Psychological First Aid: An Introduction

Introduction

This article is a training course and test for psychological first aid. Psychological first aid is a set of protocols and actions that an individual can take to help other who may be suffering from psychological trauma. It’s not medical training, it’s aimed at anyone who might come into contact with traumatised people, and it’s recommended that every one of us should be aware of the step suggested within this article.

Remember that PFA is not professional mental health care; it's about providing immediate emotional support and connecting survivors with resources during a crisis. Laypeople often perform PFA, guided by principles such as ensuring safety, connection, hopefulness, access to support, and self-reliance

At the end of the article, you can check your understanding with a short test.

What is Psychological First Aid (PFA)?

Psychological First Aid (PFA) is a systematic set of helping actions designed to reduce initial post-trauma distress, aid support and long-term adaptive functioning. It serves as an initial component of a comprehensive disaster or trauma response. PFA focuses on providing immediate support to individuals affected by traumatic events, aiming to increase their coping abilities.

Core Components of PFA

PFA consists of eight core actions:

1. Contact and Engagement: Establishing initial contact with affected individuals.
2. Safety and Comfort: Ensuring their safety and providing comfort.
3. Stabilization: Helping stabilize their emotional state.
4. Information Gathering: Collecting relevant information.
5. Practical Assistance: Offering practical help.
6. Connection with Social Supports: Linking them with social resources.
7. Information on Coping Support: Providing coping strategies.
8. Linkage with Collaborative Services: Referring them to appropriate professional mental health care if needed.

History of Psychological First Aid

The concept of PFA was introduced in the mid-20th century but gained significant traction as a disaster response after the 9/11 era. Mental health experts widely endorse and advocate for PFA as an early intervention for disaster survivors. It is akin to physical first aid, where laypeople provide basic grassroots psychological support to family, friends, neighbours, and colleagues following traumatic events.

Who Should Consider PFA Training?

PFA benefits anyone who has survived or witnessed a traumatic event, regardless of age or gender. Crisis events that could benefit from PFA include natural disasters, war, terrorist attacks, disease outbreaks, displacement, robbery, and assault.

Contact and Engagement: Establishing initial contact with affected individuals.

In the Contact and Engagement stage of Psychological First Aid (PFA), the goal is to respond to contacts initiated by survivors or to initiate contacts in a nonintrusive, compassionate, and helpful manner. Establishing an effective helping relationship during this initial contact is crucial, as it can increase the person's receptiveness to further help. Here are some key actions and considerations for this stage:

Introduce Yourself and Ask about Immediate Needs

• Introduce yourself with your name, title, and describe your role.
• Ask for permission to talk to the survivor and explain that you are there to see if you can be of help.
• Address adult survivors using last names unless given permission otherwise.
• Invite the person to sit, ensure some level of privacy for the conversation, and give them your full attention.
• Speak softly and calmly, refraining from looking around or being distracted.
• Find out whether there is any pressing problem that needs immediate attention. Immediate medical concerns take top priority.
• When contacting children or adolescents, it's good practice to first connect with a parent or accompanying adult to explain your role and seek permission. If speaking with a distressed child without an adult present, find a parent or caregiver as soon as possible to inform them about your conversation.

Culture Awareness

• Be mindful that appropriate physical or personal contact may vary across cultures and social groups.
• Avoid approaching too closely, making prolonged eye contact, or touching unless you are familiar with the survivor's culture.
• Seek guidance about cultural norms from community cultural leaders who understand local customs.

Timing and Respect for Survivor's Receptiveness

• Some survivors may not actively seek help but could benefit from assistance.
• Respect their decision if they decline your offer of help.
• Indicate when and where they can locate a Psychological First Aid provider later on.

Safety and Comfort: Ensuring their safety and providing comfort

Psychological First Aid (PFA) aims to enhance immediate and ongoing safety while providing physical and emotional comfort to survivors. After a traumatic event, restoring a sense of safety becomes crucial. By promoting safety and comfort, we can reduce distress and worry. Here are some key actions during this stage:

Ensure Immediate Physical Safety

• Make sure individuals and families are physically safe to the extent possible.
• Reorganize the immediate environment to increase physical and emotional safety.
• Remove hazards such as broken glass, sharp objects, or spilled liquids.
• Supervise children and create a safe play area for them.
• Be aware of vulnerable subgroups (e.g., elderly or disabled individuals) and address their specific needs.

