critical incident stress debrief literature review

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EFFECTIVENESS OF CRITICAL INCIDENT STRESS DEBRIEF IN COMBATING POSTTRAUMATIC STRESS DISORDER (PTSD) Literature Review by Danielle Smith Traum a PTSD CIS D

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Effectiveness of CISDs in alleviating PTSD symptoms

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Page 1: Critical Incident Stress Debrief Literature Review

EFFECTIVENESS OF CRITICAL INCIDENT STRESS DEBRIEF IN COMBATING POSTTRAUMATIC STRESS DISORDER (PTSD)

Literature Review by Danielle Smith

Trauma

PTSDCISD

Page 2: Critical Incident Stress Debrief Literature Review

This literature review looks at the process of assessing the effectiveness of

critical incident stress debriefs (CISD) following a traumatic event in alleviating

PTSD symptoms. Several studies have been conducted but with different

criteria for a traumatic event, the timeliness of the CISD, and the measures of

the outcomes of a CISD. The participants in the review range from military

soldiers to police officers to survivors of a hurricane. CISDs were conducted

anywhere between 10 hours and six months with the assessments ranging from

two days to six years. There are too many variations of measurement for an

accurate assessment of the effectiveness to reduce PTSD symptoms that they

are not reliable. The literature reviewed has some success in establishing

effectiveness of the CISD, while other show there is none. Research needs to be

conducted with distinct measures that can be repeated. An accurate

assessment needs to be conducted to help mental health providers treating

military personnel that suffered traumatic events, being susceptible to PTSD.

Abstract

Page 3: Critical Incident Stress Debrief Literature Review

History of CISD Established in 1986, the Mitchell model was

designed to help prevent PTSD in emergency personnel

Established for groups of people in the same field of work to discuss traumatic events

Members articulate what happened and know that others feel the same way that they do Part of a management model:

critical incident stress management, that continues with therapy if needed

Conducted between 24 to 72 hours after a traumatic event

CISDs should last between one to three hours

Page 4: Critical Incident Stress Debrief Literature Review

CISD contains seven separate phases:Introductory phase – facilitator discusses rules

for the group that can consist of language, talking one at a time, and respect for others

Fact phase – everyone tells what happened, together they get a clear picture of the events

Thought phase – what each person thought about what happened

Reaction phase – first reactions to what was happening

Symptom phase - what symptoms are expected over time

Teaching phase – educate group members on possible outcomes after experiencing trauma

Re-entry phase – Getting back to work or normal daily activities, seek additional help if needed

History of CISD cont.

Page 5: Critical Incident Stress Debrief Literature Review

TimelinessSeveral studies were conducted to show the

effectiveness of a CISD depending on when the CISD was administered.

A CISD, according to the Mitchell model, should be conducted within 24 to 72 hours after a traumatic event.

One study by Campfield and Hills (2001) conducted a CISD 10 hours after an event and compared it to a group that had a CISD at 48 hours. The assessments were conducted at two days, four days, and two weeks. The research did show reduction in PTSD symptoms between the two groups.

A CISD conducted in Iraq with military police and Iraqi detainees proved to be very effective not just in alleviating PTSD symptoms, but also in relations between the two groups.

Assessments taken for the studies reviewed were conducted 90 days, six months, or even six years after the CISD was conducted. Only one assessment conducted, without a baseline, could not accurately determine the effectiveness of a CISD. These time frames do not allow for the natural recovery of traumatic events.

Page 6: Critical Incident Stress Debrief Literature Review

Several studies that did evaluate the effects of a CISD

with military personnel were found to be inconclusive

due to limited number of soldiers that meet the

diagnosis for PTSD. The three studies evaluated a total

of 1,239 soldiers after a six month rotation to Bosnia.

They found that a total of only 63 met the strict criteria

for PTSD. These studies conducted a CISD for an entire

six month period and not a traumatic event, and

assessed the effectiveness of the CISD only once.

Traumatic Events

Page 7: Critical Incident Stress Debrief Literature Review

•Possible reasons for recent studies not finding positive results from CISDs• The Mitchell model was not followed explicitly,

not effectively assessing the results• CISDs not conducted with the 24 to 72 hours

time frame• Assessments completed anywhere from two

days to six years after a traumatic event• CISD and assessments conducted 90 days to six

months after trauma• Studies not controlled or conducted with

randomized participants

Standards of Measurements

Page 8: Critical Incident Stress Debrief Literature Review

Future Studies Evaluate effectiveness of CISDs conducted in

Iraq or Afghanistan for traumatic events Approximately 535 CISDs conducted in Iraq

within a six month period No studies conducted using current data

from theater of operations

Page 9: Critical Incident Stress Debrief Literature Review

Ensure CISDs conducted according to the Mitchell model

Maintain continuity to assess effectiveness

Evaluate reliability of other studies based off same

techniques

Future Studies Cont.

Page 10: Critical Incident Stress Debrief Literature Review

Conclusion Additional studies of traumatic

events need to be conducted Elimination of CISDs in military

theater of operations if found ineffective

New techniques developed to assist soldiers

Postt

rau

mati

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tress

Dis

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Page 11: Critical Incident Stress Debrief Literature Review

References

Adler, A. B., Litz, B. T., Castro, c. A., Suvak, M., Thomas, J. L., Burrell, L., McGurk, D., Wright, K. M., & Bliese, P. D. (2008). A group randomized trial of critical incident stress debriefing provided to U.S. peacekeepers. Journal of Traumatic Stress, 21(3), 253-263. doi:10.1002/jts.20342

Campfield, K. M., & Hills, A. M. (2001). Effect of timing of critical incident stress debriefing (CISD) on posttraumatic symptoms. Journal of Traumatic Stress, 14(2), 327(14).

Chemtob, C. M., Tomas, S., Law, W., Cremniter, D., (1997). Post disaster psychosocial intervention: A field study of the impact of debriefing on psychological distress. The American Journal of Psychiatry (Washington), 154(3).

Deahl, M., Srinivasan, M., Jones, N., Thomas, J., Neblett, C., Jolly, A. (2000). Preventing psychological trauma in soldiers: The role of operational stress training and psychological debriefing. British Journal of Medical Psychology, 73, 9.

Everly Jr, G. S., Boyle, S. H., & Lating, J. M. (2001). The effectiveness of psychological debriefing with vicarious trauma: A meta-analysis. Stress Medicine, 15(4), 229(5).

Hoge, C. W. (2004). Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care New England Journal of Medicine, 351(1), 13 to 22. doi:10.1056/NEJMoa040603

Hung, B. (2008). Behavioral health activity and workload in the Iraq theater of operations. U.S.Army Medical Department Journal, 39-42.

Larsson, G., Michel, P., & Lundin, T. (2000). Systematic assessment of mental health following various types of posttrauma support. Military Psychology, 12(2), 121-135.

Leonard, R., & Alison, L. (1999). Critical incident stress debriefing and its effects on coping strategies and anger in a sample of Australian police officers involved in shooting incidents. Work & Stress, 13(2), 144-161. doi:10.1080/026783799296110

Smith, M. H., Brady, P. J. (2006). Changing the face of Abu Ghraib through mental health intervention: U.S. army mental health team conducts debriefing with military policemen and Iraqi detainees. Military Medicine (Bethesda), 171(12), 4.

References