Mitchell Mode

Critical Incident Stress Management (CISM) – Mitchell Model

Jeffrey T. Mitchell is a Clinical Professor of Emergency Health Services at the University of Maryland and President Emeritus of the International Critical Incident Stress Foundation.

In 1983, after serving as a firefighter/paramedic he developed a comprehensive, systematic, integrated and multi-component crisis  intervention program called

“Critical Incident Stress Management.”

The program is based on the intervention model of military psychiatry, which used a similar method for the psychological rehabilitation of soldiers since World War II.

  • Intervention focused on post-traumatic stress that isstructured in 7 phases.
  • Reconstruction of the experience through a narrative process.
  • Application between 24-72 hours after a traumatic event.It is carried out in small groups (5-7 people).
  • Directed by a mental health professional and support staff (2-3 trained members who practice the same profession as those affected).
  • Objectives: to normalise reactions, alleviate symptoms and identify group members who may benefit from additional support services.
  • It consists of two dimensions: cognitive domain (thoughts/beliefs) and affective domain (feelings/emotions).

Members introduce themselves and describe some experiences on a voluntary basis.

It is important to motivate participants to engage in the process.

The guidelines for carrying out the CISM are explained, and it should be clear that it is NOT a psychotherapy.

Fact phase

An objective and brief description of the facts is expressly requested, without expressing how they have affected them.

It is not yet necessary to enter the emotional domain.

Anxiety reduction: participants must know that they are in control of the situation.

Thought phase

This is the transition phase from the cognitive to the affective domain.

Thoughts about the traumatic event are discussed, but painful feelings are still avoided.

Reaction phase

This is the core of the CISM, also known as debriefing.

Now the speech focuses on the emotional impact, and participants are encouraged to express all the negative emotions that the idea of the event generates in them.

We enter fully into the affective domain.

Symptom phase

The physical, emotional and cognitive symptoms are investigated.

It is important that the intervention team uses these signs as a starting point for the teaching phase.

Teaching phase

In this phase the symptoms are normalised.

The reactions of the participants are explained and given meaning.

It is at this point that specific information for stress management is provided.


Participants make statements and ask questions.

The intervention team summarizes the whole process and gives final explanations.

In this last phase, the guidelines for action must be clear and any doubts must be removed.


It is recommended that, once the intervention session is over, an informal meeting is held, accompanied by refreshments, so that participants feel uninhibited and share help. It is very positive that a common link is established. An individual follow-up, carried out by the intervention team, is also advisable: telephone calls, visits to the workplace or even contacting the family members can be some of the measures that help to maintain the benefits of the intervention.