Editorial: Promoting and exploring the effectiveness of the psychological first aid approach

Editorial on the Research Topic
Promoting and exploring the effectiveness of the psychological first aid approach

The necessity for Psychological First Aid (PFA) arises from the need to address acute stress reactions (ASRs) that individuals experience following potentially traumatic events (PTE). ASRs, characterized by anxiety, confusion, and helplessness, can severely impair a person's ability to function. Without timely intervention, ASR can escalate, leading to long-term psychological problems like post-traumatic stress disorder (PTSD) (1). Effective PFA aims to stabilize individuals immediately, reducing the risk of developing chronic mental health problems and aiding in the rapid return to normalcy.

Initially, interventions such as psychological debriefing were widely used. This model focused on encouraging emotional expression and recounting traumatic experiences shortly after the event. However, several meta-analyses found that debriefing is ineffective and sometimes increased the risk of PTSD (2).

Modern approaches to PFA emphasize immediate, cognitive-functional interventions designed to stabilize individuals and promote resilience. One such model is the Six Cs, developed by Farchi et al. (3), which focuses on Cognitive Communication, Challenge, Continuity, Control, and Commitment. This model aims to shift individuals from helplessness to active coping by engaging cognitive and behavioral processes to regulate emotional responses, thus reducing the impact of limbic system hyperactivity (3). Studies have shown that the Six Cs model effectively reduces anxiety and improves resilience and self-efficacy in both professionals and laypersons trained to respond to ASRs (4). The Israeli defense forces and other armies have adopted the Cs in the form of YaHaLOM, attesting to the applicability of the Cs in other contexts and cultures (5).

Studies were conducted to determine the effectiveness of PFA training based on the protocol developed by Farchi et al. (3). Additionally, were more effective in all cases, especially when the rescuers were trained (6). In fact, trained rescuers who were instructed to make decisions emotionally were as inefficient as untrained ones. Moreover, those with high openness to experience, high honesty, high attraction and low aversion to culturally diverse others, and low avoidant coping were the ones with the greatest ability to provide effective responses in PFA (7).

Challenges that PFA approach must address

Research over the years reaffirms the importance of early intervention in offering basic support to people who have experienced a PTE (8). This support should focus on cognitive assessments, promote coping resources, and help reduce ASR by facilitating the return to normal functioning and regulating stress responses.

Professionals must approach their actions with minimal intervention to avoid interfering with the natural recovery process. This allows different approaches from various agents, both community and professional, with varying levels of specialization. PFA differs from advanced psychological intervention (API) in that PFA provides immediate, basic support and can be administered by those affected themselves, peers, or volunteers with basic training, while API is for more severe cases and requires specialized training.

Providing PFA knowledge to non-professionals is crucial as it enables immediate support and intervention, helping reduce the impact of ASRs. New, immediate, focused, safe, and effective PFA approaches are still needed (9, 10).

This Research Topic “Promoting and exploring the effectiveness of the psychological first aid approach” aims to explore the effectiveness of implemented PFA protocols in various contexts worldwide.

Brief review of articles in this Research Topic

Mental distress often follows a stroke and affects recovery. The study by Guo et al. used advanced statistics to examine mental distress trajectories and demographic predictors in stroke patients over four time points. Although the study provided only the methodology and no results, it is relevant to PFA. Understanding potential reactions in advance can help plan preventative PFA interventions to alter negative trajectories and improve prognosis after stroke.

The well-structured study “Positive mental health and sense of coherence among emergency medical service professionals” (Mantas-Jiménez et al.) investigates the relationship between Positive Mental Health (PMH) and Sense of Coherence (SOC) among 406 healthcare professionals in the emergency ambulance service in Catalonia, Spain. Main findings reveal that high scores in PMH were significantly associated with greater job satisfaction and a strong SOC. The research identifies Meaningfulness and Comprehensibility, dimensions of SOC, as predictors of higher PMH. Furthermore, the study's findings relate to the principles of PFA and underline the importance of SOC in promoting PFA.

The study “Pilot evaluation of a Psychological First Aid online training for COVID-19 frontline workers in American Indian/Alaska Native communities” by O'Keefe et al. evaluated a culturally adapted PFA online training for COVID-19 frontline workers in American Indian/Alaska Native communities. Participants reported high satisfaction and increased PFA knowledge. The training significantly improved positive mental health, social wellbeing, and reduced burnout after 3 months. Despite the lack of a control group, the study is important because it provides a cultural perspective on PFA and highlights the increased attention to emotional wellbeing during the COVID-19 pandemic.

