How to give Psychological First Aid

When your friend gets cut on the arm, you clean the wound, apply medicine, and cover it up with a bandage. That’s basic first aid. But what do you do if your friend’s mind is wounded? Because your mind can hurt just as much as your body, and it’s common to be clueless about it. The answer is simple. You apply Psychological first aid! Follow the big 5 Ls of psychological first aid – LOOK, LISTEN, LIST, LINK, and LIVE.

What is psychological first aid? 

Psychological first aid is a way to help people psychologically and help them regain control over their lives. It is about understanding others and finding a way to help them overcome their most immediate difficulty.

1. You Look for signs of distress – breathlessness, panic, running away, overeating, yelling
2. You Listen to their suffering – “I am scared” I can’t 
3. You List what resources they can find to feel better and certain
4. You Link them to people and things which can help 
5. You help them Live by adapting to their new situation

Medical analogy: You look for the wound person. You listen to the person’s pain. You list all things that can help with recovery and prevent further damage. You link them to medicine. And finally, help them live through the discomfort. 

The good thing is that anyone can learn to provide psychological first aid. Before an asteroid destroys us or aliens harvest us, the world needs people to help us maintain our sanity. With psychological first aid, you can help anyone who is suffering!

Fast Fact: Healthcare workers get traumatized caring for people. All that death and sickness. You can help them with PFA.

Understanding the crises

There are at least 5 types of pandemics going on right now in 2020.

1. The coronavirus pandemic – The invisible virus that took over the world.
2. The informational pandemic (infodemic) – The information we see is almost always scary and heartbreaking. Some of it induces panic. And a lot of it is simply fake like denying the coronavirus. So we find it hard to believe and trust others.
3. The mental health pandemic – Our mental health is going bad. People are committing suicide. Relationships are breaking. Our mood has gone down. Energy has gone down. Sleep is disturbed. And our thoughts are full of anxiety and gloom. (more here)
4. The behavioral pandemic – We don’t know what to do or how to act. Everything is uncertain, and we have lost control over our lives. (more here)
5. The economic pandemic – People are losing money. They are losing jobs. Many can’t find ways to earn money to support themselves. People have gotten poorer.

What do 5 crises do to us? They spoil our quality of life and cause all sorts of mental health issues. And above all, we are stressed because we find it hard to handle them.

Basic needs

A crisis kills our sense of safety and stability. Basic needs are those things that we need in our lives to lead a satisfying life. An emergency means our most basic needs, like getting food/water and feeling safe, are not met. Safety is a big issue. People are scared because they are always worried about their loved ones and don’t know if they can cope with the pandemic. We see death, depression, panic, and suffering. Many of us have lost loved ones to the pandemic; some have lost relationships; and even jobs. The pandemic has cut our connectedness and every other aspect of our well-being. The very thing that supports our mental health and improves the quality of life has taken a hit.

Loss of mental clarity

When we are in a crisis, and stress takes over, we can temporarily lose our common sense. It disrupts our routine. People need people to help them out, together, as a community of support. Psychological first aid becomes more potent as more and more people start using it! 

We lose our rational mindset because the threatening situation is so close to us, it’s all we see. Our brain activates our fight-flight-freeze response, which prepares us to deal with threats. Not just physically, mentally too. All sorts of negative scenarios dominate the mind. Our body and mind get ready to deal with incoming dangers, but it takes a toll on our mental peace.

All of this puts immense stress on us. But what is stress? It’s just us trying to adapt but don’t have the right methods and resources to adapt. 

How to give psychological first aid?

Guidelines for Look 

Before you give psychological first aid, you have to spot who needs it. For that, we look at the signs of suffering, pain, and stress.

Easy to Spot- Screaming, yelling, crying, irritability, changes in sleep/appetite, easily distracted/lost in thoughts all the time, breathlessness

Difficult to Spot- Social withdrawal, rumination/brooding, low mood, denial of the situation, loss of interest in previously enjoyed activities, frequently referring to or joking about death or dying

Guidelines for Listening

Listening is about keen observation, empathizing, giving space, and reflecting on their concerns to identify their unmet needs. It’s important to tell others that you are available to help in any way you can. This is the part where comfort and rapport are set. To talk with depressed people, read these guidelines and avoid these sentences.

Dos

1. Carefully observe the signs of distress
2. Give others the time and space to share
3. Consider a person’s cultural, ethnic, and religious background to talk healthily and respectably
4. Adjust your responses to a neutral state to be sensitive to social identity and social status
5. Cooperative conversation 
6. Confirm that you understand their concerns (example)
7. Be okay with moments of silence, wait for the other person to speak but still ‘be there’ for that person
8. Ask open-ended questions without probing too much or putting pressure (ex: What is bothering you?)
9. Ask how you can help in small ways (accompanying a person for an activity such as walks, meditation, etc.)
10. Draw on your experience if you feel it helps the conversation

Don’ts

1. Don’t pressurize others to talk or respond. Let them take their time.
2. Don’t get distracted by your experiences in similar situations. Focus on listening to theirs and identify their mental state.
3. Don’t probe or nag
4. Don’t dictate how others should feel
5. Don’t respond with statements which challenge their psychological state
6. Don’t give advice prematurely without fully listening to a person
7. Don’t trivialize the intensity of their concern (Ex: oh, it’s just a phase; you’re just overthinking.)

