The Seven steps of critical incident stress debriefing to support trauma recovery
Following a critical and life-changing event, individuals often struggle to regain a sense of normalcy and safety, which can impact their mental health. Professional intervention is sometimes beneficial in helping individuals cope. 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 exposed to high levels of stress or trauma. There are seven steps of CISD, so understanding each can help you decide whether this treatment may benefit you.
What is critical incident stress debriefing?
Following trauma exposure, an individual can experience multiple emotional, mental, and physical symptoms that impact their well-being. According to the American Journal of Managed Care, critical incident stress debriefing (CISD) is a practice that allows survivors to process and reflect on the traumatic events they've experienced and gain personal control over the incident.
Stress debriefing often occurs shortly after the traumatic event to increase effectiveness. It's recommended that incident stress debriefing occurs within the first 24 to 72 hours to provide the most effective support to the trauma survivor. Prompt treatment is also crucial since symptoms and reactions may take time. However, there may also be benefits to receiving treatment even if the event happened a long time ago.
The seven steps of critical incident stress debriefing
Dr. J. T. 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 assesses as the participants introduce themselves and their initial statements, noting critical information, such as individuals' ages, their involvement in the incident, and their points of view. As the discussion continues, the facilitator can assess each participant more accurately.
2. Identify immediate issues surrounding safety
Through prompts and questioning, the group's facilitator can better understand individuals' perceived sense of safety, which can vanish instantly when sudden tragedy or loss strikes.
3. Use defusing to allow 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 therapeutic, as it helps participants process their emotions and come to terms with their trauma. The facilitator can 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 can be 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 crisis intervention.
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 it
When observing participants' moods, word choices, perceptions, and thoughts, the facilitator remains alert to maladaptive behaviors that might inhibit a survivor's ability to recover and cope with physical or psychological reactions. Common maladaptive behaviors include substance misuse, avoidance, withdrawal, and anxiety that turns into anger.
If you are struggling with substance use, contact the SAMHSA National Helpline at (800) 662-4357 to receive support and resources.
6. Bring closure to the incident and anchor the individual to community resources to initiate the rebuilding process
CISD is not intended to be the survivor's primary source of treatment. Therefore, it can be vital for group participants to learn about other resources available to them. In this stage, the facilitator may discuss future resources and community options.
7. Debrief to assist in the re-entry process into the community or workplace
After completing the CISD process, survivors may be more equipped to regain their sense of safety and well-being, allowing them to return to daily living with greater stability and reduced stress.
How CISD supports trauma recovery
Critical incident stress management was developed to provide a safe, open, and non-judgmental space for trauma survivors, enabling each participant to fully experience their initial reactions and emotions following a critical incident. CISD is intended to provide ongoing support to a small group to help those in need with the recovery process and prioritize well-being for a healthy future. Group sessions can reduce trauma impact for those experiencing post-traumatic stress disorder, help survivors recover, and identify those participants who require additional support and follow-up services.
Those in careers whose occupational safety is often at risk, like rescue and emergency workers, police officers, firefighters, disaster workers, and military personnel, can also benefit from this debriefing. While it can be critical to provide relief to their clients, service providers who experience trauma are often forgotten and may experience survivor's guilt. CISD was initially created to help individuals who may experience occupational safety hazards or industrial disasters.
CISD is typically conducted in a group format and led by a trained professional facilitating a psychological debriefing. Facilitators are medical professionals certified by the National Organization for Victim Assistance (NOVA).
It is often recommended that debriefing sessions occur within 24 to 72 hours of the traumatic event. Groups may meet over several days but for no more than two hours per session daily. This timing can allow survivors to process their experiences without becoming overwhelmed.
During 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.
What defines a critical incident?
