Critical Incident Stress Debriefing (CISD)
Please note that this blog was initially intended to be released in March, 2018. However, with the recent Parkland, Florida school shooting, it became important to release it in a more timely fashion to potentially assist those suffering from stress as a consequence of that incident.
Critical Incident Stress Debriefing (CISD) is a formalized, structured method whereby a group of rescue and response workers review the stressful experience of a disaster. CISD was developed to assist first responders, such as fire and police personnel; it was not meant for the survivors of a disaster or their relatives. (“Types of Debriefing Following Disasters - PTSD,”) A 2016 article about this topic takes a rather harsh look at this intervention reporting that: “Despite a lack of proof that expressing feelings right away is good, the U.S. has an industry of people, called critical incident stress debriefers, whose job it is to converge on disaster sites and get people to talk about their feelings.
“Not necessarily mental health experts, debriefers sent by city or county health, fire or police departments have had training in what to say to encourage emoting after a disaster. They head to scenes of death and destruction caused by Hurricane Katrina, floods in Iowa or fires throughout California, not to mention human-made horrors like the 9/11 attack on the World Trade Center or the Columbine and Virginia Tech school shootings and now, the massacre of children at Marjory Stoneman Douglas High School in Parkland, Florida. Yet a 2006 review of studies on such debriefings in the Review of General Psychology found either no benefit or worse outcomes from the interventions. 'If it's immediately after an upheaval, it's completely foolish to do that,' says James Pennebaker, chair of psychology at the University of Texas at Austin. 'Some people naturally talk and listen to others. If they don't want to talk about it, they don't. If they do, they do. They may need help in two months, but they may not want help then.’” (“Debunking debriefing,”)
To address this matter more formally, I turned to the U.S. Department of Veterans Affairs – National Center for PTSD to clarify governmental perspective pertaining to the viability of this intervention. The following material was forthcoming: “. . . [R]ecent research indicates that psychological debriefing is not always an appropriate mental-health intervention. Available evidence shows that, in some instances, it may increase traumatic stress or complicate recovery. Psychological debriefing is also inappropriate for acutely bereaved individuals. . . some negative effects of CISD-type debriefings were reported relating to PTSD and other trauma-related symptoms.
“Therefore, debriefings as currently employed may be useful for low magnitude stress exposure and symptoms or for emergency care providers. However, the best studies suggest that for individuals with more severe exposure to trauma, and for those who are experiencing more severe reactions such as PTSD, debriefing is ineffective and possibly harmful.” (“Types of Debriefing Following Disasters - PTSD,”)
Unfortunately, the perspective that CISD remains a valuable tool for trauma debriefing continues in spite of meta-analysis findings. Apparently, this information has not yet been acknowledged by those who train professionals in traumatic stress intervention strategies. As provided by The American Academy of Experts in Traumatic Stress, Inc., 10 Stages of Acute Traumatic Stress Management (ATSM) are referenced including the following:
A Brief Summary
1. Assess for Danger/Safety for Self and Others • Are there factors that can compromise your safety or the safety of others?
2. Consider the Mechanism of Injury • How did the event physically and perceptually impact upon the individual?
3. Evaluate the Level of Responsiveness • Is individual alert and responsive? Under the influence of a substance?
4. Address Medical Needs • For those who are specifically trained to manage acute medical conditions
5. Observe & Identify • Who has been exposed to the event and who is evidencing signs of traumatic stress?
6. Connect with the Individual • Introduce yourself, state your title and/or position. Once he is medically evaluated, move the individual away from the stressor. Begin to develop rapport.
7. Ground the Individual • Discuss the facts, assure safety if he is, have him “Tell his story.” Discuss behavioral and physiological responses.
8. Provide Support • Be empathic. Communicate a desire to understand the feelings that lie behind his words.
9. Normalize the Response • Normalize, validate and educate.... “Normal person trying to cope with an abnormal event.”
10. Prepare for the Future • Review the event, bring the person to the present, describe events in the future and provide referrals.” (“CATSM BOOK FINAL 11/04 - ten stages atsm.pdf,”)
The part of the above sequence that bothers me the most is the “tell his story” aspect. From the perspective of the RESET Therapy practitioner, this request is avoided so as to not inadvertently retrigger and possibly strengthen the traumatic experience. By repeating the distressing experience too close to the actual event, a strengthening of the emotional component becomes a distinct possibility.
A number of other points are also circumvented such as ‘grounding the individual’ or discussing behavioral and physiological responses. Rather, the RESET Therapist seeks to facilitate the inner healing process by being there and offering resolution when the individual is ready for it. Those who experience traumatic exposure are given hope and assurance that there is indeed, a treatment available related to the resolution of the unsettling events they have encountered. Having been transformed by the traumatic encounter into the ‘protect and defend’ mode, talking about the ‘future’ has little meaning to the afflicted person. The primary objective is to ‘tap into’ the inner resources and strengths in preparation for the conversion back to the growth mode once again.
CATSM BOOK FINAL 11/04 - ten stages atsm.pdf. http://www.aaets.org/ten%20 stages %20atsm.pdf
Debunking debriefing. http://articles.chicago tribune .com/2008-08-05/news/0808050478 _1_school-shootings-feelings-world-trade-center
Types of Debriefing Following Disasters - PTSD: National Center for PTSD. http://www.ptsd. va.gov/professional/trauma/disaster-terrorism/debriefing-after-disasters.asp