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²¹The evidence is well summarised by Lishman (Lishman, W.A. Organic psychiatry. The psychological consequences of cerebral disorder, Oxford:Blackwell Science, 1998).

²²The often vigorous assertions about psychological causes of late whiplash have not been supported by any recent evidence. Late whiplash appears to be a consistent physical syndrome with some physical correlates in which pain rather than psychological disorder is a primary factor. Prospective studies have failed to identify early psychological predictors of the occurrence of pain although it is likely that the usual psychological variables are determinants of the severity of disability (Mayou, R. and Bryant, B. Outcome of "whiplash" neck injury. Injury 27:9:617-623, 1996; 2014; Radanov, B.P., Di Stefano, G., Schnidrig, A., and Sturzenegger, M. Common whiplash - psychosomatic or somatopsychic? Journal of Neurology, Neurosurgery, and Psychiatry 57:486-490, 1994).

²³ Swartzman, L.C., Teasell, R.W., Shapiro, A.P., and McDermid, A.J. The effect of litigation status on adjustment to whiplash injury. Spine 21:1:53-58, 1996.

²⁴Debriefing has been advocated for many years following combat and other forms of trauma. There have been few systematic evaluations and those that have been published suggest that it does not have any benefit in preventing the occurrence of later post-traumatic or other psychiatric complications. It is possible that it is associated with a worse outcome (Hobbs, M., Mayou, R., Harrison, B., and Worlock, P. A randomised controlled trial of psychological debriefing for victims of road traffic accidents. Br.Med.J. 313:1438-1439, 1996; Hobbs, M. and Adshead, G. Preventive psychological intervention for road crash survivors. In: The aftermath of road accidents: psychological, social and legal consequences of an everyday trauma, edited by Mitchell, M.London: Routledge, 1997). Whilst the published evidence is modest, there remains a widely held view amongst those involved in treatment that it is a valuable approach.

²⁵Phobic anxiety, especially if specific, responds well to behavioural and cognitive behavioural treatment. Such treatments have been widely practised and extensively evaluated. They combine behavioural techniques (graded practice and