Anyone who has experienced trauma or a catastrophic event may benefit from CISD intervention. Author and researcher Joseph A. Davis, Ph.D., identifies the following events and situations as "critical incidents," all of which may be benefited from this type of debriefing:
- Witnessing a sudden death
- An occupational safety crisis
- Incidents involving children
- Serious injury
- A threat to an individual's physical or psychological safety and well-being
- A distressing situation or event that profoundly changes or disrupts an individual's physical or psychological functioning
Individuals who endure the abovementioned incidents may experience a menagerie of long-term and short-term emotions, mental health symptoms, and reactions.
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 safety and overall well-being.
Signs someone may benefit from CISD
Trauma reactions are common among survivors. Short-term reactions that affect an individual's mental health are sometimes called "cataclysms of emotion," which describe the wide range of emotions an individual may experience. Common emotional responses include:
- Traumatic stress
- Suicidal ideation
- Homicidal ideation
If you are experiencing suicidal thoughts or urges, call the 988 Suicide & Crisis Lifeline at 988 or text 988 to talk to a crisis provider over SMS. They are available 24/7 to offer support. 988 also offers an online chat for those with an internet connection.
Common physical symptoms may include:
- Sleep disturbances
- Eating disturbances
- Muscle tremors
- Profuse sweating
- Heart palpitations
Some symptoms may immediately follow the critical incident, while others can surface over time. If these reactions become chronic, individuals may begin to use substances 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.
Resources for trauma survivors
There are many resources available for individuals who have experienced trauma. The US Department of Health and Human Services has published a 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 and crisis intervention for individuals affected by natural or human-caused disasters. The helpline is multilingual and 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. Their guide lists steps for reducing tragedy-related stress and 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.
If you are experiencing sexual abuse or have experienced assault, note that the Rape, Abuse, and Incest National Network (RAINN) has a hotline dedicated to supporting individuals experiencing sexual assault, harassment, or intimate partner violence. You can contact them anytime by calling 800-656-HOPE (4673) or using the online chat.
Alternative support options
While CISD can be helpful, it may be more effective when utilized in addition to individual therapy, either in-person or online. Online platforms like BetterHelp offer convenient and affordable counseling services to help you process traumatic events and move forward healthily. It may be difficult to confide in a therapist face-to-face about the challenges you've experienced in your life. Having more control during your therapy sessions may let you experience more significant healing.
If you have experienced trauma—either recently or in the past—an online therapist may be able to support you. They might administer CISD or adopt a different approach. When it comes to treating trauma, online therapy has engendered a high degree of collaboration between counselor and client. In addition, online therapy is often as effective as in-person therapy.
Unaddressed trauma can lead to mental health conditions like post-traumatic stress disorder (PTSD), depression, and anxiety. These conditions can cause physical health challenges and affect how you function in your daily life. A therapist can help you identify the impacts of your trauma and move forward healthily. Consider reaching out to a provider online or in your area to get started.
What is Stage 5 stress?
When stress is described as having five stages, burnout is usually the fifth stage. Originally, Hans Selye outlined three stages of stress: an alarm reaction phase, a resistance phase, and an exhaustion phase. Others have expanded this categorization to include other stages, such as recovery, adaptation, and burnout.
The burnout stage is similar to the exhaustion stage, but the term usually refers to a long-term exhaustion. In burnout, a person often feels fatigued, depressed, anxious, and more sensitive to stressors. People in burnout experience physical effects of chronic stress as well, such as an impaired immune system.
What is the 4th stage of stress?
When stress is outlined in five stages, the fourth stage is generally adaptation. Research shows that during this stage, the body begins to adapt to the presence of a stressor by continuing to release stress hormones and stay on alert for threats. If a person remains under stress for too long, adaptation will lead to exhaustion or burnout.
What are the 4 steps in the stress process in order?
There are two stress-related processes: the physical process a person's body experiences while they are stressed and the process of helping people return to calm after a traumatic event or stressful critical incident occurs.
