Psychological first aid

Last updated

Psychological first aid (PFA) is a technique designed to reduce the occurrence of post-traumatic stress disorder. It was developed by the National Center for Post Traumatic Stress Disorder (NC-PTSD), a section of the United States Department of Veterans Affairs, in 2006. It has been endorsed and used by the International Federation of Red Cross and Red Crescent Societies, Community Emergency Response Team (CERT), the American Psychological Association (APA) and many others. It was developed in a two-day intensive collaboration, involving more than 25 disaster mental health researchers, an online survey of the first cohort that used PFA and repeated reviews of the draft. [1]

Contents

Definition

According to the NC-PTSD, psychological first aid is an evidence-informed modular approach for assisting people in the immediate aftermath of disaster and terrorism to reduce initial distress and to foster short and long-term adaptive functioning. It was used by non-mental health experts, such as responders and volunteers. Other characteristics include non-intrusive pragmatic care and assessing needs. PFA does not necessarily involve discussion of the traumatic event and avoids any activity associated with "debriefing" as that technique has been associated with increased rates of PTSD. [2]

Components

Steps

History

Before PFA, there was a procedure known as debriefing. Debriefing was a necessary step in a commercially available training intended to reduce PTSD called "Critical Incident Stress Management" (CISM) . It was intended to reduce the incidence of post traumatic stress disorder (PTSD) after a major disaster. PTSD is now widely known to be debilitating; sufferers experience avoidance, flashbacks, hyper-vigilance, and numbness. Debriefing procedures were made a requirement after a disaster, with a desire to prevent people from developing PTSD. The idea behind it was to promote emotional processing by encouraging recollection of the event. Debriefing has origins with the military, where sessions were intended to boost morale and reduce distress after a mission, however the US Department of Defense discontinued the practice in 2002 due to evidence indicating that the practice increased PTSD rates. [3] Debriefing was done in a single session with seven stages: introduction, facts, thoughts and impressions, emotional reactions, normalization, planning for future, and disengagement. [2]

Debriefing was found to be at best, ineffective, [4] [5] [6] [7] and at worst, harmful [8] with some studies finding that PTSD rates actually increased as a result of debriefing. [2] There are several theories as to why debriefing increased incidence of PTSD. First, those who were likely to develop PTSD were not helped by a single session. Second, being re-exposed too soon to the trauma could lead to retraumatization. Exposure therapy in cognitive behavioral therapy allows the person to adjust to the stimuli before slowly increasing severity. Debriefing did not allow for this. Also, normal distress was seen to be pathological after a debriefing and those who had been through a trauma thought they had a mental disorder because they were upset. Debriefing assumes that everyone reacts the same way to a trauma, and anyone who deviates from that path, is pathological. But there are many ways to cope with a trauma, especially so soon after it happens. [9] [2]

Effectiveness

PFA seems to address many of the issues in debriefing. It is not compulsory and can be done in multiple sessions and links those who need more help to services. It deals with practical issues which are often more pressing and create stress. It also improves self-efficacy by letting people cope their own way. PFA has attempted to be culturally sensitive, but whether it is or not has not been shown. However, a drawback is the lack of empirical evidence. [10] While it is based on research, it is not proven by research. [11] A 2024 integrative review concluded that the substantial variation in PFA protocols limits the ability to reach scientific conclusions. [12] Like the debriefing method, PFA has become widely popular without testing, however debriefing is linked to harmful outcomes whereas PFA specifically avoids debriefing. [13]

