PSYCHOLOGICAL FIRST AID: A TRAINING GUIDE1

Joseph O. Prewitt Diaz2, PhD

Anjana Dayal3, BS
Satyabrata Dash4, MD

Sessions Methodology Time

Understanding the concept of PFA
Photo language Reflection exercise 60 min
My own experience Sharing 60 min
Need for PFA Presentation 15 min
What does it involve? Presentation 15 min
Principles of PFA Presentation 15 min
Steps of giving PFA Presentation 45 min
Developing listening skills and acceptance Sensitization exercises 180 min

Providing PFA Group exercise 60 min

Session1.
Understanding the importance of childhood

Exercise:
 Ask participants to think about their childhood days (anytime when they were
between 5-16 years of age)

Session1.
Identifying needs of survivors

Exercise: Photo language

 Photographs of the disasters will be used to enable participants to come up with
needs of the survivors of a disaster. They would be able to identify that people
have both physical and emotional needs that have to be met.
 Then there will be a quick round of brainstorming where in the group would be
given a task to list out at least 5 changes they have seen in people who have been
through a stressful time whether through a disaster, loss of loved one, loss of
livelihood whatever.
 They would need to put down at least five changes down for each of the four
headings in a ten minute group activtity
Behaviour Bodily changes

1
This training guide on Psychological First Aid is an adaptation of Prewitt Diaz, J.O. (2001) Primeros
Auxlios Psicologicos. San Salvador, El Salvador. Cruz Roja Salvadorena y USAID.
2
Dr. Prewitt Diaz served as the Head of Program in India for the American Red Cross from 2002-2008. He
is the recipient fo the 22008 APA International Humanitarian Award.
3
Ms. Dayal is a psychologist and Director ef Field Operations for the American Red Cross India.
4
Dr. Dash is a psychiatrist and volunteer with the India Red Cross Society, Orissa State Branch.
 Emotions Thoughts

There would be a discussion and the facilitator will present the following points on a
slide or a chart

Behaviour Bodily changes

Change in activity level Blood pressure
Change in eating habits Body aches
Change in sleep patterns Chest pain
Change in work output Chilly
Difficulty in communicating Difficulty in breathing
Frequent arguments Dizziness
Inability to rest Faster heart beat
Increased sense of humor Fatigue
Lack of enjoyment in daily life Feeling faint
Loss of interest in activities Headaches
Nervous mannerisms Muscle twitching
Antisocial behaviour Nausea
Accident proneness Sensitivity to noise
Silence Sleep problems
Intolerant Stomach troubles
Nagging Sweating
Ersentful Sore body
Blaming nature Aqllergies
Social withdrawal Weight gain or loss
Suspiciousness Thirsty
Use of substance Weakness
Vigilance about safety

Emotions Thoughts
Agitation Blaming other people
Anger Confusion
Anxious Difficulty in making decision
Apathy Disorientation of time, place or person
Apprehension Disturbed thinking
Depression Intrusive images
Fear Low self confidence
Feeling numb Memory troubles
Guilt Poor concentration
Hopeless Racing thoughts
Impatience Repeated thoughts or memories
Irritability Slow comprehension
Isolated Uncertainty
Lost
Moodiness
Nightmares
Overwhelmed
Denial
Grief
Restlessness
Sadness
Severe panic
Shame
Session 2.
Understanding the concept of psychological first aid

Presentation cum talk

a) Need for psychological first aid

A disaster affects people emotionally. The change it brings in life seems unbearable
and people often feel helpless, hopeless and frustrated in the aftermath of a disaster.
Often people seem unable to cope with the consequences of the loss they have
experienced. The inability to cope effectively leads to symptoms in a person some of
which are manifested as changes in their behaviour, body, emotions and their
relationships.

Emotional needs tend to be neglected during relief and rehabilitation work because
they are relatively invisible when compared to the damage to life, physical health
and property. Along with relief, rehabilitation and care of physical and material needs
emotional needs are to be given importance to ensure return of normalcy in the lives
of survivors of a disaster.

Often a person who has emotional disability would like to be effective but has been
temporarily been overcome with fear, anxiety, guilt or fatigue. The person seems
unable to cope with his emotions. The person needs calm, positive encouragement
and some instruction to do a simple but useful task. They need you to be patient,
reassuring and supportive.

Psychological first aid enables people to sustain their mental and physical well being
even in adverse conditions by reducing the situational stress they are experiencing.
It reduces situational stress and prevents the persistence of problems and
development of further complications.

b) What does PFA involve

 Approaching and offering support, reassuring and ensuring safety, comforting and
communicating.
 Comforting and consoling a distressed person
 Provide safe environment.
 Meet physical needs immediately.
 Providing goal orientation and support for specific reality-based tasks.
 Comforting and consoling a distressed person
 Provide safe environment.
 Meet physical needs immediately.
 Providing goal orientation and support for specific reality-based tasks.
 Providing information necessary for appropriate actions.
 Sharing their experience.
 Linking families and significant others. Facilitating reunion with loved ones.
 Facilitating the beginning of sense of mastery.
 Identifying needs for further intervention.

c) Principles of psychological first aid

 Intervene immediately so as to be most effective be direct, authoritative and active
 Help them focus and accept what has happened
 Provide accurate information about the situation
 Be truthful do not give false assurances
 Recognize the importance of action for a survivor
 Provide emotional support to the survivors
 Focus on personal coping abilities and encourage resilience
 Be concerned and competent

d) Steps of psychological first aid

1. Meet immediate needs
 Provide Physical First Aid if needed.
 Help survivors collect their belongings.
 Offer something to drink
 Offer something to eat
 Ask whether they need anything for themselves and their children.
 If they are tired, provide a cot where they can rest.
 Help with meeting basic requirements of the person like medical aid, safe
evacuation, shelter, clothing, food

2. Listen
 Actively concentrate on what the survivors say.
 Don’t interrupt or try to assure them that everything will be all right.
 Look into the survivor’s eyes.
 Gently touch the survivor’s hand or shoulder.
 Take time to listen when people describe what happened. Telling their story will
help people understand and, eventually, accept the event.

