When a person experiences trauma, caring and appropriate support from the people around them can help them heal and move forward. One model that has proven effective for providing this support is called psychological first aid. Just as medical first aid is needed when someone is physically injured, psychological first aid can help people who have been emotionally wounded by trauma.

The basic principles of psychological first aid are relatively simple. Most come naturally in caring relationships, whether among friends, family members, work colleagues, or in the relationship between a displaced person and a housing host.

Understand the effects of trauma.

As a first step, it helps to understand the range of emotional reactions a person can have in response to trauma. These can include

• Irritability and anger
• Mood swings
• Lack of motivation
• Trouble concentrating
• Emotional numbness
• Feelings of helplessness and disconnection
• Fear and confusion
• Headaches
• Nausea or loss of appetite
• Difficulty sleeping
• Obsessive thoughts about the traumatic experiences

These reactions can be disturbing, both to the person who has them and to you, as a friend, family member, work colleague or housing host. Recognising these signs as indications of trauma can help you be kind and patient as the person you are trying to support recovers from their experiences.

Here are ways to use psychological first aid in supporting others.

Here are some ways you can apply the principles of psychological first aid in being supportive to a person who has experienced trauma.

Help them feel safe, welcomed and important.

A sense of physical safety is important in recovering from trauma. Do what you can to make your home (if you are a family member or housing host) or the workplace (if you are a work colleague) feel safe and far removed from the trauma the person has experienced. Pay attention to physical security, jarring sounds and other factors that might trigger disturbing memories and fears.

Just as important is a sense of emotional safety. Make your relationship with the person you are trying to help one of emotional comfort and safety, without pressure, judgement or criticism:

• Make the person feel welcome and important. Show that you are happy to have them in your home, that you value them as a friend or colleague, and that they matter to you as a person.
• Be present and available. Even if the person doesn’t want to talk, it can be comforting to have someone with them – even simply nearby or available by phone if they prefer to be alone most of the time.
• Listen when they are ready to talk. Don’t push the person to talk about their experiences, but be available to listen if they want to talk about them – or if they want to talk about anything else. Put aside other distractions when the person is open to talking. If their talk is tearful, angry or otherwise emotional, don’t be afraid or pull back. Be calm, keep listening and show that you are there for the person as a comforting presence. Statements like, ‘This must be so hard for you’, or ‘I can’t even imagine what you’ve been through’, show that you are listening and that you care.
• Avoid simple reassurances. While they might seem to be comforting, statements like, ‘Things could have been worse’, ‘It’s not so bad’, ‘Stop worrying’ or ‘Look on the bright side’, aren’t usually helpful. They can convey that you don’t believe or respect the pain the person has experienced. In the same way, statements like, ‘I know how you feel’ or ‘You’ll be OK’, can feel dismissive. You don’t know how the person feels, and you hope, but don’t know, that they’ll be OK.
• Accept that the person’s emotional reactions are real and valid. A person who has experienced trauma may have what seem to be exaggerated or unrealistic fears and other strong emotional reactions. Accept the person’s reactions as genuinely felt. They are the person’s real experience. Don’t criticise or find fault with the person for having those reactions. Reassure them that what they are feeling – even if it’s numbness or an absence of feeling – is a natural reaction to the trauma they have experienced.
• Help them be and feel connected. Be available to the person for conversation and human connection, but don’t be offended if they want to talk to close family members or friends instead of you. Help them make those connections. In the workplace, that might mean allowing flexibility during the workday for personal and private conversations with people outside of work.
• Be kind, patient and forgiving. A person who has experienced trauma can be moody, withdrawn, angry or tearful at times. Don’t take this as a reaction to you. Instead, understand it as a natural reaction to the trauma they have experienced. Give the person time, space and privacy to work through these traumatic reactions. Don’t let your own emotions provoke you into a cold or angry response.
• Don’t push or hurry the person to get better or move on. It can take months or longer to recover from trauma.
• Understand that the person may not know what they need and may not ask for help. Don’t assume that silence, indecision or emotional numbness are indications a person has no need for help. Without pushing it, show that you have not abandoned them and are available to help when they need it. Keep asking, gently and without pestering, what you can do that might be helpful.

Help them feel calm and comfortable.

