The 7 Steps Of Critical Incident Stress Debriefing And How They Support Trauma Recovery
By: Kelly Spears
Updated May 21, 2020
Medically Reviewed By: 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.
Critical incident stress debriefing (CISD) is a step-by-step process that promotes resiliency and recovery for individuals who have been exposed to high levels of stress and/or trauma. Later in this article, we'll cover the seven steps of CISD and the intervention's effectiveness. First, we'll provide a brief overview and history of this recovery method, identify the different types of critical incidents, and outline common symptoms and reactions.
What Is Critical Incident Stress Debriefing?
Following trauma exposure, an individual experiences both physical and psychological symptoms. CISD is a practice that allows survivors to both process and reflect on the traumatic events they've experienced.
Ideally, stress debriefing should occur shortly after the traumatic event to increase the method's effectiveness. It's recommended that debriefing occur within the first 24 to 72 hours to provide the greatest support to the trauma survivor. Prompt treatment is also considered crucial since symptoms and reactions may take time to surface. However, there are still major benefits to receiving treatment even if the event happened a long time ago.
What Defines a Critical Incident?
Anyone who has experienced trauma, suffering, and/or a catastrophic event may benefit from CISD. Author and researcher, Joseph A. Davis, Ph.D., identifies the following events and situations as "critical incidents," all of which may be helped with this type of stress debriefing:
- Sudden death
- Incidents involving children
- Serious injury
- A threat to an individual's physical and/or psychological safety and wellbeing
- A distressing situation or event that profoundly changes or disrupts an individual's physical or psychological functioning
Individuals who endure any of the above-mentioned incidents are likely to experience a menagerie of long-term and short-term emotions, symptoms, and reactions, which we'll cover later in this article.
Recognizing and accepting the need for help following a traumatic event can lead to healing and restored hope. CISD by a trained professional helps individuals process traumatic experiences in a one-on-one or group setting. Stress debriefing also allows the trauma survivor to reflect on the incident's impact.
CISD provides a bridge from the traumatic event to hope, healing, and recovery by giving the survivor a voice, offering closure, and allowing the individual to live with a restored sense of security and overall wellbeing.
Symptoms and Reactions That May Require Critical Incident Stress Debriefing
According to Davis, trauma reactions are quite common among survivors. Short-term reactions are sometimes referred to as "cataclysms of emotion," which is a good description of the wide range of emotions an individual may experience. Common emotional responses include:
- Suicidal ideation
- Homicidal ideation
Common physical symptoms 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. If these reactions become chronic, individuals may begin to abuse drugs and/or alcohol in an effort to cope with the trauma.
Absenteeism and decreased productivity are common if individuals are not empowered with coping and management skills following the critical incident.
When Is Critical Incident Stress Debriefing Helpful?
CISD was developed to provide a safe, open, and non-judgmental space for trauma survivors, enabling each participant to share their initial reactions and emotions following a critical incident. The group sessions can reduce trauma impact, help survivors recover, and identify those participants who require additional support.
Rescue and emergency workers, police officers, firefighters, and military personnel, can also benefit from this debriefing. While it's important to provide relief to the victims, service providers who experience trauma are often forgotten. CISD was initially created to provide help for these individuals.
CISD is typically facilitated in a group format and led by a trained professional. Facilitators are medical professionals who have been certified by the National Organization for Victim Assistance (NOVA).
As mentioned earlier, it is recommended that these debriefing sessions occur within 24 to 72 hours of the traumatic event. Groups may meet over the course of several days, but for no more than two hours per session each day. This allows survivors to process their experience without becoming overwhelmed.
During these group sessions, the facilitator helps participants understand their emotional reactions, validates their responses, and provides stress management tools and resources for continued support. Although similar to a therapy session, CISD is not intended to replace individual or group therapy.
The 7 Steps of Critical Incident Stress Debriefing
Dr. Mitchell explained the concept of CISD and its steps in a 1983 study published in the Journal of Emergency Medical Services, titled "When Disaster Strikes: The Critical Incident Stress Debriefing Process."
The following seven steps make up the stress debriefing process, as outlined by Mitchell's fellow scholar, Joseph A. Davis, Ph.D.:
1. Assess the Impact of the Critical Incident on Support Personnel and Survivors
The facilitator makes his or her assessment as the participants introduce themselves and share their initial statements, making note of key information, such as individuals' ages and their involvement in the incident. As the discussion continues, the facilitator is better able to make an accurate assessment of each participant.
