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Mental Health

Critical Incident Stress Debriefing

Concepts and Controversy

Katelin Bowes, Jill Fikowski and Melanie O’Neill, PhD

Reprinted from "Trauma and Victimization" issue of Visions Journal, 2007, 3 (3), p. 7

People involved with, or exposed to, modern-day traumas can experience a range of emotional responses. Concern for victims of workplace and disaster-related trauma has led to increased popularity of early intervention and prevention strategies.

Critical incident stress debriefing (CISD) is one such strategy. CISD was originally developed by Dr. Jeffrey Mitchell to ease the acute stress responses of emergency workers.1 A critical incident is any event faced by emergency service personnel that may cause strong emotional reactions that could interfere with their ability to function.1 CISD hopes that immediate intervention following a traumatic event will eliminate or at least reduce delayed stress reactions.1

CISD is an intervention conducted by trained mental health professionals, in either group or individual format. CISD encourages traumatized individuals to share their thoughts and feelings about the critical incident, with the goal of making sense of the trauma.2 Aside from the reassurance and support provided by the health care professional, resources and information regarding practical coping skills are also offered.1

Debriefing typically occurs two to three days following the traumatic event and can last three to five hours. Debriefing responses are now recommended as standard practice in many schools, workplaces and government organizations. For example, people witnessing or experiencing workplace- or school-based violence will often receive a debriefing intervention.

Controversy between debriefing and more clinically established therapies, such as cognitive-behavioural therapy, has been widely debated. Because it is difficult to demonstrate the effectiveness of CISD, the debate is likely to be ongoing.3

There is limited scientific evidence for the effectiveness of CISD. The untested thinking behind CISD is that early intervention for trauma may reduce more chronic psychological disorders.4 While some findings support the use of CISD after a traumatic event and suggest it may be an effective tool of crisis intervention,5 there is little direct evidence supporting its use to reduce or prevent future psychological symptoms.

However, there is evidence from studies that show individuals receiving CISD actually fared worse than those receiving no intervention.6-7 What might account for these findings? One criticism of CISD is that it may prevent the “natural emotional processing” that follows a traumatic event.8 CISD may also unintentionally lead trauma survivors to rely heavily on health professionals and, consequently, bypass the support of family and friends.8 The fact is, many trauma survivors, despite the initial range of stress reactions, have their symptoms completely resolved within three months of the event, without any intervention at all.9

At present, personal testimonies are largely promoting the use and popularity of CISD.10-11 In order to support its continued use, researchers must scientifically examine the effectiveness of CISD. They need to use adequate control groups (a comparison group of participants who do not receive the treatment being studied, often referred to as a placebo group or “sugar pill”). They need to follow-up and to look at the impact of CISD with different groups of traumatized people. Objectives for the use of CISD must also be re-examined,10 to ensure that the long-term psychological and emotional recovery of the traumatized individual is the first priority.

 
About the authors

Katelin is a fourth-year undergraduate student at Malaspina University-College, doing a double major in psychology and sociology. She plans to pursue a master’s degree in speech pathology.

Jill is a third-year undergrad at Malaspina. Currently a research assistant, she plans to do graduate work in clinical psychology, specializing in substance use and co-occurring disorders. Melanie is a Registered Psychologist and Professor at Malaspina, with clinical and research interest in post-traumatic stress disorder and obsessive-compulsive disorder.

 

Footnotes:
  1.  Mitchell, J.T. (1983). When disaster strikes…the critical incident stress debriefing process. Journal of Emergency Medical Services, 8(1): 36-39.

  2. Mitchell, J.T. & Everly, G.S. (1997). The scientific evidence for critical incident stress management. Journal of Emergency Medical Services, 22(1): 86-93.

  3. Deahl, M. (2000). Psychological debriefing: Controversy and challenge. Australian and New Zealand Journal of Psychiatry, 34(6): 929-939.

  4. McNally, R.J., Bryant, R.A. & Ehlers, A. (2003). Does early psychological intervention promote recovery from post-traumatic stress? Psychological Science in the Public Interest, 4(2): 45-79.

  5. Everly, G.S., Jr. & Boyle, S.H. (1999). Critical incident stress debriefing (CISD): A meta-analysis. International Journal of Emergency Mental Health, 1(3): 165-168.

  6. Hobbs, M. & Adshead, G. (1996). Preventative psychological intervention for road crash survivors. In M. Mitchell (Ed.). The aftermath of road accidents: Psychological, social and legal perspectives (159-171). London, UK: Routledge.

  7. Mayou, R.A., Ehlers, A. & Hobbs, M. (2000). Psychological debriefing for road traffic accident victims. British Journal of Psychiatry, 176: 589-593.

  8. van Emmerik, A.A., Kamphuis, J.H., Hulsbosch, A.M. et al. (2002). Single session debriefing after psychological trauma: A meta-analysis. The Lancet, 360(9335): 766-771.

  9. Litz, B.T., Gray, M.J., Bryant, R.A. et al. (2002). Early intervention for trauma: Current status and future directions. Clinical Psychology: Science and Practice, 9(2): 112-134.

  10. Arendt, M. & Elklit, A. (2001). Effectiveness of psychological debriefing. Acta Psychiatrica Scandinavica, 104(6): 423-437.

  11. Hiley-Young, B. & Gerrity, E.T. (1994). Critical incident stress debriefing (CISD): Value and limitations in disaster response. NCP Clinical Quarterly, 4(2): 17-19.

 

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