Debriefing is a concept that has been around in the area of trauma for a long time. In the lay person's mind, it has come to mean any type of intervention following a traumatic even. It is however, a very precise method of intervention. There is also the belief that if one does not receive debriefing after a trauma, they will not recover; this too is not true. Critical Incident Stress Debriefing (CISD) is a term that has been around since 1983 when it was introduced by its developer Jeff Mitchell. It was developed with the purpose of preventing PTSD by intervening with trauma victims shortly after the traumatic, or "critical", incident with a specific type of debriefing, to prevent the later insert of PTSD symptoms. The model was originally used in the military setting but later found much popularity in the hospital, police and EMS areas. As originally set out, CISD consists of 7 distinct stages to aid stress management. These stages are progressed though within 24-72 hours of the critical incident in a group format (i.e. all the trauma victims), and the group leader is responsible for the pace at which the stages are moved through, and the session should last anywhere between 90 minutes to 3 hours.
CISD was immediately adopted as a debriefing model as it was simple to follow and the implementation could easily be taught to the average person. However, over the years, there has been a constant debate regarding the efficacy of CISD and numerous studies have been conducted on its effects. Some people will remain on the side of CISD and say that it certainly has a place and serves a distinct purpose, while others adamantly say that CISD has absolutely no positive effects and that in some cases has actually proven to be harmful.
On the side of those supporting CISD, including its founder, are the fairly obvious reasons for their viewpoint. They believe that CISD works on the concept of early intervention by which the victims can express their feelings before the onset of serious symptoms. They also believe that it is important for the victim to be able to speak about their pent-up emotions and the horror they may be feeling, and while doing so are able to reconstruct the experience while talking it through with their fellow victims. Thirdly, they believe that CISD helps to show the victims that there is, or will be, an end to their struggles with the help of the strictly set out stages of CISD. Fourthly, they believe that the group setting, in itself, serves a large purpose by providing a sense of cohesion and a support group. Lastly they believe that by seeing people interact in a group setting, the leaders are able to pick out those who are more severely affected by the critical incident for possible further treatment. There have been studies conducted where victims of a traumatic event who received CISD reported less symptoms of PTSD than their counterparts who experienced the same trauma and didn't receive CISD.
However, on the other hand completely, there are many people who do not share the above view. They strongly believe that CISD is totally ineffective and that in some cases can actually cause harm. The people supporting this view-point use the following to back their reasoning: CISD rushes in when the victim has just experienced a trauma and expects them to relive and talk about it in a group. The problems with this are that that may not be the victim's main need at the time. Their primary concerns could simply be how they are going to get home, how to cancel their credit cards or how to get hold of a family member, for example. Secondly, many people have an avoidance method of coping and by avoiding the reliving of the trauma, they are actually helping themselves to recover, at least at the time. By forcing them to change this coping mechanism, one is damaging or hindering their recovery. Thirdly the counsellor could be pathologizing normal reactions to trauma and making them seem un-normal and irregular, when they aren't at all. Those against CISD also believe that by reliving the trauma, the victim could be re-traumatized, depending on their coping skills. They also argue that the group setting may not suit everyone who has been traumatized, and that one debriefing session cannot possibly be enough to solve anything. There were also studies done to try and disprove the efficacy of CISD and they found that those who received CISD were either no better off than those who didn't, or were in fact, in some cases, worse off than those who didn't. Some research has actually shown that those who did receive the CISD were more likely to develop symptoms of PTSD at a later stage.
Over the years, CISD has in fact been discredited by most research done on its efficacy. It has been shown to be of no use at all and in some cases to be harmful to the recipient. It has also been shown that debriefing may not be necessary at all; the majority of those who have experienced a trauma, will recover without any type of intervention. So what are the alternatives? Watchful Waiting was a technique that developed following CISD and called for passively waiting until the victim shows signs of PTSD before intervening. Is this possibly doing too little though? The research for supportive counseling has also shown little support for the continued use of counseling.
With all this research considered and the arguments that have continued for years, why are trauma workers still being trained to implement CISD? Does this not cross the ethical border of "do no harm"?
http://www.nspb.net/index.php/nspb/article/view/33/30
http://www.heathsommer.com/13.html
http://fsomle.com/2011/08/12/critical-incident-stress-debriefing-cisd-should-it-be-used-as-an-intervention-strategy/
http://www.houd.info/CISD.pdf
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