Post Trauma Support

Providing Psychological First Aid

Psychological First Aid (PFA) is an evidence-informed modular approach to help people in the immediate aftermath of a major incident.

It is designed to reduce the initial distress caused by traumatic events and to foster short- and long-term adaptive functioning and coping.

Find out more about PFA below.

PFA is not ‘counselling’, asking the person to ‘analyse’ their situation or pressuring them to talk. Instead, PFA is based on a set of principles that we know help people to cope with and recover from an event or ongoing situations.  

PFA offers a flexible, practical framework for supporting our colleagues and fellow citizens.  Social support is central to recovery in the aftermath of trauma exposure.  

We should also remember the key principles for trauma-informed care which aim to redress the harm trauma causes. Whether an event(s) is traumatic depends not only on our individual experience of the event, but also on the effect it has on us - how it  impacts on our emotional, social, spiritual and physical wellbeing.  You can have a look at Understanding my response to trauma and stress where we explain what happens to us when we are exposed to potentially traumatic events.

‍We are all affected by traumatic events in different ways. Providing Psychological First Aid (PFA) means applying a set of principles that involve humane, supportive and practical support to those suffering serious crisis events.  We have summarised some key points below.

Gill explains the seven key components of Psychological first aid.
A quick guide to Post Trauma Support: Providing Psychological First Aid

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Psychological First Aid

Trauma Informed Care
Trauma Informed means being able to recognise when someone may be affected by trauma, collaboratively adjusting how we work to take this into account and responding in a way that supports recovery, does no harm and recognises and supports people's resilience.When supporting people affected by traumatic events, remember the key principles for trauma-informed care which aim to redress the harm trauma causes: 
  • Safety
  • Trust
  • Collaboration
  • Choice
  • Empowerment
You may find a short animation on the NHS Inform page of help.
Why might we all react differently?
Although everyone is affected in some way by traumatic events, there are a wide range of reactions and feelings each person can have.  Many people may feel overwhelmed, confused or very uncertain about what is happening. They can feel very fearful or anxious, or numb and detached.  Some people may have mild reactions, whereas others may have more severe reactions. How someone reacts depends on many factors, including:
  • the nature and severity of the event(s) they experience
  • their experience with previous distressing events
  • their physical health
  • their personal and family history of mental health problems
  • the support they have in their life from others
  • their cultural background and traditions
  • their age (for example, children of different age groups react differently)
Every person has strengths and abilities to help them cope with life challenges. We discuss this in our sections on Why I’m OK most of the time.  However, some people are particularly vulnerable in a crisis situation and may need extra help. Have a look at  Understanding my response to trauma and stress  and also Recovering from Post Traumatic Stress Injuries where we explain what happens to us when we are exposed to potentially traumatic events and some tips on recovery.
PFA- Care for immediate needs
Start with the basics: medical care, food, drink, clothing, and shelter for example. Then find out what else people need. Discuss this with them and collaborate to come up with a plan that is both practical and realistic. Support them to action the plan – do with, not to.
PFA - Protect from further threat and distress
Remember that our urge to protect must always be trumped by importance of giving people choice and control. Watch out for the common error/unintended consequence of people feeling undermined judged by being taken away from their work/volunteering role. Being with colleagues and at work/volunteering may be best thing we can do to help them. Remember choice, control and collaboration
  • Ensure immediate safety    
  • Minimise exposure beyond what is required to fulfil role (physically and online) but don’t assume they need to leave work
  • What can we do to increase their sense of safety? (Physical, psychological, and emotional)
  • Operational debriefs - focus on understanding & learning
PFA - Comfort and console
If you’re there beside someone trying to help, then you’re already comforting and consoling. Emotional reactions are natural and there is an opportunity to reinforce this. Remember to control any desire (however well-meaning) to leap to refer people for professional help for being upset, or sending them home without assessing their individual needs:
  • Communicate care / support
  • Acknowledge (and believe) that emotional reactions are natural
  • Give choices - do they want you to stay or help them get some space?
  • Tell them you’d like to keep in touch to see how they’re doing
  • Did they know those involved, or did they remind them of a loved one?
  • Listen out for guilt / self-blame
The last two points allow you to check for personal resonance. Acknowledging that is bound to be hard.  Self-blame is a defence against helplessness – we can reassure and tell them it’s not their fault or can ask them what they think they could have done.  This may help them to realise for themselves that there wasn’t anything more they could have done.
PFA - Provide information on coping
Following trauma exposure, we need to get our alarm system back under control.    We want to have people moving following trauma exposure to use up the adrenalin. Responders often have physical things to do after a difficult job – those physical and cognitive tasks can be very helpful. But this can be more of a challenge for colleagues in desk / PC based roles.  A walk around the building can help. Here are some tips on coping following trauma exposure that you can share:
  • Give yourself time and space to recover    ‍
  • Try to keep to routines where possible
  • Be gentle with your body – it’s likely to be in alarm mode for a while
  • Trust your brain – allow yourself to think about what has happened so you can process the memory
  • Avoid avoidance – with time you will be able to cope with reminders
  • Stay connected – spend time with people who care and talk to them if you’re able
  • Accept that this experience will shape you and become part of your life story
You can also have a look at the section on Recovering from Post Traumatic Stress Injuries in What can I do if I'm not ok and also Coping and self-care
PFA - Support for practical tasks
Having worked out what help people need, work with them to achieve this. Remember the key points:
  • Do with, not to
  • Empower
  • Collaborate
  • Restore choice and control
PFA - Connect with social supports
What social supports do people have?  How can they connect with them? This might be providing people with access to a phone or a charging point for their own mobile. Consider:
  • Who’s around for them?
  • Can they talk to family or friends?
  • Can we help family & friends to understand what’s going on, for example by highlighting to people the Info for friends, family and supporters on the website?
  • If no-one is available at home, then make a plan on how they can be supported
PFA - Educate about normal responses
‍Share what you know about our hard-wired, instinctive responses.  Understanding our reactions helps:
  • Empowers us
  • Give choices
  • Reduce shame and self-blame
In the days and weeks after we’ve experienced something frightening or shocking, we go through a natural recovery process. Our body’s alarm system re-sets, we file the experience away in our memory and gradually we come to terms with what has happened. While this is happening, we’re likely to feel more emotional than usual, find ourselves frequently thinking and dreaming about it and may have some unpleasant physical sensations. To understand more about these normal reactions to trauma exposure have a look at Understanding my response to trauma and stress.

One of the most important things we can do is help people make sense of their reactions. Our Quick Guide on Post Trauma Support gives an overview of what helps us recover after a traumatic experience.
Self-care for you
Caring for ourselves is essential – it will help us to be there for others. The emotional labour involved in successfully managing our own feelings whilst attending to the needs and distress of others can be very demanding (both at work and at home) in times of crisis. It is important that we are all able to talk openly and honestly about our mental health and wellbeing. Looking after our mental health is just as important as our physical health.

Using the ABC of self-care in a crisis situation can really help us to maintain our own personal resilience and strength in the face of increasing stress and emotional labour.

Awareness

  • Awareness of your own responses   
  • Acknowledge and accept feelings and thoughts
  • Activate self-compassion and calm coping strategies

Balance

  • Breaks: regularly recharge
  • Boundaries: establish boundaries and protect these
  • Basics: routine, eat well, hydrate, exercise, sleep

Connections

  • Colleagues: kindness to and from peers
  • Community: virtual and physical connection with family and friends
  • Cherish values: the importance of things that have meaning for you
You can also have a look at this section on Coping and self-care

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