Critical Incident Stress Debriefing
Introduction
Critical Incident Stress
Debriefing, or CISD, is a form of intervention counseling within Critical Incident
Stress Management, or CISM, used to treat victims of critical incidents. It is
usually offered as a free service in the workplace in the event that something
traumatic occurs at work and puts the affected employees at risk for
post-traumatic stress disorder (PTSD). CISM was first mentioned during the
American Civil War. Back then, it was common for the unfortunate soldiers with
“combat stress” to experience imprisonment, ridicule, or even death by gunfire
due to their fellow soldiers believing they were now siding with the enemy. This “combat stress” was not recognized for
what it was until many years later, and today, we used it to describe how we
react to traumatic events although its origin lies within the military. CISD is
a very common practice that helps victims handle their symptoms of the shocking
event experienced.
Goals of Critical Incident Stress Debriefing
The primary goal of CISD is
support. This early intervention counseling method works to provide a group of
traumatized individuals with support very soon after the event has been
experienced. The victims are given help with coping and recovering from these
incidents, and help to realize that they are not alone. It also gives employees
the opportunity to reach out to potential future counseling as needed. CISD
also lowers the risk of PTSD.
When is Critical Incident Stress Debriefing Used?
CISD is used for people who
have been directly or indirectly affected by a “critical incident”, or a
traumatic event that has been witnessed and causes stress and the inability to
function normally. Some examples include serious injuries, the death of someone
close (especially suicide), or events that involve disasters, children,
terrorism, a threatening or violent scenario at work, or anything with a
negative outcome. Usually critical incident stress lasts between two days and
four weeks, whereas PTSD lasts more than four weeks.
Physical symptoms of
critical incident stress include fatigue, headaches, unusual thirst, dizziness,
chills, and chest pain. Cognitive symptoms include poor attention and
decision-making abilities, confusion, poor memory and concentration,
uncertainty, nightmares, and poor problem solving abilities. Emotional symptoms
include intense anger, chronic anxiety, fear, guilt, apprehension and
depression, grief, and irritability. Behavioral symptoms include an increase in
alcohol consumption, an increase or decrease in appetite, withdrawal, being
unable to rest, a change in communication, and antisocial behavior.
How Critical Incident Stress Debriefing Works
There are a few emergency
steps to take note of to amount for the time between the critical incident and
the beginning of the debriefing process. Victims should take a 15 minute rest
immediately, avoid odors and noise as much as possible, talk about how they
feel, drink anything that doesn’t contain caffeine, and eat anything low in fat
and sugar. It is important that the victim is not hurried back to work.
The debriefing session is a
group process that occurs within 72 hours of the critical incident. It gives
the victims a chance to talk about what they experienced and how they feel
about it. They are often asked to describe the incident from their point of
view as well as the aftermath.
Generally speaking, there
are seven steps to the CISD process. The introduction process audits the
critical incident on the victims and gives them a chance to introduce
themselves. The Fact Phase identifies the most important issues related to
security and safety. The Thought Phase gives victims the opportunity to express
their thoughts and feelings as well as share their personal experiences of the
event. The Reaction Phase predicts the reactions of events that could occur
from the aftermath of the original incident. The symptom phase takes note of
the incident’s apparent impact on the survivors physically, emotionally, and
cognitively. Maladaptive behavior must also be reported. The Teaching Phase is
meant to provide closure to the survivors as a means of initiating the building
process. For example, they might do this by identifying the positive
experiences, if any, taken from the event. The final step, known as the
Re-Entry Phase, reviews the events that took place right before, during, and
right after the critical incident. This can be done one-on-one or even in
smaller groups rather than the group as a whole, depending on the
circumstances.
Criticism of Critical Incident Stress Debriefing
Studies have proved that
CISM does not work for everyone consistently, and in fact sometimes makes the
victim’s trauma symptoms even worse. In fact, most results have yielded either
no benefit at all from CISM or a negative impact.
References
University of Washington:
Critical Incident Debriefing. 2007. http://www.washington.edu/admin/hr/polproc/work-violence/cid.html
Shalev,
Arieh Y. (Ed); Yehuda, Rachel (Ed); McFarlane, Alexander C. (Ed), (2000).
International "http://psycnet.apa.org/">handbook of human response to trauma. The Plenum series on stress and
coping., (pp. 379-387). Dordrecht, Netherlands: Kluwer Academic Publishers,
xvi, 477 pp. doi: 10.1007/978-1-4615-4177-6_27
Critical
Incident Stress Debriefing (CISD): A meta-analysis.Everly
Jr., George S.; Boyle, Stephen H. International
Journal of Emergency Mental Health, Vol 1(3), 1999, 165-168.
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