Q6: Is support based on the principles of psychological first aid better (more effective than/as safe as) than no intervention for people in acute distress recently exposed to a traumatic event?

Many guidelines caution against doing nothing shortly after traumatic events, arguing for the delivery of supportive, practical and pragmatic input in a supportive and empathic manner (IASC, 2007; NICE, 2005; Tents, 2008). Such approaches do not resemble psychological treatments, in contrast to most of the early interventions that have been subjected to randomized controlled trials. They are psychosocial with key social elements that address people’s basic needs and concerns.
Psychological first aid (PFA) has become very popular and is increasingly used and recommended (IASC (2007); National Child Traumatic Stress Network and National Center for PTSD (2006); NATO (2008); NICE (2005); NIMH (2002); Sphere Project (2004); Tents (2008); WHO (2003)). The caution against the use of individual psychological debriefing has fuelled the popularity of PFA. A variety of similar, overlapping definitions of PFA exist (see WHO commissioned systematic review by Bisson & Lewis (2009)). The Sphere Handbook (2004) describes PFA as: "basic, non-intrusive pragmatic care with a focus on: listening but not forcing talk; assessing needs and ensuring that basic needs are met; encouraging but not forcing company from significant others; and protecting from further harm." PFA is very different from psychological debriefing in that it does not necessarily involve a discussion of the event that caused the distress (IASC, 2007). Support on the principles of PFA is a form of support that may be delivered by professionals and non-professionals alike after a brief orientation.

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