Sufficiency analysis of an integrated multicomponent approach to crisis intervention: Critical incident stress management

Jr Everly, Jr Flannery, V. Eyler, J. T. Mitchell

Research output: Contribution to journalReview articlepeer-review


The purpose of this paper was to review the effectiveness of crisis intervention, more specifically, the strategic and multicomponential Critical Incident Stress Management system as described by authors such as Everly and Mitchell (1999) and Flannery (1998, 1999a, b, c). Although only 8 studies purporting to assess CISM were discovered as a result of the literature search, the resultant sufficiency ratio argues that these studies represent sufficient magnitude to suggest the effectiveness of this approach to crisis intervention. As Seligman (1995, 1996) has argued, it is difficult indeed to assess the benefit of polythetic multicomponent psychological interventions under actual field conditions. We agree with his conclusions that "effectiveness" studies such as those cited above may hold more promise than more rigid "efficacy" designs. As we review the field of crisis intervention, we find a field within which progress may be stymied by a confusing array of terms and contradictory concepts. We agree with the admonition of George Engel who noted that rational discourse is predicated on the consistent use of terms. With regard to the future of crisis intervention and CISM, the direction seems clear. First, the issue is not whether crisis intervention is of value but rather who should be administering acute crisis intervention to what populations at what time. Secondly, we believe that the future of crisis intervention resides in the integrated, multicomponent CISM approach. Only through such an approach can we effectively respond to complex physical, medical, and psychological emergencies such as mass disasters and community crises. The CISM approach is, by definition, a flexible and evolving approach. Future research should be focused on the best programmatic combinations of the elements of CISM, that is, the best catalytic sequences.

Original languageEnglish (US)
Pages (from-to)174-183
Number of pages10
JournalAdvances in Mind-Body Medicine
Issue number3
StatePublished - 2001
Externally publishedYes

ASJC Scopus subject areas

  • Medicine(all)


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