Posted by: supportivelistening | March 2, 2008

When trauma strikes

scream by Munch Critical Incident Stress Management (CISM) is a debrief method that was created in order to help people cope with traumatic events. The idea is straightforward: A trained person arrives at the site of the event, gathers people who may have been traumatized, and walks them through a debrief process in a number of well-defined stages (including giving details of the event, discussing personal reactions, and assuring people that what they’re feeling is normal).

So far so good. But a large meta-analysis by Bisson et al. in the Cochrane Review (more-or-less the final judges in evidence based medicine) concluded that it’s not working. In the authors’ own words:

No improvement if people received a single session of “critical incident stress debriefing” (CSID) as compared with controls. In fact, the long-term consequences of CSID appear to be deleterious for people that had a greater negative response to the event.

(Note: The review didn’t include any studies with children, who may respond differently to debriefing)

What can make things better? One of the main recommendations that the authors provide is to try having client-led sessions (as opposed to counselor-led). Another recommendation is to think beyond single-shot interventions – perhaps people need more than just (re)processing a traumatic event once.

This is really important. Most people will face a traumatic event at some point of their lives, often more than once. The stress that arises as a response to these events can be very disruptive to people’s lives, and may have negative emotional, social, and economical implications.

So how can people be in charge of their own “critical incident debrief” and have an opportunity to do this on an ongoing basis?

Enter Supportive Listening. Teaching people to debrief with one another could satisfy all of these requirements, in addition to strengthening the community in which the traumatic event occurred. In the Supportive Listening framework, conversations are led by the “speaker” rather than by the “listener.” Because these conversations often take place between friends and family members, it’s possible to find a willing listener on multiple occasions, thereby having an opportunity to reprocess the event and the reactions that came after it as many times as necessary. In the months to come, we hope aim to test the efficacy of Supportive Listening, using scientific methodology and standards – and, rest assured, we will let You know what we discover. In the meantime, take good care of yourselves, and of each other. :-)

– Eran

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