PSYCHOLOGICAL

FIRST AID

Good things to do when bad things happen

Scott F. Grover, PhD, ABPP

www.headington-institute.org
 OBJECTIVES

• Gain confidence in your ability to

provide psychological first aid to those
who are experiencing stress & trauma
• Prepare you to practice psychological
first aid during upcoming work.
• Detailed information is provided in
your handout.
• Learn ways to look, listen and link.

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 INTRODUCTIONS
• Tell me about your background?
• Tell me about your clinical theoretical framework
you work from most often?
• Tell me what you hope to learn?
• Tell us what you do during “normal times” to
unwind and relax.
 PREPARATION
• What resources are available in the camps?

• What do you take with you?

• Pen and paper
• Tennis ball
• Water/snacks
WHAT IS PSYCHOLOGICAL FIRST AID?
• Immediate psychosocial support…
• from those who are present or first to arrive after
a critical incident…
• aimed at reducing initial post-trauma distress.

• Not deep emotional processing.

 PEOPLE’S REACTION TO TRAUMA
• It really varies. Depends on multiple factors.
• Nature and severity of the event experienced
• Their experience with previous trauma or
distressing events.
• Support they have in their life from others.
• Their physical health
• Personal and family history of MH problems.
• Cultural background and traditions
• Their age
 PFA PRINCIPLES
• PFA respects the culture of the person we are
assisting and their dignity as a human being.
• PFA goals include helping people feel safe,
connected to others, calm and hopeful.
• Having access to social and physical, and
emotional support.
• And feeling empowered to help themselves as
individuals and communities.
• Flexible model – but does not encourage disclosing
or ordering of painful events.
 PFA PRINCIPLES
• Don’t assume anything. Don’t assume you know
what they are struggling with or needing.

• Don’t assume you know what their path to

recovery will look like.

• Don’t assume that because of their reaction or lack

of reaction – that you know what will happen next.
(Humans are incredibly hard to predict … )
 KEY ELEMENTS OF PSYCHOLOGICAL FIRST AID

• Being a calm presence

• Providing social support
• Sharing useful information about stress & trauma
• Helping the person find the resources they need
• Identifying “red flags”

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 HOW CAN YOU
IDENTIFY STRESS &
TRAUMA IN OTHERS?

Think of examples from your experiences ….

 THESE ARE NORMAL IMMEDIATE
REACTIONS TO AN ABNORMAL EXPERIENCE
• Crying
• Shaking
• Anger & irritability
• Confusion about what has happened
• Difficulty taking in detailed information
• Physical pain
• Shock (mute; not showing any emotion)
• Pro-social behavior—helping others
• https://audience.ahaslides.com/0wirzimfad
 CONTACT AND ENGAGEMENT
• Go up and introduce yourself.
• Wait for them to come to you?

• Ways to be non-intrusive, compassionate and

helpful.

• Asking permission to provide assistance

• Ask about immediate needs.
PROVIDING SAFETY AND COMFORT
• Ensure immediate physical safety
• Attend to physical comfort
• Encourage interaction with others
• Attend to children first, if present.
• Protect from additional difficult events (media
inquiries, lack of privacy).
• Comfort those with a family members who has died.
• Discuss relevant grief (more on this later).
• Support those who receive death notifications (stay
with them).
• Support those involved in body identification and
going with them (if helpful).
 OFFER REASSURANCE
These are normal reactions to an abnormal experience.

Anxiety
Sleep disturbance
Difficulty with concentration
Mood swings
Anger & irritability
Fatigue

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 HOW CAN YOU CALM
YOURSELF IN ORDER TO BE
A CALMING PRESENCE?
 KEY ELEMENTS OF PSYCHOLOGICAL FIRST
AID
• Triage
• Be a calm presence. (Introduce yourself.)
• Ask questions – listen well
• Provide practical assistance (e.g., are they cold?
thirsty?)
• Share useful information/resources
• Identify “red flags”
PROVIDING SOCIAL
SUPPORT
SOCIAL SUPPORT SHOULD BE
CULTURALLY APPROPRIATE
 SOCIAL SUPPORT
• 1. Encourage contact with primary support
persons (family and significant others)
2. Encourage use of immediately available support
persons (colleagues and respected people in
community)
• 3. Discuss support-seeking and giving
4. Model social support through your conversation
• Is there something I can do to help you?

• https://www.coursera.org/learn/psychological-first-aid/lecture/xvcxb/full-simulation-video
 GOOD THINGS TO DO
• Show interest, attention, and care
• Be respectful of their reactions & ways of coping
• Find a private place and enough time
• Respect privacy and confidentiality
• Acknowledge that recovery can take time
• Normalize their reactions
• Help “brainstorm” what they can do to recover
• Believe in them!

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 REASONS PEOPLE MIGHT RESIST SOCIAL
SUPPORT
• Not wanting to burden others
• Embarrassed
• Don’t know what they need
• Not wanting to be seen as a victim, weak or vulnerable
• Unable to control their emotions
• Fear of being judged
• Fears that others will talk about their stories/not keep
confidentiality

Remember: Social support includes just hanging out,

bringing food, going for walks, etc.

