We Could All Use Some Psychological First Aid
These five elements can help psychological recovery after a crisis.
Posted Jul 16, 2020
In the wake of a major disaster, we often rush to meet people’s needs for water, shelter, and health care, but fail to address their psychological needs. This is unfortunate because overwhelming stress can actually impede people’s ability to make effective use of the aid they are offered. Think for a minute about a scuba diver whose oxygen tank fails. Even if they have a backup plan, they have to remain calm enough to use it. The odds of their being able to do so also go up if they have a fellow diver there to help them.
As a clinical psychologist, I volunteer as a Disaster Mental Health Responder with a non-profit group called the Green Cross Academy of Traumatology (GCAT). Created after the Oklahoma City bombings, this all-volunteer group sends groups of Disaster Stress Management Specialists to assist survivors and responders on site. While the specifics of disaster events vary, we know that when people no longer fear for their lives, they find themselves coping with negative emotions such as anger, anxiety, and hopelessness. They may also experience stress-related difficulties with memory and decision making.
Helping people understand and cope with their distress makes it easier to begin the recovery process. But what happens when the disaster is not limited to a specific time or place, spreads invisibly, and has no clear end in sight? The coronavirus pandemic checks all of those boxes and has also focused our attention on the systemic discrimination and social inequities in our social system.
Fortunately, many of the flexible, time-limited strategies we use to help disaster survivors navigate their challenges can be adapted for use in the pandemic. In the immediate aftermath of a traditional disaster, life is not business as usual. Mental Health Responders don’t have access to quiet offices where they can talk to people on a regular basis about their life experiences and current situation. Instead, we talk to people on folding chairs in the corners of large shelters, behind food distribution centers, or in front of their damaged homes. We rarely see the same person more than once, and the focus is on helping them identify and cope with their most pressing needs.
This sort of intervention, sometimes called Psychological First Aid (PFA), can be learned and used by professionals and laypeople alike. Like CPR, PFA is designed to be a short-term strategy to stabilize people in distress. Both are designed to help people in crisis, not to replace more traditional treatments. In an age of social distancing, we aren’t gathering in person, but we can certainly still reach out to people online.
Definitions of Psychological First Aid vary, but at least five components seem to be key. The first is: Help people feel safe. This is difficult to do during a raging pandemic, but in addition to encouraging people to take safety precautions, we also need to provide tangible support. When people are hungry and worried about their basic needs, they don’t cope well, so whether we are serving food from a Red Cross truck after a hurricane or a food bank distribution site during the current crisis, we are helping people to feel less vulnerable. Both offering support to others and receiving help ourselves can increase our sense of control.
The second principle of Psychological First Aid is to create a sense of calm by helping people manage their own emotions. This does not mean telling people how they should feel or dismissing their responses. It literally means listening to them while they talk (or cry or complain) and then helping them to reframe the situation so they can begin to think about how to move forward. Sometimes just expressing feelings reduces their intensity so we can think more clearly. Other times taking a break to socialize, exercise, practice a relaxation technique, or just breath can help us reset our responses. Feelings aren’t always accurate, but like pain, they are a warning system that won’t just go away if we ignore it.
Another aspect of PFA is helping people to regain a sense of control and self-efficacy. During and after a crisis people often struggle with feelings of helplessness. So, engaging them in problem-solving and allowing them to determine what they need to cope can be empowering. I have seen victims of disasters regain their own footing after helping to clean up someone else’s yard, sharing their food with others, or even just being able to help other people find resources. We as humans don’t like feeling vulnerable, or out of control, so helping people realize that they still have agency can make a huge difference.
The fourth key to PFA is the need for social connection. In the wake of physical disasters, people often feel isolated and alone. Mobilizing social support in an age of social distancing can be difficult. But finding creative ways to reach out helps. Using virtual platforms to hold book clubs, collaborate on projects, or simply chat can enable us to connect. The key is to find a way to engage in an interaction with other people, not to simply observe their actions on social media.
Although it seems like an intangible concept, hope is also key for psychological recovery. We all acknowledge the destructive power of its opposite, despair. However, a little bit of perspective can go a long way! While our current situation seems dire, during the Civil War we took up arms against our fellow citizens, the Spanish Flu killed 50 million people worldwide, and wars have long resulted in people dying without having their family around them. If the past has taught us anything, it is that humans are resilient and that we can endure tough times. Psychological First Aid won’t cure the pandemic, but it can help us generate and maintain the hope that, like oxygen, is essential for our well-being.
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Green Cross Academy of Traumatology: gcat.org