Research and Reviews

If you are looking into Critical Incident Stress Management research, I have some cautions for you.  First, what you will discover is that there is unfortunately a relatively small body of research and almost none that actually studied the Mitchell Model, now the ICISF Model, when properly applied.  

The Cochrane Reviews are frequently referenced and in fact to the best of my knowledge are the starting point of the “controversy”.  The problems with the Cochrane Reviews are outlined below.

The next thing to be aware of is that if you are reading material that is prior to 2009, they likely reference the Cochrane Review of 2002.  So, you need to be aware of the statement from the Cochrane Library in 2009, again, outlined below.  

If you are reading a review of the literature that is dated 2010 or later, then it should include at the very least an acknowledgement that the Cochrane Library walked back the criticism.  If the researcher you are reading didn’t find that document in their review, then their research was incomplete.

The next thing to look for is what was studied.  Watch out for the following references or phrases that will indicate that something other than the ICISF Model of Critical Incident Stress Debriefing was looked at in the study:

• reference to a “debriefing” done with an individual – The Mitchell Model, now the ICISF Model has never used this terminology.  If there is reference to doing a Mitchell Model/ICISF Model debriefing with a single person, or with primary victims, that is a misapplication of the method.
• reference to “mandatory debriefing” – the Mitchell Model, now the ICISF Model has never called for or advocated for a “mandatory debriefing”.  In fact, quite the opposite.
• reference to the goal of “preventing PTSD”. – the Mitchell Model, now the ICISF Model has never claimed to be a prevention or cure for PTSD, but rather a means of mitigating symptoms and speeding recovery.  For anyone needing treatment for PTSD, it is a referral and support mechanism.
• reference to a “single session debriefing”.  What a “single session debriefing” may be is anyone’s guess, but is likely to refer to a single meeting with a mental health professional.  It is not a reference to a Critical Incident Stress Debriefing that was conducted in accordance with the ICISF Model.  The simple reason for this is that a CISD under the ICISF Model is not a single session event, but rather one of several points of contact with an affected group.

Finally the “reviews of literature” have become such that they appear to be feeding on themselves.  If someone were to take the time, I think a cycle of reliance on reviews of the same literature as sources would be uncovered.  All eventually landing back to a very few and very flawed studies where the model was either not actually used, or was not used properly. 

It should come as no surprise to anyone that when something is used in a way it is not designed to be used, that either the outcome will not be as good as hoped, or that an adverse outcome may result.

These are of course important considerations and anyone starting or maintaining a team should look carefully at the information to make an informed decision. 

There has been recent research completed by the Canadian Institute for Public Safety Research and Treatment.  If you are reading this page, you will likely be interested in Assessing the perceptions and impacts of Critical Incident Stress Management.  If you want to go directly to the article, it can be found here.

Should you wish to read a more recent systematic review article, I suggest this one by Harry Stileman and Christopher A. Jones.  It is an easy read and identifies many of the issues briefly discussed here, but in a more formal manner.

The Cochrane Reviews are frequently referenced.  Their information is not always easy to search or to find for people who don’t have access to research libraries.  Hence I am making a copy available here.  All credit to the authors.

You will note on page 10 (page 12 of the PDF) of  Psychological debriefing for preventing post traumatic stress disorder (PTSD) (Review) the following statements:

1. “At present the routine use of single session individual debriefing
in the aftermath of individual trauma cannot be recommended in
either military or civilian life. The practice of compulsory debriefing
should cease pending further evidence.”

 2. “We are unable to comment on the use of group debriefing, nor the
use of debriefing after mass traumas. We are also unable to make
recommendations about the use of debriefing in children.”

Regarding point #1: This is 100% consistent with the ICISF model in that there is never a “single session individual debriefing” and compulsory Critical Incident Stress Debriefings (CISD) have NEVER been a part of the ICISF model.  

Regarding point #2: It really speaks for itself.

If you are interested, I urge you to read the paper.  Download it here: Psychological debriefing for preventing post traumatic stress disorder (PTSD) (Review)

This paper examines the Cochrane Reviews and their adherence to their own standards of research.  

Download it here:  Was Psychological Debriefing Dismissed Too Quickly? An Assessment of the 2002 Cochrane Review