Critical incident stress debriefing

Domain V · Systemic, relational, group & community · Jeffrey T. Mitchell · 1983

What it is

CISD is one session inside a wider programme (CISM), not a course of therapy.

Format

• CISD is one session inside a wider programme (CISM), not a course of therapy.
• ICISF's chart compares four group or individual interventions, summarised below.

Who practises it, and how they are trained or regulated

• A fuller component list. A 2005 law-enforcement review of the Mitchell model lists ten CISM components, with timing and format: strategic planning (before any crisis); demobilizations and staff consultations (shift- or event-driven, large groups); assessment of need (any time after the crisis); defusing (within 12 h, small groups); CISD (1–10 days after, or 3–4 weeks after mass disasters, small groups); individual…
• Version followed: Jeffrey T. Mitchell's seven-phase group Critical Incident Stress Debriefing (CISD), introduced in 1983 and later placed inside the Critical Incident Stress Management (CISM) continuum taught by the International Critical Incident Stress Foundation (ICISF). The details come from ICISF and agency training handouts and from a published law-enforcement review of the Mitchell model (Malcolm et al.…

Evidence status, as the guide reports it

• Status (contested). The Cochrane review found no evidence that single-session individual debriefing prevents PTSD, and said compulsory debriefing should cease. WHO guidelines recommend against it: psychological debriefing "should not be used in an attempt to reduce the risk of post-traumatic…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• Content that implies everyone must be debriefed.
• Rumours. Do not let a CMB turn into a group debrief of a mixed audience.
• This step does the most to protect people. It is consistent with NICE's active monitoring.
• Grounding needs: WHO PFA suggests slow breathing, feeling the feet on the floor, or naming things seen or heard.
• Keep it brief and informational. A demobilization that turns into a group recounting by a mixed crowd carries the same risks as debriefing a heterogeneous group.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.