GEDC1047

CRITICAL INCIDENT STRESS DEBRIEFING

CISD definition
Critical Incident Stress Debriefing (CISD) is a process through which a facilitator helps a group of
people work through their response to a highly stressful or traumatic event. CISD is a form of
crisis intervention aimed at reducing the traumatic impact of an event by fostering a connection
between people who went through the same experience, increasing effective coping, and trauma
education after the stressful event. This can help provide space to process after a stressful or
traumatic event occurred.

Individuals who were exposed to the event can talk about their experiences and feelings in a safe
environment. The goal of this process is to provide peer and professional support immediately
following an incident, which may reduce the risk of developing trauma symptoms or other mental
health issues.

Licensed mental health professionals with training in Critical Incident Stress Debriefing to
facilitate groups immediately following a stressful or traumatic incident. Groups can have
multiple facilitators if there is a high number of participants.

CISD Requirements
It is required that all group members have experienced the same stressful event and must be
rested and emotionally regulated enough to participate in a group.

Critical Incident Stress Debriefing is intended for use as one of many resources offered to people
who have experienced a stressful or traumatic event.

History of Critical Incident Stress Debriefing

Dr. Jeffrey Mitchell developed CISD in 1974 as a way to offer support to people who experience
highly stressful events in their jobs.

Dr. Mitchell developed this intervention with inspiration from his work as a paramedic and
firefighter, but this technique can be used for any group who has experienced a traumatic event,
such as a shooting, natural disaster, or work-related crises.

Goal of CISD
Dr. Mitchell’s goal with CISD is to reduce both short and long-term impacts of traumatic events,
including mental health symptoms (such as post-traumatic stress disorder), substance
dependence, relationship conflicts, and sleep disturbance.

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Phases of Critical Incident Stress Debriefing
Although the process is flexible and can be tweaked based on the needs of the group, CISD is
generally structured in seven phases or steps. These steps are:

1. Introduction and Assessment: The facilitator what happened and begin exploring what this
or facilitators gather details about the means for them going forward.
incident in order to appropriately guide the 5. Symptom Phase: In this phase, facilitators help
intervention to meet the group’s unique participants explore what symptoms they might
needs. be experiencing in response to the event.
2. Fact Phase: Facilitators encourage group 6. Teaching Phase: This phase is educational.
members to share the facts of the incident
Facilitators normalize participants’ responses to
from their perspective.
the event and provide psycho-education about
3. Thought and Emotion Phase: After the facts
trauma, stress, and coping skills.
of the incident have been shared, group
7. Re-Entry Phase: This final phase of CISD includes a
members can disclose their thoughts and
summary of what was covered, what participants
feelings about the incident in a supportive
learned, and resources provided by facilitators.
space.
4. Reaction Phase: Facilitators help group
members safely explore their reactions to

Preventing Trauma Symptoms From Appearing Later

One goal of the group is to work through emotions participants are experiencing in the aftermath
of the event while simultaneously arming them with skills to move forward and prevent trauma
symptoms from emerging later on.

Facilitators additionally aim to educate participants about trauma and mental health so they can
make appropriate choices for ongoing support. CISD groups leave participants feeling safe,
validated, and hopeful for the future.

When to Use Critical Incident Stress Debriefing

CISD is intended for use immediately (within 24 to 48 hours) after the incident occurred. Its
purpose is to provide support and resources to people who experienced a traumatic event as
soon as possible.

However, for CISD to be effective, participants need to be well-rested and in an emotionally

stable headspace. If someone is still in a state of traumatic shock, they are not ready to
participate in CISD.

After a stressful or traumatic incident has occurred, individuals should receive any necessary
medical attention as well as any appropriate individual crisis intervention and support. If needed,
they can sleep or rest. Once they are ready, they can participate in CISD.

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CISD groups should occur after the event has finished when members are physically safe.
Facilitators should have an understanding of what occurred before starting the group.

