The aim of this paper is to shift the representation of coping patterns within high risk occupations to an existential part of cultural pattern and social structure, which characterizes high reliability organizations. Drawing upon the specific peer model of Critical Incident Stress Management (CISM), in which qualified operational peers support colleagues who experienced critical incident stress, the paper discusses critical incident stress management in air traffic control. Our study revealed coping patterns that co-vary with the culture that the CISM programme fostered within this specific high reliability organization. Seen as a social construct, CISM culture was found effective in the interaction of operational staff, supervisors and the CISM programme manager. We were able to demonstrate that social mechanisms of trust, interaction and communication are important factors in high reliability organizations. Indeed, we found that the CISM programme once integrated within the sociocultural patterns of this specific working environment enhanced not only individual feelings of being supported but also organizational safety culture.