Critical Incident Stress Debriefing: How It Works & What to Expect

What Is Critical Incident Stress Debriefing (CISD)?

Critical incident stress debriefing is a specific, structured crisis intervention to reduce traumatic stress, increase coping, and facilitate group solidarity among people who have experienced the same trauma together.¹ Dr. Jeffrey Mitchell, a former firefighter and paramedic, developed CISD as one component of a broader critical incident stress management (CISM) program.

The intervention involves emotional processing and psychoeducation to police officers, firefighters, emergency medical professionals, disaster workers, and people in similar occupations who respond to gruesome or catastrophic emergencies.2 CISD can help them manage an intense stress reaction and return to their typical level of functioning when their usual coping mechanisms have been overwhelmed.^1,2

Trained teams of two to four mental health professionals or experts in disaster response and peer support personnel (responders who have experienced traumatic events in the past) offer critical incident debriefing interventions.^1,3 Typically, the workplace hires the team, and the intervention is offered free to personnel who have just faced a critical incident in a group setting with a maximum of 25 people.⁴

This debriefing intervention progresses through seven stages during one single session that lasts approximately one to three hours. For maximum effectiveness, individuals receive CISD within the first 24-72 hours after they have completed their response work for the critical incident.^1,5

Specific requirements for this structured program are:^1,4

• The group must be homogenous (all members are of the same occupation and participated together in the critical incident)
• Members had approximately the same amount of exposure to the traumatic event
• No one is currently involved in the response efforts
• Participants must be psychologically ready rather than extremely fatigued or distraught.
• The standardized procedure and all seven steps must be followed completely and properly
• The intervention is not stand-alone but instead is one component of a crisis response management program that involves other interventions and services

What Is a Critical Incident?

“Critical incident” is another term for a traumatic event, such as any occurrence faced by public safety responders, emergency workers, and related personnel that causes distress and disruption to typical psychological or physiological functioning.5 Critical incidents often involve death or extreme threats to safety, life, and well-being.⁵

Examples of critical incidents include:

• Catastrophic fires
• Mass shootings
• Workplace violence
• Serious accidents
• Natural disasters (storms, wildfires, earthquakes, etc.)
• Industrial disasters

What Are the Common Effects of a Critical Incident?

CISD seeks to lessen the impact of a traumatic event, aid in recovery and resiliency, enhance understanding of how a critical incident naturally impacts people, build coping skills, and identify people who may benefit from additional help like individual mental health therapy.^1,3,4

Short- and long-term side effects of a critical incident may include:⁵

• Numbness or shock
• Life-disrupting emotions and other psychological reactions (anger, denial, grief, confusion, terror, survivor guilt, blame, difficulty concentrating, flashbacks, etc.)
• Acute stress disorder
• Post-traumatic stress disorder (PTSD)
• Difficulty eating and/or sleeping
• Missed work
• Substance use problems
• Relationship difficulties
• Depression
• Anxiety

7 Stages of Critical Incident Debriefing

The seven stages of CISD help people retell the event, share reactions and symptoms, and learn factual information to promote recovery and overall mental health.^1.2 This program is intended to reduce symptoms and the risk of developing mental health disorders like acute stress disorder, post-traumatic stress disorder, substance use disorders, depression, and anxiety.

Here are the seven stages of critical incident stress debriefing:

1. Assess the Critical Incident

The initial stage of CISD primarily involves the team leaders. Those conducting the program carefully consider the specific situation and the people involved to tailor each step precisely to group needs. When the participants join, team members introduce themselves, explain the process, and set guidelines.

2. Identify Safety & Security Issues

In this stage, participants are encouraged, but never forced, to open up and provide a brief, factual account of the event from their own point of view without diving into details or emotions. This stage aims to help people feel safe, reduce anxiety, provide a sense of personal control, and encourage discussion.

3. Allow Venting of Thoughts, Feelings, & Emotions

This stage begins by discussing what people think about the critical incident. A typical question is, “What was your first or most prominent thought once you realized you were thinking?”¹ This is done as a group go-around, with each person getting the chance to share. The discussion transitions from thoughts to feelings and emotions. Venting and validation should occur so people can share their emotions in a safe, supportive environment.

4. Share Emotional Reactions

Through discussion, participants process the event and begin preparing and planning for the immediate and long-term future. Sharing focuses on reactions and impact but is less structured than in the other stages. Each participant has the chance to participate and share concerns. The discussion continues until all emotions or other issues have been addressed. This stage helps reduce chronic crisis reactions and return a sense of control.

Participants can answer questions such as:^1,4

• “What was the worst thing about this event for you personally?”
• “If you could erase one part of the situation, what would you erase?”
• “What aspects of the situation cause you the most pain?”

5. Review Symptoms & the Incident’s Impact

During this segment, participants explore and express their symptoms and the effect the incident is having on them. Leaders might ask, “How has this tragic experience shown up in your life?” or “What cognitive, physical, emotional, or behavioral symptoms have you been dealing with since this event?”¹ This stage helps spot potential problems with coping and identify people who may need additional support.

6.  Teach & Bring Closure to the Incident

This educational phase helps participants understand their symptoms by explaining that their reactions are normal responses to traumatic events. Leaders provide stress management tools and other information tailored to the specific incident and group involved. This phase helps people center themselves and feel more grounded and stable.

7. Assist In Re-Entering the Workplace/Community

As the session draws to a close, leaders review and summarize what has been discussed and learned. Sometimes, they provide handouts with information, resources, and action steps. Participants have the opportunity to ask questions and make any final statements. The purpose is to help participants move forward into their deeper healing and recovery process, leading to post-traumatic growth.

Rather than abruptly dismissing the participants at the end of step seven, team leaders offer refreshments to anchor the group and allow them to connect and transition gradually out of the intervention. Leaders talk with each participant as the first part of follow-up services available after the CISD session.