To CISM or NOT to CISM
Most agencies have adopted the use of Critical Incident Stress Management (CISM) and/or Psychological Debriefing (PD) as a widespread and expected intervention following exposure to trauma. Employers, aid organizations, and other authorities frequently default to orchestrating “debriefing” services, both to help mitigate the psychological consequences of these disruptions and to meet duty of care requirements under workplace health and safety laws.
Experts still do not agree on this practice yet many agencies have made debriefings mandatory. To CISM or Not to CISM is the question. A literature search produces the full spectrum of opinions. On one side a team of experts write; “there is no convincing evidence that debriefing reduces the incident of Posttraumatic Stress Disorder (PTSD), and some controlled studies suggest that it may impede natural recovery from trauma.” An equally experienced PhD provides an opposing view on why the practice continues with pervasive support; “by using Critical Incident Stress Management (CISM), a technique of emotional first aid, peer-support officers can achieve results equal to, or better than, many mental health professionals.”
What’s the right answer? Should agencies conduct CISM? If so, should it be voluntary or mandatory?
In the recent 2013 revision of the National Fire Protection Association (NFPA) 1500 National Standards, Critical Incident Stress Debriefing (CISD) was removed from Chapter 12. The revised text in Chapter 12 focuses on the use of professional services when addressing exposure to atypical stressful events and moves away from the debriefing model as a requirement or desirable intervention. The Police Chief Magazine counters the NFPA change with continued support for CISM as “an effective and valuable crisis intervention system designed to mitigate the impact of these traumatic incidents on police officers and other emergency responders.”
There are numerous articles on effective approaches to using CISM and many start with what CISM isn’t. CISM is not psychotherapy or counseling but a group support process with the emphasis on mitigating distress, facilitating psychological normalization, providing effective stress management education, identifying external coping resources, and restoring unit cohesion and performance. I judge it’s not a simple to do or not do, but the how, where, why, who and what that make up the numerous variables associated with CISM. When done correctly, CISM is an effective tool and deserves to remain in the inventory of accepted practices of agencies for helping to maintain the health and effective performance of their personnel.
After a traumatic event personnel impacted should be offered support services like CISM but such services should not be made mandatory. The impacted individual should be allowed a voice in choosing what level of support or intervention they need. Initial offered support may incorporate psycho-education as a means to explain common reactions to trauma and typical treatment protocols available for those interested. During initial meetings it can be beneficial to set the expectation that the majority of people naturally recover from trauma without the need of therapy, especially if they resume their normal daily activities and do not engage in avoidance behavior of trauma reminders. Advise those impacted that if symptoms persist seek treatment. Those interested in treatment should be encouraged to seek out evidenced based, empirically validated treatments for PTSD, such as PE (Prolonged Exposure) therapy, CPT (Cognitive Processing Therapy), and EMDR (Eye Movement Desensitization and Reprocessing) therapy.
We share, at the end of the day, a collective responsibility to ensure that what assistance we offer indeed translates to meaningful, measurable help for those who avail themselves of our ministrations; at the very least, we share a moral obligation that first, we shall do no harm. Our intentions are surely quite honorable and our efforts strong and sincere, but it is the outcomes that ultimately matter. When applied appropriately and within the scope of its design by trained personnel, CISM is effective in assisting individuals and groups in crisis. One of the challenges is intervening only where and when needed, using the most appropriate intervention for the situation. Early psychological intervention should be based on recognition of need, not strictly the occurrence of an event.
