Theory Meets Practice: A case for Psychological First Aid Online

Lucy Adhiambo is a MA student at IPU. When the Corona lockdown happened, she stayed in Canada to collect data for her thesis. She started to develop an app that provides Psychological First Aid because of the problems she anticipated concerning mental health. This is the story of her idea.

 

In March 2020, the World Health Organization (WHO) officially declared that COVID-19 was a pandemic. The first thoughts which came to my mind were mental health disaster preparedness and action plan. While discussions throughout the media focused on the explanations given by virologists and experts in the medical field, I couldn’t help but wonder what other mental health providers were thinking about the situation at that moment. Perhaps it was just my paranoia brought on by prior experiences in the field, but my senses warned me otherwise: This will not be business as usual; this pandemic will be a difficult one, considering that it was already spreading like ‘bush fire with no equipment to fight it’.

While this was going on, I was in Canada collecting data for my thesis. During the last week of my stay there, everything changed. Messages calling for social distancing were suddenly everywhere. I knew I needed to return to Germany as soon as possible, but I had to wait until my flight that weekend. Two days before I was to depart, an official government order came to close all borders and stop international flights. My airline rescheduled my flight to an earlier date and then moved my flight to a different airline which was fully booked. The uncertainty of whether to remain in Canada or to take the flight was enough anxiety to deal with, let alone a 14-day quarantine to face afterwards. On social media, people were constantly sharing their experiences of the crisis, particularly claiming that any discomfort felt in the body or even a simple cough to clear the throat sent waves of panic or a chill down their spine. I also couldn’t tell whether the pain I felt in my body was because of jetlag or otherwise. In this situation Psychological First Aid (PFA) came to my mind. Even though PFA is already designed for interventions in the field where crisis has occurred, I thought about ways of implementing it effectively during this lockdown and social distancing period.

Inspiration for Psychological First Aid

PFA evolved from earlier versions of crisis intervention techniques such as Critical Incident Stress Debriefing by T. Mitchell and Psychological Debriefing by Dyregrov, both of which were very popular in the 1980s and 1990s but were later objected to by researchers for being harmful, as survivors relived the traumatic experience through the repetitive narration of the incidents. Psychological First Aid Field Operations Guide was then developed by the National Child Traumatic Stress Network and the National Center for PTSD as “an evidence-informed modular approach to help children, adolescents, adults, and families in the immediate aftermath of disaster and terrorism, fostering both short- and long-term adaptive functioning and coping.”

My first instinct was to develop a website to connect with people who need to share their crisis experiences, receive encouragement, or find self-help tips, but the impact of a website was minimal. I came across Hackathon on a post by the German Government about the #WirvsVirus hack seeking technological solutions to the current COVID-19 challenges. This provided an opportunity to create a bigger platform and it seemed to me that an app was the way to go—to create a standardized system where people can get online help in emergency situations. I managed to find a team of tech experts and we developed a prototype app. The challenge was, however, to convince the jury that this is a necessary solution and that PFA prevents overpathologizing or re-traumatizing individuals by providing

  1. calmness and stability,
  2. self-efficacy/ resilience,
  3. connectedness, collaboration and social support,
  4. hope and coping,
  5. and assessment of need, and information.

Lending A Helping Hand

The app provides an online space, which is safe enough for people to unload negative emotions such as anxiety, fears and worries caused by crisis. To me, anxiety is the “mother” of paralysis. Freud stated that anxiety is a manifestation of repression when primitive impulses (such as sexual urges) meet social norms and civilization. Later, he modified that notion and stated that anxiety is a manifestation of traumatic materials when the ego is overwhelmed (realistic anxiety). Whichever the case, crisis, if not adequately managed, can cause the onset of severe mental illness(es) such as social phobias, panic disorders, obsessive and compulsive disorders, etc.

 

The assumption that people need counselling and therapy after a crisis is, to an extent, incorrect. Many people emerge from a crisis without any help, while others require only minimal interventions—a listening ear, assurance, encouragement, and acknowledgement of experiences in order to normalize reactions to the abnormal event. This is what PFA is about: Facilitating stabilization, grounding, and a return to daily functioning in the immediate aftermath of a crisis. It is therefore different from therapy and counselling; however, this is not in disregard of long-term therapy. People who need therapy should be guided appropriately on where or how to find further help. PFA is therefore ideal for online intervention because no disclosure of personal information is necessary. Furthermore, it is designed to be delivered not only by mental health workers but also by other emergency first responders, faith-based clergies, or teachers who are trained in PFA techniques and approaches.