In the past few days, a public psychology website of which I am an editor, PsychAlive.org, started getting unusual visits from outside the United States. Typically only attracting an audience of nations that hold English as their first language, we were surprised to find that the place these visits were coming from was Japan.
The disaster in Japan has sent a ripple of grief, shock and fear across the world. The struggle to provide medical care and repair destruction in the face of ongoing horrors has consumed the country. And in this state of grief, shock, terror, and uncertainty, people are seeking psychological help.
Through this crisis, ensuring people's physical safety is undoubtedly of primary importance. Each day we all witness and weigh the severity of the tangible destruction. Many of us seek to help through donations or at-home volunteer work. Others are brave enough to travel thousands of miles across the world to participate in on-site efforts to forge a path back from devastation. Yet the injuries experienced by the individuals of this nation require not only physical, but psychological, first aid that can help them through what may very well be the most traumatic event of their lives.
Psychological First Aid is an integral approach to helping victims living in the wake of a dramatic event such as a natural disaster, public health emergency "or even a personal crisis." As the Minnesota Department of Health states, "Emotional distress is not always as visible as physical injury, but it is just as painful and debilitating."
Psychological First Aid is designed to help people cope with the stress, shock, confusion, fear, feelings of hopelessness, grief, anger, guilt and withdrawal that arise when a catastrophe has occurred. In Japan, these emotions are undoubtedly powerful, as people fear for their loved ones, their homes, their homeland, the jobs that sustain them and even the air they breathe.
This state of shock not only impacts people's long-term psychological stability, but their short term well-being, including their ability to survive, cope and care for themselves and their loved ones. Getting people the help they need to regain a sense of safety and security is essential, and Psychological First Aid gives us the tools to make this possible.
This method does not require a professional to carry out the steps of care. The process can be learned and employed by anyone who can make direct contact with individuals affected by crisis. The earlier you can assist someone in gaining a sense of calm and meeting their immediate needs, the better they can cope throughout their state of trauma. These methods are not only helpful to victims directly impacted by the tragedy in Japan, but to the many people around the world who have been affected by these events. Everyone reacts differently to trauma. By remaining attuned to those who may be most affected, we can employ the following steps to ensure these people optimum care:
- Engage with the person. Early intervention is key to meeting immediate needs and preventing future problems. If you are concerned for someone, seek permission from the person to engage. Be sensitive when approaching. Don't offer false reassurance or make any demands.
- Ask where they would feel safe. Even in the most frightening of circumstances, it is important to try to seek out a space where a person feels the safest. This may be in a certain room in a shelter, somewhere familiar or somewhere unfamiliar. Whatever this place may be, it will provide the best setting for you to talk.
- Stabilize the person. While some people can self-enforce a state of calm, even in dark circumstances, many people are beside themselves when a tragedy strikes. You can offer this person stability by speaking calmly and reassuring them whenever they engage in something self-soothing. This can be something as simple as a deep or even breath. Comment on these moments by saying, "That was good," whenever they take a breath. Help them engage in breathing exercises. This will help their physiological system to become regulated.
- Meet the person's basic needs. After Hurricane Katrina, 9-11 and the earthquake in Haiti, methods of Psychological First Aid were key in helping people get their needs met. Once calm, individuals are better able to comprehend their own needs to get through the next few minutes, hours or days. The person may need water or a blanket. Perhaps they need a place to sleep or someone to help them locate their family. Do whatever you can to help this person meet their needs, and try to remain calm and attentive in doing so.
- Teach Psychological First Aid. It's important that people not only practice techniques of PFA, but that they teach local citizens in a community how to do it. This will allow the effects to be maintained long after the emergency teams have moved on. In my local community of Santa Barbara, Calif., The Glendon Association was a key partner in creating a volunteer Santa Barbara Response Network of individuals who've been trained in PFA. Whenever there has been a crisis or trauma in our community, the S.B. Response Network has been able to respond to those affected and reach out to them before the crisis escalates. In Japan, this must be offered on a large-scale, a process that can only be implemented when people are trained in dealing with the emotional crises that accompany the physical.
- Connect people to social supports. A sense of connectedness and social support is vital when healing from a disastrous event. People who are hurting must be reached out to and connected with others who have been better able to cope.
- Create coping groups. Once it is possible to do so, it is valuable to form groups in which people can communicate the ways that they themselves have learned to cope with intense emotions of loss, grief, anger and fear. Sharing techniques on how to cope creates a support system and a collective desire to heal. People can learn from one another and employ the practices that can help them to stay calm and hopeful as they move into the future.
When you are using Psychological First Aid, there are several methods you should avoid -- what The New York City Department of Health and and Mental Hygiene calls, "Psychological First Aid Don'ts." These include:
- Don't force people to tell their stories. Focus on keeping them calm and meeting their needs.
- Don't offer false reassurance with statements like, "Everything will be okay."
- Don't instruct people on what they should be thinking or feeling.
- Don't make promises that cannot be kept.
You can see a full list of the do's and don'ts of Psychological First Aid here. You can also participate in an online training course in Psychological First Aid held by the National Child Traumatic Stress Network here.
There is no simple way, no straight forward list of do's and don'ts, to dispel the pain of the people going through real tragedy. However, Psychological First Aid is one of the most effective, immediate ways to help fellow human beings through the initial stage of crisis. The process is intended to lead to post-traumatic growth instead of post-traumatic stress disorder. The hope is that one day, the people impacted may gain a sense of inner peace, calm and hope, shifting this tragedy from a present encounter to a part of their past. Let's all be hopeful, and do what we can to help that day to come soon.
To read more from Dr. Lisa Firestone, visit PsychAlive.org.