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
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.
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
1. (b) What is meant by a 'Critical Incident Stress
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
- 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
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
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
5. An Outline of a debriefing group led by a counsellor or
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
- 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"
- 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
For information about any of the above services, please