Handling stress after stressful events
The critical incident stress management (SBE) (in Austria coping after stressful events or SVE ) is a series of individual and group discussion techniques that appeal to emergency services, among others, emergency services , fire services , civil protection and police uses, but also to other homogeneous groups who were jointly exposed to a potentially traumatizing situation for professional reasons.
In addition to SbE, there is a very similar method of Critical Incident Stress Management (CISM), according to Jeffrey T. Mitchell . Both methods are shown here.
There are also similar terms such as organized personnel care for extreme operations and aftercare (OPEN) (see emergency pastoral care ), and psychosocial support for emergency services (PSU) .
Handling stress after stressful events
The SbE should give the participants the opportunity to process what they have experienced and to prevent the development of post-traumatic stress disorder (PTSD). SbE therefore does roughly the same for emergency services as emergency rescue services do for relatives.
The two terms are therefore often used synonymously, although this is not the case: In contrast to relatives, emergency services usually remain fully capable of acting for the duration of the mission and work through their long-trained program. You only experience the trauma caused by an assignment in the first resting phase after the incident.
Therefore, the post-processing of the mission takes place in several phases: A mission termination ( demobilization ) can be carried out at or near the mission location , in which information about the mission and possible stress reactions are in the foreground. This event, which is mainly of a psycho-educational character, is aimed at larger groups of emergency services (maximum 50) who are released from service after their assignment. Alternatively, there is the short meeting, which can be held a few hours after the end of the assignment, for example at the end of a shift, with a smaller number of participants and in which there is more space for individual interaction. After several days of debriefing (should if indicated debriefing ) in an orderly setting (environment) occur in the subjective impressions and experiences of participants can be addressed. These meetings are conducted by teams of psychosocial specialists and specially trained emergency personnel ( peers ).
Jeffrey Mitchell, who developed these follow-up techniques, recommends that this person does not belong to any of the organizations involved in the operation, in order to maintain greater confidentiality and also to hide the organizations' own interests in the debriefing.
The SbE service is partly offered by own organizational units, but partly also offered as part of an emergency pastoral care. Some dioceses (Catholic administrative units) have their own employees who are solely responsible for pastoral care in fire and rescue services. In the police force, this task is often taken over by the police psychological service.
The Munich fire brigade, for example, has established its own peer advisor service that performs similar tasks on a smaller scale.
In the beginning, SbE was viewed critically by emergency services out of fear for the image of the "tough guy and savior". In the meantime, SbE has become indispensable, although there are some dubious providers operating in the market.
SBE in aviation
In the meantime, several airlines, for example Lufthansa , have set up and deployed crisis intervention teams. The last time these teams looked after tourists brought back from the tsunami disaster in Asia, as well as their own colleagues who were deployed as crew on these flights. Also in the Concorde -Absturz of Air France , Lufthansa-relief teams supported their French counterparts with the support of the predominantly German nationals.
The Mayday Foundation is in charge of German aviation and provides non-bureaucratic assistance to pilots and their families in need. The foundation also organizes CISM courses , among other things . Together with psychologists and those affected, the Mayday Foundation maintains a support network that assists flight crews after critical and highly stressful incidents or accidents.
Critical Incident Stress Management
CISM stands for C ritical I ncident S tress M anagement. In German usage, the term SbE (stress management after stressful events) is predominantly used.
Definition of a critical incident or a stressful event: "Any situation that provokes such unusually strong emotional reactions that the functionality of the person confronted with it is impaired". Such situations are characterized by “feelings of powerlessness”, “helplessness” or “guilt”, “identification with the victim”, “massive personal concern”, “high event intensity” or “threats to life and limb”.
What is meant by this is that this person may not be able to “go back to business as usual” because they have suffered a psychological trauma. This trauma is a reaction to a massive stressful situation, which has clearly overwhelmed the individual coping strategies of the person concerned. If the trauma persists over a long period of time, one speaks of post-traumatic stress disorder ( PTSD for short or in English Posttraumatic Stress Disorder , short: PTSD ), if it subsides after up to four weeks, the diagnosis is acute stress disorder .
All preventive and accompanying measures that support people in processing the stress symptoms after such particularly stressful events are referred to as CISM. It includes special training measures and ensures the implementation of various measures tailored to the stress reaction, for example CIS debriefings (critical incident stress debriefings) and ensures follow-up care. A scientific review of effectiveness by Harvard University found that CISD not only does not work, it can even be harmful.
In the case of poor processing, however, chronic complaints can arise, which can result in a severe reduction in quality of life, the breakdown of social contacts, in extreme individual cases even in the form of the post-traumatic stress disorder (PTSD), which is difficult to cure and which leads to incapacity for work . PTSD).
All CISM measures do not constitute therapy, but serve exclusively to keep healthy people reacting normally to abnormal events ( critical incidents ).
CISM has a similar relationship to psychotherapy as “ first aid ” has to a surgical intervention.
Interventions
If you see a crisis (i.e. PTSD / PTSD) as a poison, a CISM intervention is a possible antidote. An essential part is a highly structured conversation model developed by the American psychologists Jeffrey Mitchell and George Everly for dealing with critical events (colloquially called CIS debriefing) by specially trained people ( peers ) and psychosocial specialists, so-called MHPs (Mental Health Professionals ) is carried out. The MHP acts as a leader, usually there is also a co-leader who supports and assists the MHP. In addition to debriefing , there are also so-called defusings , demobilizations and one-on-ones . A CIS debriefing is not a (psycho-) therapy, individual counseling or psychological treatment.
