As someone who wants to advance faith-based global trauma recovery efforts, I am always on the prowl for effective interventions that could be sustainably used by local caregivers. However, it is always important to ask whether a popular or up-and-coming intervention has been fully vetted. Sadly, “does it work?” and “does it work here?” are often not fully answered before an intervention is promoted as the next best thing.
One of the most popular forms of immediate trauma intervention is called “Critical Incident Stress Debriefing,” a one time group intervention designed to forestall long-term trauma due to stressors. When you think of CISD, think of interventions with police or fire fighters or military after a traumatic experience.
But, does it work? This post here provides a helpful summary of the critique, even though it was published 2 years ago. As I read this I remembered an American Psychologist article on the same topic–but for the life of me I can’t find it. My recollection of this fantasy article is that these interventions seem to be helpful for about 50% of those who participate but that at this point it is not possible to tell which 50% will find it helpful. And further, a portion of the other 50% are actually harmed by it.
6 responses to “Critical Incident Stress Debriefing: Does it work?”
During a course on Agency-School and Community Psychological First Aid Post-Traumatic Stress Management presented by Dr. Robert H. Macy* and sponsored by the New Jersey Traumatic Loss Coalition it was pointed out that Critical Incident Stress Debriefing was predominantly designed and studied for use with first responders. This is important to note as this population will have hopefully developed a certain set of tools for dealing with the sights and sounds of a traumatic incident that the rest of the population has little opportunity to put into practice. While I am still searching for the references, it was stated that even with in this particular population the efficacy was controversial.
The methodology taught in this course focused initially on metabolic or physical stabilization to counter the adrenal overdrive, reestablishment of a sense of security and predictability of life through community and then a form of narrative therapy to assist in positioning the traumatic event in the larger tapestry of the person’s life experience. What I liked most about this approach is that in terms of a Christian world view it meets the person where they are, recognizes the normalcy of both physical as well as psychological responses to a traumatic event, imparts hope, and reestablishes community and points forward. It does not bring a person back to the traumatic event thereby avoiding the risk of having to relive the experience.
*Robert Macy, Ph.D. – Executive Director Boston Children’s Foundation
Robert Macy is a pioneer in the field of Traumatic Incident Stress Interventions, public health-mental health psychosocial intervention and research and violence prevention initiatives for children, youth, their families and their communities exposed to traumatic events including large-scale disasters, terrorist events, and political, community, armed conflict violence and trans-generational impoverishment. During the last 19 years Macy has designed, and implements and evaluates traumatic stress reduction programs, and psychosocial assessment and intervention projects in the United States, Europe, the Middle East, Asia and Africa.
Robert Macy is Co-Director of the Division of Disaster Resilience at the Beth Israel Deaconess Medical Center, a Harvard Medical School Instructor, a Research Fellow in Psychology in the Developmental Psychology and Psychopathology Program at McLean’s Hospital and an Adjunct Faculty in Counseling Psychology Graduate School Programs at Lesley University. Robert is also the Co-Founder and Director of the Intentional Center for Disaster Resilience and the former Co-Director of a National Center for Child Traumatic Stress Network-Category III site in Boston and a former Co-Chair of the National Center for Child Traumatic Stress Network-Terrorism and Disaster Branch. Macy continues to consult to the National Center for Child Traumatic Stress Network-Terrorism and Disaster Branch and serves as Core Faculty for the National Center for Child Traumatic Stress Network-Psychological First Aid Learning Community.
GREAT article and thx for the link to Thompson’s article! Thompson points out that the biggest blow to CISD came from the Cochrane Collaboration, a great resource to find out if therapies are evidence based. Sharon Begley’s blog (Newsweek) put me on to the Cochrane Collaboration a couple years back. See her Oct 2009 blogs “Some treatments just don’t Work”, and “Ignoring the evidence”, and especially read Timothy Baker’s article in Psychological Science in the Public Interest (Oct 2009). This CISD article is a great case-in-point for the much broader discussion about evidence based medicine (EBM).
But given the endorsement here of EBM (reassuring), I’d like to ask about your use “memory work” in therapy—something that shows up in your slide presentations. What kind of evidence based research is out there that validates “memory work?” I’m not even sure what to call it as a therapy… Full disclosure: I’m skeptical (too obvious?), but you should have a chance to point out what I’m missing.
Tom, a couple of quick comments. First, I like your humor :). Second, you are assuming that memory work = uncovering or recovering lost memories. I can tell you that in 20 plus years I have never set out to help a client uncover lost or missing memories. I only work with the memories they have. Third, almost every form of therapy for PTSD utilizes some form of memory work–exploring meaning, memory, narrative, etc. Prolonged Exposure, EMDR, process therapies, etc. revisit traumatic experiences. This requires a going back, a form of memory work. During this phase (which must come after someone has developed good coping skills), clients explore their memories and resulting distorted narratives about self and others. For example, an adult may well supply new interpretations about their culpability for their child sexual abuse–meaning that the no longer blame themselves. When these distorted narratives are revisited and, in essence, re-written, clients often have memories return to them that they had once lost or had set aside a long time ago. Third, I am working on some blog posts on the issue of recovered memories and hope to unveil them soon.
Shoot! No other replies. I’m disappointed… Phil, your second point about my assumptions is well taken. But it isn’t an assumption (well, maybe on a bad day…), it’s a question. The connection between “memory work” and memory recovery is a concern. But I’ll wait to read your post on the topic.
Thank you for this article. For people wanting an overview of what the actual CISD session entails – I found a few videos on Youtube that explain the content. If you type in Critical Incident Stress Debriefing you will find the same. Thanks again for giving us this helpful information!
And one question: Can you point me to the best resource/review (from a Chrisian perspective) regarding the use of EMDR and hypnosis in PTSD clients? Thanks