The 7 Steps Of Critical Incident Stress Debriefing And How They Support Trauma Recovery
By Julia Thomas
Updated December 19, 2018
Reviewer Laura Angers
Following a critical and life-changing event, individuals often struggle to regain a sense of normalcy and safety. And professional help is sometimes necessary to help people cope with their psychological reactions. One way that therapists and counselors support trauma survivors is with the seven steps of critical incident stress debriefing. Keep reading to learn what this treatment method involves and how it can support trauma recovery.
What Is Critical Incident Stress Debriefing?
Following trauma exposure, an individual experiences both physical and psychological symptoms. Critical incident stress debriefing is a process that allows survivors to both processes and reflects on what has happened to them.
In an ideal situation, stress debriefing should occur as soon as possible after the traumatic event to increase the efficacy of this method. That's because the more time that elapses between the crisis and the debriefing, the less effective the debriefing is. Therefore, it's recommended that debriefing occurs within the first 24 to 72 hours following the critical incident to provide the most support to the trauma survivor.
Prompt treatment is also thought to be a crucial step since symptoms and reactions may take time to surface, and the sooner the individual is helped, the better.
Critical incident stress debriefing was designed specifically for first responders who experienced stressful and traumatic situations while working to serve others. These brave men and women can sometimes become secondary victims, and like those whom they're helping, they can also experience strong emotions and even physical reactions, too.
What Defines A Critical Incident?
Trauma, suffering, and catastrophes abound. Author and researcher, Joseph A. Davis, Ph.D. identify the following incidents as "critical incidents" which may be helped with this type of stress debriefing:
- Sudden death, including those which occur in the line of duty, as well as coworker/colleague suicide
- Incidents involving children
- Serious injury, such as from shootings, attacks, etc.
- Threats to the safety and well-being of an individual, both physically and psychologically
- Any situation which is distressing, dramatic or profoundly changes or disrupts an individual's physical or psychological functioning
Symptoms And Reactions That May Require Critical Incident Stress Debriefing
According to Davis, trauma reactions are quite common and to be expected from survivors. Short-term reactions are sometimes referred to as "cataclysms of emotion," and this name is a good description of the wide range of emotions an individual can experience, such as:
- Suicidal ideation
- Homicidal ideation
Physical symptoms can include:
- Sleep disturbances
- Eating disturbances
- Muscle tremors
- Profuse sweating
- Heart palpitations
Some of these symptoms immediately follow the critical incident, while others surface over time, developing into long-term reactions. If these reactions become chronic experiences, the individual may turn to substance abuse to cope and cover them.
Lower productivity, as well as absenteeism, can increase if individuals have not been empowered with coping and management skills following the critical incident.
When Is Critical Incident Stress Debriefing Useful?
This form of treatment is helpful when people have been caught off guard and traumatized by events, such as workplace violence, shootings, natural disaster, attacks, and violence in public spaces, including schools, concerts, and political events.
And while it's important to provide relief to the victims, we often forget that those providing services are also in need of help, too. That's what critical incident stress debriefing is designed to do. Therefore, rescue and emergency workers, along with police officers, firefighters, military personnel, etc. can benefit from this debriefing.
What Are The 7 Steps Of Critical Incident Stress Debriefing?
Dr. Jeffrey Mitchell first developed this early intervention strategy and documented it in his study published in the Journal of Emergency Medical Services, entitled "When disaster strikes: The critical incident stress debriefing process." The following seven steps make up the stress debriefing process, as outlined by a fellow scholar, Joseph A. Davis, Ph.D.:
- "Assess the impact of the critical incident on the "
The leader makes his or her assessment as the participants introduce themselves and share their initial statements. The leader should gain information like the individual's age and their involvement in the incident. As the discussion grows, the leader is better able to make an accurate assessment of each participant.
- "Identify immediate issues surrounding problems involving 'safety' and 'security.'"
Safety and security can vanish instantly when sudden tragedy or loss strikes. Understanding an individual's perceived sense of safety and security is gathered from group discussion, which is facilitated by the leader's prompting and questions.
