Community-Based Psychological First Aid Training:

Mitigating Conflict Via Early Mental Health Interventions

Introduction

• Sign-in sheet• Schedule• What is your name and background?• Course evaluation at the end

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What You Will Learn Today

• How the characteristics of crises and violence affect people• How stress can increase conflict• Why certain groups or individuals may need more help

during and after stressful events• Psychological First Aid to support others and reduce

conflict • How to help children, adolescents and those with

vulnerabilities • How to recognize when someone needs more help• How to take care of yourself in stressful times

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YOU CAN HELP!

In difficult times, friends, family and neighbors can help each other.

Understanding and practicing Psychological First Aid will allow you to be a more effective helper

for people in your community.

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The Importance of Community Support

• Crises, disasters and violence lead to extreme stress for the people who experience them

• The impact of stressful events can last for a very long time

• BUT the stress can often be reduced if survivors get help during and right after the event. This can restore people’s trust:• In themselves• In the world • In others

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Reactions to Crises/Disasters

• Stress reactions are often related to an event’s:– Size– Cause– If it was expected or unexpected– Timing

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Crisis/Disaster Size

• How big was it? – Number of people and buildings affected

• How bad was it?– Extent of damage, injuries and deaths

• How long did it last?– Length of the actual event, or length of time people

are strongly affected by an event. It’s very hard for people to start to recover when they’re not sure the danger is over.

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• Natural– There’s no one to blame and no way to prevent

it– People often feel helpless and frightened

• Human-caused– People often feel angry as well as frightened and

helpless– They may want to punish those they think are to

blame – often blaming innocent people

Crisis/Disaster Cause

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• Expected events:–If people get a warning, there is a chance to prepare

and to take action to avoid being injured–If people get a warning but they ignore it, they

often feely guilty or ashamed• Unexpected events:- There is no chance to prepare, so people are more

likely to be injured- They also may feel more stress because it was so

surprising

Was It Expected or Not?

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•Time and day– Where were people when it happened?– Were families together or apart? – Was it light or dark?– Were people asleep?

•Season/climate– Is it very hot or very cold out? – Do people have the right clothing or shelter?

Crisis/Disaster Timing

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Some people or groups often have strong reactions to stressful events and may need more assistance. This can depend on:

• Age (very young or very old)• Gender (women often feel more stress)• Family role (especially mothers trying to take care of their families)• Amount of exposure to the disaster (if the person was very close to it,

or in danger for a long time)• Loss of family member, or injury to family member• Loss of home or possessions• Pre-disaster stress: If the person was already coping with other

problems • Lack of resources: If the person did not have much social, financial, or

personal support

Who Was Impacted?

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Reactions can also depend on how people were treated after a crisis/disaster:

• Did they get help with practical needs like medical care or assistance rebuilding a damaged home?

• Did they get help with emotional needs (support from friends and family, Psychological First Aid, professional help for those with strong reactions)?

• Do they feel their needs were ignored or overlooked, or that people blamed them for their situation?

What Help Did People Receive?

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Reactions to StressA person’s reaction will come from a combination of

the characteristics of the crisis/disaster, the individual, and the response.

Disastercharacteristics

Responsecharacteristics

Individualcharacteristics

Survivor reaction

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Common ReactionsPeople can experience many different types of

reactions when they are exposed to extreme stress. These are common reactions to difficult experiences:• Physical• Emotional• Thinking• Behavioral• Spiritual• Increased conflict

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Reactions: Physical

• Jumpiness, edginess • Appetite change (want to eat more or less than usual)• More desire for caffeine, nicotine, alcohol• Heart pounding, rapid and shallow breathing, light-

headedness• Stomach distress • Trouble sleeping (fatigue, exhaustion, insomnia)• Muscle tension or pain• Headache• Worsening of other health conditions

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Reactions: Emotional• Anger, hostility, rage• Resentment towards everyone, including those who are

not to blame• Depression, sadness, tearfulness• Anxiety, fear, panic • Guilt, shame, self-doubt• Emotional numbing - not feeling anything at all• Feeling overwhelmed, hopeless, out of control• Irritability, impatience• Mood swings

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Reactions: Thinking

• Disbelief, sense of unreality• Worry• Can’t stop thinking about the situation• Problems with memory or concentration• Can’t focus, solve problems, or make decisions• Confusion• Errors in thinking (blaming self or other when it’s not

fair, all-or-nothing thinking)

