Psychological First Aid (PFA)
Often, I have completed basic first aid courses usually as a work requirement, and learn basic skills in CPR, bandages, defibrillation and burns. These skills are often complimented by a simple Initialism (eg. DRABC) that is helpful in remembering a framework for medical assessment and intervention.
Disasters and traumatic events often require the need for medical assessment and intervention, however, not all scars are visible on the outside. Trauma, which is a deeply distressing or disturbing experience, can have a major impact on the brain and everyday functioning.
Due to the nature of traumatic events, distressing events which are often viewed as life threatening, the brain responds with the sole aim of survival. Threat centres in the brain (Amygdala) become hyperaroused and in turn the body gets pumped with stress hormones to help us respond to the life-threatening event.
This survival response (known as Fight, Flight, Freeze response) is perfectly helpful and immensely useful in ensuring our survival. Following a traumatic event steps and recommendations have been identified to assist the brain in turning off it’s survival response and returning to baseline functioning.
Psychological First Aid (PFA) is the first step of psychological support. PFA functions just like medical first aid and according to the Guidelines for Provision of Psychological Support to People Affected by Disasters by the APS (2014), PFA is the first of 3 levels. Below I am going to list my own Initialism (ISR) of the 3 levels explained in the guidelines by the APS (2014).
I – Immediate (immediately following the traumatic event)
This stage is within the first hours and days of the experienced trauma and promotes a sense of safety by connecting survivors with basics such as food, shelter, family and friends. The goal is to promote a sense of safety, a sense of calm, connectedness and hope. This is achieved by purely being there for the person in a non-intrusive manner that serves to comfort. It is recommended that during this stage debriefing not take place unless the survivor is already guiding their own conversation through the experience.
The point of the immediate needs stage is to restore a basic sense of safety, one of our most primal needs. Therefore, no fancy psychological jargon. Simple and direct reconfirming messages of support free of judgement or teachings are recommended. Human by nature are supportive, so take a human approach.
S – Skills (Weeks and months following)
For some people it takes longer to recover from the impact of a traumatic event and this is where Skills in Psychological Recovery (SPR) can be useful. SPR is not a formal mental health intervention by rather a secondary treatment designed to teach people basic skills. This can be useful for people who are not starting to feel better, continue to be highly anxious/distressed, dysfunction in home, work or interpersonal settings and communicate that they feel they need coping skills.
SPR focus areas include building problem solving skills, promoting positive activities, managing reactions, promote helpful thinking and rebuilding healthy social connections. These skills can be coached in a one on one or group format.
R – Referral
Sometimes a referral is necessary for individuals to seek intensive therapeutic assistance to mange adverse and chronic reactions related to the traumatic experience. This is often indicated by individuals who still feel fearful most of the time, display dysfunction in different areas of their life, ongoing sleep disturbance, engaging in substance abuse, unable to move pats the traumatic event and are observed to be withdrawn or numb.
The range of mental illness that can become an issue in the minority of people that experience a traumatic event include Posttraumatic Stress Disorder, Major Depression, Panic Disorder, Anxiety Disorder and Substance Use Disorder.
Unfortunately, it is probable that you will experience at least one traumatic event in your lifetime. Fortunately, most us can move past these events and can grow and feel stronger for doing so. PFA gives individuals and groups a framework to provide a return to psychological safety for survivors in a non-intrusive approach.
APS, 2014. Guidelines for provision of psychological support to people affected by disasters