Critical incident stress debriefing

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Critical incident stress debriefing (CISD) is a form of psychological debriefing that features a specific structure and format, which were developed to address critical incident stress experienced by emergency service workers. [1] It was developed by Jeffrey Mitchell and is considered the most widely used today. [1]

Contents

Components

It operates using the following three components: pre-incident functions, on-scene support services, and post-incident interventions. [2] Pre-incident functions refers to the education and coping mechanisms taught to those who are more vulnerable to traumatization before they enter combat. On-scene support services entails brief discussions and unstructured therapy sessions that occur within a few hours of an incident that may cause high stress responses in soldiers. Finally, post-incident interventions occur usually at least 24 hours after an incident to give the soldiers a bit more time to deescalate from a having high stress response to that incident. The process is peer-driven but backed up by a group of professional counselors. [3]

Evidence for use

Critical incident stress debriefing (CISD) is a controversial component of CISM, and research suggests it may cause harm. [4] [5] [6] [7] The International Critical Incident Stress Foundation rejects these claims, writing that "There is no extant evidence to argue that the “Mitchell model” CISD, or the CISM system, has proven harmful! The investigations that are frequently cited to suggest such an adverse effect simply did not use the CISD or CISM system as prescribed, a fact that is too often ignored". [8]

Format and timing

ICISF specifies that defusings and debriefings are only intended for use with groups. [9] The individual intervention technique used in CISM is a version of psychological first aid. [10] A literature review concluded that a primary flaw in criticism of CISM is "the lack of consistent terminology," which has led investigators to evaluate distinct interventions as if they were identical, and to use variable outcome measures, making it difficult to compare outcomes across different studies. The review authors concluded that CISM "should continue to be offered to secondary victims of trauma." [11]

For teams, group debriefings are suggested 48–72 hours after a critical incident giving the group an opportunity to support each other by talk about their experience, how it has affected them, brainstorm coping mechanisms, identify individuals at risk, and inform the individual or group about services available to them in their community. [12] The final step was to follow up with them the day after the debriefing to ensure that they are safe and coping well or to refer the individual for professional counselling. CISM protocols clearly state that no one should ever be pressured or coerced to speak, contrary to some of the criticisms offered (e.g., one firefighter's account of CISM properly offered [13] ).

Although many co-opted the debriefing process for use with other groups, the primary focus in the field of CISM was to support staff members of organizations or members of communities which have experienced a traumatic event.

Steps

The debriefing process (defined by the International Critical Incident Stress Foundation [ICISF]) has seven steps: introduction of intervenor and establishment of guidelines and invites participants to introduce themselves (while attendance at a debriefing may be mandatory, participation is not); details of the event given from individual perspectives; emotional responses given subjectively; personal reaction and actions; followed again by a discussion of symptoms exhibited since the event; instruction phase where the team discusses the symptoms and assures participants that any symptoms (if they have any at all) are a normal reaction to an abnormal event and "generally" these symptoms will diminish with time and self-care; following a brief period of shared informal discussion (generally over a beverage and treat) resumption of duty where individuals are returned to their normal tasks. The intervenor is always watching for individuals who are not coping well and additional assistance is offered at the conclusion of the process. [14]

Related Research Articles

Post-traumatic stress disorder (PTSD) is a mental and behavioral disorder that develops from experiencing a traumatic event, such as sexual assault, warfare, traffic collisions, child abuse, domestic violence, or other threats on a person's life or well-being. Symptoms may include disturbing thoughts, feelings, or dreams related to the events, mental or physical distress to trauma-related cues, attempts to avoid trauma-related cues, alterations in the way a person thinks and feels, and an increase in the fight-or-flight response. These symptoms last for more than a month after the event and can include triggers such as misophonia. Young children are less likely to show distress, but instead may express their memories through play. A person with PTSD is at a higher risk of suicide and intentional self-harm.

Psychological trauma is an emotional response caused by severe distressing events, such as bodily injury, sexual violence, or other threats to the life of the subject or their loved ones; indirect exposure, such as from watching television news, may be extremely distressing and can produce an involuntary and possibly overwhelming physiological stress response, but does not always produce trauma per se. Examples of distressing events include violence, rape, or a terrorist attack.

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Complex post-traumatic stress disorder is a stress-related mental and behavioral disorder generally occurring in response to complex traumas.

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Compassion fatigue is an evolving concept in the field of traumatology. The term has been used interchangeably with secondary traumatic stress (STS), which is sometimes simply described as the negative cost of caring. Secondary traumatic stress is the term commonly employed in academic literature, although recent assessments have identified certain distinctions between compassion fatigue and secondary traumatic stress (STS).

Critical incident stress management (CISM) is a system of support for individuals and groups who have been exposed to trauma. It is a form of psychological first aid. It includes pre-incident preparedness and acute crisis management through post-crisis follow-up. The purpose of CISM is to decrease the severity of symptoms of post-traumatic stress disorder developing after a crisis.