- "Use defusing to allow for the ventilation of thoughts, emotions, and experiences associated with the event and provide "validation" of possible reactions."
Being able to talk about the critical event can be incredibly therapeutic, in and of itself, as it helps people process their emotions and come to terms with what they witnessed and experienced. The leader should provide a safe and non-judgmental space for them to do so.
And it should also be an opportunity for the leader to validate each person's own, unique reaction, and let them know that this is both normal and okay.
- "Predict events and reactions to come in the aftermath of the event."
Participants are supported by also being made aware of possible reactions that may surface as the days, weeks and even months, go on. This can include emotional reactions, physical symptoms, and psychological changes. This empowers the trauma survivor to plan for the future and ward off any more stressful incidents.
- "Conduct a "Systematic Review of the Critical Incident" and its impact emotionally, cognitively, and physically on survivors. Look for maladaptive behaviors or responses to the crisis or trauma."
While observing the participant's mood, word choice, perceptions, and thoughts, the leader must stay alert to any maladaptive behaviors that might inhibit the survivor's ability to recover and cope with their physical or psychological reaction. Common maladaptive behaviors include substance abuse, avoidance, withdrawal, and anxiety becoming anger.
- "Bring "closure" to the incident, and "anchor" or "ground" the individual to community resources to initiate or start the rebuilding process."
As stated previously, critical incident stress debriefing is not meant to be the survivor's main treatment. Therefore, it's important that group participants are educated on the resources available to them in their community.
- "Debriefing assists in the "re-entry" process back into the community or workplace."
By addressing the critical event, along with the individual's reaction to it, the survivor may be better able to regain his or her self of safety, security, and wellbeing. This, in turn, allows them to return to normal life with greater equanimity and less stress.
How Does Critical Incident Stress Debriefing Usually Occur?
The most common way critical incident stress debriefing is given is in a group format, where trauma survivors led by a trained professional to discuss the critical event. Group leaders are medical professionals who have been certified by the National Organization for Victim Assistance (NOVA).
As we learned earlier, it is recommended that these debriefing sessions occur within 24 to 72 hours of the traumatic event. Groups can meet over the course of several days, but for no more than two hours per session each day. This allows survivors to process everything without becoming too overwhelmed.
Leaders help participants understand their emotional reactions, and also provide validation for their reactions. Leaders also provide stress management tools and resources for continued support.
While this may sound like a therapy session, critical incident stress debriefing (CISD) is never meant to replace therapy. Instead, it is part of a multi-faceted treatment system called Critical Incident Stress Management (CISM), of which CISD is just one of many treatments.
What Are The Goals Of Critical Incident Stress Debriefing Treatment?
This treatment method was developed to provide trauma survivors a safe, open and non-judgemental place where they can share their initial reactions and emotions following a critical incident.
Furthermore, these group sessions aim to reduce trauma impact, help survivors recover, and identify those survivors who require additional support.
Is Critical Incident Stress Debriefing Effective?
Research studies show conflicting views on the effectiveness of critical incident stress debriefing. One study demonstrates that survivors who were given CISD within the first 24 to 72 hours following the critical incident had fewer reactions and psychological trauma. Without this debriefing intervention, other studies found that emergency, rescue, police and fire personnel had an increased risk of developing clinical symptoms - both psychological and physical.
However, there is also a growing body of research suggesting an opposite viewpoint on critical incident stress debriefing. For example, one study observed that individuals who received CISD did worse than those who hadn't had any intervention treatment. This may be because the debriefing process interferes with an individual's "natural emotional processing." Another study suggested that immediate intervention leads trauma survivors to rely too much on professional help.
And some research suggests that critical incident stress debriefing is entirely unnecessary as most individuals completely resolve their symptoms within three months of the traumatic event.
Perhaps more objective scientific research is required to understand better just how helpful CISD is for trauma survivors, as well as ways to improve any of the seven steps which seem to be beneficial.
In the meantime, if you or someone you know has experienced a traumatic event, consider seeking the help of a professional counselor or therapist to help process reactions, as well as the psychological and physical symptoms that may arise following the critical incident.