CISD MODEL

THE BEST WAY TO AVOID

THESE CONSEQUENCES
IS TO PREVENT PTSD
FROM OCCURRING

CISD IS THE BEST WAY TO

PREVENT IT
C I S D

Critical

Stress
Incident

Debriefing
 TERMS:
● CRITICAL
– dangerous, serious
● INCIDENT
– event, happening
● CRITICAL INCIDENT
◘ Overwhelming / traumatic event
◘ Extraordinary event
◘ Overwhelming, powerful events
● STRESS
– tension, pressure, negative emotions from
an unpleasant experience
● DEBRIEFING
– Discussions following a critical
experience
CISD BACKGROUND
ClSD was designed by
Dr. Jeffrey T. Mitchell,
1995
University of Maryland

6
● To prevent post-traumatic stress
among high-risk occupational groups.

● Initially developed for fire fighters,

paramedics, rescuers and police officers

● This Mitchell Model has been

modified and expanded for use in natural
disasters, school-based incidents, and a
variety of other settings .
7
 CISD
Although there is a need to validate the long term
results of CISD, the immediate effects are
overwhelmingly positive.
CISD is a very effective group process where persons
learn some good coping skills from other
participants in the group, less resources are required
and less expensive form of intervention. It is also
time-saving and a socialized form of modality. This
is not a Therapy.
Most people who develop severe PTSD (post-traumatic
stress disorder) are those who never had the chance
to undergo CISD.
So… WHAT IS CISD?
Basically, a group-process involving persons who are
victims / survivors of overwhelming event or trauma
(including those who may have been impacted by the
traumatic event).

It allows participants to undergo a structure that provides

them the avenue to share their experiences, feelings, stress
responses, coping strategies, lessons learned from the
experience and create support among each other.

It aims to prevent the subsequent development of post-

traumatic stress disorder (PTSD). It is preventive than
therapeutic.
 WHY IS CISD IMPORTANT?
It can play an important role in preventing the
development of Post-Traumatic Stress Disorder;

It provides an immediate sense of safety, group

cohesion, mutual support and education; and

An opportunity for venting feelings, and normalization

of symptoms, and creating a plan for further action.
 PURPOSE :

◘ To lessen the psychological impact of a

traumatic event;

◘ Prevent the development of a traumatic

stress; and

◘ To identify individuals who will require

professional mental health follow-up.
(Mitchell JT, Everly GS, Critical Incident Stress Debriefing: The
Basic Course Workbook, 1995).
 BASICS OF DEBRIEFING

● FORMAT: :
formally, a seven - stage process
● USED :
in a group meeting
● FOR :
those involved in a critical incident
● WHEN :
is ideally held within hours of the incident
( up to 72 hours to 1 week)
STAGES / PROCEDURES
OF CISD
 7 STAGES of CISD
KENDALL JOHNSON /
STAGE / PHASE JOHNNY B. DECATORIA (2003)

STAGE 1 INTRO PHASE (ano ang Debriefing)

STAGE 2 EVENT / FACT (ang nangyari)

STAGE 3 FEELING & THOUGHT PHASE

(mga naramdaman / Mga naisip)

STAGE 4 STRESS REACTIONS ( mga simptomas

pagkatapos ng nangyari)

STAGE 5 COPING/TEACHING (paano nakaligtas?

Nalampasan and krises)

STAGE 6 LEARNING (mga natutunan)

STAGE 7 CLOSURE / SUPPORT/ RE-ENTRY PHASE (mga

plano sa hinaharap)
 CISD STAGES
Modified by Kendall Johnson &
J.B. Decatoria, 2002

OBJECTIVES / PROCEDURES
Stage / Phase 1 By J.B. Decatoria, PhD (2004)

◘ Introduce intervention;
explain process
INTRO PHASE ◘ Introduce team members
◘ Set expectations
◘ Rules- when someone
speaks, the rest listen;
confidentiality, etc.
◘ Rapport
 CISD STAGES
Stage / Phase 2 OBJECTIVES / PROCEDURES