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Debriefing is a report of a mission or project or the information so obtained. It is a structured process following an exercise or event that reviews the actions taken. As a technical term, it implies a specific and active intervention process that has developed with more formal meanings such as operational debriefing. It is classified into different types, which include military, experiential, and psychological debriefing, among others.

Crisis intervention is a time-limited intervention with a specific psychotherapeutic approach to immediately stabilize those in crisis.

Incident stress is a condition caused by acute stress which overwhelms a staff person trained to deal with critical incidents such as within the line of duty for first responders, EMTs, and other similar personnel. If not recognized and treated at onset, incident stress can lead to more serious effects of posttraumatic stress disorder.

Vicarious trauma (VT) is a term invented by Irene Lisa McCann and Laurie Anne Pearlman that is used to describe how work with traumatized clients affects trauma therapists. The phenomenon had been known as secondary traumatic stress, a term coined by Charles Figley. In vicarious trauma, the therapist experiences a profound worldview change and is permanently altered by empathetic bonding with a client. This change is thought to have three requirements: empathic engagement and exposure to graphic, traumatizing material; exposure to human cruelty; and the reenactment of trauma in therapy. This can produce changes in a therapist's spirituality, worldview, and self-identity.

PTSD or post-traumatic stress disorder, is a psychiatric disorder characterised by intrusive thoughts and memories, dreams or flashbacks of the event; avoidance of people, places and activities that remind the individual of the event; ongoing negative beliefs about oneself or the world, mood changes and persistent feelings of anger, guilt or fear; alterations in arousal such as increased irritability, angry outbursts, being hypervigilant, or having difficulty with concentration and sleep.

Childbirth-related post-traumatic stress disorder is a psychological disorder that can develop in women who have recently given birth. This disorder can also affect men or partners who have observed a difficult birth. Its symptoms are not distinct from post-traumatic stress disorder (PTSD). It may also be called post-traumatic stress disorder following childbirth (PTSD-FC).

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Trauma risk management (TRiM) is a method of secondary PTSD prevention. The TRiM process enables non-healthcare staff to monitor and manage colleagues. TRiM training provides practitioners with a background understanding of psychological trauma and its effects.

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References

  1. 1 2 Raphael, Beverley; Wilson, John (2000). Psychological Debriefing: Theory, Practice and Evidence. Cambridge: Cambridge University Press. p. 2. ISBN   978-0-521-64700-7.
  2. ↑ Adler, Amy B.; Castro, Carl Andrew; McGurk, Dennis (January 2009). "Time-Driven Battlemind Psychological Debriefing: A Group-Level Early Intervention in Combat". Military Medicine. 174 (1): 021–028. doi: 10.7205/MILMED-D-00-2208 . ISSN   0026-4075. PMID   19216294.
  3. ↑ Thurmond, Strom (1998). The Practices and Procedures of the Investigating Services of the Department of Defense and the Military Departments Concerning the Investigations Into the Deaths of Military Personnel Which May Have Resulted from Self-Inflicted Causes. Washington, D.C.: DIANE Publishing. p. 148. ISBN   978-0-7881-4236-9.
  4. ↑ Carlier IV, Voerman AE, Gersons BP (March 2000). "The influence of occupational debriefing on post-traumatic stress symptomatology in traumatized police officers". The British Journal of Medical Psychology. 73 (Pt 1): 87–98. doi:10.1348/000711200160327. PMID   10759053.
  5. ↑ van Emmerik AA, Kamphuis JH, Hulsbosch AM, Emmelkamp PM (September 2002). "Single session debriefing after psychological trauma: a meta-analysis". Lancet. 360 (9335): 766–771. doi:10.1016/S0140-6736(02)09897-5. PMID   12241834. S2CID   8177617.
  6. ↑ Carlier IVE, Lamberts RD, van Ulchelen AJ, Gersons BPR (1998). "Disaster-related post-traumatic stress in police officers: A field study of the impact of debriefing". Stress Medicine. 14 (3): 143–148. doi:10.1002/(sici)1099-1700(199807)14:3<143::aid-smi770>3.3.co;2-j.
  7. ↑ Rose S, Brewin CR, Andrews B, Kirk M (July 1999). "A randomized controlled trial of individual psychological debriefing for victims of violent crime". Psychological Medicine. 29 (4): 793–799. doi:10.1017/s0033291799008624. PMID   10473306. S2CID   35346492.
  8. ↑ "A Primer on Critical Incident Stress Management (Cism) - Icisf".
  9. ↑ "A Primer on Critical Incident Stress Management".
  10. ↑ "Assisting Individuals in Crisis - ICISF".
  11. ↑ "Is Critical Incident Stress Management Effective?" (PDF).
  12. ↑ "Critical Incident Stress Management". Corrective Service of Canada. Archived from the original on September 27, 2009. Retrieved July 16, 2009.
  13. ↑ "CISM and Peer Support: My Thoughts - ICISF".
  14. ↑ Pulley SA (March 21, 2005). "Critical Incident Stress Management". eMedicine. Archived from the original on August 11, 2006. Retrieved July 16, 2009.
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