Psychological first aid (PFA) and disasters.

A disaster is commonly thought of as an occurrence that results in property damage and physical injuries that exceed the response capabilities of local resources. History teaches that disasters also result in a surge in demand for psychological support amongst survivors and disaster responders. This surge quickly exceeds local response capacities and has the potential to exceed even the mental health resources that may be imported from neighbouring jurisdictions and disaster relief agencies. Efficient and effective acute mental health intervention is, therefore, needed. However, the effectiveness of traditional multi-session counselling during and shortly after disasters has been questioned. Instead, the utilization of efficient and effective crisis-focussed psychological interventions has been suggested as acute phase alternatives. This paper asserts psychological first aid (PFA) may be considered a specific crisis-focussed disaster mental health intervention for use during and after disasters. PFA is designed for use in assessing and mitigating acute distress, while serving as a platform for psychological triage complementing more traditional psychological and psychiatric interventions. PFA may be employed by mental health clinicians as well as 'peer responders'.

Reporting Sexual Assault: Survivors' Satisfaction With Sexual Assault Response Personnel.

Although jurisdictions have attempted to improve their response procedures, sexual assault cases are often insufficiently investigated. This study examines the survey responses of 460 female sexual assault survivors regarding their experiences with response personnel. Overall satisfaction with response services was 66.1%. Victim advocates and forensic nurses received higher satisfaction ratings than did patrol officers, detectives, and State's Attorney's Office staff. The present study also found that 65% of the variance in overall satisfaction was accounted for by four personnel behaviors: respectful treatment, clearly explained procedures, believed their stories, and demonstrated cultural sensitivity. Policy implications and suggestions for future research are discussed.

A Randomized Controlled Trial Assessing the Efficacy of Group Psychological First Aid.

A randomized controlled trial assessed the efficacy of group psychological first aid (PFA) by comparing the Johns Hopkins RAPID-PFA model with a group conversation condition in 119 participants using the state version of State Trait Anxiety Scale and the Positive and Negative Affect Schedules. Both groups showed similar baseline scores, and after watching a distressing 5-minute video, both groups showed similar significant increases in state anxiety scores and negative affect scores, as well as similar decreases in positive affect scores. However, compared with the group conversation condition, the RAPID-PFA group evidenced significantly lower state anxiety scores at postintervention and at 30-minute delay. RAPID-PFA, compared with the group conversation condition, was also more effective in lowering negative affect scores postintervention, and significantly increasing positive affect scores at 30-minute delay. These results support the two primary goals of PFA, which are mitigating acute distress and instilling hope.

Political Affiliation, Probable PTSD, and Symptoms of Depression in Iraq and Afghanistan Combat Veterans: A Pilot Study.

Ideological commitment of military personnel has been associated with mitigating trauma and protecting mental health. This pilot study assessed whether Democratic and Republican political affiliation differentially predicted probable posttraumatic stress disorder (PTSD) and symptoms of depression in 62 male Iraq and Afghanistan combat veterans. The Liberalism-Conservatism Scale, the PTSD Checklist-Military Version (PCL-M), and the Patient Health Questionnaire-9 (PHQ-9) were assessment measures. Results revealed that Democratic combat veterans had stronger liberal attitudes than Republican combat veterans (r = 0.95). Moreover, of the 50% of the entire sample higher than the cutoff score of 50 on the PCL-M, 84.8% were Democrats compared with 10.3% of Republicans. On the PHQ-9, 46.9% of Democrats compared with 3.7% of Republicans were higher than the cutoff score of 20. These initial results suggest possible mechanisms of action, including differences in shattered world view assumptions, willingness to disclose emotional concerns, and physiological reactions between Democratic and Republican combat veterans.

The Potential Efficacy of Psychological First Aid on Self-Reported Anxiety and Mood: A Pilot Study.

The authors explored the efficacy of a randomized controlled trial to assess the potential benefits of psychological first aid (PFA) compared with a social acknowledgement condition in a sample of 42 participants who spoke about a stressful life event. Demographics and standardized questionnaires, including the state version of the State Trait Anxiety Inventory Scale and the Brief Profile of Mood States, assessed anxiety and mood state. Those in the PFA group evidenced significantly lower anxiety scores at 30-minute postdisclosure than at baseline and, although not significant, showed lowered distressed mood compared with baseline at 30-minute postdisclosure. Those in the social acknowledgment condition evidenced increases in anxiety and distressed mood scores, albeit not significantly, at 30 minutes post disclosure compared with their baseline scores. These results provide preliminary empirical evidence for the efficacy of PFA, and implications for intervention and additional assessment are suggested.

