The Johns Hopkins guide to psychological first aid

Psychological first aid, or PFA, is designed to mitigate the effects of acute stress and trauma and assist those in crisis to cope effectively with adversity. PFA is designed to be applied in emergencies, including disasters and terrorist attacks. In this essential guide, George S. Everly, Jr., developer of the Johns Hopkins RAPID PFA method, and Jeffrey M. Lating, his collaborator in its implementation, describe the principles and practices underpinning this psychological model in an easy-to-follow, prescriptive, and practical manner. They explain the history of PFA and persuasively demonstrate its powerful versatility. Mental health practitioners can apply PFA in all settings. It can also be used as a public-health tool to address mental health needs following critical incidents and as a means for building community resilience.

Aimed at mental health practitioners, all first responders, and global health disaster teams such as Médecins Sans Frontières and the World Health Organization, The Johns Hopkins Guide to Psychological First Aid is the first book to thoroughly explain RAPID PFA. RAPID, a unique theoretically grounded and evidence-based PFA method, follows a set of easily understood principles. In each chapter, Everly and Lating provide a step-by-step approach and include a key point summary to emphasize essential elements. A unifying case exemplifies each phase of the RAPID PFA model in an ongoing dialogue that presents ideal PFA responses, examples of common mistakes, and various outcomes.

In addition to their counseling experience in Kuwait after the Gulf War and in New York City after the September 11 attacks, the authors have traveled nationally and internationally to teach the RAPID PFA method in numerous public health, fire, police, military, and faith-based settings. Beneficial to those with little or no previous mental health training, this book is an essential tool for people who want to learn, to practice, or to retain their ability to use psychological first aid effectively.

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This book specifically explains and provides direction for the Johns Hopkins RAPID PFA (psychological first aid) model, the first of its kind to be rooted in specific theory and whose core competencies were developed based on empirical evidence. Everly (Johns Hopkins School of Medicine) and Lating (Loyola Univ. Maryland) provide the historical background of PFA, and then describe the various scenarios a provider may encounter, with specific examples from natural disasters and war, and general approaches to acute depressive and substance use episodes. In the second half of the book, the authors address how to establish a rapport with the individual experiencing stress, and offer explicit direction in communication and response styles. The scripted case scenarios are the strength of this guide, as the reader is able to see in "real time" the progression of an encounter and evaluate what works and what does not. Each section of the guide ends with a bullet-point list of the most important elements of any PFA encounter. Finally, the authors acknowledge secondary trauma in PFA providers and why it is vital for providers to receive assistance, when necessary. This guide is appropriate for all psychology students and others in the mental health fields; teachers, police officers, and firefighters will also find it helpful. Summing Up: Recommended. All readers. --Erin Fisher, Rock Valley College

Preface \| How Did We Get Here?	p. ix
Acknowledgments	p. xvii
Part I Psychological First Aid \| The Science
1 Psychological First Aid \| Definition and History	p. 3
Defining Psychological First Aid	p. 3
Development of the PFA Concept	p. 5
PFA	p. 10
PFA Recommended	p. 14
Core Competencies of PFA	p. 17
Validation of the Johns Hopkins RAPID PFA Model	p. 22
Key Point Summary	p. 23
References	p. 24
2 Psychological Consequences of Trauma \| What You Will Encounter in the Field	p. 29
Posttraumatic Stress Disorder	p. 31
Depression	p. 33
Generalized Anxiety	p. 35
Panic Disorder	p. 36
Substance Use	p. 38
Psychophysiological Stress Syndromes	p. 40
Key Point Summary	p. 43
References	p. 45
3 In the Wake of Disaster \| The Large-Scale Context for PFA	p. 50
Types of Disasters	p. 50
Natural Disasters	p. 51
Technological Disasters	p. 56
Human-Made Disasters	p. 60
War-Related Syndromes: A Special Case of Human-Made Disaster	p. 66
Factors That Increase Severity	p. 69
Key Point Summary	p. 71
References	p. 73
Part II Psychological First Aid \| Practicing the Art
4 R-Establishing Rapport and Reflective Listening	p. 89
First Things First: The Practice of Presence	p. 89
Empathy and Rapport	p. 91
The Empathic Cascade: The Bridge from Rapport to Adherence	p. 91
Historical Development	p. 92
Mechanisms of Action	p. 94
Demonstration of the R in RAPID Model	p. 100
Key Point Summary	p. 107
References	p. 108
5 A-Assessment \| Listening to the Story	p. 109
Screening	p. 110
Appraisal	p. 111
Cognitive Indicia	p. 111
Emotional Indicia	p. 112
Behavioral Indicia	p. 112
Spiritual Indicia	p. 113
Physiological Indicia	p. 113
Demonstration of the A in RAPID Model	p. 114
Key Point Summary	p. 120
References	p. 121
6 P-Psychological Triage \| Prioritization	p. 123
Urgency!	p. 124
Psychological or Behavioral Instability: The Crisis Triad	p. 125
Putting It All Together: The A-B-C Model of Psychological Triage	p. 126
Demonstration of the P in RAPID Model	p. 127
Key Point Summary	p. 130
References	p. 132
7 I-Intervention Tactics to Stabilize and Mitigate Acute Distress	p. 134
Explanatory Guidance	p. 135
Anticipatory Guidance	p. 137
Cognitive Reframing	p. 138
Stress Management	p. 140
Instillation of a Future Orientation-Hope	p. 143
Enlisting the Support of Family and Friends	p. 143
Delay Making Any Life-Altering Decisions/Changes	p. 144
Faith-Based Intervention in PFA	p. 144
When in Doubt ...	p. 146
Caution!	p. 146
Demonstration of the I in RAPID Model	p. 146
Key Point Summary	p. 155
References	p. 157
8 D-Disposition and Facilitating Access to Continued Care	p. 160
Where Do We Go from Here?	p. 160
Encouragement	p. 162
Resources	p. 162
Demonstration of the D in RAPID Model	p. 163
Follow-Up and Disposition	p. 165
Key Point Summary	p. 179
References	p. 179
9 Self-Care \| Taking Care of Others Begins (and Ends) with Taking Care of Yourself	p. 180
The Need for Self-Care	p. 180
Terminology	p. 181
Risk Factors	p. 183
Self-Care	p. 185
Developing a Plan	p. 190
Key Point Summary	p. 191
References	p. 192
Appendix \| A Breathing Technique	p. 195
Index	p. 197

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