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Critical incident stress management (CISM): benefit or risk for emergency services?

15 Aug

B. Bledsoe, a researcher from the Department of Emergency Medicine at The University of North Texas Health Sciences Center in Fort Worth reviewed the literature and analyzed the results of various studies of Critical Incident Stress Management (CISM), a method of debriefing survivors or emergency responders involved in traumatizing events, in common use since 1983. The focus for the review was to look at findings related to the efficacy and safety of CISM.

Bledsoe accessed several pertinent databases, which were subsequently analyzed for methodology and pertinence to CISM. Several high-quality studies were identified, while others lacked adequate methodology. Overall, the meta-analyses and randomized controlled trials (RCTs) that met the author’s conditions showed that at best, CISM has no effect on preventing psychiatric after-effects following a traumatic event, and particularly post-traumatic stress disorder (PTSD). Furthermore, several studies reported possible paradoxical worsening of stress-related symptoms in patients and personnel receiving CISM.

Bledsoe concludes that despite the limitations of the existing literature base, several meta-analyses and RCTs found CISM to be ineffective in preventing PTSD. Several studies found possible iatrogenic worsening of stress-related symptoms in persons who received CISM. Because of these findings, the author recommends that CISM should be curtailed or utilized only with extreme caution in emergency services until additional high-quality studies can verify its effectiveness and provide mechanisms to limit paradoxical outcomes. It should never be a mandatory intervention.

Citation: Bledsoe BE. Critical incident stress management (CISM): benefit or risk for emergency services? Prehospital Emergency Care 2003 April- Jun;7(2):272-9. (This email address is being protected from spambots. You need JavaScript enabled to view it.)
Belleruth Naparstek

Psychotherapist, author and guided imagery pioneer Belleruth Naparstek is the creator of the popular Health Journeys guided imagery audio series. Her latest book on imagery and posttraumatic stress, Invisible Heroes: Survivors of Trauma and How They Heal (Bantam Dell), won the Spirituality & Health Top 50 Books Award