The physical stress process is often called the general adaptation response and it involves three steps: an alarm reaction, resistance, and exhaustion. The alarm reaction is the first symptom phase, when the fight-or-flight nervous system responds to stress or a threat. Resistance involves the body trying to recover after this response. If the stress does not leave, a person begins adapting to it and eventually enters exhaustion.
There are seven steps of debriefing after critical incident stress. Often, emergency responders or other professionals help walk people through these steps after a potentially traumatic event. In this process, participants explore what happened and how to reenter the community afterward.
The first steps involve assessing the impact of the incident and identifying any immediate safety issues and discussing what occurred (fact phase). The next steps involve allowing people to discuss and process thoughts and emotions related to the event in a safe space, predicting future events in the aftermath of the incident (teaching phase), bringing closure to initiate rebuilding, and debriefing to assist with reentry into the community (reentry phase).
What are the four 4 types of stress?
Some experts have categorized major stressors into four types: catastrophic events, child maltreatment, stressful life events, and minority stress. All of these stressors are associated with increased mental health issues, like addiction. A licensed therapist can help people cope with any of these stressors.
Catastrophic events are those that pose a physical or emotional threat. At an extreme end, they might involve witnessing a natural disaster or terrorist attack. Child maltreatment can include neglect or physical, sexual, or emotional abuse. Maltreatment can be mild or extreme. Stressful life events can involve stressors in relationships, finances, or at work. Minority stress refers to stressors that stem from prejudice or discrimination due to a person being part of a minority group in society.
What are the 3 stages of stress?
The three stages of stress are an alarm reaction, resistance, and exhaustion. Jointly, these stages are called "general adaptation syndrome" and they describe the way the human body responds to a stressor that remains present over time.
What are the 3 levels of stress?
Some experts categorize stress into three levels or types: acute, episodic, or chronic. Acute stress lasts for a short period of time and then is relieved. For example, if you are running late to work, you may feel stressed, but that stress will probably pass shortly after you arrive.
In episodic stress, a person experiences acute stress frequently. If you run late to work often and feel stressed about it every time, that is episodic stress.
In chronic stress, a person is exposed to an ongoing stressor for an extended period of time. For example, you may have a boss that places unrealistic expectations on you and causes you to feel stressed at work. If this goes on for weeks, months, or years, that is chronic stress.
What are the 5 stages of stress and anxiety in order?
Some people categorize stress as occurring in five stages: alarm, resistance, recovery, adaptation, and burnout.
Anxiety is generally not categorized the same as stress. Instead, anxiety is categorized as having four levels: mild, moderate, severe, and panic. The higher a person is on this scale, the more anxiety they are experiencing.
What are the 4 categories of stress symptoms?
Stress symptoms are often put into four categories: physical, emotional, behavioral, and mental. Physical stress symptoms can include headaches, nausea, and trouble sleeping. Emotional symptoms can include feelings of nervousness, irritation, or loneliness. Behavioral symptoms can include displays of anger, irritation, or frustration. Mental symptoms can include trouble concentrating, confusion, and distraction.
What are 5 types of stress?
Experts often outline three, rather than five, types of stress. These include sustress, eustress, and distress. Sustress refers to a lack of stress. In this situation, a person actually has too little stress or stimulation. Eustress refers to good stress, which is just enough stress to benefit a person and help provide motivation for learning. Distress refers to what most people call "stress," which is too much stress or stress that has the ability to upset or harm a person.
What is the rule of 5 stress management?
Sometimes people are encouraged to manage stress using five coping skills that begin with "A": avoid, alter, adapt, accept, and be active.
Avoiding is a preventative measure that involves skipping unnecessary stress by setting boundaries, creating a calm environment for yourself, and shortening your to-do list. Altering a stressful situation may involve talking openly about your feelings, being assertive, or compromising with others. Adapting involves looking at the big picture, practicing gratitude, and thinking differently about your problems. Acceptance involves accepting whatever you cannot change. Being active involves engaging in physical activity, which evidence suggests often reduces stress.
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