How to Empower Trauma Survivors Through Psychological First Aid

Providing psychological first aid (PFA) for trauma survivors can be just as important as lending physical first aid in the aftermath of an injury, accident, disaster, or other traumatic event.

While not a substitute for ongoing interventions by trained experts, bystanders in crisis situations can use psychological first aid (PFA) techniques to keep people calm, empower them to cope with the immediate situation, and improve long-term mental health outcomes, according to the National Child Traumatic Stress Network. Strategies that help those in the wake of emergency situations can also help people in ongoing crises — such as pandemics — manage chronic stress and take steps to move forward. 

With thoughtful training, nearly anyone can administer psychological first aid to help calm others in distress.

According to Valerie Cole, Ph.D., director of health services for the American Red Cross, psychological first aid helps stabilize a patient, mitigate acute distress, and facilitate access to continued support if they need it. PFA acts as a “psychological bandage” and is the counterpart to physical first aid. 

If a child falls off a bike and breaks his leg, for instance, a first responder would not put his leg in a cast; rather, they would stabilize any bleeding, keep the child calm, and take him to a hospital for treatment. Similarly, psychological first aid is not a substitute for long-term, professional mental health interventions, but it is the first step toward better mental health outcomes. 

PFA acts as a “psychological bandage” and is the counterpart to physical first aid.

According to research on PFA in Disaster Health, the evidence-based practice was initially envisioned as an approach to “do no harm” and help people in crisis feel:

Not only does psychological first aid help keep patients calm, but it may also help providers who are exposed to stressful medical situations and help reduce burnout among staff, according to research in the Journal of Patient Safety and Risk Management. 

Psychological first aid was intentionally designed to be applied by both mental health professionals and bystanders alike.

“It’s not a magic potion that somebody gives to someone else who has been through trauma,” Cole said. “The practitioner is helping the person draw on their own strength.”

Psychological first aid providers may include:

Nurses are especially well-suited to use psychological first aid to meet communities’ heightened mental health needs in disaster settings, according to research in the International Journal of Emerging Mental Health.

“People who are really good at helping people normally are probably doing most of psychological first aid anyway,” Cole said. “Everybody can learn psychological first aid; you don’t need to have a Ph.D. in order to learn it.”

Although techniques differ for helping people cope with chronic stress, some psychological first aid principles can also help people feel empowered in ongoing crises. However, individuals should have some basic training to avoid worsening outcomes for those they are assisting.

Psychological first aid techniques differ for children and adults. Children express different responses to trauma, and providers should match their language to a child’s development level for children of different ages.

Individuals offering PFA should create a sense of safety and reassurance for children and then help them connect with family and other caregivers. Adults in crisis, meanwhile, may find it helpful to focus on the next steps in recovery and be offered space for problem-solving.

“With both children and adults, you want to create as safe and as comforting of an environment as possible, so allowing them to talk about whatever they want to talk about without probing or asking a lot of questions,” Cole said. This is because asking probing questions can increase the possibility of the survivor developing post-traumatic stress syndrome (PTSD).

The Psychological First Aid Field Operations Guide (PDF, 4.8 MB) from the National Child Traumatic Stress Network and the National Center for PTSD indicates several differences to consider when working with different age groups.

Calming Exercises to Soothe Someone in Distress

Mindfulness and breathing exercises can help induce a relaxation response for people in crisis.

“The way our bodies are wired, we can’t be both in a fight or flight response and in a relaxation response at the same time,” Cole said. “If you induce or encourage deep breathing, slowing down the heart rate, decreasing the stress hormone, that will bring somebody to a relaxation response. That is when you can start thinking more clearly than when you are in a stress situation.”

The following techniques can help calm someone in a crisis.

Relaxation Breathing for Adults

1. Inhale slowly through your nose, filling your lungs down to your abdomen.
2. Think to yourself, “My body is filled with calmness.” 
3. Exhale slowly through your mouth and empty your lungs. 
4. Silently repeat: “My body is releasing the tension.” 
5. Continue as needed.

Source: National Child Traumatic Stress Network, PFA: Basic Relaxation Techniques

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Relaxation Breathing for Children 

1. Tell the child, “We’re going to practice a different way of breathing to calm our bodies down.”
2. Show the child how to put one hand on their stomach. 
3. Say, “OK, we are going to breathe in through our noses. When we breathe in, we are going to fill our lungs with a lot of air, and our stomachs are going to stick out like this,” and demonstrate. 
4. Guide the child by telling them, “Then we will breathe out through our mouths. When we breathe out, our stomachs are going to suck in and up like this,” and demonstrate. 
5. Say, “We are going to breathe in slowly while I count to three, and then breathe out slowly while I count to three.” 
6. Try it together.

Source: National Child Traumatic Stress Network, PFA: Basic Relaxation Techniques

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Four Square Breathing 

1. Inhale for a count of four.
2. Hold your breath in for a count of four. 
3. Exhale for a count of four.
4. Hold your breath out for four counts.
5. Repeat for five to 10 rounds of breath.

Source: Valerie Cole/American Red Cross 

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Finger Tracing With Breathwork

1. Place the index finger of one hand to the wrist of the opposite hand.
2. Inhale as you move your index finger from the base of your wrist to your thumb.
3. Pause, and exhale as you move your finger back down to your wrist. 
4. Repeat this exercise with all five fingers, inhaling as you trace from the wrist to the top of each finger, pausing, and exhaling as you move the finger back to the wrist.
5. Repeat on the opposite hand.

Source: Valerie Cole/American Red Cross

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Sensory Input

1. Pick an object and focus your attention on it using all five senses.
2. Look at the object and notice all its colors, shapes, forms, and structure.
3. Touch the object and notice how it feels. Is it soft or hard? Wet or dry? Rough or smooth?
4. Continue observing the object using each sense, including smelling, hearing, and tasting.

Source: Valerie Cole/American Red Cross

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Sight, Sound, and Touch

1. Ask a partner to name four things they can see, hear, and feel.
2. Then ask them to name three things they can see, hear, and feel.
3. Next, ask them to name two more of each.
4. Finally, ask them to name one more of each. 

Source: “Meet the Woman Teaching the Psychology of Survival,” Outside Magazine

Psychological first aid “lets people know that they can handle situations that they may have felt were just impossible to get through,” said Cole. 

“That sense that you’ve made it through a really difficult experience is going to make you realize, ‘Yeah, I went through that. I can probably go through other difficult experiences as well.’”

These trainings and resources offer additional information about psychological first aid:

Please note that this article is for informational purposes only. Individuals should consult their health care provider before following any of the information provided.

Citation for this content: Nursing@Georgetown, the online MSN program from the School of Nursing & Health Studies