time following work-related trauma may require more than three months and perhaps even more than 12 months. In work- place trauma, the victims return to the scene of the crime on a daily basis. This may help explain why trauma-related symptomolgy persisted for even the 6 month post-trauma group. Repeated and continued exposure to the trauma context may trigger or enhance their feelings of fear and paranoia and thus interfere with the recovery process. Implications for Practice The qualitative findings suggest that both enhanced debriefing and the bank organization provided some victims with valuable support for their recovery. The fact that the debriefing discussion was able to enlighten the victims about the recovery process, allow them to share their experiences, and help them begin to rebuild support indicates that these aspects of enhanced debriefing was valuable for some victims. Group1 respondents were most satisfied with enhanced debriefing. The other participants may have been less satisfied with enhanced debriefing because they wanted or needed follow-up sessions. The qualitative remarks and evidence that the trauma symptoms continued to remain months following the robbery suggests that follow-up educational and therapeutic intervention was necessary. Overall, victim employees continued to attend work on a consistent basis, reported minimal levels of general social anxiety, and their ability to interact and function at work was not affected to a debilitating degree. Enhanced debriefing may have helped some to stabilize their functioning level and regain their daily work activities, but longer- term trauma symptoms persisted. Enhanced debriefing includes preparation of key players in the workplace before trauma occurs. In addition, enhanced debriefing encourages victims to process their feelings with others and thus help them transition to a normal daily routine. This view suggests that trauma recovery may involve different dimensions and that enhanced debriefing may be best suited to help individuals make the transition from the traumatic event to group stability and functioning. It may not, however, be particularly useful in eliminating trauma symptoms. Though enhanced debriefing was beneficial to most victims in the days following the bank robbery, this single session debriefing did not ameliorate longer term symptomology. Perhaps there should be shift in how trauma recovery is considered, such that it is expected that some victims may need more recovery time and/or therapeutic intervention. Follow-up sessions up to a year or more subsequent to the trauma may be necessary for some. The findings also suggest that some of the instruments used did not capture other aspects of trauma that victims experienced. It is apparent from the qualitative responses that the victims did have a variety of reactions from the robbery and that the robbery had made some difference in their life, yet the quantitative instruments were not sensitive enough to measure these differences. The value of victim perspective and feedback about the trauma and their recovery process could enhance future instrument development. 202 Victim Perspective Conclusion Despite the relatively small sample, this study has provided insight into the recovery process of bank robbery victims, especially with respect to the persistence of symptoms over time. To foster a more informed view of evidence-based practice, this study sought to deconstruct the psychological debriefing process and provide an opportunity to explore the victim’s perspective of recovery. Avery, King, Bretherton, and Orner (1999) suggest that the notion of intervention immediately following exposure to a traumatic event may be inappropriate. These authors suggest that, rather than symptom change, an outcome focusing on the quality of the recovery environment may be a more appropriate goal for debriefing interventions. With the prevalence of trauma, the demand for debriefing techniques that apply to workplace trauma will not diminish. While the EDM addresses the recovery environment through social support and managerial support, continued efforts must be made to explore what can be done to provide victims with immediate and longer term assistance in dealing with traumatic events that may be unique to workplace trauma. This is especially important given the continued controversy concerning the effectiveness of debriefing techniques (Deahl, Gillham, Thomas, Searle, & Srinivasan, 1994; Raphael, Meldrum, & McFarlane, 1995). References American Psychology Association. (1994). The diagnostic and statistical manual of mental disorders (DSM-IV) (4th ed.). Washington, D.C.: American Psychology Association. Avery, A., King, S., Bretherton, R., & Orner, R. (1999, Spring). Deconstructing psychological debriefing and the emergence of calls for evidence-based practice. Traumatic Stress Points, 13 (2), 6-8. Bamber, M.