قم بتحميل هذا المقال بالعربية (PDF)*This article in ArabicCritical incident stress reactions are normal, immediate or delayed, strong physical and emotional reactions after an abnormal event. These may interfere with a person’s ability to function psychologically, socially and occupationally. The severity of these stress reactions depends on the suddenness, intensity and duration of the critical incident, the available social support, but also the person’s previous experience with similar situations, their history of personal losses, the intensity of the perceived threat and their personal coping capabilities.
J.T.Mitchell and G.S.Everly developed CISD in the early 1980s as a reaction to more and more professionals undergoing traumatic stress in their line of work. CISD is a process designed to lessen the impact of critical incidents. It is a structured intervention by a specialized trainer that takes place in the form of a group meeting. This meeting allows those involved in a critical incident to discuss their thoughts and reactions openly in a safe, non-threatening environment, 24 to 72 hours after the critical incident.
The purpose of CISD is
- To prevent unnecessary post-traumatic stress reactions
- To strengthen group cohesion
- To normalize reactions and to accelerate recovery processes
- To educate about stress and stress reactions
- To promote better coping with the future
Remember: Reactions to a critical incident are normal symptoms experienced by normal people following an abnormal event. These symptoms can interfere temporarily with a person’s ability to cope with work or private demands. For most people most symptoms will diminish both in intensity and frequency within a few days or weeks. This process will be greatly assisted by CISD and by discussing concerns with trusted family members, friends and professionals.
The setting for CISD
Who should be included? Homogeneous groups of persons who have been involved in the critical incident or have been indirectly strongly affected. No observers! Separate staff meetings from family meetings.
Best time for CISD? Not on the same day of the critical incident; 24 to 72 hours after the incident
General environment: A quiet room with day light; room size should correspond to group size; round table arrangement in which the CISD leader and the co-leader sit opposite to each other and are able to face everybody.
Ideal group size: 5 – 15 persons
The 7 steps of CISD
- Introductory phase
Objectives:
- to introduce the CISD leader
- to build trust
- to reduce anxiety and resistance
- to explain the purpose of the meeting
- to motivate participants to take an active part in the meeting
- to state the rules of the meeting
- to explain the process
- to answer questions
Rules for the meeting:
- confidentiality
- no recording or note taking
- participants should talk exclusively about their personal impressions and reactions
- participants are not required to say anything but their names and describe their involvement in the critical incident
- no breaks
- no hierarchy within the group
- everybody gets a fair chance to talk
2. Fact phase
Each group member is asked to describe what happened and what role (s)he played in the situation. The CISD leader summarizes the presentations at the end.
3. Thought and impression phase
Here, the CISD leader asks all the participants what were their thoughts during and after the incident. After the participants have reported, the CISD leader asks if they are still left with strong sensory impressions about the incident. All senses (sight, sound, touch, smell, taste) should be checked on with sufficient time, one after the other.
4. Reaction phase
The CISD leader asks: What was the worst part of the event?What part of the event bothers you most?Is there any part of the event that is especially painful to talk about?
The CISD leaders can help the group to talk about their reaction by reconstructing a time sequence from the critical incident to the present situation. Check on physical, cognitive, and emotional reactions.
5. Symptom phase
The symptom phase starts when the CISD leaders ask the group members to describe any cognitive, physical, and emotional reaction during and after the critical incident.
Then, the CISD leaders explain typical symptoms of stress that are encountered during and after critical incidents. They might have to give examples.
After the group members share their stress symptoms that they have been experiencing, the CISD leaders summarize especially the commonly shared symptoms.
6. Teaching phase
Here, the CISD leaders provide the group members with information regarding stress reactions, their normal course, and specific techniques that might alleviate these reactions. They emphasize that these reactions are normal reactions to an abnormal event. If personal disability or losses occur as a consequence of the critical incident, they should provide information about ways of coping.
7. Re-entry (closing) phase
The group members are given the opportunity to ask questions, or discuss issues that need further clarification. Further debriefings are arranged, usually after 3-4 weeks.
Group members who indicate a need for individual support should be provided with arrangements for individual counseling.
Group members are encouraged to contact the CISD leaders, if
- Their critical incident stress reactions continue with the same intensity after the first month;
- The reactions increase in intensity over time;
- They, their family members and/or colleagues experience great personal changes in them.
- They do not function in the family and/or at work.