I attended a conference on Stress, Trauma and Coping in Baltimore last weekend that was sponsored by the International Critical Incident Stress Foundation or ICISF. One of the things that ICISF does is to teach medical professionals and first responders how to cope with trauma. The organization promotes a simple seven step "debriefing" method and this debriefing process is called Critical Incident Stress Management or CISM.
CISM (also known as The Mitchell Method) is popular among the military and first responders, because it's low cost, it's immediate, it isn't psychotherapy (so it carries no stigma) and helps people deal with trauma and educates them about resources they might need in the days and weeks ahead. The counselors and trainers who use this method refer to it as "psychological first aid."
There were many memorable presentations at this conference both from the military side, the civilian side and from the perspective of police, firefighters and EMT's. People talked about responding to every kind of crisis imaginable from fires to earthquakes to tsunamis to car accidents and of course mass shootings. What struck me, is that there are so many of these traumatic events and tragedies occurring these days that this method of debriefing is growing in leaps and bounds in part because there is so much demand for anything that help people handle the increased exposure to trauma.
What many of the first responders who use this method seem to agree on, is that it's valuable to have a protocol in place, like CISM, when there's an event like the Sandy Hook shooting that suddenly overwhelms an organization, that's not really accustomed to dealing with so much trauma. Employers like it, responders like it, and the trainers who use it, like its simplicity. In fact, the featured speaker at the conference was Sgt. Troy Anderson, head of the debriefing team for the Connecticut State Police who managed the Newtown Crisis.
When Sgt. Troy got the message that there was an "active shooter" in Newtown, he sped to the scene and arrived minutes after Adam Lanza killed himself. Without describing any of the details of what people saw when they walked in that school (if I tell you, you will NEVER be able to un-think it, he said, poignantly) he described what it was like to have a protocol in place for dealing with how the first responders felt after they walked out.
He said that ten years ago those first responders would have been expected to just carry on, and move on to the next assignment without any assistance or break: Just carry on with your life and don't take any time out for the difficulty of dealing with trauma. But now, he said - thanks to this 7-step CISM method and a greater awareness about trauma in general- a protocol WAS in place and he was able to do 30 debriefings in a total of about 100 hours in the days and weeks following the tragedy.
On Friday night at the conference, there was a whole evening dedicated to dealing with trauma in the military. All the speakers were either active military or retired military or civilians working in the military. One of the interesting debate points was about the value of resilience training. While it was a catch-phrase in many of the presentations during the conference, some of the military folks thought of resilience training as nothing more than "a marketing gimmick." One retired military Psych nurse told me that a lot of people in the military were ticked off that Marty Seligman (author of books on learned helplessness, resilience and positive psychology) was personally paid $1,000,000 for a program that has little or no effect on the rates of PTSD in the military. According to this one source, studies show that soldiers who took the course were no more likely to avoid symptoms of PTSD than those who didn't take the course.
One thing I've learned about the military is, as a general rule, they don't go looking for help, especially psychological help, outside of their own circles. So an academic, like Dr. Martin Seligman, with no military service in his background, may not be the preferred go-to guy when it comes to developing military training because the advice, no matter how good it is, may be ignored.
So the upshot of this discussion was that some former military people like Dr. Glenn R. Schiraldi were touting resilience training as the key to maintaining top notch behavioral health, while other active military like Col. Kathy Platoni, who personally survived the Ft. Hood shooting massacre, weren't so sure. She thought the jury was still out on how effective resilience training really was.
One thing that's really hot right now, and a topic of much discussion at the conference, is the value of peer support. Just about everybody was talking about it. Peer support is different from social support, in that with most social support, whether it comes from a medical person, counselor or even a family member, the provider, if you will, doesn't necessarily know (firsthand) what the trauma victim is going through. And because of this crucial lack of understanding, he or she may not be able to say ANYTHING that will resonate with the trauma victim. But peer-support can circumvent this problem. This is why somebody like Sgt. Troy Anderson, who has been certified and trained in the debriefing process, can bring a lot to the table, because he is a PEER of the person who is suffering.
This may also be why the concept of the "battle buddy" in the military is so highly touted. If you can teach that "buddy" what to look out for, in terms of signs and symptoms of PTSD, you can go a long way in possibly preventing bigger problems down the road, like depression, anger problems, substance abuse or even suicide.
Another interesting concept that I heard about for the first time at the conference is the idea of post traumatic growth. One of the speakers, Dr. John Durkin, talked about the positive consequences of a traumatic experience. Seligman talks about this in his lectures as well and there are countless stories of people throughout history being transformed by traumatic events in ways that were positively life-enhancing.
John F. Kennedy's famous traumatic event - the sinking of his ship the PT 109 - is an example of post traumatic growth. The PT-109, an 80 foot boat and the smallest war vessel in the Navy at that time, was rammed and cut in half by a Japanese destroyer during WWII. The story of Kennedy's bravery and skill in managing to survive and helping 11 other crew members also survive, turned him into a war hero, which ultimately helped launch his political career.
Post traumatic growth may in fact occur more often than PTSD which only occurs in 8 to 30% of cases of people who are exposed to trauma. It was an ongoing theme of the conference that we need to look at this positive, flip side of trauma recovery. In other words what causes 70 to 82% of people to survive a traumatic event with little or no problems to speak of, and in some cases, even experiencing growth? Looking at this phenomenon in this way really is an interesting exercise.
Before the conference ended, I bought several books from the ICISF bookstore on stress and trauma. I noticed as I said it that the acronym ICISF was a bit of a tongue twister so I asked the woman helping me if she could say it five times fast. "Yes," she said, "I can. I started working for the ICISF just before 9/11, and after that event, the phone was ringing off the hook, so I learned how to say it quickly and often."
I guess dealing with stress and trauma has become so much a part of our culture that apparently it's here to stay.