Psychological First Aid

Recognizing that some phases of disasters, such as the impact phase, and some type of disasters, such as bioterrorism and other public health emergencies, are characterized more by acute fear and anxiety than by classic traumatic stress reactions, the Institute of Medicine and other leading mental health authorities are increasingly promoting the use of "Psychological First Aid"  as means of addressing the intense physiological and emotional arousal that accompanies certain crisis events. Psychological First Aid (PFA) is quickly becoming another necessary tool in the disaster mental health responder's tool kit, and training in for New Jersey's disaster mental health responders will soon be offered in several counties.

Brain research and the use of fMRI technology are used to identify those regions of the brain most involved in traumatic stress reactions and the formation of traumatic memories.

There is a growing body of empirical evidence in the area of traumatic stress that describes the relationship between the degree of physiological arousal experienced during a crisis and the possibility of longer-term emotional problems related to the situation. The research suggests that the faster levels of arousal are lowered, the less likely a person is to develop posttraumatic stress disorder and other mental health problems following a critical incident. Most popular models of crisis intervention, such as crisis counseling and debriefing, are typically not offered until hours or days after the event. Some research questions the usefulness of these techniques, especially if reliving the experience in a counseling or debriefing session also raises the level of physiological arousal. Critics of those approaches claim that debriefing may be "inert" at best, and "harmful" at worst, citing research documenting "adverse outcomes" following some types of post-crisis intervention.

Psychological First Aid (PFA) is defined by the Institute of Medicine of the National Academies as, "...a set of skills identified to limit distress and negative health behaviors that can increase fear, arousal and subsequent health care utilization."

This research is beginning to suggest that waiting several hours, or days, before providing basic psycho-social support may miss an important window of opportunity in helping people emotionally recover from the aftershock of a traumatic event. Psychological first aid may be best applied during a critical incident and in the minutes and hours immediately following the event.

A Comparison

There is a clear relationship between medical and psychological first aid. In fact, these two skill sets are not mutually exclusive. Psychological first aid can also be used in conjunction with medical first aid to help calm and support an injured or ill individual. The following comparison helps to demonstrate the overlapping areas:

Medical First Aid

• Early assistance provided by those first on-scene
• Initial assessment of physical impact of event
• Stabilization of immediate physical wounds
• Prevention of further physical exposure or injury
• Maintenance of medical status until professional medical care is available
• Facilitate transition to trained medical professional when necessary
• Promote quicker and better physical recovery

Psychological First Aid     

• Early assistance provided by those first on-scene
• Initial assessment of emotional impact of event
• Stabilization of immediate emotional wounds
• Prevention of further exposure or emotional injury
• Maintenance of emotional status until professional mental health care is available
• Facilitate transition to trained mental health professional when necessary
• Promote quicker and better emotional recovery 
   

Psychological First Aid is ...

• Practical frontline emotional assistance
• Easy to learn, recall and apply
• A way of preventing harmful behaviors
• Likely to increase the success of an overall emergency response

Psychological First Aid is not ...

• Debriefing
• Counseling
• Psychotherapy
• Mental health "treatment"

General Principles of Psychological First Aid

The most urgent tasks for the Psychological First Responder is to focus on restoring emotional equilibrium. Psychological First Aid responders should:

• Present a calm, reassuring demeanor
• Be direct, informative, authoritative, nurturing, and problem-solving oriented
• Counter denial, by encouraging individuals to deal with the facts of the event; give accurate information and explanations of what happened and what to expect--never offer false or unrealistic assurances
• Talk to individuals about their emotional reactions and encourage them to deal with such reactions as another facet of countering denial and other defenses that interfere with restoring equilibrium
• Convey a sense of hope and positive expectation--that a crisis changes things, there are ways to deal with the impact;
• Normalize the individual's emotional reaction as much as feasible
• Facilitate emotional expression (e.g., through use of empathy, warmth, and genuineness)
• Explain what can and will be done to assist the individual, their family and community

Protect

• Individuals from further physical or emotional harm, including gruesome or graphic sights and sounds
• Individuals' dignity and privacy following a crisis
• Individuals from media intrusion or curious well-wishers
• Individuals from danger to self or others

Direct

• Individuals toward quiet, safe areas
• With calm, compassionate but authoritative tone;
• Any available personnel to appropriate tasks and to offer support to co-workers

Connect

• Individuals with mental health and social service resources
• Individuals and their families with available printed and online resources for coping with the emotional consequences of crises
• Friends, family, co-workers and other sources of emotional support
• Individuals to information about the event or any relevant news pertaining to the situation

Conclusion

Experienced counselors will recognize that Psychological First Aid is consistent with other forms of trauma counseling and crisis intervention. This structured approach extends the counselor's range of skills and provides a model of assisting those most affected by a disaster or crisis in the immediate impact phase, or in other situations in which the primary response is one of acute fear and anxiety.

The first PFA training program was held on January 19th in Monmouth County. Details about other PFA programs are available in the Professional Resources section of the the www.disastermentalhealthnj.com website. Since the 2005 training schedule is currently in development, you may wish to visit this site often to learn more about upcoming training events in your area.