💗Psychological First Aid and Self-Care

What psychological first aid is and is not

The most common mistake in psychological support is the well-intentioned attempt with a harmful method — pressuring the person to "talk" before they are ready.

Psychological First Aid (PFA) is a set of practical responses offered to people who have experienced a traumatic event in the acute crisis phase — the first hours and days. The goal is not to "heal" the person or diagnose them, but to reduce acute distress and strengthen the capacity for natural adaptation. What it is not: it is not psychological therapy, counselling, or forcing the person to relive the incident. A harmful response forces discussion of the trauma before the person is ready, or makes promises that cannot be kept.

• Safety: secure the place and remove immediate distress triggers as much as possible
• Calm: be calm yourself — your calm is a positive contagion for the affected person
• Connection: be present beside the person without pressure to speak
• Self-efficacy: help the person regain a sense of control over something small
• Social connection: facilitate their contact with family or their support network

The difference between psychological support and psychological therapy is not just technical — it is the dividing line that protects both volunteer and beneficiary. Psychological first aid is provided from one person to another at the acute moment, with the goal of reducing temporary distress and strengthening the natural capacity for adaptation. Psychological therapy, by contrast, is provided by a licensed specialist, and involves diagnosing psychological disorders, treating the roots of trauma, and applying specific therapeutic protocols such as cognitive-behavioural therapy. What the volunteer must never do within the PFA framework: First — no diagnosis: do not tell anyone "you have post-traumatic stress disorder" or any other diagnostic term. Diagnosis is the right of the licensed specialist alone, and labelling without expertise causes harm even when it is accurate. Second — no forced trauma re-evocation: do not ask the person to retell the details of what happened to "release" what they carry — some trauma re-evocation methods without specialist training deepen the wound rather than ease it. Third — no false promises: avoid phrases like "you will recover soon" or "time heals everything" — these are promises beyond what you can guarantee, and when they do not materialise they break the trust you built. Fourth — no extended introspection sessions: sessions targeting interpretation of deep emotions and uncovering psychological layers exceed PFA scope and may open doors you have no tools to safely close. Awareness of these boundaries does not diminish your role — it defines it precisely and makes your support safer and more genuinely impactful.

Recognising acute distress and danger signs

Not everyone who appears calm is fine, and not everyone who cries is in danger. Reading the situation accurately determines the type of response needed.

Reactions to psychological trauma are varied: some people cry intensely, some freeze in complete silence, some laugh inappropriately, some act as if nothing happened. All of this is normal in the short term — and not in itself an indicator of danger. Danger signs requiring immediate referral to a specialist: thoughts of harming oneself or others, complete disconnection from reality (does not know where they are or what happened), violence or threats, and complete inability to meet basic needs due to psychological state.

Applying psychological first aid in the field

Field psychological first aid happens under stressful conditions with limited tools — and this does not nullify it, it shapes its application challenge.

In the field, you often do not have an office, privacy, or enough time. But you can always: **Physical presence:** be at the same level as the person (sit if they sit, stand if they stand). Avoid looking down at them. **Simple language:** "I am here. You are safe now. How can I help you?" — simple open questions, not lectures. **Basic needs first:** water, warmth, a place to sit — before any talk about feelings. **Referral is not failure:** referring the person to a specialist when the situation exceeds PFA scope is the correct response, not surrender.

Repeated exposure to traumatic situations in the field accumulates what is known as "vicarious trauma" or "compassion fatigue" — a condition where the volunteer is cumulatively affected by others' suffering, impacting their mental health and ability to continue giving. Prevention is not a luxury but a professional requirement for service sustainability. **Before intervention:** ensure you have a clear personal support point — someone you inform of your emotional state and return to. Going to crisis sites without a personal support network is not courage but a systematic error. Know your emotional limits before entering and agree with yourself when you will ask for help. **During intervention:** monitor your body's signals: persistent muscle tension, recurring headaches, and acute anxiety — these are indicators worth stopping and resting for. Take regular short breaks even when circumstances seem not to allow it. Rest is not abandoning beneficiaries — it is service continuity that protects it from collapse. **After intervention:** consciously separate the field work environment from your personal life. Do not bring the details of beneficiaries' stories home, and dedicate time to activities that give you calm and distance from the weight. Talk with fellow volunteers about your experience — conversation with those who shared the situation releases the weight without requiring a specialist. When vicarious trauma symptoms appear — recurring nightmares, excessive sensitivity, social withdrawal, or loss of meaning in work — contact a mental health specialist. These are not weakness symptoms; they are indicators of a human emotional system requiring deliberate maintenance to continue giving.

