Psychological First Aid
Guidance for those supporting activists and advocates at risk
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.
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.
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.
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 and with ways of mitigating them.
You should provide Psychological First Aid in three stages: look, listen, link:
In the first stage, the goals are to establish what has happened and who has been affected.
You should also ensure that you are up to date on developments and aware of other sources of support that may be available.
In the next stage, the goals are to initiate conversation and stabilise those affected.
You will need to use active listening and other appropriate communication skills and psychoeducation (sharing information and knowledge).
In the final stage, the goals are to follow up and connect people with further sources of support.
You will also need to hold appropriate boundaries and conclude contact.
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?
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)?
Advise on what not to do (e.g., isolating or using drugs and alcohol).
Avoid asking those affected to describe what happened. Listen carefully if they volunteer an account and acknowledge their narrative, but avoid comments or questions.
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.
- 2.Eat regular meals and maintain a healthy diet.
- 3.Regularly walk, exercise or play sport.
- 4.Address physical illness or injury, and give yourself time to heal.
- 5.Engage daily in self-reflection and contemplative practices.
- 6.Do not use drugs or alcohol as a way of coping with stress or trauma.
- 7.Maintain relationships with friends, family, co-workers and community members who can support you.
- 8.Understand what stressors might trigger changes in your health and wellbeing and learn to recognise the signs and symptoms of stress in yourself.
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.
Additional self-care guidance and a wellbeing plan template are available in the Holistic Security Protocol for Human Rights Defenders from Open Briefing:
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.