The Importance of Psychological First Aid in Japan

In the past few days, a public psychology website of which I am an editor, PsychAlive.org, started getting unusual visits from outside the United States. Typically only attracting an audience of nations that hold English as their first language, we were surprised to find that the place these visits were coming from was Japan.

The disaster in Japan has sent a ripple of grief, shock and fear across the world. The struggle to provide medical care and repair destruction in the face of ongoing horrors has consumed the country. And in this state of grief, shock, terror, and uncertainty, people are seeking psychological help.

Through this crisis, ensuring people's physical safety is undoubtedly of primary importance. Each day we all witness and weigh the severity of the tangible destruction. Many of us seek to help through donations or at-home volunteer work. Others are brave enough to travel thousands of miles across the world to participate in on-site efforts to forge a path back from devastation. Yet the injuries experienced by the individuals of this nation require not only physical, but psychological, first aid that can help them through what may very well be the most traumatic event of their lives.

Psychological First Aid is an integral approach to helping victims living in the wake of a dramatic event such as a natural disaster, public health emergency "or even a personal crisis." As the Minnesota Department of Health states, "Emotional distress is not always as visible as physical injury, but it is just as painful and debilitating."

Psychological First Aid is designed to help people cope with the stress, shock, confusion, fear, feelings of hopelessness, grief, anger, guilt and withdrawal that arise when a catastrophe has occurred. In Japan, these emotions are undoubtedly powerful, as people fear for their loved ones, their homes, their homeland, the jobs that sustain them and even the air they breathe.

This state of shock not only impacts people's long-term psychological stability, but their short term well-being, including their ability to survive, cope and care for themselves and their loved ones. Getting people the help they need to regain a sense of safety and security is essential, and Psychological First Aid gives us the tools to make this possible.

This method does not require a professional to carry out the steps of care. The process can be learned and employed by anyone who can make direct contact with individuals affected by crisis. The earlier you can assist someone in gaining a sense of calm and meeting their immediate needs, the better they can cope throughout their state of trauma. These methods are not only helpful to victims directly impacted by the tragedy in Japan, but to the many people around the world who have been affected by these events. Everyone reacts differently to trauma. By remaining attuned to those who may be most affected, we can employ the following steps to ensure these people optimum care:

1. Engage with the person. Early intervention is key to meeting immediate needs and preventing future problems. If you are concerned for someone, seek permission from the person to engage. Be sensitive when approaching. Don't offer false reassurance or make any demands.
2. Ask where they would feel safe. Even in the most frightening of circumstances, it is important to try to seek out a space where a person feels the safest. This may be in a certain room in a shelter, somewhere familiar or somewhere unfamiliar. Whatever this place may be, it will provide the best setting for you to talk.
3. Stabilize the person. While some people can self-enforce a state of calm, even in dark circumstances, many people are beside themselves when a tragedy strikes. You can offer this person stability by speaking calmly and reassuring them whenever they engage in something self-soothing. This can be something as simple as a deep or even breath. Comment on these moments by saying, "That was good," whenever they take a breath. Help them engage in breathing exercises. This will help their physiological system to become regulated.
4. Meet the person's basic needs. After Hurricane Katrina, 9-11 and the earthquake in Haiti, methods of Psychological First Aid were key in helping people get their needs met. Once calm, individuals are better able to comprehend their own needs to get through the next few minutes, hours or days. The person may need water or a blanket. Perhaps they need a place to sleep or someone to help them locate their family. Do whatever you can to help this person meet their needs, and try to remain calm and attentive in doing so.
5. Teach Psychological First Aid. It's important that people not only practice techniques of PFA, but that they teach local citizens in a community how to do it. This will allow the effects to be maintained long after the emergency teams have moved on. In my local community of Santa Barbara, Calif., The Glendon Association was a key partner in creating a volunteer Santa Barbara Response Network of individuals who've been trained in PFA. Whenever there has been a crisis or trauma in our community, the S.B. Response Network has been able to respond to those affected and reach out to them before the crisis escalates. In Japan, this must be offered on a large-scale, a process that can only be implemented when people are trained in dealing with the emotional crises that accompany the physical.
6. Connect people to social supports. A sense of connectedness and social support is vital when healing from a disastrous event. People who are hurting must be reached out to and connected with others who have been better able to cope.
7. Create coping groups. Once it is possible to do so, it is valuable to form groups in which people can communicate the ways that they themselves have learned to cope with intense emotions of loss, grief, anger and fear. Sharing techniques on how to cope creates a support system and a collective desire to heal. People can learn from one another and employ the practices that can help them to stay calm and hopeful as they move into the future.

When you are using Psychological First Aid, there are several methods you should avoid -- what The New York City Department of Health and and Mental Hygiene calls, "Psychological First Aid Don'ts." These include:

• Don't force people to tell their stories. Focus on keeping them calm and meeting their needs.
• Don't offer false reassurance with statements like, "Everything will be okay."
• Don't instruct people on what they should be thinking or feeling.
• Don't make promises that cannot be kept.

