Psychological First Aid: The STOP Model for Crisis Response

What PFA Is and Isn't

Psychological First Aid is a response framework developed by the WHO and the National Center for PTSD after a body of research showed that well-intentioned but poorly designed post-crisis interventions (particularly formal debriefing) could worsen outcomes.

PFA is:

• Practical and compassionate support
• Meeting immediate needs (safety, information, basic needs)
• Reducing acute distress
• Helping people connect to their own coping resources

PFA is not:

• Therapy
• Trauma processing or debriefing
• Pushing people to talk about what happened
• Diagnosing mental health conditions

The evidence base for PFA is broader than for most field medical interventions. The core elements have robust support from disaster psychology research.

The Five Core Elements (SAFER-R Framework)

S — Safety: Restore a sense of physical and psychological safety.

• Is the person currently in a safe location?
• Are their basic physical needs met (warmth, water, shelter)?
• Do they understand what is happening around them?

A — Acknowledge/Assess: Acknowledge what the person experienced without minimizing or dramatizing.

• Listen actively without pushing for details
• Validate feelings: "What you're feeling makes sense given what you've been through"
• Assess for immediate safety risks (suicidal ideation, self-harm)

F — Facilitate Access to Information: Accurate information reduces distress.

• What is happening now?
• What is being done to help?
• What can they expect next?
• Uncertainty and misinformation are psychologically destabilizing

E — Encourage Coping: Support and strengthen the person's own existing coping mechanisms.

• Help them identify what has helped them through hard times before
• Encourage connection to family, community, and spiritual resources if relevant
• Basic physical self-care: eating, sleeping, moving

R — Restoration/Recovery: Connect to ongoing support and monitor for deterioration.

• Connect to mental health resources if available
• Identify and connect to social support network
• Follow up

The STOP Model for Acute Crisis Response

STOP is a simpler framework for the immediate moment when someone is in acute distress.

S — Stop: Before you engage, stop. Take a breath. Regulate your own state. You cannot help a dysregulated person from a dysregulated state.

T — Take stock: Quickly assess:

• Is this person safe right now?
• What are they most distressed about?
• What do they most need in this moment?

O — Offer connection: Physical presence. Eye level contact. Your body language communicates more than your words.

• "I'm here with you"
• Gentle touch if appropriate and culturally acceptable (a hand on the shoulder)
• Don't fill silence — being present is sometimes enough

P — Provide: Give what is most needed:

• Information: "Here's what we know..."
• Practical help: water, warmth, a task that gives agency
• Referral: connecting to appropriate support

Acute Stress Response

In the immediate aftermath of a traumatic event, people commonly experience acute stress responses. Recognizing these as normal — not signs of mental illness — is important:

Normal acute responses:

• Shock and emotional numbness
• Confusion, difficulty concentrating
• Anxiety, hypervigilance (startle easily, can't relax)
• Irritability or anger
• Crying
• Physical symptoms: rapid heart rate, shallow breathing, sweating, muscle tension
• Intrusive thoughts or images of what happened
• Sleep difficulty

These symptoms are adaptive responses to genuine threat. They typically reduce within days to weeks for most people.

When to be more concerned:

• Symptoms are severe and interfere with basic functioning
• Symptoms are worsening rather than improving after 1-2 weeks
• The person has thoughts of suicide or self-harm
• The person is using alcohol or substances to cope
• The person is completely unable to care for themselves or dependents

Grounding Techniques for Acute Panic

When someone is in acute panic (rapid breathing, racing heart, feelings of unreality), grounding techniques bring attention back to the present physical environment and activate the parasympathetic nervous system.

5-4-3-2-1 Grounding

Name aloud (or to yourself):

• 5 things you can SEE right now
• 4 things you can TOUCH and feel
• 3 things you can HEAR
• 2 things you can SMELL
• 1 thing you can TASTE

This sensory inventory interrupts the rumination cycle by engaging conscious attention with immediate physical reality.

Controlled Breathing

The ratio of inhale to exhale matters. A longer exhale than inhale activates the vagus nerve and parasympathetic nervous system.

Box breathing: Inhale 4 counts, hold 4 counts, exhale 4 counts, hold 4 counts. Repeat.

4-7-8 breathing: Inhale 4 counts, hold 7 counts, exhale 8 counts.

Simple extended exhale: Any slow breathing where exhale is longer than inhale works. Inhale 4, exhale 6. Inhale 3, exhale 5.

Guide the person through this — breathe with them visibly so they can match your pace.

Cold Water Technique

Cold water on the face activates the dive reflex — a mammalian evolutionary response that slows the heart rate and reduces panic within seconds.

Technique: Hold cold water or ice pack to the face and neck. Submerge face in cold water for 30 seconds if available. This is genuinely fast-acting for acute panic and works physiologically regardless of psychological state.

Helping Children

Children's acute responses look different and are often misread:

Regression: Children may temporarily revert to behaviors of a younger developmental stage (bedwetting, thumb-sucking, clinging). This is adaptive. Do not shame or punish it.

Play themes: Children process trauma through play. Repetitive play enacting the traumatic event is normal. Do not stop it unless the child is distressing themselves or others.

Maintaining routine: Children are stabilized by predictability. Re-establishing routine (meals at regular times, bedtime ritual, school or structured activities) significantly reduces anxiety in children after a traumatic event.

What not to do: Do not tell a child they should not be scared, or that big kids/boys don't cry. Validate feelings: "It makes sense that you're scared. What happened was scary."

What to say: "I am here. I am going to keep you safe. You did not do anything wrong. What happened is not your fault."

Recognizing When Professional Help Is Needed

Acute: Someone needs immediate mental health intervention for:

• Active suicidal ideation with plan or intent
• Active psychosis (hallucinations, delusions, disorganized thinking)
• Severe dissociation (the person is unresponsive, unreachable)
• Acute risk of harm to others

Ongoing: Connect to professional mental health resources when:

• Symptoms do not improve over 2-4 weeks
• PTSD symptoms developing (intrusive flashbacks, avoidance, hyperarousal, negative thoughts/mood)
• Depression developing (persistent low mood, loss of interest, sleep and appetite disruption)
• Substance use escalating

In grid-down scenarios, formal mental health resources may be unavailable. Community connection — peer support, shared purpose, religious or spiritual communities — functions as a partial substitute for formal mental health care in many disaster scenarios. Building these connections before a crisis is part of resilience preparation.

Your Own Mental Health

Providing care for others in a crisis depletes your psychological reserves. Secondary traumatic stress and caregiver burnout are real risks.

Protect yourself:

• Maintain physical self-care (sleep, nutrition, movement) even imperfectly
• Find at least one person you can talk to honestly
• Accept that you cannot fix everything
• Define what "good enough" looks like for your role
• When possible, take breaks from direct care work

A depleted caregiver helps no one. Sustainability is part of the mission.