Building a national model of public mental health preparedness and community resilience: validation of a dual-intervention, systems-based approach.

OBJECTIVE: Working within a series of partnerships among an academic health center, local health departments (LHDs), and faith-based organizations (FBOs), we validated companion interventions to address community mental health planning and response challenges in public health emergency preparedness. METHODS: We implemented the project within the framework of an enhanced logic model and employed a multi-cohort, pre-test/post-test design to assess the outcomes of 1-day workshops in psychological first aid (PFA) and guided preparedness planning (GPP). The workshops were delivered to urban and rural communities in eastern and midwestern regions of the United States. Intervention effectiveness was based on changes in relevant knowledge, skills, and attitudes (KSAs) and on several behavioral indexes. RESULTS: Significant improvements were observed in self-reported and objectively measured KSAs across all cohorts. Additionally, GPP teams proved capable of producing quality drafts of basic community disaster plans in 1 day, and PFA trainees confirmed upon follow-up that their training proved useful in real-world trauma contexts. We documented examples of policy and practice changes at the levels of local and state health departments. CONCLUSIONS: Given appropriate guidance, LHDs and FBOs can implement an effective and potentially scalable model for promoting disaster mental health preparedness and community resilience, with implications for positive translational impact.

An academic-government-faith partnership to build disaster mental health preparedness and community resilience.

OBJECTIVES: Faculty and affiliates of the Johns Hopkins Preparedness and Emergency Response Research Center partnered with local health departments and faith-based organizations to develop a dual-intervention model of capacity-building for public mental health preparedness and community resilience. Project objectives included (1) determining the feasibility of the tri-partite collaborative concept; (2) designing, delivering, and evaluating psychological first aid (PFA) training and guided preparedness planning (GPP); and (3) documenting preliminary evidence of the sustainability and impact of the model. METHODS: We evaluated intervention effectiveness by analyzing pre- and post-training changes in participant responses on knowledge-acquisition tests administered to three urban and four rural community cohorts. Changes in percent of correct items and mean total correct items were evaluated. Criteria for model sustainability and impact were, respectively, observations of nonacademic partners engaging in efforts to advance post-project preparedness alliances, and project-attributable changes in preparedness-related practices of local or state governments. RESULTS: The majority (11 of 14) test items addressing technical or practical PFA content showed significant improvement; we observed comparable testing results for GPP training. Government and faith partners developed ideas and tools for sustaining preparedness activities, and numerous project-driven changes in local and state government policies were documented. CONCLUSIONS: Results suggest that the model could be an effective approach to promoting public health preparedness and community resilience.

Examining the role of positive and negative affect in recovery from spine surgery.

Consistent evidence supports a significant association between lower positive affect and higher negative affect and increased pain and disability in adults with chronic pain. However, examining this relation in surgical populations has received little empirical consideration. The primary purpose of this study was to determine whether preoperative and postoperative positive and negative affect predict pain, disability, and functional status after spine surgery. A secondary objective was to assess the relation of depression to postoperative outcomes compared with positive and negative affect. Participants were 141 patients treated by spine surgery for lumbar or cervical degeneration. Data collection occurred at baseline and 6 weeks and 3 months postoperatively. Affect was measured with the Positive and Negative Affect Schedule. Multivariable mixed-model linear regression analyses found that preoperative variables were not predictive of postoperative pain, disability and functional status. However, multivariable postoperative analysis found that 6-week positive affect predicted functional status, and 6-week negative affect predicted pain interference and pain-related disability at 3 months following surgery. Postoperative depression demonstrated statistically significant and stronger associations with pain intensity, pain interference, and pain-related disability at 3-month follow-up, as compared with negative affect. Results suggest that positive affect and depression are important variables to target when seeking to improve postoperative outcomes in a spine surgery population. Recommendations include postoperative screening for positive affect and depression, and treating depression as well as focusing on rehabilitation strategies to bolster positive affect so as to improve functional outcomes after spine surgery.

A defining aspect of human resilience in the workplace: a structural modeling approach.

