Psychological interventions following terrorist attacks.

BACKGROUND Psychological reactions to terror attacks have been documented as ranging from no symptoms to transient behavioural symptoms to more serious posttraumatic stress. SOURCES OF DATA A review of representative studies is presented, with a critical analysis of the salient points of the various psychological intervention strategies for terrorist attacks. AREAS OF AGREEMENT Common aspects of both most intervention approaches include multifaceted models that foster social support and include a preparatory phase, a phase of 'psychological first aid' and a follow-up phase of referral for more severe cases. AREAS OF CONTROVERSY The notion of intervention for all who may show some symptoms is not universally accepted. Where treatment or intervention is used, the debriefing aspect of CISM (Critical Incident Stress Management) remains highly disputed, with the focus on intrusively revisiting the trauma appearing to have questionable value at best. GROWING POINTS Some data questions whether formal treatment or intervention is necessary or even desirable. For many who choose not to seek out any help following a trauma, clinical data shows no negative results. Moreover, the preponderance of data shows that conventional 'debriefing' is not recommended. If the debriefing mechanism is refined so that intrusive emotional rehashing of the traumatic event is eliminated, the resultant interventions resemble resilience based approaches. AREAS TIMELY FOR DEVELOPING RESEARCH Further defining when intervention is called for and refining the mechanisms of intervention in multi-stage intervention.