Psychological First Aid: 5 Ways to Cope with Stress After a Tragedy.

When something horrible happens, feeling sad, worried, or angry is a natural response. Disasters and tragedies can be distressing for victims, first-responders, and people watching news and social media coverage from home. To support the mental health of yourself and your loved ones, psychological first aid techniques can help.

In 2003, I became the first fellow—a provider with specialized training—in disaster psychiatry at the Uniformed Services University. Since then, the field of disaster psychiatry has grown by leaps and bounds, in part because we are learning better how to respond to tragedy. 

At that time, Critical Incident Stress Debriefing (CISD) was a facilitator-led, group-based technique to help individuals cope with trauma. In this process, groups share their experiences, feelings, and reactions to the traumatic event to help them process their distress. However, our approach changed as we learned that CISD was not always beneficial immediately after a disaster.

As the disaster psychiatry representative for the American Psychiatric Association and Chair of Psychiatry at MedStar Washington Hospital Center, I know we’ve learned a lot in the last two decades. We now know more about how to provide acute care when mental health is challenged by responding to disaster.

We have learned that individuals are often better served by Psychological First Aid than by CISD. This evidence-based approach to early care and support for people who’ve experienced a distressing event is a basic intervention anyone can do, and it’s now the standard of care to help individuals cope with traumatic events. 

Signs you might be overstressed.

After a disaster or tragedy, there can be signs that you or someone you know isn’t coping well with stress. These can include:

• Avoiding social situations and activities 

• Challenges with concentration

• Changes to appetite: Feeling hungry all the time, or never

• Difficulty falling asleep or staying asleep

• Feelings of exhaustion or low energy

• Headache, stomachache, or other pains

• Misuse of alcohol, tobacco, drugs, or prescription medications

Signs in children and adults can be similar. Young children may become clingy or fearful, while older kids may get into fights, withdraw from friends, and struggle with schoolwork. 

If your feelings of distress interfere with your sleep, eating, work, and relationships, it’s time to talk with a primary care doctor, nurse, therapist or psychiatrist to get help.

How Psychological First Aid can help.

Psychological First Aid concepts can help you feel better after a disaster. For longer-term behavioral or mental health care, speak with a mental health provider who can work with you to develop an individualized treatment plan if necessary.

While therapists do not typically provide on-site therapy in a disaster, they can use psychological first aid to help people in disastrous situation build resilience and cope in the near term. The essential elements of PFA can help individuals and communities respond when distress is overwhelming:

• Safety

• Calming

• Connectedness

• Efficacy

• Hope

To begin coping with distress after a traumatic event, consider these five actions based upon recommendations from the American Psychiatric Association.

1. Stay informed and avoid overexposure.

It’s important to understand the facts of the disaster, especially if you’re involved. But it’s important for your mental health not to overdo it.

When you’re feeling distressed, turn off the news. Give your brain a break from processing the sights and sounds. Go for a walk outside or read a book instead. When it’s time to tune back in, avoid social media and choose information sources that are credible so you can avoid speculation and rumors. Good information is like healthy food for your mind.

2. Learn about local resources and share.

Take advantage of resources that can help you and share this information with other people you know who could use a hand. Taking action in difficult times can help you focus your energy in. positive direction.

The Center for the Study of Traumatic Stress has collected helpful information and resources for those experiencing distress following the mid-aid collision over the Potomac River. These include fact sheets about helping children understand frightening events and how to help your community after a disaster, as well as resources for healthcare personnel and leaders.

3. Talk with people around you.

If you feel anxious, depressed, or angry you’re not alone. Talk with your family, friends, and colleagues—they probably have similar feelings.

In the age of social media, it’s more important than ever to connect face-to-face with the people around you. Our real-life social networks provide support when we need it and being there for each other is an important part of building and maintaining our communities. 

4. Talk with your children.

If there are children in your life, discuss their fears and feelings, too. Go for a walk, play outdoors, and let the conversations happen at their normal pace. 

Children, especially young children, can get overwhelmed. Help them process their emotional reactions at a rate they can absorb. Acknowledge that tragedy is real and remind them that we will get through tough times together—in time, these feelings will pass. 

5. Remember that your feelings are natural.

Feeling sad and anxious after a tragedy is normal. While everyone responds to disasters differently, the APA has identified four common core reactions:

• Fear/anxiety

• Sadness/depression

• Guilt/shame

• Anger/irritability

These feelings can be accompanied by thoughts that increase distress, such as thinking you shouldn’t be feeling this way, that something is wrong with you, or that you’ll be judged by others. 

Remember that these feelings are a natural part of how your body and mind respond to traumatic situations. If these symptoms continue after the disaster has passed, or if they begin to overwhelm you, talk with a professional who can help.

Ways to get help: In-person is best.

Talking with someone is still the best way to get help with distress. If you’re not working with a mental health professional, there are still people who can help you talk about your feelings.

A primary care provider or nurse practitioner can be a great source of information and referrals. They can help you connect with resources in your community, including mental healthcare professionals. 

If you attend a church, synagogue, or mosque, your religious leader can talk with you about your emotions and your response to them. Children and parents often find helpful resources though schools, too. 

Trusted family members and friends can help you work through your feelings, and you can probably help them with some worries, too. It’s always a good time to reach out and connect, or reconnect, with important people in your life.

A word of caution: While telehealth counseling services have become common since the COVID-19 pandemic, we don’t yet know if they’re effective behavioral health treatment. It’s too soon to have good evidence about the long-term outcomes of remote counseling—the relationships that are central to in-person mental health care are not yet proven to be duplicated through a video screen. And please, be cautious getting advice about your mental health from artificial intelligence. 

PFA techniques to encourage feelings of safety and calmness have helped many people face disaster. When you’re feeling overwhelmed by distress, staying well-informed, gathering resources, and talking with those around you about your feelings can make a big difference.