Key points of the crisis intervention:
- quick help
- mostly on site
- normalizing
- real support
- Pronunciation of personal experiences
- Discuss and acknowledge feelings
- Feelings are cognitively processed instead of repressed / denied
- Reactions within the group are exchanged and communicated
- Reactions are discussed and experienced as normal
- Stress management techniques are explained
Debriefing, defusing, demobilization, one-on-one
Debriefing
A debriefing is usually a seven-step conversation model (according to Mitchell and Everly). It is the most intense and longest form of CISM intervention (up to four hours). A debriefing is only carried out a few days after the potentially traumatizing event, when cognitive coping mechanisms are recognizable. A debriefing can only be conducted by a doctor or psychologist with appropriate additional training.
Defusing
A Defusing is a much shorter (not longer than 45 minutes) and only three-stage "small" debriefing. It is often carried out immediately after the stressful event (but no later than the same day) and is intended to enable the participants to talk about the event before they have the opportunity to think too hard and make wrong interpretations.
Demobilization
A demobilization usually takes no longer than ten minutes and informs the participants about any physical, cognitive, emotional and behavior-specific symptoms, as well as stress management.
One-on-one
A one-on-one is a conversation between an MHP / peer and an affected person. This is the most direct form of intervention and follows the CIS debriefing model.
Every intervention is confidential and anonymous. The superiors are not aware of the content of the conversations. The MHPs / peers have a duty of confidentiality , which, however, has no legal relevance. After every form of intervention there is the possibility of a direct, non-binding conversation between the MHPs / peers and the affected persons with a small snack and drinks.
CISM in aviation
Crisis intervention teams have been formed at several airlines, for example Lufthansa. These care or special assistance teams looked after passengers affected by the 2004 seaquake in the Indian Ocean . Crew members who had been deployed on these evacuation flights were looked after by CISM teams.
The Mayday Foundation is responsible for the training and provision of these CISM teams in German aviation. This helps pilots in need and their families unbureaucratically, professional and private pilots from all branches of aviation.
Flight crews are then selected and trained to deal with stressful and stressful situations. Nevertheless, pilots, flight attendants and other crew members occasionally find themselves in situations that they perceive as critical or even life-threatening. Together with psychologists and those affected, the Mayday Foundation maintains a support network that assists flight crews after highly stressful incidents or accidents.
In order to prevent post-traumatic stress disorder and the resulting inability to fly, the CISM team carries out various interventions - tailored to the incident. The very time-consuming debriefings with complete crews make up about 10 percent of the missions. Demobilization and individual discussions (so-called one-on-ones) with crew members are the most common form of intervention, also within the airlines. The CISM teams always include peers (= equals) who have the same level of experience as the people concerned.
The CISM teams of the Mayday Foundation are on average three assignments per week.
The non-profit foundation Mayday trains and intervenes according to the rules of the International Critical Incident Stress Foundation, Inc. (ICISF), is involved in its quality monitoring and represents the ICISF as a CISM hotline for aviation in Europe with a focus on the German-speaking area.
In Austria, Mayday Austria has been the general aviation contact for CISM, especially for companies , since 2010 .
literature
- Richard J. McNally: Remembering Trauma . Harvard University Press, Cambridge. ISBN 0674018028 .
- Jeffrey T. Mitchell, George S. Everly and Andreas Igl, Joachim Müller-Lange (Ed. D. German edition): Stress treatment after stressful events. For the prevention of psychological trauma . Stumpf & Kossendey, Edewecht 1998, ISBN 3-923124-72-4 .
- George S. Everly, Jeffrey T. Mitchell: CISM - Stress Management After Critical Events - A New Standard of Care for Emergencies, Crises and Disasters. Facultas-Univ.-Verl., Vienna 2002, ISBN 3-85076-560-1 .
- Jeffrey T. Mitchell, George S. Everly, Joachim Müller-Lange: Handbuch Einsatznachsorge. Stumpf & Kossendey, Edewecht 2005, ISBN 3-932750-91-8 .
- Gisela Perren-Klingler: Debriefing - first aid through the word . Verlag Paul Haupt, Bern 2001, ISBN 3-258-05994-2 .
- Gisela Perren-Klingler: Trauma - From the horror of the individual to the resources of the group . Verlag Paul Haupt, Bern 2000, ISBN 3-258-05164-X .
Web links
- Mayday Foundation
- International Critical Incident Stress Foundation
- Bundesvereinigung SbE Stress treatment after stressful events eV
- Intervention in psychotherapy, for example keyword: intervention (from the "Lexicon of Gestalt Therapy")
- Mayday Austria
See also
Individual evidence
- ↑ SvE Peer Team of the Vienna Red Cross ( page no longer available , search in web archives ) Info: The link was automatically marked as defective. Please check the link according to the instructions and then remove this notice. as an example of Austrian peers. Retrieved December 1, 2012
- ↑ McNally, Bryant, Ehlers: Does early psychological intervention promote recovery from post-traumatic stress? In: Psychological Science in the Public Interest. 4, 2003, pp. 45-79.