Effectiveness of Critical Incident Stress Debriefing

CISD is intended to be used as one of many resources and supports for people who have
experienced trauma. As such, it is difficult to research the specific impact of CISD as other
variables are typically present in addition to the group. However, studies have been conducted
to measure the effectiveness of CISD.

CISD Reduces Burnout and Trauma Symptoms

A review of 15 studies showed that non-mandatory CISD improved coping and reduced trauma
symptoms in healthcare workers in emergency settings. It has also been shown to reduce burnout
and compassion fatigue while reducing employee turnover in healthcare settings.

Additionally, CISD can improve both physical and mental health outcomes for military personnel.

When implemented at the appropriate time and with qualified, trained facilitators, CISD can be
an important resource for groups who have experienced a traumatic event.

DISASTER RESPONDER STRESS MANAGEMENT

Stress definition
An expected hazard of disaster behavioral health response activities based on the fact that a
disaster is a traumatic event and staff are exposed to the survivors’ experiences in an in-depth
and intimate way.

Education about stress and each person’s self-awareness as to what causes him or her to be
stressed are key to managing stress. Practicing stress management in a routine, disciplined
manner is what will be helpful for most people. Staff who have a history of exposure to traumatic
events or who have suffered with a mental illness prior to working in the disaster behavioral
health response program may require more assistance with their stress management efforts.

Typical Stressors for Disaster Response/Crisis Counseling Staff

 Personal experience with the disaster  Feeling unable to alleviate the pain of
 Direct exposure to the negative effects others
of the disaster  Working long hours in difficult
 Cumulative stress from repeatedly environments
hearing survivors' stories  Lack of or insufficient supervision
 Chronic stress from approaching  Inadequate or inexperienced
strangers who may reject their help management and leadership that
 Feeling overwhelmed by the depth of negatively effects crisis counseling
others' grief and sadness staff

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Warning Signs of Excessive Stress (signs that last for more than 2 to 4 weeks)
1. Physical making decisions, difficulty
 Bodily sensations and physical remembering instructions,
effects inability to see situations clearly,
Rapid heart rate, palpitations, distortion and misinterpretation
muscle tension, headaches, of comments and events
tremors, gastrointestinal 4. Behavioral
distress, nausea, inability to
 Problematic or risky behaviors
relax when off duty, trouble
Unnecessary risk-taking, failure
falling asleep or staying asleep,
nightmares or flashbacks. to use personal protective
2. Emotional equipment, refusal to follow
 Strong negative feelings orders or leave the disaster
Fear or terror in life-threatening scene, endangerment of team
situations or perceived danger, members, increased use or
anger, frustration, misuse of prescription drugs or
argumentativeness, irritability, alcohol.
deep sadness, difficulty  Social conflicts
maintaining emotional balance. Irritability, anger and hostility,
3. Cognitive blaming, reduced ability to
 Difficulty thinking clearly support teammates, conflicts
Disorientation or confusion, with peers or family,
difficulty problem-solving and withdrawal, isolation.

Some disaster-specific warning signs include high adrenaline, physical euphoria, numbness—the
endorphin effect (a reduction in feeling) disguises distress. Coupled with fatigue, cognition can
change and create an inability to recognize poor judgment. Anger is a common defense against
recognizing these problems.

Stress-Reduction Techniques
1. Breathing exercises: Techniques to slow 4. Spending time in nature: Connecting with
heart rate and calm the nervous system. the natural world for relaxation.
2. Relaxation techniques: Muscle tension 5. Engaging in hobbies and interests:
release (progressive muscle relaxation), Participating in activities you enjoy.
meditation, mindfulness. 6. Self-Assessment: Regularly evaluate the
3. Journaling: Processing experiences and impact of stress on your personal and
emotions through writing. professional life.
7. Seek feedback from peers and supervisors

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Individual Approaches to Stress Management

 Self-awareness: Recognizing personal  Balanced Lifestyle: Scheduling stress

triggers for stress. reduction activities (exercise, hobbies),
 Workload Management: Varying caseload taking breaks, and maintaining a strong
intensity and utilizing supervision. support network.
Disaster-Specific Techniques
a. Peer Support: Working in teams and c. Monitoring Over Identification:
debriefing together. Avoiding personalizing survivor stories.
b. Controlled Empathy: Managing personal d. Defining Structure and Boundaries:
emotional response to maintain Clear roles, responsibilities, and
professionalism. limitations.