(1992). Debriefing victims of violence. Occupational Health, 44(4), 115- 117. Bergmann, L. H. & Queen, T. (1988a, October). Maintaining posttrauma programs. Fire Engineering, 73-75. Bergmann, L. H. & Queen, T. (1988b, August). Posttrauma response programs. Fire Engineering, 89-91. Deahl, M., Gillham, A. B., Thomas, J., Searle, M. M., & Srinivasan, M. (1994). Psychological sequelae following the Gulf war: Factors associated with subsequent morbidity and the effectiveness of psychological debriefing. British Journal of Psychiatry, 165, 60-65. Dunning, C. (1988). Intervention strategies for emergency workers. In M. Lystad (Ed.), Mental health responses to mass emergencies (pp.284-307). New York: Brunner/Mazel. Fischer, J. & Corcoran, K.(1996). Measures for clinical practice. New York: The Free Press. Harrison, C. A. & Kinner, S. A. (1998). Correlates of psychological distress following armed robbery. Journal of Traumatic Stress, 11, 787-798. Hobfoll, S. E. (1988). The ecology of stress. Washington, DC: Hemisphere Publishing. Horowitz, M. J., Field, N. P., & Classen, C. C. (1993). Stress response syndromes and their treatment. In L. Goldberger & S. Breznitz (Eds.), Handbook of stress (2nd Jones 203 ed.), (pp. 757-774). New York: Free Press. Horowitz, M. J., Wilner, N., & Alvarez, W. (1979). Impact of event scale: A measure of subjective stress. Psychosomatic Medicine, 41, 209-218. House, S. J. (1981). Work stress and social support. Reading, Massachusetts: Addison- Wesley Publishing Company. Larsen, D. L., Attkisson, C. C., Hargreaves, W. A., & Nguyen, T. D. (1979). Assessment of client/patient satisfaction: Development of a general scale. Evaluation and Program Planning, 2,197-207. Lewis, G. (1993). Managing crisis and trauma in the workplace: How to respond and intervene. AAOHN Journal, 41(3), 124-130. Leymann, H. (1985). Somatic psychological symptoms after the experience of life threatening events: A profile analysis. Victimology: An International Journal, 10 (1-4), 512-538. Leymann, H. & Lindell, J. (1990). Social support after armed robbery in the workplace. In E. C. Viano (Ed.), The victimology handbook: Research findings, treatment, and public policy (pp.76-95). New York: Garland. Lyons, J. A. (1991). Strategies for assessing the potential for positive adjustment following trauma. Journal of Traumatic Stress, 4, 93-111. Mitchell, J. T. (1983). When disaster strikes...The critical incident stress debriefing process. Journal of Emergency Medical Services, 8, 36-39. Mitchell, J. T, & Dyregrov, A. (1993). Traumatic stress in disaster workers and emergency personnel: Prevention and intervention. In J. P. Wilson, & B. Raphael (Eds.), International handbook of traumatic stress syndromes (pp. 905-914). New York: Plenum. McFarlane, A. C. (1992). Avoidance and intrusion in posttraumatic stress disorder. Journal of Nervous and Mental Disease, 180 (7), 439-445. Newman, E., Kaloupek D. G., & Keane, T. M. (1996). Assessment of Posttraumatic Stress Disorder in clinical and research settings. In B. A. van der Kolk, A. C. McFarlane, & L. Weisaeth (Eds.), Traumatic stress: The effects of overwhelming experience on mind, body, and society (pp. 242-275). New York: Guilford Press. Raphael, B., Meldrum, L., & McFarlane, A. C. (1995). Does debriefing after psychological trauma work? British Medical Journal, 310, 1479-1480. Raphael, B., Wilson, J., Meldrum, L., & McFarlane, A. C. (1996). Acute Preventive interventions. In B. A. van der Kolk, A. C. McFarlane, & L. Weisaeth (Eds.), Traumatic stress: The effects of overwhelming experience on mind, body, and society (pp. 463-477). New York: Guilford Press. Rose, S. & Bisson, J. (1998). Brief early psychological interventions following trauma: A systematic review of the literature. Journal of Traumatic Stress, 11, 697-709. Smith, S. M., & Vela, E. (2001). Environmental context-dependent memory: A review and meta-analysis. Psychonomic Bulletin and Review, 8(2), 203-220. Susser, E. S., Herman, D. B., & Aaron, B. (August, 2002). Taking the terror out of terrorism. Scientific American, 72-77. Tunnecliffe, M. R. & Green, S. (1986). Trauma in the workplace: Dealing with stress reactions after armed robbery hold-ups. In D. Morrison, L. Hartley, & D. Kemp (Eds.), Trends in the ergonomics of work. (Proceedings of the 23rd annual conference o the ergonomics society of Australia and New Zealand). Carlton, 204 Victim Perspective Victoria: Ergonomics Society of Australia and New Zealand. Wakefield, H. (1993, Dec.) Get ready for some workplace violence. Australian Business Monthly, 130-131. Watson, D. & Friend, R. (1969). Measurement of social-evaluation anxiety. Journal of Consulting and Clinical Psychology, 33, 448-457. Zilberg, N. J., Weiss, D. S., & Horowitz, M. J. (1982). Impact of event scale: A cross- validation study and some empirical evidence supporting a conceptual model of stress response syndromes. Journal of Consulting and Clinical Psychology, 50, 407-414. Footnote 1 Larry Bergmann is Director of Post-Trauma Research Center in Columbia, South Carolina.
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