Critical incident stress debriefing (CSID), otherwise known as crisis incident stress debriefing, is a seven phase group intervention process that assists those who have experienced a traumatic incident together. This group aims to help members process the incident and move forward together and is typically started a day to a few days after the incident.
What Is CISD?
CISD was originally developed by Jeffrey Mitchell in the 70s to help first responders cope with the traumas of their daily job. This strategy is now used for any homogenous group of individuals who have experienced a traumatic event together. In a study of volunteer firefighters, it was shown that implementing CISD after a potentially traumatic event significantly decreased the use of alcohol and increased the reported quality of life following the event in comparison to no treatment or stress reduction education.
Implementing the Seven Phases
This group can take anywhere between one and about three hours to complete. It is not considered group therapy, but is categorized as a structured process group with psycho-education as the main aspect.
Phase one is called the introduction phase. During this phase the group facilitators:
- Introduce the concept of CISD
- Go around to have group members introduce themselves
- Go over group rules and guidelines including confidentiality, mutual respect, and group participation
- Can create a rule board so participants can visually see the group rules throughout the session
This phase is known as facts. During this phase the group facilitators ask each member of the group to very briefly share their experience of the traumatic event. Although participation is highly encouraged, it is not a requirement and at any time, any individual can pass on sharing with the group. The goal of this phase is to get everyone to begin feeling comfortable speaking about the event. Facilitators can ask:
- "Can you briefly talk about what transpired?"
- "If you feel comfortable, can you please talk about the incident in a matter-of-fact way?"
- "Without inserting how the event made you feel, can you please share what happened?"
This phase is called thoughts. During this time, each person shares what their first thought was during the traumatic event. It can be challenging to pinpoint exactly what you were thinking, so the group leaders will have you focus on what came up for you during your conscious thought process. Again, not everyone has to share, but it is encouraged.
During the reaction phase, group members discuss the most difficult or scariest part of the incident. During this time emotions may come up and group members are encouraged to be supportive of each other and to listen carefully to other members. At this time, the group leader will not go around in the circle, but allows whoever wants to speak to do so. This phase is known as the most powerful part of CISD. It is not uncommon for some people to feel overwhelmed during this aspect of the group process. Some people may need to take a break, step outside, or do some grounding exercises before returning to the group.
During the symptoms phase, group members discuss how the event has impacted their life. Each person is given an opportunity to process how the incident has changed them as well as what physical and emotional symptoms have emerged. During this time the facilitators may notice people reporting symptoms of Post Traumatic Stress Disorder. If this happens, the facilitators should provide resources to those who reported these symptoms.
Based on what symptoms were reported in phase five, the facilitators will help the group process the symptoms and provide psycho-education. This phase is known as the teaching phase as it helps normalize and validate the symptoms experienced.
During the re-entry phase, anyone is allowed to make final remarks or comments. A summary of the CISD process will be reviewed and suggestions and resources will also be given out to group members. Handouts, business cards, and pamphlets may be offered to group members. At the end of phase seven, many CISD groups enjoy refreshments and chat with each other to continue the healing process. This helps end the session on a comforting note.
What to Do if Intense Emotions Come Up
During CISD, it is completely normal for strong emotional reactions to come up. In order to keep the group focused and allow everyone to process the situation, you may need to take action to keep the group moving along. If a group member is experiencing intense enough emotions that they are disrupting the group and the participant feels they are unable to continue the group session, the facilitator can:
- Take the participant outside and do some grounding exercises with the individual while the other facilitator continues on with the curriculum
- Provide helpful resources for the person so they can seek out individual treatment to help continue processing their experience
- Validate their emotional response and allow them to journal if they'd like to
- Sit with them quietly providing support when needed and seeing if they'd like to rejoin the group once they feel more grounded
To provide the best CISD group possible, be sure that the following circumstances are in place:
- Groups should be on the smaller side and not exceed 20 members
- Group members should have experienced the same trauma
- Groups should be ready to process the situation and not be experiencing ongoing traumatic events
- Groups should be led by experienced group facilitators who are properly trained in CISD techniques
- Groups should have at least two facilitators: one a mental health professional and the other a peer support person (firefighter, police officer, etc.)
- Have more than one mental health professional and one peer counselor so if someone needs to process further or privately during the group, you have another mental health professional able to continue facilitating
CISD is a great technique that can provide a supportive processing environment for groups who have experienced a traumatic event together. To find a local group or get trained in CISD techniques, take a look at the International Critical Incident Stress Foundation.