Guidelines for Listing

You have now identified the signs of distress and learned to listen. Your next step in giving psychological first aid is to list resources to solve problems, offer support, and then link people to those resources. 

Resources are all actions, people, and technologies that help to improve one’s mental status. So resources include various apps, activities, professionals, and help-lines that address a concern you identified while looking and listening. These resources are some of the most trusted ways to help someone calm down.

Here are a few common ways to help:

People

Ask the person to talk with someone they respect and value. It could be a:

1. A trusted family member
2. A trusted friend or a mentor/teacher 
3. Your family doctor/ Physician
4. Mental health professional (psychiatrist/clinical psychologist/counselor)

Actions

Many physical and mental activities can help us cope with stress and challenging times. Psychological first aid looks at two very useful approaches to deal with the pandemic and any other. These coping mechanisms can help you and manage everything from anxiety to frustration. The first approach is problem-focused coping, and the second is emotion-focused coping. 

Problem-focused coping is all about finding solutions to immediate needs people have. You might have to improvise and get creative. Sometimes the biggest problems are those that interfere with our most basic needs – food, water, clothing, safety, independence, connectedness, and stability. Your job as a psychological first aid provider would be to recognize people’s unmet needs, current problems, and help them meet those needs. Even better if you can show them how they can help others meet similar needs.

1. Get the ‘facts’ of the situation.
2. List out possible solutions, even the silly ones, in order from best to worst. 
3. Work on acceptance if the problem cannot be solved then & there (link to emotion-focused coping)

Examples:

1. Secure food, water
2. Share the workload
3. Giving company to carry out activities

Emotion-focused coping is all about managing emotions in a useful way. That means handling negative emotions and creating opportunities for positive emotions. Panic attacks, acting out, aggressive behavior, extreme frustration, are all common in a crisis and a few coping techniques can help! Here are some strategies.

Examples:

1. Breathing exercises (useful for those who are having a panic attack)
2. 54321 technique grounding technique – Find 5 things you can see, 4 things you can hear, 3 things you can touch, 2 things you can smell, & 1 thing you can taste 
3. Listen to music
4. Exercise, meditation, yoga, stretching

Technologies

Almost everyone has access to a phone, and fortunately, we can use it to aid mental health. Here is a list of all the apps that can quickly help people regain control, reduce anxiety and stress, and feel they have a mental security blanket.

1. Headspace – for breathing, mindfulness, meditation
2. Calm – for meditation and sleep
3. Simple Habit – for overall wellness
4. What’s Up?- A Mental Health App – for app-based therapy
5. Wysa – a chatbot for stress, depression, and anxiety

Check out these apps on your android and iOS devices.

Guidelines for Linking

Listing helps to identify solutions. As a psychological first aid agent, you help others use the best solutions and resources they have to deal with the most immediate concerns. While solving problems with others, you follow 4 steps:

1. Identify the facts and define the problem.
2. Judge the potency of solutions/resources to solve a problem.
3. If no solution works, help the person accept the current state using emotion-focused coping.
4. Move on to work on other solvable issues.

It is valuable to discuss what solutions and resources a person is comfortable and willing to use while linking. Brainstorming solutions in a considerate way can help you make the best recommendations and encourage solutions. 

Guidelines for Live

The hard part of giving psychological first aid is over! All of these steps help others become resilient and practical. PFA is about supporting others to adapt to their new circumstances so they can live and restore their disturbed life in a way they like. These 7 factors will help you complete your PFA in a way others feel supported, comforted, and in control.

1. Focus on adjustment – sleep hygiene, diet, exercise, mental health or self-care
2. Encourage protective factors like self-care, hygiene, clear communication, and social support
3. Identify strengths and encourage using them
4. Ignore the weaknesses that prevent coping and highlight the strengths
5. Encourage healthy sustainable behavior and motivate others to use whatever they have access to
6. Foster independence, instead of getting into a baby-sitting role
7. Protect your mental health too

Why do we need psychological first aid?

You might wonder, why should others give psychological first aid when you can just ask them to use their common sense? 

Firstly, a crisis can be traumatic and completely freeze a person’s ability to think. People get quarantined and isolated. People die, and others can’t even grieve properly. Loneliness cripples many. Some are on edge. PFA addresses people’s immediate needs and comfort when they are unable to handle them. Their brains are not in a state to perform at their best.

Secondly, it helps people feel a sense of security and safety. 

Thirdly, our psychological status directly affects our immune system. Better mental health means better immunity.

Have you ever felt you are good at solving someone else’s problems but fail to solve your personal problems? Even if they are similar? Like giving fantastic advice to deal with a break-up but still fail to use it yourself?

Think about it. The very fact that you can do this shows why giving psychological first aid is important. We can solve problems better when the problem is not very close to us. It’s called psychological distance; the closer your emotions are, the more difficult it gets. But if the feelings are slightly far away, like in a different person, it gets easier to solve problems. 

In a crisis, solving each other’s problems may be better than trying to stay isolated and deal with them privately. If everyone does this, we can finally restore our collective well-being. 

P.S. I have prepared this model with help from Manasi Jagtap^[1] (clinical psychologist) and Mrunmayee Gujar (clinical psychologist).

P.P.S. It is an extension of the model proposed by the Red Cross.

Sources