Do you know Psychological First Aid? Here’s its origin story : Shots

Survivors of the floods of Hurricane Helene and the wildfires of Los Angeles have something in common: help from frontline workers trained in something called Psychological First Aid.

It’s a mental health intervention designed to address a therapeutic deficit exposed by other terrible events — like the bombing of the Alfred P Murrah Federal Building in Oklahoma City. Nineteen children were among the 168 people who died that day in 1995. It is still the deadliest act of domestic terrorism.

Robin Gurwitch was a young psychologist in Oklahoma City at the time, and she soon found herself dealing with the aftermath. Her clients were the people who survived.

“It was my community,” says Gurwitch. “Being in the childcare [center], the YMCA, which was destroyed across the street, much less the one in the building,” she says, “ It was like, ‘OK, I need to know more about how to best support and help.'”

But Gurwitch’s training had not equipped her for dealing with collective disasters and widespread trauma. Desperate for information, she started calling experts around the country.

“There were very few,” she recalls.

The event would set the course of Gurwitch’s career, as she would help to create a new set of best practices for the early treatment of trauma that are today used by millions — including people affected by the LA fires in January and Hurricane Helene in September.

CPR for Mental Health

Gurwitch is now an authority on addressing collective trauma — especially for children — at Duke University in North Carolina. Her expertise includes a focus on Psychological First Aid, a therapy that helps to address trauma and mitigate risk for Post Traumatic Stress Disorder.

The practice was pioneered by a group of researchers who — recognizing the need for new ways of treating trauma — came together 20 years ago to create an evidence-informed approach.

“After 9-11, there was a real need to think through how we actually help primary survivors, victims in the immediate aftermath of a mass disaster,” says Melissa Brymer, who directs the Terrorism and Disaster Programs at UCLA National Center for Child Traumatic Stress.

Events like the Oklahoma City bombing had given rise to new approaches to trauma, but some of the therapeutic strategies therapists were leaning on by the time of the 9/11 attacks were compounding people’s trauma — forcing them to relive events before they were ready, says Brymer.

For people in Los Angeles dealing with the immediate aftermath of the fire, for example, Brymer says “ the unimaginable just happened to them. And it’s so overwhelming that people don’t even know what should be their first step.”

Using other evidence they had from experience with therapy, Brymer and her colleagues designed a new practice, one that would change the focus in these moments to listening to people and meeting their immediate needs.

Miriam Brown,  deputy director of the Los Angeles Department of Mental Health, oversaw the crisis centers, where people displaced by the fires could get psychological first aid.

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Ryan Kellman/NPR

“Part of what we do in the training is help people not to look at the long term, but what is that next step that they have to take so that we can help them begin that journey towards healing,” says Brymer.

Experts like Gurwitch have been critical to its dissemination to millions of people.

Often described as a kind of CPR equivalent for mental health, Psychological First Aid is a training anyone can take. It relies on four principles: Prepare for providing help, look at the situation and the need, listen actively to the person to understand their feelings, and link them to services.

Experts say it’s easy to further compound shock and trauma by presuming someone’s needs.

“ Number one, we want to make sure that people aren’t saying, ‘I have to go back into the fire.’ Or that they go back into a zone that’s not considered safe, what we call a hot zone,” says April Naturale, a clinical social worker and Vice President of disaster services at Vibrant Emotional Health — an organization that frequently sends in mental health first responders to disasters.

 Naturale says in crises, even trained clinicians can become psychologically dysregulated, unsteady and unable to control their emotional responses. They can struggle to make sound decisions: “I’ve been in situations with mental health professionals, who’ve been working in tough areas where there’s been a lot of death, or scary things like fire — they often don’t recognize that they’re not thinking clearly.”

Psychological First Aid provides a foundation to fall back on in these moments of dysregulation that can persist for weeks or months after an event.

Los Angeles opened three crisis centers quickly, while the fires were still burning, and staffed them with mental health responders trained in Psychological First Aid in order to help victims.

“ We’re just trying to make them feel comfortable, trying to get them situated, trying to orient them to what’s needed,” says Miriam Brown,  the deputy director of the Los Angeles Department of Mental Health, who oversaw the crisis centers. “Helping them to cope with the anxiety and shock of this traumatic experience.”

Brown says these frontline mental health workers saw hundreds of people in the centers in the first few days after the fires broke out.

Psychological first aid for all 

Cheryl Antoncic — a restaurant owner in Asheville — took Gurwitch’s class after Hurricane Helene brought catastrophic flooding to western North Carolina.

“It’s like you think that in order to support somebody you have to be a mental health professional, or a counselor,” says Antoncic. “That’s not the case.”

Cheryl Antonsic owns Bear’s Smokehouse in Asheville, N.C. She’s been trained in psychological first aid and is helping with free food distribution by World Central Kitchen.

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Antoncic has long had her own interest in mental health; her nonprofit Linked4Life helps foster community wellbeing. When Helene struck Asheville, Antonicic partnered with the charity World Central Kitchen to book and distribute tens of thousands of meals to survivors of the floods. Her restaurant became a hub for recovery. At times, meals were delivered by helicopter to people stranded in the Appalachian mountains.

Antoncic helped arrange for Gurwitch to travel to Asheville to teach people like her Psychological First Aid. Much of the course is predicated on the importance of listening to people in the moment of crisis — asking them their needs rather than guessing.

“Just sitting with someone, you know, and offering them something to eat, offering them some water — it goes a long way,” says Antoncic.

Asheville, N.C., on Sept. 28, 2024 when massive rainfall from Hurricane Helene inundated areas that do not usually flood.

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Melissa Sue Gerrits/Getty Images

It may sound like common sense, but it can be hard to summon common sense in the midst of trauma.

“Some people’s tendency is to reach out and try to hug someone when they’re in distress,” says Antoncic. “That can be something that you should ask first — Like, ‘Would it be OK for me to give you a hug?'”

Since the storm, Antoncic has put her training to use, feeding tens of thousands of survivors. On a day in December, she stood by gigantic paella cookers that held hundreds of gallons of beef chili. “Comfort food,” she says, “they’ll serve that with a piece of cornbread on the side.”

The science of trauma is still young

While evaluations of the practice have shown promising benefits for people treated with Psychological First Aid, researchers would like to see it studied more rigorously. It’s difficult to measure mental well-being before and after an event. Gurwitch asserts there’s still so much to learn about the whole field of trauma and disasters.

Nearly three months after Hurricane Helene, massive clean up continued in Swannanoa, N.C., near Asheville.

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“We learned from Oklahoma City, we learned from Katrina, we learned from 9-11,” she says. “We learned lessons from Sandy Hook that could help Marjory Stoneman Douglas.”

Gurwitch says it’s important to study these horrible tragedies. She still works today with the people she met in the Oklahoma City bombing.

“It’s been 30 years,” she says. ” I’ve never stopped working with them.”