Critical incident stress management (CISM) is a type of crisis intervention designed to provide support for those who have experienced traumatic events. CISM is comprised of multiple crisis response components that attempt address each phase of a crisis situation. It can be implemented with individuals, families, groups, organizations, and communities. Although some research has found CISM to be ineffective and even harmful, defenders of CISM argue that, when implemented properly, this intervention offers powerful crisis support.

HOW DOES CISM WORK?

Critical incident stress management is a system of crisis intervention meant to prevent psychological damage associated with unusual and stressful events, also called critical incidents. CISM is intended to support those who are prone to trauma exposure as well as those who have experienced an intensely traumatic event. According to one of its developers, Dr. Jeffrey Mitchell, CISM is not a type of psychotherapy. It is a system of support that is meant to do the following:

  • Lessen the impact of the critical incident
  • Normalize instinctive reactions to the incident
  • Encourage the natural recovery process
  • Restore the adaptive functioning skills of the person and/or group
  • Determine the need for further supportive services or therapy

Sometimes referred to as psychological first aid, CISM can be used to address a vast array of critical incidents. Critical incidents are defined as events that threaten physical or emotional safety or events that result in physical or psychological harm. Some examples include:

  • Death, or risk of death, in the line of duty
  • Shootings in the workplace
  • Hostage situations
  • Terrorist attacks
  • Building collapse due to an earthquake or natural disaster
  • Natural disasters

CISM has multiple components that can be used before, during, and after a crisis. These components include but are not limited to:

  • Pre-Crisis Preparation: This component involves helpful procedures that encourage stress management, crisis education, and crisis planning.
  • Community Support Programs: Often referred to as “town meetings,” these programs support organizations, schools, and communities by providing structured opportunities for discussion and processing of disasters or events.
  • Critical Incident Stress Debriefing (CISD): CISD is a major component of the CISM crisis intervention system. Because critical incident stress management originated with the development of the CISD technique, the two terms are sometimes confused. CISD is not meant to be used as standalone intervention, but rather as a CISM technique for use with small groups. This seven-phase intervention attempts to mitigate traumatic stress, determine the need for further mental health treatment, and assemble a sense of psychological closure about an incident.
    Defusing: This three-phase technique is similar to CISD in that it is a group intervention, but it is more immediate in nature. Intended to take place within hours of the event, defusing involves confidential discussion groups that promote stabilization and prevention of traumatic stress.
    Other Crisis Interventions: Additional CISM components include one-on-one crisis counseling, crisis intervention for families, and aftercare follow up and referral procedures.