critical incident stress debrief literature review
DESCRIPTION
Effectiveness of CISDs in alleviating PTSD symptomsTRANSCRIPT
EFFECTIVENESS OF CRITICAL INCIDENT STRESS DEBRIEF IN COMBATING POSTTRAUMATIC STRESS DISORDER (PTSD)
Literature Review by Danielle Smith
Trauma
PTSDCISD
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
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
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.
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.
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
•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
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
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.
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
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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