Psychological First-Aid – How it can help you

Imagine you are riding on your two-wheeler along with a friend. Suddenly your vehicle collides with another speeding vehicle and you meet with an accident. Your friend who is not as injured as you calls for an ambulance for you. You will notice that the paramedical staff triages you i.e. addresses visible, external wounds and focus on stopping any bleeding before you are transferred to the hospital. The treatment needed to address the bigger injuries would start much later, and may not in fact be addressed at the triage stage. However, first-aid in such a situation, can often make the difference between life and death.

But what happens when the injury is more on an emotional level than on a physical level? At times, one goes through incidents, events or experiences which are extremely traumatic. It could be witnessing a gory accident on the street, seeing a death of a loved one, going through any form of violence, being in the midst of a natural calamity or a terrorist attack. All of the above events besides having an impact on physical health and well-being may have a significant impact on one’s psychological well-being. However, we seldom consider these situations that need ‘first-aid’, or indeed, any longer-term treatment either. However, going through traumatic situations can have both an acute immediate impact and a profound long-term effect on our minds.

Some signs of acute distress which might be seen in survivors soon after going through a traumatic incident are as follows:

• flashbacks in which the person acts or feels as if the event were recurring
• nightmares and repetitive and distressing intrusive images or other sensory impressions from the event
• constant rumination over why the event happened to them, how it could be prevented.
• emotional numbing
• hypervigilance for threat, startle responses.
• In addition to these, trauma can also have a significant impact on the day-to-day lives of survivors.(Rose et al, 2002)

For helping survivors of trauma through such acute responses, mental health professionals often incorporate ‘Psychological First Aid’ in their intervention. Psychological First Aid is an evidence-informed modular approach to help children, adolescents, and families in the immediate aftermath of disaster and terrorism (Brymer et al, 2006). The Institute of Medicine of the US in 2003 recognized Psychological First Aid as a concept similar to physical first aid, which helps individuals cope with immediate psychological consequences of disastrous events in their own lives (as cited in Everly & Lating, 2013).

The origin of Psychological First Aid dates back to the mid 20th century where Thorne (1952) observed that chronic adverse psychological impact of a traumatic experience can be mitigated through instant recognition and intervention of signs of acute psychological distress (as cited in Everly, Barnett & Links, 2012). The core actions of Psychological First Aid are as follows:

• Initiating a contact with survivors and hearing them out with empathy.
• Assessing their safety in their present environment and taking steps to enhance their safety
• Helping with stabilizing intense emotions and physiological responses, namely, uncontrollable crying, startle responses, trembling, palpitation.
• Understanding survivors’ immediate needs and coping resources. Helping them identify and connect to social support i.e. family, friends, support groups.

Helplines and Psychological First Aid: The Approach at iCALL

At counselling helplines, telephone and e-mail are two mediums that frequently make use of psychological first aid for clients who have gone through a traumatic experience. The very first advantage of this medium is the assurance of anonymity and confidentiality. Anonymity often encourages survivors who are not willing to express their grief an opportunity to express themselves without the fear of being identified or being judged. At the same time, the telephone and e-mail medium proves to be more convenient and cost effective than availing face-to-face help.

With regard to the core interventions for survivors of trauma, counsellors at iCALL provide help with the following skills and strategies:

• Providing a listening ear to the survivors by giving them the space to express themselves.
• Validating the survivors’ experiences and reflecting their expressed emotions with empathy and sensitivity.
• Helping in stabilizing intense emotions by introducing relaxation strategies like paced breathing, guided imagery relaxation techniques, and grounding techniques (techniques that help in reorienting attention to the here and now reality)
• Exploring the survivor’s present day routine in order to understand the present challenges in coping with distress.
• Assessing the coping resources already available with the survivor as well as helping them with gathering more resources from their immediate environment.

Going through a traumatic experience could be a difficult journey for any individual. If you find yourself or your loved ones in such a situation you can reach out to iCALL(Initiating Concern For All) – a psychosocial helpline initiated by the School of Human Ecology, Tata Institute of Social Sciences, Mumbai. Since its inception in 2012, iCALL has provided emotional and psychological first aid to survivors of violence, abuse, and harassment through telephone and e-mail based counselling. With an assurance of confidentiality and anonymity, we believe in providing our clients unconditional support through the period of distress. We can be reached on our helpline number 022-25521111 anytime between 8AM to 10PM from Monday to Saturday. Our counselors will be able to cater to concerns in seven different languages: English, Hindi, Marathi, Gujarati, Bengali, Malayalam, and Tamil. You could also email us at icall@tiss.edu.

REFERENCES:

Brymer, M., Layne, C., Jacobs, A., Pynoos, R., Ruzek, J., Steinberg, A., … & Watson, P. (2006). Psychological first aid field operations guide. National Child Traumatic Stress Network.

Everly, G. S., Barnett, D. J., & Links, J. M. (2012). The Johns Hopkins model of psychological first aid (RAPID-PFA): curriculum development and content validation. Int J Emerg Ment Health, 14(2), 95-103.

Everly Jr, G. S., & Lating, J. M. (2013). Crisis Intervention and Psychological First Aid. In A Clinical Guide to the Treatment of the Human Stress Response(pp. 427-436). Springer New York.

Rose, S. C., Bisson, J., Churchill, R., & Wessely, S. (2002). Psychological debriefing for preventing post traumatic stress disorder (PTSD). The Cochrane Library.