1. Relationship and bonding
This stage is the first stage of communication between the psychological first aid provider and the affected person. In order to establish an egalitarian relationship based on trust and respect, it will be a functional first step for the psychological first aid provider to introduce himself first and state his name, the institution through which he is there, and the purpose for which he is speaking. In cases where the first interaction occurs in the acute period immediately after the event, to ask people about their needs before moving on to an in-depth interview or a different psychological first aid response step, as individuals may have some basic needs after the disaster/event; It is important to provide some basic necessities such as water, blankets, clean clothes or food.
2. Ensuring safety and relaxation
The primary priority in all kinds of disaster and crisis interventions is to ensure the safety of individuals. The psychological first aid provider can implement life safety measures such as taking the affected people to a safe place, removing them from hazards and risky areas at the disaster/incident scene, and gathering in safe areas. In addition to these, interventions to provide psychological security needs of the affected people and to provide relief by eliminating their concerns can also be evaluated within this scope.
3. Balancing (Stabilization) Acute traumatic stress reactions of varying severity and intensity may occur in individuals after disasters or extraordinary events. Shock reactions that can be seen especially in the first 24 hours after the disaster, extreme fear, panic or freezing reactions, forgetfulness, distraction and difficulty concentrating, startle and alertness, difficulty in rational thinking and decision making, blunted emotions, different, strange, unrealistic environment symptoms such as perception may require intervention. For this reason, stabilization techniques are used to return individuals to a psychologically stable state and to help them achieve emotional calm and balance. It is important for the psychological first aid provider to be knowledgeable about acute and advanced traumatic stress reactions and stabilization techniques that may occur in individuals, in terms of weeding out and prioritizing those who may need stabilization among the affected individuals and performing the right practices. One of the important applications used for stabilization is the method called grounding techniques. With the help of these techniques, it is aimed to direct the attention to the outside world and thus to balance the emotions.
A sample grounding application recommended by Brymer et al. (2006) for adults is presented below.
I. Sit in a comfortable position with your hands and feet free.
ii. Start breathing slowly and deeply.
iii. Look around and name five objects that do not cause you any discomfort or stress.
iv. Keep breathing slowly and deeply.
v. Now listen to the sounds you hear around you and say what are the five sounds that do not cause you any discomfort or stress. vi. Keep breathing slowly and deeply.
vii. And now try to pay attention to your bodily sensations and how you are feeling, and say what the five sensations are that do not cause you any discomfort or stress.
viii. Breathe in and out slowly and deeply. A similar application can be applied in a way that shorter and more understandable expressions are preferred when applied with children.
In grounding applications for children, it is recommended to use colors while directing attention to external stimuli. The instructions for some sample applications are as follows:
“Now look around from where you are sitting and name the five colors you see.”
“Do you see anything green on this street? How many objects are there in yellow? What about what’s in blue?”
In addition to visual or auditory stimuli, tactile or kinesthetic feelings can also be used in grounding studies. For this purpose, instructions such as getting up from one chair to the other in the interview area or choosing a relaxing object in the area, focusing on it or holding it in hand can be given. In addition to these, contact exercises with hot/cold objects by using various simple mechanisms or objects are examples of tactile grounding studies. In addition, it is suggested that grounding can be done by making use of the smell of perfume, cologne or coffee, since the smell can have a strong effect in terms of grounding. In addition to these, it is stated that some daily life activities such as cooking, ironing or knitting that can be recommended to individuals for non-interview times may also be grounding practices that can support stabilization.
4. Obtaining information
This stage is important in terms of determining the psychosocial support services to be provided in the psychological first aid process and planning the interventions. Understanding the physical or psychological needs of people after the event is essential to plan the appropriate intervention for them. For this purpose, the stage of obtaining information is carried out by methods such as observations made by the psychological first aid provider, interviews with individuals and/or the use of needs analysis forms.
5. Helping with basic needs
One of the most important stages of psychological first aid is to help individuals with their needs. The needs of individuals are tried to be met in the light of what is determined in the stage of obtaining information. It would be appropriate to take action on basic needs and urgent needs, and to make a plan for when and how these needs can be met for needs with less urgency and importance. This stage will help relieve anxiety and re-establish a sense of confidence and control to some extent in the case of individuals who have experienced disasters or extraordinary events. While all these processes are being carried out, it would be appropriate to position the psychological first aid provider as a bridge between the individual and the resources. For this reason, it is important for the psychological first aid provider to have information about other units, institutions and people in the field in order to be able to make the right directions.
6. Social support
Social support is shown as an important factor in the recovery process after trauma. People who have healthy social mechanisms and can use these social support mechanisms return to their normal daily lives more quickly and cope with traumatic stress better. For this reason, psychological first aid providers can engage in a series of activities that will activate the existing social support mechanisms of the individuals affected by the event. It will be beneficial to create hobby groups, sharing meetings, activity groups for children, adolescents or adults and to build sustainable social support mechanisms in order to not only bring people together with their existing social resources or increase sharing, but also to create new social resources.
7. Information
After disasters or extraordinary events, informing the affected people about various issues is an important stage of the psychological first aid process. While individuals experience shock and confusion, especially after high-impact events, they can sometimes experience confusion about what is going on, and even being informed about such matters can be critical in preventing the aggravation of their anxiety. In the case of large-scale events, individuals may have questions such as when, how, where and how some of their basic needs such as shelter, health or food can be met. Guiding and informing about these issues is important in terms of eliminating uncertainty and concerns arising from uncertainty. Another dimension of this stage is to inform individuals about post-traumatic stress reactions. This information may also include the physical, mental, behavioral and emotional changes that may occur after the event and methods that can help to cope with them. In addition to these, training and information activities can be organized on issues such as sleep hygiene recommendations to deal with symptoms that may directly affect the course of daily life, such as sleep disorder that can be seen in a large part of the affected individuals. In addition, mini-trainings on breathing and relaxation exercises can be done in order to cope with anxiety and provide a state of relaxation, and activity planning studies can be carried out to return people to their previous lives and old habits.
8. Association with other collaborative services
Since psychological first aid is a multifaceted psychosocial intervention with simultaneous progressing stages, connecting the individual with other people and services is necessary at every step from the beginning to the end of the psychological first aid process. The psychological first aid provider not only supports the relationship between the affected individuals and the person, team and institutions in charge, but also informs in cases such as team changes or rotations due to the completion of the duty period. In cases such as the completion or termination of the psychological first aid process or the change of task of the teams, it will be an important facilitating action for the process to provide information on which institution or person will continue the work. Such association activities are important for the harmony of individuals and for the service not to be disrupted.
