Question 1

What is your opinion on critical-incident stress debriefing? Is there ever a situation in which the evidence supports this being used?

George Everly · Accepted Answer

Thanks for your question. There are only 4 randomized controlled trials on CISD that adhered to the prescribed intervention guidelines. Three were conducted in the military, one was with emergency services personnel. The findings across all settings were consistent. All studies showed some evidence of positive outcome. No study showed any evidence of harm. Thus, it would seem reasonable to say the CISD intervention shows promise with homogenous (with regard to trauma exposure) groups of emeregncy service and military personnel. A similar conclusion was reached in a SAMHSA review. I know of no evidence that CISD should be applied to hetergeneous groups of civilians. I see no evidence that CISD is a "treatment" for trauma, nor should it be a subsitute for treatment.

Question 2

What factors or modifications need to be considered in using psychological first aid with children?

George Everly · Accepted Answer

Great question, Sadly I will pass on that as I'm not a child psychologist nor do i work with children. So sorry.

Question 3

With the COVID19 situation, do you have any tips for psychologists who are used to providing level 3 interventions to their clients, who now need to switch to level 1 and 2 interventions e.g., psychological first aid?

George Everly · Accepted Answer

Yes, get formal training!
Realign expectations as to what is a successful outcome.
We have found that a significant impact can be made in a 15 minute contact but it requires rethinking the intervention process.
Watch the countertransference.

Question 4

As a member of a sizeable company, I would like to recommend our HR team be trained in psychological first aid. Could you list the benefits for a corporation to have trained PFA officers?

George Everly · Accepted Answer

Hello. There are many benefits in my opinion, but several come to mind:
1) Research suggests it saves the organization money through retention and perhaps lowered healthcare costs when applied as part of a continuum of care.
2) It demonstrates the organization values the human resource.
3) It fosters personal resiliency (and organizational rsilience), which is imperative in times of crisis.
4) We believe it fosters organizational cohesion.

Question 5

I work with the volunteer rural fire service who assisted with Australia's bushfire crisis. Could you explain how the RAPID model can be used in this type of organization?

George Everly · Accepted Answer

Hello. I would recommend implementing two procudures: 1) training all supervisors in PFA and 2) establishing a peer support team all members of which would be training in PFA.

Question 6

How can I support my remote team's mental health using psychological first aid?

George Everly · Accepted Answer

PFA can be done remotely. Remember that crisis telephone hotlines date back to the early 1900s. Now with video conferencing capabilities PFA can be done very effectively in my experience. But formal training is of course required in my opnion.

Question 7

Is there a safe and helpful way to approach an angry grief-stricken parent?

George Everly · Accepted Answer

Many consider dealing with grief a specialty within mental health as it presents unique challenges. From a PFA point of view I would simply begin with a supportive and compassionate presence, resisting the temptation to quickly make it all better. Suggesting grief counseling might be appropriate.

Question 8

Do you feel that psychological first aid should be mandatory on all mine sites?

George Everly · Accepted Answer

I think PFA training should be taught to all frontline supervisors in vitually all organizations, but especially high risk professions. I also think that occupations that are high risk for psychological injury should have "peer support" teams trained in PFA. I would consider mining a high risk occupation

Question 9

How does psychological first aid affect changes in mood and anxiety?

George Everly · Accepted Answer

The question you are asking I believe has to do with mechanisms of action. As drugs have mechanisms of action, so do psychological interventions. Depending upon the type of PFA model you employ, the mechanisms of therapeutic outcome could be: cathartic ventilation, reassurance, explanatory guidance, anticipatory guidance, prescriptive guidance, cognitive reframing, or simple education.

Question 10

Hello Dr Everly, in your opinion, is PFA only suitable as an early intervention?

George Everly · Accepted Answer

Hi. Great question which no one has ever asked me. No. Depending upon the model that is used I believe it could be used at any point in the trajectorey of a problem or symptom presentation. The brief "listen and refer" model will have less utility than the "listen, mitigate, and refer" models.

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