OBJECTIVES: It has been estimated that up to 90% of the US population is exposed to at least 1 traumatic event during their lifetime. Although there is growing evidence that most people are resilient, meaning that they have the ability to adapt to or rebound from adversity, between 5% and 10% of individuals exposed to traumatic events meet criteria for posttraumatic stress disorder. Therefore, identifying the elements of resilience could lead to interventions or training programs designed to enhance resilience. In this article, we test the hypothesis that the effects of stressor conditions on outcomes such as job-related variables may be mediated through the cognitive and affective registrations of those events, conceptualized as subjective stress arousal. METHODS: The subjects were 491 individuals employed in public accounting, who were sampled from a mailing list provided by the American Institute of Certified Public Accountants. The stressors used in this study were role ambiguity, role conflict, and role overload and the outcome measures were performance, turnover intentions, job satisfaction, and burnout. Stress arousal was measured using a previously developed stress arousal scale. We conducted a series of 2 EQS structural modeling analyses to assess the impact of stress arousal. The first model examined only the direct effects from the role stressors to the outcome constructs. The second model inserted stress arousal as a mediator in the relations between the role stressors and the outcomes. RESULTS: The results of our investigation supported the notion that subjective stress arousal provides greater explanatory clarity by mediating the effects of stressors upon job-related outcome. Including stress arousal in the model provided a much more comprehensive understanding of the relation between stressor and outcomes, and the contribution of role ambiguity and role conflict were better explained. CONCLUSIONS: By understanding these relations, anticipatory guidance and crisis intervention programs can be designed and implemented to enhance human resilience. These data could serve to improve training programs for these "at risk" professional groups or even the population as a whole.

Differences in compassion fatigue, symptoms of posttraumatic stress disorder and relationship satisfaction, including sexual desire and functioning, between male and female detectives who investigate sexual offenses against children: a pilot study.

Law enforcement detectives who work with traumatized individuals, especially children who were victims of sexual abuse or assault, are likely to experience job-related emotional distress. The purpose of this study was to examine the relations among compassion fatigue, probable PTSD symptoms, and personal relationship satisfaction, including communication and sexual satisfaction, in a sample of 47 male and female detectives. Responses to the administered questionnaires indicated a relation between compassion fatigue symptoms and probable PTSD symptoms. There also were compelling gender differences. For example, for male detectives, open communication with their spouse or significant other was negatively correlated with burnout, indicating the more open the communication, the lower the reported burnout. However for female detectives there was a negative correlation between open communication with spouse or significant other and compassion satisfaction, suggesting that more open communication was related to lower levels of satisfaction with their ability to be a professional caregiver Furthermore, although stepwise regression analysis indicated that years of service as a detective is independently associated with sexual desire, female detectives evidenced less sexual desire and more difficulty with sexual functioning than did male detectives. Implications of these preliminary findings are discussed and limitations addressed.

A rationale for cognitively-based resilience and psychological first aid (PFA) training: a structural modeling analysis.

Based on the recommendations of Rodgers (2010) and practices by Smith, Davy, & Everly (2007) and Everly, Smith, and Welzant (2008), structural modeling was used in this investigation designed to better discern causal mechanisms within the cognitive-affective arousal construct that contribute to burnout, job dissatisfaction, turnover intention, and performance. The primary purpose of this study was to better inform those interested in program develop and clinical intervention of the nature of mechanisms of pathogenesis and resiliency. This study utilized the responses of the 491 individuals employed in public accounting. Results indicate that the cognitive-affective domain is an essential determinant of burnout, job dissatisfaction, turnover intention, and performance. Furthermore, cognitive states appear to exert their effect through affective arousal that subsequently appears to have a defining role in the development of the aforementioned variables.

Crisis intervention and fostering resiliency.

Current estimates are that most people living in the United States will experience at least one violent or life-threatening event during their lives. Recent data suggest, however that most people exposed to traumatic events do not experience serious disruptions in normal life functioning, and are in fact resilient. The purpose of this article is to review the constructs of resilience and recovery, and to suggest how early crisis intervention, historically linked with the mitigation or prevention of psychological distress, may more accurately be conceptualized in terms of fostering or enhancing resiliency.

The tower of ivory meets the house of worship: psychological first aid training for the faith community.

Clergy and laity have been a traditional source of support for people striving to cope with everyday tragedies, but not all faith leaders have the specialized knowledge required for the challenges of mental health ministry in the aftermath of widespread trauma and mass casualty events. On the other hand, some mental health professionals have acquired high levels of expertise in the field of disaster mental health but, because of their limited numbers, cannot be of direct help to large numbers of disaster survivors when such events are broad in scale. The authors have addressed the problem of scalability of post-disaster crisis mental health services by establishing an academic/faith partnershipforpsychological first aid training. The curriculum was piloted with 500 members of the faith community in Baltimore City and other areas of Maryland. The training program is seen as a prototype of specialized first-responder training that can be built upon to enhance and extend the roles of spiritual communities in public health emergencies, and thereby augment the continuum of deployable resources available to local and state health departments.

Psychological first aid training for the faith community: a model curriculum.