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 INFORMATION GATHERING ON CURRENT
NEEDS AND CONCERNS
• Very brief assessment process.

• Don’t get too deep into their story.

• It is okay to interrupt and re-direct doing PFA.

• There is risk in being too passive and allow the

person to ruminate on something distressing.
 INFORMATION GATHERING ON CURRENT
NEEDS AND CONCERNS
1. Nature and severity of experiences during the traumatic event
2. Death of a loved one
3. Concerns about immediate post-event circumstances and
ongoing threat
4. Separations from or concern about the safety of loved ones
5. Physical illness, mental health conditions, and need for
medications
6. Losses (home, school, neighborhood, business, personal
property, and pets)
7. Extreme feelings of guilt or shame
8. Thoughts about causing harm to self or others
9. Availability of social support
10. Prior alcohol or drug use
11. Prior exposure to trauma and death of loved ones
12. Specific youth, adult, and family concerns
 PROVIDE PRACTICAL ASSISTANCE
AND A PLAN
• Based upon the information gathered, provide the
following:
1. Identify the most immediate needs
2. Clarify these needs
3. Discuss an action plan for each need
4. Act to address each need, including making a
referral to a professional for follow-up if available.
 PROVIDE INFORMATION ON WHAT TO
EXPECT:

• Often there is great fear • Difficulty with

and terror in having concentration
unexpected symptoms. • Mood swings
• “I am going crazy” • Anger & irritability
• Anxiety • Fatigue
• Sleep disturbance • Sleep disturbance
PROVIDE INFORMATION ON WHAT TO
EXPECT:

Intense emotions may come and go in

waves.

Loud noises, or other triggers may set off

an “ALARM” in your body.

Friends and Family are very important to

help you calm down.
SUGGEST BASIC COPING TOOLS:

Breathing techniques
Restore recovery cycles
Exercise
Encourage talking, journaling, etc
Encourage social support
PROVIDING INFORMATION ABOUT DISASTER RESPONSE ACTIVITIES AND
SERVICES

• To help reorient and comfort survivors, provide

information about: What to do next
What is being done to assist them
What is currently known about the unfolding
event
• Available services
Common stress reactions
Self-care, family care, and coping, religious leaders.

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• https://audience.ahaslides.com/0wirzimfad
 GIVE BEHAVIORAL ADVICE

❖ Avoid major decisions right now

❖ Limit use of alcohol, drugs
❖ Avoid reckless, risky behaviors
❖ Provide basic anger management
Discuss sleep problems
❖ Sometimes a short-term
behavioral plan can be helpful.
 GRIEF REACTIONS
• Avoid Platitudes.
• “I know how you feel.”
• “It was her time to go.”
• “At least they went quickly.”
• “Someday you will have an answer.”

• Normalize Grief Reactions.

• Reinforce religious or spiritual beliefs and connecting to them as

appropriate. Often listening is enough.
• Sometimes religious objects can be helpful. Rosary,

• Why did God allow this? Don’t try to answer this – often an emotion
being expressed.

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THREE COMMON LINGERING
BEHAVIORAL RESPONSES

Avoidance
Intrusions
Hyper-arousal
 AVOIDANCE

Normal urge to avoid cues associated with

stress or critical incident.
Apprehension about exposing oneself again.
Fear of being in circumstances where event
occurred.

✓ Must push self to “get back in the

saddle”.

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 INTRUSIONS

Normal tendency to ponder on the event in the days

and few weeks after the incident.
Intrusive imagery of event coming to mind when not
wanted. Rumination on thoughts of the event.
Flashbacks.
Need to limit exposure to stress and create down time
for processing of experience of event.
✓ Honor your down time.

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 HYPER-AROUSAL

Acute alertness to environment

Jumpiness and startle responses to car
backfires, loud noises, etc.

✓ Adopt regular physical exercise regimen.

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 A FEW OTHER NOTES
• Self-blame is common.
• If only I had …..
• Combat medics ....

• Your Mind is trying to make sense of it. May re-

play it.

• Give your brain time to process it. Don‘t push

away memories or avoid talking about it.
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 GOOD NEWS IS:
• People can and do get better after traumatic events (critical incidents).

• Research has shown that there is a natural recovery

process from trauma. Humans have a natural
recovery mechanism that is built in. It seems to be a
gift from God.

• 8%-18% of trauma exposed people will go on and

develop PTSD.

• Most people recover from trauma without

psychotherapy or medications.

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 IDENTIFYING THOSE WHO NEED
STABILIZATION
– Looking glassy eyed and vacant–unable to find direction

– Unresponsiveness to verbal questions or commands

– Disorientation (for example, engaging in aimless disorganized behavior)

– Exhibiting strong emotional responses, uncontrollable crying, hyperventilating, roc

or regressive behavior

– Experiencing uncontrollable physical reactions (shaking, trembling)

– Exhibiting frantic searching behavior

– Feeling incapacitated by worry

– Engaging in risky activities

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 CALMING THOSE NEED STABILIZATION
• Goal is to calm and orient emotionally overwhelmed or
disoriented survivors.

