Building Community Resilience With Psychological First Aid (PFA)

George S. Everly, Jr., PhD, ABPP, FAPA

Psychology Today blog

When Disaster Strikes…

Dr. Everly discloses receiving compensation in the form of royalties and speakers’ fees related to the

topics of psychological first aid and disaster mental health.

“Mental health has large intrinsic value as it relates to the core of what makes us human,”

thus anything that threatens the mental health of large numbers of people threatens the core fabric

of society itself (United Nations, 2020, p. 5).

By most accounts, it would appear our society is challenged by divisiveness. Debates about the

pandemic, economic instability, social injustice, violence, political vitriol, healthcare, and even the national debt appear to be challenging the current

vibrancy and future well-being of our society.

During epochs of unpredictability, mistrust, and divisiveness, as well as in the wake of acute adversity and disaster, we must find ways to sustain ourselves and future generations.

The intensity of these challenges is made worse, while the likelihood of finding resolutions is greatly diminished and the trajectory of human resilience is made more circuitous, in part because of what I shall refer to as the compassion deficit.

Socially cohesive communities show reciprocal compassion and are resilient and self-sustaining

(Charles Darwin).Everly, GS, Jr (2020). Psychological First Aid (PFA) to expand mental

health support and foster resiliency in underserved and access-compromised areas. Crisis, Stress and Human Resilience, 1 (4), 227-232.

Topics – Building Compassion and Cohesion

• 6 Cs of Community Resilience• Civility• Psychological First Aid (PFA)

6 “Cs” of Community Resilience

Communication – Credible and timely communication is one way by which participative leadership is affected. This is especially important in the age of social media. If leadership is not communicating, someone else is. At that point leadership will have lost much of its effectiveness.Connectedness – This refers to the inclination and ability of subgroups within the community to communicate and develop inter-relatedness.Commitment – This refers to a shared commitment to pursue that which is in the best interest of the community, rather than communal subgroups. An analysis of the famous Robbers’ Cave experiment is revealing.

Context – This refers to an atmosphere of shared constructive values within the community. A review of the “Broken Windows” research may be useful here. Collaboration and Cooperation – Communities wherein collaboration and cooperation are fostered and rewarded are more resilient.Competence – This factor refers to the intrinsic short-term agency, or short-term self-efficacy of the community. Dr. David McClelland at Harvard University famously demonstrated the power of creating opportunity, self-efficacy, and economic competence and the community level via simple training protocols.

How to Restore Compassion and CivilityWe can work on two levels.

• On the interpersonal level:• Reach out and engage those with differing points of view.• Listen respectfully to their positions.• Employ “perspective-taking.” Switch roles momentarily and try to

understand the bases for the other’s viewpoints. Try to see and understand the world through their eyes.

• Respectfully offer your viewpoints and encourage them to do the same perspective-taking.

• Do not tolerate incivility and bullying on social media.• Practice PFA

On the societal level:

• Hold elected officials politically accountable for incivility.

• Hold the media accountable. Vote with your viewership and let advertisers know you will not support dispassionate acts and incivility.

All of these things are fostered via Psychological First Aid (PFA).

The essence of PFA is compassion, civility, and

acceptance

So if we could do ONLY ONE THING, what would it be?

• Psychological first aid may be defined as a compassionate and supportive presence designed to stabilize and mitigate acute distress and assess the need for continued mental health care (Everly and Flynn, 2005)

PFA is currently the “first, and most favored, early intervention approach” during or

immediately after a crisis, according to the National Institute on Mental Health

Shultz, J. M., & Forbes, D. (2013). Psychological First Aid. Disaster Health, 2(1), 3-12. doi:10.4161/dish.26006

Civilian paraprofessionals, educators, faith-based leaders, and emergency services personnel have

been successfully trained to deliver brief psychological crisis intervention (PFA) services

since the 1960s

Castellano received the 2018 Silver Medal from the American Psychiatric Association in

recognition of her success in implementing PFA “peer support” programs.

