What is a Critical Incident Stress Debriefing?

Following a traumatic (or critical) incident, many organisations will bring in external professionals to conduct a Critical Incident Stress Debriefing (CISD) as part of their support processes for those involved. However, it’s not unusual for people who have been invited to attend to feel concerned or apprehensive about what this session is, or to think that it is unnecessary for their needs.

If you are organising a CISD, it can be helpful to be informed of, and understand, the purpose, practicalities and principles behind this group session.

A CISD is a specially structured group meeting between the people who were directly involved in the critical incident and professional health workers who are experienced and trained to advise and support them. It is one of many crisis interventions that collectively are known as critical incident stress management.

The Critical Incident Stress Debriefing (CISD) was developed by Dr Jeffrey T. Mitchell in 1974 (Mitchell & Everly, 2001) and was originally intended for use with the emergency services and disaster workers. It is now commonly used across a range of settings following diverse incidents that are unusual, shocking or particularly emotionally challenging or intense.

A CISD is not psychotherapy nor is it a form of therapy or treatment. However, many people find it helpful to reflect on the incident alongside the people they experienced it with. This can help people to make sense of what happened as they hear others’ experiences of the same event and “missing pieces of the jigsaw” slot together.

People don’t have to speak in the CISD if they don’t want to. If they don’t feel the need to attend for themselves, it can still be very helpful for their colleagues if they are there. Often, it’s the people who we experienced an event with that truly understand the context and can offer support.

A CISD is always held in a private setting and only those directly involved in the incident will be invited.

As part of the process, the CISD team will provide advice and guidance on how they can help themselves and each other in the following days and weeks. A CISD is always followed up with assessment, triage and further support for those who need it.

The goals of a CISD are to

• Reduce the distress relating to the incident
• Help with psychological “closure” and putting together the pieces of what happened
• Teach the group about stress management that is particularly relevant to their symptoms.
• Identify coping resources both within the group and externally
• Rebuild a sense of group cohesion and peer support
• Assist with assessment, triage and referral to further services if needed

Sessions typically last around 2 – 3 hours.

The CISD team takes the group through the structured process and remains available after the meeting for any individual advice, questions or support that is needed.

In order to create a safe session that complies with best practice, it is crucially important that

• Only people with the same level of exposure are included in each session
• Group members know each other well and have a level of trust between them
• The incident is over and the group is psychologically ready for the session
• The CISD is part of a continuum of care and not a stand-alone intervention
• A recognised and validated model is used, e.g. the Mitchell 7 phase model
• It is a group intervention for use with groups, not individuals
• The professional team delivering the CISD is appropriately trained and supervised. It is not good practice to have 1 person running the session unless the group is particularly small (e.g. 4 or less) and arrangements are in place should someone need to leave the room.

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