CISM Language

CISM is an integrated system of services and procedures designed to achieve several important goals:

Delivery of these goals is done by a CISM team. The make up of a CISM team is based on the type of organization they are arranged for. CISM teams designed to assist emergency personnel may be different then those designed for the community, school system or business. All of them, however, are to provide the core components of CISM.

Before we go further into the core components of CISM, it makes sense to review the terminology. As a multi-organizational approach, there can be overlap as well as differences between the various fields in the terminology used.

When working in the field of stress, terminology is so important. The difference between the lay person discussing components of stress to the paraprofessional, student, clinician and researcher vary. What can happen during a critical incident is that a variety of populations become involved and terminology begins to get thrown around. When different schools of thought or levels of training enter into the same arena, each communicate with their own language for similar if not the same concepts. Common language is critical.

Crisis Event- any event which produces a temporary state of psychological disequilibrium and a subsequent state of emotional turmoil.

Critical Incident- Any event which has a stressful impact sufficient enough to overwhelm the usually effective coping skills of either an individual or group. They are typically sudden, powerful events which are outside the range of our ordinary human experience.

Critical Incident Stress (CIS)-The reaction a person or group has to a critical incident. Critical incident stress is characterized by a wide range of cognitive, physical, emotional, and behavioral signs and symptoms.

It should be noted that not all critical events are critical events to everybody. The key is the perception of danger. For most, being around tornadoes, earthquakes and acts of terrorism will produce critical incident stress, however, if you are trained and experienced as responders, your perception of danger may be different, thus your reactions.

Trauma- In medicine, trauma has 2 definitions. The first is that some part or particular organ of the body has been suddenly damaged by a force so great that the part of the body's natural protection (skin, skull and so on) were unable to prevent injury. The second meaning refers to injuries in which the body's natural healing abilities are inadequate to mend the wound without medical assistance.

On the psychological level, trauma refers to the wounding of the emotions, the spirit, and will to live, belief about your self and the world, one's dignity and one's sense of security. The assault on one's psyche is so severe that normal ways of thinking and feeling and the usual ways in which the person has handled stress in the past are now inadequate. Taking this a step further for CISM, a trauma is any event which penetrates and attacks the psyche, breaking through the defense structure and significantly disrupting one's life. Left unattended to, the damage can result in longer term affliction, personality change and physical illness.

Traumatic Stress- The stress response produced when a person is exposed to a disturbing traumatic event. "Traumatic Stress" is often used as a synonym with the term "Critical Incident Stress" (Mitchell, Bray,1990 Everly, 1989).

Diagnostic terms can come into play and also begin to get interchanged. One should have a working understanding of the DSM-IV and the differences between the main stress related diagnoses. While assessing and determining a diagnosis, the impact of stress should be considered in all assessments. A strong word of caution- a diagnosis has treatment implications and may influence a clinically trained professional into a treatment mode versus a crisis intervention mode. There are however three main diagnoses particularly related to stress. Of note are:

Adjustment Disorders- Adjustment disorders are the development of emotional or behavioral symptoms in response to an identifiable stressor. The symptoms are in excess to what would be expected from the exposure to the stressor and/or there is significant impairment in social or occupational functioning. Symptoms do not persist beyond 6 months after the stressor has terminated.
The identifiable stressor is not considered outside the general populations usual realm of experience. They are considered psychosocial stressors. Stressors can also be severe, but in Adjustment disorders there are a wide range of possible symptoms whereas in post traumatic syndromes there are a specific constellation of symptoms. Application of CISM is not designed to address adjustment disorders.

Acute Stress Disorder- The person has been exposed to a traumatic event where there they experienced, witnessed, or are confronted with an event that involved actual or threatened death, serious injury or a threat to physical integrity of self or others. Plus, the response involves intense fear, helplessness or horror. The person while experiencing or after the event there is the onset of dissociative symptoms, (See DSM IV Diagnostic Criteria), a re-experiencing of the event, avoidance, anxiety/hyperarousal symptoms, significant social and occupational impairment. Disturbance last for minimum of 2 days and maximum of 4 weeks. The disturbance will appear and resolve itself within a 4 week time frame.

Post Traumatic Stress Disorder: Similar to Acute Stress Disorder with the main difference: Symptoms continue beyond or the onset of symptoms is after 4 weeks.

	DSM-IV Criteria PTSD (quick reference)
A.	Have experienced at least one trauma or life threatening event that had the potential for bodily harm and that the individual responded with fear, helplessness or horror.
B.	Continue to relive the the trauma in the form of what are called experiencing phenomena, which include nightmares, flashbacks, and intrusive thoughts about the traumatic event.
C.	Evidence a persistent avoidance of situations reminiscent of the traumatic event and a numbing of emotions (Which alternates with criterion D)
D.	Evidence persistence symptoms of physiological hyperarousal: startle response, irritability, difficulty falling asleep, hyperalertness, and other symptoms (alternates with criterion C)
E.	Criterion B, C, and D must persist for at least one month after the traumatic event.
F.	The traumatic event caused clinically significant distress or dysfunction in the individual's social, occupational, and family functioning or in other important areas of functioning.

For more detailed differences in the diagnosis, the reader should review the DSM-IV which is beyond the scope of this training.