PART III - Section 6
Keep in mind that none of the information provided in this section should take the place of specialized training in the field.
Critical Incident Stress Management (CISM) represents an integrated system of services and procedures whose purpose is to achieve several goals:
A CISM team, generally comprised of mental health professionals and trained peer support personnel, provides a variety of services including:
For the purposes of this discussion, the focus will be on two of the more commonly used CISM services: debriefings and defusings.
The impact of a critical incident on an individual's life appears to be mitigated, to some degree, by the availability of resources that may intervene at various stages following the incident.
The Critical Incident Stress Debriefing (CISD) is a model designed to yield just such a result. The CISD model assists the victims of critical incidents with their recovery process. The model incorporates seven phases:
Debriefings are group meetings that are designed to give participants an opportunity to discuss their thoughts and feelings about a distressing event in a controlled and rational manner, and to help them understand that they are not alone in their reactions to the incident. It is recommended that a formal debriefing be held within 24 to 72 hours after an incident. Depending on the number of participants and the severity of the incident, debriefings generally last anywhere from one to three hours.
Given the time recommendations for debriefings and defusings, Critical Incident Stress Management (CISM) providers are reminded that CISM interventions should not interfere with the priorities of criminal investigations. In those cases where criminal proceedings are likely to result from the critical incident, it is important to coordinate CISM interventions with the appropriate prosecutory authority.
Debriefing teams represent a partnership between mental health professionals and peer support personnel. Mental health professionals serving on a Critical Incident Stress Debriefing team possess at least a master's degree in psychology, social work, psychiatric nursing, psychiatry, or mental health counseling. Peer support personnel are trained and prepared to work with mental health professionals in preventing and mitigating the negative impact of acute stress on their fellow workers. All team members receive training in crisis intervention, stress, post-traumatic stress disorder, and the debriefing process.
The following is a brief description of each phase of the debriefing model:
During this first phase the leader and team members introduce themselves to the participants. The leader describes how a debriefing works and lists the ground rules for the debriefing. The rules are as follows:
It is important to convey to participants that their chances for a successful debriefing increase when participants are made fully aware of what to expect during the process.
The fact phase begins with the team leader asking participants to identify themselves and briefly mention their degree of involvement with the incident. For example, participants may relate their role in the incident, how they were informed of the incident, where they were when they received this news, and so forth. Participants may begin relating their first reactions to the incident. This type of information lays the groundwork for the remaining phases of the process.
Participants are asked what their first thoughts were concerning the incident. The thought phase begins to personalize the experience for the participants. This is the first phase in which some participants may exhibit some reluctance to share.
Participants are asked to discuss "what was the worst part of the event for them, personally." This phase generally causes participants to begin exploring some of their deeper, personal responses to the event. Depending on the intensity of the event and the number of participants, this segment may last thirty minutes to one hour.
Participants are asked to describe the signs and symptoms of any distress they experienced, such as feeling nauseated, sweating palms, or having difficulty making decisions. Usually three occurrences of signs and symptoms are discussed:
During the teaching phase the leader and team members share information regarding the relationship between the critical incident and the subsequent cognitive, emotional, behavioral, and physiological reactions that others involved in such events have experienced. Participants are provided with a handout entitled "Critical Stress Information Sheet." During this phase, participants may ask new questions or bring up information that was not discussed earlier.
This phase signals the end of the debriefing. Participants are encouraged to ask questions and explore other issues associated with the incident that may have not surfaced earlier. Team members are asked to provide some summary remarks, and the team leader makes a few additional statements in an effort to bring closure to the debriefing. A crucial message emanating from the debriefing is that the participants' reactions are normal responses to an abnormal event.
Is a Debriefing Warranted?
The decision about whether or not a formal debriefing is consultation with mental health consultants. Though not all-inclusive, some examples of important questions to explore when assessing the need for a debriefing are these:
In some instances, as these and other questions are explored, it may be determined that a formal debriefing is not warranted. Or, perhaps there may be a decision to briefly meet with the group(s) that have been affected by the incidents to further assess the need for a formal debriefing. Under these circumstances, a critical incident stress defusing may be appropriate. This process will be discussed next.
Other than the critical incident stress debriefing, the defusing is one of the most frequently used Critical Incident Stress Management (CISM) techniques. Defusings are, in essence, short debriefings. Defusings generally last less than one hour and provide CISM team members with an immediate opportunity to ask a wide range of questions about the critical incident. As in the debriefing, participants are not required to talk during the defusing. It is recommended that defusings be conducted within the first eight hours of the resolution of a traumatic event.
The critical incident stress defusing consists of three phases.
Introduction. Here the CISM team members introduce themselves, describe the defusing process, set forth the guidelines, and encourage participation.
Exploration. In this segment, team members ask the participants to describe their experience of the critical incident. During this time, the group is permitted to talk freely while the team members monitor the participants' comments. As the group discusses their experiences, the team members can also ask appropriate questions in an effort to learn more about the most important parts of the critical incident. As the discussion begins to fall off, the discussion moves to the third and final phase.
Information. During this phase, team members provide participants with information designed to help them cope during the next few days until the distress resolves on its own or until the team can organize a formal debriefing, if one is deemed necessary. This information consists of suggestions regarding rest, diet, and exercise as well as other stress control strategies.
The critical incident stress defusing will generally result in one of two outcomes. First, it may eliminate the need for a formal debriefing. Participants receive valuable coping information during defusing that, if attended to, can go a long way in mitigating the impact of the critical incident and in accelerating their recovery. In addition, participants come away from a defusing with more information about the incident than they started with and, again, this has proven to be beneficial to the recovery process.
The second possible outcome of a defusing can be to enhance a subsequent formal debriefing. Participants who have attended a defusing will generally have a good idea of what to expect in a debriefing and, hopefully, will have realized the benefit of participating in such a group process. In addition, the team that conducts the defusing will often be part of the larger team that conducts the debriefing. Thus this Critical Incident Stress Management (CISM) team will have more information about the incident and the involved parties prior to the debriefing. The team will also have a better understanding of the impact of the event on many of the participants.
As mentioned earlier, both critical incident stress debriefing and defusing are among the two most utilized processes under the CISM umbrella. Neither model should be employed by anyone other than trained mental health professionals and other trained CISM team personnel. It should also be emphasized that the CISM process is but one crisis intervention model among others available to Federal agencies.
Case Study 1 provides practical examples of some of the issues discussed in this section.
13 This information is adapted from the following documents: Everly, G. & Mitchell, J. (1995) Critical Incident Stress Debriefing: An Operations Manual for the Prevention of Traumatic Stress Among Emergency Services and Disaster Workers, Ellicott City, Maryland: Chevron Publishing Corporation.
Mitchell, Jeffrey T. (1995) Essentials of Critical Incident Stress Management. In G. Everly (Ed.) Innovations in Disaster and Trauma Psychology, Volume One: Applications in Emergency Services and Disaster Response, Ellicott City, Maryland: Chevron Publishing Corporation, 79-81.