If your child, your spouse, a friend, or even a complete stranger has an accident, you want to be able to help. You want to stop that bleeding, ease the pain, and prevent long-term consequences of the acute emergency.
Just as we can provide quick assistance through regular first aid in the case of physical injury, we can learn to do the same for psychological distress.
Psychological First Aid (PFA) is an early intervention technique for times of acute emotional crisis. It can be applied to provide immediate assistance to people who have experienced trauma and are being psychologically vulnerable.
It has been shown that PFA training leads to improved understanding of psychosocial responses to acute crisis and it enhances the help provided by individuals who have passed through one of its training courses (Sijbrandij et al., 2020).
Given that social anxiety disorder (SAD) is frequently marked by panic attacks, intense fear, traumatic experiences, and maladaptive coping mechanisms, learning to respond to and how to assist a socially anxious person can be of big help to affected individuals.
In this practical guide, we will walk you through this process step-by-step.
- The main objective of PFA is to protect the affected person and help them cope with psychological distress.
- It can be applied by anyone who knows what to do and what not to do.
- It should be implemented within 72 hours of the crisis. If there is no improvement, contact a mental health care professional.
- PFA can be applied to people of all ages. However, there are important differences between age groups that should be kept in mind.
For Psychological First Aid to be successful for someone with social anxiety, you want to meet the following objectives:
- Reduce the anxiety.
- Connect the person to their support network (people willing to care for and support the person).
- Encourage reflection about past crises and how the person has coped. Reinforce those behaviors.
- Practice and enhance adaptive coping strategies for potential future crises.
- Encourage autonomy, do not be overprotective.
- Provide calm & tranquility and model healthy responses to these types of situations.
PFA for Different Age Groups
While Psychological First Aid can be applied to people of all ages, keep in mind the following differences between the children, teenagers, and adults:
These five main steps should be followed when applying PFA to children with an anxiety crisis:
Contain: Provide affection and security to the child, while letting them express what they feel.
Calm: Help them relax through activities that can lower the intensity of their emotions, such as singing a song, reading a story, or playing a game.
Inform: Inform them about and explain what they are feeling and what they are likely to feel in the next few hours or days. Choose sympathetic language appropriate for their age and leave room for questions.
Normalize: Allow yourself to be empathetic and allow them to express themselves. Use expressions such as “It is normal to cry” and let them know that their feelings are common phenomena.
Comfort: Encourage activities in which they can take refuge and feel accompanied until their crisis stabilizes.
When providing Psychological First Aid to teenagers with an anxiety crisis, keep in mind that most of them are likely to experience high levels of stress in their daily lives. The physical and psychological changes they are going through can take their toll on them.
When providing PFA to teenagers, follow these guidelines:
- Treat them like an adult and validate their emotions.
- Inform them about what is happening to them in a friendly manner. Do not tell them what to do, as this could have a negative impact on their feelings.
- Once the anxiety has been contained, be available but do not overwhelm them. Make sure the person wants to talk about what happened or share their emotions. Respect a decline to your offer.
- Respect their space and allow them to meet freely with their friends. Their peers can be a great source of support.
When providing PFA to an adult with social phobia, make sure to avoid any stressors that could worsen the person’s crisis. Not handling the situation properly can have a negative impact on the person’s diagnosis.
For this reason, follow these three important guidelines:
- Give the person autonomy over their process. Act as far as they allow you to act.
- The best way to contain and comfort an adult in an anxiety crisis is to provide information about what they feel. This way, you help normalizing their fear, despair, anger, or any other emotions that may occur.
- Help them find a place for what they feel and what happened to them. Encourage them to learn how to live with their experience and integrate it in their personal history.
The 10 Steps of PFA for Social Anxiety
Keeping in mind the above instructions for each specific age group, the following steps can be used as a guide when providing PFA to person with social anxiety in acute crisis.
- Remove the person from the environment or situation that caused the anxiety attack or crisis.
