Critical Incident Stress Debriefing

The impact of a critical incident on an individual’s life appears to be mitigated, to some degree, by the availability of resources that may intervene at various stages following the incident.

Critical Incident Stress Debriefing (CISD) is a model designed to yield just such a result. The CISD model assists the victims of critical incidents with their recovery process.

The model incorporates seven phases:

1. Introductory Phase,
2. Fact Phase,
3. Thought Phase,
4. Reaction Phase,
5. Symptom Phase,
6. Teaching Phase, and
7. Re-entry Phase.

Debriefings are group meetings that are designed to give participants an opportunity to discuss their thoughts and feelings about a distressing event in a controlled and rational manner and to help them understand that they are not alone in their reactions to the incident. It is recommended that a formal debriefing be held within 24 to 72 hours after an incident. Depending on the number of participants and the severity of the incident, debriefings generally last anywhere from one to three hours.

Debriefing teams represent a partnership between mental health professionals and peer support personnel. Mental health professionals serving on a Critical Incident Stress Debriefing team possess at least a master’s degree in psychology, social work, psychiatric nursing, psychiatry, or mental health counseling. Support personnel are trained and prepared to work with mental health professionals in preventing and mitigating the negative impact of acute stress on their fellow workers. All team members receive training in crisis intervention, stress, post-traumatic stress disorder, and the debriefing process.

Introductory Phase

During this first phase, the leader and team members introduce themselves to the participants. The leader describes how a debriefing works and lists the ground rules for the debriefing. The rules are as follows:

• No one is compelled to talk, but participation is strongly encouraged,
• No notes or recordings of any kind are taken during the debriefing,
• Strict confidentiality is maintained, and
• The debriefing is not intended to be therapy.

It is important to convey to participants that their chances for a successful debriefing increase when participants are made fully aware of what to expect during the process.

Fact Phase

The fact phase begins with the team leader asking participants to identify themselves and briefly mention their degree of involvement with the incident. For example, participants may relate their role in the incident, how they were informed of the incident, where they were when they received this news, and so forth. Participants may begin relating their first reactions to the incident. This type of information lays the groundwork for the remaining phases of the process.

Thought Phase

Participants are asked what their first thoughts were concerning the incident. The thought phase begins to personalize the experience for the participants. This is the first phase in which some participants may exhibit some reluctance to share.

Reaction Phase

Participants are asked to discuss “what was the worst part of the event for them, personally.” This phase generally causes participants to begin exploring some of their deeper, personal responses to the event. Depending on the intensity of the event and the number of participants, this segment may last thirty minutes to one hour.

Symptom Phase

Participants are asked to describe the signs and symptoms of any distress they experienced, such as feeling nauseated, sweating palms, or having difficulty making decisions. Usually, three occurrences of signs and symptoms are discussed:

1. Those that appeared at the time of the incident,
2. Those that arose during the next few days and
3. Those that they are still experiencing at the time of the debriefing.

Teaching Phase

During the teaching phase, the leader and team members share information regarding the relationship between the critical incident and the subsequent cognitive, emotional, behavioral, and physiological reactions that others involved in such events have experienced. Participants are provided with a handout entitled “Critical Stress Information Sheet.” During this phase, participants may ask new questions or bring up information that was not discussed earlier.

Re-entry Phase

This phase signals the end of the debriefing. Participants are encouraged to ask questions and explore other issues associated with the incident that may have not surfaced earlier. Team members are asked to provide some summary remarks, and the team leader makes a few additional statements to bring closure to the debriefing. A crucial message emanating from the debriefing is that the participants’ reactions are normal responses to an abnormal event.

Is a Debriefing Warranted?

The decision about whether a formal debriefing is warranted generally rests with management personnel following consultation with mental health consultants. Though not all-inclusive, some examples of important questions to explore when assessing the need for a debriefing are these:

• What is the nature of the incident?
• Is the event of sufficient magnitude to cause significant emotional distress among those involved?
• How many individuals are affected by the incident?
• What signs and symptoms of distress the witnesses to the incident are displaying?
• Are the signs and symptoms growing worse as time passes?
• Are any of the following key indicators of a need for a debriefing present: behavior change, regression, continued symptoms, intensifying symptoms, new symptoms arising, or group symptoms present?

In some instances, as these and other questions are explored, it may be determined that a formal debriefing is not warranted. Or, perhaps there may be a decision to briefly meet with the group(s) that have been affected by the incidents to further assess the need for a formal debriefing. Under these circumstances, a critical incident stress defusing may be appropriate. This process will be discussed next.