Critical Incident Stress Debriefing

Critical incident stress debriefing (CISD) is a specific, seven-phase, small-group crisis intervention technique. It is a structured discussion of a significant traumatic event, commonly referred to as a critical incident. A critical incident stress debriefing is a supportive crisis-focused tool that is employed by a specially trained crisis intervention team after a small, homogeneous group has encountered a disturbing traumatic experience.

The Nature of Critical Incident Stress Debriefing

Perspective

A critical incident stress debriefing is not a form of psychotherapy, nor does it constitute a substitute for psychotherapy. Instead, it is small group “psychological first aid.” The primary emphasis in a critical incident stress debriefing is to inform and empower a homogeneous group after a threatening or overwhelming traumatic situation. A CISD attempts to enhance resistance to stress reactions, build resiliency, and facilitate both a recovery from traumatic stress and a return to normal, healthy functions.

A critical incident stress debriefing is one of many crisis intervention techniques within a larger, comprehensive, integrated, systematic, and multicomponent crisis intervention program known as critical incident stress management. The critical incident stress debriefing is not a stand-alone process, and it is only employed within a package of crisis intervention processes under the critical incident stress management umbrella. A CISD should be linked and blended with numerous crisis support services including, but not limited to, preincident education; individual crisis intervention; family support services; follow-up services; referrals for professional care, if necessary; and postincident education programs. Its best effects, which are enhanced group cohesion and performance, are always achieved when it is part of a broader crisis support system.

Historical Synopsis

Critical incident stress debriefing was developed by Jeffrey T. Mitchell in 1974 for use with small homogeneous groups of paramedics, firefighters, and law enforcement officers who were distressed by an exposure to some particularly gruesome event. It is firmly rooted in the crisis intervention and group theory and practice of such notables as Thomas Salmon, Eric Lindemann, Gerald Caplan, Howard Parad, Lillian Rapoport, Norman Faberow, Calvin Frederick and Irving Yalom. The first article on CISD appeared in 1983.

Over time, the use of critical incident stress debriefing spread to other groups outside of the emergency services professions. The military services, airlines, and railroads find the process helpful, particularly when it is combined and linked to other crisis intervention processes. Businesses, industries, hospitals, schools, churches, and community groups eventually adopted the critical incident stress debriefing model as an integral part of their crisis support programs.

Objectives

A critical incident stress debriefing has three main objectives. The first is the mitigation of the impact of a traumatic incident. The second is the facilitation of the normal recovery processes in psychologically healthy people who are distressed by an unusually disturbing event. Third, a CISD functions as a screening opportunity to identify group members who might benefit from additional support services or a referral for professional care.

Conditions

The critical incident stress debriefing requires the following conditions: (1) the small group (about 20 people) must be homogeneous, not heterogeneous; (2) the group members must not be currently involved in the situation (i.e., their involvement is complete or the situation has moved past the most acute stages); (3) the group members should have had about the same level of exposure to the experience; (4) the group members should be psychologically ready and not so fatigued or distraught that they cannot participate in the discussion.

The Intervention Team

A critical incident stress debriefing relies on a team approach. Several team members work together to conduct a CISD. One team member is required for every five to seven participants. A unique feature of

CISD is that Critical Incident Stress Management-trained peer support personnel (firefighters, paramedics, police officers, military personnel, etc.) work with a mental health professional when providing CISDs to personnel from law enforcement, fire service, emergency medical, military, medical, aviation, and other specialized professions.

The Critical Incident Stress Debriefing Process

Timing

The critical incident stress debriefing is often not the first intervention to follow a critical incident. A brief group informational process may have taken place, and distressed individuals may have been supported individually. Typically, 24 to 72 hours after the incident, the small, homogeneous group gathers for the CISD. Intervention delays may occur in disasters. Personnel may be too involved in the event to hold the CISD earlier. Depending on the circumstances, a CISD may take between 1 and 3 hours to complete.

Phases in the Critical Incident Stress Debriefing

A CISD is a structured process that includes the cognitive and affective domains of human experience. The phases are arranged in a specific order to facilitate the transition of the group from the cognitive domain to the affective domain and back again. Although primarily a psychoeducational process, emotional content can arise at any time in the CISD.

Phase 1—Introduction

In this phase, the team members introduce themselves and describe the process. They present guidelines for the conduct of the CISD and motivate the participants to engage actively in the process. Participation in the discussion is voluntary and the team keeps the information confidential.

Phase 2—Facts

Only brief overviews of the facts are requested. Excessive detail is discouraged. This phase helps the participants to begin talking. It is easier for them to speak of what happened before they describe how the event affected them. The fact phase, however, is not the essence of the CISD. The usual question is, “Can you give our team a brief overview of what happened in the situation?”

Phase 3—Thoughts

The thought phase is a transition from the cognitive domain toward the affective domain. It is easier for people to speak of their thoughts than to focus immediately on the most painful aspects of an event. The typical question in this phase is, “What was your first thought or your most prominent thought once you realized you were thinking?”

Phase 4—Reactions

The reaction phase is the heart of a critical incident stress debriefing. It focuses on the impact of the event on the participants. Anger, frustration, sadness, loss, confusion, and other emotions may emerge. The trigger question is, “What is the very worst thing about this event for you personally?”

Phase 5—Symptoms

Team members ask, “How has this tragic experience shown up in your life?” or “What cognitive, physical, emotional, or behavioral symptoms have you been dealing with since this event?” The team members listen carefully for common symptoms associated with exposure to traumatic events. The team will use the signs and symptoms of distress presented by the participants as a kicking-off point for the teaching phase.

Phase 6—Teaching

The team conducting the critical incident stress debriefing normalizes the symptoms brought up by participants. They provide explanations of the participants’ reactions and provide stress management information. Other pertinent topics may be addressed during the teaching phase.

Phase 7—Reentry

The participants may ask questions or make final statements. The CISD team summarizes what has been discussed in the CISD. The teams present final explanations, information, action directives, guidance, and thoughts to the group. Handouts may be distributed.

Follow-Up

The critical incident stress debriefing is usually followed by refreshments to facilitate the beginning of follow-up services. The refreshments help to “anchor” the group while team members make contact with each of the participants.

Other follow-up services include telephone calls, visits to work sites, and contacts with family members of the participants if that is requested. At times advice to supervisors may be indicated. One to three follow-up contacts are usually sufficient to finalize the intervention. In a few cases, referrals for professional care may be necessary.

References:

  1. Mitchell, J. T. (1983). When disaster strikes . . . The critical incident stress debriefing process. Journal of Emergency Medical Services, 73(11), 49-52.
  2. Mitchell, J. T. (2004). Characteristics of successful early intervention programs. International Journal of Emergency Mental Health, 6(4), 175-184.
  3. Mitchell, J. T. (2007). Group crisis support: When and how to provide it. Ellicott City, MD: Chevron.

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