A critical incident may lead you to experience symptoms of traumatic stress, anxiety, or depression. Critical incident stress debriefing can help minimize the chances of this occurring.
Critical incident stress debriefing (CISD) is a seven-stage group intervention. It’s meant to help groups of people manage the short-term effects of a potentially traumatic event.
CISD is considered a form of crisis intervention that aims to perform “psychological first aid” to people exposed to or directly affected by a potentially traumatic incident. It typically occurs within 24 to 72 hours of the incident.
CISD is a structured debriefing process led by facilitators and carried out in small groups of around 20 people.
It was created in 1974 by Dr. Jeffrey T. Mitchell, a professor of emergency health services and a former first responder.
CISD was originally designed to help first responders manage emotional pain and stress and reduce the chances of them experiencing long-term mental health effects.
First responders may include:
- disaster response crews
- emergency dispatchers
- firefighters
- hospital workers
- lifeguards
- military personnel
- paramedics
- police officers
CISD has most recently been adopted by multiple other industries, including:
- aviation
- banking
- churches
- railroad
- mining
- oil
- education
A critical incident may mean different things to different people. In general, it refers to a sudden and unexpected event that has a significant impact on your mind, body, or emotions.
This critical incident has the potential to cause long lasting effects on your mental health.
Critical incidents may include:
- accidents or crashes
- military combat
- wildfires or arson
- natural disasters like tornadoes or floods
- shootings
- hate crimes
- tragedies involving children
In some cases, you don’t have to experience these critical incidents firsthand to experience some of their effects. Witnessing a hate crime, for example, can also feel like an intensely overwhelming event.
If you experience distress from this experience, this is referred to as “critical incident stress.”
Signs of critical incident stress
Critical stress impacts people uniquely, but there are some general signs to watch for. For some people, symptoms can be similar to post-traumatic stress disorder (PTSD).
Physical signs
- chest pains
- dizziness
- exhaustion
- headache
- increased thirst
- loss of appetite
- shallow breathing
- sleep disturbances
- tremors
Cognitive signs
- brain fog
- confusion
- dissociation
- flashbacks
- impaired ability to make decisions
- nightmares
- trouble concentrating
Emotional signs
- anger or rage
- anxiety
- depression
- grief
- irritability
- survivor guilt
Behavioral signs
- difficulty relaxing
- not showing up to work
- social withdrawal
- substance use disorder
- reduced communication
Facilitators
Typically, there’s one facilitator for every five to seven people. At a minimum, there are always two facilitators present in CISD.
At least one facilitator is a licensed mental health professional, and the other is someone with the same background or a similar background as those who experienced the critical incident.
Group
In the case of first responders, participants of CISD are typically part of the same unit or team.
They’ve had a “hom*ogeneous” experience, meaning they all experienced the critical incident or the aftermath at roughly the same time and with the same intensity.
The members of the group may have already displayed symptoms of stress or impaired functioning since the incident, or they have the potential to experience these at some point.
Goals
There are three main objectives of CISD, as outlined by Mitchell:
- reducing the long-term impacts of the critical event
- supporting the healing process so people can overcome the traumatic event
- screening for those who might need extra support
Sessions
A CISD session lasts 1 to 3 hours. It can vary depending on how many people are involved and how traumatic the experience was.
CISD goes through seven phases over the course of one session:
1. Introduction
Everyone introduces themselves, and the facilitators lay out some ground rules for the session.
2. Fact phase
The facilitators encourage everyone to go around the room and give a brief description of what they experienced.
3. Thought phase
The facilitators ask participants what they first thought about the event when they realized what was happening.
4. Reaction phase
The facilitators ask group members what impact this experience has had on them, and what emotions or thoughts they’ve experienced since.
For example, they may experience:
- anger
- grief
- confusion
- a sense of loss
5. Symptom phase
The facilitators ask the team what kinds of physical, emotional, or behavioral symptoms they’ve experienced since the disturbing event.
6. Teaching phase
The facilitators discuss the rationale behind common stress symptoms to add context to what the group is experiencing.
7. Reentry phase
The facilitators summarize what has been discussed and provide resources for further support.
Follow-up
After the group session ends, the facilitators may have the group members gather informally for refreshments so they have a chance to connect on an individual level.
Among other benefits, CISD can help people not feel so alone in their experiences, says Janika Joyner, a licensed clinical social worker in Chesapeake, Virginia, who often uses therapy dogs in conjunction with debriefs.
“As a psychotherapist who has provided CISD for mass shootings (like Virginia Beach in 2019) and multiple employee deaths for various organizations, I would say that it is effective,” she says.
While it can’t replace therapy, CISD can certainly spark conversations about therapy.
“CISD can assist individuals with deciding to enter treatment and begin therapy to deal with any long-term symptoms that go beyond acute responses,” she adds. “Then, therapy teaches a person how to manage those symptoms.”
To date, the research on CISD is still mixed.
A 2019 literature review found that while hospital personnel viewed CISD as important, it was still unknown whether it could reduce symptoms of PTSD.
In a 2021 review, Mitchell suggests that the CISD method is effective for disaster survivors and response teams alike, provided that the facilitators are crisis-trained.
On the other hand, a 2022 review of studies found that only one study out of nine showed that psychological debriefing is effective in reducing psychological distress after a critical incident.
The existing body of literature may be difficult to assess because some studies use a modified version of Mitchell’s CSID method, and this could skew the results.
Overall, more research is needed to determine how effective CISD is.
“In my own work in the disaster mental health field, I have found many of the CISD tools to be effective,” says Dr. Sandra Wartski, a licensed psychologist in Raleigh, North Carolina. “However, there are situations when CISD might not be appropriate or able to be properly put into practice.”
Pros
- provides a chance to educate personnel on the stress response and possible effects
- may be convenient to have on-site services
- may reduce burnout and compassion fatigue
- gives an opportunity to connect with others who have similar experiences
- can promote cohesion as a unit
- offers a small group environment
Cons
- may discourage folks who would rather speak privately
- is only a short-term offering, rather than ongoing support
- may be difficult to make time for it in demanding or low staff environments
Critical incident stress debriefing is a facilitated technique for helping small groups process a potentially traumatic experience.
It was designed to reduce long-term symptoms of traumatic stress and help first responder groups return to their usual level of functioning as a team.
Studies are mixed on how effective CSID can be, so more research is still needed.
