EMDR applications to critical incident stress management

A critical incident is any situation that causes unusually strong emotional reactions that have the potential to interfere with a person's ability to function immediately after the incident or later. These are situations that overwhelm a person's sense of vulnerability and/or control. A critical incident stress debriefing (CISD) is a psychoeducational group meeting or discussion about a traumatic incident which ideally takes place within 72 hours of the event. The goals of a CISD are to mitigate the psychological impact of a traumatic event, prevent subsequent development of a post-traumatic syndrome, accelerate recovery, and serve as an early identification mechanism for people who need further follow-up, including EMDR. The steps of a CISD include: 1) introduction - to introduce the intervention team, explain the process, and set expectations. 2) fact - to describe the event from each participant's perspective on a cognitive level. 3) thought - to allow participants to describe cognitive reactions and to transition to emotional reactions. 4) reaction - to identify the most traumatic aspect of the event for participants. 5) symptom - to identify personal symptoms of distress and transition back to the cognitive level. 6) teaching - to educate as to normal reactions and adaptive coping strategies 7) reentry - to clarefy ambiguities and prepare for termination; access for follow-up. In the opinion of the authors, the CISD facilitates the processing of the traumatic information before it becomes crystallized in dysfunctional form. EMDR can be very effective shortly following a CISD, and is particularly usehl for participants who are experiencing distress or intrusive symptoms after the CISD. The CISD structure helps the participant understand the traumatic impact of the incident and provides support and guidance toward adaptive resolution. The EMDR process begins where the CISD leaves off. The CISD helps to delineate the traumatic image, negative cognition, and emotions associated with the event, making the subsequent EMDR process more efficient. EMDR appears to have a very powerful and rapid effect after the CISD, perhaps, because of the initial processing. In other words, the CISD initiates an adaptive processing of the traumatic information; EMDR completes it. EMDR can be implemented individually immediately following the CISD, or the next day. While the CISD is a group process, EMDR is an individual method. EMDR can be explained during the teaching phase of the CISD or after the CISD to the whole group, but EMDR treatment is done individually and privately. EMDR can go beyond a CISD in targeting previous traumas that may underlie the current incident, delve deeper into the meaning of the incident for the person, and target specific stimuli that are relevant to the individual (e.g. Smells, tastes, etc.). The workshop will discuss the application of EMDR to critical incidents. The protocol for recent events will be reviewed. Guidelines for negative and positive cognitions will be discussed. For example, a critical incident usually involves issues of responsibility ("Is it my fault?"), Safety ("Am I safe?"), And/or control ("Do I have choices in life?). It is important that such dynamics are understood when formulating the negative cognition. The dynamics of fear, a framework for understanding a critical incident and resolving issues of vulnerability and powerlessness, will be presented. The model discusses the importance of going beyond defining the moment of peak stress to elucidating subsequent thoughts, actions, and decisions. The implications for cognitive interweaves will be discussed.

Conference

English

Jeffrey T. Mitchell
Roger M. Solomon

Mitchell, J. T., & Solomon, R. M. (1995, June). EMDR applications to critical incident stress management. Presentation at the EMDR Network Conference, Santa Monica, CA