Jonathan Lake

 
Counselling & psychotherapy
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Critical Incident Stress Debriefing (CISD) for Trauma
Executive Coaching
Workplace Mediation
 

Critical Incident Stress Debriefing (CISD) for Trauma

When people experience, or witness, a traumatic event for which they are not prepared (e.g. a car crash: death by drowning: a fire; a suicide attempt etc.) severe psychological stress can be felt. Some people may become very upset and disturbed and question whether the world in general is benevolent or malevolent; whether they are worthy or unworthy; and whether people are trustworthy or untrustworthy.

The greater the trauma, the more individuals will ask fundamental questions about themselves and their relationship to the world. Some individuals will experience intrusive thoughts and images, avoidance behaviour and general irritability. Most people will, for a short time, feel overwhelmed by the event.

The purpose of running a Critical Incident Stress Debriefing (CISD) Group is to minimise the effects of such a trauma. Some people will go on to have weekly personal counselling, if their psychological stress persists. This is particularly important if symptoms are still felt after about 3 months. Medical attention may then be sought as well.

What is Critical Incident Stress Debriefing (CISD) for Trauma?

Some general information on crisis counselling, and Critical Incident Stress Debriefing (CISD) for Trauma follows, with an outline of a debriefing group.

1. (a) What is meant by a 'Critical Incident'?

A critical incident is any abnormal event that occurs outside the range of normal human experience. The event has the effect of interrupting a person's normal ability to psychologically cope or function

1. (b) What is meant by a 'Critical Incident Stress Debriefing' (CISD)?

A Critical Incident Stress Debriefing (CISD) is not therapy but a structured educational and supportive group meeting in which trained facilitators review with the participants or victims of a traumatic incident, their thoughts, impressions, feelings and symptoms following a Critical incident, disaster or accident.

Examples of a Critical Incident Stress Debriefing Group could include any of the following:

  • Discussion of serious injury or unexpected death of a person or work colleague
  • Discussion of an incident charged with profound emotion
  • Unusual media attention
  • Unusual circumstances producing a high level of immediate or delayed reaction
  • Serious threats to life such as in an armed raid, fire, assault or natural disaster
2. What are the distinctions between Post Traumatic Stress (PTS) & Post Traumatic Stress Disorder (PTSD)?

PTS characteristically differs from PTSD by the severity of the psychological symptoms and the time taken to recover. PTS symptoms can generally influence a person's thoughts, feeling and reactions for up-to 4-6 weeks following the traumatic event. If the symptoms persist for up-to 3 months then the person is likely to be suffering from acute PTSD. Longer then 3 months, the person is likely to be suffering from chronic PTSD. PTSD affects about 1 per cent of the population and is classed as a serious mental health concern. With PTS, a person would re-experience or re-live the event as if it was happening now. PTSD sufferers would also go to great lengths to avoid reexperiencing the trauma schemata. They would also have very intrusive imagery and thoughts. PTSD is the resulting disorder of the PTS symptoms.

3. How does Crisis Counselling differ from Critical Incident Stress Debriefing?

Crisis Counselling - an individual experience
Crisis Counselling is a one to one intervention which can happen immediately following the incident. It may only be a one off session and it is not systematic. Crisis interventions such as guidance can assist the client to find their bearings. Clients can tell their story and are encouraged to express their feelings and concerns. A crisis counselling session is usually 50 minutes long. It can be followed by further one to one counselling if that feels beneficial.

Critical Incident Stress Debriefing - a group experience
The Critical Incident Stress Debriefing process has an optimum time to commence usually between 48-72 hours after the incident. It remains focused on the set aims of building a clear picture, understanding and acceptance of the typical reactions associated with being victimised by an overwhelming, stressful experience. It is a group process, which can last up to 2-3 hours. Both can be extremely helpful in dealing with the reactions associated with trauma.

4. What is the best period of time following an incident in which to hold a CISD?

Whenever possible a CISD should take place within 48-72 hours following a traumatic incident. The time delay allows the bodies natural coping mechanism to deal with the initial intense shock to the system.

5. An Outline of a debriefing group led by a counsellor or facilitator

A. The Ground Rules
A distinction is made at the beginning, between debriefing and Counselling. The length of the session is established; this can be between 1 and 3 hours. The purpose of the meeting is explained. A point is made to check that everyone is present who should be present. Important information to get over in the introduction will include:

  • Professional experience and expertise in the process
  • Duration of the session
  • Rules for staying and leaving the room, including any breaks
  • Confidentiality and ground rules
  • Explanation of the role of the facilitator in inviting all to participate who wish, by going around the group
  • The freedom to speak or not. Emphasis on supportive forum
  • Normalizing the reactions and stating that some people may temporarily feel worse.

B. The Facts Stage
The aim at this stage is to invite the participants to give a factual account of the details related to the traumatic event. Each individual will be asked, "Where were you moments before the incident and what were you doing?" "What was the first moment you realised something was wrong?" "What happened next? Such questions help the group to realise how unexpected the trauma was for them and aims to assist them to accept their lack of readiness and normalise their immediate reactions. The facilitator has the task of examining and restructuring cognitive thoughts. If a group member answers a factual questions with a feeling answer this is reframed and asked again. For example, What did you think was going to happen next?.... "I felt as though I was next..." The reframe would be to reflect that back; "What was it you thought or saw that made you feel you were going to be next....?" Once back to a factual answer the session is moved on to the next person. Once all the participants have answered they are all thanked for the details and a summary of what has been learnt so far is fed back.

C. The Feelings Stage
Certain group members may be feeling very vulnerable and fragile. Feelings and sensory impressions of the event can be shared: ie, what was seen, heard, smelt, tasted, touched and also present feelings. Participants may think this is weird as they may or may not have had flashbacks. They may remember something that can later become a trigger for re-experiencing the original event in the future so it is important to explore the memories of the event. Participants will discover that others have reacted in a similar way, some very differently. People feel, after a debriefing session, less alone and isolated.
Great care and empathy needs to be taken in order to help participants accept their emotional state. If anger, frustration or blame is presented here the facilitator acts quickly to re-establish the ground rules. Some incidents can be very gory or violent and a member may feel very distressed, needing to leave the room. In that case a facilitator or support buddy should also leave to comfort that person. Some typical questions asked in the "feelings stage" might be:-

  • What was the worst moment for you?
  • When did you feel most frightened and you were feeling what?
  • How do you feel now about everything?
  • How did you feel when you got home?

D. The Future Stage
This stage is about making sure that each group member has a support structure: some will have spoken to friends, family or a GP since the incident. It can be useful to the group for members to say what will happen after they go home and how they have been coping with regard to friends, family and the media if appropriate. Members are asked to say one thing they will do after this debriefing is over in terms of moving on and accessing personal support. Experience has found that if it is said at this point it is more likely to be done.

E. The Ending Stage
Having worked through the above stages the facilitator thanks the group for all their hard work and ends by asking a range of questions such as:

If you were back in the traumatic situation knowing what you know now, what would you do differently?

  • What are you feeling now?
  • What are you taking away with you?
  • What help do you or your family need now?
  • What you learnt most out of this debriefing?
  • The de-briefer will ensure that referrals and appropriate counselling contacts are provided on an individual basis at the end of the de-briefing session so that the correct support is provided.

More information

For information about any of the above services, please contact Jonathan.