Effective Supervision and Training

 Pre-deployment training: Preparing  Skill development: Identifying areas for

responders for the challenges they will improvement and providing ongoing
face. support.
 Evaluation: Assessing responder
readiness and effectiveness.

COPING WITH DISASTER

If your community has been hit by a disaster or violent event, you’re probably trying to make sense
of what happened and deal with the stress of the situation. These events create a tremendous
amount of stress and anxiety for those directly and indirectly affected. In the days and weeks
following the disaster, you may begin to have some of these common reactions:
Common Reactions
 Disbelief and shock  Feeling powerless
 Fear and anxiety about the future  Changes in eating patterns; loss of
 Disorientation; difficulty making appetite or overeating
decisions or concentrating  Crying for “no apparent reason”
 Apathy and emotional numbing  Headaches, back pains and stomach
 Nightmares and reoccurring thoughts problems
about the event  Difficulty sleeping or falling asleep
 Irritability and anger  Increased use of alcohol and drugs
 Sadness and depression

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Tips For Coping
It is ‘normal’ to have difficulty managing your feelings after major traumatic events. However, if you
don’t deal with the stress, it can be harmful to your mental and physical health. Here are some tips
for coping in these difficult times:
a. Talk about it. By talking with others about the event, you can relieve stress and realize that
others share your feelings.
b. Spend time with friends and family. They can help you through this tough time. If your
family lives outside the area, stay in touch by phone. If you have any children, encourage
them to share their concerns and feelings about the disaster with you.
c. Take care of yourself. Get plenty of rest and exercise, and eat properly. If you smoke or drink
coffee, try to limit your intake, since nicotine and caffeine can also add to your stress.
d. Limit exposure to images of the disaster. Watching or reading news about the event over
and over again will only increase your stress.
e. Find time for activities you enjoy. Read a book, go for a walk, catch a movie or do something
else you find enjoyable. These healthy activities can help you get your mind off the disaster
and keep the stress in check.
f. Take one thing at a time. For people under stress, an ordinary workload can sometimes
seem unbearable. Pick one urgent task and work on it. Once you accomplish that task,
choose the next one. “Checking off” tasks will give you a sense of accomplishment and make
things feel less overwhelming.
g. Do something positive. Give blood, prepare “care packages” for people who have lost
relatives or their homes or jobs, or volunteer in a rebuilding effort. Helping other people can
give you a sense of purpose in a situation that feels ‘out of your control.’
h. Avoid drugs and excessive drinking. Drugs and alcohol may temporarily seem to remove
stress, but in the long run they generally create additional problems that compound the
stress you were already feeling.
i. Ask for help when you need it. If you have strong feelings that won’t go away or if you are
troubled for longer than four to six weeks, you may want to seek professional help. People
who have existing mental health problems and those who have survived past trauma may
also want to check in with a mental health care professional. Being unable to manage your
responses to the disaster and resume your regular activities may be symptoms of post-
traumatic stress disorder (PTSD), a real and treatable illness. Help is available. Make an
appointment with a mental health professional to discuss how well you are coping with the
recent events. You could also join a support group. Don’t try to cope alone. Asking for help
is not a sign of weakness.

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References:
1. SAMHSA. (2024). Disaster Responder Stress Management. Retrieved from
https://www.samhsa.gov/dtac/disaster-response-template-toolkit/disaster-responder-stress-
management
2. Dr. Amy Marschall. (2022). What Is Critical Incident Stress Debriefing? Retrieved from
https://www.verywellmind.com/what-is-critical-incident-stress-debriefing-cisd-
6455854#citation-4
3. Mental Health America. (2024). Coping With Disaster retrieved from
https://www.mhanational.org/coping-disaster

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