# 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. It was developed by Jeffrey Mitchell and is considered the most widely used today.

## Components

It operates using the following three components: pre-incident functions, on-scene support services, and post-incident interventions. 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. The process is peer-driven but backed up by a group of professional counselors.

## Evidence for use

Critical incident stress debriefing (CISD) is a controversial component of CISM, and research suggests it may cause harm. 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".

## Format and timing

ICISF specifies that defusings and debriefings are only intended for use with groups. The individual intervention technique used in CISM is a version of psychological first aid. A literature review concluded that a primary flaw in criticism of CISM is "the lack of consistent terminology," which has led investigators to evaluate distinct interventions as if they were identical, and to use variable outcome measures, making it difficult to compare outcomes across different studies. The review authors concluded that CISM "should continue to be offered to secondary victims of trauma."
For teams, group debriefings are suggested 48–72 hours after a critical incident giving the group an opportunity to support each other by talk about their experience, how it has affected them, brainstorm coping mechanisms, identify individuals at risk, and inform the individual or group about services available to them in their community. The final step was to follow up with them the day after the debriefing to ensure that they are safe and coping well or to refer the individual for professional counselling. 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).
Although many co-opted the debriefing process for use with other groups, the primary focus in the field of CISM was to support staff members of organizations or members of communities which have experienced a traumatic event.

## Steps

The debriefing process (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.