• Make the environment as comfortable as possible. Provide places to rest and private space for them to be alone.
• Be sure regular meals and healthy snacks are available, including food options the person finds comforting.
• Establish routines, with regular mealtimes, breaks for rest, times for physical activity, and regular times to wind down at night and get up in the morning. Don’t force the person to follow these routines, just provide them as a framework for daily life.
• Encourage the person to do things that make them feel good, and help them get the rest and physical activity they need. That might be taking a walk outside, reading a book or taking a nap.
• Respect the person’s privacy. Allow them to be alone when they choose to be and silent when they don’t want to talk.
• Pay attention to media exposure. Talk with the person to find out how much news and opinion they want to see and hear. They may feel the need to keep up with news, but it might be helpful to manage that exposure so it isn’t a continuing source of trauma.

Help them connect with practical and social supports.

A person who has experienced trauma may not always think clearly or have the energy to deal with the many challenges they face. You can help by offering your own problem-solving skills and your knowledge of available support systems:

• Ask how you can help the person get any information and support they may need. Without pushing them, help them find out about services that may be available to them. Those might include
  • Information about housing options and jobs, either where they are or in other locations
  • Options for moving to another part of the country or to another country
  • Legal requirements for living outside their country or moving to another country
  • Financial support to help with the costs of housing, daily living or travel
  • Professional mental health counselling
• If it might be helpful, offer to help them locate or stay connected with distant friends and family members, especially people they may have left behind in an area of danger.

Help them regain a sense of control.

• Don’t take over in your efforts to be helpful. Among the reactions to trauma can be feelings of helplessness and loss of control. Taking even small steps on their own can help a person start to heal from trauma by rebuilding a sense of personal control. Share information you find about help and support options without pushing them or suggesting the person needs them.
• Give advice only if you’re asked for it. Offer encouragement rather than instructions. Reassure the person that you are there for, care about and believe in them.
• As appropriate, help the person think of coping strategies that have worked for them in the past. That might be deep breathing, spending time in nature or any other healthy steps (not alcohol or drugs) they have used before to feel calmer and think more clearly.
• Encourage the person to try a creative activity. Activities such as drawing, painting, writing, sewing, knitting, gardening, woodworking, dance and music can help a person engage their mind and body in an activity that is pleasurable and that they can control. An activity that brought joy to the person before the trauma may help bring it again. Help by providing needed supplies and space.
• Help the person consider what they can do to help themselves or others. Taking even small steps is empowering when a person feels that their life has no direction or feels out of control. Taking care of oneself is an important small step. Helping others can begin to restore a sense of meaning and purpose to life.
• As appropriate, encourage the person to get additional emotional support. That might be through talking with other trusted friends and family members, or it might be through talking with a professional counsellor. Respect that this is their decision. Choosing help in healing is another way for a person to regain a sense of control, and professional counselling is more effective when a person makes their own decision to seek that help.

Take care of yourself.

Hearing about trauma and seeing its effects on a person who is close to you can be traumatic in its own way. You may have your own emotional reactions to the stories you are told. You may become exhausted from your efforts to be a calm, caring and patient helper. It’s important to take care of your own mental health as you take steps to help another person. Stay in contact with supportive friends, get plenty of rest, be physically active, and engage in activities that bring you joy and help you relax. Don’t hesitate to reach out for emotional support when you need it. Your employee assistance programme is one source for this support. Your doctor (GP) can also help you find a professional counsellor.

For More Information

Check out these resources for more information about psychological first aid:

• American Psychological Association (APA). (2019, March). Understanding psychological first aid. Washington, DC: Author. Retrieved 1 April 2022 from https://www.apa.org/practice/programs/dmhi/psychological-first-aid
• Brymer, M., Elmore Borbon, D., Frymier, S., Ramirez, V., Flores, L., Mulder, L., et al. (2021). Psychological first aid for displaced children and families. Durham, NC: National Child Traumatic Stress Network (NCTSN). Retrieved 1 April 2022 from https://www.nctsn.org/resources/pfa-for-displaced-children-and-families
• World Health Organization (WHO). (2011). Psychological first aid: Guide for field workers. Retrieved 1 April 2022 from https://www.who.int/publications/i/item/9789241548205 (This is available in 20+ other languages at this URL, including Russian and Ukrainian, so readers can download any language version they need as a PDF.)