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Critical Incident Stress Debriefing

Critical incident stress debriefing (CISD) is a specific, seven-phase, small-group crisis intervention technique. It is a structured discussion of a significant traumatic event, commonly referred to as a critical incident. A critical incident stress debriefing is a supportive crisis-focused tool that is employed by a specially trained crisis intervention team after a small, homogeneous group has encountered a disturbing traumatic experience.

The Nature of Critical incident Stress Debriefing

Perspective

A critical incident stress debriefing is not a form of psychotherapy, nor does it constitute a substitute for psychotherapy. Instead, it is small group “psychological first aid.” The primary emphasis in a critical incident stress debriefing is to inform and empower a homogeneous group after a threatening or overwhelming traumatic situation. A CISD attempts to enhance resistance to stress reactions, build resiliency, and facilitate both a recovery from traumatic stress and a return to normal, healthy functions.

A critical incident stress debriefing is one of many crisis intervention techniques within a larger, comprehensive, integrated, systematic, and multicomponent crisis intervention program known as critical incident stress management. The critical incident stress debriefing is not a stand-alone process, and it is only employed within a package of crisis intervention processes under the critical incident stress management umbrella. A CISD should be linked and blended with numerous crisis support services including, but not limited to, preincident education; individual crisis intervention; family support services; follow-up services; referrals for professional care, if necessary; and postincident education programs. Its best effects, which are enhanced group cohesion and performance, are always achieved when it is part of a broader crisis support system.

Historical Synopsis

Critical incident stress debriefing was developed by Jeffrey T. Mitchell in 1974 for use with small homogeneous groups of paramedics, firefighters, and law enforcement officers who were distressed by an exposure to some particularly gruesome event. It is firmly rooted in the crisis intervention and group theory and practice of such notables as Thomas Salmon, Eric Lindemann, Gerald Caplan, Howard Parad, Lillian Rapoport, Norman Faberow, Calvin Frederick and Irving Yalom. The first article on CISD appeared in 1983.

Over time, the use of critical incident stress debriefing spread to other groups outside of the emergency services professions. The military services, airlines, and railroads find the process helpful, particularly when it is combined and linked to other crisis intervention processes. Businesses, industries, hospitals, schools, churches, and community groups eventually adopted the critical incident stress debriefing model as an integral part of their crisis support programs.

Objectives

A critical incident stress debriefing has three main objectives. The first is the mitigation of the impact of a traumatic incident. The second is the facilitation of the normal recovery processes in psychologically healthy people who are distressed by an unusually disturbing event. Third, a CISD functions as a screening opportunity to identify group members who might benefit from additional support services or a referral for professional care.

Conditions

The critical incident stress debriefing requires the following conditions: (1) the small group (about 20 people) must be homogeneous, not heterogeneous; (2) the group members must not be currently involved in the situation (i.e., their involvement is complete or the situation has moved past the most acute stages); (3) the group members should have had about the same level of exposure to the experience; (4) the group members should be psychologically ready and not so fatigued or distraught that they cannot participate in the discussion.

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