Critical incident stress debriefing
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] Despite its frequent use, major organisations such as World Health Organisation[2], NICE[3] and Phoenix Australia[4] recommended against its use based on synthesis of available evidence – no high-quality evidence of helping alleviate symptoms of PTSD and some studies reporting on worsening the PTSD symptoms trajectory due to CISD. Psychological first aid was suggested by those organisations as an evidence-informed alternative instead [3][4].
Components
[edit]CISD is a part of a larger Critical Incident Stress Management (CISM) framework. The CISM framework has three components: pre-incident functions, on-scene support services, and post-incident interventions.[5] 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. One of the post-incident interventions suggested by CISM is CISD.
The CISD (as 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.[6]
Format and timing
[edit]ICISF specifies that CISD are only intended for use with groups.[7] CISD is suggested to be administered 48–72 hours after a critical incident. 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[8]). Although many co-opted using CISD in other settings, it was originally developed by Mitchell for groups of firefighters and other first responders.
Controversy regarding its evidence
[edit]Critical incident stress debriefing (CISD) is controversial, and research suggests it may cause harm.[9][10][11][12] 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".[13] Despite a prior rebuttal of this claim by McNally and colleagues[14], ICISF has not retracted their claim.
References
[edit]- ^ a b Raphael, Beverley; Wilson, John (2000). Psychological Debriefing: Theory, Practice and Evidence. Cambridge: Cambridge University Press. p. 2. ISBN 978-0-521-64700-7.
- ^ "Psychological debriefing in people exposed to a recent traumatic event". World Health Organization.
- ^ a b National Institute for Health and Care Excellence. "Post-traumatic stress disorder: Evidence-based recommendations (NICE guideline No. 116)".
- ^ a b Phoenix Australia. "Australian PTSD Guidelines".
- ^ 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.
- ^ Pulley SA (March 21, 2005). "Critical Incident Stress Management". eMedicine. Archived from the original on August 11, 2006. Retrieved July 16, 2009.
- ^ "A Primer on Critical Incident Stress Management".
- ^ "CISM and Peer Support: My Thoughts - ICISF".
- ^ 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.
- ^ 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.
- ^ 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.
- ^ 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.
- ^ "A Primer on Critical Incident Stress Management (Cism)". Icisf.
- ^ McNally, Richard J.; Bryant, Richard A.; Ehlers, Anke (November 2003). "Does Early Psychological Intervention Promote Recovery From Posttraumatic Stress?". Psychological Science in the Public Interest. 4 (2): 45–79. doi:10.1111/1529-1006.01421. ISSN 1529-1006.