Role limits and correct referral

Knowing the limits of your role is not an admission of incapacity — it is a sign of professional competence. Timely referral saves lives.

Psychological first aid is designed for the acute phase — the first hours and days. After that, those who need ongoing support require a mental health specialist. Appropriate referral requires knowing available resources in advance: who is the available specialist in the area? What psychological services do the organisation or its partners offer? Referral requires three things: explaining the reason for referral to the person honestly and without stigma, obtaining their consent as much as possible, and ensuring necessary information transfer to the specialist (while maintaining confidentiality).

Grounding techniques are practical tools that help a person regain their presence in the current moment when intense emotions or traumatic memories overwhelm their awareness. The most widely used is the 5-4-3-2-1 exercise: ask the person to name five things they can see, four things they can touch, three sounds they can hear, two things they can smell, and one thing they can taste. This exercise redirects the brain's attention from intense emotional processing to concrete physical senses. Physical grounding is also helpful: ask the person to place their feet firmly on the ground and focus on the sensation of their body's weight. A quiet phrase can be added such as: "I am here now, and this moment will pass." These techniques are completely safe and used with adults and children alike, and can be used before specialist referral or during follow-up.

Deep breathing is one of the simplest and most effective tools in psychological first aid. The Box Breathing technique: four seconds inhale, four seconds holding, four seconds exhale, four seconds pause — then repeat. This cycle activates the sympathetic nervous system and reduces the body's "fight or flight" response. The 4-7-8 technique is deeper: four seconds inhale, seven seconds holding, eight seconds exhale. The longer exhale sends a signal to the nervous system that the danger has passed. When teaching this technique to someone in crisis, sit beside them and practise it with them — your practical participation reduces resistance and speeds calming. Three breathing cycles are usually enough to begin feeling relief.

Peer Support Circles are small groups of volunteers who meet regularly to talk about their emotional experiences in fieldwork. They are not therapy sessions — but a preserved space for mutual listening without judgment, and sharing coping strategies. How to form a successful support circle: 4-6 volunteers who meet every two weeks, a designated facilitator who rotates, clear rules (confidentiality, no unsolicited direction, everyone's right to silence). Research confirms that volunteers who participate in peer support circles suffer less from emotional burnout and continue volunteering longer compared to those who work in emotional isolation.

A self-care plan is not a luxury — it is a professional tool that determines how you renew your energy after each intensive support session. It includes three types of elements: physical (adequate sleep, physical activity, regular nutrition), social (time with people who ask nothing of you), and psychological (activities that restore meaning to life and renew joy). As a psychological first aid provider, identify in advance: what are the three things that quickly recharge your energy? Who is the person you call when you feel heavy? What are the first physical signals that indicate you are spending more than you can? Early awareness of these signals allows you to stop for rest before reaching full burnout.

Long-term psychological resilience is not built in one day — but through small daily habits that accumulate an emotional reserve. Three practices that research confirms are effective for workers in first aid and psychological support: (1) Reflective writing: five minutes daily writing what you felt without censorship — this releases pressure from inside you onto paper and reduces its effect on your sleep and thinking. (2) Finding meaning in work: remind yourself each week of one story where you made a positive impact — this maintains motivation. (3) Clear time boundaries: when a support session begins and when it ends — time ambiguity prolongs psychological pressure on you more than the session itself.

The mental health of the volunteer themselves is not a secondary luxury — but a condition for sustaining their capacity to help others. Compassion Fatigue is a state of emotional and physical exhaustion affecting those who continuously provide care and support. Its early signs: loss of the empathy capacity that was natural, persistent fatigue even after rest, repeated thinking about work cases outside of working hours, and difficulty emotionally separating yourself from the cases you are supporting. Prevention begins with early awareness: monitor these signs in yourself and your colleagues, and be the first to seek support when you need it. Asking for help is not weakness in this context — it is evidence of professional maturity and self-awareness.