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Why 'psychological first aid' is so important—and 8 key techniques to know

The United States' coronavirus epidemic is putting a strain on Americans' mental health, making it more important than ever for people to train themselves on what mental health experts call "psychological first aid" (PFA), Stacey Colino writes for the Washington Post's "Wellness."

How Covid-19 will impact behavioral health services

The coronavirus epidemic's staggering toll on America's public health

The coronavirus epidemic has taken a significant toll on Americans' mental health, according to a recent CDC report. The report—which CDC based on a survey of 5,412 U.S. adults conducted between June 24 and June 30—found that the reported prevalence of anxiety disorder symptoms was about three times higher this June, and the reported prevalence of depression symptoms about four times as high, when compared with the second quarter of 2019. Overall, according to the report, more than 40% of those surveyed said they had experienced a mental or behavioral health condition related to the epidemic.

George Everly, a clinical psychologist and professor of international health in the Center for Humanitarian Health at the Johns Hopkins Bloomberg School of Public Health and the author of "The Johns Hopkins Guide to Psychological First Aid," told Colino there are a few reasons why the epidemic is having an unprecedented effect on Americans' mental health.

For one, Everly said the epidemic is not like a natural disaster, which has a predictable aftermath and timeline. Instead, the epidemic "is like the never-ending story" with "new impacts," including new surges and outbreaks, that make it "more psychologically toxic" than anything most Americans have experienced before.

In addition, even as Americans grapple with the epidemic, they are facing an onslaught of bad news on a range of topics—including the economy, racial issues, and politics—without the in-person support of their friends, extended family, or colleagues, writes Colino. As a result, "[t]he world seems more uncertain than ever—uncertainty is a powerful toxin," Everly said.

8 ways to start practicing 'psychological first aid'

Luckily, there's a way for people to manage their stress and cope with the epidemic's "psychological ripple effects," Colino writes. According to Colino, "psychological first aid," also known as PFA, can help people restore their mental wellness amid the epidemic.

There are several ways to approach PFA, Colino writes. She outlines eight simple ways you can start to put PFA into practice in your own life right away.

1. Take care of essential bodily needs

Help others access the resources they need to feed and shelter themselves, either directly or indirectly, Colino writes—and don't forget your own basic needs as well. She cites Kaushal Shah, a psychiatric researcher at Griffin Memorial Hospital who has conducted research on PFA, who said people should make an effort to avoid substances such as alcohol and cigarettes, eat nutritious foods, exercise, get adequate sleep, and stay hydrated to help them cope with difficult times.

According to Colino, these healthy lifestyle choices are not only important for people's overall health but they're also key aspects of PFA. "Finding a baseline routine that works for you and maintaining it helps align the body's equilibrium with your psychological equilibrium," Shah explained.

2. Avoid further distress.

Protecting yourself and others from additional distress is another key component of PFA, Colino writes. To do so, you should first check whether conditions are physically safe and ensure you and others have emotional "safety" by treating one another with respect and compassion, Colino writes. 

"Remind yourself that whatever you're feeling or going through right now is perfectly normal," Nancy Haugen, a clinical psychologist in San Francisco and an associate professor of psychiatry at the University of California-San Francisco School of Medicine, told Colino. "That [acknowledgment] tends to bring down some anxiety."

You also should limit your exposure to pandemic-related media coverage, Colino writes. According to a recent study in Science Advances, people are at greater risk of epidemic-related acute stress or depressive symptoms when they have higher daily hours of exposure to Covid-19 information in the media. To protect your mental health, Haugen recommends people turn off the news to avoid troubling images, which will only add to your emotional distress. "Every time you see these images you are re-traumatized," Haugen said.

3. Stay calm.

Remembering to stay calm is also important, Colino writes. According to Colino, reminding yourself to engage in relaxing activities—including deep breathing, mindfulness meditation, and yoga—every day can help you feel less stressed and maintain your psychological equilibrium.

Setting regular intervals throughout the day or pausing when you feel overwhelmed to focus on deep breathing can be especially helpful, Colino writes. For example, research has shown people's stress hormone levels and blood pressure drop when they engage in diaphragmatic breathing.

4. Establish priorities.

When everything feels overwhelming, it's crucial for people to prioritize their most urgent needs, Colino writes. To start, people should differentiate between what they can and cannot control, and then focus on what you can control, such as how you treat your family or use your spare time, and encourage others to adopt a similar approach.

To help make this easier, Haugen recommend people frame their priorities using the words "I choose" rather than "I want" to create a greater sense of agency. 

5. Promote hope.

According to Everly, remaining positive—whether it's through learned or active optimism—and staying focused on the future are vital to protecting your mental health.

There are several ways people can maintain a positive attitude, Colino writes. For instance, research has shown people can thrive emotionally when they balance each negative feeling to three positive feelings, which can be as simple as appreciating a movie you watched or a friend's compliment, Colino writes. If you want to take it a step further, you could start keeping a gratitude journal. According to a 2019 study, adults who wrote in a gratitude journal for 14 days experienced a boost in their positive moods, happiness, and life satisfaction as well as a drop in their negative moods and depressive symptoms.

6. Connect.

According to Everly, "The single best predictor of human resilience is support from other people," which means staying socially connected is critical during the epidemic, Colino writes.

To connect with people, you should reach out to friends and family via social media—or even try rekindling old friendships through phone calls, text messages, emails, or video conferences, according to Colino. You also could consider setting up a bubble or coronavirus-safe pod to help you spend time with supportive people in person, Colino writes.

7. Be a good communicator.

During the epidemic, when people are expressing a flurry of mixed emotions, it's necessary for people to practice active listening, which involves giving people your undivided attention and allowing them to take their time to express what they're feeling—without any interruptions, Colino writes.

Active listening "helps validate the other person's emotions, which helps ease distress, and helps the person prioritize how to address the issues that are upsetting him or her," Shah said.

When you're practicing active listening, you should try to understand the speaker's concerns, use supportive language, and show empathy, according to Colino.

8. Reinforce coping mechanisms.

As you're confronting new challenges, remind yourself of what you've done to overcome difficult times in the past and apply those strategies to your current situation, Colino writes.

According to Colino, remembering and using these strategies will help boost your confidence, build your resilience, and make you feel more competent to handle difficult circumstances.

As Everly noted, "some people come out stronger" after they've handled emotional hardships. So, "[w]ith any luck, you and your loved ones could be among them," Colino writes. "And PFA practices may be among the coping skills you call upon to face another difficult situation in the future" (Colino, "Wellness," Washington Post, 9/22).

Learn more: 4 highest-priority behavioral health moves amid the Covid-19 crisis


The psychological impact of the Covid-19 pandemic is unprecedented—fear, isolation, distrust. This is rapidly increasing the need for behavioral health services. But there are significant gaps and barriers that stand in the way of people getting the help they need.

Here are four areas to prioritize immediately to support staff and manage behavioral health demand already in the system.






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