If ever there were a time for people to know the important skills that make up what mental health experts refer to as “psychological first aid,” a pandemic is it. Like regular first aid, PFA is a way of helping someone in pain — except rather than cleaning and bandaging a cut or applying ice to a sprained ankle, you tend to someone’s anxiety or distress in a way that will ease it and help restore a sense of equanimity. Many disaster responders and public health professionals have been trained in PFA, but it’s time for the rest of us to join them, so we can help our families, our friends and ourselves.
“These are life skills — [and] psychological first aid is even more essential in times such as a pandemic,” says George S. Everly, a clinical psychologist and professor of international health in the Center for Humanitarian Health at the Johns Hopkins Bloomberg School of Public Health, and author of “The Johns Hopkins Guide to Psychological First Aid.”
We know that the unprecedented challenges from the pandemic, the economic fallout it has brought on and the racial unrest in the country are having an effect on Americans’ mental health. The prevalence of symptoms of an anxiety disorder was three times as high and symptoms of depression were four times as high in June 2020 than in the second quarter of 2019, according to the Centers for Disease Control and Prevention. The pandemic’s psychological ripple effects are different from, say, those of natural disasters, which last merely hours or days. “The pandemic is like the never-ending story,” says Everly. “What makes this more psychologically toxic is that we keep receiving new impacts” as resurgences and new outbreaks occur, and more collateral damage to life and work, as we knew them, becomes apparent.
Meanwhile, on a daily, sometimes hourly, basis we’re subjected to bad news from multiple directions — not just about the pandemic, the economy and racial issues, but about political scandals, civic tensions, fires, floods, conspiracy theories and more — without the in-person support of friends, extended family and colleagues because of the pandemic. “The world seems more uncertain than ever — uncertainty is a powerful toxin,” Everly says.
Fortunately, you can dial down your stress reactivity and come to your own emotional rescue — or that of others — with PFA-based strategies. There are many different models of PFA. The World Health Organization’s approach recommends developing skills that help people feel safe, connected to others, calm and hopeful; feel that they have access to social, physical and emotional support; and feel they are able to help themselves, as individuals and communities. Here’s how to put the actual components of PFA into practice for yourself and those you care about:
Address basic bodily needs. If you know people who are struggling to get enough food, water or shelter, help them directly or indirectly (by steering them toward community resources).
As far as your own needs, make a conscious effort to consume nutritious foods, stay hydrated, get enough sleep, do some form of physical activity every day, and avoid using substances such as alcohol or cigarettes to cope, advises Kaushal Shah, a psychiatric researcher at Griffin Memorial Hospital in Norman, Okla., who has done research on PFA. Besides being important for your overall health, these healthy lifestyle practices are a vital part of PFA. “Finding a baseline routine that works for you and maintaining it helps align the body’s equilibrium with your psychological equilibrium,” Shah explains.
Avoid further harm. Protecting people from additional distress is a key aspect of PFA, and there are several ways you can do this for yourself and others. First, check to make sure conditions are physically safe, then take steps to ensure emotional “safety” by treating others and yourself with respect and compassion. “Remind yourself that whatever you’re feeling or going through right now is perfectly normal,” advises Nancy Haugen, a clinical psychologist in San Francisco. “That [acknowledgment] tends to bring down some anxiety.”
In addition, try to protect yourself from information overload. New research, involving 6,514 adults in the United States, found that people who have higher daily hours of covid-19-related media exposure and exposure to conflicting covid-19 information in the media are at greater risk for pandemic-related acute stress and depressive symptoms. To prevent this effect, limit your media exposure. In particular, Haugen recommends turning off the TV news, because upsetting images add to the feelings of stress. “Every time you see these images you are re-traumatized,” she says.
Keep calm to carry on. Maintaining a gentle tone of voice can have a calming effect on distressed people around you. In addition, remind yourself and encourage others to do a relaxing activity — such as yoga, mindfulness meditation, deep breathing or progressive muscle relaxation — every day. This will help you de-stress in a given moment and maintain your psychological equilibrium, Shah says.
At regular intervals throughout the day — or when you feel stress-overload coming on — hit the pause button on what you’re doing and focus on deep breathing. “You can override stress with deep breaths that cause the diaphragm to go up and down. Then the brain starts to calm down,” explains Haugen. Moreover, research has found that engaging in diaphragmatic breathing reduces stress hormone levels and blood pressure, as well as subjective measures of stress.
Set priorities. In tumultuous times, it’s easy to feel overwhelmed with worries and fears. That’s why PFA encourages people to consider their most urgent needs, including how to prioritize and address them, versus what can wait. To that end, it helps to distinguish between what you can and can’t control and to encourage loved ones to do the same. Then focus on the situations you can do something about, such as how you protect yourself and your family, how you behave toward others and how you spend your free time. To help with this resilience-building shift, Haugen recommends framing your goals as “I choose,” which involves a sense of agency, instead of “I want.”
Build hope. Especially during periods of uncertainty, it’s important to stay positive with learned or active optimism and remain forward-focused, Everly says. One effective way to do this is to consciously focus on what’s going right in your life now. Research has found that having a ratio of three positive emotions to every negative emotion helps people flourish. You can stack the deck in your favor by “looking for positive moments and holding onto them throughout the day,” says Haugen, who is also an associate professor of psychiatry at the UCSF Medical School. These moments could be as simple as appreciating a compliment from a friend or the scent of flowers on a walk, or watching a favorite movie. If you want to formalize the process, consider keeping a gratitude journal. A 2019 study found that adults who did this for 14 days experienced an increase in positive moods, happiness and life satisfaction, as well as a decrease in negative moods and depressive symptoms.
Connect with others. “The single best predictor of human resilience is support from other people,” Everly says. So, help people identify sources of social support in their lives with a reminder that the goal is to practice “physical distancing,” not “social distancing,” during the pandemic. Reach out to friends and family members on social media and make an effort to rekindle old friendships by phone, text, email or video conferencing. Also, consider establishing your own coronavirus-safe pod or bubble so you can spend in-person time with supportive people.
Practice good communication. When people are distressed, practice active listening by giving them your undivided attention and letting them take their time expressing themselves, rather than pressuring them to talk or immediately providing advice. These are key PFA skills. “It’s about being able to hear, rather than just listen,” Haugen says. Try to truly understand the person’s concerns and feelings and show empathy, and use supportive words and phrases that reflect the key points he or she made.
Active or reflective listening “helps validate the other person’s emotions, which helps ease distress, and helps the person prioritize how to address the issues that are upsetting him or her,” Shah says.
Reinforce coping skills. Ask someone who is distressed how he or she coped with difficult situations in the past and encourage the person to use those strengths and strategies to handle the current situation. (Do the same exercise yourself.) This contributes to a sense of confidence and competence that will allow them to face and manage the current challenge. It also builds resilience.
After handling hardships, “some people come out stronger,” Everly notes. With any luck, you and your loved ones could be among them. And PFA practices may be among the coping skills you call upon to face another difficult situation in the future.
Stacey Colino is a writer in Chevy Chase, Md., specializing in health and psychology, and co-author of “Emotional Inflammation: Discover Your Triggers and Reclaim Your Equilibrium During Anxious Times.”