Notes

  1. ↑ Bisson & Lewis 2009.
  2. 1 2 3 4 Rose et al. 2002.
  3. ↑ "Mental Health and Mass Violence: Evidence-Based Early Psychological Intervention for Victims/Survivors of Mass Violence: A Workshop to Reach Consensus on Best Practices". PsycEXTRA Dataset. 2002. doi:10.1037/e584812011-001 . Retrieved 2023-01-24.
  4. ↑ van Emmerik, Arnold A. P.; Kamphuis, Jan H.; Hulsbosch, Alexander M.; Emmelkamp, Paul M. G. (2002-09-07). "Single session debriefing after psychological trauma: a meta-analysis". Lancet. 360 (9335): 766–771. doi:10.1016/S0140-6736(02)09897-5. ISSN   0140-6736. PMID   12241834. S2CID   8177617.
  5. ↑ Carlier, I. V.; Voerman, A. E.; Gersons, B. P. (March 2000). "The influence of occupational debriefing on post-traumatic stress symptomatology in traumatized police officers". The British Journal of Medical Psychology. 73 ( Pt 1): 87–98. doi:10.1348/000711200160327. ISSN   0007-1129. PMID   10759053.
  6. ↑ Carlier, Ingrid V. E.; Lamberts, Regina D.; Van Uchelen, Annephine J.; Gersons, Berthold P. R. (July 1998). "Disaster-related post-traumatic stress in police officers: a field study of the impact of debriefing". Stress Medicine. 14 (3): 143–148. doi:10.1002/(sici)1099-1700(199807)14:3<143::aid-smi770>3.0.co;2-s. ISSN   0748-8386.
  7. ↑ Rose, S.; Brewin, C. R.; Andrews, B.; Kirk, M. (July 1999). "A randomized controlled trial of individual psychological debriefing for victims of violent crime". Psychological Medicine. 29 (4): 793–799. doi:10.1017/s0033291799008624. ISSN   0033-2917. PMID   10473306. S2CID   35346492.
  8. ↑ Kagee, Ashraf (February 2002). "Concerns about the effectiveness of critical incident stress debriefing in ameliorating stress reactions". Critical Care. 6 (1): 88. doi: 10.1186/cc1459 . ISSN   1364-8535. PMC   137400 . PMID   11940272.
  9. ↑ Gray, Maguen & Litz 2004.
  10. ↑ Hermosilla, Sabrina; Forthal, Sarah; Sadowska, Karolina; Magill, Elizabeth B.; Watson, Patricia; Pike, Kathleen M. (2022-10-27). "We need to build the evidence: A systematic review of psychological first aid on mental health and well‐being". Journal of Traumatic Stress. 36 (1): 5–16. doi: 10.1002/jts.22888 . ISSN   0894-9867. PMC   10624106 . PMID   36300605. S2CID   253158847.
  11. ↑ De Brier, Niels; Borra, Vere; Dockx, Kim; Scheers, Hans; Stroobants, Stijn; De Buck, Emmy; Lauwers, Karen; Vandekerckhove, Philippe (June 2021). "Best Available Evidence on Communicative First Aid Interventions by Laypeople for Preventing and Relieving Posttraumatic Stress Disorder–Related Symptomatology Following Traumatic Events". Journal of Traumatic Stress. 34 (3): 538–550. doi:10.1002/jts.22625. ISSN   0894-9867. PMID   33217083. S2CID   227102217.
  12. ↑ Wang, Ling; Norman, Ian; Edleston, Victoria; Oyo, Christopher; Leamy, Mary (2024-01-28). "The Effectiveness and Implementation of Psychological First Aid as a Therapeutic Intervention After Trauma: An Integrative Review". Trauma, Violence, & Abuse. doi: 10.1177/15248380231221492 . ISSN   1524-8380.
  13. ↑ Bell, Vaughan (11 May 2013). "Minds traumatised by disaster heal themselves without therapy". The Guardian . Retrieved 29 September 2022.

Related Research Articles

Post-traumatic stress disorder (PTSD) is a mental and behavioral disorder that develops from experiencing a traumatic event, such as sexual assault, warfare, traffic collisions, child abuse, domestic violence, or other threats on a person's life or well-being. Symptoms may include disturbing thoughts, feelings, or dreams related to the events, mental or physical distress to trauma-related cues, attempts to avoid trauma-related cues, alterations in the way a person thinks and feels, and an increase in the fight-or-flight response. These symptoms last for more than a month after the event. Young children are less likely to show distress, but instead may express their memories through play. A person with PTSD is at a higher risk of suicide and intentional self-harm.

