Critical Incident Stress Management (CISM) is a form of intervention used as soon as possible after exposure to trauma in order to reduce symptoms and prevent post-traumatic stress disorder (PTSD). At its most basic, it is a form of psychological debriefing that can be traced as far back as the First World War. Techniques were originally devised for military combatants. Today, variations are used with the so-called secondary victims of trauma. These include firefighters, the police, ambulance and others who may find themselves dealing with traumatic situations.
CISM typically occurs soon after a critical incident. The basic procedure involves a trained facilitator who sets out ground rules. These ground rules may include the fact that participation is voluntary. This isn't always the case as some organizations require CISM as compulsory to avoid possible negligence claims from employees who go on to develop PTSD. Other common ground rules include anything that is said remains confidential and stays within the group, and anything that might impede comments, such as rank or status, are suspended. Once agreed, the members of the group are invited in turn to provide an account of their experiences and feelings in relation to the incident. Once completed, the facilitator will talk to the group about normal stress reactions and what they may find themselves experiencing in the next few days and weeks. Some stress management techniques may also be discussed and practiced. Some sessions end in a social gathering.
A variety of strategies may be employed after a critical incident. These all come under the general category of CISM but six distinct components exist. These are pre-incident preparation training; individual crisis support; demobilization - which includes food, rest and information about coping as staff complete shifts; small group meetings for defusing; family support and referral.
CISM is not without its critics. The academic literature contains many a heated debate as to whether its use really does prevent the onset of PTSD as so often claimed. Some of the more recent literature claims that CISM has either no effect or can actually make the situation worse. Part of the problem seems to lay in the nature of the trauma, how quickly or otherwise support is offered, and the fact that many differences exist in the ways support is provided. Although it may seem reasonable to assume that it is helpful to express thoughts and feelings following a traumatic event, the assumptions are now under greater scrutiny. As things stand the emphasis seems to be moving away from CISM to a position where screening and the provision of support is available for those at risk, or actually seen as suffering from the effects of trauma.
Kenny, D.T. ‘Stress Management'. in Ayers, S., Baum, A., McManus, C., et al (2007) Psychology, Health & Medicine. Cambridge Medicine.
Published On: September 13, 2010