Practical Lessons in Psychological First Aid

Most of us have directly observed another human in psychological distress, whether it was a friend, a family member, a co-worker, or perhaps a complete stranger. Similarly, those of us who have observed someone in distress have usually been motivated to offer some form of support in an attempt to ease the suffering we witnessed. Indeed, it appears to be a natural human instinct to offer support to those in acute distress. Whether the psychological distress was caused by a personal failure, loss of a loved one, a medical emergency, a dwelling fire, a crime, or acts of violence or even disasters, we were compelled to offer words of support. Sometimes our efforts were effective and sometimes they were not. Sometimes, despite our best efforts, our words actually appeared to make matters worse, seeming to intensify acute distress. At times such as these we lamented the absence of a psychological “magic bullet,” a verbal “Hail Mary” that would immediately end the suffering and lead to the realization of the promise we made that “everything will be ok.” Consistent with our own intuitions, a recommendation in the American Journal of Psychiatry stated that ‘‘shortly after a traumatic event, it is important that those affected be provided, in an empathic manner, practical, pragmatic psychological support.’’ Sadly, however, there is no such psychological “magic bullet,” no verbal “Hail Mary,” but over the last 100 years there has evolved what we now refer to as “psychological first aid” (PFA) which represents a systematic formula for providing psychological support in the wake of adversity and trauma. PFA has been recommended by the American Psychiatric Association, the American Psychological Association, the World Health Organization, and the Institute of Medicine.

In the book THE JOHNS HOPKINS MODEL OF PSYCHOLOGICAL FIRST AID, we describe a unique theoretically grounded, evidence-informed, and evidence-based model of PFA. This model is truly unique in that it was derived from the developmental work of the authors as consultants to the Office of the Amir of Kuwait after the first Gulf War; to the United States Secret Service; the New York Police Department and the New Jersey State Police after the attacks on the World Trade Center on September 11, 2001; to the Bureau of Alcohol, Tobacco, Firearms, and Explosives after the Waco, Texas shootings; to the Hospital Authority of Hong Kon; and lastly through our work at the United States Department of State, Bureau of Diplomatic Security and the Center for Public Health Preparedness at the Johns Hopkins Bloomberg School of Public Health.

Perhaps the most significant “lessons learned” compiled within this volume are:

1.      Whenever there is a need for physical first aid, there may be a need for psychological first aid (PFA) that is largely ignored.

2.      Most protracted reactive human distress appears to be associated with one particular pattern of toxic psychological reactions that can also serve as the target for PFA.

3.      In the wake of trauma and adversity not everyone needs PFA, thus the ability to perform psychological triage becomes imperative.

4.      PFA represents a skill set that is different from psychiatric diagnosis and treatment, thus many psychiatrists and psychologists may not possess the PFA skill set.

5.      PFA can be reduced to a simple formula that can easily be taught to public health, medical, and nursing personnel, educators, coaches and trainers, mental health providers, first responders (police, fire, emergency medical providers), disaster workers, faith-based professionals, and virtually anyone in management positions, but especially first-line supervisors.

George S. Everly, Jr., is an associate professor of psychiatry and behavioral sciences at the Johns Hopkins School of Medicine, an adjunct professor of international health at the Johns Hopkins Bloomberg School of Public Health, and a professor of psychology at Loyola University Maryland. He is a former member of the Johns Hopkins Center for Public Health Preparedness. Jeffrey M. Lating is a professor of psychology at Loyola University Maryland. Everly and Lating are the coauthors of A Clinical Guide to the Treatment of the Human Stress Response and Personality-Guided Therapy for Posttraumatic Stress Disorder. Their book, The Johns Hopkins Guide to Psychological First Aid, is available now.