Critical Incident Stress Debriefing

A critical incident stress debriefing is not an uncommon need for just about anyone coming to work in a war zone like Afghanistan. Some sort of major trauma, shocking event, or tragedy occurs with somewhat frequency in Afghanistan.

You or your company may not know you should have a critical incident stress debriefing within 48 hours of the event.

Making sure you get this will prevent or minimize any post-traumatic-stress-symptoms you may be prone to develop.

Who Should Conduct a Critical Incident Stress Debriefing (CISD)

After leaving Afghanistan, if you experienced some major trauma, make sure you get a critical incident stress debriefing. You do not have to see a licensed counselor, because there are many aid workers trained specifically to handle this type of debriefing.

(By the way, the need for trained crisis responders has never been greater. War, terrorism, school shootings, and natural disasters, as well as various "small-scale" critical incidents with significant local impact take their emotional toll on those directly and indirectly involved. The International Crisis Intervention Stress Foundation (ICISF) conducts workshops training thousands to help the helpers and others impacted by traumatic events.)

However, a CISD debriefing should not be substituted for a thorough medical examination, a psychological check-up and possible psychological debrief/evaluation after serving in a war zone like Afghanistan.

Critical Incident Stress Trauma

Critical Incident Stress Debriefing (CISD) is really a structured storytelling of a specific traumatic event. It may be done with just one person, or a whole group of individuals involved in the event.

This is just one of the many crisis intervention techniques which are included under the umbrella of a Critical Incident Stress Management (CISM) program. This is simply a supportive, crisis-focused discussion of a traumatic event (which is frequently called a “critical incident”). The Critical Incident Stress Debriefing was developed exclusively for small, homogeneous groups who have encountered a powerful traumatic event. It aims at reduction of distress and a restoration of group cohesion and unit performance.

Critical Incident Stress Debriefing Guide

The following is a model developed by the American Red Cross to debrief emergency workers and survivors following natural disasters.

A debriefing process provides formats in which personnel and survivors can discuss their feelings and reactions, thus reducing the stress that results from exposure to critical incidents.

It is an organized approach to supporting emergency service personnel and survivors who are involved in emergency operations under conditions of extreme stress. The purpose of the debriefing group is to assist in mitigating long-term emotional trauma.

This model is also known as critical incident stress management.

1. Introduction:

   Go through basic steps that you do when you begin a group (i.e., establish agreements and confidentiality)

2. Fact phase:

   a. Have each person talk about where they were (or roles they assumed in the case of emergency workers)

   b. Have them talk in detail about where they were when the incident occurred, what they heard, saw, smelled. This process makes the experience come alive, and participants get to know each other and there is a sense of bonding that develops.

3. Feeling phase

   Encourage sharing of feelings.

   How did it feel when it happened?

   How are you feeling now? Have you felt this way before?

   What unusual things are you experiencing now?

   IT IS VERY IMPORTANT THAT FACILITATORS VALIDATE ALL THAT IS SHARED

4. Symptom phase

   Encourage them to share physical symptoms

   (Example with earthquake victims: Many talked about recurring migraines which occur suddenly; some said they could identify other survivors because they would suddenly see someone put their hand towards their heads because of migraines; feeling that the ground was still shaking; unable to get into elevators for fear that an earthquake will hit and they would get stuck; inability to fall asleep until 5:14 am, the time the earthquake struck; not being able to soak in the bath tub for feel that they would be naked when another earthquake struck).

   SOME PEOPLE ARE SCARED BY THEIR OWN PHYSICAL AND EMOTIONAL REACTIONS. IT IS VERY IMPORTANT TO LET THEM KNOW THAT WHATEVER THEY ARE EXPERIENCING IS A NATURAL REACTION.

5. Teaching phase:

   Provide education on stress response syndrome: provide education on how natural these reactions are. The important message is that:

   ABNORMAL REACTIONS that people might be experiencing ARE NORMAL REACTIONS TO ABNORMAL SITUATIONS.

   In case of emergency workers, use handouts, depends in the case of survivors (not immediately, but useful if meeting them after some time has lapsed)

   SOME TRAUMA RESPONSES INCLUDE:

   headaches, insomnia, flashbacks, anxiety, inability to concentrate, crying spells, lack of appetite, irritability, intense anger, depression

   Give the following concrete advice:

   1) do not use alcohol or drugs to cope

   2) do not isolate yourself from friends, family or co-workers

   3) prevent yourself from becoming obsessed with the incident

   4) eat well, exercise

   5) assess work situation, do they need time off?

   6) watch for fixation of the incident, don't become obsessed with finding their reasons for the tragedy, allow time to pass

   7) give yourself time to heal, don't have unrealistic expectations for recovery

   8) expect the incident to bother you

   9) learn about what you are going through

   10) get help if necessary

6. Re-entry phase Ask them where they want to do from the session, do they feel a need for another de-briefing?
7. Group facilitators should provide debriefings with each other after the group

Phases of Disaster Recovery in Communities: Four phases

Knowing about the following helps anticipate and prepare for the emotional responses

1. Heroic phase-- time of impact to one week post-impact

   Perform heroic acts to save lives and property;Sense of sharing with others;Sense of "family"-- immediate support of family members; agencies, government disaster personnel, strong media support of the plight of victims and needs of the community;However, pain and losses may not be recognized.

2. Honeymoon phase--immediately after impact to 2,3 months later

   Development of a strong sense of a shared danger or experienceMay experience physical symptoms such as digestive problems, changes in appetite, difficulty sleeping, migraines, anger, suspicion, apathy, social withdrawal, heightened anxiety about the future; Shelters become source of support.

   Involvement with cleaning out debris, sorting things out, anticipating the help they will receive to restore their lives.

   "Super volunteers" who are not ready to deal with their own losses, work from dawn till dark helping friends and neighbors get back on their feet;

   Unrealistic expectations towards help from governmental agencies.

3. Disillusionment phase--one month to one or two years after the event.

   Waning of media attention, feel they are objects of the media, isolated and let down by the media that's gone on to other news;

   Questions re: whether the disaster could have been avoided; Survivor guilt: feeling guilty for being spared or not having as much damage as others.

   Period of Second disaster, or secondary traumarelationships neglected, estrangement of family members begindomestic violence begins or is aggravated, children are emotionally at risk as they react to signs of stress in parents, survivors may have to move from their old neighborhood and lose their social support,

   Overwhelming amount of paper work; Long lines for assistance;Anger and frustration increase rapidly; Victims may begin to file law suites; Depression, moodiness and crying increase;Physical health begins to suffer; Relief efforts by government agency decreases; increase in use of alcohol, no financial security, job losses.

4. Reconstruction phase

   Survivors come to realize that the rebuilding of their homes and businesses and community is primarily their responsibilityMay take several years or rest of their lives depending on amount of damage.

   If the rebuilding is delayed, the recovery will also be delayed.

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