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Reactions: Behavioral• Avoiding reminders of the crisis• Sleeping a lot more or less than usual • Can’t relax• Withdrawing, isolating oneself from family and

community• Increased conflict with family or co-workers• Working too much to avoid thinking about the event• Crying easily• Bullying other people• Change in sex drive

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Reactions: Spiritual

• Change in relationship with G_d or higher power (increase in faith, or questioning of faith)

• Change in religious practices (increase or decrease in prayer or attending services)

• Questioning of belief that the world is fair• Struggle with questions about meaning, justice, fairness

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Reactions: Increased Conflict

When we are stressed we cannot: • Be fully aware of our own feelings• Really know what we need• Communicate our own needs clearly• Accurately read another person's nonverbal

communication• Hear what someone is really saying

These factors all increase conflict!

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Reactions to Loss

When a loved person dies because of crisis or violence, survivors can feel strong emotions:•If it was human-caused: anger, blame•If a warning was ignored: self-blame, guilt•If the survivor feels they should have done more:

shame •If a death was sudden and unexpected: no chance to

say goodbye or resolve issues with the person, or to prepare for the loss

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Psychological First Aid:Helping People in Need

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Helpful Helping

• Describe a difficult time in your life and a person who helped you through it.

• What were the qualities of that person?

• What did he or she say or do that helped you the most?

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Principles of Helpful Helping

We should do all that we can to: • Promote a sense of safety• Promote calm• Promote sense of confidence and competence in

self and community• Promote connection • Instill hope and faith

(Hobfoll et al., 2007)

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Defining Psychological First Aid

Psychological First Aid (PFA) describes a humane, supportive response to a fellow

human being who is suffering from a serious crisis event and who may need support.

(World Health Organization, 2011)

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Purpose of PFA

Psychological First Aid actions are designed to address all of the connected needs of the survivors:• Practical• Physical• Emotional and social

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Elements of Psychological First AidPFA is not a process, but a toolkit to be used as needed, in any

order appropriate• Model calm• Provide warmth and

acknowledgement• Listen• Be honest and trustworthy• Help survivors help themselves • Attend to safety needs• Attend to physical needs

• Provide information and direction to services

• Provide psychoeducation• Help survivors connect• Help survivors avoid negative connections • Assist with traumatic grief• Assist with conflict resolution

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Model Calm• Just being calm when you are in contact with someone in

great distress can be helpful. • Disasters and violence increase physical and emotional

arousal or excitement.• One aim of PFA is to reduce this high arousal level by

“modeling calm” - if you show people your own calm attitude and behavior, they often become less upset.

• By being steady you can help survivors control their own strong feelings.

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Provide Warmth and Recognition • Be respectful and show caring and concern for the survivor by

being attentive and speaking in a soothing tone of voice.• Do not judge the survivor’s thoughts and feelings.• Do not minimize the disaster or distress:

– Survivors need people to see that they have experienced a stressful event and that their reactions are understandable.

– If their distress is not recognized and validated, survivors may not take

the necessary time to rest and recover.

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Listen• If survivors want to describe what happened to them, be

prepared to listen.• Do not pressure people to talk if they do not want to. • Listen to both thoughts and feelings. • Be ready to listen to a survivor’s feelings of pain or loss or

rage or shock without getting overwhelmed yourself or changing the subject.

• Do not leave survivors alone if their feelings are very strong. Make sure they are with a family member, spiritual leader, or other supportive person.

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Things to Say to Show You Are Listening

–“So you feel…”– “I hear you saying…”– “I sense you are feeling…”– “You appear…”– “It seems to you…”– “So tell me if I am getting this right? You seem to be feeling that…”

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Be Honest and Trustworthy

• Only honest and genuine caring and listening is helpful for survivors.

• Being truthful does not mean being blunt or rude. • Know your own limits so you can take a rest or

break when you need to. Do not try to care for others when you are exhausted.

• Do not repeat or gossip about what you hear.

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Help Survivors to Help Themselves

• Support survivors’ strength, courage and power so they can begin to regain a sense of control.

• If they are able, survivors can be encouraged to participate in helping others.

• Ask: “How have you gotten through tough times before?” or “What skills do you have that will allow you to get through this?”

• Allow survivors to determine the kind of assistance they receive and how much they want to talk about the event.

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Attend to Safety Needs

• Try to protect survivors from threats from the ongoing disaster or violence, especially those who may be so upset or disoriented that they are not able to care for themselves.

• Help people to find shelters or places to say that maximize safety.

