A PRIMER ON

CRITICAL INCIDENT STRESS MANAGEMENT (CISM)

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George S. Everly, Jr., Ph.D., C.T.S. and Jeffrey T. Mitchell, Ph.D., C.T.S.

The International Critical Incident Stress Foundation

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As crises and disasters become epidemic, the need for effective crisis response capabilities becomes obvious. Crisis intervention programs are recommended and even mandated in a wide variety of community and occupational settings (Everly and Mitchell, 1997). Critical Incident Stress Management (CISM) represents a powerful, yet cost- effective approach to crisis response (Everly, Flannery, & Mitchell, in press; Flannery, 1998; Everly & Mitchell, 1997) which unfortunately is often misrepresented and misunderstood.

 

What is CISM? CISM is a comprehensive, integrative, multicomponent crisis intervention system. CISM is considered comprehensive because it consists of multiple crisis intervention components, which functionally span the entire temporal spectrum of a crisis. CISM interventions range from the pre-crisis phase through the acute crisis phase, and into the post-crisis phase. CISM is also considered comprehensive in that it consists of interventions which may be applied to individuals, small functional groups, large groups, families, organizations, and even communities. The 7 core components of CISM are defined below and are summarized in TABLE 1.

 

1. Pre-crisis preparation. This includes stress management education, stress resistance, and crisis mitigation training for both individuals and organizations.

 

2. Disaster or large-scale incident, as well as, school and community support programs including demobilizations, informational briefings, “town meetings” and staff advisement

 

3. Defusing. This is a 3-phase, structured small group discussion provided within hours of a crisis for purposes of assessment, triaging, and acute symptom mitigation.

 

4. Critical Incident Stress Debriefing (CISD) refers to the “Mitchell model” (Mitchell and Everly, 1996) 7-phase, structured group discussion, usually provided 1 to 10 days post crisis, and designed to mitigate acute symptoms, assess the need for follow-up, and if possible provide a sense of post-crisis psychological closure.

 

5. One-on-one crisis intervention/counseling or psychological support throughout the full range of the crisis spectrum.

 

6. Family crisis intervention, as well as, organizational consultation.

 

7. Follow-up and referral mechanisms for assessment and treatment, if necessary

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