What is CISM?
Critical incident stress management is a system of crisis intervention meant to mitigate effects 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
Psychological first aid is a component of the comprehensive system called CISM. The system can be used to address a vast array of critical incidents. Critical incidents are defined as events that are outside of the individual’s normal experience and have the capacity to cause a reaction within the individual.
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 building resilience, crisis intervention education, and strategic 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 critical incidents.
- SAFER-R Model of Assisting Individuals: The one-on-one intervention is the foundation of the overall model. Having a deliberate, compassionate conversation with a person who has experienced trauma is the key to building trust and helping someone cope. The one-on-one conversation is key to an effective CISM program as it is the intervention that is used most often.
- Critical Incident Stress Debriefing (CISD): CISD is one 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 only with groups. This seven-phase intervention attempts to mitigate traumatic stress, determine the need for further emotional support, and promote 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 mitigation of traumatic stress reactions.
- Other Crisis Interventions: Additional CISM components include one-on-one crisis counseling, crisis intervention for families, and aftercare follow up and referral procedures.
- Critical incident stress management is rooted in crisis intervention theory, group therapy, and community psychology. Theorists like Eric Lindemann, Irvin Yalom, and Gerald Caplan provided the foundation for CISM developers Jeffrey T. Mitchell and George S. Everly, Jr. to begin their work in the 1970s. During the 1980s, Mitchell and Everly officially introduced critical incident stress debriefing as part of their critical incident stress management system of crisis intervention. The field expanded further with the establishment of the American Critical Incident Stress Foundation in 1989, later named the International Critical Incident Stress Foundation in 1991. In 1997, Mitchell and Everly fully integrated their crisis intervention techniques into the comprehensive system known as CISM.
- CISM is provided by many types of professionals, such as first responders (firefighters, law enforcement officials, etc.), medical personnel (nurses, doctors, medics), education workers, search and rescue personnel, military personnel, mental health professionals, clergy, hospital staff, health and safety representatives, and community leaders. The most important qualification for a professional who provides CISM is that they are thoroughly trained in its implementation.
The International Critical Incident Stress Foundation manages the Approved Instructor Candidate Program, which trains individuals to become certified in critical incident stress management.