Psychological First Aid

Psychological first aid can help support family and friends through a crisis.

Posted October 9, 2018 | Reviewed by Jessica Schrader

The Greek philosopher Heraclitus of Ephesus noted that the only constant is change. We currently live in an era of unprecedented personal, social, economic, and political change.

While change can often be uplifting, it can also be distressing. Due to current events, or perhaps life in general, most of us have directly observed another person in psychological distress, such as a friend, family member, coworker, or even a complete stranger. Similarly, those of us who have observed someone in distress have often been motivated to offer some form of support in an attempt to ease the suffering we witnessed. Sometimes our efforts were effective, and sometimes they were not. At other times, despite our best efforts, our actions actually appeared to make matters worse, intensifying the acute distress.

During such times, we may have 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’d made that “everything will be OK.” Consistent with our intuitions, a recommendation in the American Journal of Psychiatry stated that shortly after a stressful event, it is important that those affected be provided empathic , practical psychological support beginning with a compassionate and supportive presence (Bisson, Brayne, Ochberg, & Everly, 2007, p. 1017). Over the past 100 years, there has evolved a simple yet effective helping process we now refer to as psychological first aid (PFA). The American Red Cross, the American Psychological Association, and even the United Nations have recognized the importance of PFA. In its guidelines for mental health response, the Inter-Agency Standing Committee (IASC) of the United Nations wrote that most people experiencing acute psychological distress following exposure to stressful events are “best supported without medication ” and that “all aid workers, and especially health workers, should be able to provide very basic psychological first aid” (2007, pp. 118-119).

Defining Psychological First Aid

Perhaps the best way to conceptualize PFA is as the psychological health analogue to physical first aid. It's applying a psychological bandage.

PFA may simply be defined as a supportive and compassionate presence designed to do three things: 1) stabilize (prevent the stress from worsening) 2) mitigate (de-escalate and dampen) acute distress 3) facilitate access to continued supportive care, if necessary. PFA does not entail diagnosis or treatment. Nevertheless, like physical first aid, it requires basic training to be effective and reduce the risk of inadvertently making things worse (Everly & Lating, 2017).

According to one of the early writers in the field of psychological crisis intervention, “A little help, rationally directed and purposely focused at a strategic time, is more effective than extensive help given at a period of less emotional accessibility” (Rapoport 1965, p. 30). That help can be effectively provided by a friend, teacher, coach, supervisor, or family member, especially a parent, if certain simple “first aid” guidelines are followed.

Over the last decade, the Johns Hopkins Center for Public Health Preparedness has worked to develop a simple, yet evidence-based, model of psychological first aid referred to as RAPID PFA (Everly & Lating, 2017).

As an example of how PFA might look, I have distilled some of its key steps and listed them below. I provide them here, not as guidelines, but to familiarize you with the PFA process. Although seemingly simple, as with physical first aid, some formalized training in PFA is still necessary.

Generally speaking, there are three ways that PFA might begin:

The three scenarios above are merely examples of how PFA might begin. While they are not comprehensive in their structure or analysis, they will give you an idea of what PFA might sound like in the beginning. To further assist, listed below are 15 general do's and don’ts for consideration.

In sum, PFA is no panacea, nor is it a substitute for mental healthcare, but years of research and experience has shown it can be a useful tool to assist people in acute distress when applied by those with proper training in PFA.

Bisson, J. I., Brayne, M., Ochberg, F., & Everly, G. S., Jr. (2007). Early psychological intervention following traumatic events. American Journal of Psychiatry, 164, 1016-1019. http://dx.doi.org/10.1176/ajp.2007.164.7.1016 .

Everly, G.S., Jr., Brelesky, G., & Everly, A.N. (2018). Rodney the Rabbit makes a friend. RSI.

Everly, G.S., Jr., & Lating, J.M. (2017). Johns Hopkins guide to psychological first aid. Baltimore: Johns Hopkins Press.

Institute of Medicine. (2003). Preparing for the psychological consequences of terrorism: A public health strategy. Washington, DC: National Academy of Sciences.

Inter-Agency Standing Committee. (2007). IASC guidelines on mental health and psychosocial support in emergency settings. Geneva, Switzerland: Author.

Rapoport, L. (1965). The state of crisis. In H. Parad (Ed.), Crisis intervention: Selected readings (pp. 30-38). New York, NY: Family Service Association of America.

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George S. Everly, Jr., Ph.D. serves on the faculties of Johns Hopkins Bloomberg School of Public Health and The Johns Hopkins School of Medicine

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This article is part of the Bringwise Psychology Journal — daily insights on human behavior, mental health, and personal growth.