My introduction to Critical Incident Stress Management (CISM) was a dozen years ago. A few months after a heartbreaking line of duty death in my extended familys, I realized that it had triggered incidents I was still carrying in my “stress backpack” from my days as a paramedic. Back then, “Suck it up and move on” was the only recognized coping option. I met Janet Childs, the director of the Bay Area CISM Team and we talked through it. I had no idea that she was anything other than a compassionate grief counselor until she invited me to join the CISM team, which I did.
Since then, I have received enough training and experience – many hundreds of interventions – to become an ICISF CISM instructor. I’ve assisted dozens of public safety agencies, sometimes as a volunteer, sometimes paid, when critical incidents strike. I also have returned to the field part-time as a firefighter/EMT, also in a combination volunteer/paid role.
My view of stress began to change radically at the 2015 fall California Peer Support Association meeting, where one of the speakers (Kirsten Lewis) spoke about and recommended Kelly McGonigal’s book, The Upside of Stress. The very next day, I was back with CAL FIRE friends and colleagues who had been at the conference, responding to the massive Valley Fire began, which had seriously injured several helitack crew members. The things we had just learned made an immediate difference.
- Stress doesn’t have to be bad for your health. In fact, it is only bad if you think it is.
- People perform better at many kinds of tasks if they are feeling some stress.
- It helps to think of stress positively – your brain and body are rising to a challenge.
- Stop judging your reactions – they happen for a reason.
- Pursuing meaning is far more important than avoiding stress.
- “Fight or flight” isn’t the only stress response; we also “tend and befriend.”
- Caring – choosing to help – creates resilience by activating the tend-and-befriend response.
Resilience and stress can reinforce or tear each other down. Resilient people don’t feel as stressed when life becomes difficult. They may suffer as deeply as others, but they will bounce back faster – and helping people bounce back faster is the primary goal of CISM. On the other hand, experiencing high stress – trauma – lowers our resiliency.
The reason that resilient people don’t feel as much stress is that they see challenges where others see threats. Threats can be physical, social (being excluded) or spiritual (betrayal of values). Less resilient people see permanent and generalized harm – “I’ll never be accepted by others,” while more resilient people think the situation is temporary and specific – “That didn’t work out, but I’ll get over it and try again.”
Seeing challenges instead of threats, which psychologists call “appraisal” is almost surely the reason that stress is only bad for you if you think it is. The idea “stress is toxic” makes it into a threat, rather than a challenge. The idea didn’t even really exist in popular culture until the 1950s, when tobacco companies began funding research intended to sell cigarettes for relaxation, and later to raise doubts about tobacco’s role in cancer and heart disease. “Stress will kill you” has sold a lot of tobacco and pharmaceuticals. But it is only true if you believe it.
When we focus on stress as a bad thing to be avoided or endured, or label incidents “traumatic,” we bring about the very problems we are aiming to prevent – because we push people toward seeing threats when they might have experienced challenges.
If you understand this, the importance of two CISM principles becomes clear:
- Never intervene based on what happened. Intervene based on how people are reacting.
- Don’t interfere with natural healing processes. Intervention can make things worse if you send the message, intentionally or not, that the person “should be” traumatized.
After a dozen years focused on stress, I’ve shifted to learning what gives us resilience. I’m not abandoning CISM at all, but by encouraging people to address what is missing from their “resilience recipe,” I believe I can avoid making things worse and be even more supportive.