Zahava Solomon – Enduring Outcome

• Tested PFA with Israeli soldiers finding all 3 components active, but expectancy most useful

• Re-tested 20 years later finding those who received PFA did better in post-military life than did those who did not receive PFA

Solomon, Z. & Benbenishty, R. (1986). The role of proximity, immediacy, and expectancy in frontline treatment of combat stress reaction among Israelis in the Lebanon War. American Journal of Psychiatry, 143, 613-617.

Solomon, Z., Shklar, R. and Mikulincer, M. (2005). Frontline Treatment of Combat Stress Reaction: A 20-Year Longitudinal Evaluation Study, Am J Psychiatry, 162, 2309-2314.

RECENT EVIDENCE SUGGESTS THAT Crisis intervention (Psychological First Aid - PFA)

can increase the belief in one’s personal resilience and preparedness, as well as enhance community resilience.

• Everly, GS, Jr, McCabe, OL, Semon, N, Thompson, CB, & Links, J (2014). The Development of a Model of Psychological First Aid (PFA) for Non-Mental Health Trained Public Health Personnel: The Johns Hopkins’ RAPID-PFA. Journal of Public Health Management and Practice, online

• McCabe, OL, Semon, N., Thompson, CB, Lating, JM, Everly, GS, Jr., Perry, CJ,

• Moore, SS, Mosley, AM, Links, J. (2014). Building a National Model of Public Mental Health Preparedness and Community Resilience: Validation of a Dual-Intervention, Systems-Based Approach. Disaster Medicine and Public Health Preparedness, DOI: 10.1017/dmp.2014.119

• McCabe, OL, Semon, N, Lating, JM, Everly, GS, Jr, et al. (2014). Developing an Academic-Government-Faith Partnership to Build Disaster Mental Health Preparedness and Community Resilience: Program Description and Lessons Learned. Public Health Reports., 129, S4, S96-106.

The Johns Hopkins model of PFA has been shown to reduce acute anxiety, improve distressed mood, engender hope.• Everly, GS, Jr, Lating, JM, Sherman, M. & Goncher, I. (2016). The potential efficacy of a model of psychological

first aid. Journal of Nervous and Mental Disease, 204, 3, 233-235.• Despeau, A., Lating, JM, et al. (2019). Randomized controlled trial assessing the efficacy of group

psychological first aid. Journal of Nervous and Mental Disease.• Everly, G.S., Jr. & Lating, J.M. (2017). The Johns Hopkins Guide to Psychological First Aid. Baltimore: JH Press.

“Hope Effect”

More Rapid Recovery

RESOURCES

• ONLINE TRAINING IN PSYCHOLOGICAL FIRST AID (PFA) – Coursera• (This Johns Hopkins class is a practical introduction to implementing PFA in disaster

settings.)• https://www.coursera.org/learn/psychological-first-

aid?ranMID=40328&ranEAID=je6NUbpObpQ&ranSiteID=je6NUbpObpQ-dWyXbS8QD.kO7L5pw6jqgA&siteID=je6NUbpObpQ-dWyXbS8QD.kO7L5pw6jqgA&utm_content=10&utm_medium=partners&utm_source=linkshare&utm_campaign=je6NUbpObpQ

• ONLINE TRAINING IN STRATEGIC PSYCHOLOGICAL INTERVENTION PLANNING FOR DISASTERS – International Critical Incident Stress Foundation

• (This course assumes familiarity with the Critical Incident Stress Management continuum of care.)

• https://icisf.org/course-enrollment/pandemic-bioterrorism-radiation-pollution-and-other-disasters-of-uncertainty-a-critical-incident-stress-management-cism-perspective/

• Expanding Mental Healthcare Using Psychological first Aid -https://www.crisisjournal.org/article/12297-psychological-first-aid-pfa-to-expand-mental-health-support-and-foster-resiliency-in-underserved-and-access-compromised-areasA Novel

• Way of Educating Children about Stress and Mental Health -https://www.crisisjournal.org/article/11204-fairytales-a-novel-way-of-educating-children-about-psychological-health

• Validation of Psychological Body Armor ™ -https://www.crisisjournal.org/article/10270-an-exploratory-study-on-psychological-body-armor

• Psychological First Aid - https://www.crisisjournal.org/article/7805-content-validation-of-the-johns-hopkins-model-of-psychological-first-aid-rapid-pfa-expanded-curriculum