The article “Assessing the role of sustainability competencies in enhancing psychological first aid effectiveness for disaster responders in Fiji” examines how trained and untrained disaster responders value sustainability competencies (critical thinking, integrated problem solving, systems thinking, anticipatory normative, collaboration, strategic, and self-awareness), finding that importance varies by age, experience, and training (Nair and Meirmanov). Younger and less experienced responders rate all competencies as very important, while more experienced responders with PFA training particularly emphasize integrated problem-solving, collaboration, and self-awareness.

In conclusion, the articles in this Research Topic illustrate the need for PFA, its accessibility to non-professionals, and the importance of identifying those in need of targeted interventions. Structured PFA training programs improve mental health outcomes. The primary recommendation is to expand PFA training to both non-professionals and professionals across various fields.

Author contributions

MF: Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Resources, Software, Supervision, Validation, Visualization, Writing – original draft, Writing – review & editing. AP-G: Conceptualization, Data curation, Investigation, Methodology, Supervision, Writing – original draft, Writing – review & editing. SA: Conceptualization, Investigation, Visualization, Writing – original draft, Writing – review & editing. YG: Conceptualization, Investigation, Supervision, Validation, Writing – original draft, Writing – review & editing.

Funding

The author(s) declare that no financial support was received for the research, authorship, and/or publication of this article.

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher's note

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References

1. Adler AB, Gutierrez IA, McCuaig Edge H, Nordstrand AE, Simms A, Willmund GD. Peer-based intervention for acute stress reaction: adaptations by five militaries. BMJ Mil Health. (2023) e002344. doi: 10.1136/military-2022-002344

PubMed Abstract | Crossref Full Text | Google Scholar

2. Gidron Y, Farchi M, Eisenman A, Husien A, Berends K, Hubloue I. Effects of a memory structuring plus vagal breathing intervention on acute stress reactions: three controlled trials. Ment Health Fam Med. (2018) 13:699–707.

Google Scholar

3. Farchi M, Hirsch-Gornemann MB, Whiteson A, Gidron Y. The Six Cs Model for immediate cognitive psychological first aid: from helplessness to active efficient coping. Int J Emer Mental Health Hum Resil. (2018) 20:1–12. doi: 10.4172/1522-4821.1000395

Crossref Full Text | Google Scholar

4. Farchi MU, Bathish L, Hayut N, Alexander S, Gidron Y. Effects of a psychological first aid (PFA) based on the SIX Cs model on acute stress responses in a simulated emergency. In: Psychological Trauma: Theory, Research, Practice, and Policy. Advance online publication (2024). doi: 10.1037/tra0001724

PubMed Abstract | Crossref Full Text | Google Scholar

5. Svetlitzky V, Farchi M, Ben Yehuda A, Adler BA. YaHaLOM: a rapid intervention for acute stress reactions in high-risk occupations. Mil Behav Health. (2019) 8:23242. doi: 10.1080/21635781.2019.1664356

Crossref Full Text | Google Scholar

6. Azzollini SC, Depaula PD, Cosentino AC, Bail Pupko V. Applications of psychological first aid in disaster and emergency situations: Its relationship with decision-making. Athens J Soc Sci. (2018) 5:201–13. doi: 10.30958/ajss.5-2-5

Crossref Full Text | Google Scholar

7. Becerra L, Bail Pupko V, Depaula P, Azzollini S. Entrenamiento a voluntarios en primera ayuda psicológica, empatía y estrategias de afrontamiento. Rev Actualid Psicol. (2021) 35:1–18. doi: 10.15517/ap.v35i131.38911

Crossref Full Text | Google Scholar

8. World Health Organization and UNHCR. Assessment and management of conditions specifically related to stress: mhGAP intervention guide mode. World Health Organization (2013). Available at: https://iris.who.int/handle/10665/85623

Google Scholar

9. Ashkenazi I, Hunt RC. You're it-you've got to save someone: immediate responders, not bystanders. Front Public Health. (2019) 7:361. doi: 10.3389/fpubh.2019.00361

PubMed Abstract | Crossref Full Text | Google Scholar

10. Hantman S, Farchi M. From helplessness to active coping in Israel: psychological first aid. In:Schott E, Weiss EL., , editors Transformative social work practice. London: Sage publications (2016).

Google Scholar