Psychological trauma is an emotional response caused by severe distressing events that are outside the normal range of human experiences. It must be understood by the affected person as directly threatening the affected person or their loved ones with death, severe bodily injury, or sexual violence; indirect exposure, such as from watching television news, may be extremely distressing and can produce an involuntary and possibly overwhelming physiological stress response, but does not produce trauma per se. Examples include violence, rape, or a terrorist attack.

Eye movement desensitization and reprocessing (EMDR) is a form of psychotherapy that is controversial within the psychological community. It was devised by Francine Shapiro in 1987 and originally designed to alleviate the distress associated with traumatic memories such as post-traumatic stress disorder (PTSD).

Complex post-traumatic stress disorder is a stress-related mental disorder generally occurring in response to complex traumas, i.e., commonly prolonged or repetitive exposures to a series of traumatic events, within which individuals perceive little or no chance to escape.

Critical incident stress management (CISM) has been misunderstood and unfairly criticized as a controversial, non-empirical, adaptive, short-term psychological helping-process that focused solely on an immediate and identifiable problem. Much of the "controversy" stems from confusion of terms. The overall ICISF Model of Critical Incident Stress Management includes several tactics to help mitigate the effects of a critical incident. It includes pre-incident preparedness to acute crisis management through post-crisis follow-up. Its purpose is to enable people to return to their daily routine more quickly and with less likelihood of experiencing post-traumatic stress disorder (PTSD). The term CISM is frequently confused with one of the group intervention tactics under the model. That is the Critical Incident Stress Debriefing (CISD).

Debriefing is a report of a mission or project or the information so obtained. It is a structured process following an exercise or event that reviews the actions taken. As a technical term, it implies a specific and active intervention process that has developed with more formal meanings such as operational debriefing. It is classified into different types, which include military, experiential, and psychological debriefing, among others.

Childhood trauma is often described as serious adverse childhood experiences (ACEs). Children may go through a range of experiences that classify as psychological trauma; these might include neglect, abandonment, sexual abuse, emotional abuse, and physical abuse, witnessing abuse of a sibling or parent, or having a mentally ill parent. These events have profound psychological, physiological, and sociological impacts and can have negative, lasting effects on health and well-being such as unsocial behaviors, attention deficit hyperactivity disorder (ADHD), and sleep disturbances. Similarly, children whose mothers have experienced traumatic or stressful events during pregnancy have an increased risk of mental health disorders and other neurodevelopmental disorders.

As defined by the United States Department of Veterans Affairs, military sexual trauma (MST) are experiences of sexual assault, or repeated threatening sexual harassment that occurred while a person was in the United States Armed Forces.

Incident stress is a condition caused by acute stress which overwhelms a staff person trained to deal with critical incidents such as within the line of duty for first responders, EMTs, and other similar personnel. If not recognized and treated at onset, incident stress can lead to more serious effects of posttraumatic stress disorder.

Jonathan Shay is an American doctor and clinical psychiatrist. He holds a B.A. from Harvard (1963), and an M.D. (1971) and a Ph.D. (1972) from the University of Pennsylvania. He is best known for his publications comparing the experiences of Vietnam veterans with the descriptions of war and homecoming in Homer's Iliad and Odyssey.

<span class="mw-page-title-main">Yuval Neria</span>

Yuval Neria is a Professor of Medical Psychology at the Departments of Psychiatry and Epidemiology at Columbia University Medical Center (CUMC), and Director of Trauma and PTSD Program, and a Research Scientist at the New York State Psychiatric Institute (NYSPI) and Columbia University Department of Psychiatry. He is a recipient of the Medal of Valor, Israel's highest decoration, for his exploits during the 1973 Yom Kippur War.