• Be in the area and be available – don’t be too direct.

• Strong emotions following a trauma is normal and doesn’t need

intervention usually.

• Grounding techniques.

• Moving them to a new area.

• Connecting them to friends or family if possible.

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WHEN PROFESSIONAL HELP IS NEEDED
 “LOOK FOR RED FLAGS”
• Statements indicating possible • Increase in substance use
suicide or self-harm • Dramatic decrease in
• Statements indicating possible competency and productivity
harm to someone else • Angry outbursts
• Inability or refusal to speak • Violent behavior of any kind
• Frequent weeping • Behavior which is implicitly or
• Substantial loss of weight explicitly threatening
• Dramatic increase in looking • Increase in reckless behaviors
fatigued and/or falling asleep such as gambling, promiscuity,
at work thrill-seeking
• Pronounced indecisiveness

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 DISSOCIATION
More rare reaction. Experience of being outside of body
watching self in the traumatic experience. A state of limited
awareness. Checking out experience associated with problems
remembering event.

• What does this look like? (continuum).

Get them help by physically intervening to get them to safety.
• Grounding techniques.

✓ Refer to more intensive resources.

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 WHEN TO MAKE A REFERRAL
• Dangerousness
• Basic self-care
• Substance abuse
• Decrease in work performance
• Anger or violence
• Recklessness
• Indecisiveness

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IDENTIFYING
RESOURCES

Medical
Psychosocial
Housing
Food
Legal
Other benefits and resources.
 WAYS OF OFFERING SUPPORT
• Heart

• Hand

• Head
GROUP REFLECTION QUESTIONS

• What hinders you from offering aid to a

colleague who is distressed?
• What kind of social support is easiest for you
to provide?
• What can you do this week to stretch yourself
in this area?
• Write down what you have discussed.

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 THINGS THAT INTERFERE WITH GIVING
SUPPORT
• Rushing to tell them that they will be ok
• Giving advice without listening to what is working for
the person.
• Giving them the feeling they are inadequate because
they aren’t coping as well as you are.
• Discussing your own experiences without listening
carefully to them
• Being critical of the person’s responses before or after
the event
• Telling them they are lucky because it could have been
worse.
• Asking if they are ok.

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 WITH CHILDREN
• Share a narrative for them that explains these
events.
• The power of context and a narrative can really
help.

• Syrian psychiatrist …
• Star Wars …
 LOOK, LISTEN AND LINK
• LOOK
– Check for safety
– Check for people with obvious urgent basic needs
– Check for people with serious distress reactions
• LISTEN
– Approach people who may need support
– Ask about people’s needs and concerns
– Listen to people, and help them to feel calm
• LINK
– Help people address basic needs and access services
– Help people cope with problems
– Give information
– Connect people with loved ones and social support.
 ASSESSING MOOD SYMPTOMS AND OTHERS

• Depression

• Anxiety

• Sleep

• Appetite
 ASSESSING MOOD SYMPTOMS AND OTHERS
• Normalize reactions - …

• Depression - CBT techniques, behavioral activation,

exercise.

• Anxiety – CBT techniques, Gentle avoidance vs.

exposure. Finding safety.

• Sleep - sleep hygiene

• Appetite – meals with others.

 Summary

Be available to listen to those who wish to share

about their experiences, while respecting those
who do not.

Use breathing & relaxation techniques to reduce

severe physiological arousal.

Provide simple information and education on what

individuals can expect in the days and weeks to
come.

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Encourage appropriate rest, relaxation, and
recovery practices.

Be alert to the presence of known risk factors for

chronic difficulties.

Identify resources for those with severe distress.

Refer those in need of more in-depth help and

support.

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 PSYCH FIRST AID PRACTICE

Case #1: Grief reaction

Case #2: appears dazed and disoriented.
Case #3: Inability to sleep
Case #4: Anger management
Case #5: Team-member lacking resiliency IE being
negative or blaming.

You can use the handout in your binders.

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HOW TO CARE FOR YOURSELF DURING THIS TIME

• Impact of vicarious trauma

• Check yourself for stress
• Leave time
• Social support
• Guarding your sleep.
• Exercise regimen
• Debrief/vent with colleagues… ?
The Enschede Fireworks Disaster - May 13, 2000
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 RESOURCES
• PFA App – in Ukrainian Might also have it in
Romanian?

• PFA wallet card

• https://www.nctsn.org/sites/default/files/resour
ces//pfa_walletcard.pdf
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GETTING IN TOUCH

Headington Institute, Pasadena, CA, USA

Sgrover@Headington-Institute.org

www.headington-institute.org
+1-626-487-8577 (phone)
+1-626-229-0514 (fax)

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