Support Emotional Comfort

• Assist survivors in coping by identifying their strengths and exploring coping options.
• Provide accurate, up-to-date information while avoiding excessive exposure to distressing details.
• Connect survivors with practical resources.
• Share information about how responders are making the situation safer.
• Facilitate connections with others who have shared similar experiences.

Stabilization: Helping stabilize their emotional state

Stabilization is a critical component of psychological first aid, especially in the immediate aftermath of a traumatic event. Its goal is to calm and orient emotionally overwhelmed or disoriented survivors, providing them with the necessary support to manage intense stress reactions. While most individuals affected by disasters will not require stabilization, it becomes essential for those whose reactions significantly interfere with their ability to function. Here are some key actions during the stabilization stage:

Respect Privacy and Allow Space

When encountering a distressed individual, respect their privacy. Give them a few minutes before intervening. This allows them time to collect themselves and process their emotions.

Remain Calm and Present

Rather than directly engaging in conversation, stand close by while being calm and quiet. Avoid contributing to cognitive or emotional overload. Sometimes just your presence can provide comfort.

Observe Signs of Overwhelm: Look for signs that the person is disoriented or overwhelmed

• Glassy-eyed or vacant expression
• Unresponsiveness to verbal questions or commands
• Aimless or disorganized behaviour
• Strong emotional responses (crying, hyperventilating, rocking)
• Uncontrollable physical reactions (shaking, trembling)
• Frantic searching behaviour
• Feeling incapacitated by worry
• Engaging in risky activities

Assess the Situation

• Is the person with family and friends? If so, involve them in comforting the distressed individual.
• If the person is too upset to talk, consider speaking quietly while family/friends are nearby.
• Address the person's primary immediate concern or difficulty rather than simply telling them to "calm down" or "feel safe."

For Children and Adolescents

• If separated from parents or if parents are not coping well, refer to options for stabilizing distressed persons.
• Empower parents in calming their children without undermining their authority.

General Steps for Stabilization

• Respect privacy.
• Be available for further help.
• Focus on immediate needs.
• Provide practical assistance.
• Connect individuals with resources.
• Offer coping strategies.
• Link people to collaborative services.

Information Gathering: Collecting relevant information

The Information Gathering: Needs and Current Concerns stage plays a crucial role. Let's delve into the aims and actions of this stage, along with inline APA citations and references.

Aim

• The primary goal of this stage is to identify immediate needs and concerns of survivors.
• It involves gathering additional information to tailor Psychological First Aid interventions effectively.

Flexibility and Adaptation

• PFA providers should remain flexible, adapting their interventions to meet specific individuals' needs.
• By gathering enough information, providers can prioritize interventions based on identified needs.

Immediate Action

• Information gathering begins immediately after contact with survivors.
• However, it's essential to recognize that time constraints, survivors' priorities, and other factors may limit the ability to collect detailed information.

Key Questions

While a formal assessment is not appropriate during PFA, providers may inquire about:

• Immediate referral needs.
• Additional services required.
• The possibility of a follow-up meeting.
• Components of PFA that may be helpful.

The "Survivor Current Needs" form (Appendix D) can document basic survivor information.

Nature and Severity of Experiences

Survivors who directly faced life-threatening situations, injuries, or witnessed injury or death are at higher risk for severe distress.

Providers can ask questions like

• "Where were you during the disaster?"
• "Did you get hurt?"
• "Did you see anyone get hurt?"
• "How afraid were you?"

Providers should avoid pressing for in-depth trauma descriptions that might cause additional distress.

Death of a Loved One

• The death of loved ones under traumatic circumstances complicates grieving.
• Providers can ask if someone close to the survivor got hurt or died due to the disaster.

Supportive Information

• PFA includes basic information-gathering techniques for rapid assessments.
• Providers use this information to address immediate concerns and implement supportive activities flexibly.

