The goal of providing psychological first aid is to provide acute assistance to someone in crisis. It is a useful skill to have in any day and age, but the uncertainty of our current world makes it more critical than ever. George S. Everly, who works at Johns Hopkins, developed an empirically-based model called RAPID as a framework for people such as first responders to follow. Coursera was offering free certificates for certain classes due to COVID-19, so I decided to go ahead and check this one out.
A brief overview of how RAPID works is below. There are five main components to the approach: Reflective Listening, Assessment of Needs, Prioritization, Intervention, and Disposition.
Reflective Listening and Rapport
This first part is all about establishing a connection with a person. This is a useful skill regardless of whether a person is in distress or not. People need to feel understood in order to gain trust. This can be done through empathy, and one can establish empathy through:
- A well-phrased initial question, which helps people open up
- Paraphrasing of responses helps people feel heard
- Listening to a person’s problems. Immediately trying to problem solve with a logical response generally is not helpful
- Being present with the person. Distractions of any sort will make it more challenging to build a rapport
Assessment of Needs
The next step is to determine where a person is at with regards to their basic and psychological needs. There’s no one template for this approach, as each situation is different and each person’s reactions to a crisis will vary. There are a few different generalized responses to a crisis, though:
Three General Responses to Crisis
Eustress - a person in this group generally is functional after a crisis and can take care of their needs with little to no emotional suffering
Distress - this group is generally able to get done what needs to get done, but there’s an obvious emotional strain that wears on them.
Dysfunction - this group is not able to get their basic needs met and is psychologically impaired.
Difference Between Distress and Dysfunction
It can be hard to distinguish between distress and dysfunction. A person may only be in temporary distress and then function fine after a certain period of time, or they may regress into a dysfunctional state. There are a few domains that can be looked at to determine whether a person is in distress or dysfunction:
Cognitive - distress may manifest as temporary confusion, inability to concentrate, and being overwhelmed; dysfunction can manifest as hopelessness, suicidal thoughts, and hallucinations.
Emotional - distress may manifest as fear, anxiety, sadness, and anger; dysfunction may manifest as panic attacks, immobilizing depression, and post-traumatic stress disorder (PTSD).
Behavioral - distress may manifest as disturbances in eating and sleeping patterns and being easily startled; dysfunction may manifest as reclusiveness and self-medication.
Spiritual - distress may involve a questioning of one’s faith; dysfunction may include projecting one’s faith onto others or abandoning religion entirely.
Physiologic - distress may manifest as a change in appetite or libido, dysfunction may manifest as a change in either cardiac or gastrointestinal function.
By looking at all these different domains you can see a general trend of when someone may be in distress compared to being in dysfunction.
Prioritization
This is really an extension of assessment, where attention is focused on the people that need immediate care. The main goal is to assess basic functional capacity and that someone can do what they need to in order to survive.
Two Approaches to Triage
Evidence-based triage mainly focuses on seeing examples of diminished capacity. This includes an inability to perform self-care, acting hopeless, and a reduced awareness of the consequences of one’s actions.
Risk-based triage focuses on three D’s: whether a person was forced to confront death (whether threatened with it or having to see human remains), dislocation (whether separated from loved ones or a place to call home), and disabling impact (whether there was a physical injury or dissociation).
Of course, risk-based triage can help to guide an approach, but it should be combined with evidence-based triage to obtain the best results.
Intervention
The purpose of the intervention step is to attend to basic needs, mitigate acute psychological distress, and if possible, restore acute functional capacity. For some people, this step really just requires a listening ear, but others may require more prevalent social support. A general outline that can be followed as a script is:
- Introduce self and explain your presence
- Ask about the person’s well-being
- Ask about the situation
- Clarify ambiguity along the way (ie, when a person says they’re depressed, what exactly do they mean?)
After going through that script, there are generally two ways to approach an intervention. If the person appears psychologically unstable (example: they’re having a panic attack), the main goal to focus on is stabilization. This can be done through using distraction and clearing the situation of any triggering cues. However, if the person appears to be stable but in acute distress, approaches such as reframing, reassurance, and normalization of feelings can be effective.
Disposition
Disposition is where someone is assessed and it’s determined if a person may need additional services to recover from the crisis. If a person appears capable of taking care of himself, then the process has ended. Following up on someone is a useful approach to make sure that they are still doing well. However, if it seems multiple follow-ups are needed to see how someone is doing, that’s when further professional care would be of assistance.
However, after this if a person does not seem able to function independently, then immediate access to further support is necessary, and the most appropriate support varies depending on the specific situation.
Conclusion
The Coursera class ends with a discussion on self-care and burnout, but those topics alone could be a blog post in and of themselves. Given that we’re in a pandemic right now, this course seems particularly useful to take as many people are struggling with psychological distress of some sort, and some of this advice can be useful for improved communication skills in general. If you found this interesting and want to explore the topic in more detail, I encourage you to check out the Coursera class!