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CISM - Critical Incident Stress ManagementA
PRIMER ON CRITICAL INCIDENT STRESS MANAGEMENT (CISM) 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.
TABLE
1
[From: Everly, G. & Mitchell, 3. (1997) Critical Incident Stress Management (CISM). A New Era and Standard of Care in Crisis Intervention. Ellicott City, MD: Chevron Publishing.]
As crisis intervention, generically, and CISM, specifically, represent a subspecialty within behavioral health, one should not attempt application without adequate and specific training. CISM is not psychotherapy, nor is it a substitute for psychotherapy. CISM is a form of psychological "first aid." As noted earlier, CISM represents an integrated multicomponent crisis intervention system. This system's approach underscores the importance of using multiple interventions combined in such a manner as to yield maximum impact to achieve the goal of crisis stabilization and symptom mitigation. Although in evidence since 1983 (Mitchell, 1983), this concept is commonly misunderstood as evidenced by a recent article by Snelgrove (1998), who argues that the CISD group intervention should not be a stand-alone intervention. This point has, frankly, never been in contention. The CISD intervention has always been conceived of as one component of a larger functional intervention framework. Admittedly, some of the confusion surrounding this point was engendered by the fact that in the earlier expositions, the term CISD was used to denote the generic and overarching umbrella program/ system, while the term "formal CISD" was used to denote the specific 7-phase group discussion process. The term CISM was later used to replace the generic CISD and serve as the overarching umbrella program/system, as noted in Table 1 (see Everly and Mitchell, 1997). The effectiveness of CISM programs has been empirically validated through thoughtful qualitative analyses, as well as through controlled investigations, and even meta-analyses (Everly, Boyle, & Lating, in press; Flannery, 1998; Everly & Mitchell, 1997; Everly & Boyle, 1997; Mitchell & Everly, in press; Everly, Flannery, & Mitchell, in press; Dyregrov, 1997). Unfortunately, this is a fact often overlooked (e.g. see Snelgrove, 1998). Similarly, there is a misconception that evidence exists to suggest that CISD/ CISM has proven harmful to its recipients (e.g. see Snelgrove, 1998); this is a misrepresentation of the extant data. There is no extant evidence to argue that the "Mitchell model" CISD, or the CISM system, has proven harmful! The investigations that are frequently cited to suggest such an adverse effect simply did not use the CISD or CISM system as prescribed, a fact that is too often ignored (e.g. see Snelgrove, 1998). In sum, no one CISM intervention is designed to stand alone, not even the widely used CISD. Efforts to implement and evaluate CISM must be programmatic, not unidimensional (Mitchell & Everly, in press). While the CISM approach to crisis intervention is continuing to evolve, as should any worthwhile endeavor, current investigations have clearly demonstrated its value as a tool to reduce human suffering. Future research should focus upon ways in which the CISM process can be made even more effective to those in crisis. While
the roots of CISM can be found in the emergency services professions
dating back to the late 1970s, CISM is now becoming a "standard
of care" in many schools, communities, and organizations
well outside the field of emergency services (Everly & Mitchell,
1997). Dyregrov,
A. (1997). The process of psychological debriefing. Journal of
Traumatic Stress, 10, 589-604. Everly,
G.S., Boyle, S. & Lating, J. (in press). The effectiveness
of psychological debriefings in vicarious trauma: A meta-analysis.
Stress Medicine. Everly,
G.S. & Boyle, S. (1997, April). CISD: A meta-analysis. Paper
presented to the 4th World Congress on Stress, Trauma, and Coping
in the Emergency Services Professions. Baltimore, MD. Everly,
G.S. & Mitchell, J.T. (1997). Critical Incident Stress Management
(CISM):A New Era and Standard of Care in Crisis Intervention.
Ellicott City, MD: Chevron. Everly,
0., Flannery, R., & Mitchell, J. (in press). CISM: A review
of literature. Aggression and Violent Behavior: A Review Journal. Flannery,
R.B. (1998). The Assaulted Staff Action Program: Coping with the
psychological aftermath of violence. Ellicott City, MD: Chevron
Publishing. Mitchell,
J.T. (1983). When disaster strikes...The critical incident stress
debriefing. Mitchell, J. T. & Everly, G.S. (in press). CISM and CISD: Evolution, effects and outcomes. In B. Raphael & J. Wilson
(Eds.). Psychological Debriefing. Mitchell,
J.T. & Everly, G.S. (1996). Critical Incident Stress Debriefing:
An Operations Manual. Ellicott City, MD: Chevron. Snelgrove, T. (1998). Debriefing under fire. Trauma Lines, 3 (2),3,11.
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