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Critical Incident Stress Debriefing (CISD)

Disciplines > Therapy >  > Critical Incident Stress Debriefing (CISD)

Description | Example | Discussion | See also

Description

Critical Incident Stress Debriefing (CISD) is intended as a method for reducing effects such as post-traumatic stress disorder (PTSD) that could affect people who have recently been through a potentially distressing experience. It is typically used within three days after the event and lasts three to four hours.

The seven steps of CISD are:

1. Introduction: of people and establishing guidelines
2. Establishing facts: as happened, without emotion.
3. Thoughts and impressions: as perceived, again without emotion.
4. Emotional reactions: to the situation and associated with thoughts and impressions.
5. Normalization: of experience, understanding such as 'this is all normal and you will get better with time'.
6. Planning for the future: Deciding what to do next and looking to returning to normal.
7. Disengagement: Letting go of the distress, taking charge of oneself and returning to normality.

Debriefing may be preceded by defusing, where the affected person is told that their feelings are normal and that they may go through some form of grief cycle. This may well be done on the same day as the incident.

Debriefing may be followed up a week later with a check to ensure the person is coping. As needed, they may be redirected to further support.

Example

A group of soldiers sees a colleague having limbs blown off by an explosion. They are sent to a CISD by their company commander.

A child in school is bullied. They are sent to a group session where these principles are applied.

An accident happens at work where a person is killed. Others there all go to a group session.

Discussion

Situations that cause extreme stress include witnessing death (especially when it is gory), serious injury, severe threats or other unusual and highly upsetting experiences. In a military situation, having traumatized people in operational situations can be problematic. CISD promises to quickly get such people back into a reasonable frame of mine where they can adequately (if not perfectly) continue in their operational role.

A key principle in CISD is to externalize experiences, bringing it to the surface and talking about it so it can be dealt with. The purpose in using it quickly after the traumatic event is to catch the person while their memory of the event is fresh and before they sink into any depressive or other problematic state. Another principle is of structure, where the control applied gives the distressed person a sense of reassurance as their superiors manage the process of recovery.

CISD is typically run by the military as a one-session group therapy for people who have suffered trauma. When operated as such it is a very brief intervention that risks having little positive effect and may even be negative. Problems can include:

• Reliving traumatic experiences before the person is able to handle this.
• Giving the patient the impression that this is a trivial box-ticking exercise ('Yes, we did give them therapy').
• Interrupting and slowing the natural grieving process.
• Being 'administered' by people with limited psychological qualification or experience.

A deeper question is whether the basic method works if it is implemented carefully and using an optimal timeframe. Can debriefing, with externalizing thoughts and emotions and then normalizing them, actually work?

See also

Kagee A (February 2002). Concerns about the effectiveness of critical incident stress debriefing in ameliorating stress reactions. Critical Care, 6, 1, 88