Psychological First Aid

“Psychological first aid” was first introduced conceptually in the mid-Twentieth Century; in the post-9/11 era, psychological first aid has emerged as a mainstay for early psychological intervention with survivors of disasters and extreme events. Dating from the 2001 National Institute on Mental Health conference on mass violence, psychological first aid is now the first, and most favored, early intervention approach. Psychological first aid has been broadly endorsed and widely promulgated by disaster mental health experts in reports from a series of consensus conferences and in the peer-reviewed disaster behavioral health literature. Psychological first aid is also consistently recommended in international treatment guidelines for posttraumatic stress disorder (PTSD) and as an early intervention for disaster survivors. Since 9/11, numerous psychological first aid frameworks have been introduced for use by an ever-growing range of providers whose work encompasses an enlarging array of target populations. Frameworks and models are variously labeled as psychological first aid, community-based psychosocial support, disaster behavioral health first aid, mental health first aid, and stress first aid. For ease and brevity, we will use the term, “psychological first aid,” and the generic abbreviation, “PFA,” throughout this commentary. A sampling of PFA models is listed in chronological order, based on year of release, in Table 1. In recent years, the psychosocial consequences of disaster exposure have been deftly researched and widely accepted, with a resultant demand from the broader community for early intervention strategies to ameliorate the negative impacts and to facilitate healthy recovery. Psychological debriefing initially sought to address the psychological needs of professional emergency responders returning from stressful missions and subsequently, debriefing techniques were extended for use with civilian disaster survivors. A body of controlled research, however, has raised serious questions regarding the beneficial effects of this approach in terms of long-term recovery. Of more critical concern was a suggestion that, for a minority of recipients, psychological debriefing may actually result in worse adjustment. PFA emerged in this context as an intervention that would “first, do no harm” by retaining the elements of other models most likely to assist recovery, while avoiding those elements (notably expectations for a detailed incident review) that may be iatrogenic. PFA is not a new intervention. Rather, it is better conceptualized as documenting and operationalizing good common sense— those activities that sensible, caring human beings would do for each other anyway. It is underpinned by five “essential elements” generated from the available research literature by a consensus conference of disaster mental health experts convened in 2004 and later summarized in a landmark publication by Hobfoll and 19 co-authors. These five elements are: safety, calming, connectedness, self-efficacy, and hope. The various PFA models adhere to varying degrees to these elements. In simple terms, PFA includes the provision of information, comfort, emotional care, and instrumental support to those exposed to an extreme event, with assistance provided in a step-wise fashion tailored to the person’s needs. As a front-line strategy, PFA is not intended for delivery by mental health specialists; rather, it is designed to Psychological first aid Rapid proliferation and the search for evidence