PTSD Treatment What Is Critical Incident Stress Debriefing? By Amy Marschall, PsyD Amy Marschall, PsyD Dr. Amy Marschall is an autistic clinical psychologist with ADHD, working with children and adolescents who also identify with these neurotypes among others. She is certified in TF-CBT and telemental health. Learn about our editorial process Updated on October 15, 2022 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Yolanda Renteria, LPC Medically reviewed by Yolanda Renteria, LPC Yolanda Renteria, LPC, is a licensed therapist, somatic practitioner, national certified counselor, adjunct faculty professor, speaker specializing in the treatment of trauma and intergenerational trauma. Learn about our Medical Review Board Print FatCamera / Getty Images Table of Contents View All Table of Contents History Phases When to Use CISD Effectiveness Critical Incident Stress Debriefing (CISD) is a process through which a facilitator helps a group of people work through their response to a highly stressful or traumatic event. CISD is a form of crisis intervention aimed at reducing the traumatic impact of an event by fostering a connection between people who went through the same experience, increasing effective coping, and trauma education after the stressful event. This can help provide space to process after a stressful or traumatic event occurred. Individuals who were exposed to the event can talk about their experiences and feelings in a safe environment. The goal of this process is to provide peer and professional support immediately following an incident, which may reduce the risk of developing trauma symptoms or other mental health issues. Licensed mental health professionals with training in Critical Incident Stress Debriefing to facilitate groups immediately following a stressful or traumatic incident. Groups can have multiple facilitators if there is a high number of participants. CISD Requirements It is required that all group members have experienced the same stressful event and must be rested and emotionally regulated enough to participate in a group. Critical Incident Stress Debriefing is intended for use as one of many resources offered to people who have experienced a stressful or traumatic event. History of Critical Incident Stress Debriefing Dr. Jeffrey Mitchell developed CISD in 1974 as a way to offer support to people who experience highly stressful events in their jobs. Dr. Mitchell developed this intervention with inspiration from his work as a paramedic and firefighter, but this technique can be used for any group who has experienced a traumatic event, such as a shooting, natural disaster, or work-related crises. Goal of CISD Dr. Mitchell’s goal with CISD is to reduce both short and long-term impacts of traumatic events, including mental health symptoms (such as post-traumatic stress disorder), substance dependence, relationship conflicts, and sleep disturbance. Phases of Critical Incident Stress Debriefing Although the process is flexible and can be tweaked based on the needs of the group, CISD is generally structured in seven phases or steps. These steps are: Introduction and Assessment: The facilitator or facilitators gather details about the incident in order to appropriately guide the intervention to meet the group’s unique needs. This phase also involves allowing group members to introduce themselves and ask questions about the process. Fact Phase: Facilitators encourage group members to share the facts of the incident from their perspective. Members are encouraged to focus only on the facts of the incident itself and not their emotional reactions to what happened. While members are not required to share, this phase aims to promote discussion and create a sense of safety in the group space. Thought and Emotion Phase: After the facts of the incident have been shared, group members can disclose their thoughts and feelings about the incident in a supportive space. Reaction Phase: Facilitators help group members safely explore their reactions to what happened and begin exploring what this means for them going forward. This includes sharing fears and worries about the future in light of the incident. Symptom Phase: In this phase, facilitators help participants explore what symptoms they might be experiencing in response to the event. This helps participants identify areas in which they might be struggling and explore coping skills that might benefit them going forward. Teaching Phase: This phase is educational. Facilitators normalize participants’ responses to the event and provide psycho-education about trauma, stress, and coping skills. Re-Entry Phase: This final phase of CISD includes a summary of what was covered, what participants learned, and resources provided by facilitators. Facilitators will answer any additional questions and help participants focus on moving forward, past the traumatic event. Preventing Trauma Symptoms From Appearing Later One goal of the group is to work through emotions participants are experiencing in the aftermath of the event while simultaneously arming them with skills to move forward and prevent trauma symptoms from emerging later on. Facilitators additionally aim to educate participants about trauma and mental health so they can make appropriate choices for ongoing support. CISD groups leave participants feeling safe, validated, and hopeful for the future. When to Use Critical Incident Stress Debriefing CISD is intended for use immediately (within 24 to 48 hours) after the incident occurred. Its purpose is to provide support and resources to people who experienced a traumatic event as soon as possible. However, for CISD to be effective, participants need to be well-rested and in an emotionally stable headspace. If someone is still in a state of traumatic shock, they are not ready to participate in CISD. After a stressful or traumatic incident has occurred, individuals should receive any necessary medical attention as well as any appropriate individual crisis intervention and support. If needed, they can sleep or rest. Once they are ready, they can participate in CISD. CISD groups should occur after the event has finished when members are physically safe. Facilitators should have an understanding of what occurred before starting the group. Effectiveness of Critical Incident Stress Debriefing CISD is intended to be used as one of many resources and supports for people who have experienced trauma. As such, it is difficult to research the specific impact of CISD as other variables are typically present in addition to the group. However, studies have been conducted to measure the effectiveness of CISD. CISD Reduces Burnout and Trauma Symptoms A review of 15 studies showed that non-mandatory CISD improved coping and reduced trauma symptoms in healthcare workers in emergency settings. It has also been shown to reduce burnout and compassion fatigue while reducing employee turnover in healthcare settings. Additionally, CISD can improve both physical and mental health outcomes for military personnel. When implemented at the appropriate time and with qualified, trained facilitators, CISD can be an important resource for groups who have experienced a traumatic event. What Is Critical Incident Stress Management? 6 Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Cantu L, Thomas L. Baseline well-being, perceptions of critical incidents, and openness to debriefing in community hospital emergency department clinical staff before COVID-19, a cross-sectional study. BMC Emerg Med. 2020;20(1):82. Mitchell, J.T. (n.d.). Critical incident stress debriefing (CISD). Trauma. Retrieved from http://www.info-trauma.org/flash/media-f/mitchellCriticalIncidentStressDebriefing.pdf Mitchell, J. T. (September/October, 1986). Critical incident stress management. Response, 24-25. Smith, Mary M., "Critical Incident Stress Debriefing: An Integrated Review" (2022). Doctoral Dissertations and Projects. 3483.https://digitalcommons.liberty.edu/doctoral/3483 Davis, Rachel A., "Critical Incident Stress Debriefing for Nurses in Emergency and Critical Care Departments" (2020). MSN Capstone Projects. Paper 6.http://hdl.handle.net/10950/2603 Lin MW, Tsai CW, Hsu CC, Kao LC, Tai YM, Yang SN. Critical incident stress debriefing for frontline military rescuers in a helicopter crash disaster in Taiwan: A preliminary report. Taiwan J Psychiatry 2020;34:128-33 By Amy Marschall, PsyD Dr. Amy Marschall is an autistic clinical psychologist with ADHD, working with children and adolescents who also identify with these neurotypes among others. She is certified in TF-CBT and telemental health. See Our Editorial Process Meet Our Review Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? 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