Practice Resources

Procedures for Coping

What procedures are available to help coping responses?
Critical Incident Stress Management (CISM) is an initial process that helps “settle” or “debrief” those exposed to a disaster and to identify people who may need advanced therapy. Post-traumatic stress disorder therapy or acute stress disorder therapy may be needed when responses cannot be managed by CISM.

Critical Incident Stress Management 
CISM is a comprehensive, integrative, multicomponent preventive and crisis response intervention system. CISM interventions range from the pre-crisis phase through the acute crisis phase, and into the post-crisis phase. CISM is also considered comprehensive in that it consists of interventions which may be applied to individuals, small functional groups, large groups, families, organizations, and even communities. The 7 core components of CISM are:

  1. Pre-crisis preparation. This includes stress management education, stress resistance, and crisis mitigation training for both individuals and organizations.
  2. Disaster or large-scale incident, as well as, school and community support programs including demobilizations, informational briefings, "town meetings" and staff advisement.
  3. Defusing. This is a 3-phase, structured small-group discussion provided within hours of a crisis for purposes of assessment, triaging, and acute symptom mitigation.
  4. Critical Incident Stress Debriefing (CISD) refers to the 7-phase, structured group discussion, usually provided 1 to 10 days post crisis, and designed to mitigate acute symptoms, assess the need for follow-up, and if possible provide a sense of post-crisis psychological closure.
  5. One-on-one crisis intervention/counseling or psychological support throughout the full range of the crisis spectrum.
  6. Family crisis intervention, as well as organizational consultation.
  7. Follow-up and referral mechanisms for assessment and treatment, if necessary. Part of this process involves identifying and recommending treatment for post-traumatic stress disorder.
Post Traumatic Stress Disorder

Post traumatic stress disorder (PTSD) is a mental disorder resulting from exposure to an extreme traumatic stressor. PTSD has a number of unique defining features and diagnostic criteria, which include:

Exposure to a traumatic stressor

To be diagnosed with PTSD, the person must have been exposed to a traumatic event in which both of the following were present:

  1. the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others; and
  2. the person's response to the trauma involved intense fear, helplessness, or horror.

Re-experiencing symptoms

One set of PTSD symptoms involve persistent and distressing re-experiencing of the traumatic event in one or more ways. In these symptoms, the trauma comes back to the PTSD sufferer in some way, through memories, dreams, or distress in response to reminders of the trauma. A more extreme example of this is "flashbacks," where the individual feels as if they are reliving the traumatic experience. PTSD is distinguished from "normal" remembering of past events by the fact that re-experiencing memories of the trauma(s) are unwanted, occur involuntarily, elicit distressing emotions, and disrupt the functioning and quality of life of the individual.

Avoidance and numbing symptoms

A second set of PTSD symptoms involve persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness. These symptoms involve avoiding reminders of the trauma. These reminders can be internal cues, such as thoughts or feelings about the trauma, and/or external stimuli in the environment that spark unpleasant memories and feelings.

Symptoms of increased arousal

This set of symptoms is represented by persistent symptoms of increased arousal not present before the trauma. These symptoms can be apparent in difficulty falling or staying asleep, irritability or outbursts of anger, difficulty concentrating, a hypervigilant watchfulness, and an exaggerated startle response.

Required duration of symptoms

For a diagnosis of PTSD to be made, the symptoms must endure for at least one month.

PTSD symptoms must be clinically significant
PTSD symptoms must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. Some individuals may experience a great deal of subjective discomfort and suffering owing to their PTSD symptoms, without conspicuous impairment in their day-to-day functional status. Other individuals show clear impairment in one or more spheres of functioning, such as social relating, work efficiency, or ability to engage in and enjoy recreational or leisure activities.

Symptoms of Acute Stress Disorder (ASD)
For some trauma survivors, acute stress reactions are severe enough to meet DSM-IV criteria for Acute Stress Disorder (ASD). Acute Stress Disorder is conceptually similar to PTSD and shares many of the same symptoms. Diagnostic criteria include dissociative (emotional numbness, feeling "unreal" or disconnected from emotions or environment), intrusive, avoidance and arousal symptoms. For a diagnosis of ASD to be met, symptoms must occur within 2 days and 4 weeks of a traumatic experience, after which time a PTSD diagnosis should be considered.

Associated Disorders
In addition to PTSD and ASD, individuals who have experienced trauma are at heightened risk for developing other psychiatric disorders, including:

  • Depression
  • Substance abuse
  • Panic Disorder
  • Obsessive-compulsive disorder
  • Sexual dysfunction
  • Eating disorders