This literature review examines the effectiveness of critical incident stress debriefings (CISDs) in reducing PTSD symptoms following traumatic events. The review found that studies have produced inconsistent results due to variations in what constitutes a traumatic event, the timing of CISDs, and how outcomes are measured. CISDs were most effective when conducted within 24-72 hours according to the standard model, and with consistent assessment methods. Future research with strict criteria is still needed to accurately determine if CISDs can help prevent PTSD in situations like military combat.

1. EFFECTIVENESS OF CRITICAL
INCIDENT STRESS DEBRIEF IN
COMBATING POSTTRAUMATIC
STRESS DISORDER (PTSD)
Literature Review by Danielle Smith
Trauma
PTSD
CISD

2. 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

3. 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

4. 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.

5. Timeliness
Several 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.

6. 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

7. •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

8. 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

9. 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.

10. 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

11. 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 ofTraumatic 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 ofTraumatic 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.TheAmerican 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 andAfghanistan, 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 AbuGhraib 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