In my limited experience people who withdraw benefit from being warm, dry, in a quiet location. Hot food and drink seem to help. If they go the other way to hysteria being assigned a simple repetitive job seems to be very calming. Everyone, withdrawn, hysterical, or no apparent symptoms, benefit from simply talking about their experiences and feelings, as unnatural and difficult as that may be for men to do.

I'm afraid I have a different opinion regarding CISD (and probably regarding many other forms of "Psychiatric First Aid")

Critical Incident Stress Debriefing (CISD) is often used in in an attempt to prevent or minimize adverse outcomes of traumatic exposure. There are relatively few controlled studies on CISD, and among trauma researchers (not necessarily those who train and "sell" CISD to agencies) there is IMHO no consensus that CISD is actually helpful. Some studies have shown it can be harmful, others have not.

"The intervention has generated controversy, perhaps in part due to its widespread use in the absence of solid empirical evidence from randomized clinical trials to demonstrate its effectiveness. Now a new study by VA and DoD investigators provides the first such evidence—and the results are disappointing. "

Participants in carefully done CISD probably DO feel that the intervention was helpful. This perception (among participants) that it was helpful and not harmful suggests that it will continue to be used... if only for the social and emotional comfort it initially provides. It probably reduces immediate distress and improves group cohesion among first-responders and military units.

However, aside from this there is little evidence of meaningful effect in preventing or reducing any of the serious psychological consequences seen among trauma survivors (such as ASD or PTSD). Neither the presence or absence of CISD has an effect on these problems.

According to The National Center for PTSD
"recent research indicates that psychological debriefing is not always an appropriate mental-health intervention. Available evidence shows that, in some instances, it may increase traumatic stress or complicate recovery. Psychological debriefing is also inappropriate for acutely bereaved individuals. While operational debriefing [this is NOT really CISD..sic] is nearly always helpful (it involves clarifying events and providing education about normal responses and coping mechanisms), care must be taken before delivering more emotionally focused interventions.

A recent review of eight debriefing studies, all of which met rigorous criteria for being well-controlled, revealed no evidence that debriefing reduces the risk of PTSD, depression, or anxiety; nor were there any reductions in psychiatric symptoms across studies. Additionally, in two studies, one of which included long-term follow-up, some negative effects of CISD-type debriefings were reported relating to PTSD and other trauma-related symptoms (1).

Therefore, debriefings as currently employed may be useful for low magnitude stress exposure and symptoms or for emergency care providers. However, the best studies suggest that for individuals with more severe exposure to trauma, and for those who are experiencing more severe reactions such as PTSD, debriefing is ineffective and possibly harmful. "

Damned if you do and also if you don't?

Well, perhaps. To be honest with you, I have a great deal of professional experience with this and I personally recommend the DON'T.

Well, if as I have confirmed, the Red Cross thinks psychological first aid makes sense enough to teach, then I am going to try to get into a class - or at least get a set of their teaching material.

Dweste, if you do Psychological First Aid (PFA) the way the Red Cross teaches/recommends it, I think you're good to go. I just don't like the "debriefing" components some people seem to use.

The World Health Organization (I think in recent years... at least after 2007) looked at PFA across the world. They DO seem to endorse: "basic, non‐intrusive pragmatic care with a focus on: listening but not forcing talk; assessing needs and ensuring that basic needs are met; encouraging but not forcing company from significant others; and protecting from further harm." PFA is very different from psychological debriefing in that it does not necessarily involve a discussion of the event that caused the distress..."

Psychological First Aid is designed to reduce the initial distress caused by traumatic events, and to foster short- and long-term adaptive functioning. I really can't find compelling evidence that it does the later (promotes long-term adaptive functioning). But that's a hard case to make in any event because of "base rate" problems: 70% of survivors do not suffer any such consequences. Of the 30% that may, we still aren't very adept at identifying the factors that explain who will or won't have consequences.

Here's a guide to PFA:

http://www.vdh.state.va.us/EPR/pdf/PFA9-6-05Final.pdf

The dinosaur rises to speak (I was most active before the time of CISD). I dealt with some fairly nasty outcomes in SAR, and definitely was stressed by them. What seemed to help the most was another operation with a positive outcome. IME, the high from a successful operation far exceeded the lows from a bad one. I also would not discount the support from fellow team members.

Seems this thread has a split personality about "psychological first aid." Some comments seem most relevant to first responder types, some to the victims of emergencies. I am learning from both.

C.I.S.D, Dealing with Bereavment etc, you are dealing with some very complex, difficult and often conflicting emotions that most people have no real understanding of.

Take this as an absolute:

If it has not happened to you then you will never understand what and why, or even with the best will in the world, be able to really help. Yes, you can blunt the physical harm but the mental is beyond your powers.

If it has, then you can be of great help and in my view,and speaking from experience, C.I.S.D. should only be done by people who have been there.

[quote=Leigh_RatcliffeTake this as an absolute:
If it has not happened to you then you will never understand what and why, or even with the best will in the world, be able to really help. Yes, you can blunt the physical harm but the mental is beyond your powers.

If it has, then you can be of great help and in my view,and speaking from experience, C.I.S.D. should only be done by people who have been there.
[/quote]

Leigh, I can't agree that this is an absolute. I've never been shot - yet I've helped scores of cops and operators who have been. I've never had body parts blown off, but have helped many who have. I've never lost everything in a disaster, but I treated many Katrina victims with reasonable success. I could go on, but my point is that treatment can be very helpfully delivered by someone who didn't actually experience that same or similar trauma.

I've had the training and I've done C.I.S.D., and I noted some of my objections in the above thread. I respect your opinion regarding "been there-done that", but there isn't any empirical evidence to support calling this an "absolute." For instance, there are law enforcement agencies and fire departments who use trained "peers" to do CISD. Other agencies use outside professionals. Some have.. and some have not experienced similar traumas. I can't find any evidence of a difference in efficacy.

I do know that even if one has experienced the exact same type of event it is (contrary to what one may expect) very perilous to "self-disclose" - to assume, or to communicate, that you know how the other person feels because of your own experience. The risks of such significantly outweigh any assumed benefit of self-disclosure about one's own experience or "knowing how the other person feels." This is true in treating psychological trauma (e.g. PTSD) and in PFA.