Critical Incident Stress Debriefing: Steps and Techniques

Purpose of CISD

a. To help mitigate the psychological impact of a traumatic event

b. Prevent the subsequent development of a post-traumatic syndrome, and;

c. Serve as an early identification mechanism for individuals who will require professional mental  health follow-up.

So.. what is CISD?

CISD is basically a group process involving persons who are victims/survivors of overwhelming event or trauma (including those who may have been impacted by the traumatic event)

It allows participants to undergo a structure that provides them the avenue to share their experiences, feelings, stress responses, coping strategies, lessons learned from the experience and create a support among each other.

Stages / Procedures of CISD

7 Stages of CISD
Stage/Phase	By Mitchell/Everly (1995)	Modified by Kendall Johnson/ Johnny B. Decatoria (2003)
Stage 1	INTRODUCTION	INTRO PHASE
Stage 2	FACT	EVENT/FACT
Stage 3	THOUGHT REACTION	FEELING & THOUGHT PHASE
Stage 4	EMOTIONAL REACTION	STRESS RESPONSE
Stage 5	REFRAMING (LESSONS)	COPING & TEACHING
Stage 6	TEACHING	LEARNING/LESSONS
Stage 7	RE-ENTRY	CLOSURE/SUPPORT PHASE

CISD Stages

Modified by Kendall Johnson & JB Decatoria, 2002

Stage/Phase	Objectives/Procedures By JB Decatoria, PhD (2004)
1. INTRO PHASE	·         Introduce the intervention; explain process ·         Introduce team members ·         Set expectations ·         Rules – when someone speaks, the rest listen;   confidentiality, etc.
2. FACT or EVENT PHASE or RE-LIVING STAGE	·         Each participant describes the experience on   the fact level. ·         We help each one to recall, re-live and talk   about the event. ·        Some leads: What happened? Where were you at that time? You remember anything? What did you see, smell, hear? etc.
3. FEELING & THOUGHT PHASE	·       Focus is on the feeling or motion level (What or how did you feel at that time?) ·       Also elicit  responses concerning cognitive impact; they may hold negative thoughts ·       Facilitate expressions of intense emotionality; watch for abreactions – let go of it, don’t suppress ·       Leads – How did you feel at that time of the event? Did you ever think you were going to die?, etc.
4. STRESS REACTION/RESPONSE PHASE	·       Intense emotions can have various consequences ·       Facilitate sharing of stress responses and reactions ·       It is important for them to discover that these experiences are also common to others ·       Leads – What did you notice in your body after the incident? Did you ever notice any change in your behavior? How are you different prior to the incident? Change in functioning?
5. COPING & TEACHING PHASE	·      To educate group members – on the nature and symptoms of PTSD ·       Make the understand that their stress reactions are normal responses to an abnormal event ·       Understanding these will help them gain control of their unpleasant symptoms; not the other way around ·       Teach basic stress management ·       Keep your teaching short ·       Very important – they should gain insights from each other, how others cope effectively; learn from others styles of coping. Try to model from them.. if it works.
6. LEARNING PHASE (Lessons Learned)	·       Allow participants to share what they learned from the experience ·       Not all crises are bad and destructive – some can bring tremendous lessons; they can make us more prepared, better persons in facing future crisis or similar experience ·       These positive lessons learned can help in the healing and recovery
7. CLOSURE / SUPPORT PHASE	·       This is not therapy or counseling yet it is imperative to make a sense of closure. ·       Assist participants in identifying or recognizing strategies and mechanics in order to support each other; what can they do to help each other. ·       Identify from them/share with them available resources that may be needed even long after the session. ·       Closure can be done in several ways: a. Ask them to say a short message of support/comfort addressed to the group b. A prayer may do c. Meditation / relaxation exercise d. A song; memorial service, as appropriate e. Other symbolic activities meaningful to children

Some guidelines for conducting CISD:

1. Arrange sitting in circle.

2. Exhaust during the sharing – did you miss anything important to share with us.

3. Go and debrief as a team, at least 2 debriefers/facilitators.

4. The process is not meant to be some kind of psychotherapy. It is simply meant to    “mitigate” the effects of the critical incident and provide a means for further assistance as some may require.

5. The CISD should be held within 2-3 days after the event. CISD, a week or two after the incident may still be used depending on the need and availability of the participants.

6. The group usually convenes on the job or in the home. Participants should expect to devote 2-3 hours for the discussions.

7.  Be emotionally ready.