Immediate management of

Psychological Trauma
Introduction
A psychological crisis /trauma is a response to a
critical incident or distressing event wherein the
individual’s psychological balance has been disrupted.
This disequilibrium results because the individual’s
usual coping mechanisms have failed.
As a result acute psychological or behavioural distress
coupled with some degree of functional impairment
emerges.
 Immediate management of trauma
designed to first stabilize, then
reduce symptoms of
distress/dysfunction so as to achieve
a state of adaptive
functioning; or, to facilitate access to
continued care, when necessary.
Psychological First Aid
Psychological First Aid (PFA) is an evidence-informed
modular approach to help children, adolescents,
adults, and families in the immediate aftermath of any
traumatic experience.
PFA is designed to reduce the initial distress caused by
traumatic events and to foster short- and long-term
adaptive functioning and coping
(The National Child Traumatic Stress Network and the National Centre)
•PFA does not assume that
all survivors will develop
severe mental health
problems.
•Survivors affected by
traumatic events will
experience a broad range of
early reactions.
•Some of these reactions
will cause enough distress
to interfere with adaptive
coping, and recovery may
be helped by support from
compassionate and caring
responders.
 PFA is not a new intervention.
Rather, it is better conceptualized
as documenting and operationalizing
good common sense—
those activities that sensible, caring
human beings would do for
each other anyway.
Eight core actions
 Contact and Engagement: To respond to contacts initiated by survivors, or to
initiate contacts in a non-intrusive, compassionate, and helpful manner.
 Safety and Comfort: To enhance immediate and ongoing safety, and provide
physical and emotional comfort.
 Stabilization (if needed): To calm and orient emotionally overwhelmed or
disoriented survivors.
 Information Gathering on Current Needs and Concerns: To identify
immediate needs and concerns, gather additional information, and tailor
Psychological First Aid interventions.
 Practical Assistance: To offer practical help to survivors in addressing immediate
needs and concerns.
 Connection with Social Supports: To help establish brief or ongoing contacts
with primary support persons and other sources of support.
 Information on Coping: To provide information about stress reactions and
coping to reduce distress and promote adaptive functioning.
 Linkage with Collaborative Services: To link survivors with available services
needed at the time or in the future.
(The National Child Traumatic Stress Network and the National Centre)
WHO, Red cross society etc
5 essential elements of PFA
Safety
Calming
Connectedness
Self-efficacy
Hope
(Hobfoll et al.,2007)
What Evidence Currently Exists
for PFA Effectiveness?
Scientific evidence for psychological first aid is lacking
but PFA is widely supported by expert opinion and
rational conjecture best fits the category of “evidence
informed” (Fox et al., 2012).
Thus, the best available “evidence” is currently
restricted to peer-reviewed consensus statements and
guidelines (Dieltjens et al., 2014 ).
Possible ways to seek Evidence for
PFA Effectiveness?
In some disaster events where there is advance
warning, pre-post designs may be possible.
Comparison disaster-affected communities that did
not receive PFA.
The “five essential elements”might be considered the
best “standard” available for assessing the coverage of
various PFA frameworks.
Seek evidence ...
An evaluation within the organizational context of
first responders may be a good start.
Test the implementation of PFA with civilians in
controlled settings such as hospital emergency rooms.
(Shultz & Forbes, 2014)
Crisis intervention
Crisis intervention is done to alleviate the immediate
pressure and restoring the individual to at least his
pre-crisis level of functioning.
Time limited
Extends up to 4 to 12 weeks
According to Aguilera(1 970) helping the individual
To have an understanding of the crisis.
To express his present feelings towards the crisis.
To explore alternative ways of coping with the crisis
To working on anticipatory planning.
reinforcing of those coping skills and problem solving
activities that the person has successfully used in
resolving the crisis.
it is supposed to help the client prepare for any future
crises that he may encounter.
Characteristics of crisis intervention
Directive

Prompt Time limited Preventive

Present centred
Different models for crisis intervention
 ABCD model (MacDonald &Golan 2015)
 Achieve Contact
 Boil down the problem
 Cope with the problem
 Determine the meaning of the event
 Critical incident stress management (CISM)
(Mitchell&Everly1983)
 Pre‐crisis preparation.
 demobilizations, informational briefings
 Defusing.
 Critical Incident Stress Debriefing (CISD)
 One‐on‐one crisis intervention/counseling or psychological support
 Family crisis intervention
 Follow‐up and referral mechanisms for assessment and treatment, if
necessary
Nine step model (Dixon 1987)
Rapidly Establish a Constructive Relationship
Elicit and Encourage Expression of Painful Feelings
and Emotions
Discuss the Precipitating Event
Assess Strengths and Needs
Formulate a Dynamic Explanation
Restore Cognitive Functioning
Plan and Implement Treatment
Terminate
Follow-up
Techniques used
Use of humour
Generalization
Self disclosure & story telling
Setting limits
Encouraging
to talk
to draw etc
Evidence for crisis intervention
Roberts & Everly (2006) in a meta-analysis reported
intensive home-based crisis intervention with families
as well as multi-component critical incident stress
management (CISM)are effective interventions.
Conclusion
Psychological first aid may be a one-time intervention
offered by neighbours, relatives or helping agencies to
provide basic needs (money, food, housing, or
transportation).
Although this support system is extremely important
in the overall crisis response, it does not teach clients
to problem solving or coping.
Thank you