- Offer water, medication if they take any, a coat or even food if they need it. If the person does not want any of the above options, do not insist.
- If you do not know the person, you should introduce yourself to create a bond. Tell them who you are, that you know how to provide psychological first aid, and that you are there to help them and establish safety and relief. If you know the person, you can skip this step.
- You can instruct the person to do some breathing exercises, such as box breathing (inhale 4 seconds, hold 4 seconds, exhale 4 seconds, hold 4 seconds – repeat as needed).
- Talk in a calm manner and ask the necessary questions such as “What do you need?”, “What is your biggest concern right now?”, etc. Resolve the questions with the necessary information.
- Connect with the support network. If you are not part of the person’s support network or do not live with them, find someone who can care for them for the next 48 hours. Explain what happened, what may happen, and what you can do to reduce the anxiety and shame of the affected person.
- Consider spiritual needs. If the person is religious and believes their anxiety crises might improve by praying, give them the space to do so.
- Promote empowerment. Identify coping tools that the person can use and enhance them.
- Reduce negative thoughts and avoidance behaviors. For example, if the person says “I can’t handle this.”, make them realize that they have been able to handle similar situations before and that it is likely that they will be able to handle them again.
- Once you are sure the person is at a point of emotional equilibrium and can go on with their day, you can leave the person on their own.
Before saying goodbye, you should make sure that the person is connected to their support network. Also, make sure to recommend that they seek support from a mental health care professional.
Key Phrases to Help a Person With an Anxiety Crisis
The following key phrases help us communicate effectively with a person in the midst of an anxiety crisis.
- “Hi, I’m _____ , I’m trained to help you and I’m here for whatever you need. would you like a glass of water?”
- “I know you’re distressed but let’s try some breathing exercises and talk about what’s going on with you.”
- “Is it okay if we _______?”
- “Now I’m going to explain what you can do the next time you have an anxiety attack. You can…” (Repeat the psychological first aid steps in order to make them self-practicable).
- “I will try to help you as much as I can and if I can’t help you, I will let you know.”
- “Who can we call to accompany you to _____ or to your home?”
What to Avoid?
For PFA to be as helpful as possible, refrain from doing or encouraging the following things:
- Being overprotective, as this can increase sensations of incapability and of having little control over their emotions.
- Being intrusive or interrogative by asking too many questions or making decisions for the affected person.
- Making promises that cannot be kept.
- Judging the feelings of the affected person.
- Minimizing their experience.
- Comments such as, “You do not need to feel this way.”, or, “Don’t be so dramatic.”
Psychological first aid for people with social anxiety disorder consists of 10 simple steps and varies depending on the age range of the person (Child, adolescent, and adult).
- The goals of psychological first aid are to protect and provide support, relief and reassurance to the person.
- PFA should be implemented in the first 48 – 72 hours of the anxiety crisis. After that, professional help should be sought to continue the process of emotional stability.
Remember that psychological first aid does not replace a psychological or therapeutic treatment for social anxiety disorder. It is only an early crisis intervention technique.
If one of your loved ones is suffering from social anxiety and you want to learn how to best support them, read our post on how to help someone with social anxiety.
Barcelona Crisis Center. (2017). Do’s and don’ts in the application of PAPs. Barcelona, Spain: Autonomous University of Barcelona.
Save the Children. (2013). Psychological first aid training manual for child professionals. Copenhagen, Denmark: Rosenberg Bogtryk.
Sijbrandij, M., Horn, R., Esliker, R., O’May, F., Reiffers, R., Ruttenberg, L., Stam, K., de Jong, J., & Ager, A. (2020). The Effect of Psychological First Aid Training on Knowledge and Understanding about Psychosocial Support Principles: A Cluster-Randomized Controlled Trial. International journal of environmental research and public health, 17(2), 484. https://doi.org/10.3390/ijerph17020484
World Health Organization. (2012). Psychological first aid: a guide for field workers. WHO, .: War Trauma Foundation.
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