3. Accept feelings
 Natural responses to a disaster include feelings of anxiety, grief, guilt, and anger.
 Joy at having survived without injury.
 Shame at escaping injury when others were injured.
 Anger toward a friend or relative who was injured.
 Workers should stay relaxed and let survivors know that it is OK to feel that way.

4. Next steps
Ask the survivors if they have a place to go; if not, help them find shelter.
Ask the survivors who are going home if they have someone to look after them or
someone to talk to there.
Provide factual information about where and how they can seek specific resources.

Assess their needs

 Medical aid
 Livelihood issues
 Basic relief needs
 Housing needs
 Compensation
 Social issues
 Emotional needs

According to the needs

 Discuss a plan of action to fulfill those needs
 Deliver the necessary aid or information for meeting those needs
 Network with agencies that might be able to help out
 Refer if required

Help them to resume regular life again

 One of the best ways of normalizing life after a traumatic event is to start doing
tasks for daily living or other chores.
 If people have something purposeful to do during some part of the day like taking
on something that interests them or having some responsibility to fulfill.
 These little things are productive for the people involved in terms of enhancing
their recovery process. They are engaged and their minds are meaningfully
occupied. Also the physical movement adds to the increased level of feeling better
and energized.
 Some ideas are getting back to a routine, getting back to work, socializing,
spirituality, reading, listening to music etc
 Encourage them to adopt healthy lifestyle choices like good nutritious food, regular
exercise, adequate sleep etc

5. Refer and follow up

 Identify survivors who need further counseling or intervention.
 Refer those that do not react to short intervention.
 Go back and see how the person has progressed towards leading a normal life
 Re-assess and cross check progress again

e) When to seek referral for emotional needs

When some behaviour seems unusual then we need to seek answer to four basic
questions. If the answer to any one is yes then we need to refer the person to a
mental health specialist.

1. Is the behaviour out of context

(Like a man is shouting run or you will die when there is nothing around that should
scare him this is behaviour that is out of context. If there is a fire and he is shouting
run or you will die then there is a context, which is scaring him so the behaviour is
not abnormal)

2. Has the behaviour crossed the limit of context demands

(If a teacher scolds a child for not doing her homework then the shouting is within
the limits of the context. Now for the same deed if the teacher starts thrashing the
child with a stick, throws her on the ground and then ties her up then the teacher’s
reaction is crossing the limits of the context demand)

3. Is the behaviour harmful to self or others

(If the behaviour harms the person who is displaying it or someone around that
person is some way then it is risky behaviour like throwing things, using objects to
hit out, cutting their hands with a sharp object, lighting fires etc)

4. Is there evidence of suicidal talk or low self care

(If the person talks of killing himself or appears not to be having a bath, changing
clothes and just not eating etc then this is again risk behaviour)

 Ask these four questions and if it is out of context, beyond the context limits,
harmful behaviour and or suicidal or low in self care then the person needs to see
a doctor.
 Identify these people and motivate them to see a doctor
 Always remember that if behaviour is beyond comprehension then its not you
role but that of a doctor
Session 3.
Internalizing the concept of PFA through activities

a) Exercises to help participants understand the skills required for PFA.

 An exercise to bring in the need for listening

 An exercise to highlight the role of ventilation
 An exercise to highlight the role of eye contact in listening
 An exercise to highlight the role of non verbal cues in listening
 An exercise to highlight the experience of good vs bad listening
 An exercise to bring in the issue of acceptance
 An exercise to accept people cope differently with the same event
 An exercise to bring in the aspect of next steps and referral etc

b) An exercise to understand the role of a psychological first aid giver

 There will be three people in each group
 There will be a one-hour practice session to try out the techniques of PFA
 In each group people will take turns to play the role of a helper, a person with
the problem and an observer
 Everyone will get one hour of time to play the role of a helper.
 The person with the problem needs to really try and experience how it feels when
these suggestions are made to him or her. He or she also should try and see how
the experience of being given this listening space and empathy and
understanding actually feels.
 The observer has to notice how the interaction is progressing and comment upon
the roles that were played out
 Spend 30 minutes going through the tip sheets and clarify any doubts. Think of
how you would use these in the practice sessions
 For this exercise it is essential that everyone spend about 15 minutes thinking
about an issue that is of real concern to him or her and then uses that for the
session. This would ensure that while doing the practice they are not struggling
with what to say next and the whole process gets certain smoothness. Also try
and think about how you would use these techniques read the tip sheets for
clues.

C) A round of sharing to elicit the following points

o How it feel to be a helper
o How difficult was it to use the techniques
o Which ones were easier and why
o Where did they find it difficult
o Which ones will they be able to really use in the field
o Which ones do they think are most useful
o How did I feel to play the role of a person in a problem and being helped
through these techniques
o Observes can share their observations of what worked really well and where
there were some problems.