Caveat emptor, caveat venditor, and Critical Incident Stress Debriefing/Management (CISD/M)

Abstract

Mitchell (2004) and Robinson (2004) have expressed concerns regarding our recent article on debriefing (Devilly & Cotton, 2003). In this article we respond to their concerns, some scientific, some sociopolitical, and provide further substantiation regarding our conclusions. We conclude that CISD and CISM are indistinct approaches to trauma and should be treated as synonymous terms (CISD/M) until the necessary and sufficient elements of each are fully declared. Furthermore, based upon current evidence, we restipulate that CISD/M is an ineffective response to critical incidents for individuals, and that organisations need to revise their critical incident response policies to reflect the current weight of scientific evidence. There are currently no reliable studies demonstrating the efficacy of group debriefing.

Occupational and Organizational Issues in Emergency Medical Services Behavioral Health

“…There is no Food and Drug Administration (FDA) regulation of these workplace interventions (or of behavioral health interventions in general). The only operating standard is caveat emptor: ''Let the buyer beware'' (Devilly & Cotton, 2004;Lilienfeld, 2007). Given the absence of credible evidence in the refereed literature of medicine and psychology that standard CISM interventions provide clinical benefits and repeated suggestion that they may complicate recovery for at least some recipients, there has been suggestion in several quarters that the tide may have shifted to present actual liability on the part of the providers of such interventions (Devilly & Cotton, 2004) and EMS agencies that sponsor, much less mandate, participation (Bledsoe, 2003).…”

“…The only operating standard is caveat emptor: ''Let the buyer beware'' (Devilly & Cotton, 2004;Lilienfeld, 2007). Given the absence of credible evidence in the refereed literature of medicine and psychology that standard CISM interventions provide clinical benefits and repeated suggestion that they may complicate recovery for at least some recipients, there has been suggestion in several quarters that the tide may have shifted to present actual liability on the part of the providers of such interventions (Devilly & Cotton, 2004) and EMS agencies that sponsor, much less mandate, participation (Bledsoe, 2003). It is incumbent on EMS managers, then, to acquaint themselves with current best practices according to what authoritative standards exist (see, e,g,, the guidelines of the Oxford-based Cochrane Collaboration regarding debriefing following trauma; Rose et al, 2007; see also the guidelines of the United Kingdom's National Institute for Clinical Excellence, NICE, 2005; those of the Australian Centre for Posttraumatic Mental Health, 2007; and the recommendations of the National Institute of Mental Health=Department of Defense consensus panel on early interventions following terrorism, Ritchie et al, 2002; see as well Devilly, Gist, & Cotton, 2006;Gist, 2002;Gray & Litz, 2005;McNally, Bryant & Ehler, 2003).…”

The Role of Managers in Critical Incident Stress Management Programmes: A Qualitative Study of New Zealand Social Workers

“…Criticisms of CISM and Mitchell's model of CISM include the risk of retraumatising workers by asking them to recall details surrounding critical events and their involvement in them, retrospectively (Devilly & Cotton, 2004). A targeted approach involving individual assessment guiding the intervention that is offered is considered by some theorists to be more appropriate to manage the risk of further retraumatisation (Devilly & Cotton, 2003).…”

An Invitation to Grieve: Reconsidering Critical Incident Responses by Support Teams in the School Setting

“…To the contrary, others (Echterling, Presbury & McKee,2005;Rose, Bisson & Wessely, 2001;2003, andvan Emmerik, Kamphuis, Hulbosch &Emmelkamp, 2002), found no evidence that debriefing promoted recovery from traumatic incidents. Devilly and Cotton (2004) quote data from random control trials in challenging the effectiveness of the group debriefing processes of Critical Incident Stress Management (CISM) / Critical Incident Stress Debriefing (CISD) processes for individuals and drew attention to the lack of reliable evidence. Much earlier Yule, (1991( , cited in Herbert, 1997 had cautioned "that given the few evaluative studies of debriefing, and the assumption that individuals will adapt to crises at different rates, care must be exercised before offering debriefing as a panacea to all survivors".…”