FACT or EVENT ◘ Each participant describes the

PHASE or experience on the fact level.
RE-LIVING Stage
◘ We help each one to recall,
re-live and talk about the event
Anu-ano ang
mga ◘ Some leads: what happened?
pagkakasunod Where were you at that time?
-sunod ng mga You remember anything? What
pangyayari did you see, smell, hear? etc
CISD STAGES

Stage / Phase 3 OBJECTIVES / PROCEDURES

FEELING & ◘ Focus is on the feeling or emotion
level (What or how did you feel at
THOUGHT that time?)
PHASE ◘ they may hold negative thoughts
◘ Facilitate expressions of intense
Anu- ano ang emotionality; watch for
abreactions – let go of it, don’t
mga suppress
naramdaman ◘ Leads - How did you feel at that
mo? Ang time of the event? Did you ever
mga naisipan think you were going to die?, etc.

mo?
CISD STAGES
Stage / Phase 4 OBJECTIVES / PROCEDURES
STRESS REACTION ◘ Intense emotions can have
/ RESPONSE various consequences
PHASE ◘ Facilitate sharing of stress
Anu-ano ang responses and reactions
mga napansin ◘ It is important for them to discover
mo sa sarili mo that these experiences are also
pagkatapos ng common in others.
pangyayari? ◘ Leads – What did you notice in
(kilos, isip, your body after the incident?; Did
katawan, you notice any change in your
pakiramdam) behaviours? How are you different
prior to the incident? Change in
your functioning?
CISD STAGES
STAGE / PHASE 5 OBJECTIVES / PROCEDURES
◘ Make them understand that their
COPING/ stress reactions are normal
TEACHING responses to an abnormal event

PHASE ◘ Understanding these will help them

gain control of their unpleasant
symptoms; not the other way
Papano mo around.

nalampasan ◘ Very important – they should gain

ang crisis na insights from each other, how
others cope effectively; learn from
yon? each others’ styles of coping. Try to
model from them.. if it works.
 STAGES
TRANSITION

PROCEDURES
STAGE / PHASE 6

◘ Allow participants to share what

they had learnt from the
LEARNING experience
PHASE
◘ Lead: not all crises are bad and
(Lessons Learned) destructive – some crises can bring
tremendous lessons; they can
make us more prepared, better
persons in facing future crisis
or similar experience

◘ These positive lessons learned can help in

the healing and recovery
20
CISD STAGES
OBJECTIVES / PROCEDURES
STAGE / PHASE 7
◘ CLOSURE / This is not therapy or counseling; yet, it is
SUPPORT PHASE imperative to make a sense of closure
◘ RE-ENTRY
Assist participants in identifying or recognizing
◘ Pagtatapos ng strategies and mechanics in order to support each
sesyon other; what can they do to help each other.

◘ Mga plano sa
hinaharap Identify from them / share with them available
resources that may be needed even long after the
◘ Pananaw sa session
kinabukasan
◘ Mga dapat gawin
Suggest, if any, possible institutions or agencies
they can tap when further individual sessions
would be needed.
CLOSURE
Can be done in several ways:
◘ Ask them to say a short message of
support / comfort addressed to the group
◘ A prayer may do
◘ Meditation / relaxation exercise
◘ A song; memorial service, as appropriate.
CLOSURE
Can be done in several ways:
◘ Ask them to say a short message of
support / comfort addressed to the group
◘ A prayer may do
◘ Meditation / relaxation exercise
◘ A song; memorial service, as appropriate
 SUMMARY OF CISD STEPS

1. INTRO PHASE
2. EVENT / FACT PHASE
3. FEELING & THOUGHT PHASE
4. STRESS RESPONSE PHASE
5. COPING/TEACHING PHASE
6. LEARNING
7. CLOSURE / SUPPORT PHASE
 SOME GUIDELINES IN CONDUCTING CISD

1. Arrange sitting in circle

2. Exhaust during the sharing – did you

miss anything important to share with
us?

3. Go and Debrief as a team, at least 2

debriefers / facilitators.
5. The CISD should be held within 2 –3 days
after the event. CISD, a week or two after the
incident may still be used depending on the
need and availability of the participants.
6. The group usually convenes on the job
or in the home. Participants should expect to
devote 2-3 hours for the discussions.
OTHERS…

7. BE EMOTIONALLY READY