2. Identify Immediate Issues Surrounding Problems Involving Safety and Security
Through prompts and questioning, the group's facilitator gains a better understanding of individuals' perceived sense of safety and security, which can vanish instantly when sudden tragedy or loss strikes.
3. Use Defusing to Allow for the Ventilation of Thoughts, Emotions, and Experiences Associated with the Event, and Provide Validation of Possible Reactions
Having a safe space to talk about a critical event and its aftermath can be incredibly therapeutic in and of itself, as it helps participants process their emotions and come to terms with their trauma. The facilitator should provide a safe, non-judgmental space for reflecting and processing. During this stage, the facilitator validates each person's unique experience and reactions, assuring participants that their responses to the traumatic event are valid and normal.
4. Predict Future Events and Reactions in the Aftermath of the Incident
Participants are further supported by being made aware of possible reactions that may surface as the days, weeks, and months progress, including emotional reactions, physical symptoms, and psychological changes. This knowledge empowers trauma survivors to plan for the future.
5. Conduct a Systematic Review of the Critical Incident and Its Emotional, Cognitive, and Physical Impact on Survivors, and Look for Maladaptive Behaviors or Responses to the Crisis or Trauma
When observing participants' moods, word choices, perceptions, and thoughts, the facilitator remains alert to any maladaptive behaviors that might inhibit a survivor's ability to recover and cope with physical or psychological reactions. Common maladaptive behaviors include substance abuse, avoidance, withdrawal, and anxiety turning to anger.
6. Bring Closure to the Incident, and Anchor or Ground the Individual to Community Resources to Initiate the Rebuilding Process
As stated previously, CISD is not intended to be the survivor's main source of treatment. Therefore, it's important that group participants are educated on other resources available to them.
7. Debriefing Assists in the Re-Entry Process into the Community or Workplace
After completing the CISD process, survivors may be better equipped to regain their sense of safety, security, and wellbeing, allowing them to return to normal life with greater equanimity and reduced stress.
Is Critical Incident Stress Debriefing Effective?
Research suggests the effectiveness of critical incident stress debriefing is inconclusive. But one study demonstrates that survivors who received CISD within the first 24 to 72 hours following a critical incident had fewer reactions and less psychological trauma. And other studies indicate that emergency, rescue, police, and fire personnel had an increased risk of developing psychological and physical symptoms without CISD.
Opposing the above-mentioned research, some experts believe CISD is ineffective. There is some evidence to support their view. One study found that individuals who underwent CISD struggled more than those who received no treatment, possibly because the debriefing process interferes with an individual's natural emotional processing.
Another study found that immediate intervention led trauma survivors to heavily rely on professional help. And some research suggests that CISD is unnecessary, as most individuals completely resolve their symptoms within three months of a traumatic event. Perhaps more objective scientific research is required to better understand just how helpful CISD can be for trauma survivors.
Resources for Trauma Survivors
There are many helpful resources for individuals who have experienced trauma. The U.S. Department of Health and Human Services has published an excellent guide to coping with grief after a disaster or traumatic event. This free, informative resource outlines the steps to coping with grief, and includes contact information for nationally recognized organizations.
The Disaster Distress Helpline offers 24-hour crisis counseling for individuals who have been affected by natural or human-caused disasters. The helpline is multilingual, confidential, and completely free. You can reach a trained professional by calling 1-800-985-5990 or texting TalkWithUs to 66746.
Trauma survivors can also find helpful information and support via the American Psychiatric Association. This helpful guide lists steps for reducing tragedy-related stress, along with a section dedicated to helping children who have experienced trauma. There are also several links to resources for managing stress, recovering after specific events, and dealing with grief.
How Online Therapy Can Help
While CISD can be helpful, it should be utilized in addition to individual therapy. BetterHelp offers convenient, confidential, affordable counseling services to help you process traumatic events and start moving forward.
Hundreds of thousands of individuals have gotten the help they needed thanks to BetterHelp's professionally trained counselors. Below, you'll find some reviews of BetterHelp counselors, from people experiencing similar issues.
"Dr. Cooley was able to identify my needs and address appropriate therapy. I no longer have PTSD events that are not manageable. He has give me tools and resources to deal with my issues. I became brave enough to make positive change in my life and found I could experience joy and genuine love."
"Brandon has been great and really instrumental in helping me get through a difficult period in my life. He is nonjudgmental, responsive and a great listener. He is also great at reading into what you are saying and finding the underlying cause of your fears and helping you work through it. I'm excited to continue the work to heal with the help of Brandon."
Recovery from trauma is possible. By seeking the help you deserve, you can begin to replace fear with hope and happiness. Take the first step.