PTSD or post-traumatic stress disorder, is a psychiatric disorder characterised by intrusive thoughts and memories, dreams or flashbacks of the event; avoidance of people, places and activities that remind the individual of the event; ongoing negative beliefs about oneself or the world, mood changes and persistent feelings of anger, guilt or fear; alterations in arousal such as increased irritability, angry outbursts, being hypervigilant, or having difficulty with concentration and sleep.

Childbirth-related post-traumatic stress disorder is a psychological disorder that can develop in women who have recently given birth. This disorder can also affect men or partners who have observed a difficult birth. Its symptoms are not distinct from post-traumatic stress disorder (PTSD). It may also be called post-traumatic stress disorder following childbirth (PTSD-FC).

Trauma focused cognitive behavioral therapy (TF-CBT) is an evidence-based psychotherapy or counselling that aims at addressing the needs of children and adolescents with post traumatic stress disorder (PTSD) and other difficulties related to traumatic life events. This treatment was developed and proposed by Drs. Anthony Mannarino, Judith Cohen, and Esther Deblinger in 2006. The goal of TF-CBT is to provide psychoeducation to both the child and non-offending caregivers, then help them identify, cope, and re-regulate maladaptive emotions, thoughts, and behaviors. Research has shown TF-CBT to be effective in treating childhood PTSD and with children who have experienced or witnessed traumatic events, including but not limited to physical or sexual victimization, child maltreatment, domestic violence, community violence, accidents, natural disasters, and war. More recently, TF-CBT has been applied to and found effective in treating complex posttraumatic stress disorder.

A moral injury is an injury to an individual's moral conscience and values resulting from an act of perceived moral transgression on the part of themselves or others. It produces profound feelings of guilt or shame, moral disorientation, and societal alienation. In some cases it may cause a sense of betrayal and anger toward colleagues, commanders, the organization, politics, or society at large.

Trauma risk management (TRiM) is a method of secondary PTSD prevention. The TRiM process enables non-healthcare staff to monitor and manage colleagues. TRiM training provides practitioners with a background understanding of psychological trauma and its effects.

Secondary trauma can be incurred when an individual is exposed to people who have been traumatized themselves, disturbing descriptions of traumatic events by a survivor, or others inflicting cruelty on one another. Symptoms of secondary trauma are similar to those of PTSD. Secondary trauma has been researched in first responders, nurses and physicians, mental health care workers, and children of traumatized parents.

<span class="mw-page-title-main">Trauma and first responders</span> Trauma experienced by first responders

Trauma in first responders refers to the psychological trauma experienced by first responders, such as police officers, firefighters, and paramedics, often as a result of events experienced in their line of work. The nature of a first responder's occupation continuously puts them in harm's way and regularly exposes them to traumatic situations, such as people who have been harmed, injured, or killed.

Disaster psychiatry is a field of psychiatry which focuses on responding to natural disasters, climate change, school shootings, large accidents, public health emergencies, and their associated community-wide disruptions and mental health implications. All disasters, regardless of exact type, are characterized by disruption: disruption of family and community support structures, threats to personal safety, and an overwhelming of available support resources. Disaster psychiatry is a crucial component of disaster preparedness, aiming to mitigate both immediate and prolonged psychiatric challenges. Its primary objective is to diminish acute symptoms and long-term psychiatric morbidity by minimizing exposure to stressors, offering education to normalize responses to trauma, and identifying individuals vulnerable to future psychiatric illness.

<span class="mw-page-title-main">Internet-based treatments for trauma survivors</span>

Internet-based treatments for trauma survivors is a growing class of online treatments that allow for an individual who has experienced trauma to seek and receive treatment without needing to attend psychotherapy in person. The progressive movement to online resources and the need for more accessible mental health services has given rise to the creation of online-based interventions aimed to help those who have experienced traumatic events. Cognitive behavioral therapy (CBT) has shown to be particularly effective in the treatment of trauma-related disorders and adapting CBT to an online format has been shown to be as effective as in-person CBT in the treatment of trauma. Due to its positive outcomes, CBT-based internet treatment options for trauma survivors has been an expanding field in both research and clinical settings.

References

This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.