The critical incident stress management, or CISM, is a short term therapy which helps people to return to their normal routine at the earliest possible, after they experience any traumatic event. Its main objective is to avoid any post-traumatic stress disorder one might face after a disturbing incident.
So, how do we define critical incidents? Critical incidents are any painful events which might induce strong emotional reactions in people who experienced them. Line of duty deaths, suicide of an associate, multi-casualty and terrorism related incidents top the list of critical incidents. Beside these, other stressful circumstances include serious injuries at work, threat to the person, a stressful incident, a long-standing event with depressing results, events involving children and events in which the victim is known to the person. Generally, CISM is designed to help people from all walks of life. However, it has proved to be more productive for members of the law enforcements and emergency response teams such as fire-fighters, bomb disposal squads and the medical staff. Individuals from such teams feel more comfortable with their peers and are usually of the view that their friends and family from other professions do not understand their difficulties the way they do.
The Critical incident stress management program facilitates people in dealing with their strain one event at a time. The therapist asks the participants to talk about the particular incident without passing any judgement or criticism. All the interpretations are kept confidential and are only used to evaluate whether the person pose a threat to himself or to others. The program aims at returning the affected people to their normal lives and reducing the stress levels elevated by critical incidents. Though even after the treatment, the stress level of the patient tends to remain higher than the previous one; it is set at the lowest possible level.
The type of approach varies according to the scenario, number of people involved and their appropinquity to the incident. But usually a three step procedure is adopted which includes defusing, debriefing and individual follow-up.
Defusing is done to those who are directly involved in the event, just before they get a chance to sleep. This may also be done at the site of incident, and is commonly done in an informal way. The purpose of defusing is to satisfy the people involved that their feelings are perfectly normal and rational. They are asked to watch over some symptoms for a short period of time and are provided with a telephone number, in case they need to talk to someone.
Debriefings are the second stage of this therapy for those who have undergone defusing, and the first one for those who are indirectly involved in the incident. Generally, debriefings are done within 72 hours of the incident and they give the chance to the individuals or groups involved to speak out their minds and narrate their experience and the way it has affected them. Furthermore, a variety of methods are discussed through brainstorming, which will help the individuals/groups to cope up with their normal lives. In addition, they are also informed about the services offered to them by their communities. As per the International Critical Incident Stress Foundation (ICISF), the debriefing procedure consists of seven steps. They include: introduction of the intervener and the participant, individual’s perspective of the event and its details, their emotional responses, their personal reactions and actions, discussion of the symptoms they experience after the event, analysis of those symptoms and the persuasion that their feelings are a normal response to a strange event and sooner or later the effects will attenuate with time. Although attendance at the debriefing is a compulsion, however participation is not. At the end, the participants are offered a drink or a treat and are then sent to their normal tasks. The interveners identify those participants who are not coping up well with the therapy, and therefore offer them with further support at the end of the debriefing session.
The most crucial stage of this mental healing is the follow-up. In this procedure, all the participants are called within a week after the debriefing to confirm that they are safe and are following the treatment. If necessary, the therapist may also refer them to a professional counselor.
The critical incident stress management may seem to be a breakthrough in avoiding a post-traumatic stress disorder; several studies have declared it as counter-productive. According to these studies, the CISM has little or no effect and may bump up the trauma symptoms. Conversely, another study states that the CISM therapy has valuable outcomes when aimed at emergency services and law enforcement personnel, but is ineffective when directed upon accident victims.
All in all, the Critical Incident Stress Management therapy has emerged as an effective technique to help people get over their sufferings. In the light of increasing terrorist attacks, the therapy is crucial for those who have lost their loved ones in these attacks. Thus, the CISM therapy ensures that the person does not develop other mental disorders and does not pose a threat o himself or others around him.
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