Practical Assistance: Offering practical help

The Practical Assistance stage of Psychological First Aid (PFA) aims to offer practical help to survivors in addressing their immediate needs and concerns. When someone experiences a traumatic event, their early responses can lead to distress that interferes with coping. PFA is a disaster relief technique developed by the National Child Traumatic Stress Network and the National Center for PTSD (post-traumatic stress disorder). The goal of this intervention is to provide safety, stability, and resources to people in the immediate aftermath of a traumatic event, thereby increasing their abilities to cope. Here are some key points about Practical Assistance in PFA:

Not On-Site Therapy

PFA is not professional mental health care. Instead, it connects with people in the aftermath of a disaster by providing resources and support for their immediate needs. Laypeople (individuals without professional credentials) often perform PFA.

Core Components

PFA includes eight core components:

• Making initial contact
• Ensuring people are safe and comfortable
• Calming and orienting people
• Identifying people's immediate needs
• Offering practical assistance
• Connecting people with resources
• Providing coping strategies
• Linking people to collaborative services

Guiding Principles

• The need for individuals to feel safe, connected, and hopeful.
• The importance of access to support.
• The value of self-reliance.

History

Although the concept of Psychological First Aid was introduced in the mid-20th century, it gained traction as a disaster response after 9/11. Mental health experts widely endorse and advocate for PFA as an early intervention for disaster survivors.

When Is It Used?

PFA benefits anyone who has survived or witnessed a traumatic event, including people of any age and gender. Crisis events that could benefit from PFA include natural disasters, war, terrorist attacks, disease outbreaks, displacement, robbery, and assault.

Immediate Stress Reduction

By reducing immediate stress through PFA, survivors may have better long-term coping abilities.

Connection with Social Supports: Linking them with social resources

In the Connection with Social Supports stage of Psychological First Aid (PFA), the aim is to link survivors with social resources and establish connections with primary support persons and other sources of support. This stage focuses on providing immediate emotional support and facilitating access to social networks, including family members, friends, and community helping resources.

Information on Coping Support: Providing coping strategies

In the Information on Coping Support stage of Psychological First Aid (PFA), the goal is to provide information about stress reactions and coping strategies to reduce distress and promote adaptive functioning. This stage is crucial for helping survivors manage their stress reactions and deal more effectively with problems after a disaster. Here are some key points about this stage:

Common Stress Reactions

• As a PFA provider, you should briefly discuss common stress reactions experienced by survivors. These reactions may include distressing thoughts, mental images of the traumatic event, dreams related to what happened, and upsetting emotional or physical reactions triggered by reminders of the experience.
• It's essential to avoid pathologizing survivor responses by using terms like "symptoms" or "disorder." Instead, emphasize that these reactions are understandable and expectable.
• Some survivors may also experience positive reactions, such as appreciating life, family, friends, or strengthening spiritual beliefs and social connections.

Ways of Coping

• Provide basic information on effective coping strategies for post-disaster reactions and adversity.
• Adaptive coping actions help reduce anxiety, lessen distressing reactions, improve the situation, or help people get through difficult times.
• Encourage survivors to explore various coping mechanisms that work best for them. These may include seeking social support, practising relaxation techniques, engaging in physical activity, maintaining routines, and finding healthy distractions.

Avoid Blanket Reassurance

While it's helpful to describe common stress reactions and note that intense reactions are common but often diminish over time, avoid providing "blanket" reassurance that stress reactions will disappear. Unrealistic expectations about recovery time can be detrimental.

Linkage with Collaborative Services

As part of this stage, consider linking survivors with available services needed at the time or in the future. Collaborative services may include mental health support, community resources, or other relevant assistance.

References

This content gratefully reproduced from it's source page at https://self-transcendence.org/psychological-first-aid-an-introduction-and-test

Main source document - US Department of Veterans Affairs (VA), Veterans Health Administration, Office of Mental Health Services (2006). Psychological First Aid: Field Operations Guide: 2nd Edition. https://www.ptsd.va.gov/professional/treat/type/PFA/PFA_2ndEditionwithappendices.pdf

Ruzek, J. I., Brymer, M. J., Jacobs, A. K., Layne, C. M., Vernberg, E. M., & Watson, P. J. (2007). Psychological first aid. Journal of Mental Health Counseling, 29(1), 17–49.

Jacobs, G. A., & Meyer, D. L. (2006). Psychological First Aid: Clarifying the Concept. In L. Barbanel & R. J. Sternberg (Eds.), Psychological interventions in times of crisis (pp. 57–71). Springer Publishing Company.