Psychological First Aid: A Guide to Trauma Response

Posted on Nov 8, 2024 in Psychology and Sociology

Psychological First Aid

Objectives

Psychological First Aid aims to:

  • Provide protection, security, and hope.
  • Relieve acute stress symptoms.
  • Prevent delayed stress reactions.

Basic Principles

A. Protect

Ensure affected individuals feel safe and secure. Search for and organize:

  • Physical shelters
  • Symbolic shelters
  • Protection against the media (avoid contact in early hours)

B. Lead

Guide individuals away from dangerous areas to safe locations.

C. Connect

Connect individuals with personal and social resources:

  • Loved ones
  • Information centers
  • Support providers

D. Address

Focus on treating acute stress reactions and grief.

E. Acute Care

Provide immediate and temporary assistance. Aim for rapid intervention and handover to appropriate support.

Protocol Approach

The Psychological First Aid protocol organizes intervention and provides action guidelines. It consists of 8 stages:

  • Ambiente (Environment)
  • Contacto (Contact)
  • Evaluación (Evaluation)
  • Restablecimiento Emocional (Emotional Recovery)
  • Comprensión de la Crisis (Crisis Understanding)
  • Activos (Assets)
  • Recuperación Operativa (Operational Recovery)
  • Seguimiento (Follow-up)

Ambiente (Environment)

When intervening in crisis situations, consider:

  • Context: Understand the event, its magnitude, and the situation before contact. Conduct an initial assessment upon arrival.
  • Environmental Assessment: Determine immediate needs, existing support networks, and establish individual/group strategies.
  • Patient Selection: Prioritize intervention based on vulnerability and observed severity.
  • Prior Patient Evaluation: Assess the individual’s level of impairment (physical and emotional), potential danger to self/others (panic, aggression, confusion).

Contacto (Contact)

When interacting with the affected individual:

  • Nonverbal Aspects: Ensure gestures align with the situation. Convey support through close contact and physical proximity (when appropriate).
  • Establish a Relationship: Respect the individual and their situation. Accept them without judgment, offer comfort and reassurance.
  • Psychological Distance: Help the individual detach from the situation (e.g., walk, drink, eat). Provide a suitable environment to discuss the event.
  • First Question: Ask concrete, simple questions about objective facts. Encourage descriptions that lead to cognitive processing.

Evaluación (Evaluation)

  • Initial Exploration: Conduct a mental status examination (orientation, identification, etc.).
  • Problems: Identify the precipitating event, current emotional state (anxiety, anger, numbness), and cognitive processing (interpretations, denial, guilt).
  • Coping Style: Identify coping mechanisms (avoidant vs. active) and promote active coping.
  • Identify Resources: Determine available personal and social support networks.

Restablecimiento Emocional (Emotional Recovery)

  • Facilitate Emotional Expression: Encourage expression through questions and active listening. Be alert for potential crisis escalation.
  • Manage Arousal: Address the individual’s physiological state and needs.
  • Social Network: Promote and facilitate reconnection with their natural support system.
  • Availability: Provide consistent support and be accessible.

Comprensión de la Crisis (Crisis Understanding)

  • Information: Provide information about stress, coping mechanisms, and normal reactions to trauma.
  • Understanding the Event: Help them understand what happened and promote adaptive narration. Address their questions and concerns.

Activos (Assets)

  • Cognitive Processing: Help them focus on activities and facts.
  • Action Plan: Develop a plan with achievable goals and actions. Utilize their resources and strategies.
  • Verbal Contracts: Establish agreements to implement the plan.

Recuperación Operativa (Operational Recovery)

  • Future Tasks: Plan future activities and encourage companionship.
  • Independence: Promote independent functioning.
  • Accompaniment: Ensure they are accompanied by professionals, volunteers, family, or other survivors.
  • Referral/Transfer: Consider the need for hospitalization or transfer to other services.
  • Housing: Plan for accommodation (home, family, hospital, etc.).
  • Home Activities: Plan activities for when they return home.

Seguimiento (Follow-up)

Provide short and medium-term follow-up (up to one month) to ensure continuity of care. Offer support and assistance with:

  • Basic needs
  • Sleep
  • Personal space
  • Social contact
  • Physical health
  • Reconnecting with family/friends
  • Daily functioning
  • Problem-solving
  • Resuming normal roles
  • Grief support
  • Stress management
  • Caregiver training (family)

Consider using various psychological techniques: physiological de-escalation, relaxation, breathing techniques, cognitive restructuring, information provision, defusing, and activation.

Types of Traumatic Events

  • Accidents
  • Natural disasters (hurricanes, earthquakes, floods)
  • Unexpected deaths
  • Assaults/Crimes/Violations
  • Child abuse (physical/sexual)
  • Abduction
  • Torture
  • Combat experiences

Symptoms of Post-Traumatic Stress Disorder (PTSD)

A. Re-experiencing the Trauma

  • Flashbacks
  • Nightmares
  • Intense physical/emotional reactions to trauma-related events

B. Increased Activation

  • Difficulty sleeping
  • Hypervigilance
  • Concentration problems
  • Irritability/Impulsivity/Aggression

C. Avoidance and Emotional Blocks

  • Avoidance of trauma-related situations, places, thoughts, feelings
  • Loss of interest
  • Emotional numbing
  • Social isolation

Associated Disorders

  • Panic Attacks: Intense fear and anxiety with physical symptoms.
  • Depression: Depressive episodes, loss of interest, low self-esteem, suicidal thoughts.
  • Anger and Aggression: Disproportionate anger interfering with daily life and therapy.
  • Substance Abuse: Using drugs/alcohol to cope, delaying proper help.
  • Extreme Fear/Avoidance: Severe avoidance requiring additional interventions.

Typical Features of PTSD

PTSD involves re-experiencing the trauma (flashbacks, nightmares), emotional numbing, detachment, avoidance of reminders, fear, panic, and aggression. Hypervigilance, insomnia, anxiety, and depression are common. Substance abuse can worsen symptoms. Recovery is expected in most cases, but some may experience chronic PTSD and personality changes.