Traditionally faith communities have served important roles in helping survivors cope in the aftermath of public health disasters. However, the provision of optimally effective crisis intervention services for persons experiencing acute or prolonged emotional trauma following such incidents requires specialized knowledge, skills, and abilities. Supported by a federally-funded grant, several academic health centers and faith-based organizations collaborated to develop a training program in Psychological First Aid (PFA) and disaster ministry for members of the clergy serving urban minorities and Latino immigrants in Baltimore, Maryland. This article describes the one-day training curriculum composed of four content modules: Stress Reactions of Mind-Body-Spirit, Psychological First Aid and Crisis Intervention, Pastoral Care and Disaster Ministry, and Practical Resources and Self Care for the Spiritual Caregiver Detailed descriptions of each module are provided, including its purpose; rationale and background literature; learning objectives; topics and sub-topics; and educational methods, materials and resources. The strengths, weaknesses, and future applications of the training template are discussed from the vantage points of participants' subjective reactions to the training.

Integration of cognitive and personality-based conceptualization and treatment of psychological trauma.

In the wake of the numerous terrorist attacks and horrific natural disasters that have occurred beginning on September 11, 2001, there has been increased interest in the effects of trauma, including posttraumatic stress disorder (PTSD). The purpose of this article is to provide an overview of a synergistic multicomponent approach to therapy that incorporates the integrated use of cognitive and personality-guided approaches to conceptualizing and treating psychological trauma. With Millon's personality classification system serving as a foundation, a case example is provided along with an explanation of the therapeutic stages beginning with establishing the therapeutic alliance to decreasing hyperarousal to restoring assumptive worldviews.

PTSD reactions and coping responses of East Coast and West Coast American Airlines flight attendants after September 11: a possible psychological contagion effect?

Psychological reactions and functional coping of East Coast and West Coast-based flight attendants were compared after the attacks on September 11. Demographics and standardized questionnaires were sent in June 2002 to approximately 26,000 flight attendants. The 2,050 returned surveys were separated into East Coast-based flight crews (513 from Boston, New York, and Washington, DC) and West Coast-based flight crews (353 from Los Angeles and San Francisco). Despite demographic differences between the flight crews, most notably that the East Coast members were more than twice as likely to know someone who perished in the wake of September 11, there was no difference between them regarding probable PTSD (19.1% and 18.3%, respectively) or life functioning. We suggest that a psychological contagion effect occurred in this at-risk group of workers in the war on terrorism. Public health implications, including multicomponent treatment interventions, are suggested.

Child sexual abuse evaluations in an emergency room: an overview and suggestions for a multidisciplinary approach.

The physical and emotional distress associated with child sexual abuse may be compounded when the professional response in the emergency room (ER) to this critical incident is not well planned, comprehensive, and multidisciplinary. The purpose of this article is to provide an overview of the literature on emergency room (ER) evaluations of child sexual abuse and to provide recommendations for a multidisciplinary team approach to conducting these evaluations that includes physicians, nurses, mental health workers, and law enforcement officers.

PTSD reactions and functioning of American Airlines flight attendants in the wake of September 11.

The authors explore the psychological reactions and functional coping responses of American Airlines (AA) flight attendants, a unique at-risk group of people in the war on terrorism, in the aftermath of the September 11 attacks. Demographic characteristics and standardized questionnaires, including the Posttraumatic Stress Disorder Checklist and the Psychotherapy Outcome Assessment and Monitoring System--Trauma Version, were sent in June 2002 to approximately 26,000 AA flight attendants. Of the 2050 respondents, 18.2% reported symptoms consistent with probable posttraumatic stress disorder (PTSD). Those living alone were 1.48 times more likely to have a probable PTSD diagnosis than those living with someone else. Age or years of service as a flight attendant did not predict probable PTSD; however, marital status did. Substance abuse was not endorsed as a coping strategy. Given the traumatic events experienced by AA flight attendants, and persistent threats of future terrorist attacks, these results reveal that additional assessment and treatment interventions for stress-related symptoms in this population seem warranted.

Eating disorders and posttraumatic stress: phenomenological and treatment considerations using the two-factor model.

The incidence and impact of eating disorders and posttraumatic stress disorder (PTSD) are both profound. Recent data have suggested, however, that a possible concomitance may at times exist between the two diagnoses. The purpose of this paper is to increase awareness of the possibility that a presentation of an eating disorder may not be an isolated phenomenon, and it may be diagnostically prudent for clinicians to assess for a history of trauma and/or current trauma symptoms. For a clinician treating both diagnoses concurrently, we suggest utilizing the two-factor model of PTSD, and its natural corollary of neuropersonologic therapy, as a reasonable conceptual and treatment model.