• Support safety and stability by encouraging families to maintain their routines as best they can.

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Attend to Physical Needs

• When people are very distressed, they can ignore their own injuries. Be sure that those who are hurt receive medical attention.

• Survivors could be offered water, hot drinks, or blankets, which provide comfort as well as helping with physical needs.

• If someone’s home is damaged, you may need to assist them with finding a shelter, or locating a friend

or relative to stay with.

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Provide Information and Direction to Services

• Survivors want and need different kinds of information (what happened, who was affected, where can I get help). If possible, provide lists of available resources.

• When people are very upset they may have a hard time understanding or remembering information. Speak clearly and slowly using simple language, and repeat yourself if needed.

• Provide only information you know is true.• Rumors are very common in stressful times – encourage

people to not accept or share false information.

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Psychoeducation

• Help people understand their reaction to the experience is natural and understandable:– “a common reaction to an uncommon event”

• Share materials on stress and stress management:– Teach effective ways of coping (actions that help people feel

better and function better)– Help people recognize when coping skills are not working. For

example, smoking or using drugs or alcohol may make people feel better for a while, but do not help them function better

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Help Survivors Connect • Social support can lower stress even if the support comes

from one reliable person. • Survivors should be reunited with people who can

provide emotional support and security: – Friends, neighbors, and family can offer practical support

(money, a place to stay), emotional support, and advice.– Clergy, spiritual leaders, or family leaders can offer guidance and

comfort.

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Help Survivors Avoid Negative Connections

• Not all relationships or family members are supportive; some relationships can be sources of stress and misery.

• Contact with people who blame or punish the survivors, increase their anxiety, or make demands on them will not help recovery.

• Encourage survivors to connect with family and friends they trust.

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Assisting Survivors after a Death • There may be practical problems you can help with such as

contacting family members, identifying remains or arranging funerals.

• However, when there are no problems to solve, you can help simply by being a calm and supportive presence.

• Link survivors to spiritual and family leaders.• Be kind.

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Help Survivors to Manage ConflictConflict is decreased when survivors can:

• Manage their stress and stay calm.• Pay attention to the feeling of others. Try to recognize

and respond to the things that matter to the other person.

• Control their emotions and behavior.• Try not to hold onto resentments and anger.• Be aware of and respectful of differences.

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Pay Special Attention to or Try to Get More Help for Those Who:

• Threaten to harm themselves or others • Are not thinking clearly, or seem confused• Repeat the same behavior over and over • Are hysterical or panicking• Do not seem connected to reality• Had someone close to them killed or injured or missing• Have a home that is unlivable• Have a preexisting psychiatric disorder• Are physically injured • Had a long or intense exposure to the event

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Helping Those with Vulnerabilities• These individuals may have issues related to mobility, cognition,

sensory, and/or overall health.• Be aware of their need for medications, assistive devices (like a

wheelchair or hearing aid), meals, structure, other social supports.• Recognize these individuals are unique even if they have similar

conditions.• Be clear when you communicate with them.• Be aware of your own responses to working with these individuals.• It may be helpful to keep a list of where these individuals live so

someone can check on them.

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Helping Children and Adolescents• They need special attention and care, and are not as resilient as you

might think• Their needs will vary based on developmental age and they may

regress to earlier stages in the face of disaster or violence, acting younger than they are or losing skills like toilet training.

• Do provide basic information to young people, but don’t add unnecessary details that may scare them.

• Allow children to talk about the experience if they want to, and provide supportive listening.

• As much as possible, allow them to interact with other children.• Try to establish routines as quickly as possible, such as regular meal

times and school activities.

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Take Care of Yourself

• Everyone who responds to a crisis or helps others in times of conflict is impacted.

• You need to be alert for signs of stress and distress in yourself and in others who are trying to help survivors.

• It is important to learn good self-care habits now so you can continue to use them during a crisis, and especially afterwards

• See the brochure, Help for the Helpers, for specific ways to practice healthy self-care

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Practicing Psychological First Aid

• In groups of 3-5 (depending on size of class) read the scenario and discuss how you would apply the principles of Psychological First Aid. Someone in the group should write down your responses to share with the rest of the class at the end of the exercise.

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Some Final Thoughts on Helping Others

• Be kind• Be calm• Be informed• Be tolerant• Be patient• Be flexible• Ask for help when you need it• Take care of yourself

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THANK YOU

• Questions and comments• Be sure to fill out course evaluations

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