Psychological suffering after being exposed to a negative incident is an aspect that knows no limits given the stature of the modern day world. For the common person, critical incidents are encountered in the form of natural disasters while professionals such as law enforcers and firefighters are guaranteed to witness various events in their career spans. Such exposure leaves individuals mentally disturbed, requiring what Dyregrov (1997) terms as Critical Incident Response Programs (CIRPs). CISD, which is part of CISM, is all but a small part of the larger web of CIRPs. The role of this discussion is to offer a deeper analysis on the efficiency of CISD and CISM as part of CIRPs intervention. This discussion will begin with the summary of CISD/CISM before moving ahead to cover existing literature on its efficacy and later compare it to Psychological First Aid (PFA).
Summary of CISM/CISD
This is one of the incident intervention programs that has been widely studies and put into use. Based on a consensus of studies made by Everly Jr. and Mitchell (1995), Dyregrov (1997) and Blalock (2014), CISD is known as the Mitchell model and its mission as conceptualized by Mitchell is leadership, education, training, consultation, and support services in comprehensive crisis intervention and disaster behavioral health services to the emergency response professions, other organizations, and communities worldwide (Blalock 2014, p.18). Scrutinized closely by Blalock (2014) using the findings of Everly Jr and Mitchell (1997), CISM has seven components, which determine the mode of its functionality. These seven spheres are; pre-crisis preparation, demobilization and staff consult, defusing, CISD, Individual Crisis Intervention (ICI), family CISM and follow up/referrals. As shown by this, CISD is just but a component under the large umbrella of CISM. This intervention mechanism was developed exclusively for a small group of homogenous people who have been exposed to a strong traumatic event. In the depiction of CISDs simplicity by Mitchell in Everly Jr. and Mitchell (1995), it is just a well-synchronized storytelling process outlined by practical information that is supposed to help individuals recover fast from a critical incident.
Literature Coverage on CISM/CISD
Moving further ahead to discuss the nature of CISM, Blalock (2014) indicates that the mental intervention process does not deal specifically with primary victims such as dog-bitten individuals but rather it is carefully crafted for a larger group of professionals or homogenous individuals. The best course of action for primary cases is their referral to the real psychotherapy practitioners given the complex nature of their situations. Just like the CISM, the debriefing process also has seven steps. These steps begin with the introduction of the patients to the therapy session and end with a follow-up to determine the stability of patients. Dyregrov (1997) provides a deeper analysis of the process debriefing model. He goes ahead to acknowledge that it is a process with its efficiency limited to less than 20 homogenous people, preferably professionals who have been affiliated with the same institutions such as police officers. The effectiveness of process debriefing is also dependent on the dynamics of the group as acknowledged more by Dyregrov (1997). People within a similar group are supposed to have experienced the same incident to facilitate a smooth sharing of their experiences and discerning the best way forward.
From a professional point of view, Dyregrov (1997) and Everly Jr. and Mitchell (1995) appreciate the fact that psychological debriefing is the most used process. Thus, much literature on its general efficacy is available. For instance, the analysis of Dyregrovs (1997) coverage manifests the fact that CISM is only effective if its core values are strictly adhered to. Any other process is expected to produce the same optimal results if the professionals adhere to the core standards of its practicality. However, given the tricky nature of the debriefing process, studies have been able to dispute its general efficiency. For instance, in the coverage carried out by Blalock (2014), the practical discrepancies identified for CISD include the fact that for the individuals who were likely to develop PTSD, the single sessions of process debriefings as explored further by Dyregrov (1997) were not of very much help. The second aspect that taunts the image of CISD is that subsequent re-exposure to critical incidents for individuals is very much likely to result in retraumatization as opposed to those people with similar conditions but had opted for the cognitive behavioral therapy. The other downside of CISD as explored further by Blalock (2014) is that psychological debriefing, which specializes with a limited group number, assumes that all people react the same to traumatic events. As such, the quality of therapy outcome is limited in its efficiency because some of the patients end up thinking that they have mental disorders.
In a separate study, Barboza (2005) takes the time to acknowledge the ongoing scholarly stalemate regarding the effectiveness of CISD. While much discussion might be ongoing concerning the current process, Barboza (2005) appreciates the fact that not many studies have been truly done to argue out the efficiency of the debriefing process. However, the empirical approach taken by scholars to analyze the position of CISD reveals that the process is not clinically effective. To Barboza (2005), CISD is limited by the fact that the whole process is dependent on group dynamics.
From a personal point of view, CISD efficiency highly depends on the degree of the incident that occurred. For such a simple structured incident intervention process, severe magnitudes of critical incidents are best dealt with it. Siding with Blalocks revelations, critical exposures that can result in PTSD and other serious psychological conditions are best handled by professionals who have a strong background in psychological therapy and know best what they are doing. In addition to this, CISD as a component of CISM is not effective on its own. Practical efficiency can be best deduced when other components of CISM such as family involvement into the counseling process are factored in. Regardless of this, single session debriefing of homogenous participants is not largely a major process flaw. For critical incidents of lesser magnitude, professionals such as firefighters are likely to experience relief through group sharing given the fact that they all experience a similar ordeal.
Comparison of CISD to PFA
Psychological First Aid (PFA) as described by Blalock (2014) is an alternative method of CIRPs. His coverage shows that PFA is more efficient when compared to CISD. According to Blalock (2014), PFA was established to help people in the aftermath of terrorist activity by reducing the initial distress and helping people to cope both in the short and long run. As opposed to debriefing, PFA does not include the discussion of traumatic events with patients. The most significant components in PFA include aspects such as preventing further harm from happening, offering people chances to interact without pressure, showing compassion through active listening, addressing and accepting the existence of concerns shared by the patient, providing social support and working together on deducing the coping mechanisms, and finally referrals if the symptoms get complex (p.14). Explored further by Blalock (2014), PFA effectiveness emanates from the fact that it covers aspects that are not dealt with in CISD. PFA works from an individual point of view where all patients are not treated the same. As such, the program mainly deals with people who severely require more help. Practical issues that are directly linked to stress are dealt with. Unlike CISD, the efficiency of PFA is improved when people are left to cope on their own using support they deem the best, although with a distant professional guidance. Such an approach is what makes peer provided support successful. In general, peer provided support during traumatic incidences can be maximized through volunteering and the government providing the required resource support.
CISD, which is part of CISM, as a critical incident intervention program, has its strengths and limits just like any other process. Conceptualized as the Mitchell model, CISD has been largely applied to law enforcement and the fire department. The functionality scope of the entire process is dependent on group dynamics where not more than 20 homogenous victims are allowed per session to share stories and get practical assistance from practitioners. However, compared to other CIRPs such as PFA, CISD is still underdeveloped in terms of its capability to handle complex traumatic incidences. This can be related to the fact that as a component of CISM, CISD stands alone, but with perfect synchronization with other CISM domains, the effectiveness of the response program remains a surety.
Barboza, K. (2005). Critical incident stress debriefing (CISD): Efficacy in question. The New School Psychology Bulletin 3(2) 49-70.
Blalock, D. (2014). Crisis Intervention Models. SCPHCA Conference. https://www.scphca.org/media/92733/crisis_intervention__and_debriefing_-blalock.pdfDyregrov, A. (1997). The process in psychological debriefings. Journal of traumatic stress, 10(4), 589-605.
Everly Jr, G. S., & Mitchell, J. T. (1995). Prevention of work-related posttraumatic stress: The critical incident stress debriefing process.
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