You can see a full list of the do's and don'ts of Psychological First Aid here. You can also participate in an online training course in Psychological First Aid held by the National Child Traumatic Stress Network here.

There is no simple way, no straight forward list of do's and don'ts, to dispel the pain of the people going through real tragedy. However, Psychological First Aid is one of the most effective, immediate ways to help fellow human beings through the initial stage of crisis. The process is intended to lead to post-traumatic growth instead of post-traumatic stress disorder. The hope is that one day, the people impacted may gain a sense of inner peace, calm and hope, shifting this tragedy from a present encounter to a part of their past. Let's all be hopeful, and do what we can to help that day to come soon.

***

To read more from Dr. Lisa Firestone, visit PsychAlive.org.

 

 

 

Follow Lisa Firestone on Twitter: www.twitter.com/PsychAlive

Comments

[sarb]

01:40 AM on 03/24/2011

I hadn't even thought of psychological first aid in relation to Japan before reading this article, but Lisa Firestone makes a very good point about how crucial this can be. I would hope to remember her list of "Do's" and "Don'ts" in relation to giving psychological assistance if misfortune strikes close to home.

[Arlene Moody]

11:46 AM on 03/21/2011

Thank-you, Dr. Firestone, for reminding people that we can all make a difference to those hurting from such a traumatic incident as what happened in Japan but also any incident even on a much smaller scale.

[sdrousso]

01:08 AM on 03/20/2011

It is important to know you have something to offer to someone who is hurting or has been in a traumatic situation. I love this article for outlining the steps, and showing a way to be sensitive and productive in approaching and reaching out to a person in a troubled state. This is an especially timely article, but really this is always a timely article.

[AliIronside]

08:12 PM on 03/19/2011

Thank you Lisa for your compassionate and extremely helpful blog. Sometimes it is not easy to know how to help someone in trouble, so I appreciate your thoughts on this. It is hard to imagine the level of trauma that Japanese citizens must be going through.

[JOHNSPEAKS]

07:34 AM on 03/19/2011

Damned if you do and damned if you don't, which way will -You- choose let me explain? The people of Japan have had a horrendous amount of calamities happen to their country and they can seek help from the american style mental health industry to try and heal their psychological wounds? They can use their time tested and very successful methods of culture and discipline and self help and families helping each other etc.? They can use the American or Western European model of mental health recovery which has a history of human experimentation and inhuman medical procedures and pain and suffering and bureaucracy and false hope and then suicide to end their suffering? The Japanesse or anybody else should think twice before they ask for help because of trauma or mentally illness of any kind???

[flyinghi100]

09:04 PM on 03/18/2011

This is such a timely article. It's seems like it will be useful with extraordinary trauma like what people are experiencing in Japan right now. But it also seems like PFA could be a helpful tool for the "ordinary" traumas that we suffer under more normal circumstances. The "do's" and "don't's" are good hands on guidelines that we can try to apply to real situations that come up in our daily lives. I wish that I could just blink my eyes and be transported to Japan so I could offer a kind hand or a caring look there, too.

[Badger33]

08:41 PM on 03/18/2011

Yes, I'm watching from afar and through the prism of the media. I am impressed by the relative calm and spirit of cooperation demonstrated by the Japanese people. I doubt that we would have the same result in the US under similar circumstances.

[W99]

08:12 PM on 03/18/2011

It is such a challenging situation in Japan. It helps to see there are some things that a non-professional person can do to help.

[Carolyn518]

07:47 PM on 03/18/2011

My heart goes out to those in Japan. It's important to take the psychological trauma into account as well as the physical and try to do whatever we can to help.

[Jan Lewis]

06:37 PM on 03/18/2011

Thank you Dr. Firestone for writing about the psychological aspect of this disaster. I reached out to an an aquaintance this week who is from Japan and has friends and family living there. She was pleased that I had thought of her and had given her a supportive call.

[Mimi Wolfe]

06:30 PM on 03/18/2011

The situation in Japan is so heart wrenching and I cannot imagine the challenges and difficulties the people there must feel from this crisis. I feel that Dr. Firestone's writing is so valuable as a reminder that it is not only the monetary and practical help that we can provide, but also offering help on a more psychological level is invaluable. It is so helpful to understand how to offer emotional support to those who are suffering from the magnitude of this devestation. Thank you Dr. Firestone

[Lena Elizabeth]

05:50 PM on 03/18/2011

This is an important article. So glad to have stumbled across this. It is painful to think of people's psychological (as well as psychical) needs being neglected in the wake of such a tragedy. I appreciate the step by step suggestions, it makes me wish I was there to help.

[Jina Carvalho]

02:33 PM on 03/18/2011

Dr Firestone offers sound psychological help for what we are all experiencing. Thanks