# Psychological First Aid

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In the first **24-72 hours** after any critical incident or crisis, those responding can take appropriate actions to help affected people cope more effectively and reduce further stress and trauma.
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## Common responses to traumatic events

Trauma reactions are a normal and understandable response to abnormal events. But the symptoms can be overwhelming; affected people often feel that they have lost control or are ‘going mad’. Common reactions include:

* Feeling jumpy and on edge, as if watching out for constant danger.
* Avoiding the location of the traumatic event or other reminders of it.
* Flashbacks (often triggered by smells or sounds linked to the event).
* Reoccurring intrusive thoughts, sometimes leading to nightmares.
* Difficulty sleeping and relaxing.
* Anxiety, panic, terror, and feeling unsafe.
* Headaches and/or migraines.
* Digestive problems.
* A desire to isolate and/or a fear of being alone.
* Easily triggered emotional outbursts (including anger and sadness).
* Feelings of blame, guilt, loss, and sadness.
* Physical and mental exhaustion.
* Lack of concentration and poor memory.

Most people will experience some of these responses following a traumatic event, but the majority will recover naturally with the support of friends, family, and colleagues.

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If symptoms are particularly intense or persist for more than **4-6 weeks,** then it is likely that specialist mental health support will be needed.
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## **Providing Psychological First Aid**

Psychological First Aid (PFA) is an evidence-based approach for assisting people of any age or background in the immediate aftermath of a critical incident or crisis. It can reduce initial distress, foster short- and long-term coping behaviours, and reduce the occurrence of PTSD.

Before providing PFA, it is important to:

* Consider your own resources and the support available to you. 
* Be mindful that you might be triggered (particularly if the issue is personal or sensitive), and think about how you might manage this. 
* Familiarise yourself with the concepts of [compassion fatigue, vicarious trauma, and burnout](https://www.openbriefing.org/resources/compassion-fatigue-vicarious-trauma-and-burnout-infosheet-for-those-supporting-human-rights-defenders/) and with ways of mitigating them.

You should provide Psychological First Aid in three stages: look, listen, link:

<table data-view="cards"><thead><tr><th></th><th></th><th></th></tr></thead><tbody><tr><td><strong>Look 🔎</strong> </td><td>In the first stage, the goals are to <strong>establish what has happened and who has been affected.</strong> </td><td>You should also ensure that you are up to date on developments and aware of other sources of support that may be available.</td></tr><tr><td><strong>Listen👂</strong></td><td>In the next stage, the goals are to <strong>initiate conversation and stabilise those affected.</strong></td><td>You will need to use active listening and other appropriate communication skills and psychoeducation (sharing information and knowledge).</td></tr><tr><td><strong>Link 🤝</strong> </td><td>In the final stage, the goals are to follow up and <strong>connect people with further sources of support.</strong></td><td>You will also need to hold appropriate boundaries and conclude contact.</td></tr></tbody></table>

| Look 🔎                                                                                                             | Listen👂                                                                                                                                                                  | Link 🤝                                                                                                                 |
| ------------------------------------------------------------------------------------------------------------------- | ------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | ----------------------------------------------------------------------------------------------------------------------- |
| What happened?                                                                                                      | Initiate contact in a culturally appropriate manner.                                                                                                                      | Help them access practical assistance (e.g. food, clothing or making a phone call).                                     |
| When and where did the event occur?                                                                                 | Explain what you are there to do (and not do).                                                                                                                            | Connect them directly to additional services (e.g. medical, legal or social services).                                  |
| How many people are affected and who are they?                                                                      | Give the latest update about the situation.                                                                                                                               | Allow them to make decisions for themselves and regain control, while protecting them from any unnecessary risk-taking. |
| Will others need information?                                                                                       | Ask about immediate needs.                                                                                                                                                | Encourage them to use the support that is immediately available.                                                        |
| Who is meeting basic needs (e.g. medical care, food, water, and shelter)?                                           | Speak calmly, with empathy and compassion.                                                                                                                                | Facilitate access to primary support networks (e.g. friends, family, and colleagues).                                   |
| Where and how can people access those services?                                                                     | Use grounding techniques to help you both cope with [PTSD](https://www.youtube.com/watch?v=PeO5fqHdU08) and [anxiety](https://www.youtube.com/watch?v=pJCpZBIedrw\&t=2s). | Make referrals to clinical support, if needed (e.g. counselling or trauma support).                                     |
| What other dangers may there be in the local environment (e.g. armed groups, landmines, or damaged infrastructure)? | Provide basic information on [coping strategies](https://www.youtube.com/watch?v=cPoqxmaEhL4).                                                                            |                                                                                                                         |
|                                                                                                                     | Advise on what *not* to do (e.g., isolating or using drugs and alcohol).                                                                                                  |                                                                                                                         |

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Avoid asking those affected to describe what happened. Listen carefully if they volunteer an account and acknowledge their narrative, but avoid comments or questions.
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## **Self-care following a traumatic event**

In the days and weeks following a critical incident or crisis, encourage those affected to follow some simple self-care guidelines:

1. Maintain good sleep hygiene, including establishing a regular nightly routine and a pleasant sleep environment, if possible.&#x20;
2. Eat regular meals and maintain a healthy diet.&#x20;
3. Regularly walk, exercise or play sport.&#x20;
4. Address physical illness or injury, and give yourself time to heal.&#x20;
5. Engage daily in self-reflection and contemplative practices.&#x20;
6. Do not use drugs or alcohol as a way of coping with stress or trauma.&#x20;
7. Maintain relationships with friends, family, co-workers and community members who can support you.&#x20;
8. Understand what stressors might trigger changes in your health and wellbeing and learn to recognise the signs and symptoms of stress in yourself.

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Providing PFA and other support to those affected by traumatic events may impact you, including through vicarious - or secondary - trauma. Following the above self-care guidelines will help you stay healthy and resilient and better able to provide support.
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Additional self-care guidance and a wellbeing plan template are available in the **Holistic Security Protocol for Human Rights Defenders** from Open Briefing:

{% embed url="<https://openbriefing.gitbook.io/defenders-protocol/wellbeing>" %}

**Disclaimer.** To the fullest extent permitted by law, Open Briefing will not be liable for any loss, damage or inconvenience arising as a consequence of any use or misuse of this resource.